MEDICATION ADMINISTRATION
TABLE OF CONTENTS
ADMINSTRATION OF MEDICATION
Parent/Guardian Responsibilities
Physician/Dentist Responsibilities
Pharmacist Responsibilities
Training/School Nurse Responsibilities
Use of the Blue Card – WH#98333
Use of the Orange Card – WH #98334
Self-Administration by Students
Delivery of Medication to School
Storage of Medication
Recording of Medication
Medication Errors
Field Trips
Multi-Day Field Trips
ADMINISTRATION OF MEDICATION/TRAINING MODULE FOR SCHOOL PERSONNEL
Purpose
Medication Administration Forms
Storage of Medication
Identification of Student
Administration Technique
MEDICATION ADMINISTRATION PROCEDURES
Administration of Epinephrine Auto-Inject (Epi-Pen)
Administration of Oral Medication (Liquid)
Administration of Oral Medication (Tablets and Capsules)
Administration of Topical Medication
Administration of Eye Medication
Administration of Ear Medication
Administration of Nasal Medication
Administration of Medication via Metered-Dose Devise (MDD)
Administration of Medication via Nebulizer
Administration of Medication via Gastrostomy Tube
Administration of Rectal Suppository
Administration of Rectal Diastat
Administration of Injectable Medication
Administration of Medication for Field Trips
ADMINISTRATION OF MEDICATION GUIDELINES
Periodically, the parent/guardian and/or physician requests medication be given to
students during school hours. The parent/guardian is encouraged to develop a schedule
minimizing or eliminating taking medications at school. School personnel, authorized by
the principal and trained by the School Nurse may assist students in taking prescribed
medication during school hours.
PARENT/GUARDIAN RESPONSIBILITY
The parent/guardian will assume the major responsibility in working with the school and
physician/dentist in providing: (1) Signatures and instructions on forms (WH #98333 and
#98334). (2) The medication in an original, labeled container for school personnel
School personnel should be informed of any side effects or complications from the
medication. The parent/guardian should be aware of the problems associated with
administration of medications at school, such as loss of class time, disruption of class
schedule, lack of health professional to observe the effects of medication, etc., to
discourage the administration of medication during school hours.
PHYSICIAN/DENTIST RESPONSIBILITY
Each physician/dentist who prescribes a medication for students attending school should
provide detailed information about the medication to the parent/guardian. The
physician/dentist should encourage the parent/guardian to administer medication before
and after school hours whenever possible. When an over-the-counter medication is to be
given at school, the physician/dentist must prescribe the medication on the official form
(WH #98334). The physician/dentist may call in a medication or over-the-counter
order to the pharmacist, who may sign the forms for the physician/dentist.
PHARMACIST RESPONSIBILITY
When a medication has been prescribed for a student, the pharmacist will prepare two
containers with appropriate labels for administration of medication at home and at school
Verbal orders for over-the-counter medications prescribed by the physician/dentist may
be verified by the pharmacist, and the pharmacist may sign the school’s over-the counter
medication form.
TRAINING/SCHOOL NURSE RESPONSIBILITY
Anyone designated to administer medications must complete the district’s medication training program annually. The principal should designate at least three staff members to administer all medications. Volunteers may not administer medication. (Exception: Volunteer Licensed Registered Nurses (RN) who has completed application process through Pinellas County Health Department, and received training through School Health Services.)
The principal should inform the school nurse of the designated personnel, and arrangements for a training session should be made. The Clearance for Non-Medical School Employee to Perform Health Procedure form (PCS Form 2-2332) will be signed by the nurse and the staff to be trained. The nurse should review the procedure at the beginning of each semester (and as indicated or requested), and document training and re-training.
USE OF THE BLUE CARD (WH #98333) FOR PRESCRIPTION MEDICATION
Only the parent/guardian’s signature is required since the label on prescribed medication will identify the name of the physician, medication dosage, etc. The pharmacy prescription label must be securely attached and legible. The card shall include the name of the medication, dosage and any special instruction. The Administration of Prescription Medication card (WH # 98333) should be kept in a folder in the area where the medication will be administrated. When the administration of the medication is to be discontinued, the card should be filed in the student’s “cumulative school health record” folder. A New Administration of Medication of Prescription Medication Card (WH # 98333) is required each school year. If any medications are added after the original form is signed, another form for each additional medication must be signed and returned to the school. The student’s picture must be attached to the blue card. Staff administering medications should complete the signature verification at the bottom of the medication card.
USE OF THE ORANGE CARD (WH #98334) FOR OVER-THE-COUNTER MEDICATIONS
Signatures of both the physician/dentist and parent/guardian are required. The card shall include the name of the medication, dosage, and any special instructions. All medication must be brought in the original sealed container. The Administration of Over-The- Counter Medication Card (WH # 98334) should be kept in a folder in the area where the medication will be administered. When the administration of the medication is terminated, the card should be filed in the student’s “cumulative school health record” folder. A New Administration of Over-The-Counter Medication Card (WH # 98334) is required each year. If any medications are added after the original form is signed, another form for each additional medication must be signed and returned to the school. The student’s picture must be attached to the orange card.
NOTE: The potential for adverse reactions exists with all medications. Many children may be allergic to analgesics and other drugs or have medical problems which should exclude the administration of any medication without a physician/dentist’s prescription.
Staff administering medications should complete the signature verification at the bottom of the medication card.
SELF-MEDICATION BY STUDENTS
Approval for self-administration of medication(s) (Inhaler, Epi-pen, Pancreatic Enzyme Supplement and Insulin) shall be written by the physician under “Special Instructions” on the administration of medication form.
Inhalers
Asthmatic students; possession of inhalers as provided for in section 1002.20 F.S. which states- “An asthmatic student shall be able to carry a metered dose inhaler on their person while in school when they have approval from their parents and their physician. This law requires written authority by the parent and the physician, and approval of the principal. The principal shall be responsible for obtaining PCS Authorization to Carry Metered Dose Inhaler for Asthma (PCS Form 2-3060) from School Health Services and overseeing the completion of the authorization. The Authorization shall be filed with the Administration of Medication(WH # 98333) forms used for general medications. A copy shall be filed in the student’s School Health Record”.
Epi-pens
Section 1002.20 Florida Statute was amended in 2005 it states, “to create the Kelsey Ryan Act, which gives students the right to carry and self-administer epinephrine on school grounds if exposed to their specific life threatening allergens. The law requires written authorization by the parent and the physician, and approval of the principal.” Authorization for Emergency Injection for Severe Allergy (PCS 2-2366) should be completed by physician, parent and principal and all should be in agreement that the student meets the criteria for approval to carry his/her Epi-pen while in school. The principal shall be responsible for obtaining Authorization for Emergency Injection for Severe Allergy (PCS 2-2366) from School Health Services and overseeing the completion of the authorization prior to the administration of the medication. The Authorization (PCS 2-2366) shall be filed with the Administration of Medication (WH # 98333) forms used for general medications. A copy shall be filed in the student’s School Health Record
Insulin
“2003 Florida Department of Health Nursing Guidelines for Delegation of Care for Students with Diabetes in Florida Schools” provides for students to be allowed to check their blood glucose levels and respond to the results in the classroom, at other campus locations, during any school activities, and during field trips. It requires written authorization by the parent and the physician, and approval of the principal. Authorization for Diabetes Management in School(PCS Form 2-2966) should be completed by physician, parent and principal and all should be in agreement that the student meets the criteria for approval to carry his/her insulin/glucometer while in school.” The Authorization for Diabetes Management in School (PCS 2-2966) shall be filed with the Administration of Medication forms (WH # 98333) used for general medications. A copy shall be filed in the student’s School Health Record. Students that are not yet independent in their diabetic care may require assistance with insulin administration. Such assistance at the student’s zoned school is a reasonable accommodation that the student’s Section 504 Team should consider.
Pancreatic Enzyme Supplements
FS 1002.20 amended June 2010, permits a student with pancreatic insufficiency or cystic fibrosis to carry and self-administer prescribed pancreatic enzyme supplements while in school. “The Authorization to Self-Administer Pancreatic Enzymes” must be completed and signed by parent, physician and principal. A copy of the signed form shall be filed in student’s health record. This form is available from School Health Services Office.
DELIVERY OF MEDICATION TO SCHOOL
Medication should be sent to school via parent/guardian. Parent/guardian should arrange for a separate supply of medication for school. Medication should not be transported between home and school on a daily basis. It is the parent’s/guardian’s responsibility to pick up unneeded or discontinued medication as soon as possible. Medications must be counted by a school staff member trained to administer medications upon delivery at school. Counting must take place in the presence of the adult who delivered the medicine to school. The total should then be documented on the “Administration of Medication Card” (WH # 98333 or 98334), and signed by the school staff member and parent.
STORAGE
Medication must be stored in a locked cabinet or drawer in the clinic/administrative suite. The storage area should be cool and dry. Those medications requiring refrigeration should be stored in a locked box in the refrigerator in a limited access area. Emergency injectable medications, such as Epi-Pen, Glucagon, etc. must be accessible immediately in case of an emergency. It is permissible to keep such medications in a secure location, but in an unlocked cabinet during the school day. If they are stored in that manner, there should be a sign on the outside of the medication cabinet indicating the location of emergency medications, and they should be locked in a secure cabinet after school hours.
Parents should be contacted to come to school and pick up any expired medications or those remaining at the end of the school year. Medications that are not picked up by parents should be properly disposed of. Medication disposal should be witnessed by a second person and documented by both people involved. The sharps disposal container or biohazard disposal container are not appropriate places for disposal of medication.
See Health Services Folder for medication information for medication disposal flier.
RECORDING
The school employee administering or supervising the administration of medication should sign and date the appropriate Administration of Medication Form (WH # 98333 & #98334) and note the time, dosage, medication, and amount left in bottle. Documentation must be completed immediately for each medication given.
MEDICATION ERRORS
Violation of any one of the rights of medication administration constitutes a medication error. Those rights include: right student, right medication, right dosage, right time, right route, and right documentation.
· In case of medication error, the following procedures are recommended:
o Notify the school administrator.
o Call the poison control non-emergency number (1-800-282-3171)for toxicity or expected side effects if the error involved the wrong student, medication, dosage, time or route
o Notify the parent
o Notify the school nurse/supervisor
o Notify the prescribing physician
o A Medication Incident Report (PCS Form 2-2367) must be completed.
o File the original with school health services. No copy should be filed in student health record.
o Medication errors can be used to determine needed training for school staff
FIELD TRIPS
Trained school district personnel must accompany student on the bus, field trips, or any other school-based activity off school grounds. If medication is to be administered on field trips, or at before/after school activities, the same regulations apply. Therefore, the original container must be transferred to the trained person who will be administering the medication, and administration must be appropriately documented on the approved form. It is not permissible to transfer medication to an envelope or other container for later administration. However, parents may request that the pharmacy provide them with a properly labeled duplicate prescription container for field trips. Volunteers may not administer medication.
MULTI-DAY FIELD TRIPS
For multi-day school-sponsored field trips only, parents may designate a parent/chaperone (non-school employee) to administer over the counter (OTC) medications only while on the trip with a complete “Optional Multi-Day School-Sponsored Field Trip Form”( PCS form 2-3084).
Administration of Medication Training Module for School Personnel
PURPOSE
This module has been prepared for the school nurse to utilize in the training of school staff designated by the principal as being responsible for the administration of medication. It is intended to fulfill the requirements for training as specified in 1006.062 Florida Statue.
MEDICATION ADMINISTRATION FORMS
No medication will be given without written parental authorization and physician/dentist instructions (prescription label or written order). Only a registered nurse or licensed practical nurse may take telephone orders for any medication.
Administration of Medicine Dosage Missed by Parent at Home.
· If a student was to receive medication in the morning, before coming to school, and he/she does not receive that dose, the parent or their designee should come to school to administer it.
The Blue Card (WH 98333) for Prescription Medication requires only the parent/guardian signature, since the label on the prescribed medication will identify the name of the doctor/dentist, medication, dosage, etc. Verify that the student’s name, name of the medication, dosage, and special instructions on the blue card corresponds with the information on the prescription label. A new blue card and prescription label or doctor’s order is needed for any change in the dosage, time, mode of administration, or instructions. The student’s picture is required to be attached to the blue card.