MEDICATION
ADMINISTRATION
FOR LINCOLN COUNTY SCHOOLS
OBJECTIVE
School staff who are appointed to
give medications in the schools will
understand basic principles of
medication administration, storage
and documentation in the school
setting and ultimately be able to
administer medication in a safe,
effective manner.
What do you
mean I have
to give meds?
THE LAW
• North Carolina General Statute 115C-307
sets the standard for local school board
policy. It states that:
– All medications administered by school
personnel must be prescribed by a licensed
health care provider.
– All medications administered by school
personnel must have a written
request/permission by the parent or legal
guardian.
LINCOLN COUNTY
SCHOOLS
Review LCS policy for medication
administration in your packet or
online via Lincoln County Schools
website.
WHO GETS TO GIVE
MEDS?
• Those who have been appointed by the
principal and trained. Training is needed
every other year.
• It helps to have one primary person to
ensure consistency and avoid errors.
• Additional persons should always be
trained in case of absences/emergencies.
FORMS FOR MEDICATION
ADMINSTRATION
(See School Nurse)
• Request for medication to be given at school (MD
order-Parent Permission)
• Medication Administration Record-MAR (Log for
medication received and returned, Daily
Administration of Prescribed Medication)
• Incident Report (To be completed in the event of a
medication incident)
STORAGE
• Prescription meds must always be
kept in the original, labeled container
from the pharmacy.
• Over-the-counter meds (OTC’s)
should be in original container and
labeled with the child’s name.
Storage continued…
• Medications should be kept in locked
storage spaces, yet readily accessible
to staff.
• Some meds may need refrigerated
storage. These meds need to be in a
locked container inside the
refrigerator
School Nurses and Meds
• SN’s review and help with the
development and on-going evaluation
of written school policy and
procedures.
• SN’s coordinate and monitor the
administration of meds in each school
according to adopted policy.
• SN’s review the documentation of
meds in the schools.
School Nurses and Meds
• SN’s serve as consultants to school
staff, parents and students
regarding medication safety in the
schools.
• SN’s serve as a liason with parents,
physicians, hospitals and school staff
regarding student’s progress and
complications related to the
medication plan.
SCHOOL NURSES
• Typically, because school nurses are
in schools 1 day per week, they do not
usually administer medications.
Before Administration
• Make sure you have the Request for
Medication to be Given at School filled
out completely.
• Make sure the medication the parent/
guardian brought you is the correct
medication and is not expired.
Before Administration
• Make sure you understand administration
instructions completely. If not, clarify
instructions with your school nurse or the
health care provider.
• All paperwork should be completed and in
the medication notebook before
administration (See Forms in previous
slide).
Actual Administration
Oral Medications
1. Check your doctor’s order.
2. Take medication out of locked cabinet.
3. Check to see if medication is expired (should
be on bottle).
4. Check dosage. Is it the correct dosage?
5. Confirm the student’s name.
6. Have cup of water for student.
7. Pour pill into separate cup or cap of medicine
bottle.
8. Give to student and confirm that student
swallowed pill.
9. Document time and initials on Medication
Administration Record.
Oral Medications
• Liquid medications are to be given the same
way but you need to put your measuring cup on
counter and pour liquid at eye level to confirm
dosage. If it is 1 tsp. (5ml) you can more
easily confirm an accurate dose if you have cup
on flat surface when pouring.
• Follow all the steps as you would for pills with
the exception that you may not need water for
the student.
• Never use a household teaspoon for measuring.
Use only a clearly marked medication cup
(parent should provide).
REMEMBER THE SIX RIGHTS
1.
2.
3.
4.
5.
6.
Right student
Right medication
Right dosage
Right time
Right route
Write/right
documentation
Different types of medications
•
•
•
•
•
•
•
INJECTIONS
TOPICAL
NASAL SPRAYS/DROPS
EYE DROPS/OINTMENTS
EAR DROPS
RECTAL SUPPOSITORIES AND GELS
ORAL CAPSULES/TABLETS/LIQUIDS
Injections
• There are several types of injections
(i.e. Intramuscular, Subcutaneous,
etc.).
• If you need to give an injection, the
school nurses will provide a way for
you to practice ahead of time.
• See your school nurse for instruction
and practice before administering
anything by injection.
Epinephrine AutoInjectors
• One of the more common injections is
an intramuscular injection using an
Epinephrine Auto-Injector.
• Included below are links to several
different types of Epinephrine AutoInjectors that may be used in the
school setting.**
http://www.epipen.com/How-to-Use-EpiPen
http://www.auvi-q.com/auvi-q-demo
http://www.twinject.ca/how.php?lang=en
**Please note: Sometimes websites may move or not be accessible in the school setting. If you are unable to access this training
video you may see the school nurse for one on one instruction. Typically one on one instruction is most effective for this type of
administration. The video is really only meant to familiarize you with what to expect.
Insulin
• There are several ways to inject insulin
– Syringe (shot)
– Pen (looks like a mechanical pen or pencil)
– Pump (looks like a pager)
Those who are designated as Diabetic Care
Managers will be trained further.
Topical
• Topical medications should be applied
to the skin as directed by doctor.
• Topical preparations may include
hydrocortisone cream, benadryl
cream, or lotrimin cream.
• Remember to wear gloves when
applying!
Ear Drops
• Eardrops must be administered so they
fill the ear canal.
• To use eardrops properly, have student
tilt their head to one side, turning the
affected ear upward.
• Grasp the earlobe and gently pull it
upward (toward the top of the head) and
back to straighten the ear canal.
Ear drops
• Keep the ear tilted upward for five to ten
seconds while continuing to hold the earlobe.
• Squeeze the directed amount into ear. The
doctor may want you to gently insert a small
wad of clean cotton into the ear to prevent the
medication from seeping out.
• Do not wash or wipe the dropper after use;
replace it in the bottle and tightly close the
bottle to keep out moisture.
• **Please remember: Do not put anything
smaller than an elbow inside an ear!!
Eye drops
• Before administering eyedrops or ointments, wash
your hands.
• Have student sit or lie down and tilt their head
back. Using your thumb and forefinger, gently and
carefully pull the lower eyelid down to form a
pouch.
• Hold the dropper close to the eyelid without
touching it.
• Squeeze the prescribed amount of medicine into
this pouch and have student slowly close their
eye.
• Instruct student to keep eye closed, and use your
finger to apply slight pressure at the inner corner
of the eye for a minute or two to prevent loss of
medication through the duct that drains fluid
from the surface of the eye.
» **Remember to wear gloves!
Eye ointments
• To administer an eye ointment, squeeze a
line of ointment in the prescribed amount
into the pouch formed as just described
for eyedrops (avoid touching the tube to
student’s eyelid), and have student close
their eyes.
• Instruct student to roll eye a few times
to spread the ointment.
Nose drops/Nasal sprays
• Before using nose drops or nasal sprays,
have student gently blow their nose if
you can.
• Have student tilt head back, and place
the prescribed number of drops into
student’s nose. To prevent contamination
of the rest of the medicine, do not
touch the dropper to the nasal
membranes.
• Have student keep his/her head tilted
for five to ten seconds, and have
student sniff gently two or three times.
Nose Spray
• When using a nasal spray, do not have student
tilt head back.
• Insert the sprayer into the nose, but try to
avoid touching the inner nasal membranes.
Have student sniff as you squeeze the sprayer
at the same time, according to the product
directions. Do not release grip on the sprayer
until you have withdrawn it from student’s nose
(to prevent nasal mucus and bacteria from
entering the plastic bottle and contaminating
its contents).
• After you have sprayed the prescribed number
of times in one or both of student’s nostrils,
have student gently sniff two or three times.
Rectal Medications
• To insert a suppository, have student lie on their left side
with right knee bent. Push the suppository, pointed end
first, into the rectum as far as is comfortable. You may be
instructed to coat the suppository with a thin layer of
lubricating gel to make insertion easier. Diastat is a rectal
gel and usually has a lubricating gel pack with the Diastat
syringe. See your packet insert for Diastat instructions.
• See the Diastat web site for more information**:
-http://www.diastat.com/planning/first-aid
**Please note: Sometimes websites may move or not be accessible in the
school setting. If you are unable to access this training video you may
see the school nurse for one on one instruction. Typically one on one
instruction is most effective for this type of administration. The video
is really only meant to familiarize you with what to expect.
Inhalers
Watch the video below for
detailed inhaler instructions.
Inhaler with spacer
Examples of spacers
To observe different examples of inhalers being used
go to: www.mayoclinic.com/health/asthma/MM00608
Always Remember…
1.
2.
3.
4.
5.
6.
Right student
Right medication
Right dosage
Right time
Right route
Write/right documentation
RIGHT TIME
• 30 minutes prior to the hour it is
ordered and 30 minutes after is
acceptable.
• If a medication is ordered at 9:00
a.m., you may administer it any time
between 8:30 a.m. and 9:30 a.m.
Errors
If you make a mistake…
Think about it…
• What do you do if you give a
medication 1 hour late?
• What if you give the wrong child a
medication?
• What if you give the wrong dosage?
• What if you forget to give a
medication?
DON’T PANIC
• Anyone can make a mistake
• Notify parent and parent can notify
doctor
• Most medication errors are not life
threatening
• Most medication errors can be corrected
• Follow doctors orders
• Fill out incident report
• Evaluate how you can avoid making the
same error again
Following procedure helps keep the
situation from getting worse!
Think about it…
• Mrs. Jones sends Johnny’s Ritalin to
school in his book bag with a note
asking you to please give him a dose
at lunch time. What should you do?
• Never give a medication without a doctor’s order.
In addition, no medications should be transported
by the student unless it is an emergency
medication and the doctor’s order states the
student will be carrying the medication (i.e.
inhalers, Epinephrine Auto-injectors). Call the
mother and explain that you will lock the
medication in the medication cabinet and she may
pick it up that day. Send the “Request for
Medication to be Given at School” form with her
when she picks up the Ritalin. Explain that when
she comes back with the order, the medication
will need to be counted with a designated staff
person.
Think about it…
• Mrs. Smith brings Susie’s nebulizer
and xopenex to school. She has all
the doctor’s papers and wants you to
administer to Susie every 4-6 hours
as she needs a treatment. You have
never been shown how to use this
particular kind of nebulizer? What
should you do?
• In most situations it is acceptable to
receive instructions from a parent about
how to use the equipment. You may always
call your school nurse for help. As with
many situations, you will need to make a
judgment about he ability of this
particular parent to show you how to use
the nebulizer. Always ask questions. All
equipment is different and even though
you may know one brand, you need
instruction on a brand with which you are
unfamiliar.
Think about it…
• Jack has been out of school for 1
week and his mother calls to say he
has been diagnosed with diabetes and
should return next week sometime.
What should you do?
• Jack will need a 911 Diabetes Care Plan
completed by the physician. You can fax
the plan directly to the hospital or
doctor’s office for their convenience. You
should let your school nurse know and she
will schedule a meeting with the parent,
diabetic care manager from your school
and any other significant staff that need
to be aware of this student’s situation.
Ask questions!
If you have a “red flag” about
something, always ask questions. You
can use your school nurse as a
resource.
REVIEW
• Take the Quiz in your packet and put
in school nurse box. See your school
nurse for individual help and for
specific situations as they arise.
Always feel free to call!! Click below
and RELAX!
• http://www.mayoclinic.com/health/m
editation/MM00623
THANK YOU!