Guidelines for Medication Administration in Schools

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Guideline #5: General Procedures of Medication Administration

5.1 Principles That Influence Medication Administration Procedures
It is important that these principles of medication administration be known and followed by anyone (nursing and non-nursing personnel) who is administering medications.

  • Principle 1: Guarantee that medication administration is a clean procedure by washing hands.

  • Principle 2: Give medication exactly as ordered by the health care provider or indicated on manufacturer’s instructions.

  • Principle 3: Everything should be done to avoid “no-shows,” especially for seizure medications and antibiotics.

  • Principle 4: Prevent errors! Do not allow yourself to be distracted. Do not use one student’s medication for another.

  • Principle 5: Keep individual student information private.

  • Principle 6: Apply child development principles when working with students (e.g., students do not want to be considered unique.)

  • Principle 7: If there is an error or medication incident, it must be reported. Follow district procedure for notifying your school nurse, administration (within 24 hours), the student’s parent/legal guardian, and physician. Complete documentation. It is important to act as soon as the error is discovered. The school administrator or supervisor should evaluate errors by all persons administering medications.

For detailed information about what to do in the case of medication administration errors, see Guideline #8: Quality Assurance, Monitoring, and Assessment of the Minnesota Guidelines.

5.2 Step-by-Step Procedures
When medications are administered by any school personnel, procedures such as the following should be in place:

  • Procedure 1: Wash hands. Administration of medication is a clean (not sterile) procedure, unless otherwise specified.

  • Procedure 2: Verify authorization from parent and/or prescriber; check the label and/or manufacturer’s instructions. Seek help when questions arise.

  • Procedure 3: Gather necessary items.

  • Procedure 4: Prepare and give medications in a well-lit, dedicated area. Remove medication from locked cabinet.

  • Procedure 5: Check the label for name, time, medication, dose, and route. Use current resources (e.g., medical pharmacopoeia) to verify the accuracy of the physician’s order.

  • Procedure 6: Prepare the correct dosage of medication without touching medication, if possible.

  • Procedure 7: Check the label and/or manufacturer’s instructions for name, time, medication, dose, and route while preparing the correct dose.

  • Procedure 8: Check the label and/or manufacturer’s instructions for name, time, medication, dose, and route before returning the container to the locked cabinet.

  • Procedure 9: Do not leave medication unattended.

  • Procedure 10: Provide equipment and supplies (e.g., medication cups and alcohol wipes) as needed.

  • Procedure 11: Identify the student. Ask the student to say his or her name. Nonverbal students may need third party assistance with identification. Take measures to maintain data privacy.

  • Procedure 12: Verify the student’s allergies verbally by asking the student and by checking the student health records. Also verify contraindications to medicine. Watch for typical adverse medication reactions. If an adverse reaction is evident, contact the supervisor, parent/legal guardian, or licensed prescriber, according to school policy.

  • Procedure 13: If the student questions whether it is the right medication, stop and verify the medication against records, with parent/legal guardian, or with registered pharmacist.

  • Procedure 14: Explain procedure to student.

  • Procedure 15: Position the student properly for medication administration.

  • Procedure 16: Administer medication according to the six rights (right student, right time, right medicine, right dose, right route, and right documentation).

  • Procedure 17: Discuss administration procedure and carefully observe the student as medication is administered.

  • Procedure 18: Record name, time, medication, dose, route, person administering the medication, and any unusual observations.

  • Procedure 19: Ensure accurate documentation of all medications, including the witnessed disposal of medications.

  • Procedure 20: Clean, return, and/or dispose of equipment as appropriate.

  • Procedure 21: Wash hands.

This set of medication administration procedures is modified as needed, based on routine or emergency administration and the route of administration: oral, inhaled, topical, rectal, intravenous, pumps, gastrostomy-tube, intramuscular, subcutaneous, or ear and eye.

5.3 The Six Rights of Medication Administration
The six rights can be used as a mental checklist to assist those administering medication to remember and clarify the critical elements of the process. They are the:

  • Right student. Properly identify the student (e.g., rather than asking the student, “Are you Jane Doe?” before administering the medication, ask the student to state his or her name).

  • Right time. Administer medication at the prescribed time. This can usually be within 30 minutes earlier or later than the designated time unless otherwise specified by the provider or the pharmacist.

  • Right medicine. Administer the correct medication. Check three times, prior to administration.

  • Right dose. Administer the right amount of medication.

  • Right route. Use the prescribed method of medication administration.

  • Right documentation. Promptly and accurately document the medication administration.

5.4 Field Trips
Each school district’s medication administration policy and procedures should address medication administration on school-sponsored field trips. In most schools, education staff are assigned responsibility for handling and administration of medications. Parents may choose to accompany their students and administer medications.

One option is to take the medication in its original container and put it in a small, zip-lock bag along with a copy of the prescriber’s orders and a copy of the parent authorization form. Send that package with the person who is delegated or designated to administer medications on the field trip. The school district should establish a document and process for check-in and check-out of medications for field trips.

A second option is that the parent/legal guardian provide the required amount of medication (depending on the length of the trip) in a separate container with an original label (i.e., an extra from the provider or pharmacist), with a copy of the prescriber’s orders and a copy of the parental authorization form specific to the event or trip. This may be useful for any trips that exceed one day in length.

A third option is that the policies may allow the preparation of a supply of medications by the LSN/RN or parent/legal guardian, not to exceed the duration of the trip, in paper envelopes or other more suitable containers for use by a student temporarily off-campus. A container may hold only one medication. A label on the container must include the date, the student’s name, the school, the name of the medication, its strength, dose, and time of administration, pharmacy, pharmacy phone number, prescription number, and the initials of the person preparing the medication and label. Accompanying the envelope will be a copy of the prescriber’s orders and the parental authorization form. Note that the additional steps involved in transferring medication to an envelope present another opportunity for medication error.

Some schools provide a designated volunteer with appropriate health information on students requiring medication administration, medication in properly labeled bottles, and forms on which to document medication administration. The school should provide a job description for the medication administration volunteer, make sure the volunteer has the education and training necessary to safely administer the medication, verify and document his or her competencies, and provide procedures for how medication administration is handled on field trips. The volunteer needs to follow the procedures.

When a volunteer is used, parents must be informed and sign a health data privacy release form. Some experts (Schwab, 2001) recommend the volunteer be paid, even nominally, as a school employee, perhaps as a substitute. In so doing, the volunteer becomes a school employee and is bound by policies on medication administration including documentation and data practices.

Although parents can accompany students on field trips, it is not a requirement for students with medication needs. Staff designated the responsibility for medication administration should be trained and accompany the student and ensure that all the medical supplies are brought along and appropriate documentation is completed.

The plan for coverage and care during extracurricular activities sponsored by the school that take place outside of school hours should be carefully set out in the student’s health/education plan (504, ECP, IEP, or IHP).

5.5 Before-School, After-School, and Summer-School Activities
Medication administration during these school-based times (e.g., extended day programs and sporting practice and events) should follow district policy for school staff who administer medications and for students who self-carry and self-administer. School staff (e.g., educational assistants, bus drivers, lunchroom staff) will be designated medication administration or monitoring activities on a case-by-case basis. The school staff members who are designated responsibility for medication administration will be trained and supervised related to their responsibilities and have immediate access to the health offices and school resources (e.g., student health records/emergency information, high school league physical examinations, and emergency equipment). Training and supervision will be documented in the staff personnel file. These programs are often run by contracted groups, not the school. For information on emergency medication administration, see Guideline 7.11: Policies and Procedures.

When specific health information is known about a student and her or his potential for a health emergency, the school should have a plan for medication administration, including information that enables the student to possess emergency medication and/or have immediate access to it at all times.

The plan for coverage and care during extracurricular activities sponsored by the school that take place outside of school hours should be carefully set out in the student’s health/education plan (504, ECP, IEP, or IHP).

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