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Medication Administration Handbook Fall 2013 Katy Waugh, MS, RN, CNS San Mateo County Schools Insurance Group

08 Fall

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ADMINISTRATION OF MEDICATION AT SCHOOL

Table of Contents ADMINISTRATION OF MEDICATION AT SCHOOL ................................................................................... 2 OVERVIEW ........................................................................................................................................................... 2 ADMINISTRATION OF MEDICATION ........................................................................................................... 2

HEALTH SERVICES STAFF REPONSIBLITIES .................................................................................................... 5 MEDICATION FORMS ............................................................................................................................................ 10 REFERENCES/RESOURCES ..................................................................................................................................... 11

To go directly to each section, please click on the section name.

OVERVIEW

Students are coming to school with more health needs and chronic conditions that require

medication than ever before. It is not uncommon for students with chronic health conditions to

require nursing assessment and consultation, monitoring or management to attend school.

Development of Individual Healthcare Plans (IHP) to document the necessary services and

Emergency Action Plans may be needed.

An IHP may be written to outline medication administration and specialized procedures. An IHP

may also need to incorporate special accommodations from transportation departments, food

services departments, Before-and-After-School Programs, summer enrichment, field trips and

other designated program areas. Individualized Health Plans and Emergency Plans should be

completed before the student attends school and updated each school year or as needed

throughout the school year.

If the student qualifies under Section 504 of the 1973 Rehabilitation Act the Individual

Healthcare Plan (IHP) may be incorporated into a 504 Plan. Students who also need educational

assistance in addition to their medical needs may qualify under Special Education Programs and

the IHP then becomes part of the Individualized Education Plan (IEP).

ADMINISTRATION OF MEDICATION

Medication administration policies apply to all prescription medications, over-the-counter

medications (OTC), vitamins, herbal/alternative remedies and research medications. Ideally, all

medication would be administered at home, and the school would have minimal involvement.

Altering the medication administration schedule slightly or using long-lasting medications are

strategies that can be employed so the medication will not be needed during school hours.

However, because this is not always feasible and regular school attendance is encouraged, the

law provides that school personnel may assist pupils with administration of medication if certain

requirements are met California Education Code (CEC) 49480 , CEC 49423 .

Only the following California licensed professionals are allowed to prescribe medication

California Business and Professions Code 4060 : physicians (MD), dentists (DDS), podiatrists

(DPM), veterinarians (DVM), naturopaths (ND), Nurse Mid-wives (CNM), Nurse Practitioners

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(NP), and Physician Assistants (PA). Credentialed school nurses (RN) are responsible for

implementation of the Medication Program at their sites and are responsible for contacting the

physician if questions arise (CEC 49480 ). Only a licensed nurse (RN or LVN) can take a

verbal order from a physician.

Medication Regulations include the following:

At the beginning of the school year the district will notify parents/guardians of the

options available to students who need medication during the school day and the rights

and responsibilities of parents/guardians regarding those options. (Parent Handbook/First

Day Packet).

Parent Authorization for the Medication Administration at School Form (yellow) with both parent and California licensed physician signature must be on file and renewed

every school year stating the medication, dosage, timeline, and effects of the medication.

The Parent/Guardian consent allows for school personnel to communicate with the

student’s physician regarding the medication and its effects. The physician may counsel

school personnel as to the possible side effects of the medication on the student mental,

physical, intellectual, and social behavior as well as possible behavioral signs and

symptoms of adverse side effects, omission and overdose.

Parent/Guardian must provide all medication needed in prescription/pharmacy packaging,

clearly labeled with the student name and personal information. If the medication

requires a measuring device (liquid or syringe) the parent should supply it also. If there

are special instructions for administering the medication on the forms, the instructions

should be entered onto the school Medication Log immediately.

Medication regulations must be followed for all school-sponsored events including

field trips, co-curricular and extra-curricular events, camps and after-school

programs. (See section on Medication-Field trips)

Parent/Guardian may choose to administer medication or special procedures to their child

at school or to designate in writing another individual who is not a school employee to do

so at their behalf.

If a parent/guardian wishes to designate an individual to administer the medication who is

not an employee of the district, the parent must submit a written statement with the

following information: identify the individual, state the individual is willing to accept the

designation, ask that the individual is to be allowed at the school site, state limits on the

individual’s authority.

Only licensed personnel such as a registered nurse or vocational nurse may administer

injectable medications. Medications such as Insulin, Epinephrine and Diastat may be

given by trained unlicensed volunteer school personnel per statute: CEC 49423, CEC

49414, and CEC 49414.7).

District staff assisting students with medications, medical testing or specialized

procedures are required by law to maintain current certification in cardio-pulmonary

resuscitation from a recognized provider such as the American Red Cross or American

Heart Association (CEC 49414(e)(2)). Unlicensed staff must be specifically trained for

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that specific medication, medical testing or specialized procedure, and have a

communication link.

Upon request of the parent/guardian and with the approval of a physician, a student with

a medical condition that requires frequent monitoring, treatment, or testing such as

diabetes, severe allergy or asthma; may be allowed to self carry and self administer, self

monitor and self test. The student must observe Universal Precautions in the handling of

blood and other bodily fluids. In addition, the parent/guardian agrees to release the

district and school personnel from civil liability if the student suffers an adverse

reaction as a result of the self-administration of medications.

The school administrator/school nurse will schedule yearly in-service to familiarize

school site staff with emergency medications, ensure that school staff can recognize the

signs and symptoms of emergency situations associated with asthma, anaphylaxis,

diabetes and seizures and other medical conditions where immediate medical response

might be needed. Staff will understand how to use and access emergency medications for

these conditions and understand how to follow emergency back-up procedures to include

calling 911.

The school nurse trainer/site administrator and/or Human Resources will maintain

training logs or documentation of training in the administration of epinephrine auto-

injectors, diabetic blood glucose monitoring, Emergency Anti-Seizure Medication

(Diastat) Administration, Emergency Diabetes Glucagon Administration and

cardiopulmonary resuscitation certifications at the school site. As part of the emergency

medication provision for Epinephrine auto-injectors the district will retain copies of the

CDE Anaphylaxis training standards of Education Code Section 49414 and other

authorized training standards for diabetic and seizure emergency care as reference.

Management of Epileptic Seizures: Emergency Anti Seizure Medication

CEC 49414.7 allows districts to train unlicensed school personnel to provide emergency

medical assistance if a student has emergency seizure medication (rectal valium) that is FDA

approved, when licensed health care professionals are not available.

Student Self Administering Medications Such as Asthma Inhalers

CEC 49480 and CEC 49423.1 allow students to carry asthma Inhalers if a written request

by parent and physician has been received and includes the statement that the student is allowed

to self-administer. The physician must also affirm the student was trained to correctly identify

symptoms and correctly use the inhaler. The parent/guardian must also state they absolve the

district from civil liability if a problem occurs and acknowledges that permission can be revoked

if the medication is miss-used, over used, or shared with other students, etc.

The student must be responsible (usually grade 4 and above) and must be able to identify asthma

symptoms and demonstrate correct inhaler use. Permission to self-carry/self administer can be

denied if inhaler is shared or misused. It is recommended a second inhaler be kept in the health

office for emergencies.

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Injectable: EpiPens, Insulin Pens, Glucagon and others use in school:

California law allows students with severe allergy and diabetes to carry emergency auto inject-

table Epinephrine, Insulin Pens and emergency injectable Glucagon in backpacks with

permission from parent and physician. An Individualized Healthcare Plan (IHP) should be

developed for the student with instructions on medication use.

Parent and physician must state that the student be allowed to self-administer, confirming that

the student is trained to self-administer. The physician signs that the student was trained to

correctly identify symptoms and correctly use the Epinephrine auto injector (EpiPen), Insulin

Pen, or Glucagon Kit. Parent/guardian absolves district from civil liability if a problem occurs

and acknowledges that permission can be revoked if it is found the medication is miss-used, over

used, or shared with other students, etc.

Sunscreen and Bug Repellent Use

Per California law, sunscreen, UV protective lip balm, and insect repellant will not need

physicians orders to be used in school, but parent permission must be in place and the student

must be able to self apply the lotion/spray/cream. It is recommended spray not be used in the

school setting and especially not on or around the face.

HEALTH SERVICES STAFF REPONSIBLITIES

Schools are responsible for safely assisting with student medication as prescribed by an

authorized health care provider who is licensed by the state of California to prescribe medication.

All staff must maintain strict student confidentiality.

Do not give prescription or over-the-counter-medication unless Parent Request and Physician

Statement is on file. NEVER VIOLATE THIS RULE.

Health services staff needs to periodically check Medication Administration Forms, bags and

logs to be certain the following criteria are met:

A written statement from a physician detailing the method, amount, and the time

schedules by which such medication is to be taken.

A written statement from the parent or guardian of the pupil requesting that the school

assist the pupil as set forth in the physician’s statement. (CEC 49423). It is the parent

responsibility to supply any special medication measuring or administration device

(measuring cup for liquid meds, mask and spacer for asthma inhaler, etc.)

Parent request and physician statement must be renewed every school year. A newly

signed physician statement must be submitted any time the medication type, time, dose or

method is changed.

A record of medication dosages to child, including date and time medication is

administered, shall be maintained in the Medication Log

record . It should be completed as part of the medication intake process.

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Each medication container shall have a pharmacy label with the name of the medication,

the name of the person for whom prescribed, the name of the physician, and the

physician’s instructions. Asthma Inhalers and epinephrine auto-injectors should also

have a pharmacy label or in their original containers.

Each person’s medication shall be stored in its original container.

Controlled substances must be counted by 2 people (CFR Title 21, Section 1300.01,

California Department of Education Medication Advisory 2005). The number is recorded

on the back of the Medication Log and both people sign. It is best if student’s parent and

school staff count the medication.

Special Instructions: note any special instructions about medication administration from

the parent on the back of the Medication Log. Notify the nurse/site administrator/teacher.

Medicines shall be kept in a safe and locked place that is not accessible to persons other

than employees responsible for health supervision. (CAC Title 5 §18170).

Health Office staff maintain a list of students needing medication during the school

day identifying the medication, time and dose; a list of who is authorized to self-

administer medication, and a list of staff authorized to assist and administer

medications.

If a student misses a prescribed dose, an attempt to reach the student must be made.

Changes in Dosages: If a parent states the medication dose has changed, trained school

staff must give the medication as prescribed by the physician until new orders have been

obtained (using a FAX is acceptable). Have the parent contact the physician for new

written orders.

School Sponsored events: All medication policies apply for field trips and other school

sponsored events. New orders must be obtained for morning/evening doses if not on

original orders. Parent should obtain a second labeled bottle and send only the amount

needed for the trip.

Training Documentation: School personnel trained to assist and administer medications

will receive appropriate training and documentation of training will be maintained at the

school site and District Human Resources.

Disposal of Medication: Ensure all unused, outdated, discontinued medications are

returned to the parent/guardian. At the end of the school year, all medications are

returned to the parent/guardian and if unable to return, disposed per district policy. Empty

the sharps container as needed or at the end of each school year according to district

policy.

Errors: Provide immediate assistance and report to the school nurse/site administrator if

there is an instance where the medication is not administered correctly, including

administration of the wrong medication to the wrong student, or failure to administer the

medication according to the physician statement. Document the error in the student

record, notify the parent and prescribing physician, and complete the Medication

Incident Report (send copy to SMCSIG/site administrator/health services at the

district office).

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Designated personnel must be trained and demonstrate competency to assist with

medication administration accurately and safely prior to administration. It is

recommended they maintain current CPR certification from a recognized provider whose

standards are similar to the American Red Cross or American Heart Association.

ADMINISTRATION BASICS

When assisting students to take medications, REMEMBER THE 6 RIGHTS: Right

student, Right time, Right medicine, Right dose, Right route and Right

Documentation (poster listed under Medication Forms)

When taking medication, all students must have direct observation/supervision

unless a physician states the student can self-medicate (such as inhalers, etc.).

Oral Medication Procedure

Ask the pupil to give his/her name. Double check name on medication bottle.

Check the Medication Log to ascertain when the medication was last given.

Check the physician’s statement against the medication label. If there is any

discrepancy, DO NOT GIVE THE MEDICATION! Consult the nurse/site

administrator for direction.

After washing hands pour the medicine into a paper cup, medication cup, or container

lid and assist the student to get a cup of water and to take medication. Monitor the

student while the medicine is taken and watch that the oral medication is

swallowed and not palmed or pocketed in their mouth.

Record the date, time, and signature on the pupil Medication Log after medication

is given. If the medication is not given, record whether the student was absent,

refused or did not come to the office.

Report any adverse reaction noted to the nurse/site administrator immediately and

take appropriate action. Record in the comment section on the back of the log (date

and sign initials). Contact parent and physician for assistance.

ADDITIONAL CONSIDERATIONS - CHANGE THIS HEADER

Students who do not come to the health office for their medication, need to be called

to the office so the dose is not missed. If a student refuses to come to the health

office or take the medication, document the incident and contact parent. After 3

student refusals send home a health referral and notify the physician.

Discuss any problems of student compliance with the nurse/site administrator.

Medication may be given within 30 minutes of doctor’s orders.

Early AM dose of medication that is to be given “as needed” or “PRN”. Check with

the parent to confirm a missed dose before giving additional medication.

If a student needs pain medication “as needed” or “PRN” and no medication order

was obtained, the school staff cannot give the medication. Contact the parent and

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explain that medication will not given without a physician’s order. Invite the

parent/guardian to bring the medication and assist the student.

If a medication error occurs, contact nurse/site administrator and parent. If multiple

doses or a wrong dose is given to a student call Poison Control (1.800.222.1222) for

consult before calling parent. Document on Medication Incident Report and send to

SMCSIG.

Always return medication to locked storage area immediately after administration.

Place syringes, sharps, and needles in the sharps container after use. Save EpiPens to

give to EMSA/911 personnel to accompany the student to the hospital.

Place completed Medication Log in the student’s health folder when it has been

filled, medication dose has changed/discontinued, and/or at the end of the school

year.

Medication Guidelines for Field Trips and School Sponsored Events.

School site staff will notify the school nurse when planning school sponsored events two

weeks in advance of activities such as, camps, field trips, and athletic events, if students

will need medication monitoring, specialized testing or specialized.

School nurse or site administrator will designate appropriately trained staff to coordinate

medication administration or specialized procedures of testing for the trip who are CPR

certified by a recognized provider.

The school nurse/parent/guardian will provide to the designated staff member the

necessary equipment/supplies/medications/testing equipment that will be needed to safely

allow the student to participate in the event.

Designated school staff members will receive training in the medication type, use,

administration, side effects, and contraindications and or training on any special testing or

procedures needed for the student during the event.

Medication for each student will be prepared by the school nurse/site administrator in

individual containers such as a sealed envelope labeled with student name, medication ,

dose time, with copies of the original medication at school form for ease of transport.

Designated school staff will keep medications in a locked area or for mobility in a closed

container on his/her person at all times; such as a backpack, or fanny pack.

Designated staff assisting with medications, specialized testing, or specialized procedures

will have current training in cardiopulmonary resuscitation from a recognized provider

such as the American Red Cross or American Heart Association and will be able to

recognize emergency situations and understand how to access medical care if needed.

The school administrator will provide a communication link for the staff to gain access to

emergency services if they are needed.

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The designated staff member should have access to a fully stocked first aid kit during the

event.

The designated staff member will document all care given, medications administered and

all testing or specialized procedures provided during the event for all students including

students who are self-monitoring or administering; and copies will be given to the school

nurse for student records at the end of the event.

The designated staff member will insure that all medications and supplies are present

before leaving on the field trip and insure that all students who are self-monitoring and

testing have necessary supplies before leaving on the field trip. Verify that students have

required supplies and equipment enough for the duration of the trip.

After the event, all medications, testing supplies and equipment, first aid kits, and

documentation logs are returned to the school nurse/or sent home with parent/guardians.

If parent/guardian will be attending the field trip or school event to give medications,

testing or specialized procedures; school policy and procedure on medication

administration will apply and documentation of care will be required.

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MEDICATION FORMS

Parent Authorization for the Medication Administration at School Form (yellow) – English

Parent Authorization for the Medication Administration at School Form - Spanish (LIBERAR

DE RESPONSABILIDAD Y AUTORIZAR LA ADMINISTRACIÓN DE

MEDICAMENTOS EN LA ESCUELA)

Self-Administration Parent Authorization and Release for the Administration of Medication at

School (blue) - English

Self-Administration Parent Authorization and Release for the Administration of Medication at

School - Spanish (AUTO ADMINISTRACIÓN

LIBERAR DE RESPONSABILIDAD Y AUTORIZAR LA ADMINISTRACIÓN DE

MEDICAMENTOS EN LA ESCUELA)

Medication Administration Daily Log (green)

Medication Incident Report (bright red)

Six Rights of Medication Administration

Medication Administration Check List

Glucagon Administration: A Guide for School Personnel

To access forms:

Please log on to http://www.smcsig.org Click the member resources tab

Enter user name: smcsigmember Enter password: caughtyousafe

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REFERENCES/RESOURCES

MEDICATION ADMINISTRATION: LEGAL CONSIDERATIONS

CEC 49480 – administering medication for non-episodic conditions.

http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=EDC&section

Num=49480.

Program Advisory on Medication Administration (PDF; Updated 18-Jun-2012). As

authorized by the California Code of Regulations Title 5, Section 611, and approved on May 12,

2005, by the State Board of Education, this advisory provides non-binding guidance to local

educational agencies on medication administration in California public schools.

http://www.cde.ca.gov/ls/he/hn/documents/medadvisory.pdf

Medication Administration Assistance : Provides a sample checklist for local educational

agencies with helpful information that may be given to parents and guardians when children need

to take medication before school or take medication at school.

http://www.cde.ca.gov/ls/he/hn/medassist.asp

CEC 49423 – Medication Administration in the Schools, plus Carry/Self administer Epinephrine Auto-Injector.

http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=EDC&section

Num=49423.

California Supreme Court Ruling August, 2013 (S184583) : ruled that CEC 49423 allows the

student’s physician to decide whether prescription medications, including insulin, may be safely

administered by trained unlicensed school personnel or whether a particular student’s needs can

only be met by a licensed health care provider (p. 24-25).

http://www.courts.ca.gov/opinions/documents/S184583.PDF

ASTHMA

CEC 49423.1 –Carry/self-administer Asthma Inhaler

Starlight Asthma Tool Kit For Schools (tool kit) is a comprehensive asthma resource for

schools. California Breathing collaborated with Starlight-Starbright Children’s Foundation on the

development of the tool kit.

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ANAPHYLAXIS/SEVERE ALLERGIES

CEC 49414 - Anaphylaxis - Epinephrine Auto-injectors for severe allergic reaction –

stocking for general use.

FARE/NASN Anaphylaxis Resource:

http://www.nasn.org/ToolsResources/FoodAllergyandAnaphylaxis

The Centers for Disease Control has worked with NASN, the Food Allergy & Anaphylaxis

Network and the National School Boards Association to develop comprehensive guidance and

resources for food allergy and anaphylaxis management in the school setting. A comprehensive

list of forms and resources are available on this page.

FARE/Food Allergy Action Plan/Emergency Care Plan http://www.foodallergy.org/document.doc?id=234

Training Standards for the Administration of Epinephrine Auto-Injectors . As authorized

by California EC Section 49414, California public schools may train designated school personnel

in the administration of life-saving epinephrine to students and adults who are experiencing

severe allergic reaction and anaphylaxis. Sample forms related to the "Training Standards for the

Administration of Epinephrine Auto-injectors" are available from the California School Nurses

Organization The California Department of Education does not endorse or approve the

sample forms but provides this as information only.

DIABETES

CEC 49414.5 – Diabetes – Glucagon Emergency medication

NIDDK National Institute of Diabetes and Digestive and Kidney Diseases, last reviewed

11/1/2012. Helping the Student with Diabetes Succeed: A Guide for School Personnel: This

comprehensive resource guide helps students with diabetes, their health care team, school staff,

and parents work together to provide optimal diabetes management in the school setting. View or

download

http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=97#main

Schools Legal Responsibilities: Federal laws:

http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=97#section4

Diabetes Management Plan:

http://ndep.nih.gov/media/sample-diabetes-medical-management-plan-508.pdf

Individualized Healthcare Plan (IHP):

http://ndep.nih.gov/media/sample-template-individualized-health-care-plan-508.pdf

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Hypo and Hyperglycemia Emergency Care Plans:

http://ndep.nih.gov/media/sample-emergency-care-plans-for-hypoglycemia-and-hyperglycemia-

508.pdf

Diabetes Care Tasks at School: What Key Personnel Need to Know: 13 training modules that

include PowerPoint presentations and videos, available on the American Diabetes Association

website www.diabetes.org. To find this place the name of this document in the search box in the

upper right corner on the home page. http://www.diabetes.org/living-with-diabetes/parents-and-

kids/diabetes-care-at-school/school-staff-trainings/diabetes-care-tasks.html

Glucagon Administration (PPT) Glucagon Administration= Watch the Video (2:24)

Helping to Administer to the Needs of Students with Diabetes (HANDS), National School

Nurse Association, available to members on the www.nasn.org website and available training

dates are listed.

The FACES from Novo Nordisk (handouts at the workshop)

Low Blood Sugar/Hypoglycemia: http://www.healthcarehost.net/medlink/PDF/12168-

121112_C4C_FactSheet_LowBloodSugar.pdf

High Blood Sugar/Hyperglycemia:

http://www.healthcarehost.net/medlink/PDF/12158-

121112_FINAL_C4C_FactSheet_HighBloodSugar.pdf

EPILEPSY/SEIZURES

CEC 49414.7- Seizures – Emergency Anti-Seizure Medication (Diastat)

Emergency Regulations on the Administration of Emergency Anti-Seizure Medication by

Trained Volunteer Nonmedical School Personnel, Title 5, California Code of Regulations,

Sections 620-627 (PDF)

California School Nurses Organization The Gree Book: Guidelines for Specialized Physical

Healthcare Services in School Settings. 2nd

Edition. CHAPTER XIII, Seizure Management

in the School Setting, Revised (2012). Available from www.csno.org/store

Epilepsy Foundation: http://www.epilepsyfoundation.org

Seizure First Aid (Handout from Workshop):

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6 Rights of

Administering Medication

Every Med ...…. Every Time

1. Right Student

2. Right Medication

3. Right Dose

4. Right Time

5. Right Route

6. Right

Documentation

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Medication Administration Checklist

“6 Rights”: Right Student, Right Medication, Right Dose, Right Time, Right Route, Right Documentation

Steps – One student at a time 1 Identify the student you are giving the medication to

2 Wash hands

3 Gather supplies (glass/cup, spoon, water, etc.)

4 Unlock the medication storage area

5 Locate the container containing the student’s medication.

6 Identify the right medication

7 Compare the pharmacy label with the Medication Log and the Medication

Administration Form. Make sure all the information matches. Check the expiration date.

8 Prepare the right dose. Make sure it is the right strength.

9

Assist giving the medication to the right student by the right route and right position

(if applying topical medication or eye drops or ear drops). Wear gloves if assisting with

topical creams or eye drops

10 Oral: place in cup, pill cup, or pill cap or pour into clean hand.

If oral make sure the student swallows the medication.

11

Topical: Wear gloves if assisting with topical creams, cleanse area, and apply as

directed.

Eye Drops: Wear gloves. Position student looking up, use one cotton ball to cleanse

eye, drop med onto lower lid, close eye, blot with second cotton ball.

12

Document the medication given: write down the time, and initials under the right date

on the Medication Log. Check to make sure you have signed and initialed the page.

Compare the pharmacy label to the medication record again.

13 Return the medication to the student’s medication container. Return container to the

storage area and lock the storage area. Clean the area.

14 Wash hands

15 Observe for any unusual or adverse effects from the medication.

Note: Parent Responsibilities: provide all supplies (spacers/masks for inhalers, cut pills if partial doses are

ordered, correct liquid measuring cup), notify school if there are changes in medication or in medication

dose, and remove unused medication at the end of the year.

Page 14

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GLUCAGON ADMINISTRATION: A Guide for School Personnel

NovoNordisk GlucaGen HypoKit Lilly Glucagon Emergency Kit

WHAT IS GLUCAGON?

Glucagon is a hormone made by the body

WHY use GLUCAGON?

Glucagon’s primary effect is to raise blood glucose (blood sugar) levels by helping the liver

produce more glucagon

WHEN to use GLUCAGON?

Use ONLY when the person is unconscious or having a seizure

Glucagon will most likely cause nausea and vomiting

Have another adult call 9-1-1

HOW to use GLUCAGON?

Open kit and remove the flip-top seal from the top of the glucagon vial

Remove the needle cap from the syringe (keep plastic piece on plunger)

Inject all of the sterile water from the syringe into the vial of glucagon (keep needle in vial)

Gently swirl vial until the solution is clear (do not shake the vial)

Draw up prescribed amount of solution from the vial into the syringe (See

Healthcare Provider Orders)

WHERE to give GLUGACON?

TURN person on his/her side

CLEAN injection site if possible

INJECT the glucagon into the upper arm (deltoid) or leg (outer thigh)

o Preferably not through clothing, however can if necessary

WITHDRAW the needle and apply pressure a the injection site

Discard used syringe back in kit (do not recap)

WHAT to do after giving GLUCAGON?

EMT’s should have arrived

If not, call 9-1-1 for estimated time of arrival

Give EMT the used GLUCAGON kit

WHEN the person becomes conscious and is able to chew and swallow:

The person should respond in 20 to 30 minutes

If alert and talking, give a fast-acting sugar like fruit juice or regular soda

Then give any type of milk (chocolate, whole, skim, etc.)

If available, give a protein like cheese and crackers or a meat sandwich

Used with permission San Jose Unified SD/rev. 9.2013 Page 15