Ohio Department of Health

Transcription

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.

25 Ohio Department of Health-School and Adolescent Health- School Nursing Program 25 SLIDE 37 Policy versus Procedure In the school setting, a policy is typically something that is enacted by the Board and subject to vote Procedures are guidelines developed by staff to enact the policy; they are not subject to vote by the Board and may be updated as needed to reflect current practice Slide Notes: Medication administration policies and procedures should be followed consistently throughout the district by all administering medications, whether they are licensed health professionals or other personnel designated by the board to administer medications. SLIDE 38 Best Practice Definition by Ohio rule OAC : Best practice standards means procedures, programs, activities or actions that the board has determined to demonstrate effectiveness in assuring the provision of quality health care and improving the health status of a particular population Slide Notes: Many terms are defined in Ohio statute. Best practice is one of the terms defined in Ohio law. This training provides best practices for prescription medication administration in the school setting.

26 Ohio Department of Health-School and Adolescent Health- School Nursing Program 26 SLIDE 39 Policies and Procedures As noted previously, local school boards must have a policy regarding administration of prescription medication in the school As a Home Rule State, local school boards in Ohio have wide latitude in determining their own policies and procedures, informed by best practice, as long as they do not contradict state or federal law Slide Notes: This leads to wide variation in policies and procedures adopted among school districts throughout the state. This presentation will provide examples of policies and procedures based on best practice. The trainer must refer to the policies and procedures of the local school district when providing training to the school personnel administering medications. Local school district policies and procedures are developed based on the student population. According to Schwab & Gelfman (2005), without policy and procedures, school personnel have no reliable source of direction from the district regarding their service parameters or protection regarding alleged violations of their responsibilities. Licensed health professionals/school nurses may be asked by the local school board to provide input or recommendations regarding school district medication administration policy. These slides provide information related to that role. SLIDE 40 Policy Development Definition School Policy : Any governing principle, plan, or course of action; in schools, general rules of procedure adopted by a local board of education Local school district policies and procedures are developed based on the needs of the community and student population Slide Notes: School board/district policy should support parent(s)/guardian(s) in the administration of medications at home whenever possible and should encourage collaboration with the medication prescriber. This helps ensure the establishment of a medication schedule that minimize or eliminates the need for medication administration at school.

27 Ohio Department of Health-School and Adolescent Health- School Nursing Program 27 When the medication must be administered during school and school-related activities, the school district should have a clear and precise written medication policy. This policy will not only provide directions and guidance for medication administration to students according to federal and state laws, but ensure continuity and safety for students requiring medication administration in school. SLIDE 41 Policy Development Considerations School policy should be clear and precise to: Provide direction and guidance Ensure continuity of care Ensure safety for students School policy should encourage families to: Administer medications at home whenever possible Collaborate with the prescriber to establish a medication schedule that reduces the need to administer medication at school Slide Notes: These guidelines should be considered when developing any kind of policy. SLIDE 42 Minimum Recommendations for Policy Content Purpose of policy Acknowledgement of Ohio law requirements Identification of personnel designated to administer medication (by position, not individual name) Identification of policy regarding frequency of training by the licensed health professional Routine notification of parent/guardian about policy (e.g., in School Handbook) Prescriptive medication policy Over-the-counter medication policy Slide Notes: It is likely that a circumstance will arise for which there has not been a specific board policy established. These minimum policy recommendations for procedure content recognize this fact and seek to provide guidance that is consistent with the policies that do exist and applicable state law.

28 Ohio Department of Health-School and Adolescent Health- School Nursing Program 28 SLIDE 43 Policy Development Process Policy committee should include: School administrator School legal counsel School nurse Parent(s) Student(s) Other school personnel Policy should address both prescription and OTC medications Policy should specify if policy is the same or varies among grades Slide Notes: The school board and school administration, in conjunction with the school nurse, other school personnel and in collaboration with the physician or medical advisory committee should develop a policy for the administration of prescriptive and non-prescriptive medications. These guidelines should indicate what age and/or class levels are included, such as kindergarten through grade 12 or, alternatively, separate guidelines for different grades. School districts should seek the advice of legal counsel regarding the district s responsibility for medication administration during school participation. Liability coverage should be provided for the staff, including nurses, teachers, athletic staff, principals, superintendents, school board members and school personnel who are not licensed health professionals. Parents/guardians should be advised annually of the school s medication policy and provided a medication administration informational letter along with necessary medication administration forms if medication is deemed essential during school participation. Any student who must take medication during regular school hours must do so in compliance with the school s medication policy. SLIDE 44 Prescription versus Non-Prescription Definition of Non-Prescription Medication: medicines that may be obtained over-the-counter without a prescription from an authorized prescriber (Schwab, 2005) Ohio law does not address non-prescription or OTC medication administration in the school setting Best Practice for a Non-Prescription Medication Policy: Schwab (2005) recommends that schools apply the same requirements to OTC as prescription medications Helps to ensure the safe practice of medication administration in the school setting

29 Ohio Department of Health-School and Adolescent Health- School Nursing Program 29 Slide Notes: Parents are urged to schedule, to the extent possible, a student s medication outside of school hours. This would include prescription and OTC medications. The ORC addresses only prescription medication in schools. Local school boards must develop their OTC medication administration policy based on the needs of their school community. The recommendation for best practice in this training is not meant to supersede local school board policy. Pros and Cons for OTC Policy PROS: The benefits of OTC pain relievers, antihistamines, etc., may improve student symptoms, thus enabling learning and less classroom disruption With the social reality of working parents, the policy allows students to attend school with minor health issues if medicated with OTCs CONS: Parents may have difficulty obtaining prescriber permission or have to pay a fee for additional paperwork at the prescriber s office Liability of the school district, since OTCs are non-prescribed medications that have the potential to cause harm Issues of school safety and security of medication use (e.g., sharing medications with classmates) SLIDE 45 Recommended Policy for Minimum Qualifications for School Personnel Must be willing to: Participate in training Administer medications Should maintain current CPR/AED and First Aid certification Must successfully complete medication administration training by a licensed health professional annually and when new types of medications are first introduced Slide Notes: These are suggested minimum qualifications for non-health professionals administering medication in schools. Keep in mind that every school population has different needs. For example, some districts may require that school employees administering medication in schools receive annual medication training or must review the medication administration semi-annually. No employee may be coerced into compromising a student s health and safety by being required to administer medication if that person determines that it is inappropriate to do so or determines that they are not competent in a specific medication administration skill. If a school employee is not willing to administer medications as needed, then the employee should be referred to the

30 Ohio Department of Health-School and Adolescent Health- School Nursing Program 30 school district s human resources/personnel department. It is not the role of the licensed health professional trainer to convince the unwilling school employee to be trained and administer medications. SLIDE 46 Minimum Recommendations for Procedure Content Purpose of procedure, relation to policy Procedures for : Documentation Record keeping Confidentiality Correct medication storage Medication drop-off and pick-up instructions, including end of school year procedures Medication inventory count, including policy for missing medication/security breach Disposing of medication and sharps/sharps containers Medication administration on field trip Individualized Healthcare Plans or Emergency Actions Plans Slide Notes: The school nurse or other licensed health professional should be involved in the development of procedures for medication administration or other health care procedures done in the school setting. These procedures should be available to all school staff in writing so that they can be referred to as needed. SLIDE 47 Roles and Responsibilities for Medication Administration The following are suggested roles for school personnel related to designation and training of school personnel administering medication in schools. Roles and responsibilities have been identified for: Local School Board/Administrators Licensed health professional trainer Designated employees who are not licensed health professionals administering medication in the school Slide Notes: There are roles for all school personnel involved in medication administration in the school setting. Roles for parents and students will be reviewed later.

31 Ohio Department of Health-School and Adolescent Health- School Nursing Program 31 SLIDE 48 Roles & Responsibilities of Local School Board/Administrators Adopt and implement policy for medication administration Provide administrative support for compliance with district medication administration policy Designate, in writing, personnel to administer medication Support minimal qualifications of school personnel administering medication in schools Support licensed health professional in providing required training Slide Notes: School administrators are accountable for adopting and implementing the medication administration policy, supporting the licensed health professional in providing an approved medication training (recommend annually) and reviewing policy in order to enrich and maintain safe medication administration policy and procedures. SLIDE 49 Roles & Responsibilities of Local School Board/Administrators continued Assist nurse in educating staff and families about the district s commitment to a safe medication policy Be knowledgeable about liability issues related to medication administration at school, including insurance coverage, personnel covered, etc. Monitor and participate in the evaluation of designated employees Slide Notes: School administrators are accountable for adopting and implementing the medication administration policy, supporting the licensed health professional in providing an approved medication training (recommend annually) and reviewing policy in order to enrich and maintain safe medication administration policy and procedures.

32 Ohio Department of Health-School and Adolescent Health- School Nursing Program 32 SLIDE 50 Roles & Responsibilities of the Licensed Health Professional Trainer Train designees with local school board approved medication administration training program Training program should be standardized Ongoing technical support should be provided Provide professional resources to assist school district in developing or updating medication policy and procedures Participate in assessment of skills of designees to determine who can safely administer medication Understand legal limitations on delegation of medication administration by nurses Slide Notes: While Ohio law does not specify an LSN be the licensed health professional who trains school personnel, it would be logical that the LSN or licensed school nurse wellness coordinator (LSN-WC) employed by the district would be the person to provide the training. OAC defines a licensed school nurse and licensed school nurse wellness coordinator: (F) The professional pupil services license, valid for five years for working with learners at all levels, shall be issued to an individual deemed to be of good moral character who has successfully completed the requirements specified in paragraph (F)(1) or (F)(2) of this rule: (1) An approved program of preparation; recommendation by the dean or head of teacher education; successful completion of an examination prescribed by the state board of education; and evidence of the education and experience requirements specified for whichever of the following licensure areas is applicable: (f) School nurse (i) Baccalaureate degree, and (ii) The requirements specified in paragraph (F)(1) of this rule; and (iii) Current license to practice as a registered nurse issued by the Ohio board of nursing; (iv) A school nurse wellness coordinator endorsement may be added to a professional pupil services school nurse license, or to a professional or permanent school nurse certificate, following completion of an approved program of preparation for the endorsement, and upon evidence of three years of successful experience as a licensed school nurse. The approved program of preparation for the endorsement shall include a practicum experience during which the candidate shall be required to demonstrate the knowledge, skills and dispositions for the school nurse wellness coordinator endorsement as recommended by the school health services advisory council s report (available on the department s website at education.ohio.gov). Beginning January 1, 2020, initial applicants for the school nurse wellness coordinator endorsement shall hold a master s degree.

33 Ohio Department of Health-School and Adolescent Health- School Nursing Program 33 SLIDE 51 Trainers are also encouraged to: Understand, teach and follow all school district policies and procedures related to medications Provide updates as needed on medication information Monitor skills of school personnel on at least an annual basis Alert the school administrators to take corrective action when observing unsafe medication administration Provide an educational program for all students about taking medications safely and appropriately at school Assist parents in understanding the school medication policy and use of necessary medication forms and procedures Share policies, procedures and appropriate forms with local authorized prescribers Slide Notes: The LSN or LSN-WC with a valid ODE professional pupil services license or RN in the school is the employee who brings extensive knowledge and best practices to the school health service program. This licensed health professional must assume a leadership role in policy and procedure development for the school district. While the school nurse may be employed by the school district or a local health department, the Ohio Nurse Practice Act regulates the practice of each nurse; the licensed nurse must practice within the nurse s scope of practice in every setting. The medication training that the licensed health professional provides is one of the most important tasks provided in the school in addition to maintaining a secure medication system. A secure medication system should include policy determining a locked storage system, secure key practice and secure health records, including all medication authorization and documentation forms. SLIDE 52 Roles & Responsibilities of School Personnel Administering Medication in Schools Meet recommended minimal qualifications of school personnel administering medication in schools Maintain confidentiality at all times Successful completion of local school boardapproved medication administration training program Complete self assessment using the Evaluation Check List Slide Notes: Anyone designated, willing and trained in an approved medication program can serve as a designated employee who is not a licensed health professional administering medication in schools (e.g., secretary, office manager, teacher, school administrator). As defined by nursing rule, they are unlicensed in terms of providing health services and can sometimes be referred to as Unlicensed Assistive Personnel (UAP) or non-health licensed professionals by

34 Ohio Department of Health-School and Adolescent Health- School Nursing Program 34 licensed health professionals. While they may be licensed under other law (e.g., licensed teachers), for the purposes of this training they will be considered designated employees who are not licensed health professionals administering medication in schools or simply school personnel. SLIDE 53 Roles & Responsibilities of School Personnel Administering Medication in Schools continued Strictly follow school medication administration policies and procedures Strictly follow medication administration procedures taught in medication administration training program Consult with a licensed health professional for any questions or concerns Slide Notes: School personnel must clearly understand their role, must follow school district policy and procedures, and must receive appropriate medication training to perform all functions associated with the medication training. School personnel must also be willing to communication their own ability to perform safe medication administration and associated documentation by completing a self assessment evaluation upon completion of their training. SLIDE 54 School Personnel Must: Receive appropriate medication training to perform functions associated with medication administration Clearly understand his/her role Communicate any questions or concerns with the school nurse or trainer during the training or school year Ask for additional education and training about medication administration if he/she is uncomfortable with performing a task Slide Notes: It is important to emphasize that the school personnel administering medication in schools must be willing to communicate any questions or concerns with the school nurse or trainer at any time during the training or school year to ensure student safety in medication administration.

35 Ohio Department of Health-School and Adolescent Health- School Nursing Program 35 School personnel administering medication in schools have the right to ask for additional education and training about medication administration if he/she is uncomfortable with performing a specific medication administration task. SLIDE 55 Adult Learners Adults are not just big kids, but have specific learning characteristics. Adult learners: Are autonomous and self-directed Relate their life experience to the subject matter to be learned Are goal oriented Are relevancy-oriented and must see the point of what they are learning Are practical Deserve respect honolulu.hawaii.edu/intranet/committees/facdevcom/guidebk/teachtip/adults-2.htm Slide Notes: The following slides provide a brief overview of some principles of teaching adults. Teaching adult learners can be challenging. Being appointed to provide this training is an honor and an opportunity to share your profession and professional expertise. Maintain a positive attitude and a willingness to share vital information essential to safe medication administration for children in Ohio schools. These are key elements that will enhance your presentation. Having the adult learner buy-in to the comprehensive training experience will guarantee success of your training presentation. SLIDE 56 Recommendations for the Adult Learner The adult learner should: Appreciate the opportunity to Learn Build on his/her experience Participate in safe medication administration for students Share and/or ask questions or concerns during training Be positive Keep focused Take the opportunity during breaks to stretch and refresh the mind and body! Slide Notes: Be sure to respect the skills that adult learners have acquired in their lives. On the other hand, adult learners may need to unlearn skills that were incorrect or that have been updated over time.

36 Ohio Department of Health-School and Adolescent Health- School Nursing Program 36 SLIDE 57 For the Trainer: What will your training look like? Considerations: Will you be training a group or an individual? Will you have access to a computer and projector or will you print the presentation? Are your learners new to medication administration or experienced? Will you use all training modules or only those for types of medications currently administered? Have you made arrangements for a date, time, location and invited/notified the learners of these? Slide Notes: For a successful training, the licensed health professional must make preparations in advance. The following slides contain recommendations and considerations for the trainer when planning and presenting a training. SLIDE 58 Preparation for the Presentation A few days before the presentation: Confirm room arrangements with the facility that is hosting your training Create nametags and a sign in sheet for learners Have adequate handouts and other materials needed for the training Ensure that your equipment is in working order Practice your presentation out loud Mentally rehearse your response(s) to potential participants that are resistant to learning Practice positive teaching methods that will encourage resistant participants to buy in to the medication training Slide Notes: Mentally rehearse your response(s) to potential participants that are resistant to learning. Present positive teaching methods that will encourage resistant participants to buy in to the medication training. Example: I know that your time is valuable and I thank you for being willing participants that want to ensure the safety of medication administration in our school district.

37 Ohio Department of Health-School and Adolescent Health- School Nursing Program 37 SLIDE 59 Preparation for the Presentation: Day of presentation Arrive early to set up equipment and arrange seating Greet each participant personally Be confident! Remember that what you are about to present is valuable and essential to ensuring safe medication administration to Ohio children Slide Notes: Be confident! While not everyone will agree with you 100%, it is important to remember that what you are about to present is indeed valuable and essential to ensuring safe medication administration to Ohio children. SLIDE 60 Key Elements for the Trainer Personal contact conveys your gracious reception of all participants and helps to establish an accepting and hospitable climate Remain calm, polite and neutral during your presentation and when responding to questions Provide time for breaks and stretching every minutes Allow time for the learners to share and demonstrate their new knowledge Keep to the agenda and politely re-focus the discussion back to the main topic which is How do we safeguard children who require medication at school? Slide Notes: These are behaviors of effective teachers.

38 Ohio Department of Health-School and Adolescent Health- School Nursing Program 38 SLIDE 61 Speaker Tips Greet each participant personally upon arrival Thank the learners for their time and attendance Project your voice with enough volume to be heard Raise your voice slightly or use special inflection for emphasis Pause at times for emphasis and/or for questions Avoid complex jargon and technical explanations Use short, concise answers and plain English Encourage questions Have learners write questions and hold until the end of the session Then don t forget to provide the time for these questions! Slide Notes: Avoid just reading slides to the learners. The trainer should talk around the slides by offering examples from practice or the local school setting (remembering to maintain student confidentiality). If there is a small enough group, encourage the school personnel to engage you in discussion related to the training, although be mindful of the agenda and need to complete the training in the time frame allotted. SLIDE 62 Use of Training Modules Decide whether you will provide a comprehensive training using all modules or individual modules based on the types of medications being administered by the learner Teach or review the training for specific types of medications when the school personnel encounter a new medication Use the Basic Guidelines for Medication Administration module with each training Slide Notes: These choices will be based somewhat on local school district policy. For example, if it is against school policy for school personnel to administer medications by injection, then the trainer would not be using those modules. The trainer may provide a training with all of the types of medications that might be administered by school district policy. The trainer might train on routes of medications that there are orders for currently, and conduct further training on additional routes if orders are received mid-year for those. It is recommended that all school personnel receive the 90 minute Medication Overview. The modules are for the training of specific methods to administer medications based upon the route. The following is a list of the medication administration modules: 1. Basic Guidelines for Medication Administration 2. Oral Medication Administration Module

39 Ohio Department of Health-School and Adolescent Health- School Nursing Program 39 SLIDE Opththalmic (Eye) Medication Administration Module 4. Otic (Ear) Medication Administration Module 5. Nasal (Nose) Medication Administration Module 6. Topical (Skin) Medication Administration Module 7. Rectal Medication Administration Module 8. Inhaler Medication with and without a Holding Device Administration Module 9. Nebulizer (Inhalant) Medication Administration Module 10. Injection (Subcutaneous) Medication Administration Module 11. Glucagon Injection Medication Administration Module 12. Medication Administration: Auto-Injector (Epi-Pen) 13. Gastrostomy Tube (G-Tube) Medication Administration Module 14. Emergency Medications Module Timing of Training Modules Module Name Medication Overview Basic Guidelines Oral, eye, ear, nasal, rectal, inhaler, nebulizer G-tube Injection Emergency medication overview Minimum Length of Time 90 minutes 15 minutes 10 minutes each 15 minutes 30 minutes 10 minutes Slide Notes: In addition to the times listed here, the trainer must allow time for a return demonstration of the skills for each learner. That length of additional time will be determined by the number of school personnel in the training. All modules include a posttest. SLIDE 64 MEDICATION ADMINISTRATION OVERVIEW MODULE Slide Notes: This training will take approximately 90 minutes to complete.

40 Ohio Department of Health-School and Adolescent Health- School Nursing Program 40 SLIDE 65 Medication Administration Overview Module Preparation for the training: Review the PowerPoint and training notes Prepare the following handouts: Local school district medication administration policy ORC , ORC , ORC District Medication Administration Record (MAR) District Medication Inventory Record District Medication Documentation Record (MDR) Drop off and Pick up Instructions Field Trip Medication Administration Checklist Slide Notes: All school personnel should receive the Medication Administration Overview training. After that, the training was developed to couple the Basic Guidelines for Medication Administration Module with a module dedicated to a specific route of medication administration. Not all school districts will include each route of medication administration in their district policy. Therefore, each district will choose only the medication administration module appropriate for their district. This not only saves time for the district, trainer and trainee, it allows the trainer and trainee to only focus on medication module trainings that are specific to their district s policy. In addition, recommended medication training should be reviewed twice a year. Separating the training into route-specific modules will also help ensure an efficient way to provide this review. An additional resource for the trainer: Medication Onsite Compliance Checklist found in the Medication Administration Overview Module Appendix. SLIDE 66 Medication Administration Overview Module Preparation for the training continued: Prepare the following handouts: District Medication Incident Report Handwashing Handout The Use of Alcohol-based Hand Sanitizers in the School Setting Medication Calculation Sheet and answer sheet Momentum article about unlicensed practice of nursing Medication Administration Overview Module posttest and answer sheet Slide Notes: Additional handouts for the Medication Administration Overview module.

41 Ohio Department of Health-School and Adolescent Health- School Nursing Program 41 SLIDE 67 Medication Administration Overview Module Preparation for the training continued: Collect tools for learner activities: Pharmacy medication container with sample label Sharps container Alcohol-based hand sanitizer; soap, water, paper towels Gloves Paper, pencil (possibly calculator) for dose calculation activity Local school medication administration policy, procedures and forms Slide Notes: Trainers must be sure to review the local school district policies and procedures for medication administration, as well as the facilities available to those administering medications. Training should be specific to the school district. SLIDE 68 Medication Administration Overview Module Demonstrate to learners how to properly: Read medication orders and pharmacy labels Prepare district forms for medication administration Document medication administration Complete Medication Incident Report Handle sharps Wash hands and use alcohol-based hand sanitizers Prepare field trip medications Follow the Six Rights of Medication Administration Slide Notes: Learners must complete a successful return demonstration on the skills learned in this training module. Document the successful return demonstration on the forms supplied in the Medication Administration Overview Module Appendix of this training or in the manner required by the local school district.

42 Ohio Department of Health-School and Adolescent Health- School Nursing Program 42 SLIDE 69 Medication Administration Overview Module Provide learners with opportunity for return demonstration Have learners complete posttest Document return demonstration Slide Notes: Learners must complete a successful return demonstration on the skills learned in this training module. Document the successful return demonstration on the forms supplied in Medication Administration Overview Module Appendix of this training or in the manner required by the local school district. SLIDE 70 BASIC GUIDELINES FOR MEDICATION ADMINISTRATION: STEPS 1-14 Slide Notes: The Basic Guidelines for Medication Administration should be taught and reviewed with each other medication administration module.

43 Ohio Department of Health-School and Adolescent Health- School Nursing Program 43 SLIDE 71 Basic Guidelines for Medication Administration Module Preparation for the training: Review the PowerPoint and training notes Prepare the following handouts: Local school district medication administration policy District Medication Administration Record District Medication Documentation Record District Medication Incident Report District Medication Inventory Record Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in Basic Guidelines for Medication Administration Appendix. SLIDE 72 Basic Guidelines for Medication Administration Module Preparation for the training continued: Prepare the following handouts: Basic Guidelines for Medication Administration Skills Checklist for Basic Guidelines Basic Guidelines Module Posttest and Answer Key Tips for Oral Medication Common medical abbreviations Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Basic Guidelines for Medication Administration Appendix.

44 Ohio Department of Health-School and Adolescent Health- School Nursing Program 44 SLIDE 73 Basic Guidelines for Medication Administration Module Collect tools for learner activities: Soap, water, towels, alcohol-based hand sanitizer Gloves Medication bottle with pharmacy label Slide Notes: These are the tools that the learners will need access to for the training. SLIDE 74 Basic Guidelines for Medication Administration Module Demonstrate to learners how to properly: Read medication orders Prepare Medication Administration Record and Medication Documentation Record Document medication administration Provide learners with opportunity for return demonstration Have learners complete posttest Document return demonstration Slide Notes: Learners must complete a successful return demonstration on the skills learned in this training module. Document the successful return demonstration on the forms supplied in the Basic Guidelines for Medication Administration Appendix of this training or in the manner required by the local school district.

45 Ohio Department of Health-School and Adolescent Health- School Nursing Program 45 SLIDE 75 ORAL MEDICATION ADMINISTRATION MODULE Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration Module prior to teaching the Oral Medication Administration module. The following slides review the additional trainer preparations for the Oral Medication Administration module. SLIDE 76 Oral Medication Administration Preparation for the training Review the training and PowerPoint Prepare the following handouts: District Medication Administration & Documentation Record Basic Guidelines for Medication Administration Basic Guidelines Skills checklist Oral Medication Administration Oral Medication Administration Skills checklist Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Oral Medication Administration Module Appendix.

46 Ohio Department of Health-School and Adolescent Health- School Nursing Program 46 SLIDE 77 Oral Medication Administration Preparation for the training Prepare the following handouts continued: Oral Medication Administration Tips for Oral Medication Administration Oral Medication Administration Skills checklist Oral Medication Administration posttest and Answer Key Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Oral Medication Administration Module Appendix. SLIDE 78 Oral Medication Administration continued Collect tools for learner activities: Medication cup Liquid to measure Pill bottle and pills/candy Pill splitter or crusher Soap, water, towels, alcohol-based hand sanitizer Slide Notes: These are the tools that the learners will need access to for the training.

47 Ohio Department of Health-School and Adolescent Health- School Nursing Program 47 SLIDE 79 Oral Medication Administration Demonstrate to learners how to properly: Count medication Remove pills from container to administer Pour and measure liquid medication Split and crush pills Provide learners with opportunity for return demonstration Have learners complete posttest Document return demonstration Slide Notes: Learners must complete a successful return demonstration on the skills learned in this training module. Document the successful return demonstration on the forms supplied in Oral Medication Administration Module Appendix of this training or in the manner required by the local school district. SLIDE 80 OPHTHALMIC (EYE) MEDICATION ADMINISTRATION MODULE Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration module prior to teaching the Opthalmic (Eye) Medication Administration Module. The following slides review the additional trainer preparations for the Ophthalmic (Eye) Medication Administration module.

48 Ohio Department of Health-School and Adolescent Health- School Nursing Program 48 SLIDE 81 Ophthalmic (Eye) Medication Administration Preparation for the training Review the training and PowerPoint Prepare the following handouts: District Medication Administration & Documentation Record Basic Guidelines for Medication Administration Basic Guidelines Skills checklist Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Ophthalmic (Eye) Medication Administration Module Appendix. SLIDE 82 Ophthalmic (Eye) Medication Administration Preparation for the training Prepare the following handouts continued: Ophthalmic (Eye) Medication Administration Ophthalmic (Eye) Medication Administration Skills checklist Tips for Eye, Ear & Nasal Medication Administration Ophthalmic (Eye) Medication Administration posttest and answer key Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Ophthalmic (Eye) Medication Administration Module Appendix.

49 Ohio Department of Health-School and Adolescent Health- School Nursing Program 49 SLIDE 83 Ophthalmic (Eye) Medication Administration continued Collect tools for learner activities: Gloves for each learner Cotton balls Saline eye drops Ointment Soap, water, towels, alcohol-based hand sanitizer Facial tissues Slide Notes: These are the tools that the learners will need access to for the training. SLIDE 84 Ophthalmic (Eye) Medication Administration Demonstrate to learners how to properly: Put on, remove and dispose of gloves Wiping eyes with cotton ball Administer eye drops Administer ointment Provide learners with opportunity for return demonstration Have learners complete posttest Document return demonstration Slide Notes: Learners must complete a successful return demonstration on the skills learned in this training module. Document the successful return demonstration on the forms supplied in Ophthalmic (Eye) Medication Administration Module Appendix of this training or in the manner required by the local school district.

50 Ohio Department of Health-School and Adolescent Health- School Nursing Program 50 SLIDE 85 OTIC (EAR) MEDICATION ADMINISTRATION MODULE Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration module prior to teaching the Otic (Ear) Medication Administration module. The following slides review the additional trainer preparations for the Otic (Ear) Medication Administration module. SLIDE 86 Otic (Ear) Medication Administration Preparation for the training Review the training and PowerPoint Prepare the following handouts: District Medication Administration & Documentation Record Basic Guidelines for Medication Administration Basic Guidelines Skills checklist Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Otic (Ear) Medication Administration Appendix.

51 Ohio Department of Health-School and Adolescent Health- School Nursing Program 51 SLIDE 82 Otic (Ear) Medication Administration Preparation for the training Prepare the following handouts continued: Otic (Ear) Medication Administration Tips for Eye, Ear & Nasal Medication Administration Otic (Ear) Medication Administration Skills checklist Otic (Ear) Medication Administration posttest and Answer Key Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Otic (Ear) Medication Administraiton Appendix. SLIDE 88 Otic (Ear) Medication Administration continued Collect tools for learner activities: Gloves for each learner Cotton balls Bottle with dropper and saline or water Soap, water, towels, alcohol-based hand sanitizer Facial tissues Slide Notes: These are the tools that the learners will need access to for the training.

52 Ohio Department of Health-School and Adolescent Health- School Nursing Program 52 SLIDE 89 Otic (Ear) Medication Administration Demonstrate to learners how to properly: Put on, remove and dispose of gloves Wipe ears with cotton ball Draw up proper amount of liquid in dropper Properly position the ear and administer drops Provide learners with opportunity for return demonstration Have learners complete posttest Document return demonstration Slide Notes: Learners must complete a successful return demonstration on the skills learned in this training module. Document the successful return demonstration on the forms supplied in the Otic (Ear) Medication Administration Appendix of this training or in the manner required by the local school district. SLIDE 90 NASAL (NOSE) MEDICATION ADMINISTRATION MODULE Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration module prior to teaching the Nasal (Nose) Medication Administration module. The following slides review the additional trainer preparations for the Nasal (Nose) Medication Administration module.

53 Ohio Department of Health-School and Adolescent Health- School Nursing Program 53 SLIDE 91 Nasal (Nose) Medication Administration Preparation for the training Review the training and PowerPoint Prepare the following handouts: District Medication Administration & Documentation Record Basic Guidelines for Medication Administration Basic Guidelines Skills checklist Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Nasal (Nose) Medication Administration Module Appendix. SLIDE 92 Nasal (Nose) Medication Administration Preparation for the training Review the training and PowerPoint Prepare the following handouts: Nasal (Nose) Medication Administration Nasal (Nose) Medication Administration Skills Checklist Tips for Eye, Ear & Nasal Medication Administration Tips for Transmucosal Administration of Midazolam (opt.) Notes about the use of intranasal Versed in schools (opt.) Nasal (Nose) Medication Administration posttest and Answer Key Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Nasal (Nose) Medication Administration Module Appendix.

54 Ohio Department of Health-School and Adolescent Health- School Nursing Program 54 SLIDE 93 Nasal (Nose) Medication Administration continued Collect tools for learner activities: Facial tissues Bottle with dropper and saline or water Nasal spray Soap, water, towels, alcohol-based hand sanitizer Facial tissues MAD atomizer (opt.) Slide Notes: These are the tools that the learners will need access to for the training. SLIDE 94 Nasal (Nose) Medication Administration Demonstrate to learners how to properly: Put on, remove and dispose of gloves Draw up proper amount of liquid in dropper Administer drops or spray Use of MAD atomizer (opt.) Provide learners with opportunity for return demonstration Have learners complete posttest Document return demonstration Slide Notes: Learners must complete a successful return demonstration on the skills learned in this training module. Document the successful return demonstration on the forms supplied in Nasal (Nose) Medication Administration Module Appendix of this training or in the manner required by the local school district.

55 Ohio Department of Health-School and Adolescent Health- School Nursing Program 55 SLIDE 95 TOPICAL (SKIN) MEDICATION ADMINISTRATION MODULE Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration module prior to teaching the Topical (Skin) Medication Administration module. The following slides review the additional trainer preparations for the Topical (Skin) Medication Administration module. SLIDE 96 Topical (Skin) Medication Administration Preparation for the training Review the training and PowerPoint Prepare the following handouts: District Medication Administration & Documentation Record Basic Guidelines for Medication Administration Basic Guidelines Skills checklist Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Topical (Skin) Medication Administration Module Appendix.

56 Ohio Department of Health-School and Adolescent Health- School Nursing Program 56 SLIDE 97 Topical (Skin) Medication Administration Preparation for the training Prepare the following handouts continued: Topical (Skin) Medication Administration Tips for Topical (Skin) Medication Administration Topical (Skin) Medication Administration Skills Checklist Topical (Skin) Medication Administration posttest and Answer Key Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Topical (Skin) Medication Administration Module Appendix. SLIDE 98 Topical (Skin) Medication Administration continued Collect tools for learner activities: Gloves Hand cream to simulate medication Soap, water, towels, alcohol-based hand sanitizer Wooden tongue depressors Gauze Sample transdermal patch (opt.) Manufacturer s measurement device for topical medications (e.g., Nitropaste paper), ruler Slide Notes: These are the tools that the learners will need access to for the training.

57 Ohio Department of Health-School and Adolescent Health- School Nursing Program 57 SLIDE 99 Topical (Skin) Medication Administration Demonstrate to learners how to properly: Measure prescribed amount of medication Prepare and apply transdermal patch (opt.), ointment, cream, powder Put on, remove and dispose of gloves Administer cream Provide learners with opportunity for return demonstration Have learners complete posttest Document return demonstration Slide Notes: Learners must complete a successful return demonstration on the skills learned in this training module. Document the successful return demonstration on the forms supplied in the Topical (Skin) Medication Administration Module Appendix of this training or in the manner required by the local school district. SLIDE 100 RECTAL MEDICATION ADMINISTRATION MODULE Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration module prior to teaching the Rectal Medication Administration module. The following slides review the additional trainer preparations for the Rectal Medication Administration module. There is a video by the makers of Diastat available online at Dosing.html#c This Web site has a number of resources about Diastat, including an administration training video. Licensed health professional trainers may want to show this short video during training.

58 Ohio Department of Health-School and Adolescent Health- School Nursing Program 58 SLIDE 101 Rectal Medication Administration Preparation for the training Review the training and PowerPoint Prepare the following handouts: District Medication Administration & Documentation Record Basic Guidelines for Medication Administration Basic Guidelines Skills checklist Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Rectal Medication Administation Module Appendix. SLIDE 102 Rectal Medication Administration Preparation for the training Prepare the following handouts continued: Seizure Action Plan Rectal Medication Administration Tips for Rectal Medication Administration Rectal Medication Administration Skills Checklist Diastat Accudial instruction sheet Rectal Medication Administration posttest and Answer Key Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Rectal Medication Administation Module Appendix.

59 Ohio Department of Health-School and Adolescent Health- School Nursing Program 59 SLIDE 103 Rectal Medication Administration continued Collect tools for learner activities: Gloves Diastat Accudial Trainer Glycerine suppositories Rectal applicator Lubricant Tissues, towelette Disposable bedpan Soap, water, towels, alcohol-based hand sanitizer Slide Notes: These are the tools that the learners will need access to for the training. SLIDE 104 Rectal Medication Administration Demonstrate to learners how to properly: Put on, remove and dispose of gloves Position person for rectal medication administration Work with the Diastat Accudial Apply lubricant Insert cream or suppository into applicator Position student on bedpan Provide learners with opportunity for return demonstration Have learners complete posttest Document return demonstration Slide Notes: Learners must complete a successful return demonstration on the skills learned in this training module. Document the successful return demonstration on the forms supplied in the Rectal Medication Administation Module Appendix of this training or in the manner required by the local school district. Diastat Accudial has a training video available online at If you have access to the Internet, you may want to show this short video during the training.

60 Ohio Department of Health-School and Adolescent Health- School Nursing Program 60 SLIDE 105 INHALER (INCLUDING HOLDING DEVICE) MEDICATION ADMINISTRATION MODULE Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration module prior to teaching the Inhaler (Including Holding Device) Medication Administration Module. The following slides review the additional trainer preparations for the Inhaler Medication Administration module. SLIDE 106 Inhaler (Including Holding Device) Medication Preparation for the training Review the training and PowerPoint Prepare the following handouts: District Medication Administration & Documentation Record Basic Guidelines for Medication Administration Basic Guidelines Skills checklist Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Inhaler (Including Holding Device) Medication Administration Module Appendix.

61 Ohio Department of Health-School and Adolescent Health- School Nursing Program 61 SLIDE 107 Inhaler (Including Holding Device) Medication Preparation for the training Prepare the following handouts continued: Inhaler (Including Holding Device) Medication Administration Tips for All Inhalants Medication Administration Inhaler (Including Holding Device) Medication Administration Skills Checklist Inhaler (Including Holding Device) Medication Administration posttest and Answer Key Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Inhaler (Including Holding Device) Medication Administration Module Appendix. SLIDE 108 Inhaler (Including Holding Device) Medication Optional handouts training as needed: Tips for Successful HFA Inhaler Use Manufacturer s instructions for Diskus, Asmanex Self Carry Asthma Inhaler Agreement Authorization for Student Possession and Use of Asthma Inhaler Asthma Medication Administration Record (MAR) Your Road Map for Asthma in Schools Asthma Triple MAR NAEPP/NASN Is the Asthma Action Plan Working? Sample Asthma Action Plan from CDC NAEPP Is Your Asthma Action Plan Working? Slide Notes: These are additional forms found in the Inhaler (Including Holding Device) Medication Administration Module Appendix that the trainer may find useful for this module. Abbreviations: NAEPP=National Asthma Education and Prevention Program NASN=National Association of School Nurses CDC=Centers for Disease Control and Prevention

62 Ohio Department of Health-School and Adolescent Health- School Nursing Program 62 SLIDE 109 Inhaler (Including Holding Device) Medication continued Collect tools for learner activities: Gloves Sample or empty inhalers Examples of holding devices such as spacers Soap, water, towels, alcohol-based hand sanitizer Slide Notes: These are the tools that the learners will need access to for the training. SLIDE 110 Inhaler (Including Holding Device) Medication Demonstrate to learners how to properly: Put on, remove and dispose of gloves Prepare inhaler for use Provide learners with opportunity for return demonstration Have learners complete posttest Document return demonstration Slide Notes: Learners must complete a successful return demonstration on the skills learned in this training module. Document the successful return demonstration on the forms supplied in the Inhaler (Including Holding Device) Medication Administration Module of this training or in the manner required by the local school district.

63 Ohio Department of Health-School and Adolescent Health- School Nursing Program 63 SLIDE 111 NEBULIZER (INHALANT) MEDICATION ADMINISTRATION MODULE Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration module prior to teaching the Nebulizer (Inhalant) Medication Administration module. The following slides review the additional trainer preparations for the Nebulizer (Inhalant) Medication Administration module. SLIDE 112 Nebulizer (Inhalant) Medication Administration Preparation for the training Review the training and PowerPoint Prepare the following handouts: District Medication Administration & Documentation Record Basic Guidelines for Medication Administration Basic Guidelines Skills checklist Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Nebulizer (Inhalant) Medication Administration Module Appendix.

64 Ohio Department of Health-School and Adolescent Health- School Nursing Program 64 SLIDE 113 Nebulizer (Inhalant) Medication Administration Preparation for the training Prepare the following handouts continued: Nebulizer (Inhalant) Medication Administration Tips for All Inhalant Medication Administration Nebulizer (Inhalant) Medication Administration Skills Checklist Nebulizer (Inhalant) Medication Administration posttest and Answer Key Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Nebulizer (Inhalant) Medication Administration Module Appendix. SLIDE 114 Nebulizer (Inhalant) Medication Administration Optional handouts for use with nebulizer (inhalant) medication training as needed: Asthma Medication Administration Record (MAR) You Road Map for Asthma Medication Administration Asthma Triple MAR NAEPP/NASN Is the Asthma Action Plan Working? Sample Asthma Action Plan from CDC Slide Notes: These are additional forms found in the Nebulizer (Inhalant) Medication Administration Module Appendix that the trainer may find useful for this module. Abbreviations: NAEPP=National Asthma Education and Prevention Program NASN=National Association of School Nurses CDC=Centers for Disease Control and Prevention

65 Ohio Department of Health-School and Adolescent Health- School Nursing Program 65 SLIDE 115 Nebulizer (Inhalant) Medication Administration continued Collect tools for learner activities: Gloves Nebulizer machine with tubing, mouthpiece, mask Saline to simulate medication Soap, water, towels, alcohol-based hand sanitizer Slide Notes: These are the tools that the learners will need access to for the training. SLIDE 116 Nebulizer (Inhalant) Medication Administration Demonstrate to learners how to properly: Put on, remove and dispose of gloves Prepare nebulizer equipment for use Turn nebulizer on and off Clean nebulizer equipment after use Dispose of tubing and mask Provide learners with opportunity for return demonstration Have learners complete posttest Document return demonstration Slide Notes: Learners must complete a successful return demonstration on the skills learned in this training module. Document the successful return demonstration on the forms supplied in the Nebulizer (Inhalant) Medication Administration Module Appendix of this training or in the manner required by the local school district.

66 Ohio Department of Health-School and Adolescent Health- School Nursing Program 66 SLIDE 117 INJECTION (SUBCUTANEOUS) MEDICATION ADMINISTRATION MODULE Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration module prior to teaching the Injection (Subcutaneous) Medication Administration Module. The following slides review the additional trainer preparations for the Injection (Subcutaneous) Medication Administration module. SLIDE 118 Injection (Subcutaneous) Medication Administration Preparation for the training Review the training and PowerPoint Prepare the following handouts: District Medication Administration & Documentation Record Basic Guidelines for Medication Administration Basic Guidelines Skills checklist Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration module prior to teaching the Injection (Subcutaneous) Medication Administration Module. The following slides review the additional trainer preparations for the Injection (Subcutaneous) Medication Administration module.

67 Ohio Department of Health-School and Adolescent Health- School Nursing Program 67 SLIDE 119 Injection (Subcutaneous) Medication Administration Preparation for the training Prepare the following handouts continued: Medication Administration: Injection (Subcutaneous) Tips for Injection Medication Administration Medication Administration: Injection (Subcutaneous) Skills Checklist Medication Administration: Injection (Subcutaneous) posttest and Answer Key Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration module prior to teaching the Injection (Subcutaneous) Medication Administration Module. The following slides review the additional trainer preparations for the Injection (Subcutaneous) Medication Administration module. SLIDE 120 Injection (Subcutaneous) Medication Administration Optional handouts for use with module as needed: Hyperglycemia Emergency Action Plan Tips for Diabetic Management Momentum article Insulin orders in the Public School Setting Diabetes Medication Administration Record (MAR) Tri-Form Your Road Map to Diabetes Medication Administration Record (MAR) Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Injection (Subcutaneous) Medication Administration Module Appendix.

68 Ohio Department of Health-School and Adolescent Health- School Nursing Program 68 SLIDE 121 Injection (Subcutaneous) Medication Administration continued Collect tools for learner activities: Gloves Vial Syringe Insulin pen (opt.) Alcohol swabs, band aids, gauze Something to inject into, such as an orange Sharps container Soap, water, towels, alcohol-based hand sanitizer Slide Notes: These are the tools that the learners will need access to for the training. While it may seem unnecessary to have an object such as an orange for the learners to practice injecting into, results from the ODH pilot of this training indicated that this was an especially helpful activity for the learners. SLIDE 122 Injection (Subcutaneous) Medication Administration Demonstrate to learners how to properly: Put on, remove and dispose of gloves Prepare vial and draw up liquid in syringe Dial in dosage on insulin pen (opt.) Prepare skin for injection Perform injection Dispose of syringe and contaminated materials Provide learners with opportunity for return demonstration Have learners complete posttest Document return demonstration Slide Notes: Learners must complete a successful return demonstration on the skills learned in this training module. Document the successful return demonstration on the forms supplied in the Injection (Subcutaneous) Medication Administration Module Appendix of this training or in the manner required by the local school district.

69 Ohio Department of Health-School and Adolescent Health- School Nursing Program 69 SLIDE 123 GLUCAGON INJECTION MEDICATION ADMINISTRATION MODULE Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration module prior to teaching the Glucagon Injection Medication Administration module. The following slides review the additional trainer preparations for the Glucagon Injection Medication Administration Module. SLIDE 124 Glucagon Injection Medication Administration Preparation for the training Review the training and PowerPoint Prepare the following handouts: District Medication Administration & Documentation Record Basic Guidelines for Medication Administration Basic Guidelines Skills checklist Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration module prior to teaching the Glucagon Injection Medication Administration module. The following slides review the additional trainer preparations for the Glucagon Injection Medication Administration Module.

70 Ohio Department of Health-School and Adolescent Health- School Nursing Program 70 SLIDE 125 Glucagon Injection Medication Administration Preparation for the training Prepare the following handouts continued: Quick Reference Emergency Plan for a Student with Diabetes, Hypoglycemia (Low Blood Sugar) Glucagon Administration: A Guide for School Personnel Medication Administration: Glucagon Injection Tips for Injection Medication Administration Medication Administration: Glucagon Injection Skills Checklist Medication Administration: Glucagon Injection posttest and Answer Key Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Glucagon Injection Medication Administration Module Appendix. SLIDE 126 Glucagon Injection Medication Administration continued Optional handouts for use with module as needed: Tips for Diabetic Management Tips for Injection Medication Administration Diabetes Medication Administration Record (MAR) Tri-Form Your Road Map to Diabetes Medication Administration Record (MAR) Slide Notes: These are additional forms found in the Glucagon Injection Medication Administration Module Appendix that the trainer may find useful for this module.

71 Ohio Department of Health-School and Adolescent Health- School Nursing Program 71 SLIDE 127 Glucagon Injection Medication Administration continued Collect tools for learner activities: Gloves Alcohol swabs, band aids Glucagon Demonstration Kit Sharps container Soap, water, towels, alcohol-based hand sanitizer Slide Notes: These are the tools that the learners will need access to for the training. SLIDE 128 Glucagon Injection Medication Administration Demonstrate to learners how to properly: Put on, remove and dispose of gloves Prepare Glucagon for administration Prepare skin for injection Perform injection How to dispose of syringe and contaminated materials Provide learners with opportunity for return demonstration Have learners complete posttest Document return demonstration Slide Notes: Learners must complete a successful return demonstration on the skills learned in this training module. Document the successful return demonstration on the forms supplied in the Glucagon Injection Medication Administration Module Appendix of this training or in the manner required by the local school district.

72 Ohio Department of Health-School and Adolescent Health- School Nursing Program 72 SLIDE 129 EPINEPHRINE AUTO INJECTOR (EPI-PEN) MEDICATION ADMINISTRATION MODULE Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration Module prior to teaching the Epinephrine Auto Injector (Epi-Pen) Medication Administration Module. The following slides review the additional trainer preparations for the Epinephrine Auto Injector (Epi-Pen) Medication Administration module. There is an Epi-pen training video available online at There is a Twinject training video available online at If you have Internet access, you may want to show these short videos during your training. SLIDE 130 Auto-Injector (Epi-Pen) Medication Administration Preparation for the training Review the training and PowerPoint Prepare the following handouts: District Medication Administration & Documentation Record Basic Guidelines for Medication Administration Basic Guidelines Skills checklist Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration Module prior to teaching the Epinephrine Auto Injector (Epi-Pen) Medication Administration Module. The following slides review the additional trainer preparations for the Epinephrine Auto Injector (Epi-Pen) Medication Administration module.

73 Ohio Department of Health-School and Adolescent Health- School Nursing Program 73 SLIDE 131 Auto-Injector (Epi-Pen) Medication Administration Preparation for the training Prepare the following handouts continued: FAAN Food Allergy Action Plan Auto-Injector (Epi-Pen) Medication Administration Tips for Injection Medication Administration EpiPen Patient Insert (Manufacturer Insert) Auto-Injector (Epi-Pen) Medication Administration Skils Checklist Auto-Injector (Epi-Pen) Medication Administration posttest and Answer Key Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Epinephrine Auto Injector (Epi-Pen) Medication Administration Module Appendix. Abbreviation: FAAN=Food Allergy and Anaphylaxis Network SLIDE 132 Auto-Injector (Epi-Pen) Medication Administration Optional handouts for use Auto-Injector (Epi-Pen ) Medication Administration Module training as needed: Medication Administration Record (MAR) Your Road Map for Medication Administration Record for Epinephrine Auto-Injector Epinephrine Auto-Injector Medication Administration Record (MAR) or Severe Allergy MAR Tri-Form Authorization for Student Possession and Use of Epinephrine Autoinjector Self Carry Epi-Pen Agreement Ohio Department of Health Authorization for Student Possession and Use of Epinephrine Autoinjector Slide Notes: These are additional forms found in the Epinephrine Auto Injector (Epi-Pen) Medication Administration Module Appendix that the trainer may find useful for this module.

74 Ohio Department of Health-School and Adolescent Health- School Nursing Program 74 SLIDE 133 Auto-Injector (Epi-Pen) Medication Administration continued Collect tools for learner activities: Gloves Alcohol swabs, band aids Epi-Pen and/or Twinject Trainer Sharps container Soap, water, towels, alcohol-based hand sanitizer Slide Notes: These are the tools that the learners will need access to for the training. SLIDE 134 Auto-Injector (Epi-Pen) Medication Administration Demonstrate to learners how to properly: Put on, remove and dispose of gloves Prepare Epi-pen or Twinject for administration Prepare skin for injection Perform injection Dispose of contaminated materials Provide learners with opportunity for return demonstration Have learners complete posttest Document return demonstration Slide Notes: Learners must complete a successful return demonstration on the skills learned in this training module. Document the successful return demonstration on the forms supplied in the Epinephrine Auto Injector (Epi-Pen) Medication Administration Module Appendix of this training or in the manner required by the local school district.

75 Ohio Department of Health-School and Adolescent Health- School Nursing Program 75 SLIDE 135 GASTROSTOMY TUBE (G-TUBE) MEDICATION ADMINSITRATION MODULE Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration Module prior to teaching the Gastrostomy Tube (G-Tube) Medication Administration Module. The following slides review the additional trainer preparations for the Gastrostomy Tube (G-Tube) Medication Administration Module. SLIDE 136 Gastrostomy Tube (G-Tube) Medication Administration Preparation for the training Review the training and PowerPoint Prepare the following handouts: District Medication Administration & Documentation Record Basic Guidelines for Medication Administration Basic Guidelines Skills checklist Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Gastrostomy Tube (G-Tube) Medication Administration Module Appendix.

76 Ohio Department of Health-School and Adolescent Health- School Nursing Program 76 SLIDE 137 Gastrostomy Tube (G-Tube) Medication Administration Preparation for the training Prepare the following handouts continued: Gastrostomy (G-Tube) Medication Administration Tips for G-Tube Medication Administration Gastrostomy (G-Tube) Medication Administration Skills Checklist Gastrostomy (G-Tube) Medication Administration posttest and Answer Key Slide Notes: Provide the school personnel with the forms used in their district, if available. If those forms are unavailable to the trainer for some reason or have not been developed by a district, the trainer may use the sample forms found in the Gastrostomy Tube (G-Tube) Medication Administration Module Appendix. SLIDE 138 Gastrostomy Tube (G-Tube) Medication Administration continued Collect tools for learner activities: Gloves Disposable towel, tissues Water container, medicine cup ml piston-type, catheter-tipped syringe Pill crusher Extra G-Tube plug Soap, water, towels, alcohol-based hand sanitizer Slide Notes: These are the tools that the learners will need access to for the training.

77 Ohio Department of Health-School and Adolescent Health- School Nursing Program 77 SLIDE 139 Gastrostomy Tube (G-Tube) Medication Administration continued Demonstrate to learners how to properly: Position the student in Put on, remove and dispose of gloves Properly crush tablet using pill crusher Properly mix crushed tablet or opened capsule with water Connect syringe to G-tube, including clamping techniques Slide Notes: Check orders. Some medications should not be given with food, therefore the feedings may need to be on hold for an hour or two before or after giving the prescribed medication. Orders may include the need to determine the amount of residual fluid in the student s stomach, especially after tube feedings. A high residual stomach contents level may indicate decreased motility and prevent the drug from being absorbed completely. Therefore, checking for residuals will require delegation of additional tasks associated with medication administration via a g-tube. SLIDE 140 Gastrostomy Tube (G-Tube) Medication Administration continued Add medication to the syringe Adjust the flow of medication entering g-tube a. If it flows too quickly, lower the syringe b. If it flows too slowly, raise the syringe slightly higher Remove syringe and clamp or resume tube feeding Provide learners with opportunity for return demonstration Have learners complete posttest Document return demonstration Slide Notes: Learners must complete a successful return demonstration on the skills learned in this training module. Document the successful return demonstration on the forms supplied in the Gastrostomy Tube (G-Tube) Medication Administration Module Appendix of this training or in the manner required by the local school district.

78 Ohio Department of Health-School and Adolescent Health- School Nursing Program 78 SLIDE 141 EMERGENCY MEDICATION ADMINISTRATION Slide Notes: The trainer should teach or review the Basic Guidelines for Medication Administration Module prior to teaching the Emergency Medication Administration Module. The following slides review the additional trainer preparations for the Emergency Medication Administration Module. Students may have need of emergency or rescue medications in the school setting. When the need to administer these medications arises, school personnel often panic. Training and practice will give school personnel confidence to allow them to administer emergency medications promptly, appropriately and safely. These are in fact life saving medications this cannot be overemphasized to school personnel who may be reluctant to administer them. SLIDE 142 Emergency Medication Administration Some students have a condition that might require administration of emergency medications These students should have an Individualized Healthcare Plan (IHP) and Emergency Action Plan (EAP) written by the school nurse with the parents, staff and prescriber The EAP tells school staff how to recognize an emergency situation and how to take care of the student in that situation Slide Notes: Development of the EAP and IHP are beyond the scope of this training. Licensed health professionals and school nurses should seek additional appropriate training in the development of these documents for students with chronic health conditions.

79 Ohio Department of Health-School and Adolescent Health- School Nursing Program 79 SLIDE 143 Emergency Medication Administration Common types of illnesses that might require emergency medication administration include: Asthma Diabetes Allergies Epilepsy This training is only for medication administration. You should do additional staff training regarding chronic illness management All school staff should be trained to administer emergency medication Slide Notes: It is recommended that all school staff be trained on the proper response to an emergency situation, whether they know a particular student and his/her health history or not. School personnel who are in a position to participate in the care of a student with a known health concern (potentially including teachers, cafeteria staff, bus drivers, secretaries and others) should all receive training on what to look for and how to intervene in an emergency situation, including how to administer emergency medications. SLIDE 144 Emergency Medications Training Modules for Emergency Medications: (include all appendices specific to module) Inhaler Medication Administration Module Rectal Medication Administration Module (Rectal Diastat ) Glucagon Injection Medication Module Epinephrine Auto-Injector (Epi-Pen ) Medication Administration Module Slide Notes: School districts should provide emergency medication training on the following emergency medications. These modules are included in the medication training for the designated school employees. To ensure student safety, it is recommended that a district mandate emergency medication inservice training for all school employees, including district employees such as bus drivers. Additional handouts available in the Emergency Medication Administration Module Appendix include Emergency Medication Administration and Emergency Medication Module Posttest.

80 Ohio Department of Health-School and Adolescent Health- School Nursing Program 80 SLIDE 145 Emergency Medications ORC (D) Ohio Nurse Practice Act An unlicensed person may perform nursing tasks in an emergency situation Does not require designation, delegation or specific training for unlicensed persons administering emergency medications Training on the administration of these medications improves safety Slide Notes: While medication administration is generally considered a nursing function, ORC (D) states: This chapter does not prohibit any of the following: (D) The provision of nursing services to family members or in emergency situations Thus, school personnel may administer emergency medications in an emergency situation with or without designation by the local school board or training. A copy of this may be found in the Emergency Medication Administration Module Appendix. Local school district prescription medication administration policies must address self-carry medications. Ohio legislation allows designated school personnel to administer prescribed emergency medications in the school setting. It is recommended that school districts develop policies for emergency situations such as respiratory distress, anaphylaxis (life-threatening allergies), epilepsy (seizures) and life-threatening diabetic conditions. School policy should incorporate applicable laws pertaining to emergencies in the school setting. See the Emergency Medication Administration Module Appendix for copies of the laws pertaining to legal protection of those administering emergency medications, including ORC ,

81 Ohio Department of Health-School and Adolescent Health- School Nursing Program 81 SLIDE 146 Emergency Medications Must be specifically ordered for an individual student by the licensed prescriber Nurses who administer medication prescribed for one person to another is at risk of practicing medicine without a license Ohio law prohibits standing orders and stock Epi-pens in schools Slide Notes: Even in emergency situations school staff should NOT give any medication, at any time, to a child unless the medication is ordered for that specific child. This includes nurses who do not have prescriptive authority. School nurses and school personnel can only administer emergency medications to the students for whom the medication has been prescribed. Unless there is a prescriber on site and the school has a pharmacy license, schools may not have stock items such as Epi-pens or inhalers. Below is an excerpt from the FAQs accompanying a Joint Regulatory Statement by the State Medical Board of Ohio, the Ohio Board of Pharmacy and the Ohio Board of Nursing regarding the use of protocols to initiate or adjust medications found in the Emergency Medication Administration Appendix and found online at Q: When is it appropriate to use protocols? A: A protocol may only be used in a true emergency, or for biologicals or vaccines administered to individuals for the purpose of preventing diseases. For all other situations, all orders must be patient-specific with well defined parameters for administration, and authorized by the prescriber prior to implementation. The parameters to be used include: (1) description of the intended recipients, (2) drug name and strength, (3) specific instructions of how to administer the drug, (4) dosage, (4) frequency, and (5) a signature of the authorized prescriber. The administration of drugs that are not patient-specific or authorized by the prescriber prior to implementation would be the unauthorized practice of medicine, which is a felony in this state. Q. What is an example of a "true emergency?" A: For purposes of this rule, examples of "true emergencies" would be cases such as heart attacks, severe burns, cyanide poisonings, electrocutions, or severe asthmatic attacks. Examples of non-emergencies would be earaches, stomachaches, or infections. Schwab (2005, p. 222) states Even in an emergency, medication supplied for one student, including siblings, should never be used for another student. Such a course of action leaves the second student without medication in the event that he or she requires it. Furthermore, the nurse is at risk of practicing medication without a license in using a medication not specifically ordered for that child, and would likely be in violation of school policy which should prohibit the use of one student s medication by another student.

82 Ohio Department of Health-School and Adolescent Health- School Nursing Program 82 Additional excerpts from the law ( OAC , OAC ) may be found in the Emergency Medication Administration Module Appendix. SLIDE 147 Emergency Medications ORC Inhaler Possession If conditions of ORC are met, the student may possess and use the inhaler at school or at any activity, event, or program sponsored by or in which the student s school is a participant Recommend back up inhaler at school Recommend all school staff receive medication training for emergency inhaler use ORC Epinephrine Auto-Injector Possession If conditions of ORC are met, the student may possess and use the inhaler at school or at any activity, event, or program sponsored by or in which the student s school is a participant Law requires back-up epinephrine auto-injector at school Law states must always call 911 after use Recommend all school staff receive medication training for emergency epinephrine autoinhaler use Slide Notes: While the intent of the self carry laws for asthma inhalers and epinephrine auto injectors is similar, there are some differences in the details of the statutes. This slide offers a comparison of the two laws with notes on their differences. SLIDE 148 Questions? Thank you for your attention! Slide Notes: The presenter may choose to offer the learners the opportunity to ask questions throughout the training, or may request that learners hold questions until the end of each module. The trainer MUST provide school personnel opportunity to ask questions at some point in the training. EVALUATION AND POSTTEST School personnel must pass the posttest that accompanies each medication administration training module. The posttest for each section is included in the appendix of handouts for that module. The trainer should document a successful return demonstration by the school personnel for each route of medication administration taught.

83 Ohio Department of Health-School and Adolescent Health- School Nursing Program 83 It is recommended that all trainers use an evaluation form completed by the school personnel to ensure satisfaction with the training. Obtaining these evaluations can allow the trainer to refine the training to provide the best learning experience possible for the school personnel. This improves the safety of the students cared for by the school and school personnel. ACKNOWLEDGEMENTS For the development of this training, the Ohio Department of Health School Nursing Program staff conducted a comprehensive review of the literature and of numerous states standards and guidelines. The staff must also thank the following organizations and individuals for their help in the development of the training: The National Association of State School Nurse Consultants for sharing medication guidelines from their member states for review The Ohio Department of Developmental Disabilities for sharing their training manual for certification and prescribed medications Subject matter experts who reviewed and provided comment on selected portions of the training: o Sally Bowles, Clinical Manager, Nationwide Childrens Hospital o Patricia Christoff, Clinical Pharmacist, Childrens Hospital of Dayton o Amy Dunn, Diabetes Nurse Consultant, Ohio Department of Health o Barbara Hickcox, Asthma Nurse Consultant, Ohio Department of Health o Joan Keith, School Nurse, Upper Arlington City School District o Carol Lynn O Neil, School Nurse, Columbus City Schools o Valerie Sackenheim, Asthma Educator, Cincinnati Childrens Hospital The members of the Stakeholder Review Committee: o Renee Besecker, ONA Council on Practice, Ohio Nurses Association o Monica Drvota, Office of Exceptional Children, the Ohio Department of Education o Lisa Emrich, Practice Consultant Supervisor, the Ohio Board of Nursing o Eva Garchar, President, Ohio Association of School Nurses o Lori Hogue, Supervisor of the School Nursing Program, Medina County Educational Services Center o Mark Keeley, Ohio Board of Pharmacy o Janice Lanier, Consultant o Kathleen Morris, Director of Nursing Practice, Ohio Nurses Association o Nancy Mosca, Nurse Educator, Youngstown State University o Penny Riley, Public Health Nurse, Summit County Health Department The Ohio school nurses who volunteered their time, schools and school personnel for participation in the pilot process: o Janet Wendt, Woodmoore Local School District

84 Ohio Department of Health-School and Adolescent Health- School Nursing Program 84 o Suzanne Blank, Wynford Local School District o Val Rahamut, Vinton County Local School District o Sarah McGraw-Thimmes, Lancaster City School District The school personnel who participated in the pilot process and provided invaluable feedback on the training: o Linda Anderson, Educational Assistant o Joyce Bruntz, Guidance Secretary o Robin Cathers, Building Principal o Linda Cottrell, Educational Assistant o Teresa Disbennett, Athletic Director o Shane Dyer, Assistant Principal o Pamela East, Secretary/Health Assistant o Amy Eppine, Secretary o Marge Gearing, Secretary/Health Assistant o Anthony Hale, Family Support o Mary Ann Hale, Assistant Superintendent o Nathan Hale, Building Principal o Cathy Hammond, Secretary/Health Assistant o Marcia Horman, EMIS Coordinator/Secretary o Patricia Jewett, Secretary/Health Assistant o Ralph Myers, Principal o Amy Noland, Secretary o Grace Pang, Health Assistant o Angela Patterson, Counselor o Stephen Roach, Assistant Principal o Linda Ruy-Bringman, Principal o Shari Sarengen, Health Assistant o Sara Shifley, Secretary o Denise Snyder, Secretary o Jana Taylor, Secretary o Roxann Ward, Substitute/Health Assistant o Walt Weiland, Athletic Director o Tracy Wright, Secretary The staff of the Ohio Department of Health Public Affairs, Graphics and Creative Services Programs