Guidelines for Medication Administration in Schools
Guideline #6: Education and Training
6.1 Content and Competencies
Education and training on medication administration need to be conducted on an ongoing basis to keep students safe and to ensure ongoing competency of staff members. Coordination of training of other school staff about medication administration is an essential part of the job descriptions of LSNs/RNs. The role of an LSN/RN is to determine what training is needed, for whom, the content, and available and appropriate training resources (e.g., medication training course through a local college). Education and training can range in format from formal classroom lectures to one-on-one discussions, and in content to be student-, disease-, or procedure-specific; competency-based; technical; and/or theoretical.
After training, medication administration procedures should be demonstrated by the person being taught, and that person’s competencies need to be documented in writing.
Topics to be included in periodic training and refresher training about medication administration include district policies, directions and time of administration for all medications, verification procedures for setting up medications for administration, proper documentation, data privacy, individualized student health information, emergency protocols, equipment, the six rights of medication administration, and infection control procedures (e.g., hand-washing). Demonstrations of medication administration are an excellent method of testing competencies.
It is especially important that staff members be sensitive to changing community and school populations and their diverse characteristics. All education and training needs to have a component that addresses the diverse needs of the communities and cultures within which the school is situated.
6.2 Training for Delegation
Training needs to be provided to all individuals (primary and substitute) responsible for medication administration. When planning the training that is needed for delegation, the LSN/RN must keep the following questions in mind:
- Who is being trained?
- What is the content of the training?
- How much time is there for training?
- Where is the training location?
- Why is the training necessary?
- How will competencies be evaluated and documented?
These questions must be asked and answered for appropriate delegation training to have occurred.
6.3 Education and Training Needs
Different participants in students’ health care have varying needs for information, as outlined below. Documentation and evaluation of training must follow the training.
Training needs to be done before medication administration is performed. It is important that four types of staff training be conducted. The supervisor informs the trainee of (1) school policies and availability of resources, (2) available written criteria that indicate when to contact a supervising LSN/RN or EMS, (3) student-specific information, and (4) procedures for safe medication administration. The first, second, and fourth are best done before students begin their school year (e.g., during workshop week) and the third before delegatees work with specific students.
Although there are a variety of curriculum resources available, Minnesota has no required materials at this time. A training program should have the following:
- a general medication overview that includes the purposes of medications and the various medication administration routes;
- information on medication handling and administration techniques that includes cleanliness, care, storage, the six rights of medication administration, preparing medications, administration procedures, guidance for field trips, proper medical abbreviations, student plans, and emergency information;
- need for authorizations and record keeping that includes legal requirements, policy and procedure review, record keeping, errors and omissions, and forms; and
- rights and responsibilities that include delegation and reporting, data privacy, and Minnesota statutes, rules, and guidelines.
Well-designed education of members of the community at-large will draw on the expertise of local health care and health education professionals, and advocacy organizations. These individuals, who may be members of the district’s health advisory committee, will ideally work with the school district to proactively address medication administration issues, including an understanding of staffing, expectations, compliance, and resources/financing. To be able to make good decisions about district health services, school board members must receive information about financial needs (health care staff and resources) and the health of their student population. The latter can be done through periodic statistical reports from lead health personnel regarding medication administration in schools, such as the number of students taking medications, who is giving those medications, and the training needed.
Parents/legal guardians have a responsibility to convey the following student-specific health information about their children to appropriate school staff: their children’s health conditions, medications, allergies, medication side effects, level of knowledge about their medications, and any issues with student ability or willingness to take medication.
Parents/legal guardians should be informed of the district policy and be as involved as possible in their children’s health care, including training of staff on specifics such as their student’s response to medication administration (e.g, Glucagon™, Diastat™, or Epi-pen™). When parents/legal guardians provide this information to schools, they have a right to legal protections of data privacy under A&D, FERPA, HIPAA, IDEA, the Minnesota Government Data Practices Act (chapter 13), MMHA, and MMRA.
Education of students is geared to their knowledge, skill, and developmental levels––ranging from students who have no knowledge about their medications and administration, to students with limited knowledge who need to know more, to competent students who need observing as they self-administer their medication, to students who are completely experienced in self-administration of medication and self-monitoring of their health conditions and don’t need assistance.
School district policies and staff members should enable students to grow in their self-care abilities as part of their life-long learning experiences. In turn, students need to take an active and responsible role in their health care, self-administer according to the six rights, and learn to become their own health advocates. Students should be assured that their health information is kept private.
Both the Minnesota Board of Nursing and Minnesota Board of Teaching require
continuing education units for licensure renewal for RNs and
LSNs. These continuing education units are necessary to
stay up to date on nursing practice, medical conditions, medication use,
and student health needs.
Since paraprofessionals will sometimes be LPNs, an evaluation of their skills and knowledge-based competencies are necessary. Refresher courses can be used to fill any gaps in skills or competencies, such as information about new medications, pediatric care, and school nursing procedures.
School staff who serve as UAPs working with medications need to be knowledgeable about medication administration procedures on campus and during extended day experiences (e.g., field trips and sporting events). The training content should include (1) hands-on student care that is specifically related to the assigned medication administration, (2) school district policy and procedures, such as safety measures, general emergency procedures, and how and when to contact the LSN/RN, and (3) federal, state, and local regulations.
In Minnesota, there are at present no specific training requirements for UAPs who are assisting with medical functions in the school. However, it is recommended by national and state nursing organizations that UAPs who administer medication be trained to:
- Recognize the student’s right to privacy.
- Recognize the student’s skills and abilities.
- Follow facility policies and procedures regarding medication administration, storage and handling of medications, medication expiration dates, documentation, and disposal of medication, and similar policies and procedures implemented in the facility to safeguard medication provision to students.
- Demonstrate safe medication administration procedures.
- Understand the relationship between the LSN/RN and UAP and the importance of observation and reporting.
- Recognize the limits and conditions by which a UAP may administer medications.
- Recognize the student’s property rights and physical boundaries.
- Recognize the responsibility to report and the mechanisms for communicating such to the appropriate authorities if reasonable cause exists to believe that a child or adolescent has been subjected to maltreatment or neglect.