MEDICATION ADMINISTRATION
TABLE OF CONTENTS
ADMINSTRATION OF MEDICATION
Parent/Guardian Responsibilities
Physician/Dentist Responsibilities
Pharmacist Responsibilities
Training/School Nurse Responsibilities
Use of the Blue Card – WH#98333
Use of the Orange Card – WH #98334
Self-Administration by Students
Delivery of Medication to School
Storage of Medication
Recording of Medication
Medication Errors
Field Trips
Multi-Day Field Trips
ADMINISTRATION OF MEDICATION/TRAINING MODULE FOR SCHOOL
PERSONNEL
Purpose
Medication Administration Forms
Storage of Medication
Identification of Student
Administration Technique
MEDICATION ADMINISTRATION PROCEDURES
Administration of Epinephrine Auto-Inject (Epi-Pen)
Administration of Oral Medication (Liquid)
Administration of Oral Medication (Tablets and Capsules)
Administration of Topical Medication
Administration of Eye Medication
Administration of Ear Medication
Administration of Nasal Medication
Administration of Medication via Metered-Dose Devise (MDD)
Administration of Medication via Nebulizer
Administration of Medication via Gastrostomy Tube
Administration of Rectal Suppository
Administration of Rectal Diastat
Administration of Injectable Medication
Administration of Medication for Field Trips
1
ADMINISTRATION OF MEDICATION GUIDELINES
Periodically, the parent/guardian and/or physician requests medication be given to
students during school hours. The parent/guardian is encouraged to develop a schedule
minimizing or eliminating taking medications at school. School personnel, authorized by
the principal and trained by the School Nurse may assist students in taking prescribed
medication during school hours.
PARENT/GUARDIAN RESPONSIBILITY
The parent/guardian will assume the major responsibility in working with the school and
physician/dentist in providing: (1) Signatures and instructions on forms (WH #98333 and
#98334). (2) The medication in an original, labeled container for school personnel
School personnel should be informed of any side effects or complications from the
medication. The parent/guardian should be aware of the problems associated with
administration of medications at school, such as loss of class time, disruption of class
schedule, lack of health professional to observe the effects of medication, etc., to
discourage the administration of medication during school hours.
PHYSICIAN/DENTIST RESPONSIBILITY
Each physician/dentist who prescribes a medication for students attending school should
provide detailed information about the medication to the parent/guardian. The
physician/dentist should encourage the parent/guardian to administer medication before
and after school hours whenever possible. When an over-the-counter medication is to be
given at school, the physician/dentist must prescribe the medication on the official form
(WH #98334). The physician/dentist may call in a medication or over-the-counter
order to the pharmacist, who may sign the forms for the physician/dentist.
PHARMACIST RESPONSIBILITY
When a medication has been prescribed for a student, the pharmacist will prepare two
containers with appropriate labels for administration of medication at home and at school
Verbal orders for over-the-counter medications prescribed by the physician/dentist may
be verified by the pharmacist, and the pharmacist may sign the school’s over-the counter
medication form.
TRAINING/SCHOOL NURSE RESPONSIBILITY
Anyone designated to administer medications must complete the district’s medication
training program annually. The principal should designate at least three staff members
to administer all medications. Volunteers may not administer medication. (Exception:
Volunteer Licensed Registered Nurses (RN) who has completed application process
through Pinellas County Health Department, and received training through School
Health Services.)
The principal should inform the school nurse of the designated personnel, and
arrangements for a training session should be made. The Clearance for Non-Medical
School Employee to Perform Health Procedure form (PCS Form 2-2332) will be signed
by the nurse and the staff to be trained. The nurse should review the procedure at the
beginning of each semester (and as indicated or requested), and document training and
re-training.
2
USE OF THE BLUE CARD (WH #98333) FOR PRESCRIPTION MEDICATION
Only the parent/guardian’s signature is required since the label on prescribed medication
will identify the name of the physician, medication dosage, etc. The pharmacy
prescription label must be securely attached and legible. The card shall include the
name of the medication, dosage and any special instruction. The Administration of
Prescription Medication card (WH # 98333) should be kept in a folder in the area where
the medication will be administrated. When the administration of the medication is to be
discontinued, the card should be filed in the student’s “cumulative school health record”
folder. A New Administration of Medication of Prescription Medication Card (WH #
98333) is required each school year. If any medications are added after the original
form is signed, another form for each additional medication must be signed and returned
to the school. The student’s picture must be attached to the blue card. Staff
administering medications should complete the signature verification at the bottom of the
medication card.
USE OF THE ORANGE CARD (WH #98334) FOR OVER-THE-COUNTER
MEDICATIONS
Signatures of both the physician/dentist and parent/guardian are required. The card
shall include the name of the medication, dosage, and any special instructions. All
medication must be brought in the original sealed container. The Administration of OverThe- Counter Medication Card (WH # 98334) should be kept in a folder in the area
where the medication will be administered. When the administration of the medication is
terminated, the card should be filed in the student’s “cumulative school health record”
folder. A New Administration of Over-The-Counter Medication Card (WH # 98334) is
required each year. If any medications are added after the original form is signed,
another form for each additional medication must be signed and returned to the school.
The student’s picture must be attached to the orange card.
NOTE: The potential for adverse reactions exists with all medications. Many children
may be allergic to analgesics and other drugs or have medical problems which should
exclude the administration of any medication without a physician/dentist’s prescription.
Staff administering medications should complete the signature verification at the bottom
of the medication card.
SELF-MEDICATION BY STUDENTS
3
Approval for self-administration of medication(s) (Inhaler, Epi-pen, Pancreatic Enzyme
Supplement and Insulin) shall be written by the physician under “Special Instructions” on
the administration of medication form.
Inhalers
Asthmatic students; possession of inhalers as provided for in section 1002.20 F.S. which
states- “An asthmatic student shall be able to carry a metered dose inhaler on their
person while in school when they have approval from their parents and their physician.
This law requires written authority by the parent and the physician, and approval of the
principal. The principal shall be responsible for obtaining PCS Authorization to Carry
Metered Dose Inhaler for Asthma (PCS Form 2-3060) from School Health Services and
overseeing the completion of the authorization. The Authorization shall be filed with the
Administration of Medication(WH # 98333) forms used for general medications. A copy
shall be filed in the student’s School Health Record”.
Epi-pens
Section 1002.20 Florida Statute was amended in 2005 it states, “to create the Kelsey
Ryan Act, which gives students the right to carry and self-administer epinephrine on
school grounds if exposed to their specific life threatening allergens. The law requires
written authorization by the parent and the physician, and approval of the principal.”
Authorization for Emergency Injection for Severe Allergy (PCS 2-2366) should be
completed by physician, parent and principal and all should be in agreement that the
student meets the criteria for approval to carry his/her Epi-pen while in school. The
principal shall be responsible for obtaining Authorization for Emergency Injection for
Severe Allergy (PCS 2-2366) from School Health Services and overseeing the
completion of the authorization prior to the administration of the medication. The
Authorization (PCS 2-2366) shall be filed with the Administration of Medication (WH #
98333) forms used for general medications. A copy shall be filed in the student’s School
Health Record
Insulin
“2003 Florida Department of Health Nursing Guidelines for Delegation of Care for
Students with Diabetes in Florida Schools” provides for students to be allowed to check
their blood glucose levels and respond to the results in the classroom, at other campus
locations, during any school activities, and during field trips. It requires written
authorization by the parent and the physician, and approval of the principal.
Authorization for Diabetes Management in School(PCS Form 2-2966) should be
completed by physician, parent and principal and all should be in agreement that the
student meets the criteria for approval to carry his/her insulin/glucometer while in
school.” The Authorization for Diabetes Management in School (PCS 2-2966) shall be
filed with the Administration of Medication forms (WH # 98333) used for general
medications. A copy shall be filed in the student’s School Health Record. Students that
are not yet independent in their diabetic care may require assistance with insulin
administration. Such assistance at the student’s zoned school is a reasonable
accommodation that the student’s Section 504 Team should consider.
Pancreatic Enzyme Supplements
4
FS 1002.20 amended June 2010, permits a student with pancreatic insufficiency or
cystic fibrosis to carry and self-administer prescribed pancreatic enzyme supplements
while in school. “The Authorization to Self-Administer Pancreatic Enzymes” must be
completed and signed by parent, physician and principal. A copy of the signed form
shall be filed in student’s health record. This form is available from School Health
Services Office.
5
DELIVERY OF MEDICATION TO SCHOOL
Medication should be sent to school via parent/guardian. Parent/guardian should
arrange for a separate supply of medication for school. Medication should not be
transported between home and school on a daily basis. It is the parent’s/guardian’s
responsibility to pick up unneeded or discontinued medication as soon as possible.
Medications must be counted by a school staff member trained to administer
medications upon delivery at school. Counting must take place in the presence of the
adult who delivered the medicine to school. The total should then be documented on the
“Administration of Medication Card” (WH # 98333 or 98334), and signed by the school
staff member and parent.
STORAGE
Medication must be stored in a locked cabinet or drawer in the clinic/administrative suite.
The storage area should be cool and dry. Those medications requiring refrigeration
should be stored in a locked box in the refrigerator in a limited access area. Emergency
injectable medications, such as Epi-Pen, Glucagon, etc. must be accessible immediately
in case of an emergency. It is permissible to keep such medications in a secure
location, but in an unlocked cabinet during the school day. If they are stored in that
manner, there should be a sign on the outside of the medication cabinet indicating the
location of emergency medications, and they should be locked in a secure cabinet after
school hours.
Parents should be contacted to come to school and pick up any expired medications or
those remaining at the end of the school year. Medications that are not picked up by
parents should be properly disposed of. Medication disposal should be witnessed by a
second person and documented by both people involved. The sharps disposal container
or biohazard disposal container are not appropriate places for disposal of medication.
See Health Services Folder for medication information for medication disposal flier.
RECORDING
The school employee administering or supervising the administration of medication
should sign and date the appropriate Administration of Medication Form (WH # 98333 &
#98334) and note the time, dosage, medication, and amount left in bottle.
Documentation must be completed immediately for each medication given.
6
MEDICATION ERRORS
Violation of any one of the rights of medication administration constitutes a medication
error. Those rights include: right student, right medication, right dosage, right time, right
route, and right documentation.
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In case of medication error, the following procedures are recommended:
o
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Notify the school administrator.
Call the poison control non-emergency number (1-800-282-3171)for
toxicity or expected side effects if the error involved the wrong student,
medication, dosage, time or route
Notify the parent
Notify the school nurse/supervisor
Notify the prescribing physician
A Medication Incident Report (PCS Form 2-2367) must be completed.
File the original with school health services. No copy should be filed in
student health record.
Medication errors can be used to determine needed training for school
staff
FIELD TRIPS
Trained school district personnel must accompany student on the bus, field trips, or any
other school-based activity off school grounds. If medication is to be administered on
field trips, or at before/after school activities, the same regulations apply. Therefore, the
original container must be transferred to the trained person who will be administering the
medication, and administration must be appropriately documented on the approved
form. It is not permissible to transfer medication to an envelope or other container for
later administration. However, parents may request that the pharmacy provide them
with a properly labeled duplicate prescription container for field trips. Volunteers may
not administer medication.
MULTI-DAY FIELD TRIPS
For multi-day school-sponsored field trips only, parents may designate a
parent/chaperone (non-school employee) to administer over the counter (OTC)
medications only while on the trip with a complete “Optional Multi-Day SchoolSponsored Field Trip Form”( PCS form 2-3084).
7
Administration of Medication Training Module for School Personnel
PURPOSE
This module has been prepared for the school nurse to utilize in the training of school
staff designated by the principal as being responsible for the administration of
medication. It is intended to fulfill the requirements for training as specified in 1006.062
Florida Statue.
MEDICATION ADMINISTRATION FORMS
No medication will be given without written parental authorization and physician/dentist
instructions (prescription label or written order). Only a registered nurse or licensed
practical nurse may take telephone orders for any medication.
Administration of Medicine Dosage Missed by Parent at Home.
 If a student was to receive medication in the morning, before coming to school,
and he/she does not receive that dose, the parent or their designee should come
to school to administer it.
The Blue Card (WH 98333) for Prescription Medication requires only the parent/guardian
signature, since the label on the prescribed medication will identify the name of the
doctor/dentist, medication, dosage, etc. Verify that the student’s name, name of the
medication, dosage, and special instructions on the blue card corresponds with the
information on the prescription label. A new blue card and prescription label or doctor’s
order is needed for any change in the dosage, time, mode of administration, or
instructions. The student’s picture is required to be attached to the blue card.
The Orange Card (WH #98334) for Over-the-Counter Medication required signatures of
both the physician/dentist and parent/guardian. The card shall include the name of the
medication, dosage, and any special instructions. Verify that the name of the medication
and dosage on the orange card correspond with the information on the container of
medication. A new orange card is needed for any change in the dosage, time, mode of
administration, or instructions. The student’s picture is required to be attached to the
orange card.
Administration of Prescription Medication Cards and Administration of Over-The-Counter
Medication Cards (WH # 98333 and #98334) should be kept in a folder or notebook in
the area where the medication will be administered. When the administration of the
medication is discontinued, the Administration of Medication Card (WH # 98333 or #
98334) should be filed in the student’s “cumulative school health record” folder. New
Administration of Medication Cards are required at the beginning of each school year.
8
Administration of Medication Training Module for School Personnel (continued)
STORAGE OF MEDICATION
The medication must be received and stored in its original container, labeled with the
student’s name, name of drug, directions concerning dosage, time of day to be taken,
physician’s/dentist’s name, and date of prescription. The pharmacy prescription label
must be securely attached and legible.
Check for any special storage instructions. Proper storage of medication is crucial to the
drug’s effectiveness. Drugs are often unstable and can be affected by moisture, heat,
cold, or sunlight.
Medication must be stored in a locked cabinet or drawer in the clinic or administrative
suite. If medication must be refrigerated, it should be stored in a locked box within the
refrigerator in a limited access area. Emergency injectable medications, such as EpiPen, Glucagon, etc. must be accessible immediately in case of an emergency. It is
permissible to keep such medications in a secure location, but in an unlocked cabinet
during the school day. If they are stored in that manner, there should be a sign on the
outside of the medication cabinet indicating the location of emergency medications, and
they should be locked in a secure cabinet after school hours.
Medication should be stored in a clean area with container caps replaced tightly.
Contaminated objects (i.e., thermometers, catheters) should be stored in another area of
the cabinet.
If medication is nearing its expiration date, request fresh supply from the
parent/guardian.
Do not administer medication if changes in appearance or odor are noted or expired.
The parent/guardian should be immediately notified.
IDENTIFICATION OF STUDENT
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Never administer medication if there is any doubt as to the identity of the student.
Ask the student to state his/her name. Do not prompt. Many students will often
answer to other names.
Have staff member verify identity by sending student to the office with an aide or
a name tag.
If medication card has a picture attached, use this to identify student.
9
Administration of Medication/Training Module For School Personnel (continued)
ADMINISTRATION TECHNIQUE
1. Always wash hands well before and after administrating medications.
2. To assure accuracy and safety, verify the physician/dentist’s order with the
prescription container when removing the medication from the shelf, while
pouring the medication and when returning the container to the shelf. Always
check 3 times.
3. Check date on the Administration Medication Form (WH# 98333 or #98334) to
verify the medication has not been given by someone else.
4. Follow directions carefully including any precaution stickers.
5. Immediately record all medications given on the Administration of Medication
Form (WH #98333 or #98334). Date and sign each entry with time given, name
of medication, dose and amount left in bottle.
All medications should be given at home or in the doctor’s office the first time. During
the first “at school” administration of the medication, the student should be observed
carefully because of the possibility of an allergic reaction. Most allergic reactions to
drugs present as a rash, hives, itching, localized swelling, wheezing or breathing
difficulty. A severe allergic reaction can cause anaphylactic shock. (Refer to
Emergency Guidelines for Schools for protocol.) An allergic reaction can occur at any
time with any medication, particularly antibiotics. Never leave a student suspected of
having an allergic reaction alone. If a student is sent to the emergency room, send the
medicine container and (copy of) clinic card with the person accompanying the student.
If the student vomits after the medication is administered, notify the principal and the
parent/guardian. Note the time interval between administration of medication and
emesis. Observe vomit, if possible, for evidence of pill, color of liquid, etc.
10
ADMINSTRATION OF EPINEPHRINE AUTO-INJECTOR
(Epi-Pen)
Individualized training required prior to administration by non-medical personnel.
PURPOSE
To treat anaphylaxis; to prevent anaphylactic shock.
Anaphylaxis is an acute reaction that can occur within seconds or minutes after a
hypersensitive person in exposed to an allergen. (A delayed or persistent reaction may
occur up to 24 hours later.)
COMMON CAUSES OF ANANPHYLAXIS IN HYPERSENSITIVE STUDENTS
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Stingers & Biters: bees, hornets, yellow jackets, wasps, ants, deer, flies,
black flies, and yellow flies.
Foods: milk, eggs, wheat, nuts, fish or shellfish, soy, chocolate, pork,
chicken, corn, citrus fruits, tomatoes, spices.
Drugs: antibiotics, anesthetic agents, vaccines, dyes used for x-rays
Latex: art supplies, glue, balloons, balls, chewing gum, disposable diapers,
elastic in clothes, rubber bands, zippered plastic storage bags, disposable
gloves and band aids.
SYMPTOMS OF ANAYPHLAXIS
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Itching
Dry, hacking cough
Widespread hives
Feeling constriction in the throat or chest
Wheezing
Nausea
Dizziness
Vomiting
Difficulty breathing
Hoarseness and/or thickened speech
Confusion
Feeling of impending disaster
Abdominal discomfort
IMMEDIATE EMERGENCY MEASURES FOR ANAPHYLACTIC REACTIONS
If no auto-injector available call 911 immediately and parent/guardian and give
emergency care.
POSSIBLE SIDE EFFECTS OF EPINEPHRINE
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Nervousness
Tremor of hands
Temporary increase of heart rate
Temporary increase of blood pressure
11
Administration of Epi-Pen (continued)
PREPARATION
1. Explain procedure to student using appropriate developmental approach.
2. Assemble equipment:
A. Verify physician’s orders on Authorization for Emergency Injection for
Severe Allergy(PCS 2-2366) and Administration of Prescription
Medication card (WH 98333).
B. Pre-measured epinephrine pen (Epi-pen)
C. Ice pack
PROCEDURE:
1. Assess student for symptoms and verify physician’s order.
2. CALL 911 Activate EMS as soon as possible, preferably at the time of
assessment, if another person is available.
3. Administer medication:
 Pull off cap.
 Place black tip against the outer thigh at a right angle to leg. The injector
should only be used on the fleshy outer portion of the thigh. May be
given through clothing, if necessary. If student can perform self-injection,
this is preferable, as a trained designee may not be immediately
available.
 With a quick motion, push the auto-injector firmly against thigh, releasing
mechanism that injects a dose of epinephrine. Hold in place for a few
seconds after activation.
 Remove EpiPen and give to EMS for disposal.
 Massage the injected area for 10 seconds.
4. CALL PARENT/GUARDIAN.
5. Apply ice pack to area of injection. Keep student warm.
6. Stay with student until EMS arrives. Have a copy of the Student Clinic Card
available for EMS.
7.
If an insect bite, remove stinger, if present, by scraping it away with from skin
with your fingernail or a plastic card, e.g. ID badge. If
tweezers are used; grasp the stinger and not the venom sac.
8. Dispose of used supplies.
9. Document date, time, dosage, what was done and student’s response on
Administration of prescribed medication card (WH 98333).
10. Obtain new authorization and Epi-Pen for student.
12
ADMINSTRATION OF ORAL MEDICATION
(Liquid)
Individualized training required prior to administration by non-medical personnel.
PURPOSE
To ensure maximum benefit from prescribed medication.
PREPARATION
1. Explain procedure to student, using appropriate developmental approach.
2. Assemble equipment
 Medication
 Water, unless otherwise directed.
PROCEDURE
1. Verify physician’s order
2. Wash hands.
3. If indicated, shake bottle well to mix.
4. Pour medicine on a hard surface. Hold the bottle with label facing up, so spilled
liquid won’t obscure any printed information.
5. Measure accurately in a calibrated hollow medicine spoon, medicine cup or
syringe. The teaspoon is an inaccurate measuring device. If a medication is
ordered in teaspoons/milliliters/cc the established standard is 5ml per teaspoon.
Measuring spoon
Metric Equivalent
¼ teaspoon
1- ¼ cc or ml
½ teaspoon
2-1/2 cc or ml
¾ teaspoon
3-3/4 cc or ml
1 teaspoon
5 cc or ml
1 tablespoon
15 cc or ml
1 ounce
30 cc or ml
6. Wipe bottle lip with a paper towel, if necessary, before replacing cap.
7. Always give to student in a sitting position. Be sure the medication is swallowed.
Check mouth.
8. If you are giving the student medication with a syringe, squirt between check and
teeth to prevent choking.
9. Have water available to wash away taste, unless otherwise indicated.
10. Wash medicine spoon or syringe with soap and water, rinse and air dry. Dispose
of container after last dose is given.
11. Dispose of used supplies
12. Wash hands.
13. Document date, time, name of medication, amount given and signature on
Administration of Medication Form (WH #98333 or WH #98334) or Medication
Administration Records (MAR)( PCS 2-2336)
14. When medication supply is near depletion, notify parent/guardian.
13
ADMINISTRATION OF ORAL MEDICATION
(Tablets and Capsules)
Individualized training required prior to administration by non-medical personnel.
PURPOSE
To ensure maximum benefit from prescribed medication.
PREPARATION
1. Explain procedure to student using appropriate developmental approach.
2. Assemble equipment:
 Medication
 Medication cup
 Water
PROCEDURE
1. Uncap bottle, and pour correct number of pills into the lid or medication cup.
2. Assist the student in taking the medication, if necessary.
3. Never alter the form of the tablet. If tablet needs to be cut, parent/guardian
should have it cut by the pharmacy.
4. Follow medication with water, unless otherwise indicated.
5. Always administer medication to the student in a sitting/standing position. Be
sure the medication is swallowed. Check mouth.
6. If the student has difficulty swallowing medication, have student swallow some
water, put tablet or capsule far back on tongue and swallow a large mouthful of
water. Do not let student throw back head as this may result in aspiration. For
further problems, check with parent/physician for assistance.
7. Dispose of used supplies.
8. Wash hands.
9. Document date, time , name of medication, amount given and signature on
Administration of Medication form ( WH # 98333 or #98334) or Medication
Administration Record (MAR) (PCS 2-2336).
10. When medication supply is near depletion, notify parent/guardian
14
ADMINISTRATION OF TOPICAL MEDICATION
Individualized training required prior to administration by non-medical personnel.
PURPOSE
To ensure maximum benefit from prescribed medication.
PREPARATION
1. Explain procedure to students, using appropriate developmental approach.
2. Assemble equipment:
 Medication
 Cotton tip applicators or gauze
 Gloves
PROCEDURE
1. Verify physician’s order.
2. Wash hands.
3. Apply gloves.
4. Clean area with soap and water if appropriate. Pat dry
5. Use cotton tip applicators or gauze to apply medication. Never use fingers, use
new applicator or gauze for each application.
6. Spread medication in a thin even layer, avoiding student’s eyes or lips.
7. Cover with gauze or band aid, if ordered.
8. Stress to student the importance of not touching lesion(s) and washing hands.
9. Remove gloves and dispose of used supplies.
10. Wash hands.
11. Document date, time, name of medication, amount and signature, on
Administration of Medication Form (WH #98333 or # 98334) or Medication
Administration Record (MAR) (PCS 2-2336).
12. When medication supply is near depletion, notify parent/guardian.
15
ADMINISTRATION OF EYE MEDICATION
Individualized trained required prior to administration by non-medical personnel.
PURPOSE
To ensure maximum benefit from prescribed medication
PREPARATION AND TEACHING
1. Explain procedure to student, using appropriate developmental approach.
2. Assemble equipment:
 Medication
 Clean tissue or cotton balls
 Gloves
PROCEDURE
1. Verify physician’s order.
2. Wash hands.
3. Put on gloves.
4. Remove discharge from each eye, using a clean tissue for each eye. Crusting
may be loosened by soaking with warm water on a clean cloth for 1 minute.
5. Place the student sitting with the head extended, and ask the student to look up
6. Administer medication as prescribed by physician.
7. Drop medication into the lower lid downward; the hand that holds the
dropper/bottle rest on the head.
8. Drop medication into lower eyelid (never directly onto the eyeball). If medication is
in ointment form, squeeze a ribbon of ointment inside the lower eyelid beginning at
the inner corner of eye near the nose.
9. Ask student to close the eye and look in all directions to enhance even distribution.
10. Wipe excess medication from the nose outward with a clean tissue.
11. If both eyes are to receive medication, repeat with the other eye.
12. Dispose of used supplies.
13. Remove gloves and wash hands.
14. Document any drainage, visual problems and/or any unusual response by student.
Document on Administration of Medicine Form (WH # 98333 or WH # 98334) or
Medication Administration Record (MAR) (PCS 2-2336). Date, time, name of
medication, dosage, and signature.
15. When medication supply is near depletion, notify parent/guardian.
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ADMINISTRATION OF EAR MEDICATION
Individualized training required prior to administration by non-medical personnel.
PURPOSE
To ensure maximum benefit from prescribed medication.
PREPARATION
1. Explain procedure to student using appropriate developmental approach.
2. Assemble equipment:
 Medication
 Clean tissue or cotton ball
 Gloves
PROCEDURE
1. Verify physician’s order.
2. Wash hands
3. Apply gloves
4. Administer ear drops at room temperature to decrease pain and dizziness.
5. Have student be on the side opposite the ear into which medication will be
administered.
6. Use tissue or cotton ball to remove any drainage that is present on outer ear
only.
7. Administer medication per physician’s order.
8. Place the wrist of your hand on student’s cheek or head to help steady
hand.
9. Straighten the ear canal by pulling on the outer ear. For children three (3)
years old and under, pull down and toward back of head. For older children,
pull up and back.
10. Position the dropper (bottle), so that the medication will fall against the side
of the ear canal.
11. Squeeze the dropper (bottle) for the required number of drops.
12. Keep the student lying with the medicated ear up for five (5) minutes.
Gently rub the skin in front of the ear.
13. If both ears are to receive medication, repeat with the other ear.
14. Dispose of supplies used.
15. Remove gloves and wash hands.
16. Document date, time, medication, amount administered and signature on
Administration of Medication Form (WH #98333 or WH 98334) or
Medication Administration Record (MAR) (PCS 2-2366).
17. When medication supply is near depletion, notify parent/guardian.
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ADMINISTRATION OF NASAL MEDICATION
Individualized training required prior to administration of non-medical personnel.
PURPOSE
To ensure maximum benefit for prescribed medication.
PREPARATION
1. Explain procedure to student using appropriate developmental approach.
2. Assemble equipment:
 Medication in spray or drop form
 Dropper (if needed)
 Tissues
 Gloves
PROCEDURE
1.
2.
3.
4.
5.
6.
7.
8.
9.
Verify physician’s order.
Wash hands
Put on gloves
Position student with the head hyper-extended, to prevent the medication
trickling into the throat rather than the nasal passage.
Do not allow dropper (bottle) to touch nasal mucosa.
If medication is in squeeze-bottle form, refer to specific container directions.
Remove gloves and wash hands
Document date, time, name of medication, dosage, and signature on
Administration of Medication Form (WH #98333 or #98334) or Medication
Administration Record (MAR) (PCS 2-2366).
When medication supply is near depletion, notify parent/guardian.
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ADMINISTRATION OF MEDICATION
Via METERED-DOSE DEVISE (MDD)
Individualized training required prior to administration by non-medical personnel.
PURPOSE
To administer directly into airways in a convenient, portable manner.
PREPARATION
1. Explain procedure to student, using appropriate developmental approach.
2. Assemble equipment on clean surface:
 Cartridge containing medication.
 Mouthpiece and spacer tube, if indicated
PROCEDURE
1. Verify physician’s order.
2. Wash hands
3. Shake the canister
4. Instruct student to exhale and then begin to breath in as slowly and as
deeply as possible, and get ready to activate the canister.
5. Activate the inhaler just after inhaling.
6. Hold breath 10 seconds, if possible, to allow the particles to settle on the
lining of the airways before breathing out.
7. Wait 2 minutes and repeat, if prescribed.
8. Instructions for use of Spacer
 Shake canister well
 Attach the inhaler to the spacer
 Press on the inhaler to release one spray of medication into the holding
chamber
 Breath out
 Place the mouthpiece of the spacer in the mouth and inhaler slowly.
 Hold breath for 5 seconds and then exhale.
 Repeat steps 5 and 6 for a total of 6 breaths.
 Wait 2 minutes
 Repeat from step 3 for 2nd puff as per doctor order.
9. Wash the mouthpiece after each use. Store dry in labeled prescription box
with medicine or in clean, labeled, plastic bag.
10. Wash hands
11. Document dosage, time, date, name of medication, and signature on
Administration of Medication Form (WH #98333) or Medication
Administration Record (MAR) (PCS 2-2366).
12. When medication supply is near depletion, notify parent/guardian.
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ADMINSTRATION OF MEDICATION
via NEBULIZER
Individualized training required prior to administration by non-medical personnel.
PURPOSE
To administer medication directly into airways.
PREPARATION
1. Explain procedure to student, using appropriate developmental approach.
2. Assemble equipment on clean surface:
 Medication(s)
 Diluting solution (if necessary)
 Air compressor
 Nebulizer and connecting tube
 Mouth-piece or face mask
PROCEDURE
1. Verify physician’s orders.
2. Wash hands
3. Fill the nebulizer through the main orifice with the prescribed amount of
medication and dilution solution, when necessary.
4. Position the student – sitting.
5. Position the mouthpiece between the teeth, or fit mask over the nose and
mouth.
6. Turn on the compressor.
7. Encourage student to inhale deeply and exhale slowly to maximize
medication effects. Periodically tap side of reservoir so medication that
collects on the sides will run down and be nebulized. If nebulizer is tilted, it
will not mist. Encourage student to cough periodically to clear airways of
any secretions.
8. Rinse plastic sections and tubing with water and soap, allow to air dry.
Disinfect nebulizer top and bottom daily with 1:10 bleach solution. Plastic
connector tubing needs no cleaning. May be used indefinitely unless
cracked, split or grossly discolored. Each student must have his own
equipment (tubing, mask or mouthpiece) clearly labeled and individually
stored. Nebulizers which belong to School Health Services may be used by
more than one student.
9. Wash hands
10. Document date, time, name of medication, amount, signature and reason
procedure done and student’s response on respiratory log and medication
on Administration of Medication Form (WH 98333) or Medication
Administration Record (MAR) (PCS 2-2366).
11. When medication supply is near depletion, notify parent/guardian.
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ADMINISTRATION OF MEDICATION
via GASTROSTOMY TUBE
Individualized training required prior to administration by CNA’S.
PURPOSE
To administer medications to the student, who is unable to receive them by mouth.
PREPARATION AND TEACHING
1. Explain procedure to student, using appropriate developmental approach.
2. Assemble equipment on a clean surface:
 Liquid medication or finely crushed pills.
 20cc warm water or per doctor’s orders
 Gloves
PROCEDURE
1. Verify physician’s order.
2. Wash hands and apply gloves
3. Position student in an upright or semi-reclining position. Occupy the
student’s hands, if necessary.
4. Attach syringe and verify tube placement by injecting with 10ml air and
auscultation with a stethoscope over the umbilicus for an “air rush” (gurgling
sound) and/or lower syringe to see if stomach content will come out in
syringe. Pour in prepared medication (all crushed tables should be mixed
well with water, juice or small amount of formula before placing in syringe).
Enteric coated and sustained action tables/capsules are not to be crushedneed liquid substitute.
5. Allow medication to flow by gravity. May need gentle pressure with syringe
plunger to start “flow”.
6. Rinse tube with 20-30cc warm water or per doctor’s orders to clear.
7. Maintain student’s position for a short time.
8. Dispose of used supplies and wash hands. Rinse tubing with water and air
dry.
9. Document date, time, name of medication, amount and signature, on
Administration of Medication Form (WH #98333) or Medication Administration
Record (MAR) (PCS 2-2366).
10. When medication supply is near depletion, notify parent/guardian.
21
ADMINISTRATION OF RECTAL SUPPOSITORY
Individualized training required prior to administration by non-medical personnel.
PURPOSE
To ensure maximum benefit from prescribed medication.
PREPARATION
1. Explain procedure to student, using appropriate developmental approach.
2. Assemble equipment:
 Suppository
 Warm water
 Gloves
PROCEDURE
1. Verify physician orders
2. Wash hands
3. Remove wrapper from suppository. Wet suppository with soluble water. Do not
4. Apply gloves
5. Remove student’s undergarment and position on left side.
6. Insert suppository pointed end into rectum beyond both of the rectal sphincter.
7. Hold the buttocks together to relieve the sphincter pressure for two minutes.
8. Remove gloves. Assist student with dressing.
9. Wash hands
10. Document date, time, name of medication, amount, purpose and signature, on
Administration of Medication Form (WH #98333) or Medication Administration
Record (MAR) (PCS 2-2366).
11. When medication supply is near depletion, notify parent/guardian.
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ADMINSITRATION OF RECTAL DIASTAT
Individualized training required prior to administration by non-medical personnel.
PURPOSE
To ensure maximum benefit from prescribed medication
PREPARATION
1. CALL 911 and parent/guardian.
2. Explain to student, using appropriate developmental approach
3. Assemble Equipment
 Medication in pre-filled syringe
 Gloves
 Lubricant
PROCEDURE
1. Verify physician’s order on Authorization for Emergency Administration of Rectal
Medication (PSC 2-2887) and Administration of Medication Form (WH 98333).
2. Wash hands
3. Prepare medication for administration
4. Apply gloves
5. Remove student’s undergarment and position on side.
6. Lubricate rectal tip with lubricating jelly
7. Bend upper leg forward to expose rectum
8. Separate buttocks to expose rectum.
9. Gently insert syringe tip into rectum. Note: Rim should be snug against rectal
opening.
10. Slowly count to three while gently pushing plunger in until it stops.
11. Slowly count to 3 before removing syringe from rectum.
12. Slowly count to 3 while holding buttocks together to prevent leakage.
13. Wash hands
14. Keep student on side facing you, note time given and continue to observe.
15. Give full report and dispose of used Diastat container in the trash can. May save
used Diastat to give EMS when they arrive. Give EMS a copy of Student Clinic
Card.
16. Document, date, time, name of medication, amount, purpose, student’s condition
and response to treatment, and signature, on Administration of Medication Form
(WH # 98333) or Medication Administration Record (MAR) (PCS 2-2366) and
student’s condition and response to medication.
17. Notify parent of need to replenish supply of rectal Diastat.
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ADMINISTRATION OF INJECTABLE MEDICATION
Individualized training required prior to administration by non-medical personnel.
PURPOSE
To ensure maximum benefit from prescribed medication
PREPARATION
1. Explain procedure to student, using appropriate developmental approach
2. Assemble Equipment
 Medication with syringe
 Alcohol wipe
 Sharps Container
 Gloves
PROCEDURE
1. Verify physician’s order
2. Wash hands
3. Open syringe and draw up medication or if a pre-filled syringe prepare for
administration.
4. Apply gloves
5. Cleanse injection site with alcohol.
6. Inject medication.
7. Dispose of syringe in sharp’s container
8. Dispose of all used supplies.
9. Remove gloves and wash hands
10. Document date, time, name of medication, amount given and signature on
Administration of Medication Forms (WH # 98333) or Medication Administration
Record (MAR) (PCS # 2336).
11. When medication supply is near depletion, notify parent/guardian.
NOTE: When administering glucagon the “Authorization for Emergency Glucagon
Injection Form” (PCS Form 2-2886) must be filled out and signed by parent/guardian,
Health Care Provider and school nurse.
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ADMINISTRATION OF MEDICATION FOR FIELD TRIPS
Individualized training required prior to administration by non-medical personnel.
PURPOSE
To ensure maximum benefit from prescribed medication
PREPARATION
 Explain procedure to student, using appropriate developmental approach.
 Assemble equipment on clean surface:
 Medication
 Medication cup
 Cup for drinking water
 Administration of Medication form (WH 98333 and/or 98334)
 Zip lock bags
 Gloves if needed
PROCEDURE
1. School personnel trained to administer medication will review the medication
cards (blue card prescription medication and orange cards over-the-counter
medications) to determine medications (both routine and medications ordered as
needed, i.e. inhalers) to be administered during the field trip. This should be
done a day or two before the field trip.
2. Make copies of the medication cards to take on field trip.
3. Day of the field trip count all the medications in the bottle. Document pill counts
and indicate on the original medication card with “FT” (field trip) and signature.
4. Place all bottles of medication in individual zip-lock bags along with the copy of
the medication card and a medicine cup for water, if necessary.
5. All medications will be secured at all times during the field trip by school
personnel.
6. While on the field trip ensure that mediation is being administered to THE RIGHT
STUDENT, THE RIGHT MEDICATION, THE RIGHT DOSE, THE RIGHT TIME
and THE RIGHT ROUTE.
7. Document date, time, running total of pill count and signature on the copy of the
medication card after each medication is given.
8.
On return to school count the medications remaining in the bottle with the school
personnel. Staple a copy of medication card to original medication card and
make sure the new running total of medication is on the original card along with
signatures of the personnel counting the medication.
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