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MEDICATION/TREATMENT ADMINISTRATION GUIDELINES

In this Chapter . . .

Medication/Treatment Administration Guidelines

It is most desirable to have a student take needed medication at home.  When an underlying health problem necessitates the administering of medication during the school day, school personnel can administer medication to enable the student to stay in school.

 

A Medication/Treatment Authorization Form (M/TAF) signed by a physician and parent must be provided, and medication must be stored and administered in the manner described below.  Only FDA approved prescription and over-the-counter medications are allowed to be administered by school board personnel.  Homeopathic remedies are not FDA approved and will not be administered by school personnel.  Dietary supplements are not approved by the FDA for use as drugs and will not be administered by school personnel.  A dietary supplement is any product taken by mouth that contains a so-called "dietary ingredient" and may include vitamins, minerals, herbs,  and amino acids as well as substances such as *enzymes, organ tissues, metabolites, extracts or concentrates. 

 

* Pancreatic enzymes are looked at on an individual basis to determine if they can be given at school per a physician's order.

 

Controlled Medications 

 

Controlled medications including stimulants, depressants, anabolic steroids, some anticonvulsants and analgesics may be prescribed to students with disabilities or illnesses.  Some frequently prescribed controlled medications taken at school include Valium, Diastat, Adderall, Concerta, Risperdal, Buspar, Ritalin (metadate), Abilify and Dexedrine.  Before administering a PRN controlled substance, a phone call to a parent/guardian is required to check the time of the previous dose.  Any controlled substance in Schedules 1-5 must be counted monthly by two individuals and documented on the medication log. 

 

Controlled, narcotic medications for severe pain management are not routinely administered in the school setting.  These medications are known to cause decreased coordination and decreased levels of consciousness, thus presenting both impaired learning and safety issues for the student. 

êContact your school RN when controlled medications are prescribed for a student.

 

Other

 

When wheelchair, crutches, or other temporary assistive device is needed, it must be supplied by the parent.  The school will need a completed Orthopedic Injury Assistive Device Authorization Form (translated forms can be found in the Forms chapter) signed by the licensed health care provider and parent/guardian.  This form is only valid for the current school year.

 

Other treatment equipment such as nebulizers and glucometers must be supplied by the parent.  An M/TAF Form signed by the licensed health care provider and the parent/guardian must be on file along with a signed and notarized affidavit.  Both forms are only valid for the current school year.

 

 

School personnel designated by the principal are authorized, under Section 1006.062, Florida Statutes, to assist students in the administration of prescribed medication provided that:

 

  •    The district school board includes in its school health services plan, a procedure for training school health personnel by a registered nurse, a physician, or a physician's assistant.  A yearly skills check is required for all unlicensed school staff who give medications.

  •    The district school board adopts policies and procedures for the administration of prescription/over-the-counter medication/s by school health personnel.  (“Prescribed medication” refers only to those products that have been approved by the Food and Drug Administration for use as a drug).

  •    The person designated to administer medications/treatments receives the full cooperation from all staff involved to insure that the physician's orders are followed and the medications and treatments are given at the prescribed times.

  •    The M/TAF is completed and signed by the licensed health care provider and the parent/guardian.  This form is only valid for the current school year.  If the parent/guardian has given written permission on the M/TAF, the prescription label may be used for three school days while waiting for the physician’s authorization to be received.  If authorization has not been received after the three days, do not give medication and contact the school RN. 

 êThe school RN is to check and verify all medication/treatment orders.

  •    The health room aide transcribes the medication/treatment order (unless order is for liquid medication-see next paragraph) onto the Medication/Treatment Administration Log (M/TAL), using extreme care to accurately transcribe the medication name, strength, dosage and time.  If any of this information is incomplete, or if the information is on a non-SCSB Medication Form, contact the school RN immediately. 

  •    Liquid medication is transcribed onto the administration log by a school RN only.  The health room aide must notify the school RN immediately when an order for administration of liquid medication is received.  If the school RN cannot be reached, call the School Health Landings office at 927-9000 x32102 or fax the doctor’s order and prescription bottle label to the Landings at 927-4029, along with a cover letter requesting a nurse to transcribe the order onto the log.

  •    The medication is brought to the school by the parent or guardian (not the child).  The principal may make exceptions to this rule in case of hardship (e.g. parent workday begins early).

  •    The medication prescribed for the student is labeled with the following information:

    • Student's name.

    •  Name of the medication.

    • Directions concerning dosage (route, dose, frequency).

    • Time of day to be taken.

    • Health care provider’s name.

    • Date of prescription.

    • Pharmacy label must match physician's order (Medication/Treatment Authorization Form).

    • Expiration date.

  •    Over-the-counter medication is received unopened, in its original container, and labeled with the student's name, directions for giving, and the dosage.  (If the licensed health care provider has given the parent sample bottles of medication, the bottle(s) must also be labeled as stated above.)  No over-the-counter (non-prescription) medications such as aspirin, Tylenol, cough medicine, topical creams/ointments, etc. may be given without an M/TAF (the three day medication rule does not apply).

  •    Each prescribed/over-the-counter medication to be administered by school district personnel shall be received, counted, and stored in its original container.  When the medication is not in use, it must be stored in a locked and secure location designated by the principal.  Those medications requiring refrigeration should be kept in a lockbox in the refrigerator (see medication Do’s and Don’ts).

  •  All controlled medications schedules 1-5 will be counted monthly by the school RN and another school district employee or parent.

 

The only OTC medications to be stored are those medically prescribed for specific students.  Those medications will be kept in the locked medication cabinet in the health room.  No supply of over-the-counter (OTC) medications will be kept in the health room for distribution to the staff.   

 

The signed M/TAF and M/TAL is to be placed in the student’s Cumulative School Health Record when the medication has been completed or changed by the healthcare provider and at the end of the school year.

 

Techniques for Administering Medications

 

To ensure the safety of students requiring medication during school hours, the 8 Rights of Medication Administration must be followed.

 

1.      Right student

2.      Right medication

3.      Right dose

4.      Right time

5.      Right route

6.      Right expiration date

7.      Right documentation

8.      Right of the student to refuse

  •    Ask the student to state first and last name (do not prompt).  Small children will often answer to other names.)  It is important that the student is correctly identified before medication is given.   If necessary, have the teacher send the child to the health room wearing a nametag or accompanied by an aide.

  •       Compare the label on the medication container with the M/TAF for the following information: right student, right medication, right dose, right time, and right route. Always check three times to be sure that the child is receiving the correct medication.  Check the student’s name on the container of medication when it is removed from the shelf, just before the child takes the medication, and before it is returned to the shelf.  Check the expiration date on the medication container to be sure that it has not expired.  Check when the last dose of medication was given.

  •    Document the date and time that the medication was given, and sign your initials on the M/TAL for each dose given.  Documentation of medication/treatment must be done immediately after administering.  Document the visit in the AS400 (if there is no access to the AS400, document on the daily service log).

  •    A student has the right to refuse any medication.  If a student refuses to take a medication, the principal, school RN, and parent/guardian must be notified and the variance properly documented according to directions (see Medication-Treatment Variance).  If no parent/guardian contact is made, a note must be written to the parent stating what happened (school RN or principal can assist with content and appropriate documentation of the note).  If a student questions whether the medicine is correct (i.e., appearance, number of tablets, etc.), do not give the dose until the M/TAF has been rechecked.  If there is still a question, contact the parent/guardian.  If parent/guardian information does not coincide with the M/TAF, notify the school RN for clarification/intervention. 

 

Oral Medication:

  •    Before giving tablets or capsules, have the student take a few sips of water.  This helps make swallowing medication(s) easier.

  •    Give oral medication with the child sitting up.

  •    Always measure liquid medication carefully (liquid medication is often prescribed by the teaspoon).  Measure medication in a disposable plastic calibrated cup or pharmacy provided measuring device.

  •    Remove the correct amount of medication (liquid or pills) from the bottle.  Shake suspensions before pouring.

  •    Administer the medication.  Always follow medication with water unless otherwise directed.  Make sure the medication is swallowed - check the child's mouth.

  •    Wipe off any spills on the bottle with a paper towel or clean cotton ball.

  •    Do not crush tablets unless approved by doctor.

  •    Mixing of liquid medications shall only be done by persons who are designated in their job description as licensed medical personnel.

Eardrops:

  •    Check M/TAF and the label on the medication container to make sure medication is put into the correct ear.  (See Medical Abbreviations List.)

  •    Assist the child to lie down on the side opposite the ear into which drops will be placed.

  •    Pull up and back on the ear into which drops will be placed.

  •    Put the drops in the ear.

  •    Have the child remain on his/her side for a few minutes.

  •    Wipe off any medication that runs out of the ear.

Eyedrops or Eye Ointment:

  •    Check M/TAF and the label on the medication container to make sure medication is put into the correct eye.  (See Medical Abbreviations List.)

  •    Have the child lie down with his/her neck extended back over a pillow or the head of couch.

  •    Rest your hand on the child's forehead and gently pull down the lower lid.

  •    Apply drops or ointment to the inside of the lower lid without touching the container tip to the eye or to the skin.

  •    Keep the child in the same position for a few minutes.

  •    If you contaminate the end of the tube of medicine, squeeze out a small amount onto a sterile gauze pad and start over.

 Nosedrops:

  •    Assist the child to lie down with the neck extended back over a pillow or the head of couch.

  •    Put drops in nose.

  •    Keep child in the same position for a few minutes.

  •    Observe for choking or vomiting.

Topical Medications:

  •    Apply to clean skin surface.

  •    Use cotton-tipped applicator or gauze to apply ointment; never use fingers.

  •    Cover the area with gauze or a Band-Aid.

  •    If you contaminate the end of the tube of medicine, squeeze out a small amount onto a sterile gauze pad and start over.

Inhaled Medications:  Will be dealt with on an individual basis (refer to “metered dose inhaler” and "Nebulizer" sections in this chapter and "Asthma" in the Medical Conditions/Illness/Injury chapter).

 

Injectable Medications:

  •    Injectable medication shall only be given by personnel who are designated in their job description as licensed medical personnel. 

  •    Emergency Epinephrine is the only injection school health aides or other trained personnel designated by the principal are allowed to administer, and only after documented training by school RNs.  This epinephrine is only to be given by intramuscular injection and supplied in a single dose, pre-filled syringe (EpiPen Auto-injector ®) that requires no reconstitution or dose adjustment.  The delivery device needs to be such that recapping of the needle is not required.

 

Rectal Medications:

  •      Rectal medication shall only be given by personnel who are designated in their job description as licensed medical personnel.

Medication Related Emergencies

(See Chapter on “Life-Threatening Allergies” for complete guidelines.)

 

An allergic reaction to medication can happen at any time, regardless of how long the child has been taking the medication.  The school must be given instructions about which medical facility to transport the child to in the event of an emergency.

  •     Never leave a child alone who is suspected of having an allergic reaction to medication.

  •    If a child has an adverse reaction to medication, call the parent/guardian and notify the principal.  Poison Control (1-800-222-1222) or 911 may be contacted regarding adverse effects.

  •    If necessary to call 911, call 911 first and then notify the parent/guardian.

  •    If a student is taken to the hospital emergency room, send the medication container and a copy of the Health Emergency Information Card with EMS.  The school principal or an appropriate school representative must accompany the child if the parent/guardian is not present.  (See procedures for Emergency Plan of Action in Emergency Health Needs Chapter.) 

  •    Notify the school RN.

 

Reasons for Contacting Parents/Guardians

(*You must document every action you take.)

Parents/Guardians should be contacted for any of the following reasons:

  •    Any question regarding the parent's/guardian's instructions.

  •    Failure of the child to take the medication/treatment for any reason (i.e. vomiting, refusal, forgot, out of medicine, spilled last dose).

  •    If a variance is made in giving a medication/treatment.  The school RN, principal, and the parent/guardian must be contacted immediately The Medication/Treatment Variance form must be properly documented, according to directions, the same day the variance has occurred or is discovered. The Medication/Treatment Variance form is completed and sent to the School Health office at the Landings.  If no parent/guardian contact is made, a note must be written to the parent stating what happened (school RN or principal can assist with content and appropriate documentation of the note).  Examples of variances include: wrong medication given to the wrong student, wrong dose, wrong route, wrong time or medication not given.  The prescribing physician or Poison Control (1-800-222-1222) or 911 may be contacted regarding adverse effects. 

  •    Any change in behavior or physical status that might be attributed to the medication/treatment.

  •    Change in appearance of the medication or expiration date of the medication has passed.

 

Medication Do’s and Don’ts

DO:

  •    Make a list of the names of students and times they are to receive medications and maintain the confidentiality of the list.  Do not include name of medication/procedure or dosage on this list.

  •    Wash hands before and after giving medication.

  •    Follow directions on medication label and on the M/TAF, including any precautionary notes.

  •       Remove medication from the container over a counter, never over a sink or floor.

  •    Observe medication for changes in appearance or odor.

  •       Replace cap tightly after removing medication from the container and return container to locked storage cabinet.

  •    Give the medication within one-hour (60 minutes) before or after the scheduled time it is due.  If the student comes for the medication later than one hour after the scheduled time, notify the school RN to determine if medication should be given.  The principal and parent/guardian must be notified and the variance properly documented according to directions on the back of the Medication/Treatment Variance.  If no parent/guardian contact is made, a note describing what happened must be sent home to the parent (school RN or principal can assist with content and appropriate documentation of the note).  Send the completed Medication/Treatment Variance form to the School Health office at the Landings.

  •    Document on the M/TAL time the child takes the medication.  Record the medication visit on the AS400 (if there is no AS400 access, document on daily services log).

  •    Observe child for signs of allergic reaction (rash, itching, swelling, and breathing problems, diarrhea, stomach cramps, or change in skin color).

  •   Notify the parent/guardian when a new supply of a medication is needed.

  •     Call your school RN for direction if you are unsure of what to do.

 

DON'T:           

 

   

 
  •     Don’t take authorization for any medication, prescription or non-prescription, over the telephone.  If a parent/guardian is insistent, refer him/her to the principal.

  •   Don’t mix liquid medications together.

  •   Don’t touch medications with your hands.

Health room aides: Do not crush pills without a physician’s order.

 

Medication Missed by Parent/Guardian

The school board attorney has indicated that there are limited choices at our disposal if a student was to receive medication in the morning before coming to school, but did not get that dose.

  •    The parent/guardian should come to school to give the medication. 

  •    If this is not possible, the parent/guardian must call the school health aide to authorize him/her to dispense the medication, in this scenario onlyThis can only be done if the prescription bottle at school indicates multiple doses in a day.  If, for instance, it says give one tablet at 11:30 A.M., an earlier dose may not be given by school personnel.

  •    Be careful of administering doses of medication too close together.  If a parent/guardian calls after 8:00 a.m., contact the school RN who can determine the correct time to administer the next dose.

  •    Any action taken which is different from that indicated by the physician on the M/TAF must be properly documented.

 If this is a continuing problem for a particular child, the school will contact the parent/guardian to request that the doctor adjust the times of medication administration to allow school personnel to give both the A.M. and P.M. doses at school.  Notify your school RN of this situation.

 

Missed Medication/Treatment at School

 Notify the parent/guardian any time a medication or treatment is not given, regardless of the reason.  The principal, school RN and parent/guardian must be contacted immediately and the variance properly documented, according to directions on the back of the Medication/Treatment Variance form.  If no parent contact is made, a note must be sent home to the parent describing the event (school RN or principal can assist with content and appropriate documentation of the note).  The Medication/Treatment Variance form is completed and sent to the School Health office at the Landings. 

 

End of the School Year Discarding of Medication/s

Health Room Aide Responsibility:

  •   Notify parent/guardian at least two weeks before the end of the school year that they must pick up any remaining medication by a specific date (see sample Medication Pick-up Notice. This includes any medication discontinued or changed during the school year. Explain that if the medication is not picked up by the deadline date, it will be discarded.  In addition, please include a Medication Treatment Authorization Form  for the next school year.

Medications not picked up by parent/guardian by the specified date must be given to your school RN for proper disposal and can not be flushed or thrown in trash container due to environmental considerations.  

Over-the-Counter Medications (OTC):

?     Document the name, dosage, and amount of leftover medication on the back of each student’s Medication Treatment Authorization Log.

?     Black out student’s name on containers.

?     Separate unopened from opened medication.

?     Leave unopened OTC medication in the original package and place in a plastic bag.

?     Remove opened OTC medication from packaging  and dump individual pills into a  plastic bag.

 

Prescription Medications:

?     Document the name, dosage, and amount of leftover medication on the back of each student’s Medication Treatment Authorization Log.

?     Leave student’s name on label.

?     Place containers in plastic bag labeled with school name.

 

Injectable Medications:

?     Document that the medication was discarded on the back of each student’s Medication Treatment Authorization Log.

?     Place in sharps container for pick up by biohazard personnel.

 

Inhalers:

?     Discharge any medication contents outside to empty inhaler.

?    Document that the medication was discarded on the back of each student’s Medication Treatment Authorization Log.

?     Discard inhaler into trash container.

Contact your school RN to arrange pick up date/time.

 

Medication Administration during Official School Business

off School Property

 

 

This procedure covers students who require administration of medication during temporary absences from school property for activities such as field trips during the school day.   All medication must be in the original container with the student’s name, dosage, directions for administration, and current date.

 

Over-the-counter medications will not be taken on a field trip unless the student has a request from the parent on the Emergency Medical/Treatment Field Trip Consent Form and a signed M/TAF.

 The staff person accompanying the student will be responsible for security of the medication and for medication administration.  Medication cannot be administered by volunteer staff or parent chaperones other than the student’s own parent/guardian.

 

When a field trip is planned, a student’s medication can be provided by one of the following methods:

  1. Request the parent to accompany their child on the field trip to be responsible for administering medication.

  2. If the parent is unable to attend, a teacher or other staff person who has been trained in “Field Trip medication Administration”, provided by a registered nurse, may administer medication.

  3. A teacher or other staff member can be certified to administer the medication on the field trip; however this does not qualify the teacher or other staff member to administer medication on campus. The teacher or other staff member can only administer medication on field trips.

  4. School personnel on campus who have been certified to give medications can be assigned to accompany the class to administer the medication/treatment on the field trip.

 

 

Guidelines for Medication Administration during Field Trips

 

Prior to the field trip, the School Health Aide will:

  •    Insure the staff person responsible to give the medication has a certificate of training on file in the health room.

  •    Notify the school RN and staff person at least three weeks in advance if medication training needs to take place including child specific training for students with diabetes, students with injectable medications (EpiPen®) and students with a nebulizer treatment order.

  •    Copy the M/TAF’s and M/TAL’s for each student on the list (these will be given to the staff person administering the medication/s for documentation purposes).

  •    Set aside the medication container/Inhaler/EpiPen® needed by each student.

  •    Count the medication available in the medication bottle along with the staff person responsible for the field trip medication administration.  Document the quantity on the back of the original M/TAL in the # Received field under Quantity of Medication.  Record “field trip” and the date under Date of Transport field and sign under the Signatures field.   Have the staff person sign next to your signature.

 

 

 

Quantity of Medication

 

Date of

Transport

#

Received

#

Returned

#

On Hand

Total

Signatures

Field Trip

10/2/07

10

 

 

 

Holly Healthy  / Polly Pill

 


 

Enter and circle the time on the front of the original M/TAL under the correct month/day field. On the back of the M/TAL under the Other column, enter the month, day, year and “Field Trip” as show below:

 

 

1

2

3

4

5

6

7

8

9

 

O

Other

Aug

 

 

 

 

 

 

 

 

 

 

 

Date

Explain

Sep

 

 

 

 

 

 

 

 

 

 

 

10/2/07

Field Trip

Oct

 

 

 

 

 

 

 

 

 

 

 

 

Nov

 

 

 

 

 

 

 

 

 

 

 

 

 

Dec

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Upon return from the field trip, the School Health Aide will: 

  •    Ensure that the medication administration has been recorded on the M/TAL copy by the person who administered the medication.

  •    Re-count the medication available in the medication bottle along with the staff person who gave the field trip medication.  Document the quantity returned and date on the back of the M/TAL and sign as shown below:

 

 

Quantity of Medication

 

Date of

Transport

#

Received

#

Returned

#

On Hand

Total

Signatures

Field Trip

10/2/07

10

 

 

 

Holly Healthy  / Polly Pill

10/2/07

 

8

 

 

Holly Healthy  / Polly Pill

 

 

 

 

 

 

 

  •  Return the medication(s) to the locked cabinet in the health room.

  •    Place the copy of the M/TLA behind the original in the Medication/treatment Administration book.

  •    Shred the copy of the M/TLF.

Prior to the field trip, the Staff Person will:

  •    Inform the health room aide at least three weeks in advance of the scheduled field trip date.

  •    Contact the school nurse to schedule the staff field trip medication administration training.  This must be done yearly.

  •    Come to the health room to collect all medication needed on the trip.

  •    Check the information on the medication container for each student with the information on the Medication/Treatment Authorization Form (M/TAF).

  •    Count the medication along with the health room aide.  This number will be documented on the Medication/Treatment Administration Log (M/TAL), as shown in the example below.

  •    Sign their name next to the health room aide on the back of each student's M/TAL to acknowledge receipt of the medication.

 

 

 

Quantity of Medication

 

Date of

Transport

#

Received

#

Returned

#

On Hand

Total

Signatures

Field Trip

10/2/07

10

 

 

 

Holly Healthy  /  Polly Pill

 

 

 

 

 

 

  •    Place the medications and your copies of the M/TAF’s and M/TAL’s in a fanny pack, which will remain with you (or the staff person responsible for giving the medication) for the entire duration of the trip.  If liquid medication, remember to take a device for measuring.

 

During the field trip, the Staff Person will:

  •    Assist each student with administration of his/her medication at the time it is due (must be given within one hour of that time) according to the M/TAF. *

  •    Write the time medication was given and your initials on the front of the copied M/TAL.

 

 

1

2

3

4

5

6

7

8

9

Aug

 

 

 

 

 

 

 

 

 

 

Sep

 

 

 

 

 

 

 

 

 

 

Oct

 

 

P.P.

 

 

 

 

 

 

 

Nov

 

 

 

 

 

 

 

 

 

 

  •    Print your initials and sign your name on the front of the copy of the M/T/AL.

          Persons Administering Medication/Treatment: Initials  PP Full Name              Polly Pill    Initials       Full Name                                 

              Initials                       Full Name                                              Initials             Full Name                                                                               Initials             Full Name                                                      

             Initials                         Full Name                                              Initials             Full Name                                                                               Initials             Full Name                                                      

 

Upon return from the field trip, the Staff Person will:

  •    Bring the medication containers/inhalers/EpiPens® back to the health room.

  •    Re-count, along with the health room aide, the number of medication(s) returned and sign/date the back of the M/TAL after quantity has been documented by the health room aide.

 

 

Quantity of Medication

 

Date of

Transport

#

Received

#

Returned

#

On Hand

Total

Signatures

Field Trip

10/2/07

10

 

 

 

Holly Healthy  / Polly Pill

10/2/07

 

8

 

 

Holly Healthy  / Polly Pill

 

 

 

 

 

 

* If there are any problems, questions, or concerns with medication administration, the staff person shall call the principal.

 If the medication is not given as ordered, the staff responsible for giving the medication on the field trip will notify the principal, school RN, and parent/guardian immediately and properly document the variance according to directions on the Medication/Treatment Variance form.  The Medication/Treatment Variance form is completed and sent to the School Health office at the Landings.  If no parent contact is made, a note must be sent home to the parent describing the event (school RN or principal can assist with content and appropriate documentation of the note). 

 

Medication Administration on Overnight Field Trips

  •    The staff person responsible for the overnight trip should ask the parent if their child requires medication during the time of the field trip.

  •     If student requires medication administration, the parent must submit a signed Medication/Treatment Authorization Form (unless already on file at the school).

  •    Ask the parent to bring the medication to the school health room at least 3 days before the trip (unless already available in the health room).  A cover letter is available for parent notification.

All further medication guidelines apply as above.

 

Administration of Emergency Medications

During School-Sponsored Events Held Outside Normal School Hours

In order to comply with Florida Statutes 1006.062 Administration of Medication and Provision of Medical Services by District School Board Personnel, school personnel staffing school-sponsored events before and after school must be taught child-specific medication administration procedures for those children who may require emergency medication while under their care.  Emergency medications include, but are not limited to, asthma medications and EpiPens®. 

For those students who may require emergency medication in these situations, the school RN will include the procedure for emergency medication administration in the student’s Individual Health Plan.  The procedure will be student specific, based on the child’s age and ability to self-manage their illness.

 The school registered nurse will notify school personnel of the need for child-specific training and will set up a time for that training to take place. 

All medication must be locked in a safe place at the site of the school-sponsored event according to F.S. 1006.062.

It is the parent’s responsibility to notify the school RN that their child is enrolled in a school-sponsored event before or after school and to provide school personnel with the Medication/Treatment Authorization form (signed by parent and physician) and additional prescribed emergency medication.

 


 

MEDICATION ADMINISTRATION SKILLS CHECKLIST

Display/Print Checklist

*Contact your school RN for your performance check and form completion.

 Name: ______________________________________________  School___________________________

 

SKILL

Performs skill in

accordance to written

guidelines

 

Requires further

instruction & supervision

 

Date

Date

1.      Demonstrate knowledge of location of Medication/Treatment guidelines.

 

 

2.      Wash hands before assisting with medication administration.

 

 

 

3.      Ask student to state first and last name.  Check student’s identity with name on the medication container label.

 

 

 

4.      Compare medication container label with Medication/Treatment Authorization Form and Medication/Treatment Administration Log.

 

 

 

5.      Give proper dose of medication by the correct route as indicated on medication container label and Medication/Treatment Authorization Form, and Medication/ Treatment Administration Log.

 

 

 

6.      Give medication at the time indicated on the Medication/Treatment Authorization Form and Medication/Treatment Administration Log.

 

 

 

7.      Remove dose of medication from container without touching medication and assist in administering by proper route.

 

 

 

8.      Document medication administration on student's Medication/Treatment Administration Log as soon as medication is taken. Record the visit on the AS400 (or manually if no school access to AS400).

 

 

 

9.      Return medication to locked drawer, cabinet, or refrigerator box.

 

 

 

 Preceptor's Signature_____________________________________________Initials_________Date_________

Preceptee's Signature____________________________________________Initials_________Date_________

*Initial and date in space beside each skill indicates procedure has been demonstrated in a competent manner.

Distribution: Original to preceptee, one copy in the Health Room, copy to Sherri Reynolds/PSS Landings


 

Steps for Students Using a Metered Dose Inhaler (MDI):

 

  1. Remove the cap.  Connect the inhaler to the holding chamber.
  1. Hold the inhaler like the letter “L” with your thumb on the bottom and fingers on the top.
  1. Shake gently a minimum of 3 or 4 times.
  1. Sit, or preferably, stand up straight, and breathe out as much air as you can.
  1. Tip your head back slightly.
  1. Close your lips around the mouthpiece of your spacer, keeping spacer level (closed mouth method) …OR... Close your lips around the mouthpiece of the inhaler, keeping inhaler level (closed mouth method).
  1. Press down on the inhaler to release the medication and breathe in S L O W L Y…
  1. Hold your breath for ten seconds if you can.
  1. Breathe out slowly with your lips almost together.
  1. Wait 1 minute (count 60 seconds on the clock).
  1. Repeat steps 3-9 if you’re supposed to take more than 1 puff.
  1. Be sure to rinse your mouth with water afterwards.

Note: If you observe that the student is not using the inhaler properly, notify the school RN.

NEBULIZERS

A nebulizer is a machine used to deliver medicine as a mist that is inhaled directly into the lungs. The nebulizer has a compressor or pump that pushes air through a tube and then through the medicine chamber to change the medicine into very small droplets.  This is the mist that can be seen coming from the nebulizer.

Usually it is the student with asthma who will need a nebulized medication.  Several types of medication can be given by nebulizer, such as bronchodilators, anti-inflammatory drugs, or antibiotics.  The medication may be ordered to be administered on a regular schedule each day or only for those times that the student is sick or is having an especially difficult time with breathing.

Some of the medications given by nebulizer are the same medications that are taken as pills, syrup, or in metered dose inhalers, but may work faster or better when delivered by nebulizer.  When given by nebulizer, the medication is usually ordered as a concentrated solution that will need to be diluted with saline.  The physician's order (Medication/Treatment Authorization Form) will specify the amount of saline as well as the dosage of the solution. 

Notify the school RN as soon as a student with a nebulizer treatment order has been identified in order for unlicensed assistive personnel to receive child specific training.

  

MEDICATION BY NEBULIZER PROCEDURE

Display/Print Procedure

PURPOSE:  To deliver medication by a fine mist that is inhaled directly into the lungs.

ACTION TO BE PERFORMED BY:  Person trained by licensed healthcare professional.

ACTION

POINTS OF EMPHASIS

1.       Wash hands.

1.       Use approved handwashing technique.

 

2.       Position the student in a comfortably seated position

 

2.       Facilitates better ventilation.

 

3.       Place nebulizer on table or counter and plug into electrical outlet with ON/OFF switch in the OFF position.

 

3.        

 

4.       Place medication in the medicine chamber, following all medication administration steps in the School Health Manual.  Securely close the lid to the medicine chamber.

 

4.        

 

5.       Attach a mouthpiece or facemask to the medicine chamber with an adapter.

 

5.        

 

 

6.       Connect one end of the tubing to the medicine chamber and the other end to the nipple on the nebulizer compressor.

 

6.

 

7.       Turn on the compressor switch and watch for the medication mist to flow from the mouthpiece or mask.

 

7.

 

8.       If a mask is used, place the mask over the student’s mouth and nose, securing it comfortably with the elastic strap that is attached.

 

8.

 

9.       If a mouthpiece is used, have the student place the lips around the mouthpiece to make a seal.

 

 

 

10.   Instruct the student to breathe in and out through the mouth slowly and completely.

 

10.   Mouth breathing is necessary for adequate delivery of medication with mouthpiece.

 

11.   Monitor the student for changes in respiratory rate or effort.  Initiate emergency procedures if indicated.

 

11.   If student coughs excessively, stop treatment briefly until symptoms subside.

 

12.   Continue to have the nebulizer dispense the medication until all the medication has disappeared from the chamber.

 

 

12.   If the mist stops, but you can see more medicine clinging to the sides of the medicine chamber, tap the side of the chamber. The mist should start again.

 

13.   Document the procedure accurately.

 

 

 

13.   Document medication administration on the Medication/Treatment Administration Log and describe the symptoms and response in the AS400 Clinic Program.

 

14.   If symptoms have improved, the student may go back to class.

 

14.    

 

15.   If the equipment is not to be sent home for cleaning before the next treatment, disassemble and clean the medicine chamber, adapter, mouthpiece or mask, and lid with soap and water; rinse thoroughly.  Soak for 30 minutes in a solution of 3 parts water to 1 part white vinegar; rinse thoroughly.  Lay all pieces on a towel; cover with a paper towel and air dry.  Store in a clean plastic bag.

 

15.   The tubing does not need to be cleaned since only air has been delivered through the tubing.


 

MEDICATION BY NEBULIZER SKILLS CHECKLIST

Display/Print Checklist

*Contact your school RN for your performance check and form completion.

 

Name: ______________________________________________  School___________________________

 

SKILL

Performs skill in

accordance to written

guidelines

Requires further

instruction & supervision

 

Date

Date

1.       Wash hands.

 

 

 

2.       Position the student in a comfortably seated position.

 

 

 

3.       Place nebulizer on table or counter and plug into electrical outlet with ON/OFF switch in the OFF position.

 

 

 

4.       Place medication in the medicine chamber, following all medication administration steps in the School Health Manual.  Securely close the lid to the medicine chamber.

 

 

 

5.       Attach a mouthpiece or facemask to the medicine chamber with an adapter.

 

 

 

6.       Connect one end of the tubing to the medicine chamber and the other end to the nipple on the nebulizer compressor.

 

 

 

7.       Turn on the compressor switch and watch for the medication mist to flow from the mouthpiece or mask.

 

 

 

8.       If a mask is used, place the mask over the student’s mouth and nose, securing it comfortably with the elastic strap that is attached.

 

 

 

9.       If a mouthpiece is used, have the student place the lips around the mouthpiece to make a seal.

 

 

 

10.   Instruct the student to breathe in and out through the mouth slowly and completely.

 

 

 

11.   Monitor the student for changes in respiratory rate or effort.  Initiate emergency procedures if indicated.

 

 

 

12.   Continue to have the nebulizer dispense the medication until all the medication has disappeared from the chamber.

 

 

 

13.   Document the procedure accurately.

 

 

 

14.   If symptoms have improved, the student may go back to class.

 

 

 

15.   If the equipment is not to be sent home for cleaning before the next treatment, disassemble and clean the medicine chamber, adapter, mouthpiece or mask and lid with soap and water; rinse thoroughly.  Soak for 30 minutes in a solution of 3 parts water to 1 part white vinegar; rinse thoroughly.  Lay all pieces on a towel, cover with a paper towel and air dry.  Store in a clean plastic bag.

 

 

 

Preceptor's Signature_____________________________________________Initials_________Date_________

Preceptee's Signature____________________________________________Initials_________Date_________

*Initial and date in space beside each skill indicates procedure has been demonstrated in a competent manner.

 

Distribution: Original to preceptee, one copy in the Health Room, copy to Sherri Reynolds/PSS Landings


 

EpiPen® Auto Injector

Emergency First Aid for Anaphylactic Reaction

 

The EpiPen® Auto-Injector is a disposable drug delivery system with a concealed needle that is spring activated.  The active ingredient is epinephrine, the treatment of choice in allergic emergencies (anaphylactic reactions) because it quickly constricts blood vessels, relaxes smooth muscles in the lungs to improve breathing, stimulates the heartbeat and works to reverse hives and swelling around the face and lips.

 The EpiPen® is commonly prescribed for individuals who have had prior severe allergic reactions to certain foods or food additives, to medications, to insect stings or bites or to exercise.  The most common insects that may cause anaphylaxis are the stingers (bees, hornets, yellow jackets and wasps) and the biters (deer flies, blackflies, ants and yellow flies). 

An emergency situation may occur anytime a hypersensitive student is exposed to a substance, sting, or bite to which the student is allergic.  Allergic reactions (anaphylaxis, anaphylactic response) can be fatal within minutes.  Hypersensitive students, identified for the school staff by their parents/guardian and physicians, require the availability of emergency medication.  The EpiPen® must be specifically prescribed for the student, just as any other prescription medication.  Be aware of which students are authorized to carry their own EpiPen® as indicated by the physician on the Medication Treatment/Authorization Form.

Initial symptoms of anaphylaxis may represent a potentially fatal outcome and should be treated as a medical emergency, whether the symptoms occur gradually or suddenly.  Even mild symptoms may intensify rapidly, triggering severe and possibly fatal shock.  Usually, symptoms occur immediately following the sting or bite; death may occur within minutes.  Symptoms, which often vary according to individual response, include the following:

  •    Sudden sense of uneasiness/anxiety.

  •    Flushed skin.

  •    Widespread hives.

  •    Itching around the eyes.

  •    Dry, hacking cough.

  •    Constricted feeling in throat/chest.

  •    Wheezing.

  •     Facial edema or swelling (i.e. lips, tongue, and eyes).

  •    Abdominal pain.

  •    Nausea or vomiting.

  •    Difficulty breathing.

  •    Hoarseness or thickened speech.

  •    Confusion.

  •    Feeling of impending doom.

These symptoms may escalate swiftly to anaphylactic shock characterized by cyanosis (bluish skin), reduced blood pressure, collapse, incontinence, and unconsciousness.  Epinephrine given after the onset of low blood pressure may not prevent death. 

 

If a hypersensitive student (who may experience a possible anaphylactic reaction) has been admitted to the school, immediately notify the school RN.


 

EPIPEN® INJECTION PROCEDURE

 Display/Print Procedure

PURPOSE:  To ensure immediate appropriate response to anaphylaxis when EpiPen® is available

ACTION TO BE PERFORMED BY:  Person trained by licensed health care professional.

ACTION

POINTS OF EMPHASIS

1.       Identify symptoms of anaphylaxis (systemic allergic reaction).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.       Have someone call 911.

 

 

3.       Activate the EpiPen® by removing the gray safety cap.

 

4.       Hold the EpiPen® with black tip at a 90-degree angle against the fleshy portion of the outer thigh.

 

5.       Press the EpiPen® hard into the thigh until the auto-injector mechanism functions, and hold in place for several seconds for medication to be diffused.

 

6.       Remove EpiPen® and discard in sharps container.

 

7.       Check Airway, Breathing, and Circulation and initiate steps of CPR as needed until arrival of the EMS.

 

8.       Observe for shock and treat accordingly.

 

9.       Keep student warm.

 

10.   Call parent/guardian and notify principal.

 

1.       Anaphylaxis is described in the Medical Conditions/Illness/Injury chapter.  Symptoms may include any of the following:

4      Sudden sense of uneasiness/anxiety.

4      Flushed skin.

4      Widespread hives.

4      Itching around the eyes.

4      Dry, hacking cough.

4      Constricted feeling in throat/chest.

4      Wheezing.

4      Facial edema or swelling (i.e. lips, tongue, and eyes).

4      Dizziness.

4      Abdominal pain.

4      Nausea or vomiting.

4      Difficulty breathing or swallowing.

4      Hoarseness or thickened speech.

4      Confusion.

4      Feeling of impending doom.

2.       The effects of the injection begin to wear off after 10 to 20 minutes, so it is important to seek further medical assistance.

 

3.       The safety cap prevents accidental firing.

 

 

4.       EpiPen® should only be injected into the outer thigh, never into the buttocks or a vein.

 

 

5.       If there is no time, the EpiPen® may be used directly through clothing.

 

 

6.        

 

7.        

 

 

 

8.        

 

9.        

 

10.    

 

NOTE: Check medication monthly.  Medication is light sensitive.  Store in original container in darkened area.  Advise parent/guardian immediately of need to replace medication when observing discoloration of medication or two weeks before the expiration date.  In an emergency, use the expired or discolored medication when it is the only available medication.


 

EPIPEN® INJECTION TRAINER

SKILLS CHECKLIST

 Display/Print Checklist

*Contact your school RN for your performance check and form completion.

 

Name: ______________________________________________  School___________________________

 

SKILL

Performs skill in

accordance to written

guidelines

Requires further

instruction & supervision

 

Date

Date

 

1.      Identify symptoms of anaphylaxis.

 

 

 

2.      Have someone call 911.

 

 

 

3.      Activate EpiPen® trainer by removing the gray safety cap.

 

 

 

4.      Hold the EpiPen® trainer with black tip at a 90-degree angle against the fleshy portion of the outer thigh.

 

 

 

5.      Press the EpiPen® trainer hard into the thigh until the click of the trainer simulates the functioning of the auto-injector mechanism and hold in place for several seconds to simulate diffusion of medication.

 

 

 

6.      Remove EpiPen® trainer from thigh position and simulate placement in sharps container.

 

 

 

Preceptor's Signature_____________________________________________Initials_________Date_________

Preceptee's Signature___________________________________________Initials__________Date_________

*Initial and date in space beside each skill indicates procedure has been demonstrated in a competent manner.

 

Distribution: Original to preceptee, one copy in the Health Room, copy to Sherri Reynolds/PSS Landings

 

References and Resources

 

Pasco County School Health Policy

Washington County School Health Policy

Hillsborough County School Health Policy

Johnson, Phillip, (2003) Medications Use in Schools, Florida Edition, Florida Society of Health-System Pharmacists, Inc., Tallahassee, FL.

Lake County School Health Policy

Florida School Health Administrative Guidelines (2007)

 


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Last updated: 07/25/12