1. Necessary Knowledge for Medical Assistants  Types of Medications  How they are packaged  Routes of Administration  Steps to administering oral medications  Knowledge of potential side effects and adverse reactions

2. No prescription medication may be given without: No prescription medication may be given without: – parent authorization, –a healthcare provider order, and a –pharmacy label. Review local policies. Review local policies. Specific Rules Related to Prescription Medicine

3. Under no circumstances should the school stock over-the-counter (OTC) medicines, such as Tylenol, for student or staff use. Under no circumstances should the school stock over-the-counter (OTC) medicines, such as Tylenol, for student or staff use. OTC must be provided by the parent in the original container with specific instructions as to when or why such medicines may be necessary. OTC must be provided by the parent in the original container with specific instructions as to when or why such medicines may be necessary. The delegating RN must evaluate and approve all OTC medicines and parental instructions. The delegating RN must evaluate and approve all OTC medicines and parental instructions. The delegating RN will determine if the OTC medicine is appropriate and whether a provider order is also necessary. The delegating RN will determine if the OTC medicine is appropriate and whether a provider order is also necessary. Specific Rules Related to OTC Medicine

4. No Injections by Non-Licensed Person! Only allowed in case of pre- measured emergency allergy medication like EPI-Pen

5. How to Assist Students with Particular Types of Medications When the Board of Nursing established regulations that allowed school nurses to delegate certain medications to an unlicensed school employee or teacher— When the Board of Nursing established regulations that allowed school nurses to delegate certain medications to an unlicensed school employee or teacher— –the route of the medication was specified rather than the names of medicines. An absolute prohibition exists for injectable medications. An absolute prohibition exists for injectable medications. School nurses are prohibited from delegating assisting with medications that must be delivered by injection except for pre-mixed anti-allergy injections (Epi-pen.) School nurses are prohibited from delegating assisting with medications that must be delivered by injection except for pre-mixed anti-allergy injections (Epi-pen.)

6. Delegation by School Nurses The specific delegated tasks shall not require the exercise of independent nursing judgment or intervention. Specific tasks that require independent nursing judgment or intervention that shall not be delegated include, but are not limited to: Catheterization, clean or sterile.Catheterization, clean or sterile. Administration of injectable medications, other than premeasured medication for allergic reactions (i.e., EpiPen).Administration of injectable medications, other than premeasured medication for allergic reactions (i.e., EpiPen). Administration of rectal or vaginal medications.Administration of rectal or vaginal medications. Calculation of medication dosages other than measuring a prescribed amount of liquid medication or breaking a scored tablet.Calculation of medication dosages other than measuring a prescribed amount of liquid medication or breaking a scored tablet. Tracheotomy care, including suctioning. Gastric tube insertion, replacement, or feedings. Invasive procedures or techniques. Sterile procedures. Ventilator care. Receipt of verbal or telephone orders from a licensed prescriber.

7. Importance of checking the Six Rights each and every time medication is given: Importance of checking the Six Rights each and every time medication is given: –(1) when taking medication from the cabinet, –(2) when pouring the medication, and –(3) when returning the medication to the cabinet. Appropriate, accurate, timely documentation. Appropriate, accurate, timely documentation. How to obtain assistance from the school nurse and/or other healthcare professionals. How to obtain assistance from the school nurse and/or other healthcare professionals. Understanding of local policies. Understanding of local policies. Necessary Knowledge

8. Remember! Check the Label Three Times! 1. When removing from the locked cabinet 2. When pouring the medication 3. When replacing the medication

9. Responsibilities Related to Controlled Substances Identifies controlled substances and stores in a secure location according to state and local policies. Identifies controlled substances and stores in a secure location according to state and local policies. Documents the receipt, number, and return of controlled substances according to state and local policies. Documents the receipt, number, and return of controlled substances according to state and local policies. Reports discrepancies in the quantity of a controlled substance to the school nurse, principal and other authorities according to state and local policies. Reports discrepancies in the quantity of a controlled substance to the school nurse, principal and other authorities according to state and local policies.

10.  Oral Medications can be : pills/tablets/caplets Medications Tablets Do not try to cut with a knife or break! Gel-Caps Do not open! Capsules Can Not be Crushed

11. Gel- Caps Gel- Caps Gel Caps should be swallowed whole unless opening is ordered by the physician!

12. Tablets Only crush if the physician orders it! Should only be cut into if scored! Should only be cut using a pill splitter.

13. Only scored tablets are made to be cut in half to obtain a smaller dose! Example, the tablet is 10 milligrams, but the order says the student takes only 5 milligrams. This requires cutting. Example, the tablet is 10 milligrams, but the order says the student takes only 5 milligrams. This requires cutting. If a medication must be cut, the nurse should use a pill splitter to cut the pill. If a medication must be cut, the nurse should use a pill splitter to cut the pill. Coated tablets should be swallowed whole and not chewed. Coated tablets should be swallowed whole and not chewed.

15. Necessary knowledge Do not take capsules apart, crush, or let the student chew them! Do not take capsules apart, crush, or let the student chew them!

16. Capsules Capsules Remember! Capsules should never be opened except by a doctor’s order! Always consult the nurse, the pharmacist If you have a question!

17. Liquid Medications Always use a calibrated medication spoon or cup for measuring!

18. Do Not Change the form of a Medication! Do Not Change the form of a Medication! This can only be done with the order from the physician and by the nurse. This can only be done with the order from the physician and by the nurse. Cutting >>> Cutting >>> Crushing>>>> Crushing>>>> Or sprinkling >>>>> All of these are examples of changing the form of an oral medication. Or sprinkling >>>>> All of these are examples of changing the form of an oral medication.

19. Assisting with Oral Medications Check order form and pharmacy label for instructions. Check order form and pharmacy label for instructions. Assemble necessary equipment. Assemble necessary equipment. ALWAYS wash your hands before giving any medication to a student. ALWAYS wash your hands before giving any medication to a student. If the student will touch or handle the medication, they should wash their hands. If the student will touch or handle the medication, they should wash their hands.

21. Read the Label! Always read the entire label on the medication. Always read the entire label on the medication. Make sure the directions for taking the medication is specific as to the type and the route that the medication is to be taken. Make sure the directions for taking the medication is specific as to the type and the route that the medication is to be taken. If any doubts, Do Not Give! Call the nurse. If any doubts, Do Not Give! Call the nurse.

23. Assisting with Oral Medications Pills/Tablets/Capsules: –Pour the medication into a medicine cup, the cap of the medication bottle, or a small paper cup. Ask the student to pick up the medication himself or herself and put into his/her mouth followed by 6-8 ounces of water. Ask the student to pick up the medication himself or herself and put into his/her mouth followed by 6-8 ounces of water. If the student is not physically able to pick up the medication and you have to place the medication inside the student’s mouth, you should put on gloves to avoid transferring any infection to the student or to yourself. If the student is not physically able to pick up the medication and you have to place the medication inside the student’s mouth, you should put on gloves to avoid transferring any infection to the student or to yourself. Throw away gloves after each use (now contaminated). Throw away gloves after each use (now contaminated). Make sure that the student swallowed the medication. Make sure that the student swallowed the medication. Wash your hands. Wash your hands. Record results. Record results.

26. Assisting with Oral Medications If the student is not physically able to pick up the medication and you have to place the medication inside the student’s mouth, you should put on gloves to avoid transferring any infection to the student or to yourself. Throw away gloves after each use (now contaminated). Make sure that the student swallowed all of the medication. Wash hands. Record results.

27. Liquids: Liquid medications must be precisely measured. Liquid medications must be precisely measured. –DO NOT USE SILVERWARE OR PLASTIC SPOONS—these are not accurate measuring tools. Use a calibrated medicine cup, spoon or syringe. Use a calibrated medicine cup, spoon or syringe. When using a measuring cup, place it on a flat surface and read it at eye level for accuracy. When using a measuring cup, place it on a flat surface and read it at eye level for accuracy. Pour the liquid from the side of the medicine bottle opposite the label (to protect the label). Pour the liquid from the side of the medicine bottle opposite the label (to protect the label). Clean the outside of the bottle if needed after pouring. Clean the outside of the bottle if needed after pouring. Ask the student to pick up the medication cup himself or herself and swallow all of the medication. Ask the student to pick up the medication cup himself or herself and swallow all of the medication.

29. Test is next! Test is next! This information taken from curriculum developed by the Alabama Board of Nursing & the Alabama Board of Education This information taken from curriculum developed by the Alabama Board of Nursing & the Alabama Board of Education