Vista Unified School District Health Services Medication Administration Training For 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 Advisory provides recommendations to med administration

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 District AUTHORIZATION 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:

Physicians Dentists Optometrists Podiatrists 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 TIME _ __Albuterol 11:30am__________________________ SPECIAL INSTRUCTIONS Every 4 to 6 hours as needed for cough and 15 mins before PE MEDICATION -The authorization form and bottle 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.

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 errors Remember the 5 rights Right Student Right Medication Right Dosage Right Time Right 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

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

order is not clear, parent request differs any questions or concerns Let the teacher know a student will be taking a medication

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 omitted Medication given to wrong student Inaccurate dose Wrong medication Wrong time Incorrect 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 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

Handling medications

Hand washing is the single most important practice for preventing transmission of

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

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 rash Analgesics-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 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

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 36-46 o F may be needed for some medications

Asthma

Use the ASTHMA CARE PLAN form, not the usual 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

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.

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

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

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

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

Eye Ointment

Hold the nozzle of the tube 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 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 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 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/d ont_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 school When 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