Issues Related to Medication in Issues Related to Medication in the Schoolsthe Schools

Module 3Module 3

Greater numbers of school age children with chronic health conditions like Insulin Dependent Diabetes, seizures, feeding tubes, or life threatening allergies are attending public schools.

Issues Related to Medications Issues Related to Medications

The number of students with The number of students with complex health conditions is complex health conditions is increasing.increasing.

In the past, many children with In the past, many children with chronic illnesses attended a special chronic illnesses attended a special school or did not go to school.school or did not go to school.

Societal changes resulted in a focus Societal changes resulted in a focus on the health of children in Alabama on the health of children in Alabama schools.schools.

Issues for Medications in SchoolIssues for Medications in School

The goal of administering medicines to students is to promote optimal wellness in order to enhance their ability to learn.In Alabama the individual trained by the nurse to assist the student with medications will be known as the “Medication Assistant”.The Nurse Practice Act is the legal authority for defining appropriate standards of nursing.The nurse is accountable and responsible for the nursing care delivered to students under the nurse’s jurisdiction.

The RN or LPN School Nurse is The RN or LPN School Nurse is required to have a license issued by required to have a license issued by the Alabama Board of Nursing.the Alabama Board of Nursing.

Nursing License—What Does it Nursing License—What Does it Mean?Mean?

What Difference Does a License What Difference Does a License Make?Make?

Specialized Knowledge Specialized Knowledge

Independent Judgment Independent Judgment

Training & Fitness to PracticeTraining & Fitness to Practice

The Alabama Board of Nursing:The Alabama Board of Nursing:– Regulates the nursing education programs in Regulates the nursing education programs in

Alabama.Alabama.– Assures that before issuing a license, the Assures that before issuing a license, the

individual applicant meets all the legal individual applicant meets all the legal requirements.requirements.

– Assures that the applicant passes “state Assures that the applicant passes “state boards”---a national examination that boards”---a national examination that determines the individual’s knowledge and determines the individual’s knowledge and competence to practice nursing.competence to practice nursing.

The holder of a nursing license is under The holder of a nursing license is under the authority of the Board of Nursing.the authority of the Board of Nursing.

Alabama Board of NursingAlabama Board of Nursing

The Nurse Practice ActThe Nurse Practice ActThe Alabama Board of Nursing was The Alabama Board of Nursing was established in 1915 by the Alabama established in 1915 by the Alabama legislature.legislature.The The “Nurse Practice Act“Nurse Practice Act” is the term used ” is the term used to refer to the statutes that established to refer to the statutes that established the Board and the foundational laws for the Board and the foundational laws for nursing practice.nursing practice.The Alabama Board of Nursing The Alabama Board of Nursing Administrative Code contains the Administrative Code contains the published regulations.published regulations.

Alabama Board of Nursing Alabama Board of Nursing Administrative CodeAdministrative Code

School nurse practice is very School nurse practice is very different than working in a hospital, different than working in a hospital, nursing home, clinic, or home health.nursing home, clinic, or home health.The school nurse is responsible for The school nurse is responsible for the health of children in each school the health of children in each school to which he or she is assigned by the to which he or she is assigned by the local education agency.local education agency.Giving medicines is only Giving medicines is only oneone area of area of responsibility for the school nurse.responsibility for the school nurse.

DelegationDelegationDelegation is defined in the Board of Nursing Delegation is defined in the Board of Nursing regulations.regulations.Chapter 610-X-2-.06 (2) states that Chapter 610-X-2-.06 (2) states that delegation delegation is “the act of authorizing a competent is “the act of authorizing a competent individual to perform acts supportive to individual to perform acts supportive to registered nurses or licensed practical registered nurses or licensed practical nurses in selected situations.”nurses in selected situations.”Delegation is a key issue because the licensed Delegation is a key issue because the licensed nurse retains responsibility for the task that is nurse retains responsibility for the task that is delegated to someone else---someone else delegated to someone else---someone else performs the task but the nurse retains the performs the task but the nurse retains the responsibility for the outcome.responsibility for the outcome.

Delegation by School NursesDelegation by School NursesThe school nurse is accountable and responsible The school nurse is accountable and responsible for the nursing care delivered to students under for the nursing care delivered to students under the nurse’s jurisdiction. the nurse’s jurisdiction. Registered nurses or licensed practical nurses Registered nurses or licensed practical nurses that provide nursing care in the school setting that provide nursing care in the school setting through the twelfth grade may delegate specific through the twelfth grade may delegate specific tasks to unlicensed assistive personnel. tasks to unlicensed assistive personnel. The registered nurse is accountable for The registered nurse is accountable for determining the tasks that may be safely determining the tasks that may be safely performed by the unlicensed assistive personnel performed by the unlicensed assistive personnel following appropriate training and demonstration following appropriate training and demonstration of competency.of competency.

DelegationDelegation

The task of providing prescribed oral,topical, ear, eye,nasal, and inhalation medications to students may be delegated to the unlicensed person when the following conditions have been met: The nurse identifies the appropriate individuals, to assist and the unlicensed person completes a minimum twelve hour course of instruction that includes a curriculum approved by the Board and demonstrates competency to perform the delegated task.

The school nurse shall provide periodic and The school nurse shall provide periodic and regular evaluation and monitoring of the regular evaluation and monitoring of the individual performing the delegated tasks. individual performing the delegated tasks. The school nurse shall routinely and periodically The school nurse shall routinely and periodically conduct quality monitoring of the tasks conduct quality monitoring of the tasks performed by the unlicensed assistive performed by the unlicensed assistive personnel, including, but not limited to:personnel, including, but not limited to:

a.a. Training Training b.b. Competency Competency c.c. Documentation Documentation d.d. Error reporting Error reporting e.e. Methods of identification of the right student, the right Methods of identification of the right student, the right

tasks, the right method, and the right quantity at the tasks, the right method, and the right quantity at the right time. right time.

Delegation by School NursesDelegation by School Nurses

The school nurse delegating the task may, The school nurse delegating the task may, at any time, suspend or withdraw the at any time, suspend or withdraw the delegation of specific tasks to unlicensed delegation of specific tasks to unlicensed assistive personnel. assistive personnel. The SDE School Nurse Consultant or LEA The SDE School Nurse Consultant or LEA School Nurse Administrator shall submit a School Nurse Administrator shall submit a report(s) to the ABN in a format specified report(s) to the ABN in a format specified by the Board upon request. by the Board upon request.

Author: Author: Alabama Board of Nursing. Alabama Board of Nursing.Statutory Authority:Statutory Authority: Code of Alabama, 1975Code of Alabama, 1975, § 34-21-, § 34-21-

2(c)(21).2(c)(21).History: History: September 29, 1982. September 29, 1982. Repealed and Replaced:Repealed and Replaced:

Filed October 29, 2001. Effective December 3, 2001.Filed October 29, 2001. Effective December 3, 2001.

Suspending Delegation and Suspending Delegation and ReportingReporting

The LawThe Law The Americans with Disabilities Act is a Federal Law that applies to children with physical disabilities, adults with learning disabilities,and children with mental disorders.

How other Agencies Impact How other Agencies Impact Medications in schoolsMedications in schools

– Doctors are required to have a specific DEA Doctors are required to have a specific DEA number to write prescriptions for controlled number to write prescriptions for controlled substances. substances.

– The Alabama Board of Pharmacy has The Alabama Board of Pharmacy has regulations regarding the dispensing, regulations regarding the dispensing, packaging, and distribution of medications packaging, and distribution of medications by pharmacists and pharmacies. by pharmacists and pharmacies.

Board of Pharmacy regulations impact medicines in the Board of Pharmacy regulations impact medicines in the schools---particularly field trips and off-campus events. schools---particularly field trips and off-campus events.

– The Alabama Department of Public Health The Alabama Department of Public Health has regulations about reportable events, has regulations about reportable events, communicable diseases, and other public communicable diseases, and other public health issues.health issues.

Confidentiality/Privacy Confidentiality/Privacy

a) Health records are confidential and are kept separate from the school records.

b) The medication assistant may need to know some information from the student health record if it is required in order to complete the medication task.

c) Information provided to the medication assistant should not be repeated to other students,school employees,and teachers.

Health Information is Confidential!Health Information is Confidential!

Access to medical records should be limited!Refer all release of information requests to the nurse.Use appropriate areas to administer medications, avoid public exposure.Disclosure of sensitive information could result in legal liability.

Responsibilities of the Responsibilities of the Medication AssistantMedication Assistant

a) ABA approved training for medication assistance by an unlicensed personnel.

b) Training specific to LEA and school.c) Training in specific student issuesd) Adheres to local policies and procedures.e) Follows the outlined plan of care for individual students

which is developed by the nurse.

Successfully Completes:

Responsibilities of the Medication Responsibilities of the Medication Assistant:Assistant:

1) Do not participate in activities that require: professional nursing judgment , knowledge, or skill

2) Notifies the school nurse when professional nursing care is required.

3) Notifies the school nurse immediately when there is --- suspicion of a medication reaction --- a medication error --- a change in the student’s health status

4)Completes timely, accurate documentation in accordance with state and local policies

No prescription medication may be No prescription medication may be given without:given without:– parent authorization, parent authorization, – a healthcare provider order, and a a healthcare provider order, and a – pharmacy label. pharmacy label.

Review local policies. Review local policies.

Specific Rules Related to Specific Rules Related to Prescription MedicinePrescription Medicine

Prescription MedicationPrescription MedicationMust have: Must have:

Student NameStudent Name

Physician IdPhysician Id

Name of drug and strengthName of drug and strength

DateDate

Dose, Time, RouteDose, Time, Route

Over –The Counter Medications Over –The Counter Medications Requires:Requires:

Original containerOriginal container

Student name Student name

Written parental permission Written parental permission

To be delivered to school by parent To be delivered to school by parent or guardian.or guardian.

Under no circumstances should the school Under no circumstances should the school stock over-the-counter (OTC) medicines, stock over-the-counter (OTC) medicines, such as Tylenol, for student or staff use.such as Tylenol, for student or staff use.

OTC must be provided by the parent in the OTC must be provided by the parent in the original container with specific instructions original container with specific instructions as to when or why such medicines may be as to when or why such medicines may be necessary. necessary.

Specific Rules Related to OTC Specific Rules Related to OTC MedicineMedicine

The delegating RN must evaluate and The delegating RN must evaluate and approve all OTC medicines and parental approve all OTC medicines and parental instructions. instructions.

The delegating RN will determine if the OTC The delegating RN will determine if the OTC medicine is appropriate and whether a medicine is appropriate and whether a provider order is also necessary.provider order is also necessary.

Specific Rules Related to OTC Specific Rules Related to OTC MedicineMedicine

Use of the Six Rights:Use of the Six Rights:

1. right student1. right student

2. right medication2. right medication

3. right dose3. right dose

4. right time4. right time

5. right route5. right route

6. right documentation6. right documentation

Responsibilities Related to Responsibilities Related to Controlled SubstancesControlled Substances

Identifies controlled substances and stores Identifies controlled substances and stores in a secure location according to state and in a secure location according to state and local policies. local policies. Documents the receipt, number, and Documents the receipt, number, and return of controlled substances according return of controlled substances according to state and local policies. to state and local policies. Reports discrepancies in the quantity of a Reports discrepancies in the quantity of a controlled substance to the school nurse, controlled substance to the school nurse, principal and other authorities according principal and other authorities according to state and local policies. to state and local policies.

Expected Outcomes for Expected Outcomes for StudentsStudents

Remain in school, maintain or Remain in school, maintain or improve health status, and improve improve health status, and improve his/her potential for learning. his/her potential for learning.

Receive medication as prescribed by Receive medication as prescribed by a licensed prescriber. a licensed prescriber.

Demonstrate knowledge of the Demonstrate knowledge of the principle of self-care and principle of self-care and responsibility through appropriate responsibility through appropriate self-medication procedures. self-medication procedures.

Thank – You Thank – You Please follow with Module 4 and Please follow with Module 4 and

then take test.then take test.

Information in this presentation was taken Information in this presentation was taken from the curriculum to teach unlicensed from the curriculum to teach unlicensed school personnel to assist with school personnel to assist with medications by the Alabama Board of medications by the Alabama Board of Nursing and the Alabama State Nursing and the Alabama State Department of Education. Department of Education.