MEDICATION ADMINISTRATION TRAINING

1
MEDICATIONADMINISTRATION TRAINING

• PERSON COUNTY SCHOOLS
• 2009-2010

2
Medication Training

• This training is required annually.
• School personnel may administer drugs or
  medication prescribed by a physician upon the
  written request of the parents. To minimize
  disruptions to the school day, medicines should
  be taken at home rather than at school whenever
  feasible.
• School personnel should not agree to administer
  any medication that could be taken at home.

3
Medication Policy

• All medications will be dispensed by the
  principal or the principals designee. No
  medications shall be dispensed without the
  required written permission.
• The board generally encourages school personnel
  to administer medicine from a centralized
  location. However, in all instances, whether
  from a centralized location or multiple
  locations, any medicines kept at school for a
  student must be kept in a locked and secure
  place.
• Review policy and procedure for Policy Code
  6125 Administering Medicines to Students

4
Medication Policy

• PARENT and PHYSICIAN written approval must be
  presented to school administration before ANY
  medication will be given. (over-the counter or
  prescription)
• NO non-prescription aspirin or aspirin products
  will be given to any student, even with parental
  permission, due to the possibility of Reye's
  syndrome.

5
Medication Administration

• A Medication Administration Order form must be
  signed by a PHYSICIAN and PARENT for PRESCRIPTION
  and OVER-THE-COUNTER medications! Requests are
  valid only if a person licensed to prescribe
  medications has made the request.
• The Medication Administration Order form is
  available in the main office at each school, on
  the school systems website, or directly from the
  school nurse.

6
Medication Administration

• This permission form is effective for the same
  school, 365 calendar days, and must be reviewed
  annually. If the students medication, dosage, or
  physician changes during the school year, a new
  order must be completed.
• All prescription medication shall be kept in a
  container properly labeled by a pharmacist with
  the child's name, the name of the medication, and
  the dosage, time and frequency to be given. All
  non-prescription medication shall be in the
  original container, properly labeled with the
  child's name and instructions for administration.
  Pillboxes, plastic bags, unlabeled bottles, etc.
  will not be accepted.

7
Self Medication at School

• Students with asthma and/or subject to
  anaphylactic reactions may need to possess and
  self-administer asthma medication on school
  property. As used in our medication policy,
  asthma medication means a medicine prescribed
  for the treatment of asthma or anaphylactic
  reactions and includes a prescribed asthma
  inhaler or epinephrine auto-injector.

8
Self Medication at School

• 1. Before a student will be allowed to
  self-administer medicine, the students parent or
  guardian must provide to the principal or
  designee all of the documents listed below.
•  a. written authorization from the students
  parent or guardian for the student to possess and
  self-administer asthma medication
•  b. a written statement from the students health
  care practitioner verifying
• that the student has asthma and/or an allergy
  that could result in anaphylactic reaction
• that he or she prescribed medication for use on
  school property during the school day, at
  school-sponsored activities, or while in transit
  to or from school or school-sponsored events and

9
Self Medication at School

• that the student understands, has been
  instructed in self-administration of the asthma
  medication, and has demonstrated the skill level
  necessary to use the medication and any
  accompanying device
• c. a written treatment plan and written
  emergency protocol formulated by the prescribing
  health care practitioner for managing the
  students asthma or anaphylaxis episodes and for
  medication use by the student
• d. a statement provided by the school system and
  signed by the students parent or guardian
  acknowledging that the board of education and its
  agents are not liable for injury arising from the
  students possession and self-administration of
  asthma medication and 
• e. any other documents or items necessary to
  comply with state and federal laws.

10
Self Medication cont.

• 2. Prior to being permitted to self-administer
  medicine at school, the student also must
  demonstrate to the school nurse the skill level
  necessary to use the asthma medication and any
  accompanying device.
•  
• 3. The students parent or guardian must provide
  to the school backup asthma medication that
  school personnel are to keep in a location to
  which the student has immediate access in the
  event of an emergency.

11
Self Medication at School

• All information provided to the school by the
  students parent or guardian must be kept on file
  at the school in an easily accessible location.
  Any permission granted by the principal for a
  student to possess and self-administer asthma
  medication will be effective only for the same
  school for 365 calendar days. Such permission
  must be reviewed annually.
• A student who uses his or her prescribed asthma
  medication in a manner other than as prescribed
  may be subject to disciplinary action pursuant to
  the school disciplinary policy. No one may impose
  disciplinary action on the student that limits or
  restricts the students immediate access to the
  asthma medication.

12
Transportation of Medications

• The school will not be responsible for the
  transportation of medication to and from school.
• It is the responsibility of the parent to ensure
  that proper medication is brought to school and
  provided to the appropriate school official and
  to assure that the appropriate written permission
  is provided.

13
Medication Disposal and Documentation

• It is the parents responsibility to pick up the
  medication from the school within two days of the
  discontinued date or within two days from the
  last date of the school year. If medication is
  not picked up within the require time frame, it
  will be disposed of by the principal or
  principals designee.
• A Medication Inventory, Audit, and Disposal
  Documentation form will be filled out when
  medication is brought to school and when
  medication is disposed of. That form will
  indicate the student's name, the type of
  medication received, the person from whom the
  medication is received, the date the medicine was
  received, the amount of medication received, and
  the signature of the person who received the
  medication. It will also include the emptying and
  disposal dates of the medication.
• The school nurse will conduct quarterly
  medication audits to ensure that the medication
  is being dispensed in accordance with the
  Medication Administration Order and board policy.

14
Medication Administration Record

• A Medication Administration Record will be kept
  to document the administration of all medications
  which a student has received during school hours.
  The log shall include
• The student's name
• Date and Time of medication administration
• The name of medication being dispensed
• The dosage of medication given
• Signature of the person dispensing the medication
  
• Always write in BLACK ink only on any medication
  forms. IF YOU MAKE AN ERROR ON THE FORM, ALWAYS
  DRAW THROUGH IT WITH ONE BLACK LINE AND WRITE
  ERROR ABOVE IT ALONG WITH YOUR INITIALS. Make
  sure you sign and place your initials at the top
  of every MAR.

15
Completing the Medication Log

• Copy information exactly as it is on the
  Medication
• Administration Order Form
• Document daily when medication is given
• BY PLACING YOUR INITIALS IN THE BOX. PLACE THE
• APPROPRIATE CODE IN THE BOX IF YOU DID NOT
• GIVE THE MEDICATION!
• 
  
• ALWAYS NOTIFY NURSE IF CHILD IS NOT
• COMING TO GET MEDICATION/NONCOMPLIANT,
• ETC.
• IF A STUDENT DOES NOT SHOW UP, YOU HAVE
• TO FIND THEM AND GIVE THEM THEIR
• MEDICATION EACH DAY AS ORDERED! NO
• EXCUSES!

16
MAR Codes

• AB ABSENT
• N/A NOT APPLICABLE
• FTFIELD TRIP
• D/C MEDICATION DISCONTINUED
• NMS NO MEDICATION AT SCHOOL ( MUST CONTACT
  PARENT)
• R REFUSED (MUST CONTACT PARENT)
• NS NO SCHOOL
• YOU MUST FILL IN THESE CODES WHEN APPLICABLE ON
  EVERY MAR FOR EVERY STUDENT
• Notice, there is no code for forgot because
  this is unacceptable. Each day, you must give the
  medication as ordered!

17
Medication Inventory, Audit, and Disposal
Documentation

• A Medication Inventory, Audit, and Disposal
  Documentation form will be completed when
  medication is brought to school and when
  medication is disposed of. That form will
  indicate the student's name, the type of
  medication received, the person from whom the
  medication is received, the date the medicine was
  received, the amount of medication received, and
  the signature of the person who received the
  medication. It will also include the emptying and
  disposal dates of the medication.
• The school nurse will conduct quarterly
  medication audits to ensure that the medication
  is being dispensed in accordance with the
  Medication Administration Order and board policy.
• This form should be copied (2-2 or double sided)
  to the back of each students MAR. It can also be
  stapled or placed behind each MAR.

18
THE 6 RIGHTS OF MEDICATION ADMINISTRATION
19
Right Student

• Ask students name or call name before medication
  given!
• Having a picture id of student is also helpful.

20
Right Medication

• Check prescription bottle for correct
  prescription information
• Check MAR and Medication Administration Order to
  be sure information is the same

21
Right Dose

• Check dose listed on
• prescription bottle
• Check dose that is
• listed on the MAR
• Do not give if dose is incorrect!

22
Right Time

• Check time on MAR and the Medication
  Administration Order
• Medications must be given within a 30 minute
  window of the time ordered. (example If the
  medication is written to be given at 1200pm, you
  can give it anytime between 1130 until 1230.)

23
Right Route

• Make sure that you give the medication the way it
  is ordered to be given!!
• Do not give a rectal medication by mouth or an
  ear drop by mouth? You get the idea?
• Call the school nurse with any questions about
  the proper route for medication administration

24
RIGHT WRITE DOCUMENTATION

• If you dont document, there is no record that
  you gave the medication or performed the
  procedure and therefore, it never happened. You
  must document each day that you gave the
  medication or procedure as ordered.

25
Oral Medications
26
Tablets/Capsules

• Medication given by mouth
• Only break tablets that are scored. Do not open
  any capsules or break any tablets unless the
  physician specifically orders it.

27
Liquids

• When measuring liquids use the appropriately
  labeled measuring device provided by the
  pharmacy cup or syringe.
• Check to be sure if medication needs to be
  refrigerated.

28
Inhalers

• Used for asthma (see training sheets for inhalers
  and spacers)
• Shake inhaler
• Have student take a deep breath in and out
• Have student place inhaler two finger-widths from
  mouth and press down on the inhaler while
  breathing in the medicine deeply. (Encourage them
  to use a spacer if they have one as it helps the
  student get more of the medication). Call school
  nurse for individual training on inhalers and
  spacers. Some of the new inhalers are designed
  to go directly in the mouth.
• Have student hold breath for 5 seconds, then
  breath in and out slowly
• Wait 1 minute then repeat steps above if two
  puffs are ordered.
• Call parent if student is not better in 15 20
  minutes after the first dose was given. Call 911
  for severe breathing problems
• Always notify the school nurse of a child having
  breathing problems!!

29
Nebulizers

• Used for breathing problems, especially during
  the cold months.
• Nurse will provide hands on training on these
  machines as all are different.
• Contact the school nurse if a students parent
  requests Nebulizer use at school
• Nebulizers are the equivalent to inhalers.

30
Eye Medications

• Be sure you have the correct eye
• Do not touch any part of the eye with the tip of
  the eye dropper
• Apply eye drops one drop at a time with student
  lying down
• do not allow them to rub eyes

31
INJECTIONS
32
Ear Medications

• Be sure you have the correct ear
• Have student lay with affected ear up
• Pull top part of the ear up and back
• Place correct number of drops in ear
• Have student keep head tilted, drop ear up, for 2
  minutes

33
Epi-Pen Injections (First Aid Responder)

• Take auto-injector out of cylinder container
• IF MEDICATION IS BROWN - DO NOT GIVE CALL 911 AND
  PARENT
• Remove (GREY) Safety Cap and place (GREY) cap to
  the side. DO NOT TOUCH THE BLACK TIP ON THE OTHER
  END. THAT IS WHERE THE NEEDLE IS!
• Place BLACK tip to the thigh at a right angle
• Use a quick motion and press black tip hard into
  thigh (You will hear a loud pop)
• HOLD IN PLACE FOR 10 seconds
• Remove Epi-Pen. Discard in Red Sharps Container
• Massage injection site for 10 seconds
• CALL 911 AND PARENT
• Remember to remove the insect stinger if one is
  present in the skin.

34
GLUCAGON INJECTION(FIRST AID RESPONDER OR
DIABETIC CARE MANAGER

• Remove flip-off seal from the bottle of Glucagon
  (SEND SOMEONE TO CALL 911)!
• Wipe top of bottle off with alcohol wipe
• Remove the needle protector from the syringe
• DO NOT REMOVE THE PLASTIC CLIP FROM THE SYRINGE
• Inject the entire contents of the syringe into
  the bottle of glucagon
• Swirl bottle briefly until glucagon dissolves
  completely
• GLUCAGON SHOULD NOT BE USED UNLESS THE SOLUTION
  IS CLEAR AND OF A WATER-LIKE COSISTENCY
• Using the same syringe, hold bottle upside down,
  make sure the needle stays in the solution
• Withdraw proper dose of solution into the syringe
• Cleanse injection site on buttock, arm, or thigh
  with alcohol wipe
• Inject into one of the above sites and hold for
  about 2-3 seconds, then remove
• Turn student onto his or her side
• Feed the student as soon as he or she awaken and
  can swallow

35
Glucagon Injection
To inject glucagon, the syringe should be held at
a 90 degree angle to the leg (as in the photo) or
arm and injected. The plunger is pushed down
completely. The needle is withdrawn and the
injection site is pressed lightly.
36
Glucagen Hypo-Kit Injection

• Remove the orange plastic cup from the
  vialInsert the needle through the rubber stopper
  on the glucagon vial. Inject all the liquid in
  the syringe into the vial. The rubber stopper can
  be stiff, but the needle is strong enough to
  puncture it.
• Gently shake the vialLeave the syringe in place
  and gently shake the vial until the powder is
  completely dissolved.
• Withdraw all of the liquid into the syringeWhile
  the needle is still inside the vial, turn the
  vial upside down and, keeping the needle in the
  liquid, slowly withdraw all the liquid into the
  syringe. People weighing less than 55lbs get half
  the 1mg dose (0.5 mg).
• Inject the solution into loose tissueInsert the
  needle into loose tissue under the injection site
  and inject the glucagon solution.

37
After Giving Glucagen

• After GlucaGen HypoKit treatment, give extra
  carbohydratesAs soon as the person who has
  suffered a severe hypoglycemic event awakens and
  is able to swallow, he or she should be given
  extra carbohydrates. This is especially important
  in children and adolescents. These carbohydrates
  can include a fast-acting source of
  carbohydratesuch as a regular soda pop or fruit
  juiceas well as something more substantial to
  eat such as crackers and cheese or a meat
  sandwich. If the patient does not awaken within
  15 minutes of injection, give another dose of
  GlucaGen and INFORM A DOCTOR OR EMERGENCY
  SERVICES IMMEDIATELY. Even if the GlucaGen
  awakens the patient, his/her doctor should be
  promptly notified.

38
Special Considerations

• Important Considerations for Helping Someone in a
  Hypoglycemic Emergency
• Act quickly. Prolonged unconsciousness may be
  harmful.
• Turn the person on his or her side to prevent
  choking. When an unconscious person awakens,
  he/she may vomit.
• The syringe does not contain glucagon. You must
  mix the contents of the syringe with the glucagon
  in the accompanying bottle before giving the
  injection.
• Do not mix GlucaGen HypoKit until you are ready
  to use it.
• Discard any unused portion.
• Become familiar with the technique of preparing
  glucagon before an emergency arises.
• WARNING The person may be in a coma from severe
  hyperglycemia (high blood glucose) rather than
  hypoglycemia (low blood glucose). In a case of
  hyperglycemia, the person will NOT respond to
  glucagon and requires immediate medical
  attention.

39
Diastat Rectal Injection (First Aid Responder)

• Put person on their side They are having a
  seizure 3-5 minutes long.
• Get medication and take syringe out of box
• Push up with thumb and pull to remove protective
  cover from syringe
• Lubricate rectal tip with lubrication packet
  inside box
• Turn person on their side facing you
• Bend upper leg forward to expose rectum
• Separate buttocks to expose rectum
• Gently insert syringe tip into rectum
• Slowly count to 3 while gently pushing plunger in
  until it stops
• Slowly count to three before removing syringe
• Hold buttocks together while counting to 3.
• Note the time given and keep person on their side
  facing you
• Call 911 if you are alarmed by the color of the
  person, the severity of the seizure, or if you
  are not sure. Always err on the side of caution
  and call 911 to ensure emergency medical
  services arrives as soon as possible.

40
STOP!!!

• If information on the bottle does not match the
  information on theMedication Administration
  Order, or you have any concerns, DO NOT GIVE!
• The parent and the physician should be called and
  always call the school nurse with any questions
  or concerns before giving a medication to any
  student.

41
MEDICATION ADMINISTRATION INCIDENT REPORTING

• In the event that an error occurs related to the
  dispensing of medication, a Medication
  Administration Incident Report form will be
  completed. The school will notify the parent or
  guardian of the student involved.
• This includes giving the medication to the wrong
  student, medication that fails to be administered
  for some reason and if a medication were found to
  be missing.
• If a student does not come to get their
  medication and you make no attempt to try and
  find out the reason within the required time for
  administration, YOU HAVE MADE AN ERROR. You must
  have either a code or your initials in each block
  on the MAR.

42
Field Trips

• Field Trips are considered a part of the school
  day and therefore, medication or medical
  procedures that are required during the school
  day must also be provided on a field trip.
• While on a field trip, the principal or
  principals designee trained to administer
  medication or to perform the medical procedure
  will accompany the student. The medication and/or
  necessary supplies will be removed from the
  secure location and taken on the trip in a
  secure, locked location.

43
Medication Administration Record (Field Trip)

• A Medication Administration Record Field Trip
  form will be completed for any medication or
  procedures that are completed on the field trip.
  This form will be attached to the Medication
  Administration Record within the school building.
  The medication must be returned back to the
  original location immediately following the
  return from a field trip.

44
Conclusion

• School personnel will assume no liability for
  complications or side effects of medication when
  administered in accordance with the instructions
  provided by the parent/guardian, physician or
  health care practitioner.
• Your School Nurse will meet with you and check
  you off to make sure you are competent to perform
  the skills covered in this power-point.