1. education
2. school

_________ SCHOOL DISTRICT #___
Medication Administration
Training Manual
for
Non-Licensed
School Personnel
REVISED JUNE 2014
Add Nurses Names and Phone Numbers Here
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Table of Contents
Foreward................................................................................................................................................... 5
Acknowledgement .................................................................................................................................... 5
Course Overview ..................................................................................................................................... 6
Module I: Legal Issues, Policies and Procedures ................................................................................ 9
Introduction ................................................................................................................................. 10
Laws Related to Medication Administration ................................................................................ 10
Role of Unlicensed Personnel in Medication Administration ....................................................... 13
Confidentiality and Privacy .......................................................................................................... 13
Other Legal Considerations in Medication Administration .......................................................... 14
Module II:
Classification of Medications, Medication Preparations, Administration & Documentation ........ 19
Classification of Medications ....................................................................................................... 20
Medication Resources ................................................................................................................ 20
Understanding Effects of Medications/Adverse Drug Effects ..................................................... 20
Various Forms of Medication Administration .............................................................................. 21
Handling Medication ................................................................................................................... 23
Procedure for Administering Medications ................................................................................... 25
Medication Errors ........................................................................................................................ 25
Refusal of Medications ................................................................................................................ 25
Medication Documentation (Medication Log/Medication Administration Record) ....................... 26
Module III: Emergency Medication Administration ........................................................................... 27
Epinephrine for Anaphylaxis ....................................................................................................... 28
Midazolam for Seizures .............................................................................................................. 29
Module IV: Local School District Policies and Procedures .............................................................. 31
Medication Administration ........................................................................................................... 33
___________ School District Policy/Procedures 3416 ............................................................... 33
Bibliography …………………………………………………….………………………………………………37
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Appendices ........................................................................................................................................... 39
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
RCW 28A.210.260, RCW 28A.210.270, FERPA .................................................................. 41
Sample Medication Order/Request Forms, Administration Log ............................................ 45
Sample Medication Administration Incident Report Form ..................................................... 53
Common Medication Abbreviations ...................................................................................... 57
Glossary of Medical Terms ................................................................................................... 59
Steps for Proper Hand Washing ........................................................................................... 63
Six Rights of Medication Administration ................................................................................ 65
Brand and Generic Names for Common Medications........................................................... 67
List of Common Medications ................................................................................................. 69
Hands-On Medication Administration Skills Check Lists ....................................................... 73
Medication Administration Skills Check Lists ................................................................. 75
Competency #1 – Oral Medication Administration ......................................................... 77
Competency #2 – Oral (Liquid) Medication Administration............................................ 78
Competency #3 – Eye Drops or Ointment ..................................................................... 79
Competency #4 – Ear Drops ......................................................................................... 80
Competency #5 – Topical Ointment, Pastes, Creams, Patches .................................... 81
Competency #6 – How to Administer Nasal Medications .............................................. 82
Competency #7 – How to Administer Midazolam .......................................................... 83
Competency #8 – Metered Dose Inhaler (MDI) and HFA (hydrofluoroalkane) Inhalers 84
Competency #9 – How to Administer an EpiPen®/Auvi-Q®.......................................... 85
K. Medication Administration Written Competency Tests………………………………………....87
Module I: Legal Issues, Policies and Procedures .......................................................... 89
Module II: Classification of Medications, Medication Preparation, Administration
and Documentation.................................................................................................... 90
Module III: Emergency Medication Administration ......................................................... 91
Module IV: Local School District Policies and Procedures ............................................ 92
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FOREWARD
The ________ School District (___) recognizes the need for a standardized medication administration training
program for unlicensed school personnel that will ensure student safety. Clarification of what may be safely
delegated per RCW 28A.210.260 and RCW 28A.210.270, as well as an understanding of procedures related to
medication administration by unlicensed personnel, is needed because a licensed nurse may not be physically
present in the school building at all times.
A standardized training curriculum for medication administration by unlicensed school personnel was
developed by the ___ school nurses in collaboration with NorthEast Washington Educational Service District
(NEWESD) 101. The curriculum has been reviewed and approved by ___, verifying compliance with RCW
28A.210.260 and RCW 28A.210.270. This curriculum is the official training program for all unlicensed ___
school personnel who voluntarily accept delegation to perform medication administration.
All curriculum revisions shall be made by ___ when Washington law indicates revisions are needed.
ACKNOWLEDGEMENT
Reviewers
The authors gratefully acknowledge the useful critique of the draft manuscript of the Medication
Administration Training Manual for Non-Licensed School Staff, by the following reviewers:
Amy Degon, RN
Rosalia School District
Katie Johnson, DNP, RN-BC, NCSN
Office of Superintendent of Public Instruction
Janice Doyle, MSN, RN, NCSN, FNASN
Bethel School District
Julie Schultz, BSN, RN,
Northeast Washington ESD 101
Dawn Epler, BSN, RN,
Deer Park School District
Wendy Supanchick, BSN, RN
Riverside School District
Alma McNamee, MS, BSN, RN
Northeast Washington ESD 101
Portions of this manual were used with permission by the
Kentucky Department of Education
Frankfort, Kentucky 40601
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Course Overview
Course Objectives
Upon completion of this course, unlicensed school personnel should be able to:

Understand how medication administration may be safely delegated

Identify the responsibilities of the school nurse and unlicensed school personnel in medication
administration

Understand local school board policies for medication administration

Recognize and apply the six (6) rights of medication administration

Identify proper storage of prescription and over-the-counter medication

Understand appropriate and correct documentation of medication administration

Understand proper action and documentation necessary for refusal and omission of scheduled
medications

Understand prevention of medication errors and incident reporting

Recognize when it is appropriate to contact additional resources, i.e., nurses, other licensed health
care providers, poison control, and emergency medical services
Course Goals
This course is intended for non-licensed personnel who have voluntarily accepted the delegation to provide
medication administration to students in a school setting. According to ___ Policy/Procedure 3416, designated
staff members will participate in an in-service training session prior to the opening of school each year. As per
___ Policy 3416, the delegation is only valid for the current school year.
It is understood that the employing school will reserve the right to recommend individuals for this training. Upon
successful completion of this course, the non-licensed school employee will demonstrate competency, as
determined by the registered nurse (RN), in:

Understanding legal issues-policies and procedures

Administration of student medication

Verification of student instruction on self-administration of medications

Administration of emergency medications for students with allergic anaphylactic reactions and/or
seizures.
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Course Description
This medication administration training manual has been developed to assist non-licensed school personnel
with learning the required material. The course is designed to include four modules:
Module I: Legal Issues, Policies and Procedures
Module II: Classification of Medications, Medication Preparation, Administration,
and Documentation
Module III: Emergency Medication Administration
Module IV: Local School District Policies and Procedures
Medication Administration Open Book Exam and Demonstration of Skill Competency
Personnel will be expected to score 100% on the skill competency evaluation and 85% on an open book final
exam which will include demonstration of:
1. An understanding of ___ policies and procedures
2. Using proper hygiene/standard precautions in medication preparation and administration
3. Reviewing student medication history on the Medication Request form for documentation of allergies
and other co-existing medical conditions
4. Accurately identify student medication information by comparing the medication label to the transcribed
Medication Request form.
5. Administration of:
a. Oral medications
b. Eye drops/ointment
c. Ear drops
d. Topical ointments, pastes, salves, creams, patches
e. Oral inhalers
f.
Nasal medications
g. Emergency medication (EpiPen®/Auvi-Q® and Midazolam)
School personnel may repeat either the failed open book exam or skill competency evaluation one time. If
school personnel fail the final open book exam or the skill competency evaluation twice, they must repeat the
training course.
Personnel who are trained and delegated to perform medication administration only of emergency medications;
i.e., epinephrine auto injectors/inhalers for anaphylaxis or asthma and/or nasal medication for seizures, will be
expected to score 100% on the final skill competency evaluation for competencies #6 through #9 and 85% on
the open book final exam for Module #3 - Emergency Medication Administration.
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Module I
Legal Issues
Policies and Procedures
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Module I: Legal Issues, Policies and Procedures
Introduction
Many children with chronic health conditions or illnesses attend Washington’s schools and may require
medication that would affect attendance or program participation. While many schools may have a licensed
nurse available, there are also schools where students do not have daily or immediate access to a licensed
nurse to receive their medication. Due to the increasing number of students who require medication during the
school day, whether in the classroom, during transportation to and from school, or on a field trip, school nurses
sometimes need to delegate the administration of student medications.
There is much more to administering medications than just handing a student a pill and keeping the medication
bottle in a drawer. This curriculum was developed to give school personnel more information about:





Current Washington laws
School district policies and procedures regarding delegation of medication administration
Procedures for administering medication
Correct and appropriate documentation
When to seek assistance from resources such as the school nurse, other licensed healthcare
providers, poison control, and/or emergency medical services
The curriculum was developed collaboratively with the ___ nursing staff, NEWESD 101 and OSPI.
Laws Related To Medication Administration
The number of students with complex health issues attending school is increasing. Of the students who may
require medication during the school day, some require prescription medications at a scheduled time daily.
Others may require over-the-counter medication episodically, such as to treat a headache. Some students may
have a chronic health condition that requires an emergency medication or treatment to reduce the threat of a
potential life-threatening event (RCW 28A.210.320).
The potential for unsafe administration of medication in all these scenarios poses a possible liability for
schools. An understanding of state laws and school district policies and procedures is necessary to reduce the
potential liability issues of medication administration in the school setting. School personnel who accept the
delegation of medication administration and comply with the training, delegation and supervision provided by
the school nurse, and successfully complete this course, including demonstrated competency, are protected
from liability under Washington state law (RCW 28A.210.270).
Only licensed physicians and surgeons, dentists, osteopathic physicians and surgeons, naturopathic
physicians, podiatric physicians and surgeons, physician assistants, osteopathic physician assistants, and
advanced registered nurse practitioners (ARNPs) are licensed to “prescribe” medication (RCW 18.71 and
RCW 18.79). Nurses are licensed to “administer” medications per RCW 18.79. ___ Policy 3416, allows only
registered nurses, in the school setting, to delegate the task to administer medications to persons who have
completed a course such as this, and have demonstrated competency (RCW 28A.210.260). School personnel
may be trained to administer emergency medications including inhalers, nasal medications for seizures and
epinepherine (RCW 28A.210.260, RCW 18.79.240(1)(b), ___ Policy 3416, and the Guidelines for Care of
Students with Anaphylaxis).
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In Washington, nurses working in schools may be either an Advanced Registered Nurse Practitioner (ARNP),
registered nurse (RN), or a licensed practical nurse (LPN). There is a difference in the educational preparation
and scope of practice between the ARNP, RN and LPN. The scope of practice for the ARNP, RN and LPN are
defined in WAC 246-840 and described below.
1.
Advanced Registered Nurse Practitioner (ARNP)
It is within the scope of the ARNP to provide primary healthcare services to students in accordance with
WAC 246-840-300, scope and standards of practice of ARNPs. The ARNP may also perform acts
within the scope of registered nursing practice.
2.
Registered Nurse (RN) Practice
According to the National Association of School Nurses (NASN), The Role of the School Nurse (1999)
and WAC 246-840-705, it is within the scope of registered nursing practice for an RN, qualified by
education, experience, and current clinical competence to provide school health services/acts including,
but not limited to, the following:
a. Utilize substantial, specialized nursing knowledge, judgment and skill in providing primary
healthcare to students including initial assessment, management of illness and/or referral to
other health professionals, monitoring of chronic diseases, health supervision, counseling,
promotion of healthy life-styles, disease prevention, and the coordination of services when
specialized care is required.
b. Serve as a health advocate for students and a consultant to educational staff.
c. Serve in family resource and youth services centers.
d. Provide health teaching with a focus on disease prevention, health promotion and health
restoration.
e. Monitor the quality of the healthcare services provided for students.
f. Provide direct clinical services for students with special needs and/or teach and verify
competency, supervise and delegate [as defined in RCW 18.79.040(1)(0) and RCW
18.79.260(2)] the performance of select acts to unlicensed school personnel in accordance with
the administrative regulation governing delegation of nursing tasks to unlicensed persons.
g. Participate in the development of policies and procedures to guide nursing practice in school
settings (RCW 28A.210.260), and to address expanding school health services to students,
families and communities.
h. Delegate select health services to an unlicensed school employee in accordance with
RCW 18.79.040(1)(0) and RCW 18.79.260(2).
3.
Licensed Practical Nurse (LPN) Practice
WAC 246-840-705 defines licensed practical nursing practice. By definition, LPNs practice under the
direction of licensed physicians and surgeons, dentists, osteopathic physicians and surgeons,
naturopathic physicians, podiatric physicians and surgeons, physician assistants, osteopathic physician
assistants, and ARNPs. LPNs are not licensed for independent nursing practice. The board recognizes
the participation of the LPN in school nursing practice when the LPN is qualified by education,
experience and current clinical competency and practices under the direction and supervision of a
designated RN. The LPN performs acts within the scope of licensed practical nursing practice as
defined in WAC 246-840-705.
LPNs may administer medications and treatments as prescribed by licensed physicians and surgeons,
dentists, osteopathic physicians and surgeons, naturopathic physicians, podiatric physicians and surgeons,
physician assistants, osteopathic physician assistants, and ARNPs. Supervision of the LPN may not require
the supervisor to be physically present in the same building; however, the LPN may not practice without
oversight of nursing care provided to students by at least an RN.
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While there are similarities in the RN practice and the LPN practice, the degree of educational preparation and
the responsibilities of each are different. Both the RN and LPN must hold a current license from the Nursing
Care Quality Assurance Commission (NCQAC) and their licenses must be renewed annually. For licensure
renewal, each nurse is required to complete approved continuing education. These and other laws are in place
to govern the practice of nurses in the state of Washington and to ensure the health and safety of those
served.
The NCQAC has the legal authority (RCW 18.79 and RCW 18.130) to regulate nursing practice in order to
safeguard the health and safety of citizens of Washington. Delegation is defined by the American Nurses’
Association as “the transfer of responsibility for the performance of an activity from one individual to another,
while maintaining the accountability for the outcome.” School health services, i.e., the administration of
medications, may be delegated to unlicensed school personnel according to related sections of RCW
28A.210.260 and RCW 28A.210.270, which describes who may delegate health service(s) (ARNP, RN), the
training and documentation of the training. The delegation and training is only valid for the current school year
(___ Policy 3416).
For school nurses, NCQAC (WAC 246-840-700) Standards of Nursing Conduct or Practice discusses
delegation of nursing tasks to non-licensed personnel (WAC 246-840-010(10)) and provides direction on how
tasks may be delegated to a non-licensed individual by a licensed registered nurse. The delegating school
nurse will also be responsible for ongoing training and competency evaluations of the non-licensed personnel
to safeguard the health and welfare of the students in their care.
Supervision is defined as “the provision of guidance by a qualified nurse for the accomplishment of a nursing
task with periodic observation and evaluation of the performance of the task” (WAC 246-840-010(10)). The
evaluation should include validation that the nursing task has been performed according to established
standards of practice. Even when unlicensed school personnel perform the task, the nurse who delegates the
task will retain the responsibility for the outcome. Supervision of unlicensed school personnel may not require
the delegating nurse to be present in the same building; however, the delegating school nurse should be
available by phone for consultation.
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Role of Unlicensed Personnel in Medication Administration
“The Staff Model for the Delivery of School Health Services” established the definition of “health services” and
the provisions for who may provide health services in schools. Unlicensed school personnel may be delegated
selected health services according to RCW 28A.210.260.
A school district employee not licensed under Chapter 18.79 RCW who is asked to administer medications or
perform nursing services not previously recognized in law shall at the time he or she is asked to administer the
medication or perform the nursing service file, without coercion by the employer, a voluntary written, current,
and unexpired letter of intent stating the employee's willingness to administer the new medication or nursing
service. It is understood that the letter of intent will expire if the conditions of acceptance are substantially
changed. If a school employee chooses not to file a letter, the employee is not subject to any employer reprisal
or disciplinary action for refusing to file a letter (SB 6128).
When voluntarily accepting the delegation to perform medication administration in the school setting, the
unlicensed school personnel performs this function under the supervision of the delegating nurse. Unlicensed
school personnel should only accept delegation that he/she knows is within his/her skill set or knowledge and
should always contact the supervising school nurse if unclear about administering a medication. Unlicensed
personnel have the responsibility to follow school district policies and procedures and report to the nurse if they
have any reason to believe they have made a medication error. This should be reported as soon as possible.
Confidentiality and Privacy
Confidentiality is a very important legal concept in the school setting. Family Educational Rights and Privacy
Act (FERPA) is the federal law that protects the privacy interests of students and their educational records.
FERPA applies to any educational agency that receives funds from the United States Department of Education
(USDOE). Health records maintained by school employees for pre-kindergarten through grade twelve students
are protected by FERPA.
Information regarding student health information should be shared with school personnel only on a “need to
know” basis (RCW 70.02.030 through RCW 70.02.050). Health records contain sensitive information and may
not be disclosed without parental/guardian permission. Certain student health information may be necessary to
share with school personnel who may be assisting with medication administration. However, this information is
confidential and should not be shared with other students or school employees without a legitimate need to
know (RCW 70.02.030-050).
Privacy is a separate legal concept. If a student tells school personnel how they feel about having a chronic
health condition, this information should be shared with the school nurse but not disclosed to those who do not
have a “need to know.”
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Other Legal Considerations in Medication Administration
All school districts should have written policies and procedures on medication administration. The purpose of
these policies and procedures is to give guidance to local school district employees and students. Each school
district employee administering medications should be familiar with their district’s policies and procedures on
medication administration.
A. Administration of Medication
1. Prescribed medication – whether medication requires a prescription or is over-the-counter (OTC):
Prescribed medication must be sent to the school in the original labeled container and the label shall
include:
a.
b.
c.
d.
e.
f.
g.
h.
Name of the student
Expiration date of the medication
Name of the medication, dosage and strength of medication
Route of administration
Frequency of medication
Name and address of the pharmacy*
Name of the prescribing health care provider*
Date the prescription was dispensed*
*These would be included only on prescription medications from the pharmacy.
A Medication Request form completed by the parent/legal guardian and the student’s licensed health
care provider (LHP) must be kept in the medication notebook and is only valid for the current school
year.
2. Student self-medication
Student self-medication is allowed in certain situations, with a written LHP authorization, that allows a
student to responsibly carry self-administered medication, i.e., EpiPen® or asthma inhaler. A
Medication Request form must be completed by the parent/guardian and LHP and is on file in the
school. This authorization must be renewed each school year and be approved by the school nurse.
Documentation from the prescribing LHP shall include:
a.
b.
c.
d.
e.
f.
The name and purpose of the medication.
The prescribed dosage of the medication.
The times at which or circumstances under which the medication may be given.
The period of time for which the medication is prescribed.
The side effects and further instructions if order is for more than fifteen days.
The student has demonstrated proper technique and is capable of administering
the prescribed medication.
3. Medication safety
The first dose of any new medication should be given at home and not at school, although this may not
always be possible. Except for “self-carry” medications, all medication should be transported to and
from the school by a parent/guardian.
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According to school district policy and procedures, prescribed medication should be counted and the
number of pills received should be noted on the Medication Request form/Record-Log and signed by
two adults, preferably one being the parent/guardian.
Medication shall only be administered according to the LHP’s instructions on the Medication Request
form and this should match the information on the prescription label. (Staff may apply clear tape over
the label to maintain legibility.) Discrepancies that exist between the information on the
Parent/Guardian/LHP Medication Request form and the prescription label will require one or both of the
following:
a. New Medication Request form completed by the parent/guardian and LHP
b. New prescription bottle or label issued by the pharmacy
Medications shall not be given beyond the date specified on the authorization form or beyond the
expiration date on the label.
4. Changes in medication
The authorization to administer medication is only valid for the current school year or until treatment
changes. A new Medication Request form must be obtained whenever there is a change to the
medication, dosage, time and/or frequency and a new prescription bottle (or medication label, if
applicable) from the pharmacy indicating the prescription change.
Nurses may only accept medication orders as prescribed by LHPs with prescriptive authority. Nurses
may not accept requests from parents to change a prescribed medication dose without first contacting
the prescribing LHP.
B. Storage and Disposal of Medications
Medications should be stored in locked cabinets or locked drawers with access limited to those who are
designated to receive medications for use at school and/or to administer medications. Exceptions may be needed
for emergency medications (EpiPen®/Auvi-Q®/asthma inhalers/midazolam nasal spray for seizures and
antihistamines used for severe allergies) specified in an emergency care plan which may have different
storage/student availability, requirements. Medications requiring refrigeration shall be kept in a separate
refrigerator in a supervised area or locked container that can be stored with food in a supervised area.
Temperature of that refrigerator will be checked on a regular basis and the temperatures documented on a log.
Temperatures should be maintained between 33 and 45 degrees Fahrenheit.
For students receiving medication throughout the school year, it is recommended that no more than a month’s
supply of medication be stored on school property.
When a medication is no longer needed, the school should notify the parent/guardian and request that it be
picked up by the parent/guardian.
Disposal of unused medication or expired medication that has not been picked up by parent/guardian:
1. For pills: Pour into wet coffee grounds. After pills have dissolved, they may be thrown into garbage can.
2. For liquids: Pour into coffee grounds. This may be placed in plastic bag and then thrown into garbage
can.
3. Disposal of medication must be documented on the student’s medication record to verify it was
destroyed. It must be signed and dated. A witness must also sign and date the record.
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4. Items, such as inhaler canisters, may be placed in a sharps container or disposed of according to the
school district’s Bloodborne Pathogen OSHA plan.
5. Expired EpiPens®/Auvi-Q® may be used by school nurses for unlicensed staff training.
C. Field Trips and Medication Administration
If a student is attending a field trip away from school during his/her scheduled medication time, school
personnel with current training on medication administration may be designated to administer the medication
while on the field trip.
Notification and preparation for administering medications during a field trip should begin well in advance of the
day of the field trip (at least two (2) weeks). Student medication may not be repackaged for field trips by school
personnel. The school should request the parent send a separate bottle to be sent on field trips. The
prescription medication bottle must have a pharmacy prescription label attached.
The medication will be carried on the field trip by the designated staff person(s) in a fanny pack or locked box
with access limited to those giving the medication. The medication should be in the original pharmacy-labeled
container. Prior to the field trip, the school nurse and/or designated staff person will prepare the required
medications, along with the Medication Request form (this may be the Asthma or Allergy Plan and Medication
Orders forms) The packet will also contain the medication administration log with the name of the medication,
the strength per dosage unit, the quantity, and the date. The form should have the following information:

Name of student;

Teacher and grade;

Medication name;

Dosage of medication to be given;

Time medication is to be given; and

A space for the designated and trained staff person to sign his/her name, date, and time the medication
was given to the student.
Upon returning to school from the field trip, the signed medication administration log sheet and any leftover
medication is returned to the school nurse/designee, who will assist the staff member who administered the
medication on the field trip to transfer the information to the regular school medication administration log for the
student. The school nurse/designee and staff person should sign and date the medication administration log
sheet that documents the return of the medication and any problems that might have occurred with the
medication on the field trip.
Consult ____school district policies and procedures for field trip medication administration (Module IV).
D. Refusal of School Personnel to Administer Medications
When school personnel are unable to grant the request from a parent/legal guardian/LHP to administer
medication to a student, the delegating school nurse should be notified as soon as possible. Some of the
circumstances may include:
1. Medication was sent to school not in the original container
2. Medication is prescribed twice daily and can be administered before school and after school hours
3. Medication is prescribed three times daily and can be given before school, after school and before
bedtime
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4. No written parent/LHPauthorization is on file
Other unusual circumstances that are not listed above will require consultation with the supervising school
nurse.
A student may refuse medications. As best practice and according to the student’s developmental level, the
student should understand the symptoms for which the medications are prescribed and also know any
common side effects. The student should be able to verbalize their understanding that these medications are
considered a part of treatment and that the parent and/or prescriber will be notified should he/she refuse the
medication.
A student refusing medications is not considered a medication error and should be documented on the
Medication Request form /Record-Log as “refused medication.” This shows that the individual has been offered
the medication as ordered by the LHP. When a student refuses medications, the school nurse and parent
should be notified as soon as possible.
E. Medication Errors
Preventing and Reporting Medication Errors
A medication error occurs when one of the “six rights of medication administration” has been violated.
Examples are:
1. Administering the wrong medication
2. Administering the wrong dose of medication
3. Administering medication at the wrong time
4. Administering the medication using the wrong route, e.g., ear drops administered to the eye
5. Administering medication to wrong student
6. Failing to document that medication was given or inaccurate documentation of medication given
Medication errors may result in the student having an adverse reaction. Reactions could range from a rash to a
life-threatening situation. Therefore, always check the medication label when:
1. Removing the medication from storage
2. Removing the medication from its container
3. Returning the medication to storage
Knowing the following before administering medications will help prevent medication errors:
1.
2.
3.
4.
5.
Name of medication (the generic and real or “trade” name)
Purpose
Potential side effects
Special instructions (if appropriate)
LHP and emergency contact names and phone numbers
When a medication administration error occurs, follow these guidelines:
1. Keep the student in the health room or office (where they can be observed)
2. If the student has already returned to class, have an adult accompany the student back to the
health room or office for observation
3. Observe the student’s status and document what you see
4. Identify the incorrect dose or type of medication taken by the student
5. Notify the principal and supervising school nurse immediately if medication was given by nonlicensed personnel (the supervising nurse will contact the parents of the student and/or LHP)
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6. If contacting the Poison Control Center for instructions:
a. Give the name and dose of the medication taken in error
b. Give the student’s age and approximate weight
c. Give the name and dose of any other medication the student receives
7. Follow instructions from the Poison Control Center. If unable to follow their instructions, e.g., the
order is to give Syrup of Ipecac and it is not available to give, explain the problem to the Poison
Control Center to determine if the student should be transported for emergency care.
8. Complete a Medication Administration Incident Report form (see Appendix C). Carefully record all
circumstances and actions taken, including instructions from the Poison Control Center or the
student’s LHP, and the student’s status. All reports are to be filed and kept according to district
policy.
9. It the error is committed by an unlicensed school employee and causes bodily harm or injury to the
student, the incident may be reportable to the Department of Health, Unlicensed Practice Unit at
(360)236-4659. There may be administrative actions or fines.
Errors made in recording medications on the Medication Administration Record should be marked “error,”
initialed and dated. Whiteout may not be used nor documentation “blacked” out.
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Module II
Classification of Medications, Medication
Preparation, Administration, and
Documentation
19
Module II: Classification of Medications, Medication Preparation, Administration, and
Documentation
Classification of Medications
Prescribed Medications
Prescribed medications are those medications that an LHP has ordered for treatment of a student’s particular
diagnosis or symptoms. These medications may include controlled/scheduled or non-controlled/scheduled.
Prescribed medications may be ordered on an “as needed” basis (PRN) or on a routine scheduled basis.
A. Controlled/scheduled medications
“Controlled/scheduled medications” are medications that are potentially addictive and that are regulated under
the Controlled/Scheduled Substance Act of 1970. Controlled/scheduled medications cannot be obtained
without a written prescription from a licensed practitioner, e.g., Ritalin® or Tylenol® with Codeine.
It is very important that controlled/scheduled medications be handled according to school district policies and
procedures:
 Kept locked in appropriately constructed medication cabinet
 Signed out each time a dose is administered
 Disposed of according to medication storage and disposal guidelines in Module I, Section B
B. Non-controlled/scheduled medications
All prescription, non-controlled/scheduled medications, e.g., Tegretol® or Dilantin®, requires an order from a
LHP. All non-controlled/scheduled medications are kept locked according to school district policies and
procedures. School district policies will address student safety in relation to secure storage of medication.
C. Over-the-counter (OTC) medications
OTC medications are administered to students according to school district policy. OTC medications require a
completed Medication Request form by the parent/legal guardian and the student’s LHP. Examples of these
medications would be ibuprofen (Motrin®), acetaminophen (Tylenol®), cough medication (Robitussin®),
antibiotic ointment (Neosporin® or Bactracin®), antacids (Tums® or Rolaids®), etc. Documentation of OTCs
on the student’s Medication Administration Record is required.
Medication Resources
The chart “Common Medications” (Appendix I) lists commonly used medications. These medications may be
controlled or non-controlled. The chart is not an all-inclusive list. It is very important that a person administering
medications compares the medication label with the Medication Request form including the student’s name,
time of administration, how the medication is to be given and the dosage for administration. All OTC
medications must be given in accordance with school district policies.
It is recommended that school employees administering medication have access to an updated drug book for
review of any newly prescribed medications and/or over-the-counter medication when questions arise.
Student health information is important for student safety in medication administration and management. This
information includes, but is not limited to, student name, date of birth, sex, and any allergies.
Understanding Effects of Medications/Adverse Drug Effects
It is very important to be familiar with any medication that is being administered. An adverse effect is an
unwanted, unexpected and/or dangerous reaction to a drug. Pharmacies are required to provide a “medication”
20
education sheet with each drug dispensed. The sheet contains the most common adverse effects of that
medication.
Another way to learn the adverse effects of medications is to review the medication in a current drug
handbook. These books are updated on an annual basis and contain the most current information on newly
developed drugs, recommended dosage, what diagnosis or symptom the drug treats how the drug is absorbed,
and most importantly the potential side effects /adverse effects of the drug. Medication information is also
available online at the:
National Institute of Health’s website Medline Plus: http://nlm.nih.gov/medlineplus/druginformation.html
Observing the student after a medication has been administered is crucial in identifying any adverse reactions
to that medication. If a student vomits after taking a medication, report to the supervising school nurse the
student’s name and age, medication name and dose, time interval between the medication administration, and
when vomiting occurred. Severe adverse reactions should be treated as emergencies and unlicensed school
personnel should be familiar with school district policies and procedures regarding how emergencies are to be
handled.
An allergic reaction is an immune response to a foreign substance resulting in inflammation and/or organ
dysfunction. In the case of medications, the drug itself may be the substance that causes the effect. Allergic
reactions may have many symptoms that could appear immediately or not for several days or weeks.
Examples of an allergic reaction may be: redness, rash, hives, shortness of breath, itching, swelling, yellowing
of the skin, fever, and/or nausea/vomiting.
Anaphylaxis is the most dangerous type of an allergic reaction. Anaphylaxis is a life-threatening event where
the blood pressure drops, respiratory distress occurs, i.e., shortness of breath, and the student may become
unresponsive. Emergency procedures should be implemented if anaphylaxis is suspected.
Various Forms of Medication Administration
Medications may be administered in many different ways. Procedures for administering different forms of medication
are located in the Appendix section of this manual.
A. Oral (by mouth or gastrostomy tube)
Oral medications include solid forms such as tablets or capsules, and liquid forms such as syrups/elixirs and
suspensions. Oral medication should not be crushed without an LHP’s order.
Tablets (pills) come in many forms: regular, chewable, sublingual and scored. Regular tablets are simply taken
with liquid. Chewable tablets should be chewed before they are swallowed. Tablets that are not clearly designated
as chewable should be swallowed whole. Scored tablets are designed so that they can be cut up into smaller doses
with a special cutting tool. Tablets are delivered in either enteric coated or uncoated form. Certain medications can
cause irritation to the stomach. These tablets are “coated” so that they cannot dissolve in the stomach, protecting
the stomach from irritation. The “coating” actually dissolves in the small intestine instead of the stomach. These
tablets should not be split or crushed.
Oral disintegrating tablets dissolve in the mouth (do not chew). Sublingual medications are placed under the
tongue to be dissolved and absorbed. Buccal medications are placed inside the cheek and along the gum line to be
dissolved and absorbed.
Capsules are coated so they dissolve over a period of time in the stomach or the intestines - but not in the mouth.
Most often, the prescription calls for capsules to be swallowed whole, just like tablets. Gel coated capsules are not
to be broken.
21
There are also capsules designed to be broken apart and sprinkled onto soft food, like applesauce. These are called
a “sprinkle” and are most often given to students who have asthma or seizures. If a capsule should be “sprinkled,”
the directions on the prescription will specifically say to do so.
Capsules may be coated with substances that permit delayed release in the small intestine in small amounts over a
prolonged period of time. Do not break or crush any medications considered slow release, sustained release, longacting, extended or controlled release (usually identified with SR, LA,
EX or CR).
Syrups and elixirs are clear liquids. Suspensions are liquids that are not clear. Suspensions contain medication
that doesn’t dissolve completely in the liquid and usually need to be refrigerated. Because suspensions can
separate, they always need to be shaken for at least 15 seconds before being measured and given to the student.
All oral medications should be given with water or other liquid that allows for easy swallowing. After the student has
received the medication, it is very important to make sure he/she has swallowed the medication. Ask the student to
open his/her mouth and raise their tongue. Inspect cheeks, under tongue, roof of mouth, and teeth for hidden
medication. Check orthodontic braces as well. This practice will ensure students are not hoarding medications
(cheeking).
*Enteral medications (by gastrostomy tube) are considered oral medications as they are administered directly
into the digestive tract. An RN may delegate medications given via gastrostomy tubes following delegation
procedures.
B. Topical
Topical medications include eye drops or ointments, ear drops, creams, ointments, salves, pastes, and
patches that are applied to the skin. NOTE: Gloves should be worn when administering any of the
following medications. Hands should be washed before and after use of gloves.
Ointments (salves or pastes) are a semisolid preparation, usually containing a medical substance, used for
external application on the skin.
Creams are a fluid mixture of a thick consistency, usually applied to the skin or body surface.
Drops are a liquid form of medication given through a dropper when a very small dose of medication is
required. Drops are usually prescribed for the eyes (ophthalmic) or ears (otic).
Patches are an adhesive-backed system that provides a continuous release of medication over several hours
or days. Rotation of application sites helps reduce localized reactions.
C. Inhalers and Nebulizers
Inhaled medications may be delivered in a fine mist by spray bottle/inhaler, an oral inhaler, spray syringes, or
nebulizer machine. Most inhalers are hand-held portable devices that deliver medication at a metered (premeasured) dose. A nasal spray delivers medication as a spray directly into the external nares (nostrils) and
may be prescribed for allergies or for prolonged “cluster” seizures.
Oral inhalers deliver medication directly to the lungs through the mouth by squeezing the canister or by direct
inhalation.
The nebulizer produces a fine spray mist by rapidly passing air through a liquid that is inhaled through the
mouth. Nebulizer medication use may be prescribed for treatment of asthma. Pre-mixed nebulizer medication
is already prepared to be used with a nebulizer. Consult the equipment product information on how to use the
nebulizer. Individualized training is required to ensure understanding of medication and use of equipment.
Common inhaler problems include:

Not taking the medication as prescribed
22

Incorrect activation which may occur by not following the recommended sequencing of inhaling and
squeezing the canister

Forgetting to shake the canister - if the canister is not shaken multiple times, the correct amount of
medication may not be delivered. Prime as indicated per manufacturer instructions

Not waiting long enough between puffs

Failure to clean the valve - if debris is present, this will cause delivery failure of the correct amount
of medication

Failure to observe whether the inhaler is actually releasing a spray; if not, call the delegating school
nurse
A student’s need for bronchodilators (rescue inhalers) more than every four (4) hours can signal respiratory
problems. Call the supervising school nurse if this occurs.
Until recently, all MDIs contained a chemical harmful to the earth’s ozone (CFC). The government is
requiring that all MDIs be transitioned to HFA (hydrofluoroalkane) inhalers which are more environmentally
friendly. The new HFA propelled inhalers are different than what most students may be accustomed, and
education may be required. Some differences include:

The propelled spray (plume) with HFA propelled inhalers are softer than CFC propellants and
students need to be reassured that they will be receiving the correct dose of active ingredient.

HFA MDIs have different cleaning requirements. HFA MDIs need to be cleaned more frequently
than CFC MDIs. The HFA medication tends to clog the exit port of the plastic actuator more
quickly than CFCs. This prevents medication from reaching the airways, which may explain why
students sometime report HFA inhalers aren’t working.

HFA MDIs have different priming requirements. Priming (spraying multiple doses into the air)
loads the correct dose of medication inside the inhaler. Each HFA inhaler has different priming
instructions, how many sprays are needed and exactly when the medication requires priming,
which can be different from CFC priming.
ALWAYS CONSULT THE STUDENT’S ASTHMA ACTION PLAN/PRESCRIPTION FOR
INSTRUCTIONS ON HOW TO ADMINISTER THE INHALER.
D. Emergency Medications
EpiPen®/Auvi-Q® are emergency injectable medications (epinephrine) prescribed for treating severe allergic
reactions causing life-threatening respiratory distress, or a condition referred to as anaphylaxis. Anaphylaxis is
a life threatening allergic reaction that may be fatal within minutes and requires immediate action. Anaphylaxis
may be a reaction to: food (particularly peanuts, tree nuts, fish, wheat or eggs), stinging insects, latex, exercise
or medication. See Module III for more information on this medication.
Midazolam (Versed) is an intranasal or buccal medication that can be used for the treatment of acute seizures
in children. Intranasal Midazolam is administered via a spray syringe (needle-less) into the nostrils.
Handling Medication
A. Hand Washing
Before administering any medication to a student, always wash your hands. If the student will touch the
medication, he or she should also wash their hands. Good hand washing techniques include washing the
hands with soap and water. Alcohol-based hand sanitizers are an alternative to washing only when soap and
water is not available. However, if the hands are visibly soiled, wash hands with soap and water (see hand
washing procedure-Appendix F).
23
B. How to Avoid Touching the Medication
Pour pills, tablets, or capsules into the bottle cap first, and then pour them into the disposable medicine cup.
(This technique allows for more control in pouring and avoids having to remove extra amounts.) A clean paper
towel or catsup-sized paper cup may also be used if the medicine is only one capsule or tablet. Have the
student pick up the medication themselves and put it in their mouth.
Some children do not have the developmental skills to put tablets or capsules into their mouth. If you must put
the medication directly into the child’s mouth, use disposable gloves. The gloves are considered contaminated
after use. Pills may also be given with applesauce/pudding to assist in swallowing, if necessary.
C. Cutting or Crushing Tablets
Cutting, crushing or sprinkling of the medication are examples of changing the form of an oral medication. If the
form of an oral medication must be changed, e.g., cutting, crushing or sprinkling, the prescribing health care
provider will indicate this in the written prescription and on the pharmacy label.
Scored tablets that must be cut in half to obtain a smaller dose should be cut by the parent/guardian or the
student’s dispensing pharmacist. For example, the medication is packaged in 10 milligram (mg) tablets and
the health care provider’s order or prescription indicates the student is to receive 5 milligrams or ½ a tablet.
D. Measuring Liquid Medication
When pouring liquid medications, always place bottle cap upside down on a solid surface to avoid
contaminating the inside of the bottle cap. Liquid medications must be measured to ensure accurate dosage.
For liquid medications, always use a plastic marked medicine cup, oral syringe or dropper. Pay close attention
to the medication order (dosage on the bottle) and find the corresponding markings on the medicine cup or
dropper. When using a plastic marked medicine cup, place the cup on a solid, level surface and look at the
medicine cup at eye level to ensure the correct amount has been poured. If a student is to receive more than
one liquid medication at the same time, each liquid medication must be measured separately.
When pouring the medication out of the container, hold the bottle so the label is in the palm of your hand to
prevent spillage and causing the label to become illegible. Some liquid medications are suspensions and
require shaking before being administered. This information will be on the label of the medication bottle.
Tips on Using Measuring Tools for Liquid Medicines can be found at the following link:
http://www.cbwchc.org/project/brochures/pdf/Tips%20on%20Using%20Measuring%20Tools%20for%20Liquid%20Medicines%20(E
nglish).pdf
Ensuring Accurate Administration of Medication
To safely manage and administer medications to students, the “six rights of medication administration” must be
followed (see Appendix G for the Six Rights).
Note: Only set up and administer one individual's medication at a time. Never document administration of the
medication before the student receives it.
24
Prescription Label Example
Pharmacy #04849
4838 Polar Level Rd
Louisville KY 40213
DEA: BR860780
RPHL JWI (initials of pharmacist)
Date filled: 8/27/02
04849
Right Student
Right Dose, Right Time, Right Route
Jones, Haley
Take 1 tablet every 8 hours by mouth
Right Drug
Precare Caplet 25 mg
QTY: 30
Expires 8/27/03
MFG: Ther-rx
Dr. James Lind (prescribing physician)
Procedure for Administering Medications
All medication administration procedures must include these basic steps regardless of the type of medication
to be administered:





Student reports to office or call student to the office (or staff go to the student)
Verify identity of student (using two methods of identification)
Identify yourself and what you will be doing
Assemble necessary equipment
Wash your hands before and after administering medications
Steps to follow when administering each type of medication are located in Appendix J.
Medication Errors
District policies and procedures state what documentation is required if a mistake in medication administration
has been made. Any error must be documented on the school district’s “Medication Administration Incident
Report” form and reported as soon as possible to the school nurse, school principal and parents.
Report accidental errors such as:
 Forgetting to give a dose of medication
 Giving medication to the wrong student
 Giving the wrong medication or the wrong dose
 Giving medications at the wrong time
 Giving medication by the wrong route
 Incorrect documentation
Errors do happen and in the interest of the student’s health and safety, report all errors promptly.
Refusal of Medications
Refusing medications is not considered a medication error and the refusal should be documented on the
Medication Request form/Record-Log as a “refused” medication. The documentation assures the student has
been offered the medication as ordered and proves staff followed school district policy in
administration/documentation.
25
As best practice and according to the student’s developmental level, the student should understand why the
medication is being administered and should be made aware of any common side effects. He/she should also
be able to verbalize understanding that these medications are considered a part of treatment and that the
parent/guardian will be notified should he/she refuse the scheduled medication. Be sure to notify your school
nurse as soon as possible.
Medication Documentation (Medication Log/Medication Administration Record)
Record-keeping is very important when medication is given at school. A medication “log” (medication
administration record) must be kept for each student. Each medication given must be recorded on a separate
form. The log contains the student’s name, the prescribed medication and dosage, the route the medication is
to be given, the time the medication is scheduled to be given, and any student allergies.
Compare the information on the medication label with the information on the Medication Request form. This
information must match. Whenever a change in the dose of the same medication is ordered by the LHP, a new
Medication Request form must be created. Contact the school nurse immediately and do not give the
medication if the medication label is missing or the label cannot be read.
The Medication Request form/Record-Log (on the back of the sheet) may also be used to make notes of
additional comments of any unusual circumstance related to the student receiving the medication. This
medication record becomes a permanent part of the student’s file and provides legal documentation for those
who administer medications to students. When a student receives a medication, the actual time must be
recorded on the medication record. This must also be done when a medication is missed due to an absence or
a field trip or if the student refuses to take the medication. The Medication Request form/ Record-Log is a legal
and permanent document. It is to be saved for eight (8) years. Use only ink and never use “whiteout.” If a
mistake is made in the recording of the medication administration on medication record-log form, draw a single
line through the error, write “error” and initial/date beside the time.
Samples of student Medication Orders/Request forms/Record-Log may be found in Appendix B.
If the medication has been administered but not documented on the Medication Administration Record there is
a potential for error if the medication were to be re-administered.
** Note-When initialing the Medication Administration Record/log be sure NOT to circle your initials unless
there was an issue that needs to be further addressed such as a missed dose. Circled initials indicate that
there was some sort of problem.
See _____ school district medication administration form and follow school district policies for documentation
(Module IV).
26
Module III
Emergency Medication Administration
27
Module III: Emergency Medication Administration
Epinephrine for Anaphylaxis
Anaphylaxis is a life-threatening allergic reaction that can be fatal within minutes. Anaphylaxis can be a
reaction to: food (particularly peanuts, tree nuts, fish, wheat or eggs), stinging insects (such as wasps or bees),
medications, latex, exercise and/or even “unknown” causes.
Symptoms of anaphylaxis include:






Itching and/or hives, particularly in the mouth or throat
Swelling of the throat, lips, tongue and/or eye area
Difficulty breathing, swallowing or speaking
Increased heart rate and/or sense of impending doom
Abdominal cramps, nausea, vomiting, diarrhea
Weakness, collapse, paleness, lightheadedness or loss of consciousness
Since the severity of an allergic reaction is difficult to predict, the allergic response may rapidly progress to
anaphylaxis. It is important for students with severe allergies who are at risk of anaphylaxis to have an
Individualized Healthcare(IHP)/Emergency Care(ECP)/504 plan. The IHP/ECP/504 may include the
administration of epinephrine from an EpiPen® or Auvi-Q® (RCW 28A.210.370).
Severe allergic reactions may be unavoidable because foods may contain unknown ingredients, insects range
widely and latex can be found anywhere. Once anaphylaxis has begun, the treatment is an immediate injection
of epinephrine (EpiPen® or Auvi-Q®) which may be effective for only 10 to 15 minutes. It is not necessary to
remove the student’s clothing before administering the EpiPen® or Auvi-Q® auto injector. After receiving the
epinephrine, the student should then be transported for further emergency medical attention to the nearest
hospital emergency room.
The EpiPen®/Auvi-Q® are prescribed medications that contain epinephrine to reverse the most dangerous
effects of an anaphylactic reaction. The prescription is written according to the weight of the child. The
prescribing health care provider will provide instructions that clearly explain the circumstances under which the
EpiPen®/Auvi-Q® should be used. Some students may carry and self-administer an EpiPen® or Auvi-Q®.
Unlicensed school personnel may administer the EpiPen® or Auvi-Q® after receiving training from a registered
nurse (Guidelines for Care of Students with Anaphylaxis).
The manufacturer recommends the EpiPen®/Auvi-Q® be stored at room temperature in a dark area. The
expiration date of the EpiPen®/Auvi-Q® kits should be checked monthly and the parent/guardian notified by
school personnel one month in advance of the expiration date.
**Note: Epinephrine may also be ordered by a student’s LHP for the treatment of severe asthma attacks.
28
Midazolam Nasal Spray for Seizures
Epilepsy is a neurological disorder that causes a student to have recurrent seizures. Seizures are caused by a
brief disruption in the brain’s electrical activity resulting in altered or loss of awareness, shaking, convulsing,
confusion or sensory experiences.
Seizures can take many different forms, often not resembling the convulsions that many associate with
epilepsy. Common types of seizures include:
 Generalized Tonic Clonic (Grand Mal) - convulsions, muscle rigidity, jerking
 Absence (Petit mal) - blank stare lasting only a few seconds, sometimes accompanied by
blinking or chewing motions
 Complex Partial (Psychomotor/Temporal Lobe) - random activity where the student is out of
touch with their surroundings
 Simple Partial - jerking in one or more parts of the body or sensory distortions that may or may
not be obvious to onlookers
 Atonic (Drop Attacks) - sudden collapse with recovery within a minute
 Myoclonic - sudden, brief, massive jerks involving all or part of the body
Seizure symptoms depend on where in the brain the disruption occurs and how much the brain is affected by
the seizure. Seizures may last from a few seconds to a few minutes. Most seizures are not medical
emergencies and resolve after one or two minutes. Use a watch to time the seizure from the beginning to the
end.
Many students achieve good seizure control with prescribed medication. However, a seizure is generally
considered an emergency under the following conditions:

a convulsive (tonic-clonic) seizure lasts longer than 5 minutes

a student has repeated seizures without regaining consciousness

a student is injured or has diabetes

a student has a first-time seizure

a student has breathing difficulties

a student has a seizure in water
The first two priorities during a seizure are airway patency (keeping the airway open) and safety.
Do not try to place an object in the student’s mouth during a seizure. Efforts to hold the tongue down could
injure teeth or jaw. Instead, turn the student to one side. This will help keep the airway open.
Do not attempt to hold the student down or restrain their movements. Instead, clear the area around the person
of anything hard or sharp.
Students receiving medication for the control of their seizures should have a written Seizure Emergency Action
Plan with instructions for how to manage the student’s seizures during school hours. The student’s LHP will
determine when emergency rescue medication should be given for seizure activity. The Seizure Emergency
Action Plan may include the administration of the emergency medication Midazolam which unlicensed school
personnel may administer after receiving training from a registered nurse per RCW 28A.210.260. The
expiration date of the Midazolam kit should be checked monthly and the parent/guardian notified by school
personnel one month in advance of the expiration date.
29
30
Module IV
Local School District
Policies and Procedures
31
Module IV: Local School District Policies and Procedures
Medication Administration
Schools will administer health services per WAC 392-172-A01155(1), including medication administration, to
students who require these services during the school day. Therefore, school districts should have policies and
procedures in place that address how medications and other health services will be delivered. The school
district policies and procedures should be readily accessible for reference by all school personnel who may be
delegated and trained to administer medication.
Local school district policies for medication administration should include:


Consent forms to be signed by parent/guardian giving authorization to the school district to
administer medication
LHP forms to be signed regarding medication administration instructions
The above policies would also address prescription medication, OTC medication and self-administered
medication.
Other local school district policies/procedures should include:






Storage of medication
How to dispose of unused medication
Administration of medication on a field trip
Medication administration documentation
Documentation and reporting of medication errors
Possession and use of asthma and/or anaphylaxis medications
The above policies/procedures should also specify the appropriate school district forms to be completed.
32
SAMPLE
3416
Page 1 of 2
Medication at School
Under normal circumstances medications, including oral, topical, eye, ear, and nasal, should be dispensed before
and/or after school hours under the supervision of a parent or guardian.
If a student must receive medication from an authorized staff member, the parent must submit a written
authorization accompanied by a written request from a licensed health professional (LHP) with prescriptive
authority. If the medication will be administered for more than fifteen consecutive days, the prescriber must also
provide written, current and unexpired instructions for the administration of the medication.
The superintendent and/or designee shall establish procedures for:
1. Training, delegation and supervision of staff members in the administration of all medications to students by a
registered nurse.
2. Designating staff members who may administer medication to students.
3. Obtaining a signed and dated parental/guardian and LHP with prescriptive authority authorization for the
administration of all medications, including instructions if the medication is to be given for more than fifteen
(15) days.
4. Storing medications in a locked or limited access area.
5. Maintaining records pertaining to the administration of medications.
6. Permitting, under limited circumstances, students to carry and self-administer medications necessary to their
attendance at school.
The use of injectable medications for the treatment of anaphylaxis is covered in ________ School District Policy
____ and ________ School District Procedure ____P.
Medications including suppositories, and/or non-emergency injections, may NOT be administered by school staff
other than by registered or licensed practical nurses. Non-oral diabetic medications may not be delegated to nonlicensed school staff by the school district’s registered nurse.
If the district decides to discontinue administering a student’s medication, the superintendent or designee must
provide notice to the student’s parent/guardian orally and/or in writing prior to the discontinuance. There shall be
a valid reason for the discontinuance that does not compromise the health of the student or violate legal
protections for the disabled.
Legal References:
RCW
28A.210.260
RCW 28A.210.270
RCW 28A.210.383
WAC 392-380
Administration of medication - Conditions
Administration of Medication – Immunity from Liability
Anaphylaxis – Policy Guidelines Procedures – Report
Life-Threatening Health Condition
Cross References:
Policy 3418
Policy 3419
Emergency Treatment
Self-Administration of Asthma and Anaphylaxis Medications
Management Resources:
Policy and Legal News, November 2013
Discretionary new “EpiPen” law allows districts to stock and administer
their own supply of epinephrine auto injectors
Policy News, August 2012
Anaphylaxis Prevention and Response
Policy News, February 2009
Anaphylaxis Prevention Policy Required
OSPI, March 2009
Guidelines for the Care of Students with Anaphylaxis
33
3416P
Page 1 of 3
Medication at School
Each school principal shall designate at least two staff members to administer oral, topical, eye, ear, and/or nasal
medications. These designated staff members will participate in an in-service training session prior to the start of
school each year. They shall receive training in the following:
1. School board policies and procedures governing the administration of all medications.
2. Procedure to follow in administering medication, including description of when not to administer medication.
3. Procedure to follow in the event of a medication error, missed doses, or delayed doses.
4. Required documentation.
5. When to contact supervising nurse.
6. Confidentiality issues regarding the administration of medications and student health information.
The supervising nurse will evaluate the staff member’s skill and document the successful completion of training.
The supervising nurse will determine the degree of supervision necessary and provide the delegation and
supervision.
Prescribed medications may be dispensed to students on a scheduled basis upon written authority from a
parent/guardian and a signed and dated authorization form with written directions from a licensed healthcare
provider (LHP) with prescriptive authority. Requests shall be valid for not more than the current school year. The
prescribed medication must be properly labeled, unexpired and in the original medication container.
Prescribed medications shall be dispensed as follows:
1. Collect the medication authorization form properly signed by the parent/guardian, and by the prescribing LHP
with prescriptive authority. All new orders for medication should be approved by the school nurse prior to
school staff administering the first dose.
2. There should be no more than a one month supply of medication brought in at one time. Medication must be
counted and the number in the container recorded, with initials and date received, on the medication log. It is
preferable to have two people count and initial. Staff/parent signatures along with their initials, will be on the
bottom of each page of the medication log or on a signature sheet.
3. Store the medications in a locked or limited access area.
4. Safe administration of oral, topical, eye, ear, and nasal medications:
a. Verify the identity of the student with the medication order.
b. Check medication notebook for correctly completed forms.
c. Obtain medication container from locked or limited access area.
d. Check medication container for the following:
1. Correct student name.
2. Correct medication name (same as on “authorization” form).
3. Correct dosage (such as how many milligrams [mg] in pill).
NOTE: If the pills are 10 mg. and the dosage is 5 mg., the pills should be broken prior to being
brought to school. School staff should not be responsible for breaking pills.
4. Correct time for administering.
e. Medications are to be taken in the office area or other pre-designated area approved by the building
administrator and the school nurse. Medications are not to be given by untrained school district staff, e.g.,
substitute secretaries and parent volunteers.
f. If medication is in tablet or capsule form, check the request form and label and give the accurate number
ordered. Pour into bottle cap and then pour into the student’s hand.
g. For topical, eye, ear, and nasal medications, check request form for the correct dose to administer and
follow administration instructions from the school nurse including the wearing of gloves.
h. Help student get water, if needed, prior to taking medication.
i. For liquid medication, pour into measuring device, e.g., plastic medicine cup or measuring “dosage” spoon.
34
j. For topical medications, place desired amount of ointment or cream on a Q-tip or tongue depressor and
apply or assist student to apply.
k. Do not use kitchen silverware teaspoons for measuring – volume varies greatly.
l. DO NOT pre-pour any medication.
m. DO NOT give medication that someone else has prepared.
n. Watch student take medication – make sure medication is taken. If student refuses, call parent/guardian
and school nurse immediately.
o. Do not give “PRN” (as necessary) medication more frequently then indicated by the LHP. Be sure to find
out when the last dose was given. Notify parent/guardian if student asks for medication more frequently
than the LHP indicates.
5.
Maintain a daily record which indicates that the prescribed medication was administered. This record is the
legal evidence that the medications were given. If a dose is missed, note why, e.g., “absent.” This record must
be kept for eight (8) years.
6.
Prescription medications should not be brought to the school by the student.
7.
A copy of this policy shall be provided to the parent/guardian upon request for administration of medication in
the schools.
8.
Inhalers:
a. Follow the same procedures as for all other types of medications.
b. EXCEPTION: The student may carry the inhaler if there are specific written orders from the parent/guardian
and the LHP. Be sure the student’s name is written on the inhaler. This may be done with an indelible
marker.
c. All parties shall be informed that the school will not be responsible for documentation of medication carried
and self-administered by the student. *The school nurse must also agree to the student carrying the
inhaler and verify that the student can correctly administer.
9.
Nasal Medications:
a. Follow the same procedures as for all other types of medications.
b. EXCEPTION: If a school nurse is on the premises, a nasal spray that is a legend drug (prescription, not
over-the-counter medication, e.g., Versed) or a controlled substance must be administered by the school
nurse.
c. School staff, who have received appropriate training and volunteered for such training and agreed in
writing to administer a nasal medication that is a legend drug or controlled substance, may administer the
medication.
d. After a school staff member, who is not a school nurse, administers a nasal spray that is a legend drug or
a controlled substance, the staff member or designee shall summon emergency medical assistance as
soon as practicable.
10. Field Trips:
If the student needs medication during a field trip, the medication will be carried on the field trip by the
designated trained staff member in a fanny pack or locked box with access limited to those giving the
medication. The medication should be in the original pharmacy-labeled container with only enough medication
for the field trip. Upon returning to school from the field trip, the signed log sheet and any leftover medication
is returned to the school nurse or designee who will assist the field trip staff member to transfer the
information to the regular school medication log for the student.
11. Accountability in Administering Medication:
a. If the school accepts medication in the correctly labeled container, “authorization” forms are properly filled
out and signed, the designated staff member is legally obliged to see that the medication is
administered to the student.
b. The principal shall designate a trained staff member, (e.g., secretary) to call the student to the office if the
student has failed to come at the designated time.
c. The designated staff member reviews the medication log/s daily to assure that medications have been
given and documented as ordered.
12. Medication Error:
a. It is important that any medication error be reported to the school nurse, who in turn, shall notify the school
nurse, appropriate district administrator, and the student’s parent/guardian.
35
b. If a medication is more than one half-hour late in being given, the school nurse shall be notified and the
medication-trained and delegated staff member shall call and notify the parent/guardian. The nurse may
contact the student’s LHP.
c. The medication error and reporting procedure need to be recorded on the back of the student’s medication
log and on the Medication Administration Incident Report Form.
d. The Medication Administration Incident Report form will be kept in the health room files by the school
nurse. It shall be kept with the rest of the health room files to be destroyed after eight (8) years.
13. Liability:
a. When district procedures and protocols are followed, designated school staff are released from liability for
damages which might result from administration of medication.
b. Administration of medications is exclusively a procedure of a licensed nurse. However, the nurse can
delegate this procedure to non-licensed staff members in a school setting according to statue. The
licensed registered nurse delegating the task retains the responsibility and accountability for the nursing
care of the client.
14. Discontinuation of Medication:
a. The principal or his/her designee will provide notice, orally and/or in writing, in advance of discontinuance.
b. Such notice shall be made to the parent/guardian having legal control over the student.
c. Document the parent/guardian notification and attach to the medication log.
d. If the medication is discontinued by the parent/guardian, the school nurse shall be notified. The school
nurse will inform the LHP and document on the back of the medication log that the medication has been
discontinued.
e. If the medication is discontinued by the LHP, the school nurse shall be notified. The school nurse will
document that the medication has been discontinued on the back of the medication log.
15. Storage of Medication Records:
Authorization for Medication Authorization forms, Medication logs, and Medication Administration Incident
forms must be kept for eight (8) years. These forms are kept in the individual school medication record files.
16. Disaster Planning:
When the schools are planning for disaster situations, student medication issues must be addressed. There
are two elements to consider:
(1) The school should have at least a three-day supply of medications on hand for students who take
medications during the school day;
(2) The school nurse should question parent/guardian to identify medications that students normally take only
at home and to whom the missing of three days of medications would pose a serious health risk for the
student or others. The parent/guardian must then provide a three-day supply of these medications and
the necessary parent/guardian and LHP request and instructions for these medications.
In some instances, by working with the student’s LHP and parent/guardian, the need for the medication
can be attenuated or delayed. These situations will have to be identified and addressed on an individual
basis to ensure that those students needing medication receive the amount they need in situations where
medications cannot be readily obtained without prior planning.
(3) All medications must be securely and properly stored according to prescription container directions, e.g.,
refrigerated and monitored for expiration dates. It may be necessary to rotate the school’s stock of
medications given only at home to ensure a fresh supply at school.
17. End of Year Procedures:
Two weeks prior to the end of the year:
a. Notify parents/guardians to pick up any medication by noon the last day of school.
b. Mail letter notification.
c. Medications left the last day of school shall be counted by the school nurse and one other witness,
destroyed and the number or amount of medication/s destroyed, documented on the back of the
“Medication Authorization form.” This record shall be kept in the medication file in the school for eight (8)
years, according to district policy.
36
Bibliography
Statutory/Regulatory
Reference
RCW 28A.210.260
Title/Description
Link
School health services – Expanding types of
medications school employees may administer
apps.leg.wa.gov/rcw
RCW 28A.210.270
Health services in the school setting – Designated
provider– Liability protection
apps.leg.wa.gov/rcw
RCW 28A.210.260
Staff Model for Delivery of School Health Services
www.k12.wa.us/HealthServic
es/pubdocs/SchHealth.pdf
RCW 28A.210.370
Self-administration of medications by students with
asthma or anaphylaxis – authorization – written
statement – acknowledgement of liability limitation
– duration of permission
apps.leg.wa.gov/rcw
www.k12.wa.us/HealthServic
es/pubdocs/GuidelinesforCar
eofStudentswithAnaphylaxis
2009.pdf
RCW 28A.210.370
Possession and use of asthma or anaphylaxis
medications.
Guidelines for Care of Students with Anaphylaxsis
apps.leg.wa.gov/rcw
www.k12.wa.us/HealthServic
es/pubdocs/GuidelinesforCar
eofStudentswithAnaphylaxis
2009.pdf
RCW 18.71
Physicians – prescriptive authority
apps.leg.wa.gov/rcw
RCW 18.130
Law relating to nursing care and regulation of
health professions – Uniform Disciplinary Act,
WSDOH
apps.leg.wa.gov/rcw
RCW 18.79.240 (1)(b)
RCW 18.79.260 (2)
Delegation of nursing tasks requiring the use of
emergency medications
apps.leg.wa.gov/rcw
WAC 246-840-700
Roles of nurses in the supervision and delegation
of nursing acts to unlicensed personnel
apps.leg.wa.gov/WAC
WAC 246-840-705
Functions of registered nurse, licensed practical
nurse
apps,leg.wa.gov/WAC
RCW 28A.210.320
Children with life-threatening health conditions
apps.leg.wa.gov/rcw
20 U.S.C. § 1232g; 34
CFR Part 99
The Family Educational Rights and Privacy Act
(FERPA)
http://regweb.unc.edu/official
/FERPA/FERPA.html
RCW 18.79
Law relating to ARNPs prescribing medications
apps.leg.wa.gov/rcw
WAC 246-840
Scope of practice for ARNP, RN, and LPN
apps.leg.wa.gov/rcw
WAC 246-840-300
Scope of practice for ARNPs
apps.leg.wa.gov/rcw
NASN
National Association of School Nurses – The Role
of the School Nurse (1999)
Delegation of nursing tasks to nonlicensed
personnel
Law relating to RN and LPN practice
www.nasn.org
WAC 246-840-010
(10)
RCW 18.79
apps.leg.wa.gov/wac
apps.leg.wa.gov/rcw
37
RCW 70.02.030
through 70.02.050
WAC 392-172A01155(1)
SB 6128
Laws relating to confidentiality
apps.leg.wa.gov/rcw
Rules related to provision of school health services
and school nurse services
An act relating to the delivery of medication and
services by unlicensed school employees
apps.leg.wa.gov/wac
apps.leg.wa.gov
38
Appendices
Appendix A
RCW 28A.210.260
RCW 28A.210.270
FERPA
39
40
RCW 28A.210.260
Public and private schools — Administration of medication — Conditions.
Public school districts and private schools which conduct any of grades kindergarten through the twelfth grade may
provide for the administration of oral medication, topical medication, eye drops, ear drops, or nasal spray, of any
nature to students who are in the custody of the school district or school at the time of administration, but are not
required to do so by this section, subject to the following conditions:
(1) The board of directors of the public school district or the governing board of the private school or, if none, the
chief administrator of the private school shall adopt policies which address the designation of employees who may
administer oral medications, topical medications, eye drops, ear drops, or nasal spray to students, the acquisition
of parent requests and instructions, and the acquisition of requests from licensed health professionals prescribing
within the scope of their prescriptive authority and instructions regarding students who require medication for more
than fifteen consecutive school days, the identification of the medication to be administered, the means of
safekeeping medications with special attention given to the safeguarding of legend drugs as defined in chapter
69.41 RCW, and the means of maintaining a record of the administration of such medication;
(2) The board of directors shall seek advice from one or more licensed physicians or nurses in the course of
developing the foregoing policies;
(3) The public school district or private school is in receipt of a written, current and unexpired request from a
parent, or a legal guardian, or other person having legal control over the student to administer the medication to
the student;
(4) The public school district or the private school is in receipt of (a) a written, current and unexpired request from a
licensed health professional prescribing within the scope of his or her prescriptive authority for administration of the
medication, as there exists a valid health reason which makes administration of such medication advisable during
the hours when school is in session or the hours in which the student is under the supervision of school officials,
and (b) written, current and unexpired instructions from such licensed health professional prescribing within the
scope of his or her prescriptive authority regarding the administration of prescribed medication to students who
require medication for more than fifteen consecutive workdays;
(5) The medication is administered by an employee designated by or pursuant to the policies adopted pursuant to
subsection (1) of this section and in substantial compliance with the prescription of a licensed health professional
prescribing within the scope of his or her prescriptive authority or the written instructions provided pursuant to
subsection (4) of this section. If a school nurse is on the premises, a nasal spray that is a legend drug or a
controlled substance must be administered by the school nurse. If no school nurse is on the premises, a nasal
spray that is a legend drug or a controlled substance may be administered by a trained school employee or parentdesignated adult who is not a school nurse. The board of directors shall allow school personnel, who have received
appropriate training and volunteered for such training, to administer a nasal spray that is a legend drug or a
controlled substance. After a school employee who is not a school nurse administers a nasal spray that is a legend
drug or a controlled substance, the employee shall summon emergency medical assistance as soon as
practicable;
(6) The medication is first examined by the employee administering the same to determine in his or her judgment
that it appears to be in the original container and to be properly labeled; and
(7) The board of directors shall designate a professional person licensed pursuant to chapter 18.71 RCW or
chapter 18.79 RCW as it applies to registered nurses and advanced registered nurse practitioners, to delegate to,
train, and supervise the designated school district personnel in proper medication procedures;
(8)(a) For the purposes of this section, "parent-designated adult" means a volunteer, who may be a school district
employee, who receives additional training from a health care professional or expert in epileptic seizure care
selected by the parents, and who provides care for the child consistent with the individual health plan.
(b) To be eligible to be a parent-designated adult, a school district employee not licensed under chapter 18.79
RCW must file, without coercion by the employer, a voluntary written, current, and unexpired letter of intent stating
the employee's willingness to be a parent-designated adult. If a school employee who is not licensed under chapter
18.79 RCW chooses not to file a letter under this section, the employee shall not be subject to any employer
reprisal or disciplinary action for refusing to file a letter;
(9) The board of directors shall designate a professional person licensed under chapter 18.71, 18.57, or 18.79
RCW as it applies to registered nurses and advanced registered nurse practitioners, to consult and coordinate with
the student's parents and health care provider, and train and supervise the appropriate school district personnel in
proper procedures for care for students with epilepsy to ensure a safe, therapeutic learning environment. Training
may also be provided by an epilepsy educator who is nationally certified. Parent-designated adults who are school
employees are required to receive the training provided under this subsection. Parent-designated adults who are
not school employees must show evidence of comparable training. The parent-designated adult must also receive
additional training as established in subsection (8)(a) of this section for the additional care the parents have
authorized the parent-designated adult to provide. The professional person designated under this subsection is not
responsible for the supervision of the parent-designated adult for those procedures that are authorized by the
parents.
41
RCW 28A.210.270
Public and private schools — Administration of medication — Immunity from liability — Discontinuance,
procedure.
(1) In the event a school employee administers oral medication, topical medication, eye drops, ear
drops, or nasal spray to a student pursuant to RCW 28A.210.260 in substantial compliance with the
prescription of the student's licensed health professional prescribing within the scope of the
professional's prescriptive authority or the written instructions provided pursuant to RCW
28A.210.260(4), and the other conditions set forth in RCW 28A.210.260 have been substantially
complied with, then the employee, the employee's school district or school of employment, and the
members of the governing board and chief administrator thereof shall not be liable in any criminal
action or for civil damages in their individual or marital or governmental or corporate or other
capacities as a result of the administration of the medication.
(2) The administration of oral medication, topical medication, eye drops, ear drops, or nasal spray to
any student pursuant to RCW 28A.210.260 may be discontinued by a public school district or private
school and the school district or school, its employees, its chief administrator, and members of its
governing board shall not be liable in any criminal action or for civil damages in their governmental or
corporate or individual or marital or other capacities as a result of the discontinuance of such
administration: PROVIDED, That the chief administrator of the public school district or private school,
or his or her designee, has first provided actual notice orally or in writing in advance of the date of
discontinuance to a parent or legal guardian of the student or other person having legal control over
the student.
42
The Family Educational Rights and Privacy Act (FERPA)
20 U.S.C. § 1232g; 34 CFR Part 99
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a federal law
that protects the privacy of student education records. The law applies to all schools that receive funds under
an applicable program of the U.S. Department of Education
Generally, schools must have written permission from the parent or eligible student in order to release any
information from a student's education record. However, FERPA allows schools to disclose those records,
without consent, to the following parties or under the following conditions (34 CFR § 99.31):

School officials with legitimate educational interest;

Other schools to which a student is transferring;

Specified officials for audit or evaluation purposes;

Appropriate parties in connection with financial aid to a student;

Organizations conducting certain studies for or on behalf of the school;

Accrediting organizations;

To comply with a judicial order or lawfully issued subpoena;

Appropriate officials in cases of health and safety emergencies; and

State and local authorities, within a juvenile justice system, pursuant to specific state law.
Forum Guide to the Privacy of Student Information: A Resource for Schools
(NFES 2006–805). U.S. Department of Education, Washington, DC: National Center
for Education Statistics
43
44
Appendix B
Sample Medication Order/Request Forms
and Administration Log
45
46
Name of School District___________________
MEDICATION REQUEST FORM
Please note: This form must be completed and signed by the parent and the student’s Licensed Healthcare Provider-with
prescriptive authority. This form is for both prescription and nonprescription medication. Complete a separate form for
each medication. All medication must be transported to and from the school by a responsible adult.
PARENT REQUEST
STUDENT NAME ___________________________________ SCHOOL _________________________________
I certify that I am the parent, legal guardian, or other person in legal control of the above identified student and request and
authorize the school to dispense medication to the above identified student in accordance with the prescription or doctor’s
instructions for the period commencing: START DATE ____________ TERMINATION DATE______________.
In the event of half-day school schedule, I want my child to take his/her medication at school: ______ Yes ______ No
_______________________
_____________________________________________________________
Date
Parent Signature
___________________________ ____________________________
Home Phone
Work Phone
LICENSED HEALTHCARE PROVIDER REQUEST
MEDICATION (Name, Dosage) _____________________________________________________________________
ADMINISTRATION SCHEDULE _______________________________________________________________
REASON FOR MEDICATION __________________________________________________________________
FURTHER INSTRUCTIONS (possible reactions, etc.): This section must be completed if medication is to be dispensed
for more than 15 days. __________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
I request and authorize that the above named student be administered the above identified medication in accordance with the
instructions indicated above for the period commencing:
START DATE___________TERMINATION DATE: ______________ as there exists a valid health reason which makes
administration of the medication advisable during school hours or during such time that the student is under the supervision
of school officials.
_________________________
____________________________________________________________
Date
Licensed Healthcare Provider Signature
_________________________
Office Phone
____________________________________________________________
Name (Please print)
MEDICATION ORDER
This record must be retained for eight (8) years.
47
STUDENT NAME ________________________________________ BIRTHDATE ________________ GRADE ____________ NAME OF MEDICATION __________________________________ DOSAGE ___________ _______ TIME ______________ DATE TIME PILLS LEFT INITIALS COMMENTS
DATE
TIME
PILLS
LEFT INITIALS COMMENTS
INITIALS ________ SIGNATURE _________________________ INITIALS ________ SIGNATURE ___________________________ INITIALS ________ SIGNATURE _________________________ INITIALS ________ SIGNATURE __________________________ MEDICATION ADMINISTRATION RECORD
This record must be retained for eight (8) years
SCHOOL ASTHMA/504 PLAN & MEDICATION ORDERS
Student Name:
Birthdate:
Grade:
School:
History of anaphylaxis
PE/Sports: Day/Time/Periods
Brief medical history:
Weight:
Bus #
Walk
Date of last hospitalization:
Inhaler(s) location:
OFFICE
BACKPACK
ON PERSON
OTHER:
Epinephrine auto-injector (EAI) location:
OFFICE
BACKPACK
ON PERSON
OTHER:
Drive
Place
student
picture
here
All SECTIONS ON THIS PAGE TO BE COMPLETED BY STUDENT’S LICENSED HEALTHCARE PROVIDER (LHP)
ASTHMA TREATMENT INSTRUCTIONS: (check all that apply)
None Known
Animals
Cold Air
Exercise
Pollens
Exercise
Asthma Triggers:
Smoke, chemicals, strong odors
Other ________________________________________ (i.e., foods, emotions, insects, etc.)
USUAL ASTHMA SYMPTOMS: (check all that apply)
Cough
Wheeze
Shortness of breath
Chest tightness
GO ZONE (GREEN)
Asking to use inhaler
Other ______________________
INFREQUENT/MINIMAL SYMPTOMS
 Symptoms and/or use of quick relief medication < 2 times per week. (Does not include exercise pre-treatment usage.)
Infrequent and minimal symptoms like cough, wheeze, and short of breath
 Full participation in physical education and sports
CAUTION ZONE (YELLOW)
SIGNIFICANT SYMPTOMS
DO NOT LEAVE STUDENT UNATTENDED
 If Student is using the quick relief inhaler > 2 times per week or requires frequent observation by school staff Notify parents and nurse
 If Student is coughing, wheezing, and having difficulty breathing:
Give 2 puffs of quick relief inhaler. May repeat in 10 minutes. Notify parents and nurse if repeated
Other: _________________________________________________________________________________________________
 Until symptoms are in the GO ZONE (green), restrict strenuous physical activity.
 If no improvement after repeated dose Call 911—See below
STOP ZONE (RED)
C AL L 9 1 1
DO NOT LEAVE STUDENT UNATTENDED
If Student is very short of breath, can see ribs during breathing, difficulty walking or talking, blue appearance to lips or nails, quick relief medication not working.
 CALL 911
Give 4 puffs quick relief inhaler (or nebulizer treatment) and notify parents and school nurse.
This student needs Epinepherine Auto Injector (EAI) for severe asthma attacks and
Can carry and self-administer EAI.
Needs help giving the EAI.
Other: __________________________________________________________
EXERCISE PRE-TREATMENT: (check all that apply)
Give 2 puffs of quick relief inhaler 15- 30 minutes prior to
N/A
PE
As needed with no less than 2 hours between doses unless
student complains of symptoms.
May repeat 2 puffs of quick relief inhaler if symptoms occur. Notify parents and nurse if occurs.
Quick relief medication orders: (check the appropriate quick relief med(s)
Uses inhaler with spacer
Albuterol 2 puffs (Pro-air®, Ventolin HFA®, Proventil®) as needed every 4 hours for cough/wheeze
Levalbuterol 2 puffs (Xopenex®) as needed every 4 hours for cough/wheeze
Other ____________________________
Epinephrine auto-injector
0.3 mg
Jr. 0.15 mg
Daily Controller meds: _________________________________________________ dose _________________ time ____________
Takes daily controller medications at home
Takes daily controller medications at school
SIDE EFFECTS of medication(s): increased heart rate, shakiness,
This student demonstrated correct use of the inhaler in the LHP’s office.
Yes
This student is able to carry and use inhalers
Yes
No
LHP Signature:
LHP Print Name:
Start date
End date
Date:
Telephone #:
Last day of school
Fax #:
49
Other:
No
Student Name:
TO BE COMPLETED BY PARENT OR GUARDIAN
EMERGENCY CONTACTS
Home Phone
Work Phone
Other
ADDITIONAL EMERGENCY CONTACTS
1
Relationship:
.
2
Relationship:
.
My student may carry and use his/her asthma inhaler?
My student may carry and is trained to self-administer his/her own EAI?
Parent:
Father/Guardian Mother/Guardia
n
Name
Name
Home
Phone
Work
Phone
Other
Phone:
Phone:
Yes
Yes
No
No
Provide extra for office?
Provide extra for office?
Yes
Yes
No
No
 I have reviewed the information on this School Asthma/504 Plan Medication Orders and request/authorize trained school employees to provide this care
and administer the medications in accordance with the Licensed Healthcare Provider’s (LHP’s) instructions.
 I authorize the exchange of medical information about my child’s asthma between the LHP office and school nurse.
 I understand that the school board or the school district’s employees cannot be held responsible for negative outcomes resulting from self-administration of the inhaled
asthma medication.
 The permission to possess and self-administer asthma medication may be revoked by the principal/school nurse if it is determined that the student
effectively self-administering the medication.
is not safely and
 A new LHP order/school asthma and Parent/Student Agreement for an Inhaler/EAI must be submitted each school year.
 I understand that if any changes are needed on the school asthma plan, it is the parent’s responsibility to contact the school nurse.
Parent/Guardian Signature
Date
Student:
 I have demonstrated the correct use of the inhaler to the medical provider and school nurse.
 I agree never to share my inhaler with another person or use it in an unsafe manner.
 I agree that if there is no improvement after self-administering, I will report to an adult at school if the nurse is not available or present.
Student Signature (Required)
Date
For School Registered Nurse’s Use Only
This student has demonstrated the skill to use the medication and any device necessary to administer the medication ordered whether selfadministered or not. This plan has been reviewed/approved by a registered nurse.
Device(s) if any, to be
Expiration date(s):
used:
Registered Nurse Signature
Phone
50
Date
SEVERE ALLERGY REACTION/504 PLAN & MEDICATION ORDERS
Place
student
picture
here
Student has severe allergy to:
Student Name:
Birthdate:
Weight:
Bus #
Walk
Drive
Grade:
School:
Allergy History:
History of anaphylaxis/severe reaction
Skin testing indicates allergy Date of Last Reaction:
Student has Asthma (increased risk factor for severe reaction)
Other Allergies:
Epinephrine auto-injector (EAI) location:
OFFICE
BACKPACK
ON PERSON
OTHER:
_____________________
Inhaler(s) location:
OFFICE
BACKPACK
ON PERSON
OTHER:
_____________________
Anaphylaxis (Severe allergic reaction) is an excessive reaction by the body to combat a foreign substance that has been eaten, injected, inhaled
or absorbed through the skin. It is an intense and life- threatening medical emergency. Do not hesitate to give EAI and call 911.
USUAL SYMPTOMS of an allergic reaction: (Students usual s/s are in bold, italics, and/or underlined)
MOUTH--Itching, tingling, or swelling of the lips, tongue, or mouth
SKIN--Hives, itchy rash, and/or swelling about the face or extremities
THROAT--Sense of tightness in the throat, hoarseness and hacking cough
GUT--Nausea, stomach ache/abdominal cramps, vomiting and/or diarrhea
LUNG--Shortness of breath, repetitive coughing, and/or wheezing
HEART--“Thready” pulse, “passing out”, fainting, blueness, pale
GENERAL--Panic, sudden fatigue, chills, fear of impending doom
This Section To Be Completed By A Licensed Healthcare Provider (LHP):
If a student has symptoms or you suspect exposure (is stung, eats food he/she is allergic to, or exposed to something allergic to):
0.3 mg
1. Give Epinephrine Auto Injector (EAI)
Jr. 0.15 mg
May repeat EAI (if available) in 10-15 minutes if symptoms are not relieved or symptoms return and EMS
has not arrived.
Document time medications were given below and alert EMS when they arrive.
_____________________
______________________
_____________________
_____________________
EAI #1
EAI #2
Antihistamine
Inhaler
2. Stay with student.
3. CALL 911 – Advise EMS that student has been given Epinephrine
4. Notify parents and school nurse.
®
5. After EAI given, give Benadryl or antihistamine _______________________________ (ml/mg/cc)
6. If student has history of Asthma and is having wheezing, shortness of breath, chest tightness with allergic reaction,
After EAI, administer:
Albuterol 2 puffs (Pro-air®, Ventolin HFA®, Proventil®)
Albuterol/Levalbuterol unit dose SVN (per nebulizer)
®
Levalbuterol 2 puffs (Xopenex )
Other_______________________________________
7. A student given an EAI must be monitored by medical personnel or a parent and may NOT remain at school.
SIDE EFFECTS of medication(s):
EAI: increased heart rate, ________________________________ Antihistamine: sleepy, ______________________
Albuterol/Levalbuterol: increased heart rate, shakiness,___________________________________________________________
Student may carry & self-administer EAI +/or antihistamine
Student has demonstrated EAI use in LHP’s office
Student may carry & self-administer Inhaler
Student has demonstrated inhaler use LHP’s office
PLEASE COMPLETE THIS SECTION IF THE STUDENT HAS A SEVERE FOOD ALLERGY – (required by
Check here if student will EAT school provided meals during the entire school year. If so, one of the following must be completed.
1. Foods to omit: _____________________________________________________________________________________________________
Suggested general substitutions: ___________________________________________________________________________________________
2.
Check here if standard substitutions offered in our district are acceptable.
(Contact district Food Services Manager for details.)
LHP Signature:
Note: Meals from home provide the safest food option at school.
LHP Print Name:
Start date:
End date
Date:
Telephone #:
Last day of school
Other:
Fax #:
Page 1 of 2
51
Care Plan for Severe Allergy – Part 2 – Parent
Student Name: ______________________________________
Brief Medical History_____________________________________________________________________
Food Allergy Accommodations
•
Foods and alternative snacks will be approved or provided by parent/guardian.
•
Parent/guardian should be notified of any planned parties as early as possible.
•
Classroom projects should be reviewed by the teaching staff to avoid specified allergens.
•
Student is responsible for making his/her own food decisions.
•
When eating student requires:
Yes
No
Yes
No
Specified eating location. Where? ______________________________________________
No restrictions
Bus Concerns –Transportation should be alerted to student’s allergy.
•
This student carries Epinephrine auto-injector (EAI) on the bus?
•
EAI can be found in
•
Student will sit at front of the bus?
Backpack
Yes
Yes
Waist pack
No
On Person
Other (specify) __________________
No
Field Trip Procedures – EAI must accompany student during any off campus activities.
•
The student must remain with the teacher or parent/guardian during the entire field trip?
•
Staff members on trip must be trained regarding EAI use and this health care plan (plan must be taken).
Yes
No
Yes
I wish to meet with the building 504 team to discuss additional accommodations
No
EMERGENCY CONTACTS
Name
Home Phone
Home Phone
Work Phone
Work Phone
Other
ADDITIONAL EMERGENCY CONTACTS
1.
2.
Father
Mothe
Name
Other
Relationship:
Relationship:
Phone:
Phone:
My child may carry and is trained to self-administer his/her own EAI:
Yes
No
Yes
No
Provide extra for office?
Yes
No
Provide extra for office?
My child may carry and use his/her asthma inhaler
Yes
No

I request this medication to be given as ordered by the licensed health professional (LHP) (i.e., doctor, nurse practitioner, PAC).I give health

I understand that any medication will not necessarily be given by a school nurse but may be given by trained and monitored school staff.

I release school staff from any liability in the administration of this medication at school.

I understand this is a life threatening plan and can only be discontinued, in writing, by the prescribing LHP.

Medical/medication information may be shared with school staff working with my child and 911 staff, if they are called.

All medication supplied must come in its originally provided container with instructions as noted above by the LHP.

I understand that my child is encouraged to wear a medical ID bracelet identifying the medical condition.

I request and authorize my child to carry and/or self-administer their medication.

This permission to possess and self-administer any medication may be revoked by the principal/school nurse if it is determined that the student
services staff permission to communicate with the LHP/medical office staff about this plan and medication.
Yes
No
cannot safely and effectively self-administer.
Parent/Guardian Signature
Date
For School Registered Nurse’s Use Only
This student has demonstrated to the nurse, the skill to use the medication and any device necessary to administer the medication ordered whether
self-administered or not. This plan has been reviewed/approved by a registered nurse.
Device(s) if any, to be used
Expiration date(s):
Registered Nurse Signature
Phone
Date
A copy of the Health Care Plan will be kept in the substitute folder and given to all staff members involved with the student.
52
Page 2 of 2
Appendix C
Sample Medication Administration Incident Report Form
53
54
Medication Administration Incident Report Form
Student name: _____________________________________________________________ Date of birth: ____________________
School name: ___________________________________________________________________________ Age: __________
Date/time of error: _________________________________________________________________________________________
Name of person administering medication: ______________________________________________________________________
Name of medication: ______________________________ Dosage: _____________ Route: _______________________________
Time(s) to be given: ________________________________________________________________________________________
Circle all that apply to this medication error:
Wrong student
Wrong time
Wrong dose
Wrong route
Wrong medication
Wrong documentation
Describe the error (should be completed by the person making the error. If wrong medication given, include the name and dosage of what was
given):
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Action taken/intervention: _______________________________________________________________________________________________
____________________________________________________________________________________________________________________
Persons notified at time of error:
________________________________________________________________Date/time of notification_____________________
_________________________________________________________________Date/time of notification_____________________
_________________________________________________________________Date/time of notification_____________________
Student’s Health Care Provider notified: _______________________________________________ Date/time of notification: _________________
(if applicable)
Name of person completing incident report: _____________________________________________________________________
(please print)
Signature (person completing incident report: ______________________________________________________ Date: _____________________
Follow-up care/information (if applicable) :____________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
55
\
56
Appendix D
Common Medication Abbreviations
57
Common Medication Abbreviations
Abbreviation
ac
ADD
ADHD
bid
bucc
cc
cap
D/C
gtt/gtts
inh
MDI
mg
mL
nka
NKDA
OD
OS
OTC
OU
Ounce
pc
PCN
po
prn
qd
qh (q1h)
qam
q2h
q3h
q4h
q6h
qid
qod
stat
S/E
SL
S-R
susp
tab
tid
tsp
Definition
Before meals
Attention Deficit Disorder
Attention Deficit Hyperactivity Disorder
Two times a day
Buccal (inside the cheek, along the gum line)
Cubic centimeter (1cc=1mL)
Capsule
Discontinue
Drop/Drops
Inhalation
Metered-dose inhaler
Milligram
Milliliter (1mL=1cc)
No known allergies
No known drug allergies
Right eye
Left eye
Over-the-counter
Both eyes
(1oz=30cc’s=30mL’s)
After meals
Penicillin
By mouth
When needed or necessary
Every day
Every hour
Every morning
Every two hours
Every three hours
Every four hours
Every six hours
Four times a day
Every other day
At once
Side effects
Sublingual (under the tongue)
Sustained release (slow release)
Suspension
Tablet
Three times a day
Teaspoon (5mL=1tsp)
58
Appendix E
Glossary of Medical Terms
59
Glossary of Medical Terms
Term
Abrasion
Acute
ADD
ADHD
Adverse effects
Allergic reaction
Analgesic
Anaphylaxis
Anti-anxiety
Antibiotic
Anticoagulant
Antidepressant
Anti-mania
Antipsychotic
Antiseptic
Binging
Bipolar Disorder
Broad
Spectrum
Antibiotics
Cerebral
stimulants
Cheeked
Chronic
Conjunctivitis
Controlled
substances
Corticosteroids
Decongestant
Dermal
Dermatitis
Dyspnea
Definition
Superficial scraping away of the skin
Sudden onset, the opposite of chronic
Attention Deficit Disorder. A disorder manifested by poor impulse control,
distractibility and forgetfulness.
Attention Deficit Hyperactivity Disorder. ADD with added symptoms of
hyperactivity
Unexpected or unwanted reaction to a medication. It may be sudden or
develop over time
Immune response to a foreign substance resulting in inflammation and/or
organ dysfunction. Symptoms may occur immediately or over time, such as
redness, rash, hives, itching, swelling, and yellowing of skin and fever
Medicine for relief of pain
Most dangerous type of allergic reaction. Anaphylaxis is a life-threatening
event that may include symptoms such as falling blood pressure, respiratory
distress and unresponsiveness
Medication that reduces the feelings of worry or apprehension
Medication that kills or stops the growth of bacteria
Medication that hinders the coagulation of blood (blood thinner)
Medication used to relieve or prevent depression
Medication used to relieve the mental state of extreme excitement and
activity (manic or bipolar disorders)
Medication that reduces the symptoms of psychosis, such as delusions,
hallucinations and distorted reality
Substance that stops or prevents the growth of various microorganisms on
the skin
Period of excessive indulgence as in eating or drinking
Any of several mood disorders characterized usually by alternating episodes
of depression and mania or by episodes of depression alternating with mild
nonpsychotic excitement – also called bipolar affective disorder, bipolar
illness, manic depression, manic-depressive psychosis
Medication used to treat a wide range of disease-causing bacteria
Medication prescribed for youth with ADD or ADHD often resulting in calmer
behavior and better impulse control
Medication that has been hidden or attempted to be hidden inside the
mouth, generally either in the cheek or under the tongue
Persistent or long lasting health condition. Opposite of acute
Itchy swollen eyes that may be caused by allergies, foreign body or bacterial
or viral infection. Highly contagious. Also called “pinkeye.”
Potentially addictive medications regulated by Federal laws
Medications prescribed to quickly reduce inflammation and pain (also called
“steroids”). To maximize benefits, but minimize potential side effects,
corticosteroids are usually prescribed in low doses or for short durations
Broad class of medications used to relieve nasal congestion. Generally, they
work by reducing swelling of the mucous membranes in the nasal passages
Refers to skin
Inflammation of the skin; the skin inflammation varies from mild irritation and
redness to open sores, depending on the type of irritant, the body part
affected, and sensitivity
Difficulty in breathing
60
Dyspepsia
Edema
Enteric coating
EpiPen®
Epilepsy
Expectorant
Feces
Finger cot
Flat affect
Fungicidal
Grandiosity
Grand Mal
Seizure
Hallucinations
Hypertension
Hypoglycemia
Hypothyroidism
Inflammation
Jaundice
Lacerations
Laxatives
Lethargic
Licensed
Practitioner
Mania
MAR
Narcolepsy
Nebulizer
Non-controlled
medications
Ophthalmic
Oral
medications
Otic
Over-thecounter (OTC)
medications
Paranoid
Disorder
PRN
Indigestion, heartburn
Swelling
Substance covering a tablet that will not dissolve until reaching the small
intestine
Disposable pre-filled injectable medication prescribed for treating severe
allergic reactions causing respiratory distress (anaphylaxis)
Neurological disorder that causes recurrent seizures
Medication that loosens mucous from the respiratory tract
Also called stool
Close fitting sheath worn at the end of a finger as a device for protection of
the finger
Lack of emotional response, no expression of feelings, talking in monotone
voice or having lack of facial expression
Medication used to kill fungus
False or exaggerated belief in one’s own worth
Major epileptic seizure involving the entire body
Perceived sights, sounds, tastes, smells, or sensations that are not actually
there
High blood pressure readings above the “normal” range appropriate for age
Abnormally low blood sugar
Condition of the thyroid gland characterized by low energy, weight gain and
often can mimic depression
Response of the immune system to injury or destruction of cells. Symptoms
may include redness, heat, pain and swelling
(Icterus) Yellowing of the whites of the eyes, skin and body fluids
Cuts or scratches on the body
Medications that will cause evacuation of feces (stool) from the body
Drowsy or sluggish, difficult to stay awake
Individual who has been granted a license to practice within the parameters
designated by the board of record. The NCQAC grants licenses to RNs,
APRNs and LPNs.
Mental state of extreme excitement and activity (manic)
Medication Administration Record; documentation record for medications
given
Chronic sleep disorder in which a person experiences extreme tiredness
and possibly falls asleep during inappropriate times, such as at work or
school
Device used to administer medication in the form of a liquid mist into the
airways
Non-controlled medications – medications with no history of addictive
potential; not governed by the same laws and storage requirements as for
controlled medications
Pertaining to the eyes
Drugs that are given by mouth
Pertaining to or concerning the ear
Medications that may be purchased without a prescription, such as Tylenol®
or Advil®
Excessive anxiety or fear concerning one’s own well being
Medications ordered to be given only on an “as needed” basis, such as
61
medications
Psoriasis
Psycho
therapeutic
agents
Route of
administration
Seizure
Tardive
Dyskinesia (TD)
Topical
medication
Tourette
Syndrome
Tylenol for a headache
Chronic skin disease with scaly red patches
Classification of medication used to treat mental disorders, may be
prescribed to treat depression, psychosis or bipolar disorders
How a medication is to be given, such as by mouth, on the
skin (topical), etc.
Brief, excessive discharge of electrical activity in the brain that alters one or
more of the following: movement, sensation, behavior, awareness
Neurological disorder that may be due to long term and/or high dose use of
some antipsychotic medications; characterized by abnormal repetitive,
involuntary movement of the face, such as grimacing, lip smacking, or rapid
eye blinking
Medications applied to the skin
Neurological disorder characterized by unusual, involuntary movements or
sounds, called tics. Common tics are throat-clearing and blinking. May occur
with other neurological disorders such as ADHD, Obsessive-Compulsive
Disorder (OCD), anxiety or depression
62
Appendix F
Steps for Proper Hand Washing
63
Steps for Proper
Hand Washing
Proper hand washing is
essential in preventing
spread of germs.
Always wash your hands
before preparing to
administer medications.
the
Alcohol-Based Hand Sanitizers
Alcohol-based hand sanitizers are an alternative when soap and water are not available. However, if
hands are visibly soiled, soap and water must be used.
Using an alcohol-based hand sanitizer


Apply ½ tsp (nickel size) of the sanitizer to the palm of the hand
Rub hands together, covering all surfaces until they are dry (approximately 20 seconds)
64
Appendix G
Six Rights of Medication Administration
65
Six Rights of Medication Administration
1. Right Student
Always have two (2) ways of identifying the student when
administering medications.
2. Right Medication
Verify that the name of the medication on the label on the medication container matches the
information on the Medication Administration Log
3. Right Dose
Read the label on the medication container and compare it to the information on the Medication Log.
Be sure to note the dose of the medication to be given.
4. Right Route
Read the label on the medication container and compare it to the information on the Medication Log.
Be sure this information matches.
5. Right Time
Follow the instructions on the Medication Log. Compare with the instructions on the medication
container label. Follow school district policy for the time frame acceptable to give the medication
(example: 30 minutes before or 30 minutes after the scheduled time).
6. Right Documentation
Each medication given must be documented when it is given. Remember - If a medication has been
given but not documented, there is the potential of overdosing.
Always Check the Medication:

When removing the medication from storage (drawer/shelf)

When removing the medication from the container/package

When returning the medication container to storage (drawer/shelf)
66
Appendix H
Brand and Generic Names for Common Medications
67
Brand and Generic Names for Common Medications
Brand Name
Abilify
Generic Name
Aripiprazole
Actifed
Adderall,
Adderall XR
Advil
Atarax
Ativan
Benadryl
Buspar
Catapres
Aphedrid, Aprodine
Amphetamine
Sulfate
Ibuprofen
Hydroxyzine
Lorazepam
Diphenhydramine
HCL
Buspirone
Clonidine
Celexa
Citalopram
Claritin
Cogentin
Colace
Concerta
DDAVP
Loratidine
Benztropine
Docusate Sodium
Methamphenidate
Desmopressin
acetate
Divalproex Sodium`
Trazodone
Dextroamphetamne
Sulfate
Venlafaxine
Lithium
Tiagabine
Simethicone
Zipraxidone
Haloperidol
Imipramine
Loperamide
Lamotrigine
Escitlopram
Lithium
Clotrimazole
Fluvoxamine
Depakote
Desyrel
Dexadrine
Effexor
Eskalith
Gabitril
Gas-X
Geodon
Haldol
Imipramine Hcl
Immodium
Lamictal
Lexapro
Lithobid
Lotrimin
Luvox
Brand Name
Metadate ER, Metadate
CD
Mellaril
Motrin
Generic Name
Methamphenidate
Neurontin
Paxil
Prozac
Remeron
Gabapentin
Paroxetine
Fluoxetine
Mirtazapine
Risperdal
Ritalin, Ritalin SR,
Ritalin EC
Robitussin DM
Risperidone
Methamphenidate
Thioridazine
Ibuprofen
Seroquel
Singulair
Strattera
Synthroid
Tegretol, Carbitrol
Guaifenesin
Dextromethorphan
Hbr
Quetipine
Montelukast
Atomoxetine
Levothyroxine
Carbamazepine
Tenex
Guanfacine
Thorazine
Chlorpromazine
Tinactin
Topamax
Tolnaftate
Topiramate
Trileptal
Tylenol
Valium
Wellbutrin, Wellbutrin SR
Xanax
Zantac
Zoloft
Zyprexa
Oxcarbasepine
Acetameniphen
Diazepam
Bupropion
Alprazolam
Ranitidine
Sertraline
Olanzapine
68
Appendix I
List of Common Medications
69
Common Medications
Please note: Not an all inclusive list
Medication
Classification
Antibiotics
*Pay close
attention to any
student allergies
Common Use
Common Names
Infections caused by
bacteria. Not
commonly used for
viruses
Amoxicillin, Ampicillin,
Penicillin, Cefaclor
(Ceclor), Ceftin, Biaxin,
Zithromax
Anti-Asthma
agents
Asthma, respiratory
distress
Advair, Albuterol,
Singulair
Antihistamines
Allergies, i.e., hay
fever
Tavist-D, Claritin,
Singulair, Zyrtec,
Allegra, Benadryl
Analgesics
Pain relief
Tylenol, Advil, Aspirin
Stomach upset,
tinnitus, nausea
Anticonvulsants
Antiepileptic
Neurological
disorders, seizures
Phenobarbital, Valproic
Acid, Tegretol,
Dilantin, Topamax
Dizziness, drowsiness,
confusion, fainting
Antidiabetics
To treat diabetes
Insulins, Actos,
Glucophage, Glucotrol
Nausea, heartburn,
fatigue, dizziness, low
blood sugar
Cardiovascular
High blood pressure,
irregular heart-beat,
heart failure
Tenormin, Capoten,
Catopres
Dizziness, drowsiness,
chest pain, loss of
appetite, leg pain
Cerebral
stimulants
Attention Deficit
Disorder
(ADD/ADHD),
Narcolepsy
Relieves congestion
“CONTROLLED”
Adderall, Ritalin
Insomnia, irritability,
restless, decreased
growth
Tavist-D, Clartin-D
Nose bleed, nasal
irritation
Bacitracin, Zovirax,
Neosporin
Rash, skin irritation,
burning
Decongestants
Dermatological
(skin)
Skin infections
70
Common Adverse/
Side Effects
Nausea, diarrhea, rash,
yeast infections, fever
Nervous feeling,
sweating, nausea,
vomiting, increased heart
rate, jitters
Drowsiness, insomnia,
weakness
Medication
Classification
Gastrointestinal:
Antacid
Heartburn, acid reflux Tums, Mylanta, Maalox
Anti-Ulcer
Treat ulcer condition
Tagamet,
Pepcid,Zantac
Dizziness, mild diarrhea
Anti-Diarrhea
Stop diarrhea
Immodium, Lomotil
Fatigue, dry mouth,
nausea
Laxatives
Relieve constipation
Metamucil, Colace,
Surfak
Common Use
Common Names
Common Adverse/
Side Effects
Constipation, bloating
Cramping, depends on
medication for bowel
movement
Opthalmic (eye)
Eye irritation or
infection
Polysporin,
Neosporin, Liquifilm
Burning sensation,
itching, blurred vision
Otic (ear)
External ear
infections
Acetic Acid (VoSol),
Ofloxacin
Ear irritation, itching
Antidepressants
Depression
Wellbutrin, Paxil, Zoloft
Weight gain, insomnia,
nervous feeling
Antipsychotic
Psychosis, behavior
disorder
Abilify, Risperdal,
Haldol
Tardive dyskensia,
sedation
Anti-mania
Bipolar disorder
Lithium, Eskalith
Tremors, drowsiness,
thirst
Psychotherapeutic
agents:
71
72
Appendix J
Hands on Medication Administration
Skills Check Lists
73
74
Medication Administration Skills Check List Date Skill Verbalized / Demonstrated A. Knows policy on medication
1) All medications (prescription and over‐the‐counter) need a request for medication administration form signed by a licensed health care provider (LHP) and parent and approved by the school nurse before medications are given. 2) Medications are to be in prescription bottle or original pharmacy container. 3) Medications are stored in locked drawer or cabinet. 4) Only designated and trained staff members or school nurses may give medications at school. 5) Medication administration records will be maintained on each student receiving medications at school. B. Procedure as forms and medications are
received by staff
1) Medication folder contains the following: a) Signed parent and LHP request forms. b) District medication administration policy/procedure. c) Medication administration record. d) List of trained staff able to administer medication (copy of skills sheet). e) Poison Control phone number 2) Familiarize oneself with the medication that each student is taking. 3) Check possible side effects for each medication (list on form). 4) Check and compare Medication Request Form/Record‐
Log and medication label to assure that the SIX RIGHTS for medication administration can be followed (everything should match and school nurse must have signed off on it): a) Right student (medication form could include student’s picture) b) Right medication c) Right dose (dose per pill and number of pills to give) d) Right time e) Right route (oral, eye, ear, topical – please see below) f) Right documentation 5) Transfer student’s medication information on Medication Request Form to Record‐Log on back of form (this is done by the nurse). 6) Count the number of pills in bottle and record, initial, and date. 75
C. General principles for administering medication
1) Wash hands. 2) Check and compare Medication Request Form/Record‐
Log and medication label to assure that the SIX RIGHTS for medication administration are followed (everything should match): a) Right student b) Right medication c) Right dose (dose per pill and number of pills to give) d) Right time e) Right route (oral, eye, ear, nasal, topical – please see below) f) Right documentation 3) If the information on record does not match medication container. a) Call school nurse for instructions b) Parent may give medication until situation is resolved 4) Do NOT touch medication with your hands. 5) For any changes in medication, a new parent/LHP Medication Request Form and newly labeled bottle is needed before medication can be administered at school. If changes are requested immediately, call RN. 6) Medication may be discontinued at any time by the parents, either verbally or in writing, when approved by the RN, with input from LHP. 7) Any problems or concerns should be communicated to parents and/or school nurse. I have voluntarily received training and had an opportunity to ask questions about the above information. I understand my responsibility and voluntarily agree to administer medication as outlined above. _____________________________________________________ ________________________ Staff signature Date This staff member has received the above general medication training and demonstrated sufficient understanding and knowledge in administration of medication. _____________________________________________________ ________________________ Registered nurse signature Date
76
Oral (Solid) Medication Administration Skills Checklist Date Skill Verbalized / Demonstrated 1) Follow the Six Rights of Medication Administration; Right student, Right medication, Right dose, Right time, Right route and Right documentation. 2) Wash hands. 3) Pour medication into the bottle lid and then into the disposable medicine cup holding the cup over a counter. 4) Provide the student with water or other liquid that allows for easy swallowing. 5) Verify the student has swallowed the medication. 6) Document on the Medication Request Form/ Record‐Log that you have administered the medication. 7) Replace the medication in locked storage area. 8) Observe the student for any medication reaction as appropriate. I have voluntarily received training and had an opportunity to ask questions about the above information. I understand my responsibility and voluntarily agree to administer solid oral medication as outlined above. ______________________________________________________ ___________________ Staff signature Date This staff member has received the above training and demonstrated sufficient understanding and skill in administration of solid oral medication. ______________________________________________________ ___________________ Registered nurse signature Date 77
Oral (Liquid) Medication Administration Skills Checklist Date Skill Verbalized / Demonstrated 1) Follow the Six Rights of Medication Administration; Right student, Right medication, Right dose, Right time, Right route and Right documentation. 2) Wash hands. 3) Have the container at eye level when measuring. 4) Holding the bottle so that the label is in the palm of the hand, pour the liquid into a plastic marked cup or other receptacle such as a medicine spoon or syringe. Pay attention to the markings on the container to make sure the dose is accurate. 5) Verify the student has swallowed the medication. 6) Document on the Medication Request Form/ Record‐Log that you have administered the medication. 7) Replace the medication in locked storage area. 8) Observe the student for any medication reaction as appropriate. I have voluntarily received training and had an opportunity to ask questions about the above information. I understand my responsibility and voluntarily agree to administer liquid oral medication as outlined above. ______________________________________________________ ___________________ Staff signature Date This staff member has received the above training and demonstrated sufficient understanding and skill in administration of liquid oral medication. ______________________________________________________ ___________________ Registered nurse signature Date 78
Eye Drops or Ointment Skills Checklist Date Skill Verbalized / Demonstrated 1) Follow the Six Rights of Medication Administration; Right student, Right medication, Right dose, Right time, Right route and Right documentation. Know which eye is to be treated. Initials may be used to specify the eye that requires treatment, O.D. = right eye; O.S. = left eye; O.U. = both eyes. 2) Wash hands. 3) Put on gloves. 4) Stabilize the head by having the student tilt their head back or have them lie down. 5) Have the student look upward. 6) Gently pull the lower lid away from the eye to form a “pocket.” 7) Place drop(s) into pocket area allowing the drop(s) to fall into the pocket. Do not place medicine directly on the eye itself. Make sure the bottle tip does not touch the eye or eyelid. 8) If an ointment is used, apply a thin strip into the “pocket” without touching the eye or eyelid. 9) Have the student close their eye(s) for a few moments. 10) Dab away excess with tissue. 11) Remove gloves and wash hands. 12) Document on the Medication Request Form/ Record‐Log that you have administered the medication. 13) Replace medication in locked storage area. 14) Observe the student for any medication reaction as appropriate. I have voluntarily received training and had an opportunity to ask questions about the above information. I understand my responsibility and voluntarily agree to administer eye medication as outlined above. ______________________________________________________ ___________________ Staff signature Date This staff member has received the above training and demonstrated sufficient understanding and skill in administration of eye medication. ______________________________________________________ ___________________ Registered nurse signature Date 79
Ear Drops Skills Checklist Date Skill Verbalized / Demonstrated 1) Follow the Six Rights of Medication Administration: Right student, Right medication, Right dose, Right time, Right route and Right documentation. 2) Wash hands. 3) Put on gloves. 4) Loosen lid on medication and squeeze rubber stopper to fill the dropper. 5) Stabilize the student’s head by tilting it toward the opposite shoulder and turn head to the side or have them lie down on their side. 6) Gently pull the top of the ear (cartilage) back and up and hold. 7) Place the prescribed number of drops into the ear canal without touching the dropper to the ear. 8) Have the student remain in the same position for a few minutes to avoid leakage. 9) Remove gloves and wash hands. 10) Document on the Medication Request Form/ Record‐Log that you have administered the medication. 11) Replace medication in locked storage area. 12) Observe the student for any medication reaction as appropriate. I have voluntarily received training and had an opportunity to ask questions about the above information. I understand my responsibility and voluntarily agree to administer ear medication as outlined above. ______________________________________________________ ___________________ Staff signature Date This staff member has received the above training and demonstrated sufficient understanding and skill in administration of ear medication. ______________________________________________________ ___________________ Registered nurse signature Date 80
Topical Ointment, Pastes, Salves, Creams, Patches Skills Checklist Date Skill Verbalized / Demonstrated 1) Follow the Six Rights of Medication Administration; Right student, Right medication, Right dose, Right time, Right route and Right documentation. 2) Wash hands. 3) Put on gloves. 4) Loosen cap on the medication and squeeze a small amount directly onto cotton tipped applicator (Q‐tip®). 5) Apply ointment directly to the area or give applicator to student for them to apply. 6) Cover area, if indicated. 7) Patches should be applied to clean, dry skin. Sites should be alternated if possible to avoid skin irritation. 8) Remove gloves and wash hands. 9) Document on the Medication Request Form/ Record‐Log that you have administered the medication. 10) Replace medication in locked storage area. 11) Observe the student for any medication reaction as appropriate. I have voluntarily received training and had an opportunity to ask questions about the above information. I understand my responsibility and voluntarily agree to administer topical medication as outlined above. ______________________________________________________ ___________________ Staff signature Date This staff member has received the above training and demonstrated sufficient understanding and skill in administration of topical medication. ______________________________________________________ ___________________ Registered nurse signature Date 81
Nasal Spray Skills Checklist Date Skill Verbalized / Demonstrated 1) Follow the Six Rights of Medication Administration; Right student, Right medication, Right dose, Right time, Right route and Right documentation. 2) Have the student blow their nose. 3) Have the student block one nostril with a finger. 4) Insert the nozzle of the inhaler into the other nostril. 5) Aim inhaler so that the spray is directed upward and outward away from mid‐line. 6) Instruct the student to exhale. 7) Squeeze the inhaler quickly and firmly, then instruct the student to inhale. 8) Repeat as directed for the other nostril. 9) Document on the Medication Request Form/ Record‐Log that you have administered the medication. 10) Replace medication in locked storage area. 11) Observe the student for any medication reaction as appropriate. I have voluntarily received training and had an opportunity to ask questions about the above information. I understand my responsibility and voluntarily agree to administer nasal medication as outlined above. ______________________________________________________ ___________________ Staff signature Date This staff member has received the above training and demonstrated sufficient understanding and skill in administration of nasal medication. _______________________________________________________ ___________________ Registered nurse signature Date 82
Intranasal Midazolam Delivery Procedure Basic Intranasal Midazolam Delivery Materials: 1.
2.
3.
Syringe and needle/needleless device to draw up the medication Atomizer Midazolam of appropriate concentration for nasal medication delivery  High concentration ‐ Low volume  5 mg/ml generic midazolam or  Compounded in pharmacy to 25 mg/ml (revise all dose volume calculations) Procedure: 1.
Aspirate the proper volume of midazolam required to treat the patient (0.2 to 0.3 mg/kg for seizures, 0.5 mg/kg for sedation) – (an extra 0.1 ml of medication should be drawn up to account for the dead space within the atomizer at the end of the procedure.) 2.
Twist off/remove the syringe from the needle/needleless device 3.
Attach the atomizer tip via Luer lock mechanism – it twists into place.  Slip Luer is also effective as long as the tip is firmly seated on the syringe tip and you hold it against the patients nose while delivering 4.
Using your free hand to hold the crown of the head stable, place the tip of the atomizer snugly against the nostril aiming slightly up and outward towards the top of the ear on the same side. 5.
Briskly compress the syringe plunger to deliver half of the medication into the nostril. 6.
Move the device over to the opposite nostril and administer the remaining medication into that nostril. I have voluntarily received training and had an opportunity to ask questions about the above information. I understand my responsibility and I voluntarily agree to administer nasal midazolam as outlined above. ________________________________________________________________ ___________________ Staff signature Date This staff member has received the above training and demonstrated sufficient understanding and skill in administration of nasal midazolam. ________________________________________________________________ ___________________ Registered nurse signature Date 83
Metered Dose Inhalers (MDI) HFA (hydrofluoroalkane) Inhalers A metered dose inhaler is a pressurized canister of medicine that is sprayed through a mouthpiece. You can help a student follow these simple steps to properly use their MDI. MDI / HFA Skills Checklist Date Skill Verbalized / Demonstrated 1) Follow the Six Rights of Medication Administration; Right student, Right medication, Right dose, Right time, Right route and Right documentation. 2) Wash hands. 3) Shake the inhaler several times. Prime inhaler if necessary. 4) Check that canister is firmly positioned in plastic holder (attach spacer if required). 5) Have student slightly tilt their head backward. 6) Have student breathe out (exhale) completely. 7) Have student place the mouthpiece between the teeth and close lips around it. 8) Squeeze the inhaler to discharge the medicine and have student begin to inhale immediately. 9) Instruct student to breathe in slowly and deeply for 3‐5 seconds. Once inhaled, have student remove the inhaler from their mouth, hold their breath for 5‐10 seconds and then exhale. 10) Rest for a minute, then repeat this sequence for each prescribed “puff.” 11) Document on the Medication Request Form/ Record‐Log that you have administered the medication. 12) Replace medication in locked storage area. 13) Observe the student for any medication reaction as appropriate. I have voluntarily received training and had an opportunity to ask questions about the above information. I understand my responsibility and voluntarily agree to administer MDI medication as outlined above. ______________________________________________________ ___________________ Staff signature Date This staff member has received the above training and demonstrated sufficient understanding and skill in administration of MDI medication. ______________________________________________________ ___________________ Registered nurse signature Date 84
How to Administer an EpiPen®

Identify someone to call 9-1-1.

Flip open cap at top of carrier tube.

Remove EpiPen® from carrier tube and
remove the blue safety release.


Form a fist around the unit with the orange tip pointing downward.
Swing and firmly push orange tip against outer thigh until click is heard.
(Auto-injector may be given through clothing.)




Hold in place for 10 seconds. The injection is now complete.
Remove pen from thigh and massage injection site for 10 seconds.
Place used auto-injector into carrier tube and give to EMS when they arrive.
Document administration of EpiPen® in Medication Request Form/Record-Log.
**Auvi Q® is a new type of automatic epinepherine injection system. Administration is
basically the same. The shape is different and there are battery operated voice prompts
to walk the administrator through the steps of administration.
Note: Always refer to the package insert for additional information on administration.
I have voluntarily received training and had an opportunity to ask questions about the above information.
I understand my responsibility and voluntarily agree to administer epinephrine injections as outlined
above.
_______________________________________________
Staff signature
_________________________
Date
This staff member has received the above training and demonstrated sufficient understanding and skill in
administration of epinephrine.
______________________________________________
Registered nurse signature
85
____________________________
Date
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Appendix K
Medication Administration Written Competency Tests
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Module I: Legal Issues, Policies and Procedures
1.
Unlicensed school personnel may be delegated to administer medications in schools by
their _______________ _____________.
2.
The length of time that the delegation and training is valid for unlicensed school personnel
is the ________________ ______________ ______________.
3.
Periodic supervision of a nursing task must be provided by the _____________
____________.
4.
True or False: Supervision of unlicensed school personnel requires that the supervising
nurse be physically present in the same school building.
5.
Information regarding student health information may only be shared with school
personnel on a ____________ ______ ____________ basis.
6.
True or False: All unlicensed school personnel administering medications should be
familiar with their district’s policies and procedures for medication administration.
7.
The completed medication authorization form signed by the parent/guardian and LHP is
valid only for the ____________ school year. All medication should be sent to school in the ___________ labeled container.
8.
9.
True or False: Except for emergency medications, all medications should be kept in an
appropriately labeled, secure, locked cabinet accessible only by responsible, authorized
school personnel.
10.
True or False: For field trips, student medication may be repackaged by placing the
necessary medication needed into a smaller container and labeled with the student’s
name, medication name, and time medication is to be given.
11.
Examples of medication errors include:
A._______________________________
B._______________________________
C._______________________________
D. _______________________________
E. _______________________________
F. _______________________________
12.
Errors made in recording medication on the Medication Administration Record should be
marked as _________________, _________________ and ______________________.
13.
If a medication error occurs, ____________________ the delegating school nurse and
principal and complete a Medication Administration Incident Report form.
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Module II: Classification of Medications, Medication Preparation,
Administration, and Documentation
1.
___________________ medications are those medications that a licensed practitioner
orders to treat a particular medical diagnosis or symptoms.
2.
An unwanted, unexpected or potentially dangerous response to a medication is known as
________________ ________________.
3.
True or False: A licensed practitioner must write an order (or prescribe) for oral
medication to be crushed.
4.
Suspensions are a form of liquid medication that must be ________________________
before being measured and administered.
5.
When pouring liquid medication, the label should face the ______________ of the hand to
prevent spilling on the label and causing the label to become illegible.
6.
All oral medications should be given with ____________or other ____________ to allow
for easy swallowing.
7.
It is important to verify that the student has swallowed the medication by asking them to
open their mouth and checking under the tongue, roof of mouth, and _____________ for
hidden medication.
8.
True or False: When administering eye (ophthalmic) drops, gently pull down the lower
eyelid to create a pouch or “pocket.” (See Appendix J)
9.
True or False: When administering ear drops, gently pull the top of the ear (cartilage)
back and up and hold. (See Appendix J)
10.
List the “Six Rights” of medication administration: (See Appendix G)
1_______________________________
4. ________________________________
2_______________________________
5. ________________________________
3._______________________________
6. ________________________________
11.
True or False: To ensure the right medication is given to the right student, always
compare the medication label on the prescription bottle with the student’s Medication
Request Form.
12.
If the medication has been administered but not documented on the Medication
Administration Record, there is the potential for _________________________ if the
medication were to be re-administered.
13.
True or False: The Medication Administration Record is a legal and permanent document
and therefore, only ink must be used and never “whiteout.”
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Module III: Emergency Medication Administration
1.
True or False: Anaphylaxis is a life-threatening allergic reaction that can be fatal within
minutes.
2.
True or False: Anaphylaxis can be a reaction to: foods, stinging insects, medication,
latex or exercise.
3.
List common symptoms of anaphylaxis: (List at least 3)
1.
_____________________________
2.
_____________________________
3.
_____________________________
4.
The ____________________ is a prescribed medication that contains epinephrine to
reverse the most dangerous effects of an anaphylactic reaction.
5.
Once administered, epinephrine may only be effective for __________________ to
_________________ minutes.
6.
True or False: Washington state law permits a student to self-carry and self-administer
medication to treat anaphylaxis.
7.
True or False: The emergency medications, EpiPen®/Auvi-Q®/Midazolam and inhalers,
must be checked for their expiration date and parents notified in advance of the expiration
date.
8.
A seizure is generally considered an emergency under what conditions? List at least
three (3).
9.
1.
_____________________________
2.
_____________________________
3.
_____________________________
___________________ is a nasal medication that is sometimes used to treat seizures.
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Module IV: Local School District Policies and Procedures
Discussion Questions
1.
Describe your school district’s policy and procedures for daily medication administration.
2.
Describe your school district’s policy for administering over-the-counter (OTC) medication,
such as Tylenol.
3.
Describe your school district’s policy and procedures for administering medications to
students on a field trip during the school day.
4.
How does the school district policy state all student medication is to be stored?
5.
Describe your district’s policy for disposing of unused medication.
6.
Describe your district’s policy and procedures for reporting and documenting medication
errors.
7.
Review your district Medication Administration Record and how to document medications
administered or refused.
__________________________________________________ ________________________ Staff signature Date ___________________________________________________ ________________________ Registered nurse signature Date
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