Guidelines for Medication Administration in Schools

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Guideline #3: Staffing

3.1 Student-Focused Staffing
The number of health personnel needs to be in proportion to student numbers and the breadth and severity of health issues. The overall needs of the total population of students should drive the health program, rather than current staffing, existing funding, or available supervision for medication administration.

Health services staffing should enable students to successfully manage their medication needs in the classroom and at all school-related activities. If a student is moving towards self-administration, the LSN/RN needs to be available to assist the student through health assessment and planning; teach about medication administration; and supervise changes for medication administration.

3.2 Health Services Staffing Options
Healthy People 2010 (U.S. Department of Health and Human Services, 2000) recommends a school nurse:student ratio of 1:750. In schools with a significant number of special needs students, the ratio should be adjusted accordingly (See Minnesota Statutes § 121A for Minnesota requirements). Although the involvement of an LSN/RN in each school’s provision of health services to students is crucial and a legal requirement, resources are uneven throughout the state, so alternative staffing options can secure participation of an LSN/RN. These options include sharing an LSN/RN or substitute with another school district or hiring health services staff or contract staff through a local community’s best available resources, such as an education cooperative, public health agency, hospital, clinic, or home-care agency.

Whether or not an LSN/RN is physically at the school during all school hours, nursing coverage and availability needs to be arranged. Therefore, when medication administration is delegated, the delegatee must be able to communicate during that time with an LSN/RN or other health professional with medication administration knowledge and expertise.

Each school district should consider having a part-time medical advisor working with its health services program. The physician or provider could review policies, develop model policies, and provide individual medical consultation.

3.3 Preparing for Emergencies
When developing school health staff positions, keep in mind that emergencies will inevitably take place and sometimes involve medication administration. Two types of emergencies can arise, those involving individual students receiving medications and system-wide emergencies (e.g., violence, threat, or natural disaster).

School staff should be trained and available to administer first aid and CPR any time students are in school. It is also important that for times when an LSN/RN is not available during health emergencies, each school has a plan in place that delineates the roles and responsibilities of staff members, including communication channels. School policy and procedures need to include guidelines for intervention in an emergency or crisis and for debriefing following it.

Schools request emergency information from parents/legal guardians each school year. This information may necessitate the development of emergency care plans (ECPs) or individualized health plans (IHPs) to ensure student safety.

The Emergency Information Form for Children With Special Health Care Needs (EIF) is a tool to transfer critical information to physicians, parents, emergency medical service (EMS) professionals, and nurses when dealing with a student’s acute illness or injury (American Academy of Pediatrics, 1999, and American College of Emergency Physicians, 1998). The EIF, also called a safety plan, concisely summarizes the child’s complicated medical history and makes it available when the child’s parents and pediatrician are not immediately available.

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