Ohio Department of Health

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1 Ohio Department of Health-School and Adolescent Health- School Nursing Program 1 Ohio Department of Health Medication Administration in Ohio Schools: Training for School Personnel

2 Ohio Department of Health-School and Adolescent Health- School Nursing Program 2 Dear Colleagues: In the spring of 2011, Medication Administration in Ohio Schools: Training for School Personnel was developed by the Ohio Department of Health (ODH) School Nursing Program as a resource for school nurses and other licensed health professionals to use to train designated employees who are not licensed health professionals to administer medication in schools. The goal of the training is to provide these school personnel with the knowledge, skills and resources to safely administer prescriptive medication to Ohio s school children. This training guide supersedes or replaces the ODH Train the Trainer Instructional Manual on the Delegation of Medication Administration to Unlicensed Personnel in Ohio Schools (January, 2001) due to changes in the Ohio Revised and Administrative Code. This 2011 revision not only expands the framework based on current Ohio Revised and Administrative Code, but also includes a variety of new resources. It provides comprehensive information on topics such as training adult learners, relevant federal laws and best practice for school medication policies. The appendices provide useful resources that include modules that are specific to administration route, templates for school administrators, sample medication administration and documentation records, action plans and more. This is a companion document that accompanies a PowerPoint presentation by the same name that may be used by the licensed health professional in training school staff. A variety of representatives from school districts, public health departments, state boards of nursing and pharmacy have reviewed the content of these guidelines. The goal of this multidisciplinary partnership was to use the broadest possible range of expertise to help achieve the ultimate goal of assuring safe medication administration and management to Ohio school children. Thank you for your commitment to continuing education to safeguard the health and academic success of Ohio school children. It has been a pleasure providing these guidelines to you and we hope that they serve you well. Sincerely Caring for Ohio s School Children, Dawn Abbott, BSN, M.Ed, RN, LSN, NCSN School Nurse Consultant, Ohio Department of Health Ann M. Connelly, MSN, RN, LSN, NCSN Supervisor, School Nursing Program, Ohio Department of Health

3 Ohio Department of Health-School and Adolescent Health- School Nursing Program 3 Table of Contents Page Introduction 2 How to use this document 4 Medication administration overview 5 Medication administration in schools is guided by federal and state laws 12 Medication administration policies and procedures 24 Principles of adult learning 35 Use of the medication administration modules 38 Medication administration overview module 39 Basic guidelines for medication administration module 42 Oral medication administration module 45 Ophthalmic (eye) medication administration module 47 Otic (ear) medication administration module 50 Nasal (nose) medication administration module 52 Topical (skin) medication administration module 55 Rectal medication administration module 57 Inhaler medication administration module 60 Nebulizer (inhalant) medication administration module 63 Injection (subcutaneous) medication administration module 66 Medication administration: glucagon injection module 69 Epinephrine autoinjector (Epi-pen) medication administration module 72 Gastrostomy tube (G-tube) medication administration module 75 Emergency medication administration 78 Evaluation and posttest 82 Acknowledgements 83

4 Ohio Department of Health-School and Adolescent Health- School Nursing Program 4 HOW TO USE THIS DOCUMENT This is a companion document to the ODH PowerPoint presentation entitled Medication Administration in Ohio Schools:. The sections in this document correlate with the slides in that PowerPoint. The text from each slide is presented here, with additional notes and talking points provided for the instructor. Near the end of this document are appendices that group handouts for each section of the training. Those appendices will be noted in the speaker notes for each slide. The instructor may choose to print any or all of those handouts that would be useful in training school personnel. It is recommended that all school personnel who will administer medications receive the 90 minute Medication Administration Overview training. In addition, all school personnel administering medication must have training on the Basic Guidelines (15 minutes). Finally, school personnel should be trained on the modules pertaining to the routes of medication they will be expected to administer. The Gastrostomy Tube Module should take 15 minutes and the Injection Module should take 30 minutes; all other modules should take 10 minutes each. This is a minimum amount of time to train people who are not licensed health care providers the basic procedures to safely administer prescription medications to students. MEDICATION ADMINISTRATION OVERVIEW The first section of the Medication Administration in Ohio Schools: Training for School Personnel is an overview of medication administration in the school setting. It is recommended that all school personnel who will administer medication receive this training annually. The training is estimated to take 90 minutes. If school personnel have questions or require a review or refresher of the information between annual trainings, then selected slides and handouts regarding specific topics may be used.

5 Ohio Department of Health-School and Adolescent Health- School Nursing Program 5 SLIDE 1 Medication Administration in Ohio Schools: Training for School Personnel Slide notes: Throughout the training, school staff who are not licensed health professionals will be referred to as school personnel. They may at times be referred to as the learner. Other terminology used in this training: LSN LSN-WC RN LPN ODE ODH ORC OAC OTC Parent Trainer School Nurses licensed by the Ohio Department of Education Licensed School Nurse Wellness Coordinator Registered Nurse licensed by the Ohio Board of Nursing Licensed Practical Nurse licensed by the Ohio Board of Nursing Ohio Department of Education Ohio Department of Health Ohio Revised Code Ohio Administrative Code Over the counter medications The parent, guardian or other person or entity legally responsible for the student The licensed health professional providing the training to school personnel SLIDE 2 Overview Goal and objectives Background Law and legal considerations Policies, procedures and best practice Roles and responsibilities Principles of adult learning Tips for preparation and presentation Course modules

6 Ohio Department of Health-School and Adolescent Health- School Nursing Program 6 Slide notes: This is the outline of the medication administration training overview for licensed health professionals. SLIDE 3 Goal The goal or purpose of the ODH Medication Administration in Ohio s Schools: Training for School Personnel is to provide designated employees who are not licensed health professionals (school personnel) administering medications in schools with the knowledge, skills and resources to safely administer medication prescribed for Ohio school children. Slide Notes: Designated employees who are not a licensed health professional will be referred to as school personnel in the slides that follow. SLIDE 4 Objectives for Training for Licensed Health Professionals At the completion of this training course, the licensed health professional will be able to: 1. Explain the content of the Medication Administration in Ohio Schools: Training for School Personnel 2. Name three characteristics of adult learners 3. Describe best practices for teaching the Medication Administration in Ohio Schools: Training for School Personnel 4. Successfully pass the Medication Administration in Ohio Schools: Training for School Personnel post-test DRAFT Slide Notes: These are the objectives for the licensed health professionals taking this course in order to train school personnel.

7 Ohio Department of Health-School and Adolescent Health- School Nursing Program 7 SLIDE 5 Objectives for Training for School Personnel At the completion of this training course, the designated employee who is not a licensed health professional will be able to: 1. Identify the requirements of ORC Explain how federal confidentiality law (FERPA and HIPAA) effect medication administration 3. Locate the local school district s medication administration policy 4. List the components of the local school district s medication administration policy 5. Tell the general procedures for administering medications in the school, including the six rights of medication administration 6. Successfully demonstrate selected medication administration procedures 7. Successfully pass the medication administration post-test Slide Notes: The information contained in this training represents a compilation of best practice standards and policies that are consistent with the Ohio Revised Code for medication administration in the school setting. Each local board of education has the authority and is required to develop school policies and procedures specific to their individual school district. Prior to teaching this course to school personnel, it is highly recommended that the licensed health professional review and become familiar with the local school district s policies regarding health services, specifically the administration of medication during the school hours and activities. The information contained in this manual is not meant to supersede local school board policies. Further, the inclusion of information, addresses or Web sites for particular items does not reflect their significance, nor it is intended to endorse any views expressed or products or services offered. The scope of this training is intended to address the administration of prescriptive medications. The health conditions that are associated with the needs to administer medications are multifaceted and are separate studies by themselves. This training is not designed to address the care and management of students with diabetes, asthma, epilepsy or other chronic illnesses; the only purpose of this training is to teach school personnel the procedures to administer prescription medications safely. School districts that have students with chronic illnesses requiring nursing care should employ or contract with a nurse who can assess the student, create a nursing plan of care and delegate nursing care as appropriate to school personnel. That delegation would include additional training of school personnel beyond the scope of this training.

8 Ohio Department of Health-School and Adolescent Health- School Nursing Program 8 SLIDE 6 Special Notes The information contained in this training represents a compilation of best practice standards and policies that are consistent with the Ohio Revised Code for medication administration in the school setting. It is important to note that each local board of education has the authority to develop school policies and procedures specific to their individual school district. The information contained in this training is not meant to supersede local school board policies. Further, the inclusion of information, addresses or Web sites for particular items does not reflect their significance, nor is it intended to endorse any views expressed or products or services offered. Slide Notes: In 2009, Ohio House Bill 1 included language to update the school medication administration law ORC Previously there were no requirements for training for school staff designated to administer medication. ORC (B) (2) now states Effective July 1, 2011, only employees of the board who are licensed health professionals, or who have completed a drug administration training program conducted by a licensed health professional and considered appropriate by the board, may administer to a student a drug prescribed for the student. was developed in response to the change in law. SLIDE 7 Suggestions for the Trainer Prior to teaching this course to school personnel, it is highly recommended that the licensed health professional review and become familiar with the local school district policies regarding health services, specifically the administration of medication during the school hours. Notes regarding the PowerPoint slide content are provided in the outline in labeled as Slide Notes in the accompanying text. Please refer to the Notes section on each PowerPoint slide for those talking points. Slide Notes: The licensed health professional trainer must train school personnel about their own district medication administration policy and procedures. The Slide Notes in this document provide additional details, references, resources and talking points for the trainer. The trainer should review the entire document before training school personnel.

9 Ohio Department of Health-School and Adolescent Health- School Nursing Program 9 SLIDE 8 Chronic Disease Management in Ohio Schools The scope of the Medication Administration in Ohio Schools: Training for School Personnel is to address safe procedures to administer prescriptive medications. The health conditions that are associated with the needs to administer medications are multi-faceted and are separate studies by themselves. School nurses should consider additional training of school staff regarding the management of students with challenging chronic illnesses such as epilepsy, diabetes, asthma and severe allergies. Slide Notes: Due to time constraints, it will not be possible for the trainer to thoroughly train school personnel about the chronic illnesses that may require medication administration at school. There are a variety of programs available for the licensed health professional to use in educating school personnel about the management of chronic diseases such as asthma, diabetes and epilepsy. These trainings, however, are outside the scope of this training; the purpose of this training is to teach school personnel how to administer medication only. SLIDE 9 Background Children with chronic and acute health conditions may require medication administration during the school day in order to be academically successful In 2009, Ohio House Bill 1 updated school medication administration law (ORC ) to require school employees administering medications after July 1, 2011 be: A licensed health professional OR Complete a drug administration training program conducted by a licensed health professional and considered appropriate by the board Slide Notes: Many Ohio students are able to attend school because of the effectiveness of their medication. The health circumstances requiring medication during school participation are diverse. Medication administration at school should be discouraged unless medically necessary for the student s health, safety and optimal learning. For most students, the use of medication is beneficial to control acute minor or major illnesses, allowing a timely return to the classroom with minimal interference to learning or missed days of school. The American Academy of Pediatrics states that medication may be essential for continued functioning, either as a component of an elaborate treatment plan for a student with a complex disability or illness or as the only treatment necessary for a student to maintain or regain control of a chronic or acute illness. Medication that is essential should be given at school. In addition, a student may also symptomatically benefit from nonprescription medications. If so, non-prescriptive medication

10 Ohio Department of Health-School and Adolescent Health- School Nursing Program 10 policy must be established. In rare instances medications may be necessary for life-threatening emergencies. SLIDE 10 Purposes of Medication Administration in School Medication administration at school is discouraged Only administer medications at school that are essential to be given during school hours Medication may be used for acute and chronic minor or major illnesses Allows return to the classroom Minimizes missed school days Improves student functioning As part of treatment plan for management of a complex disability or illness May be necessary for life-threatening emergencies Slide Notes: Many Ohio students are able to attend school because of the effectiveness of their medication. The health circumstances requiring medication during school participation are diverse. Medication administration at school should be discouraged unless medically necessary for the student s health, safety and optimal learning. For most students, the use of medication is beneficial to control acute minor or major illnesses, allowing a timely return to the classroom with minimal interference to learning or missed days of school. The American Academy of Pediatrics states that medication may be essential for continued functioning, either as a component of an elaborate treatment plan for a student with a complex disability or illness or as the only treatment necessary for a student to maintain or regain control of a chronic or acute illness. Medication that is essential should be given at school. In rare instances, medications may be necessary for life-threatening emergencies. SLIDE 11 Over-the-Counter Medications Nonprescription (over-the-counter or OTC) medications School districts should have a policy addressing the administration of OTC and homeopathic medications School OTC policies vary because they are based on the community needs

11 Ohio Department of Health-School and Adolescent Health- School Nursing Program 11 Slide Notes: Definition of non-prescription or OTC medication: medicines that may be purchased over-the-counter without a prescription. If a prescription is written for a medication that can be purchased over the counter, that is considered a prescribed/prescription medication in the school setting and must be administered following the school district s medication administration policies and procedures. A student may also symptomatically benefit from nonprescription medications. ORC does not address OTC medication administration in the school setting. This allows local school boards to develop their own OTC medication policy to meet the needs of the local school community. School personnel will likely be aware that OTC policies vary from district to district. They should be trained on the district OTC medication policies so they can follow them. The instructor should provide the learner with a copy of the school s OTC medication administration policy. SLIDE 12 Limitations in the Law Ohio law does not address OTC medications This training specifically addresses prescription medications ORC addresses city, local, exempted village, and joint vocation school district*s+ It does not speak to private/parochial schools Nurses may administer medications in private/parochial schools based on their nursing license There is no provision in state law for unlicensed private school employees to administer prescription medications Slide Notes: State law which allows trained, unlicensed school personnel to administer prescription medication pertains only to public schools. In the past, non-public schools have assumed they should follow the same law as public schools as there is not one addressing them. However, the Ohio Board of Nursing notes that there is no provision in ORC allowing non-public school personnel to administer prescription medications. In the non-public school setting, licensed health professionals such as RNs may administer prescriptions based on their licenses. School personnel (who are not licensed health professionals) who administer medications in non-public schools are practicing nursing without a license, which is a felony in Ohio. The non-public school administrators who allow this are also committing the same felony (please refer to the Momentum article in the Medication Introduction Appendix regarding this). Nonpublic schools who administer prescription medication should employ a licensed health professional for that purpose.

12 Ohio Department of Health-School and Adolescent Health- School Nursing Program 12 SLIDE 13 MEDICATION ADMINISTRATION IN SCHOOLS IS GUIDED BY FEDERAL AND STATE LAWS Slide Notes: The next section is an overview of selected federal and state laws that bear on medication administration in Ohio schools. School personnel should understand that there are legal underpinnings for the policies and procedures related to medication administration in the school setting. While there are other areas of law, such as pharmacy law, that affect medication administration in schools, the following slides review the laws most often questioned. SLIDE 14 Law Federal Laws Federal laws primarily emphasize the rights of students to have access to a free and appropriate public education and address management and confidentiality of student records State Laws State laws emphasize the safety of children, including the establishment of school medication policies and regulate the practice of licensed health care professionals Slide Notes: There are many federal and state laws related to medication administration in the school setting, including but not limited to those regulating the practice of licensed health professionals. All school personnel, including school administrators, LSNs, RNs, LPNs and other school personnel need to be mindful of these laws. Those most relevantly applicable to health services in schools will be briefly described in the Medication Introduction Appendix.

13 Ohio Department of Health-School and Adolescent Health- School Nursing Program 13 SLIDE 15 Medication Administration in Schools is Guided by Federal Laws Federal Law: FERPA Family Educational Rights and Privacy Act Ensures confidentiality of student records Records must NOT be disclosed to anyone without consent If confidentiality is breached, it can lead to liability and lawsuits Slide Notes: The Family Educational Rights and Privacy Act ensures the confidentiality of student records, including student health records such as those used in medication administration. While the student health record is stored separately in many schools, it is in fact part of the student s cumulative record. As with all other student educational records, the student health record is subject to protection under FERPA. In general, these student health records (including medication records) must NOT be disclosed to anyone without the consent of a parent or a student who is 18 years of age or older. SLIDE 16 What is Disclosure? Sharing information With personally identifiable information By any means (including oral, written, electronic, etc.) To anyone else Slide Notes: Share with school personnel that parents and students have an expectation of privacy where the students health records are concerned. Disclosure means to permit access to or the release, transfer, or other communication of personally identifiable information contained in education records by any means, including oral, written, or electronic means, to any party except the party identified as the party that provided or created the record. (Authority: 20 U.S.C. 1232g(b)(1) and (b)(2))

14 Ohio Department of Health-School and Adolescent Health- School Nursing Program 14 SLIDE 17 Exceptions There are a few exceptions regarding disclosure: 1. School officials with legitimate educational interest 2. Transferring schools 3. Emergency situations 4. Directory information Slide Notes: Lists of all students who have illnesses that are shared with all school teachers and staff are a violation of FERPA. Information about a student s health concerns should only be shared with those directly interacting with the student who have a legitimate educational interest in it. SLIDE 18 Legitimate Educational Interest While many are interested in students personal health information, few may access it. Only those: Designated responsible for an emergency response Who require it to fulfill professional responsibilities With educational need Am I going to change the way I teach or interact with the student because of the information? If in doubt, informed consent would always be best. Slide Notes: Many people working or volunteering in the school setting are curious about the health concerns of students. Disclosure of the students personally identifiable health information without consent of the parents is allowed in only a few specific instances. All school staff expected to observe a student for changes in behavior or other chronic illness symptoms should be trained on what they should observe for and the appropriate intervention. Only the minimal amount of information necessary to provide safety for these students should be shared. For instance, school staff (including bus drivers, cafeteria workers, teachers and others as appropriate) should be trained on how to respond to a student who has seizures, but the specific diagnosis does not need to be shared.

15 Ohio Department of Health-School and Adolescent Health- School Nursing Program 15 SLIDE 19 Emergency Situation Exception FERPA provides for disclosure in health and safety emergencies such as: Critical illness Serious accident Threatened homicide or suicide Incidents serious enough to call 911 and release information to assist in emergency treatment Disclose only to appropriate parties and only if knowledge of the specific information is necessary to protect the health or safety of the student or other individuals Slide Notes: In the event of an emergency situation, there are criteria for sharing confidential student health information with emergency responders in order to provide appropriate care for the involved student. SLIDE 20 Medication Administration in Schools is Guided by Federal Laws Federal Law: HIPAA Health Insurance Portability Accountability Act Generally, does not apply to schools Does apply to health care providers with whom schools may work FERPA is the confidentiality law that schools must follow Slide Notes: Ultimately, the licensed health professional or school nurse must remember that the basic underlying protection principals of FERPA and HIPAA are the same. FERPA protects student information in education records, while HIPAA protects health information, in any form, that is used or disclosed by a covered entity. School nurses should collaborate with their school district and school community to help ensure that all federal and state laws regarding confidentially and student health records are upheld and followed.

16 Ohio Department of Health-School and Adolescent Health- School Nursing Program 16 SLIDE 21 Federal Law: HIPAA Purpose: To improve the efficiency and effectiveness of the health care system by standardizing the electronic data interchange of certain administrative and financial transactions. Regulations focus on three areas: Privacy Rule Security Rule Transaction Rule Reference: or or Slide Notes: Purpose of HIPAA: To improve the efficiency and effectiveness of the health care system by standardizing the electronic data interchange of certain administrative and financial transactions. The U.S. Department of Health and Human Services issued regulations that focus on three areas: Privacy Rule Security Rule Transaction Rule Reference: Please refer to the Overview Introduction for additional resources regarding HIPAA and FERPA, including Joint Guidance on the Application of the Family Educational Rights and Privacy Act (FERPA) And the Health Insurance Portability and Accountability Act of 1996 (HIPAA) To Student Health Records and the Forum Guide to the Privacy of Student Information: A Resource for Schools. SLIDE 22 Federal Law: HIPAA HIPAA says FERPA is generally to be followed for student medical records Note: Schools may be covered under HIPAA Transaction Rule if they are engaged in electronic billing transactions but not under the HIPAA Privacy Rule For example: Under the Medicaid School Program (MSP), schools may bill for services provided by licensed health professionals, but not by other school employees Reference:

17 Ohio Department of Health-School and Adolescent Health- School Nursing Program 17 Slide Notes: Schools may be covered under the HIPAA Transaction Rule if they are engaged in electronic billing transactions (e.g., Medicaid billing), but not under the HIPAA Privacy Rule. Under the Medicaid School Program (MSP), schools may only bill for services provided by licensed health professionals. Reference: SLIDE 23 Medication Administration in Schools is Guided by State Laws ORC Policy for employees to administer drugs prescribed by physicians to students Describes: Requirement for school boards to adopt a policy regarding administration of prescription medication in the school Educational requirements for employees designated to administer prescription medication Authorizations required to administer prescription medications in school Requirements for storage of medications ORC is silent on over-the-counter medications Slide Notes: ORC Policy for employees to administer drugs prescribed by physicians to students is silent on over-the-counter medications. Effective July 1, 2011, only school personnel employed by the board that are either licensed health professionals or who have completed a drug administration training program conducted by a licensed health professional and considered appropriate by the board may administer to a student a drug prescribed for the student. SLIDE 24 Effective July 1, 2011 Only employees of the board who are: licensed health professionals OR who have completed a drug administration training program conducted by a licensed health professional and considered appropriate by the board may administer to a student a drug prescribed for the student

18 Ohio Department of Health-School and Adolescent Health- School Nursing Program 18 Slide Notes: Effective July 2011, only school personnel employed by the board that are either licensed health professionals or who have completed a drug administration training program conducted by a licensed health professional and considered appropriate by the board may administer to a student a drug prescribed for the student. Before a prescription medication can be administered in school, a school administrator may designate only employees that meet all requirements mentioned in the law (ORC ). SLIDE 25 ORC School board policy may also state: Except as otherwise required by federal law,* no person employed by the board shall, in the course of such employment, administer any drug prescribed to any student enrolled in the schools of the district * e.g. Americans with Disabilities Act (ADA) and the Individuals with Disabilities Education Improvement Act (IDEA) Slide Notes: ORC also states: Except as otherwise required by federal law,* no person employed by the board shall, in the course of such employment, administer any drug prescribed to any student enrolled in the schools of the district. In other words, school districts could have a policy stating they will not administer any prescription medications. However, schools must accommodate the needs of students with disabilities, so it is unlikely that a district could truly never administer prescription medications. * E.g. the Americans with Disabilities Act (ADA) and the Individuals with Disabilities Education Improvement Act (IDEA). The ADA and IDEA are federal laws that require schools to accommodate the needs of special education/disabled students in order for them to benefit from a free and appropriate public education. If medications are required for the student to benefit from the education, then the school is required to administer them. These include students with IEPs (Individualized Education Programs) and 504 Plans.

19 Ohio Department of Health-School and Adolescent Health- School Nursing Program 19 SLIDE 24 Designation states: Designated persons employed by the board are authorized to administer to a student a drug prescribed for the student The local school board must identify (designate) which employees may administer prescription medications. The board may designate: A licensed health professional Designated employees who are not licensed health professionals who have received training by a licensed health professional Slide Notes: Within the framework of existing federal and state laws, school district policy must provide for the safe administration of medication to students. This helps protect the school and staff from liability and helps ensures student safety and academic success. The law requiring designated employees who are not licensed health professionals in a school to complete a drug administration training program conducted by a licensed health professional will help ensure student safety and academic success. SLIDE 27 Designation The administration of the public school district has the authority/responsibility to designate employees to administer prescription medications in school. Designees must: Be a school employee Have completed a medication administration training, which is acceptable to the local school board, and given by a licensed health professional Slide Notes: In other words, before a prescription medication can be administered in school, a school administrator may designate only employees that meet all requirements mentioned in the law (ORC ).

20 Ohio Department of Health-School and Adolescent Health- School Nursing Program 20 SLIDE 28 State Law: Ohio Revised Code 4723 Ohio Nurse Practice Act Describes: Education, licensure and scope and standards of practice for nurses licensed in Ohio The authority of licensed nurses to delegate nursing tasks to unlicensed persons The unlicensed practice of nursing Discipline for licensed nurses Slide Notes: While the school nurse may be employed by the school district or a local health department or other contracting entity and must follow the employer s policy, the Ohio Nurse Practice Act regulates the practice of each nurse; the licensed nurse must practice within the nurse s scope of practice. OAC states: (A) A registered nurse may delegate a nursing task to an unlicensed person if all the conditions for delegation set forth in this chapter are met. (B) A licensed practical nurse may delegate to an unlicensed person only at the direction of the registered nurse and if all the conditions for delegation set forth in this chapter are met. An LPN can only delegate if directed to do so by an RN. SLIDE 29 Nursing Medication Administration Delegation Nursing Rule OAC Nurses may delegate the administration of only a few kinds of medications: OTC topical medications to be applied to intact skin as a barrier OTC eye drop, ear drop and suppository medications, foot soak treatments, and enemas Note: this does not allow the delegation of any oral OTC medications Slide Notes: OAC states: (C) Except as otherwise authorized by law or this chapter, a licensed nurse may delegate to an unlicensed person the administration of only the following medications:

21 Ohio Department of Health-School and Adolescent Health- School Nursing Program 21 (1) Over-the-counter topical medications to be applied to intact skin for the purpose of improving a skin condition or providing a barrier; and (2) Over-the-counter eye drop, ear drop, and suppository medications, foot soak treatments, and enemas. Note that nurses may not delegate administration of any oral medications, including prescription and OTC. SLIDE 30 Medication Designation Versus Delegation Education Law (ORC ) Designated persons employed by the board are authorized to administer to a student a drug prescribed for the student only employees of the board who are licensed health professionals, or who have completed a drug administration training program conducted by a licensed health professional and considered appropriate by the board, may administer to a student a drug prescribed for the student. Nursing Rule (OAC ) A licensed nurse may delegate to an unlicensed person the administration of only the following medications: (1) Over-the-counter topical medications to be applied to intact skin for the purpose of improving a skin condition or providing a barrier; and (2) Over-the-counter eye drop, ear drop, and suppository medications, foot soak treatments, and enemas Slide Notes: This slide compares the delegation of nursing tasks by a licensed nurse and designation of school personnel to administer medications by the school district. SLIDE 31 Medication Designation Versus Delegation Only the local school board may designate a school employee to administer medication who is not a licensed health professional The local school board may designate a licensed health professional (e.g., RN) to administer medications The school nurse or RN cannot designate or delegate prescription medication administration to school personnel Slide Notes: Licensed health professionals and others often have difficulty understanding the differences between delegation of a task by a licensed nurse and designation of school personnel to administer medications by the administration. Note that school officials are only able to designate school personnel to administer medication all other nursing tasks must be delegated

22 Ohio Department of Health-School and Adolescent Health- School Nursing Program 22 by a nurse according to the Ohio Nurse Practice Act and the OAC Delegation of Nursing Tasks. SLIDE 32 Over-the-Counter Medication Considerations This training is about school personnel administering prescription medication in accordance with the Ohio Revised Code Licensed nurses have the authority to administer over-the-counter medications in accordance with their nursing plan of care and following their employer s policy Slide Notes: While a medication may be purchased OTC, if a prescriber writes an order for it on a prescription pad, whether it be for insurance reasons or as part of a medical regimen, that medication must be managed just like any other prescribed medication. It would be managed according to the school district s prescription medication policy, not the OTC policy. Registered Nurses in Ohio can administer OTC medications in two ways. First, they may administer an OTC by order of a licensed prescriber in accordance with a medical plan of care. Second, the RN can assess a client, develop a nursing plan of care and administer an OTC medication in accordance with that nursing plan of care. This can be done without an order by a prescriber, but can only be done by an RN (not an LPN). Of course, all nurses must follow the OTC medication administration policy of their employer. The Ohio Board of Nursing oversees nursing practice in Ohio in accordance with the Ohio Nurse Practice Act. Please see the Medication Overview Introduction for the Ohio Board of Nursing clarification of non-prescription medication administration by licensed nurses.

23 Ohio Department of Health-School and Adolescent Health- School Nursing Program 23 SLIDE 33 Delegation Delegation of nursing tasks (OAC ): May only be done by a licensed nurse Requires nurse to be available by telecommunication when the task is being done Includes training of the delegee by the nurse and documentation Does NOT include administration of prescription medications There may be nursing tasks associated with medication administration that can only be delegated by a nurse Slide Notes: OAC states: (C) Except as otherwise authorized by law or this chapter, a licensed nurse may delegate to an unlicensed person the administration of only the following medications: (1) Over-the-counter topical medications to be applied to intact skin for the purpose of improving a skin condition or providing a barrier; and (2) Over-the-counter eye drop, ear drop, and suppository medications, foot soak treatments, and enemas. SLIDE 34 Available at the Ohio Board of Nursing Web site: Slide Notes: These two slides are School Nurse Decision Making Model created by the Ohio Board of Nursing and are available on their Web site at The first page of the model reviews the delegation of medication administration in the school setting, while the second reviews delegation of other nursing tasks. This training only addresses the delegation of medication administration; delegation of other nursing tasks is beyond the scope of this training.

24 Ohio Department of Health-School and Adolescent Health- School Nursing Program 24 SLIDE 35 Available at the Ohio Board of Nursing Web site: Slide Notes: These two slides are School Nurse Decision Making Model created by the Ohio Board of Nursing and are available on their Web site at The first page of the model reviews the delegation of medication administration in the school setting, while the second reviews delegation of other nursing tasks. This training only addresses the delegation of medication administration; delegation of other nursing tasks is beyond the scope of this training. SLIDE 36 Policy versus Procedure Policy-a set of ideas or a plan of what to do in particular situations that has been agreed officially by a group of people Procedure-a set of actions which is the official or accepted way of doing something Definitions: Slide Notes: In addition to following state and federal laws regarding the administration of medication in the school setting, licensed health professionals and school personnel must also follow the local school district s policies and procedures regarding medication administration. While those terms are often used interchangeably, they are different, as noted in this slide.