School Medication Administration
How to Make It Work for You and Your Child
A University of Iowa study, reported in the November 2000 issue of Journal of School Health, found that nearly half of the school nurses in a survey reported medication errors in their schools during the previous year.
The survey, which was completed by 649 school nurses in both large and small schools throughout the United States, looked at medication administration in schools, including policies and guidelines for dispensing drugs to students, the types of medication commonly administered, and which school personnel are authorized to dispense medications.
The nurses estimated that an average of 5.6 percent of students in grades kindergarten through 12 receive medications on a typical school day. Common medications dispensed include over-the-counter remedies, analgesics such as aspirin and ibuprofen, stimulant medications for attentional disorders such as Ritalin and Adderall, asthma inhalers and drugs, and anti-seizure medications commonly used to treat epilepsy and bipolar disorder.
Errors included giving an overdose or double dose (22.9%), giving medicines without authorization (20.6%), giving the wrong medicine (20%) or unspecified mistakes (29.8%).
A major factor in medication errors was the use of "unlicensed assistive personnel" such as school secretaries, health aides, teachers, parents, and even students, to administer medications. Only 25 percent of the nurses said they administered all the medication in their schools. The other 75 percent said that unlicensed personnel dispense medications to students.
Three-quarters of the schools where unlicensed personnel dispense drugs have training programs for those persons, but in most cases the training is two hours or less in length. And the survey reported that those unlicensed personnel were three times more likely to make medication errors.
How can you ensure that no mistakes are made with your child?
There is only one federal mandate regarding medications at school. Under section 504 of the federal law -- the Americans with Disabilities Act -- schools are required to provide for the health needs of children with chronic health problems. The school must provide whatever health assistance is needed to meet the needs of a disabled child ... including, and not limited to, the dispensing of medications.
Guidelines regarding medication dispensing are set at the state level. Every school sets its own guidelines regarding medications based on state laws - and those laws vary widely from state to state.
As a parent, it is your right to know what your school policy is on medication dispensing and to have those guidelines in writing. In most school districts, the school board, in consultation with its nursing staff, has the responsibility for establishing a safe and secure system for control and delivery of medications.
Written guidelines on the medication dispensing policies for your district should be available through your school superintendent's office. Obtain a copy of the policies and keep it on file for reference. If you have a child with an IEP or 504, keep this document stored with your current paperwork in case questions arise during planning meetings.
Schools sometimes falsely tell parents who do not know their rights or the rights of their disabled child that they [the parents] have the responsibility for coming to school and providing the services. If you are told by your school district that you must come to school and administer healthcare or medications to your child during the school day, your school is in serious violation of federal law and they could easily lose their federal funding.
The American Academy of Pediatrics and the National Association of School Nurses recommend that you follow these steps to ensure that your child is medicated properly at school:
If you have a special needs child and he/she has an IEP but not a 504, call a meeting immediately or contact the school social worker and apply for a 504. It's a necessity for children who require healthcare and/or medications at school.
Be certain that your child knows what the medication looks like and how much and how often it should be given. Work with your child until he/she is able to make the distinction. Doing this will help your child know if he or she is getting the wrong medication or incorrect dosage at school.
-Contact your school administrator and obtain the written guidelines your school follows for handling and distributing medicine. Keep them on file at all times.
-Know that as a parent, it is your right to request that only trained personnel distribute medication to your child. It is even within your right to ask that the school nurse be the sole distributor of medication for your child.
-Find out who is responsible for administering medication in your school and what medical training they have. The school administrator's office will have this information.
-Deliver the bottles of medication to the school yourself (in the original container, as required by law) and bring them directly to the school nurse or office. Do NOT give a medication to your child to deliver - ever.
-Put everything in writing. If your child has prescription medication for a specific illness, you'll need a note from your child's doctor. A similar note, either from a parent or doctor, is advisable for any over-the-counter medication your child is taking for an illness, or may take for a health issue - including something as simple as aspirin for headaches.
-Tell your child never to share prescription or over-the-counter medication with another student.
-Keep vitamins and natural and homeopathic remedies at home.
-Tell the nurse about any special considerations for storing the medication, such as need for refrigeration. Follow up to make sure this is being done.
-Know how your children will get the medication. Will someone call your child to the school office, or will he or she have to remember to get his or her medication? Insist that your child be CALLED to the school office daily. Some schools will advise you that this makes an older child more vulnerable for singling out. If your school tells you this, don't buy it. In many cases this is an attempt by the school to skirt responsibility. Under the ADA the school bears SOLE responsibility for meeting the needs of the child. A child should not be required to manage his or her care at any time.
-Schools are required by law to keep a record of medications dispensed, times, and names of the dispensing personnel. You have a right to inspect these records at any time. A smart parent will exercise that right frequently to find out who is giving their child medication, and when.
-Remember to update your child's medical history forms as needed, preferably after each doctor visit.
Special considerations for carrying and self-administering medication: In general, all medication should be kept in the nurse's office. However, there are situations in which the severity of the illness, particularly asthmatic or allergic conditions, dictates that students should carry and administer their own medications. Under the Education Law, school districts must permit students who have been diagnosed as having a severe asthmatic condition to carry and use a prescribed inhaler during the school day, with the written permission of a licensed health care provider and the student's parents.
Other requests for students to carry and self-administer medication should be directed to nursing personnel, who will make decisions on an individual basis considering factors such as:
-The severity of the health care problem.
-A licensed prescriber's order directing that the student be allowed to carry his or her medication and self-administer.
-The parent's consent to such prescriber's order.
-Evidence that the student has been instructed in the procedure of self-administration and can assume responsibility for carrying properly labeled medication on his or her person or keeping it in a school locker.
-Field trips and after-school activities.
Students may not be prevented from participating in an educational activity such as a field trip solely on the basis of a special health need. Taking medication on field trips and at after-school activities is usually not a problem because most students are capable of administering their own medication. The Department of Special Education recommends that on field trips or at other after-school activities, teachers or other school staff carry the medication so that the self-directed student can take it at the proper time.
If a student goes on a field trip but is not fully aware of and capable of understanding the need and assuming responsibility for taking medicine, the district's policy may offer such options as:
-The parent or guardian may attend the activity and administer the medication.
-The parent can personally request another adult who is not employed by the school to voluntarily administer the medication on the field trip or activity and inform the school district in writing of such request.
-The student's health care provider may order the medication time to be adjusted or dose eliminated.
-If no other alternative can be found, a school nurse or licensed practical nurse under the direction of the school nurse must administer the medication.
As of September 2000, commissioner's regulations permit school nurses to carry and administer agents used in non-patient specific emergency treatment of anaphylaxis (severe and dangerous allergic reactions).
For example, a school nurse or a licensed practical nurse under the direction of a school nurse responding can administer treatment such as an epi-pen in an emergency in which an individual has a serious allergic reaction to a wasp sting or the ingestion of peanut butter.
Without federal guidelines in place to regulate public school medication administration, school districts will continue to write their own programs - and mistakes will continue to be made. To keep these mistakes to a minimum, there is no substitution for parental involvement. Mistakes in school medication administration can be avoided when parents are educated and schools and parents are working together.
Be nice to me, I have powers and Andrew no longer compensates me with shoes!!
Do what you feel in your heart to be right - for you'll be criticized anyway. You'll be damned if you do, and damned if you don't.--Eleanor Roosevelt
I'm all in favor of keeping dangerous weapons out of the hands of fools. Let's start with typewriters. --Frank Lloyd Wright
Everything I write is fully substantiated by my personal opinion.
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