ProcedureforPrescriptionMedicationsandInjections
TheKirkwoodCommunityCollege,CampusHealthofficeisstaffedwithregisterednursesthatmayadministerprescriptionmedicationsand
injectionsunderthefollowingconditions:
1.
2.
3.
4.
5.
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8.
9.
Awrittenorderisobtainedfromthepatient’shealthcarepractitioner.Thisordermustberenewedevery6months.
Theprescribinghealthcarepractitionerisawarethereisnotaphysician,physicianassistantornursepractitioneronstaffatKirkwood
CampusHealth.
UndernocircumstanceswillaninitialdoseofamedicationorinjectionbeadministeredatCampusHealthduetotheriskofallergicreaction
oradversereaction.
Formildallergicreactionsafteramedicationorinjection,patients/studentsmaytakeBenadryl25to50mgpo,availableatCampusHealth.
Epinephrine1:1000iskeptintheemergencykitforacuteanaphylacticreactionsthatcausesevererash,hives,facialandthroatswelling,and
breathingdifficulties.Intheeventofasevereallergicreaction,adultswillreceive0.3ccEpinephrineSQandanambulancewillbenotifiedfor
transporttotheemergencyroom.
Students/patientsmustbeatleast18yearsofagetoreceiveprescriptionmedicationsorinjectionsatCampusHealth.
Ifpatient/studentisnotcompliantwiththemedication/injectionschedule,theCampusHealthDirectormayrefuseadministration.Patients
areresponsibletocontacttheirhealthcarepractitionertoobtainneworders.
Patients/studentsarenotchargedforprescriptionmedication/injectionadministration.
Forpatients/studentsreceivingmedicationsorinjectionsknowntocauseallergicand/oranaphylacticreactions,awaitingperiodof15-20
minutesaftereachmedicationorinjectionadministrationisrequired.Studentshavingreactionsafterleavingthecampusaretocall911orgo
tothenearestemergencyroom.
10. Studentrecordswillbesenttothehealthcarepractitioner’sofficeperiodicallyanduponrequestbytheorderinghealthcarepractitioner.
11. TheprescribinghealthcarepractitionermustprovideanofficetelephonenumberandaddresstoCampusHealth.
Patient/Student:
Iunderstandthatmedication/injectionadministrationmaybereceivedinCampusHealthfreeofcharge.Ifasevereallergicreactionoccurs,I
understandEpinephrinewillbeadministeredandIwillbetransportedtotheemergencyroomviaambulance.Allmedicalcostswillbemy
expense.Ifanallergicreactionoccursafterleavingthecampushealthoffice,Iamtocall911orgotothenearestemergencyroom.IfIcannot
makeanappointment,Imustcallandrescheduletheappointment.Informationaboutmymedicationorinjectionadministrationmaybereleased
tomyorderinghealthcarepractitioneruponhis/herrequest.
________________________________________________
Student/Patientsignature
_______________________
Date
HealthcarePractitioner’sorder:
________________________________________mayreceivethemedication/injectionof_________________________________byanRNat
KirkwoodCampusHealth.Themedicationanddosageinformationisenclosedorhasbeenfaxed,alongwiththeofficetelephonenumberand
addressoftheattendinghealthcarepractitioner.
__________________________________________________
SignatureofHealthcarePractitioner _________________________________________________
HealthcarePractitionerpleaseprintlastname
Date:____________________
Reviewed:KP12/2015
Pleasemailorfaxto:
KirkwoodCommunityCollege
CampusHealth,132IowaHall
6301KirkwoodBlvdSW
CedarRapids,IA52404
319-398-5588Phone
319-398-7114Fax
kpritts@kirkwood.edu