Medication Administration Training

1. Medication AdministrationTraining For Designated School Personnel By Diane Torna, RN, M.Ed. Fresno Unified School District August 2008 Revised June 2009 Barbara Miller, RN, PNP Fresno County Office of Education

2. California Education Code 49423 “…any student who is required to take, during the regular school day, medication prescribed for him by a physician, may be assisted by the school nurse or other designated school personnel if the school district receives: • (1) a written statement from such physician detailing the method, amount, and time schedules by which such medication is to be taken and • (2) a written statement from the parent or guardian of the student indicating the desire that the school district assist the student in the matters set forth in the physician's statement.

3. Confidentiality You must maintain confidentiality : • Every time you enter the Health Office and • Every time you are dealing with Health or Medical Information of Students.

4. Who can Administer Medication to Students at School: 1. Licensed School Personnel (RN or LVN). 2. School Administrator 3. Personnel, as defined in Job Description 4. Trained Designated School Personnel “willing” to administer medication and deemed competent by School Nurse. 5. Parent /Parent Designee 6. Sibling designated by the parent, with school administration approval, to administer medication to his or her own sibling. (Competency verified by School Nurse.) 7. A student may Carry and Self-Administer an inhaler for Asthma or an EpiPen for a life-threatening allergy when competency is verified by School Nurse.

5. Reminder: • A parent or guardian may not be required to administer medication to their child as a condition of receiving medication at school or of receiving any placement or related services to which the student is entitled.

6. Requirements forDesignated School Personnel: 1. Designated by School Administrator and School Nurse. 2. MUST receive training in Medication Administration by School Nurse prior to administering medication to student. 3. Must be Supervised by School Nurse. 4. MUST have current CPR certification, if administering Emergency Medications, such as EpiPen, Glucagon, or Emergency Seizure Medication.

7. Medication at School Orders: 1. Must be received for all medications, including over-the-counter and herbal medications. 2. Must be signed by California-Authorized Health Care Provider. 3. Must be signed by Parent or Guardian. 4. Must be renewed at the beginning of every school year and whenever there are changes in the medication.

8. Medication Orders for School Must include: • Name of Student • Name of Medication • Dose • Time of Administration • Route Verbal Orders for medication can not be accepted from Health Care Provider. Health Care Provider may fax medication order to school.

9. Reminder: All Medication must be administered according to the time indicated by the Health Care Provider. Example: Medication must be administered within 30-45 minutes of time indicated by Health Care Provider. Example: If a student misses their AM medication dose at home, contact parent. The parent may choose to come to school to give the medication. Example: A missed AM medication dose may be given by designated school personnel ONLY if Health Care Provider’s authorization specifies that AM dose may be administered at school. Even if the student has an order to give doses missed at home, ALWAYS verify with parent that the AM dose was missed at home before giving the medication at school.

10. Reminder: A Parent may submit a written statement to withdraw consent for administration of medication at school at any time.

11. A Student may carry own inhaler or EpiPen and Self-Administer if: 1. Authorized by Health Care Provider. 2. Parent or Guardian permission obtained. 3. School Nurse determines that student is competent to safely self-administer the medication at school. 4. If student misuses this privilege they will not be allowed to carry medication. Medication will remain locked in Health Office or other designated safe place for easy access.

12. Medication to be delivered to school by parent, guardian, or adult designee: Must be delivered in Pharmacy-labeled container indicating: • Name of Student • Name of California-authorized Health Care Provider • Name of Medication • Dose • Time for Administration • Route Over-the-Counter Medication must be in original container or packaging.

13. Always Count Number of Pills delivered to School Document in Medication log in Health Office

14. Remember: • Medication must be stored in a locked cabinet. • Do not leave keys in door of cabinet or where a student can access them easily.

15. If you receive a Medication Order and School Nurse is not onsite: This includes new medication orders or any changes to original order (dose, time, route). Do not give Medication until you: • Contact your School Nurse. • Fax Medication Order to School Nurse for verification. .

16. To Administer Medication to a Student “Five Rights” of Medication Administration

17. “FIVE RIGHTS” 1. Right Student 2. Right Time 3. Right Medicine 4. Right Dose 5. Right Route • Properly identifies student. • Administer medication at the prescribed time. • Administer the correct dose. • Administer the right amount of medication. • Use the prescribed method of medication administration.

18. “Sixth Right” • Documentation is referred to as the “Sixth Right”. • Documentation of Student Name, Time, Medication, Dose, Route, Date, Person Administering andUnusual Observations and Circumstances. • Document in Medication log in HealthOffice.

19. Steps to Administering Medication

20. Steps: 1. Wash Hands 2. Verify the authorization with the label. 3. Gather necessary items. 4. Prepare and give medications in a well lighted area free from distractions. 5. Check the label for name, time, medication, dose, and route.

21. Steps cont: 6. Prepare the correct dosage of medication without touching the medication. 7. Check the label for name, time, medication, dose, and route while preparing the correct dose. 8. Check the label for name, time, medication, dose, and route before returning the container to the locked and limited access place.

22. Steps cont: 9. Do not leave medication unattended or within reach of student. 10. Identify student. Ask the student to state his or her name. 11. Observe the student for unusual behaviors or conditions prior to medication administration. If unusual behaviors or conditions exist, do not give medication and report to your school nurse immediately and record.

23. Steps cont: 12. Explain the procedure to the student. 13. Position the student properly to administer medication. 14. Provide equipment and supplies as needed. 15. Administer the medication to the correct student.

24. Steps cont: 16. Administer the medication at the correct time. 17. Administer the correct medication. 18. Administer the correct dose. 19. Administer the medication by the correct route.

25. Steps cont: 20. Verify that student took the medication. 21. Record as soon as possible after administration in Medication log. 22. Report unusual reactions immediately to your school nurse and document. 23. Should any questions arise report immediately to your school nurse.

26. Steps cont: 24. Clean, return and/or dispose of equipment as necessary. 25. Wash hands.

27. Practice Universal Precautions: • Treat all blood and bodily fluids as though they are potentially infectious. • Proper hand washing before administering medication. • The use of disposable non-latex gloves when the person administering medications may come in contact with body fluids. • Proper disposal of wastes, including materials contaminated with blood or other body fluids and all sharps (needles and lancets). • Use of disinfectants approved by the Environmental Protection Agency (EPA) and Occupational Safety and Health Administration (OSHA) for cleaning spills of body fluids.

28. Be Prepared to Recognize the Signs and Symptoms for: 1. Adverse Side Effects of Medication 2. Overdose of Medication 3. Omission of Medication Call 911 for life-threatening emergency

29. Medication Errors • 1. Report immediately to your School Nurse and Principal. • 2. School Nurse will notify Parent or Guardian and authorizing Health Care Provider, if necessary. • 3. Complete medication error “Notification Form” and submit to Director of Health Services or immediate supervisor. • 4. Continue to observe the student. Record and report any changes. • Call 911 for life-threatening reactions.

30. Medication Errors Include: • 1. Medication given to the wrong student. • 2. The wrong medication given to a student. • 3. The wrong medication dose given to a student. • 4. Medication given at the wrong time. • 5. Medication given by way of a wrong method or route. • 6. Medication omission.

31. Field Trips and All School-Related Activities All staff members who are planning school-sponsored activities, including Overnight Camps and Field Trips, must notify the school nurse as soon as possible in the school year, in the event trained staff needs to be scheduled to attend and administer medications to students.

32. Field Trips cont: • The school nurse, provides designated trained staff members with all the necessary student medication (including emergency medication) that will allow students who need medication during the regular school day to participate in the school-sponsored activity. • Medication will be provided in individual containers (that contain only the amount to be administered during the activity) with labels that include the student's name, authorized health care provider's name, name of medication, dose of medication, method of administering the medication, and time of administration. Parent will supply pharmacy labeled containers for Overnight Camps.

33. Field Trips cont: • Designated trained school personnel must keep all medication in a closed container on his or her person at all times, such as in a fanny pack or back pack. • Only designated trained school personnel will be allowed access to student medication and medication administration responsibilities for students needing medication at school-sponsored activities. • The school nurse will provide information about how trained designated school personnel gain access to emergency services.

34. Field Trips cont: • The school will provide the designated school personnel with a communication device, such as a two-way radio or cellular telephone, for gaining access to emergency services at school-sponsored activities. • A medication log to record the time the medication was administered will accompany each medication that is to be administered during the school-sponsored activity.

35. The process must ensure that: • Documentation of medication administration on all field trips and school-sponsored activities occurs at the time and place of administration. • On return to school, the log is returned to the health office, is reviewed by the school nurse, and is documented in the Medication log.

36. References • 1. California Education Code • 2. California Department of Education

37. California Department of Education • Program Advisory on Medication Administration • The content of this advisory was prepared from information provided by a medication committee that was convened by the CDE to assist with the development of the Title 5 regulations pertaining to medication administration in school.

38. The End Thank you If questions please contact your school nurse