Recommended guidelines for medication administration in schools
Objective At the end of the session the nurses will be aware of the HAAD standards and roles and responsibilities of a nurse in medication administration. promote student health and safety in administering medications in schools
HAAD Standards It sets out the service specifications for administration of medication in schools and for record keeping in order to ensure that treatment is administered in accordance with the laws and regulations of the Emirate of Abu Dhabi and consistent with HAAD policies and standards.
School Medication Policy In line with HAAD standards, Schools should develop a clear School Medication Policy understood and accepted by staff, parents and students to ensure that children with medical needs receive proper care and support in a school or other school related settings.
Continuation.. This policy should include the administration of the emergency medication, prescribed medication and medication needed that is not prescribed.
Objective of School Administered Medication Example definition from the USA The purpose of administering medication is to help each student maintain an optimal state of health to enhance his or her education. The administration of medication to students should be discouraged unless absolutely necessary for the student s health.
Aim of School Supervised Medication Example from the UK The primary aim of educating children and young people who have medical needs is to minimise, as far as possible, the disruption to normal schooling by continuing education as normally as the incapacity allows.
Continuation. Enabling children and young people to access education appropriate to their medical condition is important to their future mental and physical development. (Bradford UK).
Continuation All medicines are drugs. The purpose of the school s policy is to ensure that these drugs are taken in an appropriate manner and in a safe environment. (Bradford UK).
Administering The Medication Definition Administering the medication Accepted nursing practice holds that to administer means to select the correct medication, deliver it by the correct route, and to give it to the student at the time prescribed.
The 7 rights The 7 rights: 1. Right Drug 2. Right Patient. 3. Right Dose. 4. Right Time. 5. Right Route. 6. Right Reason. 7. Right Documentation
A policy should include: 1. Procedures for managing medications. 2. A clear statement on the roles and responsibility of staff managing administration of medications. 3. A clear statement on parental responsibilities in respect of their student s medical needs. 4. The need for prior written agreement from parents before any medications can be given to a student.
Continuation 5. Staff training in managing medications safely and supporting an identified individual child. 6. Record keeping. 7. Ensuring that student confidentiality is protected.
Continuation 8. Safe storage and disposal of medications. 9. Quick access to the school s emergency procedures and emergency medication. 10. Risk assessment and management procedures.
Administration of Prescribed Medication Medication should only be taken/ administered at school when essential (i.e. detrimental to a child s health if they are not taken during the school day).
Continuation... School and settings should keep prescribed medication in a locked non-portable container and only named staff have access. A record should be kept for audit and safety purposes. School nurses should ensure that the following are complete before administering
Prior to the administration of prescribed medication: Signed Medication Consent Form by parent/guardian. This should be renewed on an annual basis or when there is a change to the prescription. Copy of the prescription form.
Continuation... Medications should be provided by parents in the original container and include the prescribes instructions for administration and dosage. School nurses should not accept medication that is provided in a different container or if changes have been made to the prescription instructions
Medication should be returned to the student s parents when: The course of treatment is complete. Medication labels become detached or unreadable. Prescription instructions are changed. The expiry date has been reached. End of school term/ year.
Returning medications to parents: Send parents a request to come and pick up the medication. Medications returned to parents must be documented on the student medical record, including name of medication and return date. Obtain the signature from parents/guardian receiving the medication as well as the school staff member returning the medication.
Administration of medication needed that is not prescribed Staff should never give a non-prescribed medication unless there is specific prior consent from the parents. All medication must be appropriate for the age group and be given in line with product specifications.
Continuation.. Parents must inform the school of any known allergies, medical conditions and contraindications and this must be kept in the student school medical record.
Continuation... Before administering the medication, staff should check in the student medical record that there are no contra-indications to the medication. Whenever possible parents should be contacted prior to administering the medication.
Administration of Emergency Medication Emergency medications are often given by non-oral routes. Some require training to administer.
Continuation. Some medications, such as epinephrine injections for severe allergic reactions or oral glucose for hypoglycemia (low blood sugar), have few significant adverse effects. Because these episodes, by nature, occur at unpredictable times when a school nurse may not be available, trained designated school staff should be available
Continuation... Individual care plans should be in place for students and staff members whose health conditions may cause them to experience emergencies (e.g. known food or insect anaphylaxis, asthma, diabetes, hemophilia etc.)
Continuation. Emergency medication needs to be kept safe, secure but quickly accessible in an emergency. The details of this should be included in the School Medication Policy
Administration of Epinephrine in acute allergic reactions (Anaphylactic shock): Epi-pens (Epinephrine) Epi-pen is an auto-injector device, which contains a single measured dose of adrenaline (also known as epinephrine) for administration in cases of severe allergic reaction. A version containing half the standard dose of adrenalin (EpipenJr) is available for small children under 20kg.
Continuation... When the child has signs of an acute allergic reaction, the Epipen5 should be given according to the instructions. Not giving the Epi-pen can be much more harmful than giving it when it may not have been necessary. The Epinephrine should be readily accessible for use in an emergency.
Administration of Epinephrine in acute allergic reactions (Anaphylactic shock): The Epi-Pen should be stored at room temperature and protected from heat and light. It should be kept in the original labeled box. Expiry dates and discoloration of contents should be checked by the school nurse monthly.
Continuation... The Epi-Pen should be replaced by the school at the request of the school nurse in private schools, and by Ambulatory Healthcare Services School Health Services in public schools The use of the Epinephrine must be recorded on the student s medication administration record, with time, date and full signature of the person who administered the Epinephrine.
Continuation... Once the Epinephrine is administered, an ambulance/ emergency room must be called for follow up and transfer. The used Epi-pen should be given to the ambulance crew so that they will know what medication the student has received.
Continuation. Student is allowed to keep and self-administer Epipen provided the parent consent form is filled and signed by the physician and parent/guardian.
Administration of metered dose inhaler (Salbutamol): Children with asthma need to have immediate access to their reliever inhalers when they need them. Children who are able to use their inhalers themselves should be allowed to carry them with them. If the child is too young or too immature to take
Continuation... personal responsibility for the inhaler, staff should make sure that it is stored in a safe, but accessible place, and clearly marked with the child s name. For children with asthma, the child s pediatrician/ health care professional must prescribe a spare inhaler to be kept in the school or setting.
Continuation. When a child has an asthma attack they should be treated according to their individual health care plan or asthma card as previously agreed. An ambulance should be called if any warning signs are identified
Continuation... An appropriate inhaler can be provided if the child forgets his own inhaler, or runs out of his own inhaler. A spacer device should be available along with the inhaler. Expiry dates of the inhaler should be checked by the school nurses monthly. The spacer device needs to be cleaned at least once a month.
Record Keeping The Consent to Administer medications needed that are not prescribed Form, must be completed and signed by parents annually. Where appropriate, consent to administer prescribed medication should be filled in by the referring physician and signed by both the physician and parent. A record should be kept of the administration. All forms should be kept in the student s medical file.
Medication management Medications storage School Nurse should only store, supervise and administer medications that are registered with the Federal Ministry of Health (MOH). All medications must be stored in the designated medication storage area (cupboard in the nurse office or medication fridge).
Continuation... Storage areas must be kept locked at all times. Keys remain the responsibility of the nurse with special access arrangements when she is not available. Emergency medication, however should be quickly available when needed.
Continuation. Medications should be stored strictly in accordance with product instructions (paying particular note to temperature) and in the original container in which dispensed. Large volumes of medications should not be stored
Medication management The medications are only accessible by the nurse. All emergency medications should be readily available for children and should not be locked away but kept in a safe, secure, accessible place. The school administration and nurse must make a special access arrangements for emergency medications that it keeps.
References HAAD Standards for Administration of Medication in Schools 2010 PHP/FSH Ver 0.9 Local School District Illinois USA School Policy on Medications Bradford UK