Medication
Administration
For School Health Aides
Healthy Kids Learn
Better
• Many kids require medications while
at school so that they can be active
participants in the classroom.
• “kids bring their whole life to school
with them…and it doesn’t fit in a
locker.”
Just a Little History…
• A federal mandate created in the 1970’s
obligated schools to provide children with
medical services, including medication
administration. Medications that schools
are asked to manage may include
controlled substances, emergency and
psychotropic medications, and a range of
therapeutic interventions for chronic
illnesses such as diabetes and asthma.
Training
• Each school principal must select regular
and back up staff to be trained.
• Only trained staff can administer
medication.
• The School Health Coordinator is
responsible for providing training in the
administration of medication to designated
personnel at the beginning of each school
year.
Staff Protection
• School staff are protected by law if
careful observation of the regulations
are observed:
– Florida Law states, “there shall be no liability for
civil damages resulting from the administration of
such medications where the person administering the
medication acts as an ordinarily reasonably prudent
person would have acted under the same or similar
circumstances”.
Let’s begin…
• This presentation was developed to allow you to
orient to medication administration at your
convenience.
• You will be given a post test to take after you’ve
viewed this presentation. Please leave the
completed test for your School Nurse.
• Your School Nurse will check you off on the
administration of all medication including the use
of an EpiPen.
An “Authorization for
Prescribed Medication” Form is
required and should include:
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Child’s name
Name of medication
Date of Authorization
Dosage
How the medication
should be given
• When the medication
should be given
• Special instructions about
the child or the
medications
• Parent/guardian signature
• The amount of medication
(pills, tablets, capsules)
received and counted by
parent and trained school
staff
Non-Prescription or Overthe-Counter Medication
• Must have:
– An “Authorization for Prescribed Medication”
form completed by parent/guardian
– Authorization Form approved by the School
Nurse prior to medication administration
• Must be:
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Necessary for the child to remain in school
FDA approved
Non-alcohol based
In the ORIGINAL CONTAINER
Provided by the parent/guardian
Prescription Medication
• Requires written instruction by a doctor
(prescription label meets this requirement).
• Must be prepared and labeled by a pharmacist.
• Must be in the original pharmacy container.
• Administered only if required during school hours.
• Must have a signed “Authorization for Prescribed
Medication” form.
• New Authorization Form must be completed each
year.
• This includes injectable drugs such as Insulin and
EpiPen.
6 Rights of Medication
Administration
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Right Student
Right Medicine
Right Dose
Right Time
Right Route
Right Documentation
Right Student
• Don’t guess – Ask the student to tell
you their full name (first and last).
• If a student is non-verbal or unable
to tell you their name, ask a staff
member who knows the student to
verify that it is the correct student.
• If the student has a photo ID you
can use that to verify.
Right Medication
• Read the student’s name
aloud from the label and ask
the student to verify again
that this is their name.
• Check the Authorization for
Prescribed Medication Form
with the label on the
medication container, making
sure that:
– The student’s name on both are
the same.
– The name of the medication on
both are the same.
Right Dose
• Compare the dosage listed on the Authorization
Form with the dosage listed on the container,
making sure they agree.
• Note strength of medicine (i.e., 25 mg) and note
amount to be given (i.e., 1 tab, ½ tsp.).
• Again compare what you have measured with the
Authorization Form making sure they are the
same.
• If any of the above do not agree DO NOT give
the medication and call the School Nurse.
Right Time
• Compare the time on the
Authorization Form with the actual
time the medication is being given.
• A medication may be given a half
hour before or after the time that it
is ordered to be given by the doctor
(grace period).
Right Route
• Compare the route listed on the
Authorization Form with the label on the
medication bottle.
– Oral (by mouth, swallowed – tablets, capsules,
liquids)
– Topical (on the outside of the body –
ointments, creams, eye drops, ear drops)
• If the route on the Authorization Form
and the medication label are different –
DO NOT give the medication and call the
School Nurse.
Right Documentation
• Document in Health Office:
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on the correct student file
after the medication has been given
the actual time the medication was given
the reason if a medication was given late or not
at all
• Medication administration records are
CONFIDENTIAL
– Access is limited to school staff with a “need to
know” and parents
Safe Storage and
Handling
• Store all medications in their original
containers.
• NEVER administer medications from
an unlabeled container.
• Store medications in a clean, locked
cabinet.
Safe Storage and
Handling (cont’d)
• Medication should be brought to school
and returned home by a parent.
• DO NOT ALLOW STUDENTS to carry
medications to and from home.
• Medications must be counted on arrival at
school by parent and trained school staff
and recorded on the Authorization Form.
• Changes in medication instructions
requires a new Authorization Form be
completed by parent.
Remember…
• You must get permission from the School
Nurse prior to administering a new
medication to a student.
• You must notify the School Nurse if there
is a change in a medication order.
• Contact the School Nurse if you have ANY
questions prior to giving the medication.
Medication
Administration Do’s
• DO give your full attention to the task –
verify each step.
• DO remain with the student until the
medication is taken, make sure that oral
medications are swallowed.
• DO prepare and administer medication for
only one student at a time.
• DO allow parents to administer medication
to their child if desired.
Medication
Administration Don’ts
• DON’T give medication from a container which has
a label that can not be read.
• DON’T give medication from another student’s
container, even if they are the same.
• DON’T leave medication unattended.
• DON’T increase or decrease any medication
without specific instructions.
• DON’T give a medication if there is any question
about whether it is correct.
• Don’t crush or break tablets.
• Don’t open capsules.
What are Medication
Errors?
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Dose not given
Medication given to wrong student
Inaccurate dose or wrong medication
Wrong time
Incorrect route
What you should do…
• Keep the student in the office with you.
• Assess the student’s status (Are you
feeling okay? Is your heart racing,
stomach hurting, etc.)
• IMMEDIATELY call the School Nurse and
let the Principal know.
– The School Nurse will determine if Poison
Control needs to be called.
– The School Nurse will notify the student’s
parents.
• Complete a “Medication/Treatment
Variance Report”.
Epinephrine
• Epinephrine is available in an auto injector
called an EpiPen.
• Students who require the use of an EpiPen
for a life threatening allergic reaction
should carry this medication with them at
all times.
When? Based on
Student’s Symptoms
– hives spreading over
the body
– wheezing
– difficulty swallowing
or breathing
– swelling in face or
neck
– tingling or swelling
of tongue
– signs of shock
• extreme paleness,
gray color
• clammy skin
– loss of consciousness
– any other childspecific known
symptom
Steps in EpiPen Administration
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Take a deep breath.
Have student lie down.
Follow the 6 Rights of Medication Administration.
If in a carrying case unscrew cap and remove EpiPen from tube.
Grasp unit, with black tip pointing downward.
Form fist around unit (black tip down).
With your other hand, pull off the gray activation cap.
Hold black tip near outer thigh.
Swing and jab firmly into outer thigh at a 90 degree angle. (Designed
to work through clothing).
Hold firmly in thigh for approximately 10 seconds.
Remove unit and massage injection area for 10 seconds.
Call 911, seek medical attention and notify school administrator.
Stay with student until help arrives.
Document dose given in Health Office.
*Return EpiPen into storage tube so that the student can take it with
them to the emergency room.
Epinephrine
Administration
• The EpiPen is administered into the
large outer thigh muscle.
What next?
• Have someone notify the student’s doctor (on
emergency card) regarding incident and where
student is being transported.
• Notify parent/guardian regarding incident,
student’s condition, and hospital destination.
• Document
– Student’s symptoms
– Location of injection
– Time of injection
Handling the 3 Most
Common Unexpected
Situations…
Student Does Not Come
at Scheduled Time
• Send for student
• Document
• Notify:
– Teacher
– Parent
– Nurse
Student Refuses
Medication
• Encourage
• Document
• Notify
– Parent
– Nurse
Student Vomits or Spits
out Medication
• Document
• Notify
– Parent
– Nurse
• Check for symptoms of illness
– Fever
– Stomach Ache
– Headache
• Look for medicine in vomit…
What if…
• A parent brings in an antibiotic that
the student was just prescribed and
the mother requests that you start
the medication as soon as possible.
– What do you do?
Right!
• Review and complete the “Authorization
for Prescribed Medication” Form with the
parent (don’t forget to count the
medication).
• Explain to the parent that you must get
permission from the School Nurse prior to
administering the medication. However,
you can…
• Allow the parent to administer the
medication to their child until permission
has been granted.
What if…
• The phone is ringing, the principal
asked you to retrieve a file, a
student is waiting for a pass, and the
meds are due to be given.
– What do you do?
Good Job!
• Remain calm.
• Ask the students to have a seat.
• Answer the phone with a pleasant, “Hello this is
____, can I please put you on hold for a moment?
Thank you.”
• Pull the chart for the Principal and call the office
to let them know you’ve retrieved the chart.
Could someone please come get it?
• Give the student a pass back to class.
• Answer the phone.
• Carefully administer the medications following the
6 rights of medication administration.
What if…
• After the meds have been given, you
realize that you gave Jon Jensen’s
medication to John Jones.
– What do you do?
You did it!
• Remember...
– “All men make mistakes, but only wise men learn from
their mistakes” – Winston Churchill
• Call John Jones to the Health Room.
• Assess John Jones’ status (is he feeling
okay?).
• IMMEDIATELY call the School Nurse and
let the Principal know.
• Complete a “Medication/Treatment
Variance Report.
The End
• Thank you for all that
you do.
• Don’t forget to take
the post test and give
it to your School
Nurse.
• Don’t forget to get
checked off on EpiPen.
• Have a peaceful day…
• Prepared by:
– Kathleen Gross, MSN, RN
School Nurse
Levy County Health Department
July 2009