ADMINISTRATIVE PROCEDURE

 

Type of 

Procedure:      Pupil Services/                          Procedure No.:           D-10

                        Health Services                                                                        

 

Title:               Medication for Students                        Policy No.:                  3.12

                                   

Authority:       1001.41, F.S.                                       Date Issued:               01/04/05

 

Fla. Statute:    1003.22, 1006.062, F.S.                      Superintendent's

                                                                                    Signature:       ___________________

 

State Board

Rule:                                                                           ______________________________________________________________________________

 

Procedures:

 

1.         DELIVERY AND ACCEPTANCE OF MEDICATION

 

A.        MEDICATION PERMISSION FORM

      Medicine may be delivered to and from school only by a parent, legal guardian, or designated adult.  Parent or legal guardian must complete and sign Medication Permission Form and include the following information:

 

1)         Student’s legal name (If there is a name discrepancy, the parent/guardian must list each name used by the student).

2)         Name of medication/generic name of medication

3)         Reason for medication (diagnosis)

4)         Allergies

5)         Dosage to be given

6)         Route of medication, (by mouth, ear drops, nose drops, eye drops, injection, etc.)

7)         Time medication is to be administered

8)         Beginning and ending date for administration of medication

9)         The amount of liquid or count of pills brought to school.

10)       Name of parent

11)       Phone number of the parent, or legal guardian during school hours 

12)       Name and phone number of doctor.  If a parent or legal guardian can not be reached in the event a problem should arise the doctor who prescribed the medication shall be called.

 

B.         The Medication Permission Form is valid only for the current school year.  A separate form must be on file for each prescription or non-prescription medication.

 

C.                 If a student brings medication to school with written permission from the parent, the parent should be contacted to verify the request for medication.  The phone contact must be documented on the permission form, and every attempt should be made to obtain a completed Medication Permission Form, either via fax or in person.  If verbal verification has been obtained, then the medication can be given.

 

D.                 If medication is brought to the school by someone other than the parent or legal guardian (e.g. grandparent), phone verification shall be obtained from the parent or legal guardian and documented before the medication can be given.  When possible, the Medication Permission Form should be signed (via fax or in person) by the parent or legal guardian.  If phone verification cannot be obtained, Health Services shall be contacted for further instruction.

 

E.                  Leon County Schools will not accept any medication containing aspirin, such as children’s aspirin, Pepto-Bismol, or headache medications such as Excedrin and its generic, unless there is a written physician’s authorization.

 

F.                  Leon County School will not accept any non-FDA approved medication without written physician’s authorization.

 

2.         PRESCRIPTION MEDICATION

 

A.        The prescription bottle information must match the information on the parent permission form. The medicine prescribed for the student shall come in the original container and shall be labeled with the following information:

 

1)      The student’s name (If there is a name discrepancy, the parent/guardian must list on permission form)

2)      Name of health care provider and phone number

3)      Name of medication

4)      Issue date of the medication

5)      Expiration date

6)      Dosage to be given

7)      Route of the medication (by mouth, ear drops, nose drops, eye drops, injection, inhaler/nebulizer, topical, patch, etc.)

8)      How often to give medication (“as needed” or specific times) and duration of administration of the medication (i.e. for 10 days)

9)      Specific recommendations such as with or without food and any precautions such as “May cause drowsiness”.

10)  A beginning and ending date for administration of the medication (if applies to entire school year indicate dates of the school year, i.e. begin date medicine brought to school and the end of the school year).

11)  Storage requirements

 

 

B.                 The following information should be asked of the parent/guardian or pharmacist about the medicine:

 

1)                  Anticipated effects of the medication

2)                  Signs that might indicate an adverse reaction to the drug

 

C.        Changes in the medication times or dosage can only be made by written permission from the physician, and may be faxed to the school. Parent phone calls are insufficient to change the dosage or times. Any changes from the physician must be attached to the Medication Permission Form.

                         

3.                  NON-PRESCRIPTION MEDICATION

 

A.                 Students requiring over-the-counter (OTC) medicine for a temporary medical condition (i.e. cough and cold medicines, pain relievers, allergy medicines, skin conditions, etc.) do not need a written health care provider order for the first five (5) days of medicine administration, although the Medication Permission Form must still be completed by the parent/guardian.  

 

B.                 Dosage shall not exceed recommended amount printed on the container and/or package without a health care provider’s written order.

 

 

C.                 When the five (5) day window expires for parent-approved over-the-counter medication, a written health care provider’s authorization is necessary in order for the medication to be continued.  A parent may not “renew” the medication for another five (5) days.

 

D.                 After five (5) days, the over-the-counter medication becomes a prescribed medication authorized by the health care provider.  Only written and signed prescriptions will be accepted as valid medication orders.  Written and signed prescriptions may be faxed to the school by the health care provider’s office (doctor, dentist, etc).

 

4.                  STORAGE OF MEDICATION

 

A.                 Medication must be stored in a secure fashion under lock and key in a location designated by the principal.  This is usually in the school clinic.

 

B.                 Medication that requires refrigeration must be stored either in a locked refrigerator or in a locked box inside a secured refrigerator with limited access. 

 

5.         PREPARING TO ADMINISTER MEDICATION

 

A.        Determine which students are to receive medications by checking the master list, which is a compiled list that includes the students’ names and the times medicines are to be given.

 

B.         Any master list must be kept out of view of school visitors and non-essential school staff.  A copy of the master list should also be kept in the medication administration log book.

 

C.        Medication can be given at most 30 minutes before or after the specified time to be “on time.”

 

D.         Identify the student by asking state his/her full name.  Do not prompt. Children will often answer to other names.

 

E.         Verify dose on Medication Administration Log, since a change could have been made by the doctor.

 

F.         Check the name on the bottle of medicine when it is removed from the cupboard, again when the student takes the medicine, and when it is returned to the cupboard.  Always check three times.

 

6.         ADMINISTRATION OF MEDICATION

 

A.                   General Procedure

 

1)                  Always wash and dry hands well before and after giving medications and have the student wash his/her hands or assist student to wash and dry his/her hands.

2)                  Follow the Medication Authorization directions carefully including any precaution stickers.

3)                  Follow the five “R’s” of Medication Administration:

Right student

Right medication

Right amount

Right route

Right time                     Plus documentation

 

B.         Administration Times

The times medicines will be given shall be determined by a) the type of medicine to be given, and b) the health care provider, the parent/legal guardian, licensed nursing staff, or the school health assistant under the direction of the school nurse.  Medicines cannot be administered outside of the prescribed dosage restrictions.  For example, an over-the-counter medicine with directions stating that it may be given “four times per day,” means that it should be given four times in a twenty-four hour period, not four times during the school day.  If there are any questions regarding administration times, Health Services shall be contacted for further instructions.

 

 

 

C.        AFTER MEDICATION IS ADMINISTERED

 

1)                  Return medication to locked location immediately following administration.

2)                  Never leave medicine cabinet unlocked.

3)                  Document.

 

7.   DOCUMENTATION

 

A.        Prescription medicine will be given only to the student whose name appears on the labeled container.

 

B.         Each dose shall be documented on the Medication Administration Log after administering the medicine (time/initials in the individual box; signature must be on the Medication Administration Log page).

 

C.        The Medication Administration Log must include the following:

 

1)         Student’s name

2)         Reason for medication/diagnosis

3)         Name of medication/generic name of medication

4)         Dose, amount, route, time to be given

5)         Amount of liquid and count of pills

6)         Date and time medication administrated

7)         Signature and title of person assisting with administration of medication

 

D.        The person who administers the medicine shall document the time on the student’s Medication Administration Log at the time the medicine is given.  Do not wait until the end of the day to record that the medicine was given.

 

E.         The Medication Permission Form should be kept with the Medication Administration Log, along with written health care provider’s order changes.

 

F.                  The Medication Administration Log should be kept in a separate notebook.

 

G.        The logs should be organized in the following order:

 

1)         Daily medicines organized by time.  If a student receives multiple doses of the same medication, only one log sheet is required.  However, the subsequent dosage times should be flagged in order to prevent omission.

2)         PRN (as needed) medicines listed alphabetically

 

H.        A master list of daily medicines should be kept inside the log notebook.  Backup school personnel who also administer medicines should also be provided with an up-to-date copy of the master list of the times that students come to the clinic for medicines.  This list must be kept out of view of school visitors.

 

I.                    The persons responsible for administering medication shall document when a student refuses to take the prescribed dosage and the parent shall be notified.  If a medication error occurs, the parent and site administrator shall be notified and a Medication Variance Form shall be completed.   A copy of the Medication Variance Form shall be sent to Health Services.  Health Services will determine which Medication Variance Forms need to be sent to the Risk Manager.

 

J.                   Note any specific information about the student’s reaction/response on the Clinic notes.

 

K.                The school health assistant must perform a weekly pill/liquid/device (inhaler, EpiPen, Glucagon, etc.) count on all medications in the clinic, including PRN medications. The count is documented weekly in the appropriate column on the Medication Administration Log.  The documentation will include the count, date, and the SHA’s initials.  A Medication Variance Form shall be completed for any discrepancies in the count, and Health and Nursing Services shall be notified by phone. 

 

8.                  CONFIDENTIALITY

 

A.                 Every effort must be made to protect the privacy of each student

 

B.                 Do not remind students on the intercom or call them aloud out of a group to come take their medication

 

C.                 Do not discuss the students’ health information with teachers, parents, or other workers who are not directly involved in the student’s care

 

D.                 Medical or cumulative records should not be left out on a desk or counter or posted in plain view where unauthorized people can view the information

 

E.                  All confidential information should be locked up.

 

F.         Keep all conversations/phone calls confidential and out of ear shot of staff and visitors.

 

9.        MEDICATION - RELATED EMERGENCIES

 

A.        Medication-related emergencies may include the following and others:

Difficulty breathing

Turning blue

Clammy

Abnormal heart rate

Breathing stops

Seizures

                         

B.         If a Medication-Related Emergency occurs you shall do the following:

 

1)         Call parent and 911 immediately.

2)         Send a copy of the student’s emergency medical information card with person accompanying student to hospital emergency room.  If the student is reacting to his/her own medicine, send the medicine container with EMS.

3)         Never leave a student suspected of having an allergic reaction alone.

 

10.              PROCEDURE FOR MEDICATION ERROR

 

A.                 If a medication error of any kind is made, the principal and parent/legal guardian must be notified.

 

B.                 The nature of the error should be clearly stated. Examples of common errors are:

 

1)                  Medication given too early or too late (MUST be given within 30 minutes before or after designated time)

2)                  Medication not given

3)                  Wrong medication

4)                  Wrong dosage

5)         Drug diversion (missing medicine)

 

C.                 Fill out the Variance Report.  For each medication error, the school personnel responsible for the error must complete a “Medication Variance Report”. Include the following:

 

1)                  Provide only the facts and no extenuating circumstance or opinions.

2)                  State appropriate actions taken on the Medication Variance Report.

Examples:

Parent contacted

Notified Site Administrator

Health and Nursing Services notified

Physician or Pharmacy contacted

Student observed

911 called

3)         Sign the Medication Variance Report.

5)         Keep original on file at school.

6)         Send a copy to Health & Nursing Services

 

D.                 It may be necessary to notify the health care provider as well.

 

11.       PROCEDURE FOR DISPOSAL OF MEDICATION

 

A.        Notify parent either in writing or verbally that the student has unused medication remaining at school.  Written notification regarding this policy is on the Medication Permission Form.

 

B.         Give the parent a specific deadline for picking up the medication, noting that “medication not picked up by the specified date will be discarded”.

 

C.        Document the above notification in writing on Student Clinic Record.

 

D.        All medicine to be discarded shall be counted and logged on the “Disposal of Prescription and Nonprescription Medication Log” form (12:8).

 

E.         Discard medication as follows:

 

1)         Secure a witness.

2)         Identify the medication to be discarded.

3)         Count the number of pill/capsules or liquid, then flush tablets and capsules.  Liquids may be poured down the sink.

4)         Place syringes, injectable medicine and metered-dose-inhalers in the biohazard container.

5)         Document disposal of medication on the medication record, making sure both the School Health Assistant and witness sign the record.

6)         Do not dispose of the prescription bottle in the trash can until after you remove the prescription label.  Dispose of the label so no one can identify the student’s name or medicine.  (If you are unable to remove the label, mark through the student’s name and prescription number with a permanent marker before discarding.)

7)         The Disposal of Prescription and Nonprescription Medication Log form shall be kept in the Medication Log notebook.

 

 

12.       PROCEDURE FOR ADMINISTERING MEDICATION ON FIELD TRIPS

 

A.                 GENERAL FIELD TRIP INFORMATION

 

1)         Every LCSB employee who administers medicine must have a Medication Administration Certificate of completion within the past two years.

2)         Secure medication in a safe place.  (On the employee’s body or in a locked place.)

4)                  If medication needs to be refrigerated, provide a cooler for transport.

4)         Administer medication at designated time.  Medication can be given 30 minutes before or after the specified time to be “on time.”

5)         Document medication administration on appropriate form.

6)                  If unable to give medication for any reason, fill out the Report of Medication Variance form (12:7) and notify parent and site administrator as soon as possible.

 

B.                 PROCEDURE FOR SHORT FIELD TRIPS

 

1)         EMPLOYEE MUST HAVE:

 

a)         Copy of prescribed Medication Permission Form (form 12:5), completely filled out and signed by parent or guardian.

b)         Copy of Medication Administration Log (form 12:6)

c)         Prescription Medication in the labeled prescription container.

 

2)         DAY OF FIELD TRIP:

 

a)         Receive from school health assistant: the student’s prescription bottle containing medication to be given.

b)         Count the number of pills/amount of liquid in prescription labeled container with school health assistant and record on student’s Medication Administration Log.

c)         Copy the Medication Permission Form and Medication Administration Log. Take both copies with the medication bottle on field trip.  (A zip lock bag works well.)

d)         Follow General Field Trip Information (see above).

e)         Document (time and initials) on the copy of the Medication Administration Log.

f)          After returning from field trip, return prescription bottle and student papers to clinic.   Sign the student’s original Medication Administration Log (not copy) for medication given and the return count of medication.

 

C.        PROCEDURE FOR EXTENDED DAY OR OVERNIGHT TRIPS:

 

1)         PARENT MUST:

 

a)                  Complete a separate Medication Permission Form for Extended Day/Overnight Field Trips (Form 12:8) for each medication to be given. 

b)                  Complete a new form, even if the student already receives the medicine at school.

c)                  Supply the medicine for the field trip in the original container.

 

2)                  EMPLOYEE MUST HAVE:

 

a)                  Completed form(s) from parent (one Medication Permission Form for Extended Day/Overnight Field Trips for each medication to be given). 

b)                  Prescription Medication in the labeled prescription container.

 

 

3)                  PRIOR TO EXTENDED DAY/OVERNIGHT FIELD TRIP, LCSB EMPLOYEE MUST:

 

b)                  Receive from parent: the student’s prescription or non-prescription medicine in the original container.  The student’s name must be written on the container of non-prescription medicine.

c)                  Count the number of pills/liquid with the parent and record amount on the Medication Permission Form for Extended Day/Overnight Field Trips.

 

4)                  DURING THE EXTENDED DAY/OVERNIGHT FIELD TRIP, LCSB EMPLOYEE MUST:

 

a)                  Follow General Field Trip Information (see above).      

b)                  Document each dose of medicine given on the back of the Medication Permission Form for Extended Day/Overnight Field Trips.

c)                  Return unused medicine, if any, to parent at the end of the extended day/overnight field trip.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.       RESOURCES

 

Caring for Our Children. National Health and Safety Performance Standards: Guidelines for Out –of-Home Child Care, Second Edition. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care. 2002.

 

Johnson, Philip, et al.  Medication Use in Schools, Florida Edition, 2003.  Health Care Logistics, May, 2003.

Policy Statement:  Guidelines for the Administration of Medication in School. Committee on School Health.  PEDIATRICS Vol. 112 No. 3 September 2003, pp. 697-699.  http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/3/697?eaf

Seminole County Health Services Manual.  July, 2000.

 

Wong, Donna L.  Whaley & Wong Essentials of Pediatric Nursing, 5th Ed.  Mosby.  St. Louis.  1997.

 

For More Information on inhalers and nebulizers:

www. respuleskids. com

http://www.pharmacyandyou.org/healthinfo/200l_inhaler.htm

 

Administrative Code:  64B9-14.002

Florida State Statutes: 381.0056, 381.059, 1002.20, 1002.22, 1002.2, 1006.062, 464.003(3), (a),(b),(d),(e), 464.018(1),(h)

Federal Laws:  20 USC s. 1232g, 65FR 82452

 

 

See Policy 3.12—Medication for Students