Medication Administration Training for Sub-Secretaries

1. Mad River Local School’sMEDICATION ADMINISTRATION TRAINING For Sub-SECRETARIES • Introduction • This training is designed for the non-medical and non-licensed school personnel to provide the basic knowledge for safe medication administration. • There are areas that will require individual training modules to supplement this training with “hands-on” instruction provided by the School Nurse. More in-depth training will occur for schools with students with diabetes and other more involved medical issues. • The “hands-on” training is specific for each route of medication administration that should be accomplished prior to administering medication. • Check with your School Nurse for current “hands-on” training procedures.

2. MEDICATION ADMINISTRATION • Introduction • Many children who take medications require them during the school day. Providing necessary medications by trained faculty and staff enables these children to attend school every day. • The ideal situation is for districts to have school nurses available to administer medication. However, situations such as personal absences, field trips, or conditions where nurses work between multiple schools may create the need for other staff members to administer medication. • Medication must be administered under the safest possible conditions. The purpose of this course is to educate school employees on the policies and procedures that relate to the safe administration of medication to students.

3. MEDICATION ADMINISTRATION • Introduction • This course contains the following topics: • State Laws and Board Policies • General Medication Information • Forms and Procedures • Medication Administration Guidelines • The “Six Rights” of Medication Administration • Procedures for Medication Administration • Hand washing Procedures • Administration of Oral Medication • Administration of Topical Medication • Administration of Eye Medication • Administration of Eardrops • Administration of Auto-injector Medication • Administration of DIASTAT AcuDial™ • Self-administration of Medication • Medication Errors • Field Trips

4. MEDICATION ADMINISTRATION • Introduction • Children with chronic and acute health conditions may require medication administration during the school day in order to be academically successful. • In 2009, Ohio House Bill 1 updated school medication administration law (ORC 3313.713) to require all school employees who administer medications after July 1, 2011 be: • A licensed health professional such as a School Nurse • OR • Complete a medication training program conducted by a licensed health professional (i.e. School Nurse)

5. MEDICATION ADMINISTRATION • State Laws and Board Policies • Policies for administering medication vary from state to state. Most states have laws that require districts to develop formal policies for dispensing medication. • As a general guideline, the policies include: • Designation of a primary staff member responsible for dispensing medicine onsite. • A list of who may dispense medication in the absence of that person. • Description of training required for the individuals who will be dispensing medication. • Procedures for reporting and managing errors. • Procedures for handling medications on field trips or other outings. • Remember: • It is recommended that you review the Mad River Local District board policy prior to administering any medication. (See the link to the MRLS Board Policy on the class page.) • The Board policy requires the written prescription from a licensed health professional to accompany the written authorization of the parent. These forms are kept on file in the office of the School Nurse.

6. MEDICATION ADMINISTRATION • B. General Medication Information • Definition of medications • Medications are substances used to prevent, diagnose, cure or relieve signs and symptoms of disease. They are created from plant, animal, mineral and synthetic materials. • Actions • Local medications act mainly at the site of the application. • Systemic medications are absorbed into the bloodstream and circulated to various parts of the body. • Variables that affect actions are: • Dose • Route of administration • Drug-diet interactions • Drug-drug interactions • Age • Body weight • Pathological considerations • Psychological considerations

7. MEDICATION ADMINISTRATION • B. General Medication Information • Adverse effects • All medications are capable of producing undesired responses from rare, mild, and localized, to widespread, severe, and life threatening, depending on the medicine and the person receiving it. • System of naming • Medications are classified and grouped according to the effect on a particular body system, therapeutic use and chemical characteristics. • A generic name is related to the chemical or official name. • A brand or trade name is one that is designated and patented by the manufacturer. • Sources of medication information: • Pharmacology textbooks • Drug reference books • Journal articles • Local pharmacist - package insert • Poison control center

8. MEDICATION ADMINISTRATION • B. General Medication Information • Classification of drugs • Prescription: Medications (including controlled substances) that require a licensed prescriber’s order. • Over-the-counter (OTC): Medications which may be purchased without a prescription e.g., first aid cream, antibiotic ointment/cream, analgesics (such as acetaminophen), antacids, cough drops, and cough syrup. • Controlled Substances: There are five schedules of drugs and drug products under the jurisdiction of the Controlled Substances Act. These drugs must be kept in a locked container and the drug amount documented when received and at the time of administration. • Radke, K.D. & Thompson, S. (1997). Administering medications to students in California schools. California School Nurses Organization. • Federal and state drug legislation and regulations are designed to ensure the public’s safety and regulate the manufacture and sale of drugs.

9. MEDICATION ADMINISTRATION • C. Forms and Procedures • General Procedure for Medication Administration • Parents will: • Obtain written medication order from licensed prescriber that is filled by pharmacist. • Ensure permission for the school to give medication is documented by the prescriber and the parent on the Medication Authorization Form (MAF). • (Licensed prescriber may be a doctor, dentist, physician’s assistant or nurse practioner) • The School Nurse will: • Create a Medication Administration Record (MAR). • Count the medication and document the count and date received on the back of the MAR. • Administer medication according to district policy. • Properly dispose of unused medication.

10. MEDICATION ADMINISTRATION • D. Medication Administration Guidelines • Before administering medication • The following information and documents should be received before administering medication at school: • Medical authorization • A written authorization by a licensed prescriber for all prescription and OTC medications should include • Student’s name. • Licensed prescriber’s name, telephone number, and signature. • Date the prescription was written. • Name of the medication. • Required dosage. • Time of the day to be given. • Anticipated length of treatment. • A diagnosis or the reason the medication is needed (unless confidential). • Serious reactions the student may experience. • Any serious reactions that may occur if the student is not administered the medication. • Special handling instructions.

11. MEDICATION ADMINISTRATION • D. Medication Administration Guidelines • Parental Consent • Parental consent must be obtained before a medication is given to a student. The consent form should include the following: • Student’s name. • Parent / guardian’s name. • A daytime phone number and phone number to call in the event of an emergency. • A statement of consent for the medication to be administered. • The date consent was given. • Reason for the medication (unless it is already on the medical authorization form and not confidential). • It is important that dates on the parental consent form include the entire school year.

12. MEDICATION ADMINISTRATION • D. Medication Administration Guidelines • Medication Label • The medication should be received by the school in the original container. You can remind parents to request that their pharmacist divide medication into two containers: one for school and one for home. The container should have the pharmacy label that states the following: • Student’s name. • Name of the medication. • Directions for dosage. • Frequency the medication is to be administered. • Licensed prescriber’s name. • Date the prescription was filled. • The Mad River Local School District policy prohibits the administration of over-the-counter medications unless accompanied by written authorization from the licensed health care professional.

13. MEDICATION ADMINISTRATION • Medication Administration Guidelines • Authorized staff should use the following guidelines, in addition to the district policy, when dispensing medication to students. • Whenever possible, medication required by a student should be administered by the parent or guardian before or after school hours. • No medication is to be given until the Medication Authorization form is completed by the parent/guardian and the licensed prescriber. This form is only valid for the current school year. • A new prescription is required when a student registers during the school year. Prescriptions written for other districts are not accepted. • A new prescription is needed anytime any detail on the order changes. (Such as medication, dose or time.) • Only those unlicensed school personnel who have successfully completed the administration of medication training will administer medication to students. The administration of medication by any person other than a designated and properly trained staff member is prohibited.

14. MEDICATION ADMINISTRATION • Medication Administration Guidelines • Medication must be stored in a designated location in a locked storage place. Medications requiring refrigeration should be kept in a refrigerator located in an area NOT commonly used by students. • Before medication is administered “as needed”, the time the student last received the medication must first be established by • Determining that the time between the start of school and the time the medication is to be given is equal to or greater than the prescribed intervals between medication administration. • Or by calling the parent to determine the last time the medication was given and verifying that the time is equal to or greater than the prescribed intervals between medication administration. • The parent or guardian must be notified of the time the medication was given, the presenting signs and symptoms, and the student’s response to the medication unless the school nurse has authorized self-reporting by the student. • Emergency medications must be accessible at all times.

15. MEDICATION ADMINISTRATION • Medication Administration Guidelines • Some students may be authorized to self carry medication (i.e. inhalers & Epi-pen). Before a student should be permitted to carry medication on his or her person for the purpose of self-administration, there must be written permission from the parent or guardian. • In addition, the licensed provider should write on the Medication Authorization form permitting self-administration and a statement attesting to the student’s competence in self-care. • Each dose of medication administered or not administered to a student should be accounted for on a medication administration record (MAR) and recorded by the person who actually administered the medication to the student. (See the codes for missed medication on the MAR.) • The School Nurse should be notified of any student who develops a pattern of inconsistently reporting for his or her medication or stops reporting for medication administration altogether.

16. MEDICATION ADMINISTRATION • Medication Administration Guidelines • At the end of the school year, or when medication has been discontinued, the parent/guardian should be advised to pick-up any unused portion of the medication. Medication not claimed or out of date may be destroyed under the supervision of the school nurse. • An emergency action plan (EAP) should be developed for each student having an Epi-pen or auto-injector medication order. Each staff member who works with the student should review the plan. • Any medication error must be immediately acknowledged and the appropriate actions taken without delay. • All information regarding student health and medical conditions, including information regarding medication, is confidential.

17. MEDICATION ADMINISTRATION • “Six Rights” of Medication Administration • Remember the “Six Rights” of medication administration. Following these steps before dispensing medication to a student will help to minimize errors. • Right Student: Accurately identify the student. •  Accurate identification must be made each time medication is administered. • Use the method of student identification established by the school nurse or district policy. (i.e. “Who are you and what medication are you getting?”) • Right Medication: Check that the name of the medication matches in 3 places: the MAF, medication container, and the MAR the first time you give student medication. • Right Dose: Do not give a dose if it does not match the MAF, medication container, or the MAR. • Right Route: The route indicates how and where the medication enters the body. • .

18. MEDICATION ADMINISTRATION • “Six Rights” of Medication Administration • Right Time: • Administer medication at the prescribed time. • An acceptable time frame for the administration of medication is ½ hour before to ½ hour after the time ordered by the licensed prescriber. • Medication can only be given at the time identified by the prescriber’s orders. In the event a medication was not given at home prior to school, a parent or their designee may come in to give the medication at other times. We cannot give a medication for a time not order. • Disruption to the student’s school schedule should be kept to a minimum Right Documentation: While documenting medication administration, once again compare the medication label to the medication record while recording on the documentation form. • Document everything. • Document promptly, but not in advance. • Documentation should be readable, accurate and complete. • Paper documentation must be in black or blue ink.

19. MEDICATION ADMINISTRATION • Procedures for Medication Administration • The 16 steps for general administration of medication • Wash hands. Administration of medication is a clean procedure which requires hand washing. • Administer the medication. Use the “Six Rights” of medication administration: • Right Student • Right Time • Right Medication • Right Dose • Right Route • Right Documentation • Identify the student. Use the method of identification established by the school nurse. Non-verbal students may require picture identification. Ask school personnel familiar with the students to verify the student’s identity if necessary. Verify first and last names.

20. MEDICATION ADMINISTRATION • Procedures for Medication Administration • The 16 steps for general administration of medication • Observe the student. If unusual behaviors or conditions exist, do not give the medication. Notify the school nurse or parent or guardian if the nurse is not available. Document observations and actions • Gather necessary items. Organize all needed equipment and supplies. Medications should be prepared and administered in a well-lighted area, free from distractions. • Check #1 - Check the medication label. Read the name, time of administration, dose and route. Notify the school nurse of any discrepancies before administering medication. • Check #2 - Compare the information on the label with the medication administration record. Contact the school nurse if any discrepancy exists or additional information or clarification is needed before administering the medication. • Prepare the correct dosage. During preparation, the medication should never be touched. Pour medication into the medication bottle cap. Also, never alter any medication (for example, crushing tablets, increasing or decreasing dosage) without approval of the school nurse. .

21. MEDICATION ADMINISTRATION • Procedures for Medication Administration • The 16 steps for general administration of medication • Explain the procedure, as necessary. Use terms and language appropriate to the development level of the student. Position the student properly for medication administration, if indicated. • Check #3 - Recheck the label just before giving the medication to the student. Again read the name, time, dose and route. • Verify. Watch the student carefully to make sure the medication is swallowed or properly inhaled. • Check #4 - Recheck the label. Before returning the medication container to the locked, designated space, once again read the name, time, dose and route. Notify the school nurse of any discrepancies. • Observe the student. Immediately report any unusual reactions to the school nurse, parents or guardians, or the student’s physician per procedure. Document observations and actions.

22. MEDICATION ADMINISTRATION • Procedures for Medication Administration • The 16 steps for general administration of medication • Clean. Return and/or dispose of equipment and supplies as necessary. • Wash hands. Follow proper hand washing procedure. • Document. As soon as possible, document the administration of medication.

23. MEDICATION ADMINISTRATION • Hand washing Procedure • Before you give any medication, always wash your hands. Follow these steps when washing your hands: • Wet hands with water and apply soap. • Liquid soap is preferred. • Avoid the use of hot water – it removes protective oils and causes irritation. • Rub hands together for no less than 15 seconds. • Include the front and back of hands, between fingers, knuckles, around and under nails, and wrist. • Rinse hands well under running water, leaving water running. • Running water rinses away soil and microorganisms. • Use paper towels to gently and thoroughly dry hands. • Use paper towels to turn the water off. • This prevents the transfer of organisms from faucet • An alcohol-based hand sanitizer (minimum 60% alcohol content) may be used if soap and water are not available

24. MEDICATION ADMINISTRATION • H. Administration of Oral Medication • To administer any type of oral medication, follow the 16 steps for general administration of medication along with the following specific instructions. • Specific instructions are identified for each type of oral medication you may be required to administer to a student. • Tablets, caplets, capsules, etc. • Remove bottle cap and hold cap in one hand the bottle in the other hand. • Pour the prescribed dose into the cap. • Transfer medication from cap to the student’s hand. (Mouth if unable to self administer.) • Give a cup of water unless otherwise ordered. • Verify the student swallowed the medication. • Close the medication container and return it to the designated, locked space.

25. MEDICATION ADMINISTRATION • H. Administration of Oral Medication • Individually wrapped medication (blister packs) • Remove or tear off the number needed and give to the student. • Do not touch medication. • Blister packs are usually dated. • Check to make sure the proper date is being administered.

26. MEDICATION ADMINISTRATION • H. Administration of Oral Medication • Liquids • Shake medication per label instructions. • Pour liquid from the side of the container opposite the prescription label into the graduated medicine cup. (Hold the label side of the container in the palm of the hand.) • Place medicine cup on a hard, level surface. • Pour medication at eye level. • Carefully measure the correct dosage. •  Wipe off any medication on the outside of the container. •  Use a calibrated medicine dropper or syringe to measure small amounts of liquid.

27. MEDICATION ADMINISTRATION • H. Administration of Oral Medication • Possible problems with oral medication • Refusal of the medication. • Immediately report to the school nurse or notify parent/guardian if the school nurse is not available. • Vomiting the medication. • Immediately report to the school nurse or notify parent/guardian if the school nurse is not available, the following: - Student’s name and age. - Medication and dosage given. -Time lapse since administration of medication. - Whether or not the medication appeared intact or what portion of liquid medication was vomited or spit out.

28. MEDICATION ADMINISTRATION • H. Administration of Oral Medication • Possible problems with oral medication • Difficulty swallowing medication. • The following are techniques that may be used to assist a student in swallowing medication: • Position the student in an upright position • Give only one medication at a time with adequate amount of fluid. • Watch for choking and be prepared to perform the Heimlich Maneuver, if needed. Follow the emergency action plan for any student who is known to have a swallowing or breathing problem. • Check with the school nurse before giving medication with food or crushing medication unless such directions are specifically ordered.

29. MEDICATION ADMINISTRATION • Administration of Oral Medication • Inhalers • Always follow the instructions provided by the licensed prescriber. If no instructions are given, these steps are followed: • Attach the mouthpiece to the inhaler. If using a spacer, attach the canister & mouthpiece to the spacer or holding chamber. • Position the student standing or sitting in an upright position. • Shake the inhaler for two seconds. • Position the inhaler with the canister upside down above the mouthpiece. • Instruct student to breath out naturally. • Then instruct the student to place mouth around mouthpiece making a seal. If a chamber or spacer is used, the mouth will be placed around the mouthpiece of the spacer. • Instruct the student to begin to inhale a deep breath slowly as the canister is depressed. • Instruct the student to hold the deep breath for as long as possible, at least 10 seconds, to allow medication to settle as deeply as possible into the air passages. • Wait approximately 1-2 minutes and repeat the process, if more than one puff is ordered.

30. MEDICATION ADMINISTRATION • I. Administration of Skin (Topical) Medication • To administer medication to the skin, follow the 16 steps for general administration of medication along with the following specific instructions. • Organize the necessary equipment which may include tongue blade, gauze, tape, cleansing material and cotton-tipped applicator. • Use gloves for broken skin or open lesions. • Note the condition of the affected area. Before applying the medication, report any unusual observations to the school nurse or parent/guardian, if the nurse is not available. • Cleanse the area removing any previously applied medication. • Place a small amount of the medication on the tip of a tongue blade or cotton-tipped applicator. • Apply a thin layer of the medication to the area, or as ordered. • Cover the area with a dressing, if ordered. • Document any unusual conditions observed.

31. MEDICATION ADMINISTRATION • J. Administration of Eye Medication • To administer any type of eye medication, follow the 16 steps for general administration of medication along with the following specific instructions. • Eye drops • Use only medication that is labeled for ophthalmic use. • Organize the necessary equipment including cotton balls and tissues. • Wear gloves if an infectious condition is being treated. • Observe affected eye for any unusual condition. Before applying the medication, report any unusual observations to the school nurse or parent/guardian, if the nurse is not available. • If there is eye discharge, wipe the eye with a clean cotton ball, wiping once from the inside to the outside of the eye. Use a clean cotton ball for each eye if medication is being administered to both eyes. • Position the student with the head tilted back and the eyes looking up. • Continued…

32. MEDICATION ADMINISTRATION • J. Administration of Eye Medication • Eye drops cont’d • Use the thumb and index finger to open the eye to expose the lower inside of the eyelid. • Approach the eye with the medication from outside the student’s field of vision • Drop the medication gently into the lower eyelid, not the eyeball. Do not allow the drop to fall a distance of more than 1 inch from the eye. DO NOT touch the eye with the dropper. • Wait 1-5 minutes between administering medication if more that 1 drop is ordered for the eye or if medication is to be administered to both eyes. • Gently close the eye. Instruct the student to keep the eyes closed for a few minutes. • Blot the excess medication from around the eye and face with a clean cotton ball or tissue. • Document any unusual conditions observed.

33. MEDICATION ADMINISTRATION • J. Administration of Eye Medication • Eye Ointment • Organize the necessary equipment including cotton balls and tissues. • Wear gloves if an infectious condition is being treated. • Observe affected eye (s) for any unusual condition. Before applying the medication, report any unusual observations to the school nurse or parent/guardian, if the nurse is not available. • If there is eye discharge, wipe the eye with a clean cotton ball, wiping once from the inside to the outside of the eye. Use a clean cotton ball for each eye if medication is being administered to both eyes. • Position the student with the head tilted back and the eyes looking up. • Continued…

34. MEDICATION ADMINISTRATION • J. Administration of Eye Medication • Eye Ointment cont’d • Use the thumb and index finger to open the eye to expose the lower inside of the eyelid. • Approach the eye with the medication from outside the student’s field of vision. • Apply a thin layer of medication along the inside of the lower lid, or as ordered. DO NOT touch the tip of the tube to the eye. • Hold the lid open for a few seconds. • Gently close the eye. Instruct the student to keep the eyes closed for a few minutes. • Blot the excess medication from around the eye and face with a clean cotton ball or tissue. • Document any unusual conditions observed.

35. MEDICATION ADMINISTRATION • K. Administration of Ear Drops • To administer ear drops, follow the 16 steps for general administration of medication along with the following specific instructions. • Position the student. • If lying on a cot, position the student on his/her side with the ear to be treated facing up. • If sitting, tilt the head sideways until the ear is horizontal. • Observe the ear canal for any unusual condition. Before applying the medication, report any unusual observations to the school nurse or parent or guardian, if the nurse is not available. • Straighten the ear canal by: • Gently pulling the outer ear down and back (for ages 3 and under.) • Gently pulling the outer ear up and back (for older children). • Continued…

36. MEDICATION ADMINISTRATION • K. Administration of Ear Drops • To administer ear drops, follow the 16 steps for general administration of medication along with the following specific instructions. • Ear Drops cont’d • Gently roll the bottle of drops between palms for 1 minute to warm the medication. Cold ear drops can cause dizziness. • Drop the medication on the side of the ear canal. Do not allow the dropper to touch the ear • Instruct the student to maintain his or her position for 1 minute. Gently rub the skin in front of the ear to assist the medication to flow to the inside of the ear. • If the other ear is to be treated, repeat the procedure after waiting 1 minute. • Loosely place a cotton ball in the treated ear(s) if ordered or if requested by the student. • Document any unusual conditions observed.

37. MEDICATION ADMINISTRATION • L. Administration of Auto Injector (Epi-pen) Medication • An auto injector is a disposable injection system that contains a spring activated, concealed needle. It is used for the emergency self-administration of medication in individuals with potentially fatal allergic reactions. The school nurse should develop an emergency action plan (EAP) for any student with an order for an emergency auto injector medication. Follow the student’s individualized plan including the following: • Pull off the safety cap of the auto injector. • Place tip on the outer aspect of the upper thigh. • With a firm motion, press auto injector against thigh until the mechanism activates. Hold it in place for 10 seconds. (May be injected through clothing.) • Dispose of the auto injector in the “Sharps Container.” • Document the situation necessitating the administration of the auto injector medication, the student’s reaction to the medication, and the following events. • 911 must be called if the Epi-pen is given. Parents should also be notified.

38. MEDICATION ADMINISTRATION • Administration of DIASTAT AcuDial™ • DIASTAT AcuDial™ is a gel formulation of diazepam (Valium) intended for rectal administration for children over age of 2 with seizure disorder who may require intermittent use to control bouts of increased seizure activity. • DIASTAT AcuDial ™ provides a range of dosing capabilities to meet the needs of individual patients in a single administration. • Administration instructions: • Follow the child Emergency Action Plan (EAP) • Put the person on their side where they can’t fall. Protect child’s privacy if possible. • Get medicine. • Get syringe. (Note: Seal Pin is attached to the cap.) • Push up with thumb and pull to remove cap from syringe. Be sure Seal Pin is removed with the cap. • Lubricate rectal tip with lubricating jelly. • Continued… • DIASTAT AcuDial™ should only be administered by caregivers who have been instructed on how to administer it and are competent to do so.

39. MEDICATION ADMINISTRATION • M. Administration of DIASTAT AcuDial™ • Administration Instructions cont’d: • Turn the person on side facing you. • Bend upper leg forward to expose rectum. • Separate buttocks to expose rectum. • Gently insert syringe tip into rectum. (Note: Rim should be snug against rectal opening.) • Slowly count to 3 while gently pushing plunger in until it stops. • Slowly count to 3 before removing syringe from rectum. • Slowly count to 3 while holding buttocks together. • Once DIASTAT is given, keep the person on his or her side, facing you, note time given and continue to observe. • After Use – Dispose of DIASTAT Properly: • Discard all used materials in the garbage can. • Do not reuse. • Discard in a safe place, away from children.

40. MEDICATION ADMINISTRATION • N. Self Administration of Medication – May Carry Orders • Mad River Local School District has a policy to allow for “may carry” orders for self-administration of medication provided the student has prior written permission from the parent and the medical provider and has submitted the Medication Authorization form. • The following questions should be addressed before permitting self-administration of medication during the school day. • Has the student demonstrated his or her capability for self administration and has an understanding that medication is not to be shared? • Is there a need for a medication order stating that the student is qualified and/or able to self-administer the medication? • Is there a need for parental consent for self-administration? • What medication will the student be allowed to carry and administer? • Does the medication require refrigeration or security? • Is there a need for notification of appropriate team members (such as teachers, principals, support persons) of all self-testing or self-administration of medication?

41. MEDICATION ADMINISTRATION • Self-Administration of Medication – “May Carry” Orders • Preparing & Monitoring students who are self-administering “may carry” medication during the school day includes: • Discussions of student’s responsibilities use of “may carry” medications during the school day • Discussion of repercussions for inappropriate handling or sharing of medications • Visually observing the student taking medication to ensure proper administration. • Reminding student to take the medication when necessary. • Recording the medication administration. • Reporting any concerns, unusual procedure or circumstance to the school nurse. • Students who self carry an Epi-pen must have a back-up Epi-pen kept in the school.

42. MEDICATION ADMINISTRATION • O. Medication Errors • A medication error is a violation of the “six rights” of medication administration. It is also the omission or incorrect documentation of required information. • A medication error may be one or more of the following: • Medication was given to the wrong student. • The student received the wrong medication. • Medication was not given at the correct time. • The student received an incorrect dosage of medication. • An incorrect route of administration was used. • The administration of medication was not documented. • The medication was not administered to the student and the reason was not documented. • Any other event that would be inconsistent with the order of the licensed prescriber. • Continued…

43. MEDICATION ADMINISTRATION • O. Medication Errors cont’d • What if you give a student the incorrect medication? • Notify the parents and physician immediately with name of medication and dosage given. Follow the physician’s orders. • What if a required dose of medication is not given? • Report this immediately to the student’s parents and/ or physician. Determine when the medication should be given. • What if a student is choking? • Stop giving medication immediately. When student begins to breathe regularly and has completely recovered, medication can be given. If the student does not recover and is believed to have an obstructed airway, perform the Heimlich Maneuver, implement emergency procedures according to your school or district’s crisis management plan, and begin CPR. • What if the student has an adverse reaction to the medication? • Any side effects should be reported to the parents. If the student has an allergic reaction, the medication should be discontinued.

44. MEDICATION ADMINISTRATION • Medication Errors • If something goes wrong: • NEVER attempt to cover up a medication error. • Keep the student with you – do not leave them unsupervised or allow them to return to class. • Immediately report the suspected error to the school nurse or building administrator. • Notify the parents or guardians of any wrong medications, wrong dosages, or wrong routes. • After the child’s health and safety are appropriately addressed, document the incident as directed by your School Nurse.

45. MEDICATION ADMINISTRATION • P. Field Trips • A field trip is an extension of the normal school day and the same medication policies should be followed. • The administrator will: • Designate a trained school employee to administer the medication on the field trip. • The teacher will: • Notify parents per district policies and procedures. • Notify the school nurse of a scheduled field trip. • Obtain the necessary “hands-on” medication training by the school nurse prior to giving any medication on the field trip. • The school nurse will: • Provide the “hands-on” medication training prior to the field trip. • Continued…

46. MEDICATION ADMINISTRATION • Field Trips cont’d • Medication Preparation: • Medication must be stored in a secure container. • Designated school personnel must pick up the medication on the day of the field trip. • A copy of the MAF (medication authorization form) and the MAR (documentation form) must accompany the medication. • The Individual Healthcare Plan (IHP) or the Emergency Action Plan (EAP) may be included if needed. • After the Field Trip: • Designated school personnel will return the medication. • Return the documentation forms. • The designated personnel must verify that a student who self-carries an Epi-pen or an inhaler has it in their possession prior to departing on the field trip.

47. Congratulations!You have completed the on-line portion of the course.Find the link for the quiz on the class page. You must pass the test with the score of 80% or higher to receive credit for taking this course. You may retake the test until you pass.Always remember – during any emergency:STAY CALM OR FAKE IT! Follow up with your School Nurse to complete the “hands-on” training prior to administering medications. You will only need to complete the “hands-on” training for the specific type of medication that you will or may be giving.