Guidelines for Medication Administration in Schools
As the number of Minnesota students taking medication during the school day grows, it becomes increasingly important to address this issue thoroughly to help students maintain an optimal state of health to enhance their education. The issue has become more complex due to factors, such as federal and state laws that protect children who require medications to fully benefit from free and appropriate public education, new pharmaceutical and medical technologies, evolving mental and medical health practices, and changes in school nurse staffing patterns.
The goal of the Minnesota Guidelines for Medication Administration in Schools (Minnesota Guidelines) is to increase the safe and efficacious administration of medications to students in schools by providing crucial information. As the Centers for Disease Control note (Wheeler, 2004, p. 1), the benefits of meeting the needs of students with chronic health conditions include “better attendance, improved alertness and physical stamina, fewer symptoms, fewer restrictions on participation in physical activities and special activities, such as field trips, and fewer medical emergencies.”
According to the American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care (2002), a guideline is “a statement of advice or instruction pertaining to practice. . . . it originates in an organization with acknowledged professional standing. . . . a guideline is developed in response to a stated request or perceived need for such advice or instruction.” The Minnesota Guidelines define student-centered goals of medication administration that are evidence-supported and draw from best practice throughout the nation, including those recognized by the National Association of School Nurses and the National Council of State Boards of Nursing, and in accordance with federal and state laws. The Minnesota Guidelines address both student-specific needs and the school health system.
The study originally requested by the Minnesota Legislature (Minnesota Department of Health, 2002) led to a collaborative process and publication of the guidelines by four state agencies––Minnesota Department of Health, Minnesota Board of Nursing, Minnesota Department of Education, and Minnesota Department of Human Services. In addition, a statewide multidisciplinary work group was established and met regularly to provide direction to and discuss the details of this project. The Minnesota Guidelines offer advice on what ultimately needs to be in place for students to be safe in Minnesota schools.
Members of the four state agencies and the statewide work group brought multiple perspectives to their invaluable contributions to the guidelines’ development and review process. Thus the final document does not represent a consensus, but reflects diverse input from a large number of individuals in a variety of agencies and organizations.
The comprehensive process involved a broad search and rigorous evaluation of pertinent literature, including numerous states’ standards and guidelines, and analysis of key concepts. From an initial pool of 686 pieces of literature published from 1990 to 2004, 475 of the highest quality were selected for evaluation by 16 trained graduate students and Department of Health staff members who scored them using a system of 51 criteria and reported results on an online database. The top–ranking literature was then examined by expert panels held throughout the state and made up of 193 parents, educators, school administrators, nurses, other health professionals, paraprofessionals, regulatory board representatives, and advocacy group members, among others. Expert panelists drew from the literature a long list of key concepts that they considered most significant for inclusion in the Minnesota Guidelines. These concepts were sorted into categories that form the 10 content areas in the final Minnesota Guidelines.
The articles reviewed by the expert panels are available by individual request.
These guidelines, published in January 2005, serve as an update to the Minnesota Legislature on the study recommendations discussed in the Report to the Minnesota Legislature: Medications dispensed in schools study (Minnesota Department of Health, 2002). Key intended users are health and education organizations across the state that are developing and updating medication administration policies and procedures.
Thanks to the National Association of School Nurse Consultants for sharing medication guidelines from their member states for our review. Our appreciation goes to the numerous individuals, ad hoc groups, and multidisciplinary teams of students, health and education professionals, and parents who contributed across the state. Literature evaluators, who spent hundreds of hours reading, analyzing, scoring, and reporting on articles and books, and members of the multidisciplinary work group are listed in the appendices. The work group, which provided direction for this project, represented 20 statewide agencies and organizations.
Special acknowledgment goes to the core Minnesota Department of Health team — Gwen Willems, Kathy Wittnebel, Cheryl Smoot, Nancy Blume, Gretchen Griffin, Sue Strohschein, and Chad Kielas — and members of the State Interagency Staff Team — Joan Lee, Minnesota Department of Health; Gayle Hallin, formerly Minnesota Department of Health; Shirley Brekken and Mariclaire England, Minnesota Board of Nursing; Cathy Griffin, Ruth Ellen Luehr, and Debbykay Peterson, Minnesota Department of Education; Jan Bodnia, formerly Minnesota Department of Education; Colleen Olson, Minnesota Department of Human Services; and Pat Brandstaetter, Northeast Service Cooperative.