Watch the PowerPoint Go to View, Slide Show on the menu above Hit the space bar to advance slides

1. Vista Unified School DistrictHealth Services Medication Administration TrainingFor School Personnel Watch the PowerPoint Go to View, Slide Show on the menu above Hit the space bar to advance slides Use the arrow keys to go back

2. Healthy Kids Learn Better • Many students require medications while at school, so that they can be active participants in the classroom. Laws ensure their needs are met. • “Kids bring their whole life to school with them……and it doesn’t fit in a locker.”

3. Your role • This presentation was developed to allow you to have regular training on medication administration at your convenience. • There is a post-test at the end. Print the test and answer the questions. • Leave the completed answer sheet for your School Nurse to review.

4. The Law: California Ed Code Section 49423 • The California Department of Education issued a Program Advisory On Medication Administration • The Advisory provides recommendations to local educational agencies on all aspects of med administration • All info in this training is from the Advisory

5. School personnel can administer meds if they: • Are designated by the site administrator to do so • Are trained and supervised by a credentialed school nurse or physician • Training is reviewed regularly • They are willing to do so

6. Things to Remember • Site administrators should select REGULAR and BACK-UP staff to be trained • ONLY trained staff can administer medication • You should not be required to administer medications until you have received training

7. Paperwork • Three forms are required before a medication is given at school • AUTHORIZATION FOR MEDICATION ADMINISTRATION • WRITTEN STATEMENT BY PARENT OR GUARDIAN • MEDICATION LOG

8. Vista Unified School DistrictAUTHORIZATION FOR MEDICATION ADMINISTRATION(Education Code Section 49423) • Must be signed by a health care provider for ALL medications given at school, even Over-The-Counter medicines • Is valid for one school year only • If the student’s medication, dosage, or provider changes during the school year, a new form must be completed and signed

9. All who authorize meds must be licensed in the state of California • Providers can be: • Physicians • Dentists • Optometrists • Podiatrists • Nurse practitioners • Certified nurse midwives • Physician assistants

10. The Authorization, continued • Our VUSD Authorization for Med Admin form meets all state standards when completed • A faxed Authorization form is acceptable • Telephone orders are not acceptable • The medication, dose, time, and other instructions should be clear

11. Written Statement from the Parent or Guardian • Side 2 of the health care providers Authorization form • Only medication needed during the school day should be administered at school, except in special cases • The parent or guardian will provide all necessary medication, supplies, and equipment

12. Parent authorization, continued • The parent is to notify the school if there is a change in the medication, health status, or health care provider. • Parent is to provide a new AUTHORIZATION form to reflect any changes

13. Bringing meds to school • The parent should deliver to school all medications, except medications that the student is authorized to carry and self-administer. • School staff are to count ADHD and controlled medications with the parent and document the amount on side 2 of the med log

14. Some Considerations • Prescription meds are to be in a container labeled by a pharmacist listing the student’s name, provider’s name, medication, dose, and directions for use • Over-the-counter medication must be in the original container

15. Some parent rights • A parent should not be required by school officials to administer medication to their child as a condition of receiving any services • A written statement from an authorized health care provider is not required when a parent administers medication to their own child in school

16. Remember • Do not accept a medication if the provider’s AND parent authorizations are not received (teach this to your coworkers) • You may choose to offer to assist parents by faxing providers • Invite the parent to come and give the medication until all paperwork is received • Before giving medications, make sure a separate MED LOG is prepared for EACH medication

17. STUDENT NAME___Jones, Jane ______________MEDICATION__Albuterol TIME _11:30am__________________________SPECIAL INSTRUCTIONSEvery 4 to 6 hours as needed for cough and 15 mins before PE • Our MEDICATION LOG meets all state standards when we complete it • MEDICATION -The authorization form and bottle should match. • Be sure to note the entire name, for example Adderall XR is not the same as Adderall • The bottle may list generic names and the authorization lists brand names. Call your school nurse for info • TIME -The exact time authorized by the provider • SPECIAL INSTRUCTIONS -be sure to list ALL that is written on the Authorization form.

18. DOB __10-21-2000___________DOSE __2 puffs____ROUTE ___inhaled____________________________________________ • DOSE -The number of milligrams, teaspoons, number of puffs, etc • ROUTE -may be oral (by mouth,) topical (cream or ointment,) inhaled (asthma inhaler,) eye drop, ear drop

19. Medication Administration Procedure • Follow a standard routine every time to minimize errors • Remember the 5 rights • Right Student • Right Medication • Right Dosage • Right Time • Right Route • Practice the 3 checks (next slide)

20. Medication Administration Procedure • Check #1 –Make sure the MEDICATION LOG MATCHES the AUTHORIZATION form • Check #2 –As you pick up the bottle, READ THE BOTTLE LABEL to see that it MATCHES the MED LOG • As you check the log, look at the date to be sure the med wasn’t given already by a coworker • Do check #3 of the LABEL of the BOTTLE again as you pour the med

21. Med Administration, continued • Give medications to only one student at a time • Check the student for unusual behavior or conditions • Explain the procedure to the student • Afterward, verify that the med was taken

22. Timing • Have a plan for calling students to come for meds so they are not missed or late • 30 minutes before or after the time authorized is considered OK • It is considered an error if later or earlier • If more than 30 minutes late, talk to the parent before giving it

23. Documentation • Immediately after giving the med, document on the MEDICATION LOG • Put your initials and the time in the square for the month and date • Make sure you sign and initialthe bottom of each med log once SIGNATURE/INITIALS __P. Nichols______ __PN___________ • Your school nurse will review and sign in the column to the right.

24. More on documentation • Document on side 2 of the med log all conversations, concerns, medication counts, or incidental information • IF for some reason a daily medication is not given, indicate in the box why it was not.

25. As needed, or PRN • Before giving “as needed meds”, be very sure to check the med log box to see if it was given recently • If needed early in the school day, consider phoning the parent to see if the med was given at home. • If needed again too soon after being given, this may indicate a worsening problem that needs doctor’s evaluation.

26. Things to remember • Contact a school nurse if the physician’s order is not clear, parent request differs from the physician’s orders, or you have any questions or concerns • Let the teacher know a student will be taking a medication • Let your site school nurse know of any new medications

27. If Errors Happen • Stay calm and keep the student with you • Call a school nurse, who will advise about the particular medication • Notify your site administration • Call the student’s parent and explain what happened • Fill out a student accident report

28. What Are Medications Errors • Dose is omitted • Medication given to wrong student • Inaccurate dose • Wrong medication • Wrong time • Incorrect route

29. “Special Needs” programs • If a special program classroom is not accessible to the Health Office, medication can be kept in a locked cabinet or drawer • The medication cabinet or drawer is to remain locked at all times except when individual medication is administered by a trained individual

30. Students may self administer meds • When self-administration is authorized by the health care provider • When the parent gives written consent • When the student is competent to do so • Please be sure to let the school nurse know when students are authorized to self administer

31. Handling medications • Avoid touching medications; pour it into the bottle cap or the cup • Wear gloves if placing medication in the students mouth or administering eye or ear drops or topical meds • Hand washing is the single most important practice for preventing transmission of infectious organisms

32. Some Considerations • Use a calibrated spoon/cup to measure doses of liquid medications • If pill splitting is required, • the pill needs to be scored • split in half only • use a commercial pill-splitter

33. Student Refuses Medication • Encourage the child to take the medication • Document on the medication log • Notify the parent/guardian right away

34. Student Vomits or Spits Out Medication • Check for symptoms of illness, for example, take temp (wait 5 minutes after vomiting) • Notify the parent • Document on side 2 of the med log

35. Side Effects • All medications have a potential for side effects • Antibiotics-may cause a rash • Analgesics-may cause an upset stomach • Promptly report any unusual symptoms or behaviors to the school nurse and parent

36. Field Trip & Off Campus Activities • Students have the right to participate in ALL school related activities • A trained staff member is to accompany students and carry the medications in a secure manner • Document “FT” on the med log • Document on Side 2 the name of the person who administered the med

37. Safe Storage • All medications are kept in a locked cabinet or lock box • Med keys are available only to persons who are authorized to administer medications • Refrigeration between 36-46oF may be needed for some medications

38. Asthma • Use the ASTHMA CARE PLAN form, not the usual Authorization for Med Admin form for asthma meds • The CARE PLAN provides more info on student’s individual asthma characteristics and needs • It provides the legal “Emergency Care Plan” for changing conditions that the other form does not • It helps in student and family asthma education

39. Asthma medication delivery • Inhalers • Mouthpiece and cap are to be washed in warm soapy water and thoroughly dried regularly • Use spacers if available, they deliver medication to the lungs very well • Read the instructions that come with spacers, if available.

40. Inhaler use • Remove mouthpiece cover • Shake inhaler well for 2 to 5 seconds • Place inhaler in mouth • Take a deep breath and exhale completely • Inhale slowly and deeply through mouth while depressing the medication canister fully • Hold breath for 10 seconds • Wait 1 minute between puffs

41. Procedures • Contact your school nurse if a parent requests a Specialized Physical Health Care Procedure, as there are different authorization and training requirements • SPHCs • Nebulizer machine use for asthma meds • EpiPens • Diabetes meds and care • Catheterization • Gastrostomy feedings

42. Eye and ear medications • Always use gloves • If there is discharge, clean around each eye or ear with separate pieces of clean moist gauze • Have the student lie down • Be sure to use the correct eye or ear if the medicine is not prescribed for both • Practice good hand washing afterward

43. Eye drops • Using one hand gently pull down on the lower eye lid forming a small pouch • Hold the dropper about 1 inch above the lower lid pouch with the other hand • Drop the prescribed number of drops one at a time • Ask the student to rest with eyes closed for a minute and avoid rubbing eyes • Give them a kleenex to wipe excess moisture

44. Eye Ointment • Hold the nozzle of the tube approximately ½ to 1 inch above the eye • Apply a line of ointment to the inner edge of the lower eyelid • Start at the nose edge and move outward • Have student keep eye closed a minute and avoid rubbing eyes

45. Ear drops • Cleanse away any discharge • Warm the ear drops in the palms of hands; never use hot water or microwave • Shake the container gently • Have the student lie down with the affected ear up or sit and tilt the head to the side • Do not allow the dropper to touch the ear • Pull the ear backward and upward (older child and adult) or back and down (under age 3) to open the ear canal • Put in prescribed number of drops • Keep the student still at least five minutes or, if prescribed, place a clean piece of cotton gently into the child’s ear

46. Disposing of Medications • Send home unused meds with the parent • Don’t flush meds down the toilet; 80% of our streams contain drugs that contaminate our water supply • http://www.pharmacy.ca.gov/publications/dont_flush_meds.pdf gives info on proper disposal

47. File Medication Records • In the health cums • At the end of the year • If a student leaves the school • When the med is discontinued

48. Confidentiality • Only parent/guardian and authorized school staff should have access • Parent/guardian authorization is required for release of information

49. You are almost done • Print out and complete the Medication Administration Training for School Personnel Quiz • When finished, let your site school nurse know so she can meet with you to review the Quiz and answer any questions