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Medication Administration

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					  Medication
 Administration
For School Health Aides
    Healthy Kids Learn
         Better
• Many kids require medications while
  at school so that they can be active
  participants in the classroom.
• “kids bring their whole life to school
  with them…and it doesn’t fit in a
  locker.”
    Just a Little History…
• A federal mandate created in the 1970’s
  obligated schools to provide children with
  medical services, including medication
  administration. Medications that schools
  are asked to manage may include
  controlled substances, emergency and
  psychotropic medications, and a range of
  therapeutic interventions for chronic
  illnesses such as diabetes and asthma.
             Training
• Each school principal must select regular
  and back up staff to be trained.
• Only trained staff can administer
  medication.
• The School Health Coordinator is
  responsible for providing training in the
  administration of medication to designated
  personnel at the beginning of each school
  year.
Staff Protection
• School staff are protected by law if
  careful observation of the regulations
  are observed:
  – Florida Law states, “there shall be no liability for
    civil damages resulting from the administration of
    such medications where the person administering the
    medication acts as an ordinarily reasonably prudent
    person would have acted under the same or similar
    circumstances”.
            Let’s begin…
• This presentation was developed to allow you to
  orient to medication administration at your
  convenience.
• You will be given a post test to take after you’ve
  viewed this presentation. Please leave the
  completed test for your School Nurse.
• Your School Nurse will check you off on the
  administration of all medication including the use
  of an EpiPen.
         An “Authorization for
    Prescribed Medication” Form is
      required and should include:
• Child’s name            • Special instructions about
• Name of medication        the child or the
• Date of Authorization     medications
• Dosage                  • Parent/guardian signature
• How the medication      • The amount of medication
  should be given           (pills, tablets, capsules)
                            received and counted by
• When the medication       parent and trained school
  should be given           staff
 Non-Prescription or Over-
  the-Counter Medication
• Must have:
  – An “Authorization for Prescribed Medication”
    form completed by parent/guardian
  – Authorization Form approved by the School
    Nurse prior to medication administration
• Must be:
  –   Necessary for the child to remain in school
  –   FDA approved
  –   Non-alcohol based
  –   In the ORIGINAL CONTAINER
  –   Provided by the parent/guardian
 Prescription Medication
• Requires written instruction by a doctor
  (prescription label meets this requirement).
• Must be prepared and labeled by a pharmacist.
• Must be in the original pharmacy container.
• Administered only if required during school hours.
• Must have a signed “Authorization for Prescribed
  Medication” form.
• New Authorization Form must be completed each
  year.
• This includes injectable drugs such as Insulin and
  EpiPen.
    6 Rights of Medication
        Administration
•   Right Student
•   Right Medicine
•   Right Dose
•   Right Time
•   Right Route
•   Right Documentation
         Right Student
• Don’t guess – Ask the student to tell
  you their full name (first and last).
• If a student is non-verbal or unable
  to tell you their name, ask a staff
  member who knows the student to
  verify that it is the correct student.
• If the student has a photo ID you
  can use that to verify.
        Right Medication
• Read the student’s name
  aloud from the label and ask
  the student to verify again
  that this is their name.
• Check the Authorization for
  Prescribed Medication Form
  with the label on the
  medication container, making
  sure that:
   – The student’s name on both are
     the same.
   – The name of the medication on
     both are the same.
              Right Dose
• Compare the dosage listed on the Authorization
  Form with the dosage listed on the container,
  making sure they agree.
• Note strength of medicine (i.e., 25 mg) and note
  amount to be given (i.e., 1 tab, ½ tsp.).
• Again compare what you have measured with the
  Authorization Form making sure they are the
  same.
• If any of the above do not agree DO NOT give
  the medication and call the School Nurse.
          Right Time
• Compare the time on the
  Authorization Form with the actual
  time the medication is being given.
• A medication may be given a half
  hour before or after the time that it
  is ordered to be given by the doctor
  (grace period).
           Right Route
• Compare the route listed on the
  Authorization Form with the label on the
  medication bottle.
  – Oral (by mouth, swallowed – tablets, capsules,
    liquids)
  – Topical (on the outside of the body –
    ointments, creams, eye drops, ear drops)
• If the route on the Authorization Form
  and the medication label are different –
  DO NOT give the medication and call the
  School Nurse.
        Right Documentation
• Document in Health Office:
   –   on the correct student file
   –   after the medication has been given
   –   the actual time the medication was given
   –   the reason if a medication was given late or not
       at all
• Medication administration records are
  CONFIDENTIAL
   – Access is limited to school staff with a “need to
     know” and parents
     Safe Storage and
         Handling
• Store all medications in their original
  containers.
• NEVER administer medications from
  an unlabeled container.
• Store medications in a clean, locked
  cabinet.
      Safe Storage and
      Handling (cont’d)
• Medication should be brought to school
  and returned home by a parent.
• DO NOT ALLOW STUDENTS to carry
  medications to and from home.
• Medications must be counted on arrival at
  school by parent and trained school staff
  and recorded on the Authorization Form.
• Changes in medication instructions
  requires a new Authorization Form be
  completed by parent.
          Remember…
• You must get permission from the School
  Nurse prior to administering a new
  medication to a student.
• You must notify the School Nurse if there
  is a change in a medication order.
• Contact the School Nurse if you have ANY
  questions prior to giving the medication.
       Medication
    Administration Do’s
• DO give your full attention to the task –
  verify each step.
• DO remain with the student until the
  medication is taken, make sure that oral
  medications are swallowed.
• DO prepare and administer medication for
  only one student at a time.
• DO allow parents to administer medication
  to their child if desired.
       Medication
   Administration Don’ts
• DON’T give medication from a container which has
  a label that can not be read.
• DON’T give medication from another student’s
  container, even if they are the same.
• DON’T leave medication unattended.
• DON’T increase or decrease any medication
  without specific instructions.
• DON’T give a medication if there is any question
  about whether it is correct.
• Don’t crush or break tablets.
• Don’t open capsules.
     What are Medication
          Errors?
•   Dose not given
•   Medication given to wrong student
•   Inaccurate dose or wrong medication
•   Wrong time
•   Incorrect route
   What you should do…
• Keep the student in the office with you.
• Assess the student’s status (Are you
  feeling okay? Is your heart racing,
  stomach hurting, etc.)
• IMMEDIATELY call the School Nurse and
  let the Principal know.
  – The School Nurse will determine if Poison
    Control needs to be called.
  – The School Nurse will notify the student’s
    parents.
• Complete a “Medication/Treatment
       Variance Report”.
           Epinephrine
• Epinephrine is available in an auto injector
  called an EpiPen.
• Students who require the use of an EpiPen
  for a life threatening allergic reaction
  should carry this medication with them at
  all times.
    When? Based on
   Student’s Symptoms
– hives spreading over    – signs of shock
  the body                    • extreme paleness,
– wheezing                      gray color
– difficulty swallowing
  or breathing                • clammy skin
– swelling in face or     – loss of consciousness
  neck                    – any other child-
– tingling or swelling      specific known
  of tongue
                            symptom
    Steps in EpiPen Administration
•   Take a deep breath.
•   Have student lie down.
•   Follow the 6 Rights of Medication Administration.
•   If in a carrying case unscrew cap and remove EpiPen from tube.
•   Grasp unit, with black tip pointing downward.
•   Form fist around unit (black tip down).
•   With your other hand, pull off the gray activation cap.
•   Hold black tip near outer thigh.
•   Swing and jab firmly into outer thigh at a 90 degree angle. (Designed
          to work through clothing).
•   Hold firmly in thigh for approximately 10 seconds.
•   Remove unit and massage injection area for 10 seconds.
•   Call 911, seek medical attention and notify school administrator.
•   Stay with student until help arrives.
•   Document dose given in Health Office.
•   *Return EpiPen into storage tube so that the student can take it with
          them to the emergency room.
        Epinephrine
       Administration
• The EpiPen is administered into the
  large outer thigh muscle.
            What next?
• Have someone notify the student’s doctor (on
  emergency card) regarding incident and where
  student is being transported.
• Notify parent/guardian regarding incident,
  student’s condition, and hospital destination.
• Document
   – Student’s symptoms
   – Location of injection
   – Time of injection
Handling the 3 Most
Common Unexpected
   Situations…
 Student Does Not Come
   at Scheduled Time
• Send for student
• Document
• Notify:
  – Teacher
  – Parent
  – Nurse
  Student Refuses
    Medication
• Encourage
• Document
• Notify
  – Parent
  – Nurse
Student Vomits or Spits
    out Medication
• Document
• Notify
  – Parent
  – Nurse
• Check for symptoms of illness
  – Fever
  – Stomach Ache
  – Headache
• Look for medicine in vomit…
           What if…
• A parent brings in an antibiotic that
  the student was just prescribed and
  the mother requests that you start
  the medication as soon as possible.
  – What do you do?
               Right!
• Review and complete the “Authorization
  for Prescribed Medication” Form with the
  parent (don’t forget to count the
  medication).
• Explain to the parent that you must get
  permission from the School Nurse prior to
  administering the medication. However,
  you can…
• Allow the parent to administer the
  medication to their child until permission
  has been granted.
           What if…
• The phone is ringing, the principal
  asked you to retrieve a file, a
  student is waiting for a pass, and the
  meds are due to be given.
  – What do you do?
              Good Job!
• Remain calm.
• Ask the students to have a seat.
• Answer the phone with a pleasant, “Hello this is
  ____, can I please put you on hold for a moment?
  Thank you.”
• Pull the chart for the Principal and call the office
  to let them know you’ve retrieved the chart.
  Could someone please come get it?
• Give the student a pass back to class.
• Answer the phone.
• Carefully administer the medications following the
  6 rights of medication administration.
           What if…
• After the meds have been given, you
  realize that you gave Jon Jensen’s
  medication to John Jones.
  – What do you do?
              You did it!
• Remember...
  – “All men make mistakes, but only wise men learn from
    their mistakes” – Winston Churchill
• Call John Jones to the Health Room.
• Assess John Jones’ status (is he feeling
  okay?).
• IMMEDIATELY call the School Nurse and
  let the Principal know.
• Complete a “Medication/Treatment
  Variance Report.
               The End
• Thank you for all that
  you do.
• Don’t forget to take
  the post test and give
  it to your School
  Nurse.
• Don’t forget to get
  checked off on EpiPen.
• Have a peaceful day…
• Prepared by:
  – Kathleen Gross, MSN, RN
    School Nurse
    Levy County Health Department
    July 2009

				
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posted:11/24/2011
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