Vista Unified School DistrictHealth Services

Medication Administration TrainingFor School Personnel

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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.”

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.

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

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

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

Paperwork

Three forms are required before a medication is given at school

AUTHORIZATION FOR MEDICATION ADMINISTRATION

WRITTEN STATEMENT BY PARENT OR GUARDIAN

MEDICATION LOG

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

All who authorize meds must be licensed in the state of California

Providers can be:PhysiciansDentistsOptometristsPodiatrists Nurse practitioners Certified nurse midwives Physician assistants

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

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

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

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

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

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

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

STUDENT NAME___Jones, Jane ______________MEDICATION __Albuterol TIME _11:30am__________________________SPECIAL INSTRUCTIONS Every 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 AdderallThe 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.

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

Medication Administration Procedure

Follow a standard routine every time to minimize errorsRemember the 5 rights

Right StudentRight MedicationRight DosageRight TimeRight Route

Practice the 3 checks (next slide)

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

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

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

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 initial the bottom of each med log once

SIGNATURE/INITIALS __P. Nichols______ __PN___________

Your school nurse will review and sign in the column to the right.

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.

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.

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

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

What Are Medications Errors

Dose is omittedMedication given to wrong studentInaccurate doseWrong medicationWrong timeIncorrect route

“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

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

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

Some Considerations

Use a calibrated spoon/cup to measure doses of liquid medications

If pill splitting is required, the pill needs to be scoredsplit in half only use a commercial pill-splitter

Student Refuses Medication

Encourage the child to take the medication

Document on the medication log

Notify the parent/guardian right away

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

Side Effects

All medications have a potential for side effects

Antibiotics-may cause a rashAnalgesics-may cause an upset stomach

Promptly report any unusual symptoms or behaviors to the school nurse and parent

Field Trip & Off Campus Activities

Students have the right to participate in ALL school related activitiesA trained staff member is to accompany students and carry the medications in a secure mannerDocument “FT” on the med logDocument on Side 2 the name of the person who administered the med

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

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

Asthma medication delivery

InhalersMouthpiece 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 wellRead the instructions that come with spacers, if available.

Inhaler use

Remove mouthpiece coverShake inhaler well for 2 to 5 secondsPlace inhaler in mouthTake a deep breath and exhale completelyInhale slowly and deeply through mouth while depressing the medication canister fullyHold breath for 10 secondsWait 1 minute between puffs

Procedures

Contact your school nurse if a parent requests a Specialized Physical Health Care Procedure, as there are different authorization and training requirements

SPHCsNebulizer machine use for asthma medsEpiPensDiabetes meds and careCatheterizationGastrostomy feedings

Eye and ear medications

Always use glovesIf there is discharge, clean around each eye or ear with separate pieces of clean moist gauzeHave the student lie downBe sure to use the correct eye or ear if the medicine is not prescribed for bothPractice good hand washing afterward

Eye drops

Using one hand gently pull down on the lower eye lid forming a small pouchHold the dropper about 1 inch above the lower lid pouch with the other handDrop the prescribed number of drops one at a timeAsk the student to rest with eyes closed for a minute and avoid rubbing eyesGive them a kleenex to wipe excess moisture

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

Ear drops

Cleanse away any discharge Warm the ear drops in the palms of hands; never use hot water or microwaveShake the container gently Have the student lie down with the affected ear up or sit and tilt the head to the sideDo not allow the dropper to touch the earPull the ear backward and upward (older child and adult) or back and down (under age 3) to open the ear canalPut 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

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

File Medication Records

In the health cums At the end of the year If a student leaves the schoolWhen the med is discontinued

Confidentiality

Only parent/guardian and authorized school staff should have access

Parent/guardian authorization is required for release of information

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