Guidelines for Medication Administration in Schools

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Guideline #8: Quality Assurance, Monitoring and Assessment

8.1 Definitions
If a medication error occurs, districts are best protected from liability when policies and procedures are established collaboratively with input from school nursing personnel, district administrators, and parents.

Medication errors include any failure to administer a medication as prescribed for a particular student and may include not administering to the right student, at the right time, the right medicine, the right dose, by the right route, or with the right documentation.

8.2 Procedures to Follow in Case of Medication Errors
If an error in medication administration occurs, the following steps should be initiated:

  • Identify the nature of the error.
  • Keep the student in the health office. If the student has already returned to class when the error is determined, have the student accompanied to the health office.
  • Monitor the student’s behavior and physical symptoms. If the student’s symptoms are life-threatening, call 911 prior to calling parents.
  • Notify parents/legal guardians, supervising LSN/RN, principal/designee, and student’s physician.
  • If unable to contact the physician or licensed prescriber, contact the Poison Control Center for instructions. Give the name and dose of the medication given in error; the age and approximate weight of the student; and the name, dose, other medications being taken by the student, and time of last dose of other medication, if possible.
  • Carefully record in the student’s health record all circumstances and actions taken.
  • Submit an occurrence report (see sample in appendices) to the principal or program administrator within 24 hours. Include the name of the student, the parent/legal guardian’s name and phone number, and a specific statement of what the medication error was, who was notified, and what remedial actions were taken.

8.3 Refusal to Take Medication
Schools should have consistent policies to address handling situations with students who do not appear or who refuse to take ordered medications. It is best to address these situations on an individual basis depending upon what the medication is and how often the student fails to take the medication. If a medication is not given, policies should address the extent to which school personnel will attempt to administer the medication, as well as procedures for notifying a parent/legal guardian and licensed prescriber and completing an occurrence report.

Health services staff should monitor student noncompliance with medication administration. Action or issues of medication administration refusal or noncompliance should be reported by the LSN/RN or designated school health personnel to the licensed prescriber, parent/legal guardian, and student.

8.4 Reducing Errors and Omissions
The LSN/RN or designated school health personnel should review reports of medication errors, analyze patterns, and take necessary steps to avoid future problems. The purpose of monitoring medication errors is for system correction rather than individual blame. Eliminating distractions and/or other responsibilities during periods of concentrated medication administration can increase safety and decrease the potential for errors. School administration and/or the LSN/RN should review medication error reports and take steps to develop a correction plan to avoid future problems.

8.5 A High Quality School Health Program
The following are significant actions leading to a high quality school health program:

  • The school would identify students with conditions that require IHPs and utilize applicable health information to develop IHPs.
  • Schools would have highly qualified staff members who have access to an LSN and are trained in student health issues, first aid, and CPR; teachers would be informed of their students’ health needs.
  • All students who need IHPs would have them.

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