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MEDICATION ADMINISTRATION TRAINING

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Title: MEDICATION ADMINISTRATION TRAINING


1
MEDICATIONADMINISTRATION TRAINING
  • PERSON COUNTY SCHOOLS
  • 2009-2010

2
Medication Training
  • This training is required annually.
  • School personnel may administer drugs or
    medication prescribed by a physician upon the
    written request of the parents. To minimize
    disruptions to the school day, medicines should
    be taken at home rather than at school whenever
    feasible.
  • School personnel should not agree to administer
    any medication that could be taken at home.

3
Medication Policy
  • All medications will be dispensed by the
    principal or the principals designee. No
    medications shall be dispensed without the
    required written permission.
  • The board generally encourages school personnel
    to administer medicine from a centralized
    location. However, in all instances, whether
    from a centralized location or multiple
    locations, any medicines kept at school for a
    student must be kept in a locked and secure
    place.
  • Review policy and procedure for Policy Code
    6125 Administering Medicines to Students

4
Medication Policy
  • PARENT and PHYSICIAN written approval must be
    presented to school administration before ANY
    medication will be given. (over-the counter or
    prescription)
  • NO non-prescription aspirin or aspirin products
    will be given to any student, even with parental
    permission, due to the possibility of Reye's
    syndrome.

5
Medication Administration
  • A Medication Administration Order form must be
    signed by a PHYSICIAN and PARENT for PRESCRIPTION
    and OVER-THE-COUNTER medications! Requests are
    valid only if a person licensed to prescribe
    medications has made the request.
  • The Medication Administration Order form is
    available in the main office at each school, on
    the school systems website, or directly from the
    school nurse.

6
Medication Administration
  • This permission form is effective for the same
    school, 365 calendar days, and must be reviewed
    annually. If the students medication, dosage, or
    physician changes during the school year, a new
    order must be completed.
  • All prescription medication shall be kept in a
    container properly labeled by a pharmacist with
    the child's name, the name of the medication, and
    the dosage, time and frequency to be given. All
    non-prescription medication shall be in the
    original container, properly labeled with the
    child's name and instructions for administration.
    Pillboxes, plastic bags, unlabeled bottles, etc.
    will not be accepted.

7
Self Medication at School
  • Students with asthma and/or subject to
    anaphylactic reactions may need to possess and
    self-administer asthma medication on school
    property. As used in our medication policy,
    asthma medication means a medicine prescribed
    for the treatment of asthma or anaphylactic
    reactions and includes a prescribed asthma
    inhaler or epinephrine auto-injector.

8
Self Medication at School
  • 1. Before a student will be allowed to
    self-administer medicine, the students parent or
    guardian must provide to the principal or
    designee all of the documents listed below.
  •  a. written authorization from the students
    parent or guardian for the student to possess and
    self-administer asthma medication
  •  b. a written statement from the students health
    care practitioner verifying
  • that the student has asthma and/or an allergy
    that could result in anaphylactic reaction
  • that he or she prescribed medication for use on
    school property during the school day, at
    school-sponsored activities, or while in transit
    to or from school or school-sponsored events and

9
Self Medication at School
  • that the student understands, has been
    instructed in self-administration of the asthma
    medication, and has demonstrated the skill level
    necessary to use the medication and any
    accompanying device
  • c. a written treatment plan and written
    emergency protocol formulated by the prescribing
    health care practitioner for managing the
    students asthma or anaphylaxis episodes and for
    medication use by the student
  • d. a statement provided by the school system and
    signed by the students parent or guardian
    acknowledging that the board of education and its
    agents are not liable for injury arising from the
    students possession and self-administration of
    asthma medication and 
  • e. any other documents or items necessary to
    comply with state and federal laws.

10
Self Medication cont.
  • 2. Prior to being permitted to self-administer
    medicine at school, the student also must
    demonstrate to the school nurse the skill level
    necessary to use the asthma medication and any
    accompanying device.
  •  
  • 3. The students parent or guardian must provide
    to the school backup asthma medication that
    school personnel are to keep in a location to
    which the student has immediate access in the
    event of an emergency.

11
Self Medication at School
  • All information provided to the school by the
    students parent or guardian must be kept on file
    at the school in an easily accessible location.
    Any permission granted by the principal for a
    student to possess and self-administer asthma
    medication will be effective only for the same
    school for 365 calendar days. Such permission
    must be reviewed annually.
  • A student who uses his or her prescribed asthma
    medication in a manner other than as prescribed
    may be subject to disciplinary action pursuant to
    the school disciplinary policy. No one may impose
    disciplinary action on the student that limits or
    restricts the students immediate access to the
    asthma medication.

12
Transportation of Medications
  • The school will not be responsible for the
    transportation of medication to and from school.
  • It is the responsibility of the parent to ensure
    that proper medication is brought to school and
    provided to the appropriate school official and
    to assure that the appropriate written permission
    is provided.

13
Medication Disposal and Documentation
  • It is the parents responsibility to pick up the
    medication from the school within two days of the
    discontinued date or within two days from the
    last date of the school year. If medication is
    not picked up within the require time frame, it
    will be disposed of by the principal or
    principals designee.
  • A Medication Inventory, Audit, and Disposal
    Documentation form will be filled out when
    medication is brought to school and when
    medication is disposed of. That form will
    indicate the student's name, the type of
    medication received, the person from whom the
    medication is received, the date the medicine was
    received, the amount of medication received, and
    the signature of the person who received the
    medication. It will also include the emptying and
    disposal dates of the medication.
  • The school nurse will conduct quarterly
    medication audits to ensure that the medication
    is being dispensed in accordance with the
    Medication Administration Order and board policy.

14
Medication Administration Record
  • A Medication Administration Record will be kept
    to document the administration of all medications
    which a student has received during school hours.
    The log shall include
  • The student's name
  • Date and Time of medication administration
  • The name of medication being dispensed
  • The dosage of medication given
  • Signature of the person dispensing the medication
  • Always write in BLACK ink only on any medication
    forms. IF YOU MAKE AN ERROR ON THE FORM, ALWAYS
    DRAW THROUGH IT WITH ONE BLACK LINE AND WRITE
    ERROR ABOVE IT ALONG WITH YOUR INITIALS. Make
    sure you sign and place your initials at the top
    of every MAR.

15
Completing the Medication Log
  • Copy information exactly as it is on the
    Medication
  • Administration Order Form
  • Document daily when medication is given
  • BY PLACING YOUR INITIALS IN THE BOX. PLACE THE
  • APPROPRIATE CODE IN THE BOX IF YOU DID NOT
  • GIVE THE MEDICATION!

  • ALWAYS NOTIFY NURSE IF CHILD IS NOT
  • COMING TO GET MEDICATION/NONCOMPLIANT,
  • ETC.
  • IF A STUDENT DOES NOT SHOW UP, YOU HAVE
  • TO FIND THEM AND GIVE THEM THEIR
  • MEDICATION EACH DAY AS ORDERED! NO
  • EXCUSES!

16
MAR Codes
  • AB ABSENT
  • N/A NOT APPLICABLE
  • FTFIELD TRIP
  • D/C MEDICATION DISCONTINUED
  • NMS NO MEDICATION AT SCHOOL ( MUST CONTACT
    PARENT)
  • R REFUSED (MUST CONTACT PARENT)
  • NS NO SCHOOL
  • YOU MUST FILL IN THESE CODES WHEN APPLICABLE ON
    EVERY MAR FOR EVERY STUDENT
  • Notice, there is no code for forgot because
    this is unacceptable. Each day, you must give the
    medication as ordered!

17
Medication Inventory, Audit, and Disposal
Documentation
  • A Medication Inventory, Audit, and Disposal
    Documentation form will be completed when
    medication is brought to school and when
    medication is disposed of. That form will
    indicate the student's name, the type of
    medication received, the person from whom the
    medication is received, the date the medicine was
    received, the amount of medication received, and
    the signature of the person who received the
    medication. It will also include the emptying and
    disposal dates of the medication.
  • The school nurse will conduct quarterly
    medication audits to ensure that the medication
    is being dispensed in accordance with the
    Medication Administration Order and board policy.
  • This form should be copied (2-2 or double sided)
    to the back of each students MAR. It can also be
    stapled or placed behind each MAR.

18
THE 6 RIGHTS OF MEDICATION ADMINISTRATION
19
Right Student
  • Ask students name or call name before medication
    given!
  • Having a picture id of student is also helpful.

20
Right Medication
  • Check prescription bottle for correct
    prescription information
  • Check MAR and Medication Administration Order to
    be sure information is the same

21
Right Dose
  • Check dose listed on
  • prescription bottle
  • Check dose that is
  • listed on the MAR
  • Do not give if dose is incorrect!

22
Right Time
  • Check time on MAR and the Medication
    Administration Order
  • Medications must be given within a 30 minute
    window of the time ordered. (example If the
    medication is written to be given at 1200pm, you
    can give it anytime between 1130 until 1230.)

23
Right Route
  • Make sure that you give the medication the way it
    is ordered to be given!!
  • Do not give a rectal medication by mouth or an
    ear drop by mouth? You get the idea?
  • Call the school nurse with any questions about
    the proper route for medication administration

24
RIGHT WRITE DOCUMENTATION
  • If you dont document, there is no record that
    you gave the medication or performed the
    procedure and therefore, it never happened. You
    must document each day that you gave the
    medication or procedure as ordered.

25
Oral Medications
26
Tablets/Capsules
  • Medication given by mouth
  • Only break tablets that are scored. Do not open
    any capsules or break any tablets unless the
    physician specifically orders it.

27
Liquids
  • When measuring liquids use the appropriately
    labeled measuring device provided by the
    pharmacy cup or syringe.
  • Check to be sure if medication needs to be
    refrigerated.

28
Inhalers
  • Used for asthma (see training sheets for inhalers
    and spacers)
  • Shake inhaler
  • Have student take a deep breath in and out
  • Have student place inhaler two finger-widths from
    mouth and press down on the inhaler while
    breathing in the medicine deeply. (Encourage them
    to use a spacer if they have one as it helps the
    student get more of the medication). Call school
    nurse for individual training on inhalers and
    spacers. Some of the new inhalers are designed
    to go directly in the mouth.
  • Have student hold breath for 5 seconds, then
    breath in and out slowly
  • Wait 1 minute then repeat steps above if two
    puffs are ordered.
  • Call parent if student is not better in 15 20
    minutes after the first dose was given. Call 911
    for severe breathing problems
  • Always notify the school nurse of a child having
    breathing problems!!

29
Nebulizers
  • Used for breathing problems, especially during
    the cold months.
  • Nurse will provide hands on training on these
    machines as all are different.
  • Contact the school nurse if a students parent
    requests Nebulizer use at school
  • Nebulizers are the equivalent to inhalers.

30
Eye Medications
  • Be sure you have the correct eye
  • Do not touch any part of the eye with the tip of
    the eye dropper
  • Apply eye drops one drop at a time with student
    lying down
  • do not allow them to rub eyes

31
INJECTIONS
32
Ear Medications
  • Be sure you have the correct ear
  • Have student lay with affected ear up
  • Pull top part of the ear up and back
  • Place correct number of drops in ear
  • Have student keep head tilted, drop ear up, for 2
    minutes

33
Epi-Pen Injections (First Aid Responder)
  • Take auto-injector out of cylinder container
  • IF MEDICATION IS BROWN - DO NOT GIVE CALL 911 AND
    PARENT
  • Remove (GREY) Safety Cap and place (GREY) cap to
    the side. DO NOT TOUCH THE BLACK TIP ON THE OTHER
    END. THAT IS WHERE THE NEEDLE IS!
  • Place BLACK tip to the thigh at a right angle
  • Use a quick motion and press black tip hard into
    thigh (You will hear a loud pop)
  • HOLD IN PLACE FOR 10 seconds
  • Remove Epi-Pen. Discard in Red Sharps Container
  • Massage injection site for 10 seconds
  • CALL 911 AND PARENT
  • Remember to remove the insect stinger if one is
    present in the skin.

34
GLUCAGON INJECTION(FIRST AID RESPONDER OR
DIABETIC CARE MANAGER
  • 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
  • Using the same syringe, hold bottle upside down,
    make sure the needle stays in the solution
  • Withdraw proper dose of solution into the syringe
  • Cleanse injection site on buttock, arm, or thigh
    with alcohol wipe
  • Inject into one of the above sites and hold for
    about 2-3 seconds, then remove
  • Turn student onto his or her side
  • Feed the student as soon as he or she awaken and
    can swallow

35
Glucagon Injection
To inject glucagon, the syringe should be held at
a 90 degree angle to the leg (as in the photo) or
arm and injected. The plunger is pushed down
completely. The needle is withdrawn and the
injection site is pressed lightly.
36
Glucagen Hypo-Kit Injection
  • Remove the orange plastic cup from the
    vialInsert the needle through the rubber stopper
    on the glucagon vial. Inject all the liquid in
    the syringe into the vial. The rubber stopper can
    be stiff, but the needle is strong enough to
    puncture it.
  • Gently shake the vialLeave the syringe in place
    and gently shake the vial until the powder is
    completely dissolved.
  • Withdraw all of the liquid into the syringeWhile
    the needle is still inside the vial, turn the
    vial upside down and, keeping the needle in the
    liquid, slowly withdraw all the liquid into the
    syringe. People weighing less than 55lbs get half
    the 1mg dose (0.5 mg).
  • Inject the solution into loose tissueInsert the
    needle into loose tissue under the injection site
    and inject the glucagon solution.

37
After Giving Glucagen
  • After GlucaGen HypoKit treatment, give extra
    carbohydratesAs soon as the person who has
    suffered a severe hypoglycemic event awakens and
    is able to swallow, he or she should be given
    extra carbohydrates. This is especially important
    in children and adolescents. These carbohydrates
    can include a fast-acting source of
    carbohydratesuch as a regular soda pop or fruit
    juiceas well as something more substantial to
    eat such as crackers and cheese or a meat
    sandwich. If the patient does not awaken within
    15 minutes of injection, give another dose of
    GlucaGen and INFORM A DOCTOR OR EMERGENCY
    SERVICES IMMEDIATELY. Even if the GlucaGen
    awakens the patient, his/her doctor should be
    promptly notified.

38
Special Considerations
  • Important Considerations for Helping Someone in a
    Hypoglycemic Emergency
  • Act quickly. Prolonged unconsciousness may be
    harmful.
  • Turn the person on his or her side to prevent
    choking. When an unconscious person awakens,
    he/she may vomit.
  • The syringe does not contain glucagon. You must
    mix the contents of the syringe with the glucagon
    in the accompanying bottle before giving the
    injection.
  • Do not mix GlucaGen HypoKit until you are ready
    to use it.
  • Discard any unused portion.
  • Become familiar with the technique of preparing
    glucagon before an emergency arises.
  • WARNING The person may be in a coma from severe
    hyperglycemia (high blood glucose) rather than
    hypoglycemia (low blood glucose). In a case of
    hyperglycemia, the person will NOT respond to
    glucagon and requires immediate medical
    attention.

39
Diastat Rectal Injection (First Aid Responder)
  • Put person on their side They are having a
    seizure 3-5 minutes long.
  • Get medication and take syringe out of box
  • Push up with thumb and pull to remove protective
    cover from syringe
  • Lubricate rectal tip with lubrication packet
    inside box
  • Turn person on their side facing you
  • Bend upper leg forward to expose rectum
  • Separate buttocks to expose rectum
  • Gently insert syringe tip into rectum
  • Slowly count to 3 while gently pushing plunger in
    until it stops
  • Slowly count to three before removing syringe
  • Hold buttocks together while counting to 3.
  • Note the time given and keep person on their side
    facing you
  • Call 911 if you are alarmed by the color of the
    person, the severity of the seizure, or if you
    are not sure. Always err on the side of caution
    and call 911 to ensure emergency medical
    services arrives as soon as possible.

40
STOP!!!
  • If information on the bottle does not match the
    information on theMedication Administration
    Order, or you have any concerns, DO NOT GIVE!
  • The parent and the physician should be called and
    always call the school nurse with any questions
    or concerns before giving a medication to any
    student.

41
MEDICATION ADMINISTRATION INCIDENT REPORTING
  • In the event that an error occurs related to the
    dispensing of medication, a Medication
    Administration Incident Report form will be
    completed. The school will notify the parent or
    guardian of the student involved.
  • This includes giving the medication to the wrong
    student, medication that fails to be administered
    for some reason and if a medication were found to
    be missing.
  • If a student does not come to get their
    medication and you make no attempt to try and
    find out the reason within the required time for
    administration, YOU HAVE MADE AN ERROR. You must
    have either a code or your initials in each block
    on the MAR.

42
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
    principals 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.

43
Medication Administration Record (Field Trip)
  • A Medication Administration Record Field Trip
    form will be completed for any medication or
    procedures that are completed on the field trip.
    This form will be attached to the Medication
    Administration Record within the school building.
    The medication must be returned back to the
    original location immediately following the
    return from a field trip.

44
Conclusion
  • School personnel will assume no liability for
    complications or side effects of medication when
    administered in accordance with the instructions
    provided by the parent/guardian, physician or
    health care practitioner.
  • Your School Nurse will meet with you and check
    you off to make sure you are competent to perform
    the skills covered in this power-point.
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