Medication Administration

1. Medication Administration Michelle Mullins

2. Introduction House bill 126 Defines health services to include administration of medication This excludes first aid or emergency procedures. • Requires documentation of employee consent, training, and competency

3. Ky Department of Education Responsibilities • Leadership to school districts • Cooperation with the Department of health • Identification of standardized protocols and guidelines: • Delegation of nursing function • Training of unlicensed nonmedical personnel • Documentation of nonmedical personnel

4. Criteria for delegation • The task can be completely and safely performed by the unlicensed person involved without compromise to the clients welfare • The task shall not require the unlicensed person to exercise independent nursing judgment or intervention • The delegator shall be responsible for assuring that the delegated task is performed in a competent manor by the unlicensed

5. You shouldn’t have to exercise judgment • Should follow instructions like a recipe • Injectable medications cannot be delegated

6. Safety precautions • Always make sure that the proper forms are signed • Always dispense from the original container • Only deal with one child at a time • Do not handle phone calls when administering meds

7. Safety precautions (cont.) Do not have any interruptions If any pill “looks different “ call the parents immediately. Call the school nurse. You can always contact the pharmacist Applies to over the counter medications as well as prescription • Triple check! Triple check!

8. Paperwork! • Administering medication permission form • Must be completed each school year or if dosage changes • Keep daily log of administration • Must also complete if student is absent or on field trip • At end of school year-file permission form and logs in permanent record folder • Must follow-up if student is present at school but does not come to the office when med is due

9. Field Trips • Place medication in envelope and seal • Write student’s name, name of medication,dosage, and when to give on outside of envelope • Place copy of permission form inside envelope in case of emergency

10. 5 R’s of medication administration • This serves as protection for the individual that is receiving medication as well as the person who is administering the medication • The 5 R’s of administering medication eludes to the 5 Rights of every patient or person that is receiving medication

11. The 5 R’s • The right person • The right medication • The right dose • The right route • The right time • The administering medication permission form as well as the prescription bottle will have all this information available

12. Injectable medications • Only a nurse can administer insulin in a school setting • Other than self administration by the student or the parent • Glucagon and epipens are considered emergency medications

13. Inhalers • New law states that any student can carry their own inhaler(no matter the age) as long as the doctor signs the administration medication form and parents sign the wavier form • Nebulizer treatments must contact district school nurse on each individual request

14. ADVERSE REACTIONS Body is reacting negatively to medication Systemic reaction to medication- for example: antibiotic and rash Reactions to look for: rash, difficulty breathing, swollen tongue or lips, severe headache, heart fluttering, flushing, increased heart rate or blood pressure,seizure, syncope, or anaphylactic shock REQUIRES IMMEDIATE ATTENTION!!!! Contact EMS, parent, and district school nurse

15. SIDE EFFECTS • All medications have documented side effects • Some side effects are to be expected- example erythromycin causes stomach upset • Blood pressure medications and hypotensive reactions • Blood pressure monitored 3 times a week at the beginning of regimen and once weekly after dosage is established • Record and provide the parent and physician a copy. A copy also is filed in permanent record file • Notify parents with a note or phone call

16. Mild SIGNS AND SYMPTOMS OF HYPOGLYCEMIA • Sweating • Tremor • Nervousness • Hunger

17. Moderate S/S of hypoglycemia • Headache • Inability to concentrate • Lightheadness • Confusion • Memory lapse • Slurred speech • Incoordination • Drowsiness • Double vision • Irrational behavior • Numbness of lips and tongue

18. SEVERE S/S of Hypoglycemia • Disorientated behavior • Seizures • Difficulty arousing from sleep • Loss of consciousness

19. Treatment of hypoglycemia • 4-6 oz of fruit juice or regular soda • 6-10 life savers or hard candy • 2-3 teaspoons of sugar or honey • After treatment and the student is better provide them a snack of cheese and crackers or peanut butter sandwich. They can eat a regular meal within 30 minutes

20. Medication errors • Immediately contact the parent and the district school nurse • Determination will be made by the school nurse on whether to contact poison control center, EMS, and the student’s physician. • If unable to contact the parents, contact the student’s physician • Complete the medication incident form • Keep record of follow-up care

21. Disposing of medication • Call parent to pick up remaining medications • Parents must sign that the meds were picked up • Disposing of pills or liquids by flushing • If disposing of Ritalin or other controlled meds- have a witness to flushing and document how many on the disposal form • May dispose of inhalers or injectables in sharp’s container