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MEDICATION ADMINISTRATION PROCEDURE - Humble by pengxuebo

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									Administering Medications
            to
        Students
            in
      Humble ISD
       2010 – 2011




     A Training Guide
        ADMINISTERING MEDICATIONS TO STUDENTS IN HUMBLE SCHOOLS
                                                      A TRAINING GUIDE

                                                         Table of Contents


INTRODUCTION............................................................................................................................1
MEDICATION GUIDELINES ........................................................................................................2
MEDICATION ADMINISTRATION PROCEDURE ....................................................................3
MEDICATION ADMINISTRATION TO STUDENTS AT SCHOOL ..........................................8
     Self and Instructor Evaluation..............................................................................................8
ADMINISTERING MEDICATIONS TO STUDENT IN THIS SCHOOL ..................................12
    Pre and Post Test ................................................................................................................12
TEST KEY .....................................................................................................................................16
APPENDIX ....................................................................................................................................17
     Classification of Drugs ......................................................................................................17
     Verification of Medication Intake ......................................................................................18
     Recording Medication and Treatments ..............................................................................18
     Receiving Medication for Administration at School .........................................................18
     Reporting Unusual Reactions or Events ............................................................................18
     Disposal of Medication ......................................................................................................19
     Measurement Conversion Table ........................................................................................19
     Medication Errors ..............................................................................................................19
TRAINING-SUPERVISION-MONITORING RECORD ............................................................20
2010 – 2011 MEDICATION RECORD ........................................................................................21
MEDICATION VARIANCE REPORT ........................................................................................22
Certificate of Completion .......... Error! Bookmark not defined.Error! Bookmark not defined.
                                        INTRODUCTION
Humble ISD students with acute and chronic illness may need medication in order to attend school.
Administering medication at school supports the student's right to educational opportunity.

A campus nurse (RN) shall train any non-medical and/or unlicensed health personnel, e.g., teachers,
administrators, secretaries, and school health aids who are regularly assigned to supervise students who
are required to take medication during the school day.

A.    Purpose
      The purpose of this course is to teach school personnel basic knowledge of medication
      administration at school. The goal of the training is safe and accurate administration of oral,
      topical, inhalant and emergency medications.

B.    Objectives
      1.   Understand role differentiation in medication delivery.
      2.   Understand the general purpose of medication.
      3.   Demonstrate administration procedures for oral, topical, inhalant and emergency
           medications.
      4.   Demonstrate appropriate and correct record keeping.

C.    Activities NOT delegated to non-medical/unlicensed personnel
      1.    Calculation of any medication doses except measuring a prescribed amount of liquid
            medication and breaking a tablet for prescribed dose after the registered nurse has calculated
            the dose.
      2.    Administration of the initial dose of medication that has not been previously administered to
            the client.
      3.    Administration of medication by injection route except epinephrine via auto injector
      4.    Administration of medications used for intermittent, positive pressure breathing equipment.
      5.    Administration of medication by way of a non permanent tube inserted in a cavity of the
            body.

D.    Roles of Personnel
      1.    Nurse
            a.    Provide a training course for all personnel who will administer medications.
            b.    Maintain a record of satisfactory course completion.
            c.    Offer a two year certification update.
            d.    Observe skills yearly and following any unusual incident.
            e.    Arrange for medication information and updates as needed.
            f.    Encourage ongoing contact with the training instructor.
      2.    Qualified Delegated Personnel (QDP)
            a. Course attendance.
            b. Assume responsibility and accountability for procedures as taught in the course.
            c. Written and performance evaluations which demonstrate 85% mastery.
            d. Obtain prescription and over-the-counter medication information.
            e. Know the specific instructions for administration of each medication.
            f. Record medication administration.
            g. Record and report any unusual reactions.
            h. Seek guidance from the nurse when uncertain about medications.
            i. Follow district policy for medication administration.




                                                    1
                                MEDICATION GUIDELINES
A.   Definitions – (See Appendix for additional information.)
     1.    Medication: Prescription and non prescription substances or preparations used for the
           maintenance of health, prevention, and alleviation of disease.
     2.    Non-prescription medication: Substances and preparations obtained without a prescription;
           also referred to as over the counter (O.T.C.)
     3.    PRN medication: Medications given as needed
     4.    Authorization: Written statement from parents/legal guardian indicating permission to give
           medication even if ordered by physician.
     5.    Prescription: Written instructions from a licensed physician, dentist, nurse practitioner, or
           physician’s assistant.
     6.    Delegation: Process used by a registered nurse to assign tasks to a qualified individual.
           Effective delegation includes the following guidelines:
           a.     Defined task is clear and the related authority specified.
           b.     Task demands do not exceed the individual's job description.
           c.     Method of supervision is established in advance.
     7.    Student: Any person enrolled in Humble ISD for the purpose of education.
     8.    Monitoring: Insuring that medication is given as ordered:
           a.     Student actually swallows medication.
           b.     Student comes for the medication.
           c.     Record documentation of medication in proper place.
           d.     Notify parents of side effects.
           e.     Complete appropriate documentation if student refuses to take medication.
     9.    Qualified Designated Personnel: School employee who has successfully completed a
           medication administration course and periodic updates.
     10. Medications from foreign countries or health food stores will not be accepted or administered by the
           school nurse or the principal’s designee. All medications must be FDA approved.
     11. Health food products and nutritional supplements and/or treatments will not be administered
           by the school nurse or the principal’s designee.

B.   System of Naming: Medications are classified and grouped according to their effect on a particular
     body system, therapeutic use, or chemical characteristics.
     1.    Generic: related to chemical or official name.
     2.    Brand or trade: designed and patented by the manufacturer.
     3.    Health Food and Diet Supplement – related to products that are not FDA approved.

C.   Federal and state drug legislation and regulations are designed to ensure the public's safety and
     regulate the manufacture and sale of drugs.

D.   "Eight Rights" of Medication Administration
     1.    Right Student: Properly identify the student.
     2.    Right Time: Administer medication at the prescribed time.
     3.    Right Medicine: Administer the correct medicine.
     4.    Right Dose: Administer the correct amount of medication.
     5.    Right Route: Use the prescribed method of medication administration.
     6.    Right Documentation
     7.    Right Assessment
     8     Right Evaluation

F.   Storage
     All medications must be secured in a locked cabinet or drawer. The keys to the cabinet must not be
     common with any other lock. Keep one key within the clinic, and keep the other key secured in the
     campus key box.

                                                     2
                  MEDICATION ADMINISTRATION PROCEDURE
Name

Date                                                         Score

I.     General Guidelines
       A. It is the responsibility of the person designated to give medications and treatments to ensure
            that all orders are carried out. Students who do not report for medication administration or
            treatment must be located. Sources include the classroom teacher, attendance clerk, or
            principal(s).
       B.   Students who vomit following medication administration should remain in the clinic. The
            nurse or her backup must be notified as well as the parent/guardian. A medication variance
            report must be completed. (See Appendix.#I)
       C.   Medications that are dropped to the floor or other “dirty” surfaces are to be destroyed and a
            medication variance report prepared. (See Appendix – Disposal of Medication #J.)
       D. Injectable medications are not administered by QDPs. Exception: Auto Injector.
       E.   A parent or guardian must sign approval for medications ordered by a physician to be given
            to the student.
       F.   The first dose of medication the student receives from a prescription or non prescription
            should never be given by a QDP.
       G. Only parents/guardian may bring medications to school. In order for medication to be given
            at school, a written request from the parent/guardian to give the medication must accompany
            the medication. The note should indicate the purpose of the medication, dose, and time
            medication is to be given.
       H. Medications are to be counted and documented in the presence of person delivering the
            medication.
       I.   Medication brought by student must be placed in clinic and counted. The parent must be
            notified of the presence of the medication at school.
       J.   Medication not in the original container will not be given under any circumstances.
       K. Parents may administer medication to their child during school hours.
       L.   Handwashing before administration of medication is encouraged. This reduces contamination
            of medication and prevents spread of germs.
       M. When unclear about administering medication – do not administer, but call campus nurse or
            campus back up nurse for clarification and direction.
       N. Medications from foreign countries or health food stores will not be accepted or
            administered by the school nurse or the principal’s designee. All medications must be FDA
            approved. Health food products and nutritional supplements and/or treatments will not be
            administered by the school nurse or the principal’s designee.
       O. Parent Requests to give OTC Medications will only be given according the package
            instructions.
       P.   Parents of students requesting PRN medication must be notified of the request prior to the
            medication being given. Documentation of the student’s reason for requested information
            and parent conversation should be made on the Clinic Visit Sheet.
       Q. All medications must be locked in a cabinet in the clinic.
       R.   Texas State law allows for Life Saving Emergency Medications (Epinephrine via auto
            injector, Diastat, asthma inhalers) to be administered by properly trained UAP’s.
       S.   All mediations are to remain in the nurse’s office and be locked at all times. Exception:
            those students who are allowed to carry medications which address a life threatening
            situation. (Asthma and Epinephrine)




                                                    3
II.    General Procedures
       A. Wash hands.
       B.   Verify the labeled medication bottle with the written order.
       C.   Identify the student.
       D. Read the label three times.
            1.    When removing from storage area
            2.    Before pouring
            3.    Before returning and storage area
       E.   Observe the student for any unusual behaviors or conditions.
       F.   Explain the procedure to the student.
       G. Position the student properly for the medication administration.
       H. Administer:
            1.    the medication to the correct student;
            2.    the correct medication;
            3.    at the correct time;
            4.    the correct dose; and
            5.    the correct route.
       I.   Verify the student swallows the medication. (See Appendix F for procedure.)
       J.   Record medication administration. (See Appendix G for procedure and form.)
       K. Report unusual reactions immediately. (See Appendix for procedure.)
       L.   Return medication to locked area.
       M. Clean work area.
       N. Wash hands.

III.   Oral Medication Administration
       * All students should wash their hands before medication administration.
       A. Tablets or Capsules
             1.    Remove bottle cap and hold cap in one hand and container in other hand.
             2.    Pour the medication into the cap.
             3.    Transfer the medication from cap to (a) a clean container (medicine cup) and give cup
                   to the student; or (b) pour directly into student’s hand.
             4.    Offer cup of water and encourage drinking the entire cup of water.
             5.    Verify that the student swallowed the medication.
             6.    Recap the bottle and return it to the proper place.
       B.    Individually wrapped medications
             1.    Remove or tear off number of tablets or capsules needed.
             2.    Remove packaging and place in student’s hand.
             3.    Follow steps 4 and 5 under Tablets or Capsules.
       C.    Liquid
             1.    Shake container if indicated.
             2.    Pour liquid from the side of the bottle opposite the label (hold label in palm of hand).
                   Pour into graduated medicine cup.
             3.    Pour medication at eye level and directly in front of eyes.
             4.    Measure the dosage at the bottom of the disc.
             5.    Wipe any medication from the outside of the container.
             6.    When giving more that one liquid medication, do not mix, use separate medicine cups
                   * (See Appendix for teaspoon to c.c. conversion chart K)

IV.    Topical Medication Administration
       A. Skin Medications
            1.   Gather necessary equipment: tongue blade, gauze, tape, cotton-tipped applicator, and gloves.
            2.   Cleanse the skin, if indicated or as ordered.
            3.   Apply medication in a thin layer using a tongue blade or a cotton-tipped applicator.
            4.   Cover medicated area, if indicated.

                                                       4
B.   Eye Drops
     1.    Gather necessary equipment: cotton balls and tissue.
     2.    Cleanse the eye, if indicated. Use clean cotton ball for each eye. (The eye is cleansed
           with a cotton ball by wiping once from inside (near nose) to outside.)
     3.    Position student with head tilted back and eyes gently closed.
     4.    Approach the eye from outside the field of vision. Avoid touching the dropper tip to
           conjuctival sac.
     5.    Place drops in the corner of eye nearest nose and ask student to blink 2 or 3 times.
     6.    Blot excess medication with a clean cotton ball or tissue.
C.   Eye Ointment
     1.    Gather necessary equipment: cotton balls and tissue.
     2.    Cleanse the eye, if indicated. Use a new, clean cotton ball for each eye. Wipe once
           from inside (near nose) to outside.
     3.    Position student with head tilted back and eyes gently closed. Open the eye to expose
           the conjunctival sac.
     4.    Approach the eye from outside the student’s field of vision. Do not allow tip of
           applicator to touch conjunctival sac.
     5.    Apply ointment in a thin layer along inside lower lid.
     6.    Gently close the eye. Ask the student to blink eye 2 or 3 times.
D.   Ear Drops
     1.    Gather necessary equipment: cotton balls and tissue.
     2.    Position the student.
           a.     Position student flat on a cot, and turn his/her face to the opposite side, or
           b.     Position student in a chair, and tilt his/her head sideways until ear is horizontal.
     3.    Cleanse entry to ear canal with a clean cotton ball. Observe area.
     4.    Straighten the ear canal by pulling the outer ear gently down and back (ages 3 and
           under) or up and back (older children).
     5.    Drop the medication on the side of the canal. Avoid contact of applicator with ear
           canal.
     6.    Instruct the student to maintain the position for 1 minute.
     7.    Loosely place a cotton ball in the ear.
E.   Inhaler
     1.    Inhalers may be administered PRN (as needed) or on a regular schedule. Students who
           are prescribed inhalers on a regular schedule may have a plan that encourages or
           includes self-management and self-administration. Students with PRN inhalers should
           likewise have a plan indicating their instructions for use.
     2.    Students whose inhaler is ordered PRN (as needed) will require a specific Asthma Care
           Plan (ACP) for paraprofessionals or unlicensed assistive personnel to follow.
           Observations when monitoring student self-administration of medication may include:
           a.     Attach mouthpiece to inhaler that contains the medicine.
           b.     Stand up with feet slightly apart.
           c.     Shake inhaler for approximately 30 seconds or according to manufacturer’s
                  instructions.
           d.     Prime inhaler. (See chart in nurses office regarding priming instructions for each
                  inhaler).
           e.     Apply spacer, if available. Spacers allow medication to be delivered with more
                  accuracy. This insures that the child is more likely to get the required dose.
           f.     Position inhaler with canister upside down above mouthpiece.
           g.     Hold mouthpiece 1-2 inches from lips and open mouth wide. This position
                  allows the student to:
                  (1) point the inhaler properly toward the back of the throat.
                  (2) draw the medicine into the mouth in a steady stream.
           h.     Check to see that the medication is being properly inhaled.
           i.     Breathe out naturally.
                                              5
           j.     Open mouth and begin to inhale. If using an air chamber (spacer), seal mouth
                  around mouthpiece and inhale a deep breath.
           k.     After the beginning of deep breath, squeeze canister down on mouthpiece and
                  breathe slowly as deeply as possible.
           l.     Hold breath as long as possible - up to 10 seconds - to allow medication to settle
                  as deeply as possible into and onto air passages.
           m. This procedure may be repeated. Check the medication order or plan.
           n.      Observe for any immediate reaction or side effect.
F.   Auto-Injector Medication
     1.    Some medications are packaged in such a manner as to provide quick and easy
           delivery. These are called Auto Injectors.
     2.    Epinephrine Auto-injector Pens* – These contain epinephrine which is used in allergic
           reaction situations. *(Epi Pen and Twinject brands)
           a.     Familiarize yourself with students who have the potential for these situations.
                  Individual Care Plans are available addressing each student’s unique situation.
           b.     General auto-injector instructions:
                  (1) Pull off safety cap.
                  (2) Place cap on the opposite end from safety cap end. Place the pen with
                        needle protruding on the thigh. Clothing does not have to be removed.
                        DO NOT PLACE THUMB OVER THE END OF THE PEN IN CASE
                        YOU HAVE IT TURNED THE WRONG WAY. THIS CAN CAUSE
                        INJECTION INTO YOUR THUMB AND LEAD TO SIGNIFICANT
                        INJURY.
                  (3) Press auto-injector against thigh until mechanism activates, and hold in
                        place several seconds.
                  (4) Follow the school emergency procedure.
     3.    Insulin Pens – Some students have “pens” for insulin administration. Care plans will
           address their use and needs.
G.   Blood Sugar Testing
     1.    Diabetic students require monitoring of their blood sugar levels to determine food
           intake and insulin requirements. This is done with a glucometer. Instructions for their
           use will be given on an individual basis. In general, the test requires that a drop of
           blood be placed on a test strip.
     2.    Glucometer use (See instructions for individual glucometer use.)
           In general:
           a.     Remove a test strip from the package and insert in instrument.
           b.     Place lancet in the auto injector device.
           c.     Clean the finger with alcohol.
           d.     Allow finger to dry.
           e.     Press lancet device to skin.
           f.     Press button to impale lancet into finger.
           g.     Gently squeeze finger to produce a drop of blood.
           h.     Touch the test strip to the blood and allow it to absorb onto strip.
           i.     Push button to activate glucometer.
           j.     Read results.
           k.     Consult plan to determine needs.
H.   Nebulizer Treatments
     Definition - Administration of medication in a fine mist by way of breathing airways.
     1.    Procedure - Assemble nebulizer according to equipment directions.
     2.    Using the 8 Rights of Medication Administration, place the unit dose medication in the
           reservoir. *QDP may only use unit dose medications in the nebulizer. Prescriptions
           requiring the mixing of multiple medicines must be given by the nurse.
     3.    Attach nebulizer tubing which student has provided.

                                             6
     4.    Attach reservoir mouth piece to mask.
     5.    Student will place mask on face or position mouthpiece.
     6.    Turn nebulizer on. A fine mist should be emitting from the mouthpiece.
     7.    Treatment lasts approximately 15 minutes; check reservoir periodically.
     8.    Following treatment, clean reservoir with soap and water and allow to air dry.
I.   Rectal Medications
     Rectal Medications (Diastat) (Use Trainer for practice)
     1.    Place person on their side
     2.    Get medication
     3.    Get syringe – note seal pin is attached to the cap
     4.    Pull cap from syringe
     5.    Lubricate rectal tip with lubricating jelly.
     6.    Turn person on side facing you
     7.    Bend upper leg forward to expose rectum
     8.    Separate the buttocks
     9.    Gently insert syringe tip into rectum (Rim should be snug against rectal opening)
     10. Slowly count to 3 while gently pushing plunger in until it stops
     11. Slowly count to 3 before removing syringe from rectum
     12. Slowly count to 3 while holding buttock together to prevent leakage
     13. Keep person on side facing you, note time given and continue to observe.




                                             7
        MEDICATION ADMINISTRATION TO STUDENTS AT SCHOOL
                                   Self and Instructor Evaluation

Name                                                                        Key for scoring
                                                                             = satisfactory completion
Date                                                                        0 = unsatisfactory completion
                                                                                 or omission
Score

General Procedure

        1.    Wash hands.
        2.    Verify the labeled medication bottle with the written order.
        3.    Identify the student.
        4.    Read the label three times.
                      a. When removing from storage area
                      b. Before pouring
                      c. Before returning and storage area
        5.    Observe the student for any unusual behaviors or conditions.
        6.    Explain the procedure to the student.
        7.    Position the student properly for the medication administration.
        8.    Administer:
                      a. the medication to the correct student;
                      b. the correct medication;
                      c. at the correct time;
                      d. the correct dose; and
                      e. the correct route.
        9.    Verify the student swallowed the medication.
        10.   Record medication administration.
        11.   Report unusual reactions immediately.
        12.   Return medication to locked area.
        13.   Clean work area.
        14.   Wash hands.

Oral Medication Administration

Tablets or Capsules
        1.    Remove bottle cap and hold cap in one hand and container in other hand.
        2.    Pour the medication into the cap.
        3.    Transfer the medication from cap to (a) a clean container (medicine cup) and give cup to
              the student; or (b) pour directly into student’s hand.
        4.    Offer cup of water and encourage drinking the entire cup of water.
        5.    Verify the student swallowed the medication.
        6.    Recap the bottle and return it to the proper place.

Individually wrapped medications
        1.    Remove or tear off number needed.
        2.    Remove packaging and place in student’s hand.
        3.    Follow step 4 and 5 under Tablets and Capsules.



Page 1 of 4



                                                    8
Liquid
         1.   Shake container per label instructions.
         2.   Pour liquid from the side of the bottle opposite the label (hold label in palm of hand). Pour
              into graduated medicine cup.
         3.   Pour medication at eye level and directly in front of eyes.
         4.   Measure the dosage at the bottom of the disc.
         5.   Wipe any medication from the outside of the container.

Topical Medication Administration

Skin Medications
       1.    Gather necessary equipment: tongue blade, gauze, tape, cotton-tipped applicator, and
             gloves.
       2.    Cleanse the skin, if indicated or as ordered.
       3.    Apply medication in a thin layer using a tongue blade or a cotton-tipped applicator.
       4.    Cover medicated area, if indicated.

Eye Drops
       1.     Gather necessary equipment: cotton balls and tissue.
       2.     Cleanse the eye if indicated. Use clean cotton ball for each eye. (The eye is cleansed with
              a cotton ball by wiping once from the inside (near nose) to the outside.)
         3.   Position student with head tilted back and eyes gently closed. Open the eye to expose the
              conjunctival sac.
         4.   Approach the eye outside the field of vision. Avoid touching the dropper tip to
              conjunctival sac.
         5.   Place drops in the corner of eye nearest nose and ask student to blink 2 or 3 times.
         6.   Blot excess medication with a clean cotton ball or tissue.

Eye Ointment
       1.    Gather necessary equipment: cotton balls and tissue.
       2.    Cleanse the eye, if indicated. Use a new, clean cotton ball for each eye. Wipe once from
             inside (near nose) to outside.
       3.    Position student with head tilted back and eyes gently closed. Open the eye to expose the
             conjunctival sac.
       4.    Approach the eye from outside the student’s field of vision. Do not allow tip of applicator
             to touch conjunctival sac.
       5.    Apply ointment in a thin layer along inside lower lid.
       6.    Gently close the eye. Ask the student to blink eye 2 or 3 times.

Ear Drops
       1.     Gather necessary equipment: cotton balls and tissue.
       2.     Position the student.
                       a. Position student flat on a cot, and turn his/her face, or
                       b. Position student in a chair, and tilt his/her head sideways until ear is
                            horizontal.
         3.   Cleanse entry to ear canal with a clean cotton ball. Observe area.
         4.   Straighten the ear canal by pulling the outer ear gently down and back (ages 3 and under)
              or up and back (older children).
         5.   Drop the medication on the side of the canal. Avoid contact of applicator with ear canal.
         6.   Instruct the student to maintain the position for 1 minute.
         7.   Loosely place a cotton ball in the ear.


Page 2 of 4
                                                    9
Inhaler

1.        Inhalers may be administered PRN (as needed) or on a regular schedule. Students who are
          prescribed inhalers on a regular schedule may have a plan that encourages or includes self-
          management and self-administration.
2.        Students whose inhaler is ordered PRN (as needed) will require a specific Asthma Care Plan
          (ACP) for paraprofessionals or unlicensed assistive personnel to follow. Observations when
          monitoring student self-administration of medication may include:
                  a. Attach mouthpiece to inhaler that contains the medicine.
                  b. Stand up with feet slightly apart.
                  c. Shake inhaler for approximately 30 seconds or according to manufacturer’s
                       instructions.
                  d. Prime inhaler according to instructions (See chart in nurse’s office regarding
                       priming instructions for each inhaler).
                  e. Apply spacer, if available. Spacers allow medication to be delivered with more
                       accuracy. This insures that the child is more likely to get the required dose.
                  f. Position inhaler with canister upside down above mouthpiece.
                  g. Hold mouthpiece 1-2 inches from lips and open mouth wide. This position allows
                       the student to:
                                (1) point the inhaler properly toward the back of the throat.
                                (2) draw the medicine into the mouth in a steady stream.
                  h. Check to see that the medication is being properly inhaled.
                  i.   Breathe out naturally.
                  j.   Open mouth and begin to inhale. If using an air chamber (spacer), seal mouth
                       around mouthpiece and inhale a deep breath.
                  k. After the beginning of deep breath, squeeze canister down on mouthpiece and
                       breathe slowly as deeply as possible.
                  l.   Hold breath as long as possible - up to 10 seconds - to allow medication to settle as
                       deeply as possible into and onto air passages.
                  m. This procedure may be repeated. Check the medication order.
                  n. Observe for any immediate reaction or side effect.

Auto-Injector Medication (Use trainer for practice)
1.     Some medications are packaged in such a manner as to provide quick and easy delivery. These
       are called Auto Injectors.
2.     Epinephrine Pens – These contain epinephrine which is used in allergic reaction situations.
                a. Familiarize yourself with students who have the potential for these situations.
                     Individual Care Plans are available addressing each student’s unique situation.
                b. General auto injector instructions:
                             (1) Pull off safety cap.
                             (2) Place tip on the opposite end from safety cap end. Place the pen with
                                   needle protruding on the thigh. Clothing does not have to be
                                   removed. DO NOT PLACE THUMB OVER THE END OF THE
                                   PEN IN CASE YOU HAVE IT TURNED THE WRONG WAY.
                                   THIS CAN CAUSE INJECTION INTO YOUR THUMB AND
                                   LEAD TO SIGNIFICANT INJURY.
                             (3) Press auto-injector against thigh until mechanism activates, and hold
                                   in place several seconds.
                             (4) Follow the school emergency procedure.
3.     Insulin Pens – Some students have “pens” for insulin administration. Care plans will address
       their use and needs.




Page 3 of 4
                                                     10
Blood Sugar Testing
Diabetic students require monitoring of their blood sugar levels to determine food intake and insulin
requirements. This is done with a glucometer. Instructions for their use will be done on an individual
basis. In general, the test requires a drop of blood be placed on a test strip.

1.   Glucometer use
            a.     Remove a test strip from the package and insert in glucometer instrument.
            b.     Place lancet in the auto injector device.
            c.     Clean the finger with alcohol.
            d.     Allow finger to dry.
            e.     Press lancet device on the skin.
            f.     Press button to impale lancet into finger.
            g.     Gently squeeze finger to produce a drop of blood.
            h.     Touch the test strip to the finger and allow blood to absorb onto strip.
            i.     Push button and activate glucometer.
            j.     Read results.
            k.     Consult plan to determine needs.

Nebulizer Treatments
Definition - Administration of medication in a fine mist by way of breathing airways.
        1.    Procedure - Assemble nebulizer according to equipment directions.
        2.    Using the 8 Rights of Medication Administration, place the unit dose medication in the
              reservoir. *QDP may only use unit dose medications in the nebulizer. Prescriptions
              requiring the mixing of multiple medicines must be prepared by the nurse.
        3.    Attach nebulizer tubing which student has provided.
        4.    Attach reservoir mouth piece or mask.
        5.    Student will place mask on face or position mouthpiece.
        6.    Turn nebulizer on; a fine mist should be emitting from the mouthpiece or nose.
        7.    Treatment should last 15 minutes – check reservoir periodically.
        8.    Following treatment, clean reservoir with soap and water and allow to air dry.

Rectal Medications (Diastat) (Use Trainer for practice)
        1.   Place person on their side
        2.   Get medication
        3.   Get syringe – note seal pin is attached to the cap
        4.   Pull camp from syringe
        5.   Lubricate rectal tip with lubricating jelly.
        6.   Turn person on side facing you
        7.   Bend upper leg forward to expose rectum
        8.   Separate the buttocks
        9.   Gently insert syringe tip into rectum (Rim should be snug against rectal opening)
        10. Slowly count to 3 while gently pushing plunger in until it stops
        11. Slowly count to 3 before removing syringe from rectum
        12. Slowly count to 3 while holding buttock together to prevent leakage
        13. Keep person on side facing you, note time given and continue to observe.




Page 4 of 4

                                                   11
    ADMINISTERING MEDICATIONS TO STUDENT IN THIS SCHOOL
                                             Post Test


Circle the appropriate response.

T     F        1.     Medication administration at school requires a parent's written consent.

T     F        2.     Medications can be delivered to school by the students.

T     F        3.     Medications may be stored in an unlocked cabinet in a locked room.

T     F        4.     Medication administration may be recorded prior to giving medication.

T     F        5.     When a student refuses to take a scheduled medication, you should report this
                      immediately.

T     F        6.     Prescription medication is an over-the-counter medication.

T     F        7.     Proper hand washing is very important in fighting the spread of germs.

T     F        8.     It is acceptable to place tablets and capsules into the student's hand from the
                      bottle cap.

T     F        9.     Unwrap individually wrapped medications when you are ready to give the
                      medication.

T     F        10.    Measure liquid medication at eye level to assure proper dosage.

T     F        11.    Topical medications, such as ointments, creams, and lotions, may be applied
                      using your fingers if you wash your hands first.

T     F        12.    If you are unsure about how to administer a medication, check with nurse before
                      administering.

T     F        13.    Report any change in the student's condition.

T     F        14.    The epinephrine auto-injector pen may be administered through clothing.

T     F        15.    School personnel may administer prescription medication.

T     F        16.    A legal prescriber of medication includes a pharmacist, physician, and dentist,
                      nurse practitioner, and a physician’s assistant.




                                                                                               Page 1 of 4




                                                 12
        ADMINISTERING MEDICATIONS TO STUDENT IN THIS SCHOOL
                             Post Test


17.   Drugs are classified as:
      A.     OTC (Over The Counter)
      B.     Controlled substances
      C.     Prescription medication
      D.     All of the above

18.   The first action you take when you are unclear about administering a medication is:
      A.      Check with the student
      B.      Check with the prescriber
      C.      Do not administer the medication
      D.      Use judgement

19.   The record of medication administration includes:
      A.     Name of the student
      B.     Date
      C.     Time medication is given
      D.     All of the above

20.   The student does not come for the medication on time. You should:
      A.      Check with the classroom teacher or registrar to determine attendance
      B.      Call the student's parents
      C.      Notify the school nurse immediately
      D.      Call the physician

21.   You make a medication error. You should immediately:
      A.    Report the error following school guidelines
      B.    Complete a medication variance report
      C.    Induce vomiting
      D.    Notify the student's parents and physician

22.   To prevent the spread of germs as applied to medication administration, wash hands
      A.     1, 2, 5                  1.      Before giving each student's medication.
      B.     3, 4, 6                  2.      After giving each student's medication.
      C.     All of these             3.      At the beginning of the day.
      D.     None of these            4.      After using the restroom.
                                      5.      Between giving each student medication.
                                      6.      After removing gloves.

23.   Each time you give a medication you should:
      A.      Perform proper hand washing techniques.
      B.      Check the "Five Rights".
      C.      Record on medication sheet.
      D.      All of the above.



                                                                                            Page 2 of 4




                                                 13
            ADMINISTERING MEDICATIONS TO STUDENT IN THIS SCHOOL
                                 Post Test


24.       A student is taking two liquid medications. You do all except:
          A.     Measure each liquid in a separate medicine cup.
          B.     You may mix liquid medications in the same cup.
          C.     Hold the bottle with the label facing your palm.
          D.     Measure dosage at the bottom of the disc.

25.       Administration of eye drops includes:
          A.     Approach from outside the student's field of vision.
          B.     After administration the student blinks their eyes 2 or 3 times.
          C.     Blot excess medication from the eye.
          D.     All of the above.

26.       Administration of the epinephrine auto-injector medication in an emergency includes:
          A.     Pull off safety cap.
          B.     Place tip on thigh.
          C.     Press auto-injector against thigh until mechanism activates.
          D.     All of the above.

27.       When administering ear drops:
          A.    Pull the ear up and back for children.
          B.    Wait at least 1 minute before putting drops in the second ear.
          C.    Washing your hands is not necessary since the chances of spreading germs are minimal.
          D.    All but C.

28.       Qualified School Personnel may administer medication by injection:
          A.      In situations where no previous training has occurred.
          B.      In emergency situations such as allergic reactions.
          C.      Both A and B.
          D.      None of the above.

29.       Monitoring student self-administration by inhaler does not include:
          A.     Exhale immediately after inhalation for medication to settle.
          B.     Reminding the student to take medication.
          C.     Shaking the inhaler according to directions.
          D.     Waiting 2 minutes before the second inhalation.

30.       The role of the qualified person to administer medication includes all except:
          A.      Responsibility in following medication administration procedures.
          B.      Obtain medication information from the school health plan.
          C.      No accountability for errors.
          D.      Know the specific instructions for each medication administered.

T     F           31.     A glucometer is used to administer medication into the lungs.

T     F           32.     An order from a physician for medication to be given at school must also have
                          permission from the parent before administration.



                                                                                                 Page 3 of 4


                                                      14
        ADMINISTERING MEDICATIONS TO STUDENT IN THIS SCHOOL
                             Post Test



33.   List the "Eight Rights" of medication administration and explain each one (10 points).




                                                                                           Page 4 of 4



                                                15
                                            TEST KEY

      1.    T                         12.    T                         23.    D
      2.    F                         13.    T                         24.    B
      3.    F                         14.    T                         25.    D
      4.    F                         15.    T                         26.    D
      5.    T                         16.    F                         27.    D
      6.    F                         17.    D                         28.    B
      7.    T                         18.    C                         29.    A
      8.    T                         19.    D                         30.    C
      9.    T                         20.    A                         31.    F
      10.   T                         21.    A                         32.    T
      11.   F                         22.    C



33.   Right Student - Properly identifies the student.
      Right Time - Administer medication at the prescribed time.
      Right Medicine - Administration of the correct medication.
      Right Dose - Administration of the right amount of medication.
      Right Route - Use the prescribed method of medication administration.
      Right Documentation – Proper documentation of medication administration – time, route, assessment,
             and evaluation
      Right Assessment – Proper procedure for PRN medication – when symptoms started and what
             interventions were tried before medication, were parents notified
      Right Evaluation – Check that medication given produced the desired outcome within the designated
             time.




                                                  16
                                                      APPENDIX
A.   Drugs (definition): a chemical substance given with the intention of preventing or curing disease or otherwise
     enhancing physical or mental welfare of man

B.   Sources: Plant, animal, mineral, and synthetic

C.   Actions
     1.   Local: Act mainly at site of application
     2.   Systemic: Absorbed into the bloodstream and circulated to various parts of the body
     3.   Variables that affect actions:
          a. Dose
          b. Route of administration
          c. Drug-diet interactions
          d. Drug-drug interactions
          e. Age
          f. Body weight
          g. Sex
          h. Pathological conditions
          i. Psychological considerations
     4.   Adverse effects: undesired responses to medication ranging from rare, mild, and localized to widespread,
          severe, and life threatening, depending on the medicine and the person receiving it

D.   Sources of Medication Information
     1.   Pharmacology textbooks
     2.   Drug reference books
     3.   Journal articles
     4.   Online pharmacy websites

E.   Classification of Drugs
     1.    Prescription: Medications (including controlled substances) which require a prescriber's order.
     2.    Schedules of Controlled Substances: Five schedules of drug and drug products are under the jurisdiction of
           the Controlled Substances Act. Some examples are listed. Listings are subject to change. For a complete list
           contact the Drug Enforcement Administration or a pharmacist. The drugs are kept in a locked container and
           the drug amount is documented when received and at administration.
           a. Schedule I: Substances that have no accepted medical use in the U.S. and have a high abuse potential
                 (heroin, marijuana, LSD, MDMA, peyote, mescaline.)
           b. Schedule II: Substances that have a high abuse potential with severe psychic or physical dependence
                 liability. Consist of certain narcotic, stimulant, and depressant drugs (opium, codeine, Demerol,
                 Percodan, Dexedrine, Ritalin).
           c. Schedule III: Substances that have an abuse potential less than those in I and II. Includes compounds
                 with limited quantities of certain narcotic drugs and non-narcotic drugs (Doriden, compounds or
                 mixtures containing secobarbital).
           d. Schedule IV: Substances with potential for abuse less than those in III (phenobarbital, Placidyl, Libium,
                 Valium, Tranxene, Darvon, and Talwin-NX).
           e. Schedule V: Substances with an abuse potential less than IV and contain limited quantities of certain
                 narcotic and stimulant drugs generally for cough, diarrhea and pain purposes (buprenorphine and
                 propylhexedrine).
     3.    Over the Counter (OTC): Drugs which may be purchased without a prescription, e.g., first aid cream, pain
           medications, and antacids.

                                              Classification of Drugs



                                                         17
F.   Verification of Medication Intake
     Medications should be administered to one student at a time. Do not attempt to administer medication to multiple
     students at the same time. This increases the chance of error and prevents observation of the intake of the
     medication.
     1.    Observe the entire process of handing the student the medication until swallowing is complete.
     2.    Observe the student as he places the medication in his mouth, drinks the liquid, and swallows the
           pill/tablet/capsule.
     3.    On occasion it is permissible to inspect the mouth to determine the medication has actually been swallowed.
           This can be done by asking the student to open his mouth and move his tongue in such a way as to observe all
           the areas of the cavity. Should there still be doubt; a tongue blade can be used to inspect the mouth cavity.
     4.    Students who refuse to take medication should be reported to the nurse, nurse back up or the principal.
           Parents must to be notified and a medication variance form completed, on copy is sent to the Health Services
           Coordinator and one copy remains on the campus.

G.   Recording Medication and Treatments
     (See medication sheet in this publication.)
     1.    Only one medication per sheet.
     2.    Sign your full name in the space provided. After signing your name, initials are allowable.
     3.    Place your initials and the time in which the medication is given on the space on the calendar of the
           medication sheet that represents the date the medication is being given. This is done after you observe the
           student taking the medication.
     4.    Medications are charted after administration.

H.   Receiving Medication for Administration at School
     1.   All medications are to be brought to school by parents.
     2.   If a student should deliver the medication,
          a.     determine that the medication is in the original container and properly labeled with the student’s name,
                 dose, time to be given, and authorization for medication to be given.
          b.     count the number of pills/tablets/capsules in the container and record on the medication sheet.
          c.     call the parent and notify him or her that medication has been received indicating the number of tablets
                 in the container.
          d.     report to the parent that medication can only be delivered and retrieved by an adult.
          e.     indicate that medication cannot be returned home by the student; an adult must retrieve from the
                 school.
          f.     if not in a properly labeled container, it will not be given. Indicate that medication that is in an
                 improperly labeled container or has no container will not be given.

I.   Reporting Unusual Reactions or Events
     This is a rare event. However, from time to time, a student will complain of not feeling well following
     administration of medication or, in some cases, develop various unexpected symptomatology. In these events, the
     campus nurse or the campus back up nurse should be notified of the situation. Should neither be available, the
     parent should be notified. Should the student show signs of respiratory compromise (shortness of breath, difficulty
     breathing), call 911 immediately.


                                      Verification of Medication Intake
                                    Recording Medication and Treatments
                              Receiving Medication for Administration at School
                                   Reporting Unusual Reactions or Events




                                                          18
J.   Disposal of Medication
     From time to time there is a need to destroy medication. This can occur when medication is dropped to the floor or
     other unclean surface or when it is abandoned.
     1.    Notify nurse or her backup regarding the action.
     2.    Notify the parent/guardian regarding need to destroy.
     3.    Medication is flushed down the toilet.
     4.    The action must be observed by another person.
     5.    Following the disposal, make a notation on the medication sheet and have person sign that the action was
           taken.

K.   Measurement Conversion Table
     1 Tablespoon (T)     =      15 cc/ml
     1 teaspoon (t)       =       5 cc/ml
     1 ounce (oz)         =      30 cc
     ½ ounce              =      15 cc

L.   Medication Errors
     Medication Errors include:
     1.   Giving the wrong dose of medication
     2.   Giving the wrong medication
     3.   Giving the medication at the incorrect time
     4.   Forgetting to give medication
     5.   Student refusing to take medication
     6.   Student not reporting for medication and nurse/assignee not sending for student

                                           Disposal of Medication
                                        Measurement Conversion Table
                                             Medication Errors




                                                         19
                      TRAINING-SUPERVISION-MONITORING RECORD

Name                                             Instructor                           Date

Detailed description of training (Attach training or location of course materials.)




Performance evaluation                 Date                          Comments


Return evaluation                      Date                          Comments


Supervision follow-up date          Update Due                       Comments


Date                     Comments
    /   /
    /   /
    /   /
    /   /
    /   /
    /   /
    /   /
    /   /
    /   /
    /   /
    /   /
    /   /
    /   /
    /   /
    /   /
    /   /
    /   /
    /   /




                                                              20
                                    HUMBLE INDEPENDENT SCHOOL DISTRICT
                                             HEALTH SERVICES
                                               2010 – 2011 MEDICATION RECORD
Teacher                                         Grade                                   Student's Name

    Parent Note            Doctor's Note                 Start Date_____________            Received by
Medication                                                                        Dosage                                  Time
Special Instruction
                       July                                                August                                              September
  M          T         W            TH         F         M        T          W           TH        F        M         T            W         TH          F
                                           1         2        2        3          4            5        6                                1         2          3
        5         6            7           8         9        9       10        11            12       13        6         7             8         9         10
       12        13       14              15        16       16       17        18            19       20       13        14            15        16         17
       10        2-       21              22        23       23       24        25            26       27       20        21            22        23         24
       26        27       28              29        30       30                                                 27        28            29        30
                      October                                             November                                             December
   M         T          W           TH          F        M        T          W           TH        F        M         T           W          TH          F
                                                     1        1        2            3          4        5                                1         2          3
        4         5            6           7         8        8        9          10          11       12        6         7             8         9         10
       11        12        13             14        15       15       16          17          18       19       13        14            15        16         17
       18        19        20             21        22       22       23          24          25       26       20        21            22        23         24
       25        26        27             28        29       29     30                                          27        28        29            30         31
                      January                                         February                                                  March
   M         T          W           TH          F        M        T      W               TH        F        M         T          W           TH          F
        3         4            5           6         7                1           2            3        4                  1             2         3          4
       10        11       12              13        14        7       8           9           10       11        7         8             9        10         11
       17        18       19              20        21       14    15           16            17       18       14        15            16        17         18
       24        25       26              27        28       21    22           23            24       25       21        22            23        24         25
       31                                                    28                                                 28        29            30        31
                       April                                                May                                                  June
   M         T          W           TH          F        M        T         W            TH        F        M         T           W          TH          F
                                                     1        2       3           4            5        6                                1         2          3
        4         5            6           7         8        9    10           11            12       13        6         7             8         9         10
       11        12       13              14        15       16    17           18            19       20       13        14            15        16         17
       18        19       20              21        22       23    24           25            26       27       20        21            22        23         24
       25        26       27              28        29       30    31                                           27        28            29        30

Pill Count                                                                                     Nurses Signature                               Initials
   Date          #Rec’d            Init




                                                                                               After giving medication(s) record time(s)
                                                                                               administered and initial in the appropriate date box.
                                                                                               AB – Absent                     NM – Out of medicine
                                                                                               DC – Discipline Center

                                                                           21
                                 HUMBLE INDEPENDENT SCHOOL DISTRICT
                                    MEDICATION VARIANCE REPORT
                                                                                                                         Date

STUDENT INFORMATION:

Name                                                                           Sex: M         F     Age             Grade/Advisor

Parent/Guardian                                                                                             Telephone

Address                                                                                                     School

MEDICATION VARIANCE INFORMATION:

Date                Time                    Person Administering Medication
                                                                           (name)                                     (title)

Current Medication Order
                                    (medication)                                                  (instructions)

Licensed Prescriber
                                    (name)                                                        (instructions)

Reason Medication is prescribed                                                                             Date of Order

Actual medication administered                                                       Dosage:                Route:              Time:

DESCRIBE VARIANCE AND HOW IT OCCURRED – use back if needed




MANAGEMENT OF OCCURENCE

Date and time student first seen by nurse                                                                   Location of assessment

Name of Licensed Prescriber notified                                                 Title:                 Date:                  Time:

Notified by whom                                                                                            Date:                  Time:

Name of Parent/Guardian notified                                                 Relationship:              Date:                  Time:

Notified by whom                                                                                            Date:                  Time:

Was student sent to doctor?                                               Name of Physician:                       Name of Hospital:

Outcome




                                                             Nurse Signature

CORRECTIVE ACTION PLAN:

1.     Review student’s authorization form for medicine administration at school for accuracy.

2.




Nurse Signature                                                         Principal Signature

White – Student File            Yellow – Nursing Coordinator             Pink – Originator                                        Health Form, rev. 4/00


                                                                         22
              HUMBLE INDEPENDENT SCHOOL DISTRICT


             Certificate of Completion

          School
 Medication Administration
         Training

               satisfactorily completed the training


Date                           Instructor

Update Due



                                23

								
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