MEDICATION ADMINISTRATION TRAINING WILKES COUNTY SCHOOLS

How to use this training…… It can be used to supplement the Medication Training that is provided at the beginning of each school year It can also be used as a review for staff regarding Medication Administration Policies and Procedures

Medication Administration Policy ESTABLISHED BY THE WILKES COUNTY BOARD OF EDUCATION POLICY CODE 6125 ADMINISTERING MEDICINES TO STUDENTS AVAILABLE ON THE WILKES COUNTY SCHOOLS WEBSITE

WHAT THE POLICY SAYS………

MEDICATIONS AT SCHOOL Administered at school only if needed and can’t be taken at home. (e.g. due at l2:00) Must have a completed Request for Medication to be given during school hours form Medications can only be administered by staff members who have received appropriate training.

Physicians Authorization For Medication To Be Given At School To be valid the form must include: -Child’s full name -Date of Birth -Name of Medication -Medication Dosage -How often the Medication should be given -Contraindications to giving the medication -Possible side effects of the medication -If medication given on PRN (as needed basis), when the medication should be given -Doctors name and phone number, Doctor Signature -Parents Signature

MEDICINE All Medications must be presented by the parent to the school. Students are not allowed to transport medications on the school bus. Prescription Medications must be brought in their original pharmacy/physician labeled container. Over the Counter Medications must be presented to the school in the original container. If school staff have concerns about the appropriateness of a drug or dosage for a student, medication should not be given and staff should contact physician who ordered medication.

MEDICINE Medications will remained locked up at all times for safety reasons Parents are permitted to come to school and administer medication to his or her child at anytime while the child is on school property All student prescribed medications should be taken on field trips unless otherwise instructed by the parent or guardian prior to the trip

STUDENT SELF ADMINISTRATION OF MEDICATION Per Policy, Students with Diabetes, Asthma, and Severe Allergies should be allowed to self-administer their medication during the school day and during school sponsored activities Students who may need to carry and self administer medication must also have a Authorization for Self Medication form completed by physician and school nurse

STANDING ORDER MEDICATIONS School Nurses May Administer Certain Medications to students with approval of parent and without a Physician’s Authorization for Medication. School Staff CANNOT administer these medications even with approval of parent. All School Staff must have a Physician’s Authorization for Medications that includes a parent signature before giving medications

PROCEDURES FOR GIVING MEDICATION

THE FIVE RIGHTS OF MEDICATION ADMINISTRATION RIGHT PERSON RIGHT MEDICATION RIGHT DOSAGE RIGHT ROUTE RIGHT TIME

RIGHT PERSON VERIFY THE IDENITY OF THE INDIVIDUAL BEFORE ADMINISTERING MEDICATION

RIGHT MEDICATION VERIFY THE MEDICATION THAT YOU HAVE WITH THE MEDICATION LISTED ON THE PHYSICIAN MEDICATION AUTHORIZATION FORM.

RIGHT DOSAGE VERIFY THE DOSAGE ORDERED BY THE PHYSICIAN * Are the Miligrams correct? * How much medicine does the student receive (e.g. 1 tablet, 1 tsp???)

RIGHT ROUTE PER DOCTORS ORDERS,IS THE MEDICATION SUPPOSE TO BE GIVEN BY MOUTH, AS AN INJECTION, OR BY ANOTHER ROUTE

RIGHT TIME WHAT TIME IS THE MEDICATION SUPPOSE TO BE GIVEN? (Should be given within 30 minutes before or after the prescribed time)

MEDICATION ERRORS

TYPES OF MEDICATION ERRORS Medication Dose Omitted Wrong Child/Wrong Medication Medication given by the Wrong Route (e.g. ears drops administered into eyes) Medication given at Wrong Time Wrong Dose of Medication (e.g. 2 tabs instead of 1)

DOSE OMITTED/WRONG TIME Notify Parent that dose was not given or given at the wrong time Notify School Nurse If dose not given document why on back of Medication Log Form Contact Prescribing Doctor if necessary Monitor for Possible Side Effects

WRONG MEDICATION/WRONG CHILD Notify School Nurse, Student’s Doctor and Parent Immediately Monitor Students for complaints or signs and symptoms of Emergency (e.g. problems breathing) Call Poison Control at 1-800-848-6946 Call EMS for Emergency Symptoms Do not leave student alone

ORAL MEDICATIONS Most Medication given at school will be given by mouth (e.g. ADHD Meds, Tylenol) Always use a medication cup or syringe or medication measuring spoon when given liquid medications Do not open capsules or crush meds unless ordered by MD Parents or Pharmacy should precut any tablets in which dose is ½ tablet

INHALED MEDICATIONS USUALLY USED FOR SUDDEN ASTHMA SYMPTOMS Some Indications for rescue inhaler use are: –Difficult, shallow, rapid breathing –Longer time exhaling than inhaling, whistling or wheezing noise with breathing –Unable to speak more than 1-2 words without gasping –Coughing continuously –Flaring nostrils –Neck/chest muscles pull in (retract) with breathing –Cyanotic (turning blue)

Procedure for Administering Inhaled Medications Shake Inhaler before using Make sure that Inhaler is not clogged if hasn’t been used recently (point inhaler away from persons and press down to make sure mist comes out) Have student take deep breath and exhale all air out of lungs Place inhaler in mouth Start breathing in slowly through mouth and press down one time on the inhaler. Keep breathing in slowly as deeply as possible. •Hold breath as count to 10 slowly. •If using a spacer-first press down on inhaler and breathe in for 5-10 seconds. Hold breath for count of 10. •Wait 30-60 seconds between doses if 2 puffs are ordered •Contact the school nurse if a student frequently uses the inhaler or has any breathing problems.

INHALERS (continued) Seek Emergency Medical Care if the student has any of the following: Coughing constantly No improvement 15-20 min. after initial treatment with Inhaler AND a relative cannot be reached. Difficulty breathing with: Chest and neck “pulled in” with breathing Stooped body posture Struggling or gasping respirations Lips or fingernails grey or blue

EYE MEDICATIONS Check the medication log for proper eye to administer medication to. –Wash hands, Put on gloves •Pull the lower lid down and apply medication to the inner lower lid. •Apply eye drops one drop at a time with student lying down if possible. •Do not touch any part of the eye with the tip of the eye dropper. •Do not allow student to rub eyes. Blotting with a tissue is ok.

EAR MEDICATIONS Check the medication log for correct ear to administer medication to. –Wash hands. –Roll the bottle between your hands to warm the medication. Have student lay or sit with head lying on table with affected ear up. Pull top part of the ear up and back to open up the ear canal. Place correct number of drops in ear canal. Release the ear. Have student remain in this position, for several minutes to ensure absorption of medication

INJECTABLE MEDICATIONS STAFF WILL RECEIVE INDIVIDUAL TRAINING BY THE SCHOOL NURSE EXAMPLES OF INJECTABLE MEDICATIONS: EPI PEN INSULIN GLUCAGON

EPINEPHERINE AUTO INJECTOR •Epi-Pen, Epi-Pen Jr. or Twinject are used for students who have a severe allergic reaction to a food or other allergen. •These medications should always be readily accessible to the student. * School Nurse will provide one on one training in usage and when to administer to staff

ADMISTERING EPI PEN Have someone CALL 911, then Parent or Guardian Remove medication from cylinder. Pull off GRAY activation cap. DO NOT TOUCH THE BLACK TIP. THAT IS WHERE THE NEEDLE IS! Hold black tip near outer thigh (always apply to thigh) Administer through clothing. Jab firmly into outer thigh until Auto-injector mechanism functions. –It dispenses very quickly and loudly Hold in place and count to 10 Remove Epi-Pen unit. Place back in storage cylinder and send with emergency personnel to hospital. Massage injection area for 10 seconds

GLUCAGON INJECTION Administered to Diabetic Students who are unconscious or unresponsive due to low blood sugar Indicated on Individual Students Diabetes Care Plan on when to administer Needs to be kept with student or near student for emergency access School Nurse will provide Individualized Training with School Staff on how and when to administer Glucagon

GLUCAGON ADMINISTRATION Remove flip-off seal from the bottle of Glucagon (SEND SOMEONE TO CALL 911)! Wipe top of bottle off with alcohol wipe Remove the needle protector from the syringe DO NOT REMOVE THE PLASTIC CLIP FROM THE SYRINGE Inject the entire contents of the syringe into the bottle of glucagon Swirl bottle briefly until glucagon dissolves completely GLUCAGON SHOULD NOT BE USED UNLESS THE SOLUTION IS CLEAR AND OF A WATER-LIKE COSISTENCY

GLUCAGON ADMNISTRATION (CONTINUED) Using the same syringe, hold bottle upside down, make sure the needle stays in the solution Withdraw the prescribed amount of solution (1/2 to 1 ml) into the syringe Cleanse injection site on buttock, arm, or thigh with alcohol wipe • Inject the needle into one of the above sites at a 90 degree angle • Turn student onto his or her side • Once the student is awake and can swallow, offer juice if emergency personnel have not arrived yet.

INSULIN INJECTIONS Insulin is administered to Diabetics to treat high blood sugars or counteract carbohydrate intake Insulin can be drawn from a multiple dose vial by a syringe or in a Insulin Pen in which the correct dose can be “dialed” and administered by a needle placed on the end of the pen The amount of insulin a student will receive is based on the student’s Individualized Diabetes Care Plan. Most Students can Self Administer their own insulin The School Nurse will provide intensive individualized training with the staff member responsible for helping the student with their diabetes management. Also, an intensive diabetes training is provided each year for selected staff members

DIASTAT RECTAL VALIUM USUALLY USED FOR STUDENTS WHO HAVE SEIZURES LASTING MORE THAN 5 MINUTES SPECIFIC INSTRUCTIONS FOR WHEN TO ADMINISTER WILL BE PROVIDED BY PRESCRIBING PHYSICAN SCHOOL NURSE WILL DO INDIVIDUALIZED TRAINING WITH STAFF WHO IS RESPONSIBLE FOR PROVIDING CARE FOR STUDENT WHEN SEIZURE OCCURS REFER TO STUDENTS EMERGENCY SEIZURE CARE PLAN SEEK ADVANCED MEDICAL CARE IF ADMINSTERED ACCORDING TO CARE PLAN INSTRUCTIONS

DIASTAT ADMINISTRATION Position the person on their left side Have another staff member escort other student from classroom and notify parent and or emergency contact. Assemble syringe and supplies ( an instructional sheet accompanies the med) Put on disposable gloves, push up thumb and pull protective cover from syringe Expose buttocks, bend upper leg forward to expose rectum use coat or blanket to cover student and maintain as much privacy as possible Lubricate syringe tip, gently insert tip into rectum Slowly count to 3 while pushing plunger in till it stops Slowly count to 3 again before removing syringe from rectum

DIASTAT ADMINISTRATION (continued) Repeat count of 3 while holding buttocks together to prevent leakage of medication Replace clothing and keep student on side facing you Note time given and monitor student. If unable to locate parent or emergency contact person or persons call 911. Call 911 per instructions on Seizure Care Plan or if students exhibits any trouble breathing or you are concerned about the health or safety of the student at any time. •If student is on bus when seizure occurs, contact parent to transport student. If no parent can be contacted-DO NOT TRANSPORT. Call 911

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

THINGS TO REMEMBER YOUR SCHOOL NURSE IS AVALIABLE FOR QUESTIONS YOU MIGHT HAVE YOU WILL RECEIVE REQUIRED TRAINING BEFORE ADMINISTERING MEDICATIONS TO STUDENTS

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