The Woods Charter School’s
Medication Training
FOR ANY EMPLOYEE THAT
GIVES MEDICATION AT
SCHOOL
Medication Policy
• The Woods Charter School discourages the
practice of students taking medication during the
school day.
• Parents’ and physicians’ written approval must be
presented to school administration.
• The school will assume no responsibility for
students who self-medicate without written
permission.
• Chapstick and throat lozenges are not covered by
this policy.
Medication Administration
• Written instructions will be required on the
“Administration of Medication Form”.
• The “Administration of Medication Form”
must be signed by a physician and parent.
• The “Administration of Medication Form”
must be completed annually and if there are
any changes.
• Copy the “Administration of Medication
Form” and place in the Nurses’ box.
The Woods Charter School
ADMINISTRATION OF MEDICATION DURING TE SCHOOL DAY
Student name: _______ DOB:________ Height:______ Weight:______
School Year: ________ Grade:______
Teacher:______
It is against school policy for students to have medications on their person.
All medications will need a physician’s prescription on file, and must be
kept in the front office in a secure location. Please make an appointment
with the front office if you wish to discuss your child’s health concerns.
Exceptions are students who may carry emergency medications for asthma
and/or severe allergies, ect., such as inhalers, epi-pen and glucagon. For
these children, and additional form called “Student Agreement for SelfCarried Medications” must be completed prior to the start of the school
year. This form is available in the front office.
This section must be completed by health care provider
• FILL OUT THIS FORM FOR EACH MEDICATION ADMINISTERED
• This form can be brought into school or faxed to Woods Charter at 919-9600133
• Each medication must be in its original container, and should have:
Student’s name, Physician, medication name, dose, route, frequency, time
and pharmacy name
Physician’s order for administration of medication by school personnel
Allergies Medication and other: _________
Type of reaction: _____________________
I have prescribed the following medication for the student named above and
request that dosages be given at school:
Medication:_________ Dose:________ Route:___________
Time:_____________ Frequency:___________________
For treatment of:________________________________
This section must be completed by health care provider
Possible side effects:____________________________________
Special Instructions:__________________________________________
Other medication including over the counter the student is currently taking:_____________
Physician’s name (print)_________________ Phone:_______________
Physician’s signature:_____________________ Date:_______________
Parental request for administration of medication:
I hereby give permission for my child (named above) to receive medication during school
hours. This medication has been prescribed by a licensed physician (health care provider). I
assume full responsibility for informing the principal (or representative) of any changes in
my child’s health or medication. I release Woods Charter, their agents ad employees from
any and all liability that may result from my child taking the prescribed medication. I will
furnish this medication with a container properly labeled by a pharmacist with identifying
information (e.g., name of child, medication dispensed, dosage prescribed, time and
frequency to be given.) I give authority to communicate with the ordering physician about
this medication.
Parent/Guardian (print) :______________________ Date: _____________________
Parent/Guardian (signature) :__________________________
This section must be completed by health care provider and legal parent /guardian
Parent Responsibilities
• Supplying the medication to the school
• Medication must be in a container labeled by the
pharmacist
• Over the counter medications must be provided in
the original container or in a pharmacy labeled
bottle
• Complete medical permission form
• Student agreement for self carried medications
form
• Provide new labeled containers and medication
form when medication changes are made.
Medication Log
Medication Log
Student:___________________________________
School:_________________________
School year:______________________
Teacher:_______________________________
Physician:________________________
Telephone number:________________
Name of Medication:_______________________________Special Comments/Instructions:__________________________________________
(If a new medication is prescribed or if the dose changes, a new medication log needs to be completed)
(Please initial the block on day medication is given or chart reason why not given - See chart below)
Month
1
2
3
4
5
6
7
8
9
10
11 12
13
14 15
16
17 18
19
20 21
22
23 24
25
26 27
28
29 30
31
August
September
October
November
December
January
February
March
April
May
Initials
Name
Initials
Name
_____ ____________________ ______ ___________________
Codes (Chart Reason)
ED = Early Dismissal
_____ ____________________ ______ ___________________
D/C = Medication Discontinued
_____ ____________________ ______ ___________________
R = Refused
S = Self Administered
Ab = Absent
FT = Field Trip
NMS = No Medication at school
O = Omitted/Attempted to locate student unsuccessful
Completing the Medication Log
• Copy information exactly as on the
“Administration of Medication Form”
• Document daily when medication is given
• Please count the number of tablets and
document on the Medication Log.
(Document on the medication log each time
new medication is brought in.)
Emergency Medications
Asthma Inhalers, Epi-Pens, Glucagon, and Diazepam
New laws have given students the right to
carry emergency medications and self
administer these medications.
The Physician must specify on the Medication
Dispensing Form that students may carry
emergency medication and self administer.
The nurse needs to be aware of any students
who carry their emergency medications.
The 5 Rights to
Medication Administration
Right Student
• Ask student’s name
or
call name before
medication given
• Have picture on
medication log if
available
ALWAYS STATE STUDENT’S NAME
Right Medication
• Check prescription
bottle for correct
prescription
information
• Check Medication Log
or Dispensing Form to
be sure information is
the same
Right Dose
• Check dose listed on
prescription bottle
• Check dose that is
listed on the
Medication Log
Date
Child’s Name
Medication
Time to be given
Oral Medications
Tablets/Capsules
• Medication given by
mouth
• Only break tablets or
capsules that are
scored.
Liquids
• When measuring
liquids use a small cup
or syringe.
• Check to be sure if
medication needs to be
refrigerated.
Inhalers
• Shake inhaler
• Have student take a
deep breath in and out
• Have student place
inhaler in mouth and
puff inhaler while
breathing in deeply
• Have student hold
breath for 10 seconds
• Wait 1 minute then
repeat steps above
Eye Medication
• Be sure you have the
correct eye.
• Do not touch any part
of the eye with the tip
of the eye drop bottle.
• Have student dab eye
after insertion (do not
allow them to rub
eye).
Ear Medication
• 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 for
2 minutes
Injections
Epi-Pen Injections
•
•
•
•
•
•
•
•
•
•
•
Remove insect stinger
Remove white plastic cap
Take medication from amber colored cylinder
IF MEDICATION IS BROWN - DO NOT GIVE
CALL 911 AND PARENT
Place (gray) cap to the side
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 5-10 seconds
Remove Epi-Pen. Discard in Red Sharps Container
Massage injection site for 10 seconds
CALL 911 AND PARENT
Glucagon Injection
•
•
•
•
•
Remove flip-off seal from the bottle of glucagon
Wipe top of bottle off with alcohol wipe
Remove the needle protector 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 1 milligrams of solution into the syringe
• Cleanse injection site on buttock, arm, or thigh with alcohol wipe
• Inject the needle into one of the above sites
• Turn student onto his or her side
• Feed the student as soon as he or she awaken and can swallow
Right Time
• Check time on
Medication Log or
Medication
Dispensing Form
• Medication may be
given 30 minutes prior
to or after prescribed
time
If information on the bottle does
not match the information on the
Administration of Medication
Form,
the physician’s office and/or
parent should be called.
Notify the School Nurse.
If medication is
given to the wrong student
or
the right student gets wrong medication
or
medication is found to be missing,
a Variance Report
must be completed.
Medication Variance Reports
are located in
School’s main office Health
Complete Variance Report
Notify Parent
Notify School Nurse
Send copy of report to Principal
If medication is found to be missing,
complete a
Medication Variance Report.
Complete Variance Report
Notify Principal
Notify Police
Notify School Nurse
Review
• Administration of Medication Form must be
present and signed by Physician and Parent
• Medication Log should be copied directly from
Administration of Medication Form
• Remember the 5 Rights
Right student, medication, dose, route, time
• Be sure student takes medication correctly
• Initial Medication Log
• Complete Variance Report if medication is given
incorrectly
• Complete Variance Report if medication is
missing
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August 31, 2010