SCHOOL BOARD OF ST. LUCIE COUNTY

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SCHOOL BOARD OF ST. LUCIE COUNTY Policy For Medication Administration At School Requirements: Administration of medications during school hours should occur only when medication schedules cannot be adjusted
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SCHOOL BOARD OF ST. LUCIE COUNTY Policy For Medication Administration At School Requirements: Administration of medications during school hours should occur only when medication schedules cannot be adjusted to provide for administration at home. School personnel will only administer medications to students who meet the following conditions: those with long-term or chronic illnesses or disabilities, which necessitates taking prescribed medication in order to protect the student s health. those with acute conditions i.e.: fractures, allergic dermatitis, etc, which may necessitate medication for the students comfort. those with learning related conditions in which medication is necessary to improve performance. those who have a statement from the physician explaining the necessity for the prescribed medication to be provided. Students will be expected to follow clinic rules and conduct themselves in a safe and non-disruptive manner in consideration of their fellow students who are in the clinic ill. If the school disciplinary procedures fail to correct inappropriate behavior other arrangements will need to be made for medication administration. Any medication found on school property without authorization on file will be treated as any other illegal substance and will be turned over to the Principal or School Resource Officer (SRO). Physician Authorization for Medication: 1. No medication, prescription or nonprescription i.e.: Tylenol, aspirin, or cough drops, can be given at school without a written Physician Authorization for Medication Form (PA Form) filled out completely and correctly by the physician and signed by the physician. 2. It is the parent s responsibility to take the PA Form to the physician and ensure that it is filled out correctly, completely and signed by the physician. 3. If the medication is ordered PRN, as needed, the frequency (i.e. bid, every 4 hours) and under what conditions it should be given (i.e. cough, headache) must be noted. 4. The student name on the PA Form should match the name on the school records. 5. Only one medication per PA Form. 6. The PA Form must also be signed by the parent or guardian granting the school permission to assist in the administration of the medication. 5/17 SCHOOL BOARD OF ST. LUCIE COUNTY 7. When the Health Paraprofessional receives the PA Form it should be signed and dated as received. The PA Form should also be reviewed and signed by the Principal and the School RN. 8. A new PA Form is not needed when a medication is refilled UNLESS the medication dosage or time is changed from the previous order. 9. A new PA Form is required each school year. 10. A PA Form is not needed if a parent or guardian comes to the school to administer a medication to their child. Oral or written permission is needed from the parent or guardian if a person other than the parent or guardian comes to the school to administer a medication. NOTE: Prescription medication can be given for two days with a written note from the parent or guardian however the PA Form must be completed and returned to school by the third day. The medication will not be given on the third day unless the form is returned correctly filled out and signed by the physician and parent. Non-prescription medication cannot be given without the PA Form due to the fact that there are no child specific directions on the bottle as with prescription medications. Sunscreens: Sunscreens are best applied at home by the parent/guardian, before the student comes to school. If sunscreen is to be administered by school personnel, it must be provided by the parent along with a PA Form. Herbal Products: FDA regulated, non-prescription herbal or natural products have the same requirements as non-prescription medications. Non-regulated herbal or natural products will not be administered by school personnel. Parents are permitted to come to school and administer these substance to their children. Physician Authorization for Emergency Medications, Injectable Medications or other Procedures: Written authorization from a Physician is also required for emergency medications, injectable medications, blood glucose testing, or oxygen administration. Specific forms are available for each and should be completed and signed by the parents and physician. The school will not accept Emergency or Injectable medications until the appropriate forms have been completed. When the Emergency or Injectable medication is received the Health Paraprofessional should contact the school RN immediately. A determination will be made by the Principal and the school RN as to whether additional staff training is required and who should be included in the training. Nonmedical assistive personnel shall be allowed to perform health-related services upon successful completion of child-specific training by the school RN. To assure availability of emergency intervention, training should be given to at least three (3) people at any school site where a student requires intervention. Training must take place within 48 hours of receipt of the medication and completed forms. 5/17 SCHOOL BOARD OF ST. LUCIE COUNTY Florida Statute states that students may carry and self administer their metered dose inhaler, epinephrine auto-injector and/or diabetic supplies with written parental and physician authorization. This statute also addresses safety provisions and liability indemnification. No IV (intravenous) medications will be given by school staff. If a student has an IV port and requires IV medications during school hours, the parent or guardian would be responsible for administering the medication or arranging for the administration to be done by a nursing agency. School health staff can help make arrangements for a clean, private area where the administration can take place. Consideration for a 504 Plan may also be needed. Medications: 1. Medication should be brought to school by the parent and MUST be in the original container as dispensed by the pharmacist and labeled to match the physician s orders as follows: Student s name Name of the medication. Directions concerning dosage. Time of day to be taken. Physician s name. Date of prescription with current expiration date. 2. The label should not be altered in any way. 3. Nonprescription medication must be in its original bottle with the label intact. 4. All non-emergency medications are to be given in the clinic unless student is off campus on school sponsored activity. 5. The parent must provide any additional equipment needed for medication administration i.e.: nebulizer, spacer, dosage cup, applesauce etc. 6. The maximum number of doses allowed for any one medication that s considered a schedule II controlled substance and is ordered PRN (as needed), i.e. narcotic for pain, is five (5). If a student requires continued treatment the parents must supply no more than five (5) doses at a time. NOTE: All medication should be given at home the first time. If given at school the first time, the student should be observed carefully for 30 minutes, because of the possibility of an allergic reaction. This can happen at any time with any medication, especially antibiotics. Storage of Medication: Once the Health Paraprofessional receives the medication it will be counted and entered on the Medication Log. All routine medications kept in the clinic will be stored under lock and key. Emergency injectable medications kept in the clinic should be stored in an unlocked cabinet during the school day for easy access by adults. This cabinet should be clearly marked with a sign indicating that emergency medications are inside. The cabinet must be locked during overnight hours. A written release from the parents and physician will be on file for all emergency and/or diabetic medications that must be carried by the student (see PA Forms). An 5/17 SCHOOL BOARD OF ST. LUCIE COUNTY asthmatic student may carry a metered dose inhaler and students with cystic fibrosis may carry pancreatic enzymes while in school when they have approval from their parents and their physician on file. Any medication that must be refrigerated should be stored in a locked box within the refrigerator. When the medication bottle is empty it will be returned home for refill if needed. No medication will be sent home with the student, exceptions will require approval by the principal and school RN. An adult family member may retrieve medication from the school at any time. Medication may/will be destroyed by the Health Paraprofessional if it is not picked up within 1 (one) week following termination of order or 2 (two) days beyond the close of the school year. If the medication is destroyed it should be witnessed by one other staff member and the amount destroyed should be noted on the Medication log with both signatures. For off campus activities (Field Trips) medications should be obtained from the clinic the day of the event. Medication is placed in a small envelope with the students name, medication dosage, time medication is to be given, a blank area for actual time medication was given, and the name of the teacher or staff member who will administer the medication. It is the responsibility of the teacher or staff person who will administer the medication to go to the clinic the day prior to the event and prepare the medication. All medications transported for off campus activities should be carried on a staff member s person in a secure fashion, not in an unattended bag or other areas in which there is easy access by students. Documentation: The Health Paraprofessional will maintain a written record on the Medication Log, which will be kept in the clinic, concerning the amount of medication brought to school as well as the time the student takes the medication each day. The log is to be completed each time the medication is administered with the date and time of administration and the signature of the person assisting with the medication, not initials. If the medication is to be taken daily the log should have an entry for everyday in which school is in session, if the student is absent or out of medication it should be noted on the log. If medication is administered during an off campus activity it should also be noted on the Medication Log by the person who actually assisted the student once they return to school. The log should also be utilized to record notes regarding parent or physician contact concerning that medication. The Medication Log along with the PA Form will become part of the students permanent Health Record (CUM) and should be considered a legal document. These forms will remain in effect for 1 (one) school year only. It is primarily the responsibility of the Health Paraprofessional to ensure that the medications are administered as ordered, but Teachers and Administrators should work as a team with the Health Paraprofessional, Student and Parents to ensure that the Physicians orders are followed. If the Health Paraprofessional has concerns regarding the administration of medication they should consult the school s RN, who will confer with those involved and if necessary arrange a meeting with them. A Medication Incident Report should be completed within 48 hours any time the medication is not administered in the prescribed manner or a dose is missed. The report is sent to Student Services for review and is used to track incidents and assist in the revision and improvement of this county policy. See form titled Ways to Avoid Medication Errors. 5/17 SCHOOL BOARD OF ST. LUCIE COUNTY Training: Health Paraprofessionals who have received mandatory medication training will administer the medication. The training is to include: instruction on county policy and state and federal laws, confidentiality, ways to avoid medication errors, demonstration of correct administration, and a return demonstration. The training will also include information on common chronic conditions in which medication may be ordered prn, as needed, such as signs and symptoms of an asthma attack, seizure, or anaphylactic reaction. Teachers and other staff members who may be required to give medications on off campus school sponsored activities will receive separate mandatory training. At least one staff person on all off campus activities will be trained to give medications. At least two other employees, assigned by the Principal, will be oriented and trained as to medication procedures and clinic policy in order to cover the clinic in the absence of the Health Paraprofessional. The Registered Nurse assigned in each school will provide this training and documentation of all training will be kept in Student Services by the School Health Services Coordinator. The Medication Training & Return Demonstration Checklist will be used at the time of training and periodically for return demonstrations. The Registered Nurse assigned to each school will start a new checklist at the beginning of each school year. Florida law states that in no instance should there be any liability for civil damages as a result of the administration of any prescription medication when the person administering such medication acts as an ordinarily reasonably prudent person would have acted under the same or similar circumstances and when appropriate safeguards are taken. Florida law prohibits school personnel from referring students to or offering students contraceptive services at the school facility without the consent of a parent or legal guardian. Florida Statutes: , , Authority: (2), F.S. Law Implemented: (6), F.S. 5/17 SCHOOL BOARD OF ST. LUCIE COUNTY Steps in Medication Administration: 1. Always wash hands well before and after giving medications or wear gloves. 2. Identify student by asking them to state his/her name. Never give medication if there is any doubt as to the identity of the student. 3. Read the Physician s Authorization Form and perform the 1 st check of the 6 Rights. Right Child Right Medication Right Dose Right Route Right Time Right Documentation 4. Unlock medication storage area and obtain medication. Compare the information on the label with PA Form, 2 nd check of the 6 rights. 5. Prepare the student and/or medication. Oral Medication: The student should be given a cup with water when taking oral medication and then measure the medication into a dosage cup or remove the correct number of pills from the bottle using care not to touch or drop. Liquid medication should be measured in a dosage cup or as provided by parent. Ear/Eye Drops: For eye/ear drops the student should be sitting in a comfortable position prior to administration. Encourage older students to instill drops themselves. Topical Ointments: For topical application the student should be given privacy if clothing must be disrupted. The student should be encouraged to apply topical ointments themselves if possible. Metered Dose Inhalers: Inhalers should be shaken well prior to administration. See page titled Use of a Metered Dose Inhaler. 6. Administer medication after 3 rd check of the 6 rights. Hand the medication to student and if necessary assist them. 7. Observe student to make sure the medication is swallowed or check the mouth. Always follow oral medication with water unless otherwise directed (medication stuck in the esophagus can sometimes burn). 8. Return medication to locked storage area. 9. Document administration of medication immediately on the Medication Log. 5/17 SCHOOL BOARD OF ST. LUCIE COUNTY Medication Administration while off campus Preparation: 1. Prior to the event determine what students will need medication and who is trained to administer it. Don t forget about students that take medications as needed i.e. asthma, allergies, headaches etc. When students are in an unfamiliar setting these conditions are more likely to occur. 2. The person who will administer the medication should make arrangements to meet with the Health Paraprofessional the day prior to the event to prepare the medication. 3. The Physician Authorization for Medication and the Medication label should be reviewed and compared before the medication is measured and placed in the envelope. 4. The Envelope should be labeled with: Students name Medication amount Time medication is to be given A blank area for the actual time medication was given Name of person responsible for administration 5. The Envelope should be sealed and placed in the locked medication cabinet. Day of Event: 1. Pickup previously prepared medication from the clinic. 2. Medication should be carried on a staff member s person in a secure fashion and not in an unattended bag or other areas in which students may have access. 3. Identify student by asking them to state his/her name. Never give medication if there is any doubt as to the identity of the student. 4. Accompany the student to an area away from the other students so the medication can be given privately to ensure confidentiality. 5. Always wash hands well before and after giving medications or wear gloves. 6. Perform a 2 nd check of the students name and compare with the information on the envelope. 5/17 SCHOOL BOARD OF ST. LUCIE COUNTY 7. Prepare the student and/or medication. Oral Medication: The student should be given a cup with water when taking oral medication. Measure the medication using a dosage cup provided by the clinic or remove the correct number of pills from the envelope using care not to touch or drop. Ear/Eye Drops: For eye/ear drops the student should be sitting in a comfortable position prior to administration. Encourage older students to instill drops themselves. Topical Ointments: For topical application the student should be given privacy if clothing must be disrupted. The student should be encouraged to apply topical ointments themselves if possible. Metered Dose Inhalers: Inhalers should be shaken well prior to administration. See page titled Use of a Metered Dose Inhaler. 8. Hand the medication to student and if necessary assist them. 9. Observe student to make sure the medication is swallowed or check the mouth. Always follow oral medication with water unless otherwise directed (medication stuck in the esophagus can sometimes burn). 10. Note time medication was given on the envelope. 11. After returning to the school campus document the administration of the medication on the appropriate page in the Medication Log in the clinic. 5/17 Part I: (To be completed by physician s office) THE SCHOOL BOARD OF ST. LUCIE COUNTY 4204 Okeechobee Road, Fort Pierce, FL PHYSICIAN S AUTHORIZATION FOR MEDICATION To the Principal of School Name of Student/Patient DOB In order to keep this child in optimum health and to help maintain maximum school performance and attendance, it is necessary the medication listed below be given during school hours. (No injections are given except in extreme emergencies, such as allergic reaction to insect stings). ONE MEDICATION PER FORM PLEASE MEDICATION Name: Dosage: FORM: Pill/Tab Capsule Liquid Other ICD-9 D Code Schedule: (how often or what time) PRN ORDERS IF YOU ARE ORDERING MEDICATION AS NEEDED, PLEASE SPECIFY UNDER WHAT CONDITIONS THE CHILD IS TO TAKE i.e. pain: ANY SPECIAL INSTRUCTIONS: INHALER/NEBULIZER: Medication Name: # of puffs Schedule: (how often or what time) If you are ordering the inhaler as needed, please specify under what conditions: (check all that apply) SHORTNESS OF BREATH COUGHING WHEEZING OTHER The Student has been trained and has my permission to self-administer the MDI. CHECK ONE: Student may carry inhaler Inhaler to be kept in clinic Physician Name (Please Print) Date Physician Signature Telephone Number Part II: (to be completed by parent/guardian) I HEREBY GIVE PERMISSION: For my child named above to receive medication during school hours. A licensed physician has prescribed this medication. To the school nurse to share information with appropriate school staff relevant to the prescribed medication administration as he/she determines appropriate for
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