The Woods Charter School’s Medication Training

1. The Woods Charter School’sMedication Training FOR ANY EMPLOYEE THAT GIVES MEDICATION AT SCHOOL

2. Medication Policy • The Woods Charter School discourages the practice of students taking medication during the school day. • Parents’ and physicians’ written approval must be presented to school administration. • The school will assume no responsibility for students who self-medicate without written permission. • Chapstick and throat lozenges are not covered by this policy.

3. Medication Administration • Written instructions will be required on the “Administration of Medication Form”. • The “Administration of Medication Form” must be signed by a physician and parent. • The “Administration of Medication Form” must be completed annually and if there are any changes. • Copy the “Administration of Medication Form” and place in the Nurses’ box.

4. The Woods Charter School ADMINISTRATION OF MEDICATION DURING TE SCHOOL DAY Student name: _______ DOB:________ Height:______ Weight:______ School Year: ________ Grade:______ Teacher:______ It is against school policy for students to have medications on their person. All medications will need a physician’s prescription on file, and must be kept in the front office in a secure location. Please make an appointment with the front office if you wish to discuss your child’s health concerns. Exceptions are students who may carry emergency medications for asthma and/or severe allergies, ect., such as inhalers, epi-pen and glucagon. For these children, and additional form called “Student Agreement for Self-Carried Medications” must be completed prior to the start of the school year. This form is available in the front office. This section must be completed by health care provider

5. FILL OUT THIS FORM FOR EACH MEDICATION ADMINISTERED • This form can be brought into school or faxed to Woods Charter at 919-960-0133 • Each medication must be in its original container, and should have: Student’s name, Physician, medication name, dose, route, frequency, time and pharmacy name • Physician’s order for administration of medication by school personnel • Allergies Medication and other: _________ • Type of reaction: _____________________ • I have prescribed the following medication for the student named above and request that dosages be given at school: • Medication:_________ Dose:________ Route:___________ • Time:_____________ Frequency:___________________ • For treatment of:________________________________ This section must be completed by health care provider

6. Possible side effects:____________________________________ Special Instructions:__________________________________________ Other medication including over the counter the student is currently taking:_____________ Physician’s name (print)_________________ Phone:_______________ Physician’s signature:_____________________ Date:_______________ Parental request for administration of medication: I hereby give permission for my child (named above) to receive medication during school hours. This medication has been prescribed by a licensed physician (health care provider). I assume full responsibility for informing the principal (or representative) of any changes in my child’s health or medication. I release Woods Charter, their agents ad employees from any and all liability that may result from my child taking the prescribed medication. I will furnish this medication with a container properly labeled by a pharmacist with identifying information (e.g., name of child, medication dispensed, dosage prescribed, time and frequency to be given.) I give authority to communicate with the ordering physician about this medication. Parent/Guardian (print) :______________________ Date: _____________________ Parent/Guardian (signature) :__________________________ This section must be completed by health care provider and legal parent /guardian

7. Parent Responsibilities • Supplying the medication to the school • Medication must be in a container labeled by the pharmacist • Over the counter medications must be provided in the original container or in a pharmacy labeled bottle • Complete medical permission form • Student agreement for self carried medications form • Provide new labeled containers and medication form when medication changes are made.

8. Medication Log Medication Log Student:___________________________________ School:_________________________ School year:______________________ Teacher:_______________________________ Physician:________________________ Telephone number:________________ Name of Medication:_______________________________Special Comments/Instructions:__________________________________________ (If a new medication is prescribed or if the dose changes, a new medication log needs to be completed) (Please initial the block on day medication is given or chart reason why not given - See chart below) Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 August September October November December January February March April May Initials Name Initials Name Codes (Chart Reason) _____ ____________________ ______ ___________________ ED = Early Dismissal Ab = Absent FT = Field Trip _____ ____________________ ______ ___________________ D/C = Medication Discontinued NMS = No Medication at school _____ ____________________ ______ ___________________ R = Refused O = Omitted/Attempted to locate student unsuccessful S = Self Administered

9. Completing the Medication Log • Copy information exactly as on the “Administration of Medication Form” • Document daily when medication is given • Please count the number of tablets and document on the Medication Log. (Document on the medication log each time new medication is brought in.)

10. Emergency MedicationsAsthma Inhalers, Epi-Pens, Glucagon, and Diazepam New laws have given students the right to carry emergency medications and self administer these medications. The Physician must specify on the Medication Dispensing Form that students may carry emergency medication and self administer. The nurse needs to be aware of any students who carry their emergency medications.

11. The 5 Rights to Medication Administration

12. Right Student • Ask student’s name or call name before medication given • Have picture on medication log if available ALWAYS STATE STUDENT’S NAME

13. Right Medication • Check prescription bottle for correct prescription information • Check Medication Log or Dispensing Form to be sure information is the same

14. Right Dose • Check dose listed on prescription bottle • Check dose that is listed on the Medication Log Date Child’s Name Medication Time to be given

15. Oral Medications

16. Tablets/Capsules • Medication given by mouth • Only break tablets or capsules that are scored.

17. Liquids • When measuring liquids use a small cup or syringe. • Check to be sure if medication needs to be refrigerated.

18. Inhalers • Shake inhaler • Have student take a deep breath in and out • Have student place inhaler in mouth and puff inhaler while breathing in deeply • Have student hold breath for 10 seconds • Wait 1 minute then repeat steps above

19. Eye Medication • Be sure you have the correct eye. • Do not touch any part of the eye with the tip of the eye drop bottle. • Have student dab eye after insertion (do not allow them to rub eye).

20. Ear Medication • Be sure you have the correct ear • Have student lay with affected ear up • Pull top part of the ear up and back • Place correct number of drops in ear • Have student keep head tilted for 2 minutes

21. Injections

22. Epi-Pen Injections • Remove insect stinger • Remove white plastic cap • Take medication from amber colored cylinder • IF MEDICATION IS BROWN - DO NOT GIVE CALL 911 AND PARENT • Place (gray) cap to the side • Place black tip to the thigh at a right angle • Use a quick motion and press black tip hard into thigh (You will hear a loud pop.) • Hold in place for 5-10 seconds • Remove Epi-Pen. Discard in Red Sharps Container • Massage injection site for 10 seconds • CALL 911 AND PARENT

23. Glucagon Injection • Remove flip-off seal from the bottle of glucagon • Wipe top of bottle off with alcohol wipe • Remove the needle protector from the syringe • Inject the entire contents of the syringe into the bottle of glucagon • Swirl bottle briefly until glucagon dissolves completely • GLUCAGON SHOULD NOT BE USED UNLESS THE SOLUTION IS CLEAR AND OF A WATER-LIKE COSISTENCY • Using the same syringe, hold bottle upside down, make sure the needle stays in the solution • Withdraw 1 milligrams of solution into the syringe • Cleanse injection site on buttock, arm, or thigh with alcohol wipe • Inject the needle into one of the above sites • Turn student onto his or her side • Feed the student as soon as he or she awaken and can swallow

24. Right Time • Check time on Medication Log or Medication Dispensing Form • Medication may be given 30 minutes prior to or after prescribed time

25. If information on the bottle does not match the information on theAdministration of Medication Form, the physician’s office and/or parent should be called. Notify the School Nurse.

26. If medication is given to the wrong studentorthe right student gets wrong medicationor medication is found to be missing,a Variance Report must be completed.

27. Medication Variance Reports are located inSchool’s main office Health

28. Complete Variance Report Notify Parent Notify School Nurse Send copy of report to Principal

29. If medication is found to be missing,complete a Medication Variance Report.

30. Complete Variance Report Notify Principal Notify Police Notify School Nurse

31. Review • Administration of Medication Form must be present and signed by Physician and Parent • Medication Log should be copied directly from Administration of Medication Form • Remember the 5 Rights Right student, medication, dose, route, time • Be sure student takes medication correctly • Initial Medication Log • Complete Variance Report if medication is given incorrectly • Complete Variance Report if medication is missing

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