MEDICATION ADMINISTRATION PROCEDURE

MEDICATION ADMINISTRATION PROCEDURE Objective: To provide procedure and protocols to ensure the safe administration of medication to students at school. Always refer to FFAC Legal and FFAC Local for district-approved policy upon which the following procedures are based. Procedural Guidelines: ROLE DESIGNATION AND TRAINING 1. Medication will be administered by the school nurse. In the absence of the school nurse or RN substitute, campus staff designated by the principal will administer medications. (TEC 22.052; FFAC Legal; HB 984) a. Calculation of medication dosage will only be done by the school nurse. b. Part (i.e., ½) of pills as prescribed dose may only be split by the parent, pharmacist or school nurse. c. Initial doses of medication will only be given by the school nurse. d. Injectable medication will only be given by the school nurse, with the exception of the administration of insulin or glucagon to students with diabetes and autoinjectable epinephrine for students with severe allergies. e. Unlicensed Diabetes Care Assistants (UDCA)may provide care for students with diabetes if: i. Designated by the Principal; ii. Trained as a Level III UDCA by the School Nurse; and iii. If parental consent has been given for an UDCA to provide diabetes care to their child. f. Diastat will be given by the school nurse. Assignment of the administration of Diazepam Rectal Gel to Unlicensed Assistive Personnel will be made only with approval of the parent and prescribing physician, and at the discretion of the campus administrator and professional registered nurse. (Refer to Nursing Administration of Diazepam Rectal Gel procedure for additional information). 2. At the beginning of each school year the school registered nurse will: a. Provide a copy of the Principal Assignment for Medication Administration to the principal to be completed. A copy of this will be forwarded to the Health Services Coordinator. The original will be kept in the campus clinic (FFAC Local; TEC 22.052) b. All staff members designated by the principal for medication administration will be trained by the school registered nurse. Training and subsequent review will be documented on the Medication Training Checklist Oral, Inhaled Medication Training Checklist, or medication-specific district training checklist. Documentation of training will be kept on file in the campus clinic. c. Provide a copy of the Principal Designees for Unlicensed Diabetes Care Assistants (Level III Training) to the principal to be completed. A copy of this form will be 1

forwarded to the Health Services Coordinator. The original will be kept in the campus clinic. (HB 984) d. All staff members designated by the principal as an UDCA will be trained by the school registered nurse. Training and subsequent review will be documented on district diabetes training forms. (HB 984) e. Provide training to designated campus employees who care for students with severe allergic reactions on the use of auto-injectable epinephrine. Documentation of training will be done on the appropriate checklists and these will be kept on file in the campus clinic. (TEC 38.015) 3. The school registered nurse will provide individualized medication administration training for staff members who accompany a student on field trips or activities away from campus as needed. a. Documentation of training will be maintained in the campus clinic. b. All medication policies and procedures will be maintained during field trips and offcampus activities. ADMINISTRATION OF MEDICATION (FFAC Legal) 4. To avoid undue classroom interruption, medications will be given only if necessary during school hours as determined by the school nurse, parent, and student s healthcare provider. (Texas DSHS School Health Guidelines) 5. Nurses may refuse to administer medication if, in their best clinical judgment, they believe that doing so would be unsafe for the student. The nurse should always contact the prescribing provider and the student s parent/guardian with concerns. ( 217.11 Standards of Nursing Practice; Texas DSHS School Health Guidelines; DG Legal) 6. Parent/guardian must provide written request/authorization for medication administration including (TEC 22.052; FFAC Legal; FFAC Local): a. Student s name b. Name of the medication to be given and reason for giving c. Date of permission and the number of days the medication is to be given. d. Time the medication is to be given, if applicable e. Signature of the parent/guardian f. Written request/authorization is valid for one school year OR less if revoked by the parent (Texas DSHS School Health Guidelines. 7. Medication will be provided by the parent/guardian (TEC 22.052; FFAC Local): a. Prescription in a properly labeled prescription bottle from a pharmacy that includes the student s name, physician, instructions for administration, and is not expired. b. Over-the-Counter (OTC) in the manufacturer s packaging, labeled with the student s first and last name, is not expired, and preferably unopened. 2

8. OTC medications: a. Must have written physician s order, or order from healthcare provider with legal prescriptive authority. b. Must be listed in the Physician s Desk Reference or other lawful formulary; c. Are FDA-approved for use in children, as applicable to the student s age; 9. A properly labeled prescription container, including dosage and frequency, is acceptable as the prescriber s signature for oral, instilled, topical and inhaled medications. Physician or legally authorized prescribing healthcare provider orders are required for: a. Prescription labels that do not provide adequate instructions, such as give as directed, PRN or as needed but no frequency given. b. Prescription medications given by feeding tube, injection, rectally, or nebulizer treatments followed with chest physiotherapy must written physician s orders. c. OTC medications containing aspirin or aspirin derivatives for students age 12 and older (refer to Medications Containing Salicylates section). d. OTC medications that may be needed for more than 5 days (one school week). After that a request from the student s physician may be required at the discretion of the school nurse as long-term need for OTC medication may indicate the need for clinical evaluation and possible treatment. 10. Herbal substances or dietary supplements will only be given if provided by the parent and if required by the student s individualized education program (IEP) or Section 504 plan of a student with disabilities. (FFAC Local) Before approval to administer/add to a student s IEP/Section 504 plan the parent/guardian, with the assistance of the school RN, will provide: a. Written order from a healthcare provider authorized to prescribe in Texas; b. Identification of the condition for which the product is being used; c. Written request from the parent/guardian; d. Verification that the product and requested dosage are safe for the student (considering age, body weight, and condition); and e. Reasonable information about therapeutic and untoward effects and interactions. 11. Off-label medications are those that are FDA approved legal medications that are prescribed for non-approved indications in children (medications prescribed in doses or routes outside FDA guidelines; medications known to be safe in adults and prescribed without long-term studies demonstrating safety in children; or medications approved to treat one type of medical condition but prescribed for a different medical condition). Before administration at school, off label medications require: a. Written consent from the parent/guardian; b. Physician s order for the medication that includes adequate information to support the safe administration at school including benefits and potential side effects for the student, and signs/symptoms for which to notify the prescribing physician; c. Sources of information to provide reasonable medical evidence concerning the medication and the condition for which it is being prescribed including published anecdotal reports, reports from the medication manufacturer or reliable pharmacy, current medical journals, or information from a pediatric medical or mental health facility. 3

12. Research/Experimental medications requests will be evaluated on a case-by-case basis by the school nurse and the prescribing healthcare provider. Requests must be accompanied by: a. A copy of the written protocol or study summary from the research organization; b. A copy of the detailed consent form signed by the parent/guardian which describes the study (including potential benefits and risks); c. Signs and symptoms of adverse reactions to be reported; and d. The names(s) and telephone numbers of the investigator or research team. 13. Changes in medication can be received via telephone from the prescribing physician, but must be confirmed in writing within 3 days of the change. Legible faxed orders and changes will be accepted. 14. DO NOT USE ONE STUDENT S MEDICATION FOR ANOTHER. 15. Medication orders and requests must be updated annually. 16. Nurses in Texas may accept orders only from those physicians who are legally authorized to practice in Texas; however orders from physicians licensed in other US states may be implemented on a temporary, 30-day basis while families new to Texas establish a medical home. (Texas DSHS School Health Guidelines; Texas Medical Practice Act; Texas Nurse Practice Act; Texas Board of Nursing) 17. Sample medication provided by a physician can be administered when accompanied by a written order for the medication from the student s healthcare provider AND written permission from the child s parent/guardian. The sample medication should only be given until a proper prescription can be obtained by the parent/guardian. (Texas DSHS School Health Guidelines) 18. The Rights of Medication Administration will be followed for each medication given: a. Right Student properly identify student (see #15, Two Unique Patient Identifiers, below) b. Right Time Administer medication at the prescribed time. Unless otherwise specified by the healthcare provider or the pharmacist, medication can be given up to 30 minutes before or after the prescribed time. c. Right Medicine Administer the correct medication. Check 3 times. d. Right Dose Administer the right amount of medication. e. Right Route Use the prescribed method of medication administration. 19. Two unique patient identifiers will be available to all nurses, principal designated staff, and nurse subs who administer medication. A minimum of two unique patient identifiers will be used to properly identify the right person prior to administration of a medication. The school nurse will ensure that a minimum of two unique patient identifier are available for all medications to be administered by principal designated staff and/or nurse subs. Acceptable patient identifier include: a. Student verbalization of name, or DOB, or Rockwall ISD Student ID number b. Rockwall ISD Student badge with picture and/or ID number c. Student Picture (printed and attached to Permission to Administer Medication format OR on Skyward Student) printed with name, DOB, and Rockwall ISD Student ID number. d. Verification of student s identity with another Rockwall ISD staff member 4

MEDICATION CONTAINING SALICYLATES 20. Medication containing Salicylates (aspirin) should not be giving to children under 19 years of age during episodes of fever-causing illnesses due to the risk of Reye s Syndrome. (FDA, CDC, American Academy of Pediatrics) 21. Aspirin may be labeled as an ingredient on medications with the following terms: a. Acetylsalicylate b. Acetylsalicylic acid c. Salicylic acid d. Salicylate e. Bismuth subsalicylate or bismuth salicylate (a derivative of salicylic acid) 22. No OTC medication containing salicylic acid or its derivatives will be given to students under the age of 12. 23. Administration of OTC medications containing salicylic acid to students 12 and older requires a doctor s note/order prior to administration. 24. The student s temperature will be checked and documented on the medication administration record calendar or Skyward medication administration prior to administration of each dose. STORAGE OF MEDICATION 25. All medications classified as controlled substances will be counted upon receipt in the clinic. This pill count will be documented by the school nurse and witnessed by one other campus staff member. Liquid medications that are classified as controlled substances will be counted by estimating the volume by the measurement markings on the prescription bottle. 26. Storage of medications that are not taken daily throughout the year will be limited to a 30 day supply. 27. Storage of medications that are administered on a daily basis should be limited to a 30 day supply. 28. All medications will be kept in locked cabinets in the clinic with the exception of: a. Medications that are classified as controlled substances will be kept in a double-lock medication cabinet in the clinic. b. Medications requiring refrigeration will be kept in the clinic refrigerator. c. Emergency epinephrine should be kept unlocked during business hours/when students are present to assure quick access by the school nurse or trained staff. d. Students with asthma or severe allergies may carry their own prescription asthma or anaphylaxis medication while on school property or at school-related events (refer to Asthma/Anaphylaxis Self-Administration section). Emergency autoinjectable epinephrine may be kept nearby students at the discretion of the professional registered nurse. e. Diazepam Rectal Gel kept nearby students with history of seizures at the discretion of the professional registered nurse. 5

29. Access to medication cabinet keys will be limited to the principal, nurse, and staff designated for medication administration by the principal. 30. It is the responsibility of parents to take unused medication home. Written notification will be given to parents to pick up unused medication and any left will be destroyed at the end of the school year. (Texas DSHS School Health Guidelines) ASTHMA/ANAPHYLAXIS SELF-ADMINISTRATION OF PRESCRIPTION MEDICATION 31. Student who demonstrate competency in self-administration of rescue asthma or anaphylaxis medications may self-carry their medications while at school or school-related events. (TEC 38.015; FFAC Legal) a. The medicine has been prescribed for that student as indicated by the prescription label on the medication; b. The student has demonstrated to their healthcare provider and school nurse that they can competently self-administer their prescription medication, including any device required to administer the medication; c. The parent provides written request/authorization to the school nurse for the student to self-administer their asthma/anaphylaxis prescription medication; d. Written statement signed by the student s healthcare provider is provided that states the student has asthma/anaphylaxis and is capable of self-administering their medication. MEDICATION ADMINISTRATION DOCUMENTATION 32. Scheduled and as-needed medication requests will be entered into Skyward by the school nurse. Documentation of medication administration will be completed on Skyward by the school nurse. 33. Binders for scheduled and as-needed medication requests with administration logs will be kept in each clinic. When the school nurse is absent: a. Principal designated staff or nurse subs will review the medication binders at the beginning of the school day to determine students who need medication. The school nurse may also leave a printed scheduled medication worksheet from Skyward or other list of scheduled medications for the substitute. b. Nurse sub/designated campus staff will document medication administration on the calendar on the back of each student s Permission to Administer Medication form in the appropriate box for the date. The individual will initial and note the time given or appropriate code/reason for not giving the medication. 34. Record the administration of medication immediately, or as soon as feasible, after administering the medication. 35. A No Show is not acceptable. Check attendance and make sure the student is in school. Contact the student to come to the clinic for their medication. Contact the parent if the student still does not appear for medication and document. (Texas DSHS School Health Guidelines) 6

36. If a medication error is made, a complete student physical assessment with appropriate interventions must be performed. Report medication errors immediately to the school nurse, principal, parents, Health Services Coordinator and student s healthcare provider (as applicable). 37. A written medication variance report will be provided on the day of the incident to the Health Services Coordinator. MEDICATION ADMINISTRATION OFF SCHOOL GROUNDS (FIELD TRIP OR CAMP) 38. Principals will designate other school employees to administer medication while a student is involved in a school-related event away from school property if no school nurse or nurse substitute accompanies the students. (Ed Code 22.052) 39. The school nurse will ensure that the principal designated employee is properly trained to administer medication, and training is documented and kept on file in the clinic. 40. The nurse or clinic assistant will prepare the dose(s) of medication to be taken on the field trip the day before the field trip.. a. Only the required doses of medication will be taken on the field trip. b. Medication taken on the field trip will be properly labeled with the student s name, name of medication, dosage, time to be given, and route of administration. The remainder of the student s medication will be kept in the clinic in a properly labeled container. The school nurse may request a second medication label or properly labeled bottle from the parents for prescription medication. Parents can obtain this from their pharmacy. c. A copy of the Permission to Administer Medication form will be included with the medication. The authorized school employee on the trip will administer the medication at the appropriate time(s), and will document administration on the medication administration calendar on the back of the Permission to Administer Medication form. Upon return from the field trip, the copies will be kept with the original medication forms in the clinic. d. The School Nurse will document FT (field trip) in Skyward or the original medication calendar in the clinic. 41. For overnight camps the school nurse or clinic assistant will: a. Send out written request with deadline for parent to provide authorization and medications necessary during overnight camp dates. This will also include written authorization for OTC medications approved for use at overnight camp. i. Only OTC medications with current standing orders will be administered at camp. ii. Standing orders for camp medications will be reviewed and renewed annually by the Health Services Coordinator and district s Medical Advisor. b. Only the required doses of medication will be taken on the field trip. c. Collect and organize the medications and authorizations prior to departure for camp. A copy of the Permission to Administer Medication form will be included with the medication. The authorized school employee on the trip will administer the medication at the appropriate time(s), and will document administration on the 7

medication administration calendar on the back of the Permission to Administer Medication form. Upon return from camp, the copies will be filed in the student s health record OR kept with the original medication forms in the clinic for medications that are administered at school. d. Medication taken on the field trip will be properly labeled with the student s name, name of medication, dosage, time to be given, and route of administration. The remainder of the student s medication will be kept in the clinic in a properly labeled container. The school nurse may request a second medication label or properly labeled bottle from the parents for prescription medication. Parents can obtain this from their pharmacy. 42. All district medication policies and procedures will be followed during field trips and overnight camps. 8