MEDICATION ADMINISTRATION FOR SCHOOL PERSONNEL

Presented by MVNAMarch 2014

Purpose of the PresentationTo promote safe, accurate medication administration in

the school setting• Ensure the safety of students receiving medications• Accommodate students’ health needs• Increase school personnel’s knowledge and

competency when administering a medication in an emergency situation and/or on school field trips

• Provide consistent medication administration practice within the school building

Medication Administration Policy

When appropriate, encourage parents to administer medications to students before or after school hours.

If a student needs a medication during the school day, it is recommended that you follow your school’s medication administration policy

Six Rights of Medication Administration

• Right Student• Right Medicine• Right Route• Right Time– Within ½ hour before or

after designated time• Right Dose• Right Documentation– Record administration

on record as soon as possible

• It is recommended that both the student and medication administrator wash their hands prior to delivery of the med.

• Administrator: Always observe the student taking the medication

Daily Medications

• Designated school personnel will administer the daily medications

• Daily meds are usually oral and inhalers, but they can also include a topical medication such as eye drops or an ointment

• Document the administration of the medication as soon as possible

Medication Authorization and Administration Form

Emergency MedicationsEmergency medication may include:• Epi Pen – for Allergic Reaction• Inhaler and/or Nebulizer – for Asthma Episode• Diastat Rectal Gel – for Seizure Control• Glucose Source/Glucagon Injection – for

Diabetics

Where are your school’s emergency medications stored?

(in the office? classroom? lunch room? student’s backpack?)

If parents/students bring meds to school:

• If you are a classroom teacher: do not accept medications from parents or students

• Direct them to the person who administers daily medications in your building

• If a student informs you of a medication they are self-administering, notify your school’s medication administrator for recommended procedure

•

ADMINISTRATION OF ASTHMA AND ALLERGY EMERGENCY MEDS

AsthmaDefinition: Respiratory condition that includes:• Airway swelling (inflammation)• Tightening of the airway muscles (broncho-

constriction)• Mucous production

Asthma medications are:rescue/relievers (bronchodialators) and controllers (anti-inflammatories)

Asthma Medications• Controller Inhaler:

• Administered 1 or 2 times/day• Most students take the first dose at home before school, but some make

take it at school in the morning.• Advair (purple disk) and Pulmicort are two common controller

medications.• When used over time, a controller medication will prevent/control

asthma symptoms. It will not relieve acute asthma symptoms• Rescue/Reliever Inhaler:

• Most common inhalers are Albuterol, ProAir and Ventolin.• Administered “when needed”• Purpose is to relax muscles in the airways temporarily in order to help

relieve the student’s asthma symptoms.• May be used prior to exercising to prevent asthma symptoms.• “When needed” implies that a student is having asthma symptoms in

response to asthma triggers, such as cold and/or warm weather, illness, exercise, pollens/grass, or animals with fur.

DEMONSTRATION OF THE PROPER ADMINISTRATION OF AN INHALER

Nebulizer

• This is used instead of an inhaler.• In a school setting, it is commonly used for the

administration of a rescue/reliever medication.

• It’s often used by younger children who are not ready to use an inhaler

• Often used when a student has an upper respiratory infection (common cold).

DEMONSTRATION OF THE ADMINISTRATION OF A NEBULIZER

ALLERGY EMERGENCY MEDICATIONS

Allergies and Anaphylaxis• Normal immune defense

is a response to a harmful substance (antibodies formed to fight virus, bacteria etc.)

• An allergy is an exaggerated immune response. Antibodies and histamine are produced in response to a generally harmless substance (like a specific food)

Common Foods:•Eggs•Milk•Peanut•Wheat•Shellfish•Soy•Tree nut•Fish

Allergies and Anaphylaxis• Anaphylaxis is a severe,

potentially life-threatening reaction to something to which the body has become hyper-sensitive. Anaphylaxis happens quickly after the exposure, is severe, and involves the whole body.

• Tissues in different parts of the body release histamine and other substances. This causes the airways to tighten and leads to other symptoms which can include a rapid, weak pulse, a skin rash, and nausea and vomiting.

More Common Causes of Anaphylaxis:•Food •Insect stings/ bites•Medications•Latex•Unknown

Anaphylaxis: Life-threatening type of allergic reaction

Severe symptoms after suspected of known ingestion: one or more:

Or a combination of symptoms from different body areas even if not severe:Example—hives and nausea/vomiting

Part of Body One or more combination of:

Lung Short of breath, wheeze, repetitive cough

Heart Pale, blue, faint, weak pulse, dizzy, confused

Throat Tight, hoarse, trouble breathing or swallowing

Mouth Obstructive swelling (tongue or lips)

Skin Many hives over body

Gut Nausea, abdominal cramps, vomiting, diarrhea

DEMONSTRATION OF THE ADMINISTRATION OF A AN EPI-PEN

Documentation

Document the administration of an emergency medication on the student’s med administration form.

Locate the student’s form. Check with your school’s designated medication administrator, if needed.

Medication Errors• They are never intentional• Usually the result of “chaos” in the health room• Error may include:– Giving medication at the wrong time– To the wrong student– Wrong dose– Wrong medication – Incorrect documentation– Wrong route

• Notify your school’s administrator, student’s parent/guardian, and physician.

Injury/Incident Report Form

ADMINISTRATION OF MEDICATIONS

ON FIELD TRIPS

Field Trip Medication Planning for School Staff

Field Trip Student Health Information

Medication Order and Administration Form

QUESTIONS?

ADMINISTRATION OF DIABETES EMERGENCY MEDICATIONS

Diabetes• Diabetes is a condition in which the body

cannot use sugar/ carbohydrates from food that is eaten because the body does not make or cannot properly use the hormone insulin that is made in the pancreas. Without insulin the body cannot use the food for energy and therefore results in high bloods sugars.

• Diabetes management involves insulin injections, testing blood sugar, following a meal plan and getting regular exercise.

Low blood sugar (or blood glucose)• Both high and

low blood sugar are serious and can result in an emergency. However, high blood sugar develops over hours or days while low blood sugar can develop in minutes. This emergency will be addressed here.

• Common symptoms of low blood sugar:– Shakiness– Hunger– Irritability, crying– Sweating, pallor– Weakness, tiredness– Dizziness– Headache– Poor coordination– Confusion– Slurred speech – Blurred vision– Combativeness– Seizure– Loss of consciousness

Fast-acting sources of sugar

• 3-4 glucose tabs; a tube glucose gel• 4 oz. of juice• 4 oz of regular (not diet) soda• 8 oz skim milk• Quick-absorbing carbohydrates work fastest,

but any carbohydrate source can be used:– Crackers, bread, dry breakfast cereal– Hard candy or something like Starbursts– (Chocolate candy contains fat that slows absorption so is not first choice)

Glucagon• Glucagon is a hormone made by the

pancreas. It raises blood sugar by sending a signal to the liver to release stored sugar.

• It must be injected—much like an insulin injection.

• It’s used in a severe low blood sugar—when s/he is– Unconscious– Having a seizure– So uncooperative that you cannot given juice

or sugar by mouth

Glucagon Kit

1. Remove cap from the bottle2. Inject the liquid from the syringe into the dry powder bottle

3. Roll the bottle gently to dissolve the powder. Do not shake the bottle.4. Draw the fluid back into the syringe.

Child dose may be a half of adult dose—see

individual emergency plan.

5. Inject into loose tissue on upper arm, thigh or buttocks—much as you would inject insulin.

After injecting glucagon:• Position child on their side. Nausea and

vomiting is a common reaction. • Ensure that appropriate help has been called:

EMS, parents, doctor • Recovery should occur in 15-20 minutes. • As soon as the child is able to swallow, give

some fast-acting sugar. Then give a longer-acting source of carbohydrate (cheese, sandwich)

ADMINISTRATION OF EMERGENCY MEDICATION FOR A SEIZURE

Basic Seizure First Aid• Stay calm and track time• Keep person safe• Do not restrain• Do not put anything in

mouth• Stay with person until fully

conscious• Record/ report seizure

appropriately

• For tonic-clonic seizure– Protect head– Keep airway

open– Turn child on

side

When is a seizure an emergency?

• When—–Convulsive (tonic-clonic) seizure lasts

longer than 5 minutes (see individual emergency plan)– Student has repeated seizures without

regaining consciousness– Student is injured or has diabetes– Student has breathing difficulties– Student has a seizure in the water

Seizure Action Plan

Rectal administration of Diastat

• Sometimes a doctor may prescribe a medication by a sublingual or a buccal route– Sublingual: This means that the pill is placed under

the tongue where it will dissolve and be absorbed into the bloodstream. The person should not drink or eat anything until the medicine is gone.

– Buccal: This means that the medicine can be placed in the mouth between one of the cheeks and the nearby gum where it will dissolve and be absorbed into the bloodstream. Usually, medicines that can be taken sublingually can also be taken buccally. The person should not drink or eat anything until the medicine is gone.

Thanks for your attention!