Emergencies Related to Medications in Schools Module 10

Emergencies Related to Emergencies Related to Medications in Schools Medications in Schools

Module 10 Module 10

Emergencies Related to Emergencies Related to Medications in SchoolsMedications in Schools

Schools should establish an ongoing Schools should establish an ongoing relationship with local hospitals and local relationship with local hospitals and local

Emergency Medical Services (EMS) Emergency Medical Services (EMS) personnel to expedite a student’s transfer to personnel to expedite a student’s transfer to

a hospital or health-care facility in cases a hospital or health-care facility in cases where emergency medical services are where emergency medical services are required (e.g., student having a serious required (e.g., student having a serious

adverse reaction to medication). adverse reaction to medication).


Current emergency telephone Current emergency telephone numbers should be available to numbers should be available to permit school personnel to permit school personnel to contact the parent/guardian in contact the parent/guardian in case of emergency. case of emergency.


Emergency procedures covering on-campus Emergency procedures covering on-campus and off-campus occurrences need to be and off-campus occurrences need to be established. established.

An emergency action plan, including EMS An emergency action plan, including EMS transport authorization by the transport authorization by the parent/guardian, is advised for students with parent/guardian, is advised for students with known life-threatening conditions as identified known life-threatening conditions as identified by a physician (e.g., anaphylactic reaction, by a physician (e.g., anaphylactic reaction, asthma, cardiac disorders, diabetes, asthma, cardiac disorders, diabetes, seizures, hemophilia). seizures, hemophilia).


These students need to be identified to These students need to be identified to permit appropriate action to be taken in case permit appropriate action to be taken in case of emergency during activities on- or off- of emergency during activities on- or off- campus. campus.

Such plans and procedures should be Such plans and procedures should be incorporated in each school’s crisis incorporated in each school’s crisis management or safety plan. management or safety plan. For example, the ready availability of an For example, the ready availability of an

emergency injection medication such as emergency injection medication such as epinephrine (e.g., EpiPen) is needed for some epinephrine (e.g., EpiPen) is needed for some students in the event of severe allergic reactions students in the event of severe allergic reactions (e.g., bee stings).(e.g., bee stings).


EMS should be called for each student EMS should be called for each student requiring emergency procedures. requiring emergency procedures.


The decision to transport to a medical The decision to transport to a medical facility or to provide other emergency care facility or to provide other emergency care will be made at the time of EMS arrival by will be made at the time of EMS arrival by EMS personnel in collaboration with the EMS personnel in collaboration with the EMS medical control (physician), the EMS medical control (physician), the school principal, the school nurse and the school principal, the school nurse and the parent, if available. parent, if available.


The decision should also be based on the The decision should also be based on the individual health care plan (IHP) or individual health care plan (IHP) or emergency care plan developed earlier by emergency care plan developed earlier by the registered school nurse in the registered school nurse in collaboration with the physician, collaboration with the physician, parent/guardian, student and other parent/guardian, student and other appropriate school personnel. appropriate school personnel.


Attempts should be made to notify parents and Attempts should be made to notify parents and the principal at the same time EMS is called the principal at the same time EMS is called and/or the student receives any emergency and/or the student receives any emergency medication (e.g., EpiPen). medication (e.g., EpiPen).

In all cases where feasible and where the In all cases where feasible and where the attending physician so advises, the student attending physician so advises, the student should be trained by his/her physician and/or the should be trained by his/her physician and/or the registered school nurse to give his/her own registered school nurse to give his/her own emergency injection (e.g., EpiPen) with school emergency injection (e.g., EpiPen) with school personnel acting as back up for the procedure. personnel acting as back up for the procedure.


Establishing an information system for properly Establishing an information system for properly monitoring emergencies in terms of notifying the monitoring emergencies in terms of notifying the parent/guardian, EMS, the registered school nurse, and parent/guardian, EMS, the registered school nurse, and the physician is advised. the physician is advised.


Written Unusual Occurrence Reports (UOR) should be Written Unusual Occurrence Reports (UOR) should be completed and reviewed at least annually in an effort to completed and reviewed at least annually in an effort to revise policies and procedures in order to reduce revise policies and procedures in order to reduce unnecessary risk. This UOR form is included in the unnecessary risk. This UOR form is included in the Appendix. Appendix.

In-service which provides “hands-on” training of the In-service which provides “hands-on” training of the procedures to use in case of emergency should be procedures to use in case of emergency should be provided at least annually for school personnel by the provided at least annually for school personnel by the registered school nurse and other appropriate local registered school nurse and other appropriate local personnel (e.g., physicians, EMS). personnel (e.g., physicians, EMS).

Medication ErrorsMedication Errors

As soon as an incorrect dosage of medication is As soon as an incorrect dosage of medication is recognized, the medication assistant should initiate the recognized, the medication assistant should initiate the following steps: following steps:

Closely supervise and observe the student in the health Closely supervise and observe the student in the health room, office, or other designated place. If the student is room, office, or other designated place. If the student is in class when the error is determined, have the student in class when the error is determined, have the student escorted back to the health room or office. escorted back to the health room or office. Do not leave Do not leave the student alone.the student alone.


Observe the student. Note if any of the following Observe the student. Note if any of the following are present: are present: Difficulty with breathing.Difficulty with breathing. Change in skin color.Change in skin color. Swelling around eyes, face, and/or throat.Swelling around eyes, face, and/or throat. Skin rash. Skin rash. Change in mental alertness.Change in mental alertness. Slurred speech.Slurred speech. Sick at stomach or vomiting. Sick at stomach or vomiting. Dizziness. Dizziness. Abdominal pain. Abdominal pain. Any other unusual complaints or observations. Any other unusual complaints or observations.


IdentifyIdentify the incorrect dose, time, and the incorrect dose, time, and name of the medication taken by the name of the medication taken by the student. student.


ImmediatelyImmediately have an adult notify the principal have an adult notify the principal and the registered school nurse of the errorand the registered school nurse of the error. .

SimultaneouslySimultaneously, contact the , contact the Alabama Poison Alabama Poison Control Center at 1-800-462-0800Control Center at 1-800-462-0800 and provide and provide the following information: the following information: Name, dose, and time of the medication taken in Name, dose, and time of the medication taken in

error. error. Age and approximate height and weight (see Age and approximate height and weight (see

authorization form) of student.authorization form) of student. Name(s), dose(s), and time of last dose of other Name(s), dose(s), and time of last dose of other

known medication being taken by the student.known medication being taken by the student.


Follow the instructions provided by the Poison Follow the instructions provided by the Poison Control Center if at all possible. Control Center if at all possible.

If unable to complete their directions, explain the If unable to complete their directions, explain the problems to the Poison Control Center to problems to the Poison Control Center to determine if the student should be transported determine if the student should be transported for emergency medical care. for emergency medical care.

Notify student’s parent/guardian and physician.Notify student’s parent/guardian and physician. Do not delay initiating further action if unable to Do not delay initiating further action if unable to

reach the parent/guardian, physician, or reach the parent/guardian, physician, or registered school nurse.registered school nurse.

Medication ErrorsMedication Errors Submit a completed Submit a completed Unusual Occurrence ReportUnusual Occurrence Report

within 24 hours to the delegating registered within 24 hours to the delegating registered school nurse and document the following:school nurse and document the following: Student’s name.Student’s name. Parent’s/guardian’s name and telephone number. Parent’s/guardian’s name and telephone number. Specific statement regarding the medication error. Specific statement regarding the medication error. Persons notified and time of notification. Persons notified and time of notification. Poison Control Center instruction or physician’s Poison Control Center instruction or physician’s

instructions. instructions. Actions taken. Actions taken. Condition and outcome of student Condition and outcome of student

(e.g., transported to hospital, sent home with parent). (e.g., transported to hospital, sent home with parent).


The registered school nurse should file a The registered school nurse should file a copy of the copy of the Unusual Occurrence Report Unusual Occurrence Report (UOR)(UOR) in the student’s health record and in the student’s health record and in the school’s quality assurance record.in the school’s quality assurance record.

Medication ErrorsMedication Errors When an When an omissionomission of medication is first recognized, immediately of medication is first recognized, immediately

initiate the following steps: initiate the following steps:

Identify the student who missed the dose of medication.Identify the student who missed the dose of medication.

Notify the principal or designee and contact the registered school nurse. Notify the principal or designee and contact the registered school nurse.

The registered school nurse should use his/her professional judgment to The registered school nurse should use his/her professional judgment to determine whether the remainder of the dose should be omitted, given, or determine whether the remainder of the dose should be omitted, given, or whether physician contact is appropriate. whether physician contact is appropriate.

Contact the parent/guardian.Contact the parent/guardian.

Document all circumstances and actions taken on the student’s health Document all circumstances and actions taken on the student’s health record and other reports required by the SDE and ABN. record and other reports required by the SDE and ABN.

Follow SDE and ABN requirements for reporting all errors, including Follow SDE and ABN requirements for reporting all errors, including omissions on the omissions on the Unusual Occurrence Report (UOR)Unusual Occurrence Report (UOR). .

Staff TrainingStaff Training

Medication assistants should receive school-Medication assistants should receive school-specific and student-specific training from specific and student-specific training from the delegating registered school nurse prior the delegating registered school nurse prior to assisting students with medication. The to assisting students with medication. The training should be repeated at least annually training should be repeated at least annually and cover at a minimum the following areas:and cover at a minimum the following areas:

Legal requirements, state and local policies and Legal requirements, state and local policies and regulations.regulations.

Oral, injection (e.g., EpiPens only), topical Oral, injection (e.g., EpiPens only), topical ointments, eye drops, or eardrops. ointments, eye drops, or eardrops.

Liquid medication should be measured in Liquid medication should be measured in disposable, calibrated medicine cups rather than disposable, calibrated medicine cups rather than teaspoons or tablespoons. teaspoons or tablespoons.

Importance of being sure that oral medications Importance of being sure that oral medications have been completely swallowed/ingested in the have been completely swallowed/ingested in the presence of the medication assistant. presence of the medication assistant.

Routes of MedicationRoutes of Medication

InjectionsInjections Injections required during the school day must be Injections required during the school day must be

administered by a licensed nurse (RN or LPN) administered by a licensed nurse (RN or LPN) unless the student is able and authorized to self-unless the student is able and authorized to self-administer his/her own injection by the administer his/her own injection by the parent/guardian and prescriber (e.g., insulin). parent/guardian and prescriber (e.g., insulin).

EXCEPTIONEXCEPTION: Emergency injections (e.g., : Emergency injections (e.g., EpiPen) are designed for delivery by nonmedical EpiPen) are designed for delivery by nonmedical personnel and encouraged to be provided by the personnel and encouraged to be provided by the student or unlicensed school employee with the student or unlicensed school employee with the written consent of the parent/guardian and written consent of the parent/guardian and prescriber. prescriber.

Such medications are prescribed for children with severe Such medications are prescribed for children with severe allergic conditions and must be used immediately in allergic conditions and must be used immediately in order to be effective in preventing anaphylaxis (a life-order to be effective in preventing anaphylaxis (a life-threatening, rapid onset allergic reaction).threatening, rapid onset allergic reaction).

InjectionsInjectionsUnlicensed school personnel (teachers, Unlicensed school personnel (teachers,

aides, and secretaries) are aides, and secretaries) are NOTNOT to provide to provide any other injections to student (e.g., any other injections to student (e.g., insulin, solu-cortef, glucagoninsulin, solu-cortef, glucagon).).

SuppositoriesSuppositories

Vaginal or rectal suppositories (e.g., Vaginal or rectal suppositories (e.g., Diastat) may only be administered by Diastat) may only be administered by the RN or LPN.the RN or LPN.

Medications should not be provided to a student Medications should not be provided to a student who is vomiting or has vomited. who is vomiting or has vomited.

If there is any discrepancy that might be If there is any discrepancy that might be injurious to the student, the medication assistant injurious to the student, the medication assistant should refuse to provide the medication until should refuse to provide the medication until clarification is received. clarification is received.

Contact the LEA registered school nurse to Contact the LEA registered school nurse to obtain clarification, and, as necessary to notify obtain clarification, and, as necessary to notify the parent/guardian immediately that no the parent/guardian immediately that no medication will be given.medication will be given.

ContraindicationsContraindications

Possible signs and symptoms of adverse side effects, Possible signs and symptoms of adverse side effects, omission, or overdose. omission, or overdose.

Documentation and procedures for assisting with Documentation and procedures for assisting with medication. medication.

Proper handling, storage, and security measures to be Proper handling, storage, and security measures to be followed during the school day, during field trips, and followed during the school day, during field trips, and other school events. other school events. (e.g., overnight trips).(e.g., overnight trips).

Emergency procedures including preparation for routine Emergency procedures including preparation for routine bus transportation, field trips, and unforeseen events. bus transportation, field trips, and unforeseen events. (e.g., inclement weather, lockdown, and evacuation of school). (e.g., inclement weather, lockdown, and evacuation of school).

Staff TrainingStaff Training

School Nurse Shall:School Nurse Shall:

Review periodically, the implementation of Review periodically, the implementation of the medication policy, related procedures, the medication policy, related procedures, and documentation in the school and and documentation in the school and monitor all medication assistants who monitor all medication assistants who assist students with medication. assist students with medication.

Provide and document at least annual Provide and document at least annual training for medication assistants who are training for medication assistants who are eligible for delegation to assist students eligible for delegation to assist students with medication. with medication.

School Nurse Shall:School Nurse Shall:Consult with parents/guardians and Consult with parents/guardians and

prescribers to design emergency plans prescribers to design emergency plans as needed. as needed. The plan should include possible side The plan should include possible side

effects of medications as well as possible effects of medications as well as possible behavioral signs and symptoms of adverse behavioral signs and symptoms of adverse side effects, omission, or overdose. side effects, omission, or overdose.

Develop an individual health plan (IHP) Develop an individual health plan (IHP) and health record for all students and health record for all students requiring long-term medications or requiring long-term medications or having other special health care needs. having other special health care needs.

School Nurse Shall:School Nurse Shall:File a copy of the prescriber and parent-File a copy of the prescriber and parent-

signed authorizations for medication in signed authorizations for medication in the student health record. the student health record.

Enhance student’s knowledge about Enhance student’s knowledge about his/her health status and the his/her health status and the medication(s) used to manage the health medication(s) used to manage the health condition. condition.

Provide the required medication Provide the required medication documentation to the ABN through an documentation to the ABN through an annual report and other documentation annual report and other documentation required by the SDE. required by the SDE.

Follow the policy requirements for Follow the policy requirements for assisting students with medication. assisting students with medication.

Medication Assistant Shall:Medication Assistant Shall:

Assist students with medication in a Assist students with medication in a safe and private setting, i.e. an area safe and private setting, i.e. an area free of distractions and disruptions. free of distractions and disruptions.


Obtain proper identification from the Obtain proper identification from the student as determined by the delegating student as determined by the delegating registered school nurse and LEA policy registered school nurse and LEA policy (e.g., picture I.D.).(e.g., picture I.D.).

Check prescriber’s authorization against Check prescriber’s authorization against medication label and notify registered medication label and notify registered school nurse of any discrepancy. school nurse of any discrepancy. (Do not give the medication if there is a (Do not give the medication if there is a

discrepancy.)discrepancy.)


Not give a different amount of medication or Not give a different amount of medication or change the order in any way based on change the order in any way based on parental or student communication. parental or student communication.

Not accept any verbal orders from a Not accept any verbal orders from a physician or physician’s office personnel. physician or physician’s office personnel. (The RN or LPN school nurse must accept all (The RN or LPN school nurse must accept all physician orders). physician orders).

Assist student with medication as directed by Assist student with medication as directed by the licensed prescriber and by the delegating the licensed prescriber and by the delegating school nurse.school nurse.


Record date, time, dosage, and signature on Record date, time, dosage, and signature on the medication record immediately following the medication record immediately following the time that medication was provided. the time that medication was provided.

Report any unusual occurrence, behavior, or Report any unusual occurrence, behavior, or observation immediately to the delegating observation immediately to the delegating school nurse and the school principal.school nurse and the school principal.

Ask questions of the delegating registered Ask questions of the delegating registered nurse as necessary to provide a safe nurse as necessary to provide a safe environment for students.environment for students.


ExpectationsExpectations

Assisting a student with prescribed Assisting a student with prescribed medications during the school day will medications during the school day will enable the student to remain in school, to enable the student to remain in school, to maintain or improve health status, and to maintain or improve health status, and to improve potential for learning. improve potential for learning.

The student will receive medication as The student will receive medication as prescribed by a licensed prescriber. prescribed by a licensed prescriber.

ExpectationsExpectations

The student will demonstrate knowledge of The student will demonstrate knowledge of the principle of self-care and responsibility the principle of self-care and responsibility through appropriate self-medication through appropriate self-medication procedures when applicable. procedures when applicable.

Annual reports from the LEA to the SDE Annual reports from the LEA to the SDE will provide continuing data to the ABN will provide continuing data to the ABN regarding the outcomes of permitting regarding the outcomes of permitting school nurses to delegate certain school nurses to delegate certain medications to medication assistants.medications to medication assistants.

Congratulations! Congratulations! You have completed your Medication Assistant You have completed your Medication Assistant

Training!.....AFTER you complete quiz 10. Training!.....AFTER you complete quiz 10. Thank-you !Thank-you !We do appreciate your time and response to the We do appreciate your time and response to the

needs of the students!needs of the students!Always know you can rely on your school nurse Always know you can rely on your school nurse for any concerns you have or help you need.for any concerns you have or help you need.

Materials from Alabama Board of Nursing & the Materials from Alabama Board of Nursing & the Alabama Department of Education Curriculum Alabama Department of Education Curriculum for medication Assistant Trainingfor medication Assistant Training

Documents

Emergencies Related to Medications in Schools Module 10