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    9 views60 pages

    Medication Administration

    Uploaded by

    Vhiiettd_aciuhma
    administrasi

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 60
    MEDICATION ADMINISTRATION PROCEDURE REVISION HIGHLIGHTS-June 1, 2010 GENERAL INFORMATION: ‘References to health services manager were changed to coordinator Form numbers were updated; revised Incident/Error Form & Med Receiving & Disposing Record Changes made after review of HCPSS policies (Health Services policy # 5100 and Field Trip and student activity tips policy # 8100); Board of Nursing and State MSDE Medication Training Program; MSDE State Health Services Guidelines; ‘COMAR School Health Standards, NASN (National Association of Schoo! ‘Nurses) and consultation with Safety Office and HCHD ‘Continuots format has been changed to separate pages to simplify future additions/revisions Revised Table of Contents to correlate wit revised procedures ‘Removed OTC labels and Epi Pen labels CONTENT CHANGES: “Moved procedures for administration of medications outside the school setting (field trips) to a new separate DRAFT chapter X titled HCPSS School Field Trips Revised OTC medication labeling, Pareat or Nurse Ffealth Assistant need to ‘write student’s first and last name on OTC medication container with permanent marker [Revised “Hlealth services staff should be informed of date of field trip and students attending as soon as possible"- changed to at least TWO weeks prior totrip ‘Revised Medication administration time to ONE HOUR before or ONE HOUR after the preseribed time Revised Medication Training Course hours to 20 hours (previously 16 hours) ‘Added: Permission to setf-administer medication may be Revoked if student ‘endangers self or others ‘Updated phone number for Biomedical Waste Services, Ine. Registered Medication Assistant changed to Certified Medication Technician ‘Added New HIFA inhaler instructions Revised Subcutaneous injections: hold in place $ seconds (per H.A.N.DS.) ‘Added Nurse Communication with Physicians statement for Cluster Nurses ‘and School Nurses Revised medication disposal procedures in consultation with Safety, Environment and Risk Management Office Updated CN and principal responsibilities ‘Added new Epi Pen instructions ‘Added Sample Medications procedure CHAPTER 6: MEDICATION ADMINISTRATION PROCEDURES ‘TABLE OF CONTENTS Physician Orders. Parental Consent for Medication Administration or Omission. Labeling Medication; OTC. Receipt and Disposition. ‘Disposal of Medication... Counting and Recording of Medication.. Filing of Medication Orders. PRN (as needed) Medication . Injectable or 1V Medication ‘Modication Administered by Net 7 Homeopathic and Hertel upplemens/Medicaon ‘Study Medication ‘Sample Medication... ‘Stolen of Lost Medication RESPONSIBILITIES RELATED TO MEDICATION ADMINISTRATION.......VI-10, Cluster Nurse Responsibilities... . School Health Assistan’School Nurse Responsibilities. Health Services Specialist/Coordinator Responsibilities. Principal Responsibilities. arentGuardian Responsibilities. Student Responsibilities... ‘The First Dose... Self-Administratic Carrying of Medication by Students... Genera Initial Measures forthe Administration of All Medication (Oral Medication (Tablet, Capsule, Caplet, Liquid)... Topical Meication (ines and Salve, CHAPTER 6: MEDICATION ADMINISTRATION PROCEDURES ‘TABLE OF CONTENTS Ear Drops Nasal Medications... Nose Drops. Nasal Spray. Inhaler.. [Nebulizer Treatments... Injections — Subcutaneous. Reconsttuting a Powdered Medication... ‘Withdrawing Medication from a Vial Disposing of Syringes an _EpiPen Auto-Inject Epinephrine. ‘General Instructions and Information. Students Needing EpiPens. Anaphylaxis Symproms (By Baty Sy Syn) ‘Student EpiPen Order Form/Care Plan. Exposure to an Allergen. Procedure for Administering EpiPen.. Rectal Valium (Diastat) Administration Medication Via Gastrostomy Tube or Button. Gastrostomy Button Medication Port. : Feeding Port by Gravity Gastrostomy Tube.. MEDICATION ADMINISTRATION INCIDENT/ERROR ‘Over Dosage or Incorrect Medication. Under Dosage of Medication e Missed Dosage of Medication Refusal/No Show .. Omission NON-MEDICATION .. Food Supplements. Cough Drops. Hand and Body Lotion ‘Sunsereen/Suntan Lotion ‘Contact Lens Solutions and Receptacles. DOCUMENTATION OF MEDICATION . Documentation on the Health Services Medication Form... NeRSSGFODSSTain Savi Mamaa010 Hh (CHAPTER 6: MEDICATION ADMINISTRATION PROCEDURES Documentation on the Medication Charting Recor. Documentation on Continuation Sheet... . Documentation on Medication Receiving/Disposing Record... VI39 ‘TABLE OF FORMS. ‘Anaphylaxis Symptoms. i Blood Glucose Monitoring Record. Diabetes Medication Order/Management Form Diabetes Medication Order/Management Form (Back) EpiPen Order Form/Care Plan . “Health Services Medication Form Physician's Order. ‘Medication Charting Recotd.. Medication Incident/Error Report Form. Medication Procedure Information. ‘Medication Receiving/Disposing Record. ‘PRN Medication Recording Flow Sheet. Report of Missing Medication . ACrNSFCDRSTae ser Memne10 Medication Administration MEDICATION ADMINISTRATION PROCEDURE DEFINITION “The Howard County Public School System (HCPSS) encourages the taking or administering of medication et home. ‘Timing of medication doses should be adjusted to occur either before or after schoo! hours if medically appropriate. Itis recognized, however, that students with chronic ‘conditions or acute illnesses may require medication at school. ‘The administration of medication {in the school setting is a service that is provided to promote wellness and decrease absenteeism. ‘When there is a need for a student to receive medication in school, safe and proper administration is essential. To facilitate this end, students should have medication available in the health room and administered in a manner consistent with school health services procedure. “The school or cluster nurse delegates the administration of medication to the school health assistant, No medication may be administered by the nurse or any other designated school personnel unless the following procedures are followed. PROCEDURES ‘The following procedures apply to all prescription, “over-the-counter” (OTC), and homeopathic! herbal medication, including all oral medication (tablets, capsules, caplet, and liquids), topical ‘Olntments and creas, inhalant medication Gnbalers and nebulizer), injectable and intravenous medication and rectal medication. Any circumstances not specifically addressed in these procedures should be immediately referred to the cluster nurse, school nurse or health Sspecialist/coordinator. Note: For Administration of Medication outside the school building see Chapter X. PHYSICIAN ORDERS: + A-complete written and signed order from a physician or an authorized health care prescriber, ‘must accompany all medication to be administered. In Maryland an authorized prescriber is 4 physician, nurse practitioner, certified midwife, podiatrist, physician's assistant or dentist. ‘Avstamp with the preseriber's signature is acceptable; however a printed name stamp is NOT ‘acceptable. All of the following information must be included on the HCPSS Health Services Medication Form (39513035): = Name of student Date of medication order Name of medication ; Expiration date of medication Dosage and strength of medication ‘Time and frequency of administration ‘Whether or not the medication may be self administered Route of administration Length of time to be administered (date order expires or end of school year) Diagnosis (reason for administration of the medication) Possible side effects and toxic effects erst Sere Manual Vel Medication Administration = Special instrtions i any, including whether or not medication may be slf- administered) a = Physician’sPrescriber’s printed name and origina signature or stamped signature. *+ The order should be writen on « HPSS Health Services Medication Form (39513035). The physician'prescriber's order section must be completed in fll and signed by the parent guardian. However, «physicin'sprescribers prescription form including all required information and signatures willbe accepted. The order must be submited tthe schoo! health assistan/aurse, who must transcribe the information onto the HCPSS Health Services Medication Form (39513035). *+ New orders ae required for: = Achange of medication = Acchange of dosage = ‘change in time and or frequency of administration = Bach acho! year (orders must be dated on or aftr July 1 ofthe current yea) = Any medication that hasbeen held by parent/guardian o physician request for 4 wecks or + tarification from the physician/prescriber is required when the medication isto be ‘dministered in a form ote han that ordered (such as crushed, opened and sprinkled in food or liquid, pill in ew of ligui or liquid in lew of pill), ‘+ Medication must be given according tothe frequency prescribed by the physician/preseriber. nce the physician/prescriber determines the frequency the parent guardian and the nurse tay detetmine time of adminiotraton. Consult the school or cluster nurse for any concerns ‘+ Medication must be administered within atime frame of one hour before to one hou fter the designated time. + When schools pen fate or close erly, students should take medication a ordered at home if the ordered time is before schools open or afte they cose. If necessary, a prescriber’ order tay include special instructions for late opening and early closing days. + Faxed medication orders forthe administration of medication may be accepted when submited onan authorized form and signed by an authorized prescriber. When fexed orders te requested or received, every effort must be made to ensure confidentiality +All new orders must be reviewed bythe school nurse or cluster nurse before the frst school doses given ‘+ The parent/guardian must sign the HCPSS Health Services Medication Form (39513035) in the designated area. If a completed HCPSS Health Services Medication Form is received and the parent guardian signature is omitted, the parent/guardian may give verbal permission to the school health assistan/aurse to administer the medication as directed on the ‘medication form for that particular school day. Written permission must be received within three days for continued administration. The parentguardian may send in a note stating the name of the medication and the name of the student. The signed note must be atached to the ‘medication form. ‘© Medication may be omitted for up to four weeks with written parent/guardian notification ‘and the approval of the schoo! nurse or cluster nurse. ‘The school health assistant may temporarily receive the request from the parent/guardian by phone. The verbal consent must HCFSSOSS al Serie Maal010 via be followed up with a written note from the parent within three days. The school nurse or Cluster nurse must approve this within a three-day period. Medication may be resumed ‘within four weeks with written parent/guardian notification. If medication is to be resumed after four weeks, a new writen order is required. LABELING MEDICATION. ‘= Medicetion most be in clearly labeled container that protects it from damage. The original prescription container should accompany all prescription medication to be administered at School. Two containers, one for home and one for school, should be obtained from the pharmacist. ‘+The prescription medication container should be labeled =» Student aame =" Name of medication = Dalsage and strength of medication “Time and frequency of administration ‘Rote of sministration “Phiysician's/Presoriber’s name Date of order ‘Expiration date 6f medication + Over-the-counter (OTC) medication must be in the original container, preferably unopened. "The parent/guardian should write the student's first and last name on the over-the-counter medication euntainer. The achool nurse or elustor nurse must review the order for accuracy ‘and completion, verify the proper medication, and compare the student's name on container ith student name on the order before the frst dose is given at school. School nurse/health assistant may use a permanent marker to write the students first and last name on the ‘unopened OTC container. ‘+ Medications will not be accepted in unlabeled containers. Unit dose packaging will be accepted with proper labeling. ‘The expiration date of the medication isthe earlier of either the date printed on the pharmacy label or the manufacturer's expiration date. the following information: RECEIPT AND DISPOSITION ‘= The HCPSS Health Services Medication Form and the medication, labeled as required, must ‘be delivered tothe schoo! by the parent/guardian or other designated adult. ‘+ Students should not transport medication except in special circumstances. Prior to the “elivery of medication by a student, the parent/guardian must make arrangements with the school health assistant or cluster nurse forthe safe delivery of medication to the health room. ‘The parent should identify how much medication is in the container. ‘© Ifthe dosage of medication is ordered asa half tablet, the parent/guardian should provide the tablets cutin hal. ‘+ The school health assistant/aurse is responsible for initially reviewing the medication order ‘and medication when itis received in school. The school health assistant/nurse will then arrange for the administration of medication in accordance with the order and the student's ‘RCrRUOSS ah Se Mamala010 vis Medication Administration schedule, A final review by the nurse/delegating nurse is required before the administration ofthe first school dose. *) ‘The school health assistant/nurse reviews the order and determines that The form is completed properly. The required signatures are provided. = Each medication is accompanied by a separate order. The order from the physician/prescriber includes al the information, including side effects and adverse reactions. = The medication i properly labeled. = The information on the medication label is consistent with the information on the Health ‘Services Medication Form (39513035). ‘The medication has not expired. * Unused medication must be picked up by the parent/guardian or designated adult atthe end ofthe school year (by the end of staff hours on the last day of school) or within one week after expiration of the order or expiration of medication, whichever occurs first. Medication ‘not collected by the parent/guardian or designee will be discarded/destroyed by the school health assistani/nurse after the parent/guardian has been notified to pick up the medication using the following procedures Pills and liquids should be made ‘unusable by adding water to pills and liquids. = Unused medications should be kept in original containers with all labels removed or ‘obscured, sealed in plastic bags, and placed in the sharps container (If medication container is too large for sharps container, empty pills or liquid directly into sharps container). = Close sharps container and call for pick up- follow the Care and Disposal of Sharps Procedure, page V1-15. = Inhalers are to be thrown in the trash (canisters should be separated from mouthpiece and all labels removed or obscured) = EpiPens and other sharps should be placed in a sharps container. Disposal of this, ‘container and other medical waste should follow the Care and Disposal of Sharps Procedure, page VI-15. NERSSOSSHia Seen Mamata via ‘Medication Administration COUNTING AND RECORDING OF MEDICATION Counting and recording ofall medication (pills, inhalers, EpiPens, insulin, glucagon, et.) is necessary to ensure accuracy and control of medication received and administered in the school setting. All medication must be counted and recorded on the Medication ReceivingDisposing Record (39513038) under the following circumstances: = Medications brought to the health room withra new medication order ~ Medication brought othe Bealih oom to continneidministaon ofan existing order = Medications picked up by «parent/guardian; forexample, atthe end ofthe school year or ‘whien aumedicationis iseontinned 0202 2 ~ Medications that are wasted Because of contamination (most commonly, pills dropped or ‘pit out by-student)-or medications teplaced due to expiration * "The muniber6f tablets, capsule fs "counted must be recorded and signed by the person receiving or disposing of the medication and witnessed by the parent/guardian or designated adult; ora school staff mefbét-1f there is discrepancy between the pill count andthe actual ‘oumber of pills, review the:mediaation administration documentation to find possible erors ‘and contact the cluster nurse for further investigation. EILING OF MEDICATION ORDERS: ‘© Current medication orders must be fled ina clearly labeled folder or binder. ‘© When the medication administration is completed, during or atthe end ofthe school year, medication otdets tat be fled in the student ’xhealth record. When medication is ‘+ Notifies parents/guardians and cluster nurse when a student does not receive ordered ‘medication. ‘Assists the cluster nurse with the actual medication count on a monthly basis. + Stores all medication in compliance with the School Health Standards, Code of Maryland Regulations (COMAR 13A.05.05,). All medication must be stored in locked cabinet. “Medications that require refrigeration must be stored in a locked refrigerator or ina locked box in the refrigerator. Access to medication locked inthe designated space shall be under the authority of the school health assistant, the cluster nurse (who is responsible for the second set of keys), and the principal/ designee (who is responsible forthe third set of keys). * Develops a plan forall students who carry medication according to the Carrying of “Medications by Students procedure, page VI-13 and in consultation with the cluster nurse ‘+ Notifies the parent/guardian when additional medication is needed and when medication is bout to expire. ‘+ Informs the parent/guardian ofthe date when the unused portion of the medication must be collected, ‘ - Destroys any unused portion of the medication not personally collected by the parent/guardian within one week after expiration ofthe medication order, ora the end of the School year, and follows procedures for disposition above. See Receipt and Disposition, page VI-3. + Refers any medication concems to the luster muse ‘The health services specialisvcoordinator: ‘+ Works in consultation with nurses and schoo! health assistants to assist them in performing, their designated responsibilities. + Reviews, evaluates, and addresses concerns related to medication erors and missing medication. Reviews Medication Incident/Error Report Forms (39513034) and Mis Medication Record Form (39513038). ‘= Arranges Maryland Board of Nursing approved Medication Assistant Training classes for all ‘new school health assistants and designated school staf. ‘+ Arranges re-registration training classes for medication technicians. ‘© Develops and reviews Medication Policy and Procedure as needed. ‘= Reviews Maryland School Health Services Guidelines and aligns HCPSS Medication Procedures as appropriate. PRINCIPAL RESPONSIBILITIES ‘The principal: ‘Assures that the administration of medication follows the HCPSS Health Services Procedures {or administration of medication. ‘© Assures thatthe cluster nurse is notified ofthe health assistant absence. Nero8S ea Sie MeO Vira Medication Administration PARENT/GUARDIAN RESPONSIBILITIES ‘The parent/guardian: ‘+ Obtains a written medication order from the physician or other authorized prescriber. ‘© _Assures that all portions of the Health Services Medication Form are complete. * ‘Signs the medication order form in the designated area. ‘Delivers the writen order with parent/guardian signature and the medication labeled as required tothe school health room. ‘+ Witnesses the counting of medication at school and signs Medication Receiving/Disposing Record (39513038). + Provides sufficient medication for 60 days or the full course of administration if less than 60 days, when possible and reasonable. ‘+ Provides medication in the proper form and in the ordered dosage, such as half tablets. + Replenishes medication supply as needed. ‘Submits tothe school a new order from the physician/preseriber for any change in ‘medication, dosage, of frequency of administration. ‘+ Gives the first dose of any medication at home and observes for adverse reactions. ‘> Works with school staff in planning for students who frequently fail to come for medication ‘administration ‘Retrieves unused medication according to procedure. ‘STUDENT RESPONSIBILITIES “The student: + Comes to the health room for medication atthe designated time on a regular basis. ‘Takes the dosage prescribed by the physician/prescriber, provided to the stadent by the schoo! health assistant‘nurse, who monitors the provess, Students may not remove their ‘medication from the medication eabinet. + Selfadministers medication as ordered by the physician/prescriber under the supervision/monitoring of the school health assistant/nurse, student's self-administer order Signed by a physician/preseriber must be on file in the health room, and the student must report to the school health asistantor cluster nurse about each self-administration according, to the individual plan. ‘= Does not carry medication on self unless specifically authorized to do so in writing by physician/prescriber on the medication order form. Only a limited supply of medication may be carried ‘ncrss0setila Serio Mena Vis Medication Administration MEDICATION ADMINISTRATION SAFETY PROCEDURES ‘When medication is administered, certain safety rules, called the Six Rights, must be followed. my ‘THE SIX RIGHTS © Right student ~ Ask the student's name = Compare the name with the medication form and the label * Right medication = Know the action, dosage, and method of administration. = Know the side effects of the drug. = Compare the order with the Inbel on the medication container, three times: ‘© When taking medication from the storage area. © Before placing medication into the lid/medicine cup/mouthpiece. (© Before retuming medication to the storage area. + Right dose =~ Compare the order with the medication container label. OTC: refer to order for directions + Rightroute = Oral, inhaled, injection, topical, et. + Right time ‘+ Right documentation = Record the medication after itis given following correct charting procedure. ‘THE FIRST DOSE, “The frst dose of any new medication should be administered to the student at home. This does not apply to emergency medication, for example EpiPen or Glucagon. SELF-ADMINISTRATION ‘+ IF medication is to be self-administered according to the medication order, the student must demonstrate competency to the cluster nurs. ‘© {A student's order to self-administer, signed by a physician/prescriber, must be on file inthe ‘health room, + A student’s order to self-administer medication may be revoked ifthe student endangers himself or another student through this use of medication. ‘© The student must report each self-administration to the school health assistant or cluster nurse according to the individual plan. ‘© Ifthe student fails to report self-administration of medication tothe school health assistan/cluster nurse, the cluster nurse develops a plan for student accountability withthe ‘school health assistant, the parent/guardian, the student, and with teacher involvement as necessary, + The student may not carry medication unless specifically authorized to do so in waiting by physician/prescriber on the medication order form. The student may carry only a limited supply of medication. ACPO Sav MaapWO0 Via Medication Administration CARRYING OF MEDICATION BY STUDENTS: + Inbalers for asthma and other airway constricting conditions and EpiPens are the only form ‘of medication that students are routinely permitted to cary as directed by the physician/prescriber. ‘+ Medications in other forms and for other specific heath concems will be considered on @ case-by-case basis and a plan put in place for documentation and accountability + ‘Avwritten medication order that specifically states thatthe student may carry a limited supply ‘the medication must be on file inthe health room for any student who carries medication

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