ohio department of health medication administration in ohio schools: training for school personnel...

Ohio Department of Health Medication Administration in Ohio Schools: Training for School Personnel

Medication Administration in Medication Administration in Ohio Schools: Ohio Schools:

Training for Training for School PersonnelSchool Personnel


OverviewOverview Background, goals and objectivesBackground, goals and objectives Law and legal considerationsLaw and legal considerations Medication overview Medication overview Forms and proceduresForms and procedures Hand hygieneHand hygiene Field tripsField trips Six rights of medication administrationSix rights of medication administration The role of the designated employee who is The role of the designated employee who is

not a licensed health professional not a licensed health professional administering medication in schoolsadministering medication in schools


GoalGoal

The goal or purpose of the ODH The goal or purpose of the ODH Medication Administration in Ohio’s Medication Administration in Ohio’s Schools: Training for School Personnel Schools: Training for School Personnel is is to provide designated employees who to provide designated employees who are not licensed health professionals are not licensed health professionals (school personnel) administering (school personnel) administering medications in schools with the medications in schools with the knowledge, skills and resources to safely knowledge, skills and resources to safely administer medication prescribed for administer medication prescribed for Ohio school children.Ohio school children.


Course ObjectivesCourse Objectives

At the completion of this training course, the At the completion of this training course, the designated employee who is not a licensed designated employee who is not a licensed health professional will be able to:health professional will be able to:

1.1. Identify the requirements of ORC 3313.713 Identify the requirements of ORC 3313.713 2.2. Explain how federal confidentiality law (FERPA and HIPAA) Explain how federal confidentiality law (FERPA and HIPAA)

effect medication administrationeffect medication administration3.3. Locate the local school district’s medication administration Locate the local school district’s medication administration

policypolicy4.4. List the components of the local school district’s medication List the components of the local school district’s medication

administration policyadministration policy5.5. Tell the general procedures for administering medications Tell the general procedures for administering medications

in the school, including the six rights of medication in the school, including the six rights of medication administrationadministration

6.6. Successfully pass the medication administration post-testSuccessfully pass the medication administration post-test


BackgroundBackground Children with chronic and acute health Children with chronic and acute health

conditions may require medication conditions may require medication administration during the school day in order to administration during the school day in order to be academically successfulbe academically successful

In 2009, Ohio House Bill 1 updated school In 2009, Ohio House Bill 1 updated school medication administration law (ORC 3313.713) medication administration law (ORC 3313.713) to require school employees administering to require school employees administering medications after July 1, 2011 be:medications after July 1, 2011 be:– A licensed health professional A licensed health professional OROR– Complete a drug administration training program Complete a drug administration training program

conducted by a licensed health professional and conducted by a licensed health professional and considered appropriate by the boardconsidered appropriate by the board


Medication Administration in Medication Administration in Schools is Guided by Federal LawsSchools is Guided by Federal Laws

Federal Law: FERPAFederal Law: FERPA

Family Educational Rights and Privacy Family Educational Rights and Privacy ActAct

Ensures confidentiality of student Ensures confidentiality of student recordsrecords

Records must NOT be disclosed to Records must NOT be disclosed to anyone without consentanyone without consent

If confidentiality is breached, it can lead If confidentiality is breached, it can lead to liability and lawsuitsto liability and lawsuits


What is Disclosure?What is Disclosure?

Sharing information with Sharing information with – Personally identifiable Personally identifiable

informationinformation– By any means (including oral, By any means (including oral,

written, electronic, etc.)written, electronic, etc.)– To anyone elseTo anyone else


ExceptionsExceptions

There are a few exceptions There are a few exceptions regarding disclosure:regarding disclosure:1. School officials with 1. School officials with “legitimate educational interest”“legitimate educational interest”2. Transferring schools2. Transferring schools3. Emergency situations3. Emergency situations4. Directory information4. Directory information


““Legitimate Educational Legitimate Educational Interest”Interest”

While many are interested in students’ personal While many are interested in students’ personal health information, few may access it. health information, few may access it.

Only those: Only those: Designated responsible for an emergency Designated responsible for an emergency

responseresponse Who require it to fulfill professional Who require it to fulfill professional

responsibilitiesresponsibilities With educational need – Am I going to change With educational need – Am I going to change

the way I teach or interact with the student the way I teach or interact with the student because of the information?because of the information?

If in doubt, informed consent would always be If in doubt, informed consent would always be best.best.


Medication Administration in Medication Administration in Schools is Guided by Schools is Guided by

Federal LawsFederal LawsFederal Law: HIPAAFederal Law: HIPAA

Health Insurance Portability Health Insurance Portability Accountability ActAccountability Act

Generally, does not apply to schoolsGenerally, does not apply to schools– Does apply to health care providers with Does apply to health care providers with

whom schools may workwhom schools may work FERPA is the confidentiality law that FERPA is the confidentiality law that

schools must followschools must follow


Medication Administration in Medication Administration in Schools is Guided by State LawSchools is Guided by State Law

Ohio Law: Ohio Revised Code (ORC) Ohio Law: Ohio Revised Code (ORC) 3313.7133313.713

Refers only to prescription medication:Refers only to prescription medication: Requires school boards to have a policy Requires school boards to have a policy

for medication administrationfor medication administration Requires training for employees who Requires training for employees who

administer medicationadminister medication Describes authorization needed to Describes authorization needed to

administer medicationadminister medication Describes proper storage of medicationDescribes proper storage of medication


Who Can Administer Medication in Who Can Administer Medication in School?School?

ORC 3313.713 states:ORC 3313.713 states:OnlyOnly employeesemployees of the board who are: of the board who are:

– Licensed health professionals Licensed health professionals OROR– Who have completed a drug Who have completed a drug

administration training program administration training program conducted by a licensed health conducted by a licensed health professional which is considered professional which is considered appropriate by the board mappropriate by the board may ay administer medication prescribed administer medication prescribed for the studentfor the student

Non-Prescriptive or Over-the-Non-Prescriptive or Over-the-Counter (OTC) MedicationCounter (OTC) Medication

To administer OTC medication, school To administer OTC medication, school personnel must follow the local school personnel must follow the local school district OTC medication policy district OTC medication policy

OTC medication policy:OTC medication policy: Is not governed by ORC 3313.713 Is not governed by ORC 3313.713 Each school board must have an OTC policyEach school board must have an OTC policy• This may be different from other districtsThis may be different from other districts



General Procedure for General Procedure for Medication AdministrationMedication Administration

ParentsParents– Receive medication order from prescriberReceive medication order from prescriber– Have order filled by pharmacistHave order filled by pharmacist– Parent and physician must complete Parent and physician must complete

medication authorization form (MAF)medication authorization form (MAF)– Provide the medication and MAF to schoolProvide the medication and MAF to school– Tell the school about any changes in Tell the school about any changes in

medicationmedication


General Procedure for General Procedure for Medication Administration Medication Administration

continuedcontinued School personnelSchool personnel

– Create a Medication Documentation Create a Medication Documentation Record (MDR)Record (MDR)

– Administer medication according to Administer medication according to order and school policy/procedureorder and school policy/procedure

– Properly dispose of unused medication Properly dispose of unused medication


This is NOT acceptable…This is NOT acceptable…


Medical Authorization for Prescriptive Medical Authorization for Prescriptive MedicationsMedications

Prescriptive medication must be Prescriptive medication must be authorized in writing by a licensed authorized in writing by a licensed prescriber such as a:prescriber such as a:– PhysicianPhysician– DentistDentist– Advanced Practice Nurse (APN) with a Advanced Practice Nurse (APN) with a

certificate to prescribecertificate to prescribe– Physician Assistants (PA)Physician Assistants (PA)

A Medication Authorization Form (MAF) A Medication Authorization Form (MAF) must be used to document medication must be used to document medication administration order for the schooladministration order for the school


Medication Authorization Form Medication Authorization Form (MAF) (MAF)

Required by ORC 3313.713:Required by ORC 3313.713: A written statement signedA written statement signed byby

– The prescriber ANDThe prescriber AND– The parentThe parent

Must include ALL information on Must include ALL information on next slidenext slide

You must have a new MAF each school You must have a new MAF each school yearyear


Medication Authorization Form Medication Authorization Form (MAF) (MAF) continuedcontinued

1.1. Student’s name and addressStudent’s name and address

2.2. Student’s school and classStudent’s school and class

3.3. Name of the medicationName of the medication

4.4. Dose of the medicationDose of the medication

5.5. Times or intervals to administer the medicationTimes or intervals to administer the medication

6.6. Date to start medication administrationDate to start medication administration

7.7. Date to end medication administrationDate to end medication administration

8.8. Any possible severe reactionsAny possible severe reactions

9.9. Emergency phone number for the prescriberEmergency phone number for the prescriber

10.10. Special instructions for medication administrationSpecial instructions for medication administration


Prescription Medication in Prescription Medication in SchoolSchool

Must be in the original containerMust be in the original container Must have pharmacy labelMust have pharmacy label Must have an MAF signed by Must have an MAF signed by

prescriber and parentprescriber and parent


All Medication ChangesAll Medication Changes

ORC 3313.713 requires parents to tell ORC 3313.713 requires parents to tell the school about any changes in the school about any changes in medications administered at schoolmedications administered at school

Each change will require:Each change will require: A new MAF or update the current A new MAF or update the current

record if applicablerecord if applicable A new prescription label and containerA new prescription label and container


Medication Drop-Off and Pick-Medication Drop-Off and Pick-Up Instructions Up Instructions

Medication should be Medication should be dropped-off/picked-up by:dropped-off/picked-up by:– The parentThe parent– A parent-designated responsible adult A parent-designated responsible adult


Medication Documentation Medication Documentation RecordRecord

Contains all information needed for a Contains all information needed for a person to administer medication to a person to administer medication to a studentstudent

Created by school staff (nurse, Created by school staff (nurse, administrator or designated school administrator or designated school personnel)personnel)

Must be clear enough to be understood Must be clear enough to be understood by all (including substitutes) and provide by all (including substitutes) and provide evidence of medication administration evidence of medication administration according to prescriber ordersaccording to prescriber orders


Storage of Medication Storage of Medication ORC 3313.713ORC 3313.713

All medication must be in a locked All medication must be in a locked storage placestorage place

Medication requiring refrigeration Medication requiring refrigeration must be in a place not accessed by must be in a place not accessed by studentsstudents

Medication should be in a locked Medication should be in a locked container for field tripscontainer for field trips

Emergency medication must be Emergency medication must be accessible at all times accessible at all times


Unused MedicationUnused Medication

Arrangements must be made for the Arrangements must be made for the safe disposal of unused medication safe disposal of unused medication

Options include: Options include: – Parent pick up in the school Parent pick up in the school

office/clinic office/clinic – Parent may request that the school Parent may request that the school

dispose of any remaining medicationdispose of any remaining medication


Medication Incident Medication Incident Reporting Reporting

Medication ErrorMedication Error: a deviation from : a deviation from the standards of care owed to student the standards of care owed to student in the area of correct medication in the area of correct medication delivery, including:delivery, including:

Omitted dosesOmitted doses Incorrect dosesIncorrect doses Incorrect time of administrationIncorrect time of administration Incorrect studentIncorrect student Improper injection techniquesImproper injection techniques Incorrect route of administrationIncorrect route of administration


Medication Incident Medication Incident Reporting Reporting

Follow school policy/procedure for Follow school policy/procedure for “incident” involving medication “incident” involving medication

Report medication errors to the Report medication errors to the school nurseschool nurse

The school nurse and school The school nurse and school administrator should review administrator should review medication incident reports to medication incident reports to analyze patterns and take steps to analyze patterns and take steps to avoid or reduce future incidentsavoid or reduce future incidents


Six Rights of Medication Six Rights of Medication AdministrationAdministration

Standard safety procedures followed by all people Standard safety procedures followed by all people who administer medicationswho administer medications

Procedure includes checking the “six rights” of Procedure includes checking the “six rights” of medication administration:medication administration:– Right studentRight student– Right medicationRight medication– Right doseRight dose– Right routeRight route– Right timeRight time– Right documentationRight documentation


Right StudentRight Student Medication must be given to the Medication must be given to the right studentright student

– Ask the student to state their name orAsk the student to state their name or– Ask another staff person to identify the student orAsk another staff person to identify the student or– Refer to a photograph of the studentRefer to a photograph of the student

Compare the student’s name on MDF with:Compare the student’s name on MDF with:– The student’s name on the pharmacy /medication The student’s name on the pharmacy /medication

container labelcontainer label– If the names match, the medication can be givenIf the names match, the medication can be given

If all names do not match, DO NOT GIVE the If all names do not match, DO NOT GIVE the medicationmedication– Contact the school nurse or supervisor for Contact the school nurse or supervisor for

instructions instructions


Right MedicationRight Medication The The right medication right medication must be given must be given Check that the names of the medication Check that the names of the medication

match in two places: match in two places: – Pharmacy/medication container labelPharmacy/medication container label– MDRMDR

If all medication names do not match, DO If all medication names do not match, DO NOT GIVE the medicationNOT GIVE the medication– Contact the school nurse or supervisor for Contact the school nurse or supervisor for



Right DoseRight Dose

The The right dose right dose of medication must be of medication must be givengiven

Check the exact dose of the medication, Check the exact dose of the medication, the dose must match the:the dose must match the:– MDRMDR– Medication bottleMedication bottle

If all three medication doses do not If all three medication doses do not match, DO NOT GIVE the medicationmatch, DO NOT GIVE the medication– Contact the school nurse or supervisor for Contact the school nurse or supervisor for



Dose CalculationDose Calculation To determine the dose, you must know the To determine the dose, you must know the

strength of the medication and the strength of the medication and the amount to be givenamount to be given

The dose is located on the MDF The dose is located on the MDF The The right dose right dose of medication is how much of medication is how much

is given at one timeis given at one time Always use standard measuring devices Always use standard measuring devices

to assure proper doseto assure proper dose


Right TimeRight Time Medication must be given at the Medication must be given at the right timeright time Compare the time on the MDF with:Compare the time on the MDF with:

– The pharmacy /medication container labelThe pharmacy /medication container label If times do not match, DO NOT GIVE the If times do not match, DO NOT GIVE the

medicationmedication– Contact the school nurse or supervisor for Contact the school nurse or supervisor for


Medication given within a ½ hour Medication given within a ½ hour before or after the ordered time is before or after the ordered time is considered “on time”considered “on time”


Right RouteRight Route Medication must be given by the Medication must be given by the right routeright route The route indicates how and where the The route indicates how and where the

medication enters the body medication enters the body Compare the medication route on the MDF Compare the medication route on the MDF

with:with:– The pharmacy /medication container label The pharmacy /medication container label

If all routes do not match, DO NOT GIVE If all routes do not match, DO NOT GIVE the medicationthe medication– Contact the school nurse or supervisor for Contact the school nurse or supervisor for



Right DocumentationRight Documentation

While documenting medication While documenting medication administration, once again compare administration, once again compare the pharmacy label while recording the pharmacy label while recording on the MDRon the MDR– Document promptly, but not in advanceDocument promptly, but not in advance– This includes all medication forms, This includes all medication forms,

including error documentationincluding error documentation– Remember: If it is not written, it did not Remember: If it is not written, it did not

happenhappen


General Guidelines of General Guidelines of Documentation:Documentation:

Must be readableMust be readable Must be accurateMust be accurate Must be completeMust be complete If on paper, must be written in inkIf on paper, must be written in ink

– NEVER use correction fluid or tape. If an NEVER use correction fluid or tape. If an error is made, draw a single line through the error is made, draw a single line through the error and write “error” above the line and error and write “error” above the line and initialinitial

If electronic, must be overwrite protectedIf electronic, must be overwrite protected


School Personnel Administering School Personnel Administering Medication in Schools: Medication in Schools:

NEVER shares confidential information NEVER shares confidential information NEVER gives medication without written NEVER gives medication without written

instructions and a properly labeled containerinstructions and a properly labeled container NEVER gives medication if the written NEVER gives medication if the written

information does not match the labeled containerinformation does not match the labeled container NEVER makes a medical or nursing diagnosis or NEVER makes a medical or nursing diagnosis or

decision about what should or should not be decision about what should or should not be done for a student. Medical decisions are to be done for a student. Medical decisions are to be made by licensed health care professionals. made by licensed health care professionals.


NEVER call themselves “the nurse” nor leads others NEVER call themselves “the nurse” nor leads others to think they are a nurse. It is a felony to practice to think they are a nurse. It is a felony to practice nursing without a license or to supervise someone nursing without a license or to supervise someone doing thatdoing that

NEVER performs a task he/she has not been trained NEVER performs a task he/she has not been trained to do or is not competent in performingto do or is not competent in performing

NEVER leaves any medication unattended or within NEVER leaves any medication unattended or within the reach of a studentthe reach of a student

NEVER delegates or designates, or “sub-”delegatesNEVER delegates or designates, or “sub-”delegates NEVER ignores medical orders due to lack of NEVER ignores medical orders due to lack of

understandingunderstanding NEVER refers to medication as candyNEVER refers to medication as candy

School Personnel Administering School Personnel Administering Medication in Schools: Medication in Schools:


ALWAYS maintains confidentialityALWAYS maintains confidentiality ALWAYS counts medication and ALWAYS counts medication and

records on appropriate medication records on appropriate medication documentation formdocumentation form

ALWAYS locks up medicationALWAYS locks up medication ALWAYS identifies the studentALWAYS identifies the student ALWAYS triple check the “6 Rights”ALWAYS triple check the “6 Rights”

School Personnel Administering Medication in Schools:


ALWAYS observes the student for any unusual ALWAYS observes the student for any unusual behaviors or conditions before and after behaviors or conditions before and after medication administrationmedication administration– Report unusual behaviors to the parents and Report unusual behaviors to the parents and

licensed health providerlicensed health provider ALWAYS ensures proper equipment/supplies ALWAYS ensures proper equipment/supplies

are availableare available ALWAYS explains the procedure to the studentALWAYS explains the procedure to the student ALWAYS, if applicable, positions the student ALWAYS, if applicable, positions the student

appropriately for medication administrationappropriately for medication administration

School Personnel Administering Medication in Schools:

What are Sharps? What are Sharps?

Definition in Ohio Administrative Code Definition in Ohio Administrative Code

3745-27-01(6)(g): 3745-27-01(6)(g): Sharp wastes used in the treatment…of Sharp wastes used in the treatment…of human beings…that have… come in human beings…that have… come in contact with infectious agents… contact with infectious agents… including… hypodermic needles and including… hypodermic needles and syringes, scalpel blades, and glass articles syringes, scalpel blades, and glass articles that have been broken. Such wastes are …that have been broken. Such wastes are …referred to as “sharp infectious waste” or referred to as “sharp infectious waste” or “sharps.” “sharps.”


Sharps ContainersSharps Containers

Must be: Must be: Puncture resistantPuncture resistant Leak proofLeak proof CloseableCloseable Properly labeledProperly labeled


Sharps DisposalSharps Disposal

Ohio Environmental Protection Agency Ohio Environmental Protection Agency states:states:

If you create less than 50 pounds of If you create less than 50 pounds of sharps a yearsharps a year

You may place the full sharps You may place the full sharps container in the trashcontainer in the trash


Preventing Injuries from Preventing Injuries from SharpsSharps

Always:Always: Have student discard the sharp if possibleHave student discard the sharp if possible Replace a sharps container when 75% fullReplace a sharps container when 75% full Pay complete attention when handling a sharp-Pay complete attention when handling a sharp-

no multi-tasking!no multi-tasking! Alert your supervisor if no sharps container is Alert your supervisor if no sharps container is

availableavailable Keep the sharps container no more than “arms-Keep the sharps container no more than “arms-

length” awaylength” awayNever:Never: Recap or bend a sharp/needleRecap or bend a sharp/needle Shake a sharps container Shake a sharps container Place your hand under or in a trash bagPlace your hand under or in a trash bag


How to Care for a Sharps How to Care for a Sharps Injury Injury

Run under warm water immediatelyRun under warm water immediately Wash thoroughly with warm water Wash thoroughly with warm water

and soapand soap Rinse very wellRinse very well Follow district’s Bloodborne Follow district’s Bloodborne

Pathogen Policy for whom to notify Pathogen Policy for whom to notify and what to doand what to do


HandwashingHandwashing

Handwashing before and after each Handwashing before and after each student contact is the single most student contact is the single most important routine practice in the important routine practice in the control of infectionscontrol of infections


Alternative: Alcohol-based Alternative: Alcohol-based Hand SanitizersHand Sanitizers

If soap and water are not available, use an If soap and water are not available, use an alcohol-based hand sanitizer to clean alcohol-based hand sanitizer to clean handshands

Must be 60% alcohol to be effectiveMust be 60% alcohol to be effective

When using an alcohol-based hand sanitizer: When using an alcohol-based hand sanitizer: Apply product to the palm of one hand Apply product to the palm of one hand Rub hands togetherRub hands together Rub the product over all surfaces of hands and Rub the product over all surfaces of hands and

fingers until hands are dryfingers until hands are dryOhio Department of Health Medication Administration in Ohio Schools: Training for School

Personnel

Click on the link Click on the link below and view the below and view the

entire videoentire video

H:\Medication Administration video


Basic Guidelines for Basic Guidelines for Medication Medication

AdministrationAdministration

The following steps should be The following steps should be followed each time medication is followed each time medication is administeredadministered

If interrupted at any time in this If interrupted at any time in this process, restart from the beginningprocess, restart from the beginning


Medication Administration Medication Administration ProcedureProcedure

1. Wash hands well 1. Wash hands well

2. Start at the beginning of the MAR, review and 2. Start at the beginning of the MAR, review and check each of the following (check each of the following (11stst Check Check):):– 6 Rights of Medication Administration:6 Rights of Medication Administration:

Right StudentRight Student Right MedicationRight Medication Right DoseRight Dose Right TimeRight Time Right RouteRight Route Right DocumentationRight Documentation

– Order is currentOrder is current– Any known allergiesAny known allergies– Special instructionsSpecial instructions


Medication Administration Medication Administration Procedure Procedure continuedcontinued

3.3. Gather all equipment neededGather all equipment needed

4.4. Get medication from the locked storage areaGet medication from the locked storage area

5.5. Check the expiration date on the medication containerCheck the expiration date on the medication container

6.6. Compare and confirm that the container label, the MAR Compare and confirm that the container label, the MAR and the MDR and the MDR all match (2nd Check)all match (2nd Check)

7.7. Identify student verballyIdentify student verbally

8.8. Administer medication as orderedAdminister medication as ordered

9.9. Assure that the student leaves in a safe and Assure that the student leaves in a safe and comfortable mannercomfortable manner



1010. If gloves are worn, remove and dispose of . If gloves are worn, remove and dispose of gloves properly. Wash handsgloves properly. Wash hands

11.11. Document: Document:a.a. Write your initials and exact time the medication was given Write your initials and exact time the medication was given

in the dated square on the MDR or on the electronic recordin the dated square on the MDR or on the electronic record

b.b. While documenting, compare the container label to the MAR While documenting, compare the container label to the MAR and MDR again (and MDR again (44thth check check) and return to locked storage) and return to locked storage

c.c. Write your full name/signature, initials and title in space Write your full name/signature, initials and title in space provided on the MDRprovided on the MDR

d.d. Record any unusual complaints, concerns, errors and Record any unusual complaints, concerns, errors and action(s) takenaction(s) taken



1212.. Clean and return used equipment Clean and return used equipment to proper storage areato proper storage area

13.13. Wash hands before contact with Wash hands before contact with another student or procedure in the another student or procedure in the clinicclinic


Oral Medication Administration Oral Medication Administration

Follow steps 1-8 of the Basic Follow steps 1-8 of the Basic Guidelines for Medication Guidelines for Medication

Administration Procedure, then: Administration Procedure, then:

A.A.Get a new medication cup for each Get a new medication cup for each studentstudent– If medication is a tablet, the student must If medication is a tablet, the student must

have water to drink to take ithave water to drink to take itB.B. Compare medication container label Compare medication container label

and MAR and MAR (3(3rdrd check) check)


Oral Medication Oral Medication Administration Administration continuedcontinued

C.C. Prepare the medication: Prepare the medication:1.1. FOR TABLETS: FOR TABLETS: – Pour tablet from the bottle into the lid of Pour tablet from the bottle into the lid of

the container and then into the the container and then into the dispensing cup or the student’s washed dispensing cup or the student’s washed hand. Do not touch the tablethand. Do not touch the tablet

2.2. FOR LIQUIDS: FOR LIQUIDS:– Pour liquid medicine by setting the Pour liquid medicine by setting the

measuring cup on a firm surface at eye measuring cup on a firm surface at eye level to pour, reading the fluid level level to pour, reading the fluid level carefullycarefully


Oral Medication Oral Medication Administration Administration continuedcontinued

D.D. Watch the student take the medication Watch the student take the medication – With water if a tabletWith water if a tablet– Confirm that the medication was taken Confirm that the medication was taken

(swallowed). If uncertain, check (swallowed). If uncertain, check student’s mouthstudent’s mouth

Return to the Basic Guidelines for Return to the Basic Guidelines for Medication Administration Medication Administration

Procedure and complete steps Procedure and complete steps 10-14 10-14


Ophthalmic (Eye) Medication Ophthalmic (Eye) Medication AdministrationAdministration

Follow steps 1-8 of the Basic Guidelines for Follow steps 1-8 of the Basic Guidelines for

Medication Administration Procedure, then:Medication Administration Procedure, then:

A.A. Compare medication container label and MAR Compare medication container label and MAR (3(3rdrd check)check)

B.B. Put on glovesPut on gloves

C.C. If needed, wipe the eye while closed with a tissueIf needed, wipe the eye while closed with a tissue• Wipe from the inner corner of eye outward once Wipe from the inner corner of eye outward once • If working with both eyes, use a If working with both eyes, use a separateseparate clean clean

tissue for each eye tissue for each eye


Ophthalmic (Eye) Ophthalmic (Eye) Medication Administration Medication Administration

continuedcontinued

D.D. Prepare the medication for Prepare the medication for administrationadministration

E.E. Tilt the student’s head back and Tilt the student’s head back and have student look up and awayhave student look up and away

F.F. Gently pull down the lower lid to Gently pull down the lower lid to administer the medicationadminister the medication


FOR DROPS:FOR DROPS: DO NOT touch the any part of the eye medication DO NOT touch the any part of the eye medication

against anything (including the eye)against anything (including the eye) Instill drops into the inner corner of the eye, not directly Instill drops into the inner corner of the eye, not directly

onto the eyeball.onto the eyeball. Have the student open their eye and tilt head so drops roll Have the student open their eye and tilt head so drops roll

into eyeinto eye Approach the eye from below, yet level, with the dropper Approach the eye from below, yet level, with the dropper

remaining outside the student’s field of visionremaining outside the student’s field of vision Do not point dropper toward the eye or touch the eye at Do not point dropper toward the eye or touch the eye at

any timeany time


continuedcontinued


FOR OINTMENT: FOR OINTMENT: Apply by squeezing a small layer along the Apply by squeezing a small layer along the

inner, lower lidinner, lower lid Apply amount of ointment prescribed Apply amount of ointment prescribed

(usually about ½ inch long “ribbon” of (usually about ½ inch long “ribbon” of ointment)ointment)

Break off ribbon of ointment from the tube Break off ribbon of ointment from the tube by relaxing the pressure on the tubeby relaxing the pressure on the tube

Do NOT use your fingers!Do NOT use your fingers!


continuedcontinued


IF BOTH EYES INVOLVED:IF BOTH EYES INVOLVED: Give the student a separate clean tissue Give the student a separate clean tissue

for each eyefor each eye Change gloves between eyes to avoid Change gloves between eyes to avoid

cross contamination cross contamination


continuedcontinued


G.G. After putting in medication, allow the After putting in medication, allow the student to close the eye gently for a few student to close the eye gently for a few minutesminutes– Discourage rubbing the eyeDiscourage rubbing the eye– If needed, wipe eye with a tissue, using If needed, wipe eye with a tissue, using

separate tissue for each eyeseparate tissue for each eye

Return to the Basic Guidelines for Return to the Basic Guidelines for Medication Administration Procedure and Medication Administration Procedure and

complete steps 10-14 complete steps 10-14


continuedcontinued


Otic (Ear) Medication Otic (Ear) Medication AdministrationAdministration

Follow steps 1-8 of the Basic Guidelines for Follow steps 1-8 of the Basic Guidelines for Medication Administration Procedure, then: Medication Administration Procedure, then:

A.A. Compare medication container label and Compare medication container label and MAR MAR (3(3rdrd check) check)

B.B. Position the student by sitting or lying Position the student by sitting or lying down, tilting head sideways until ear is as down, tilting head sideways until ear is as horizontal as possiblehorizontal as possible

C.C. Put on glovesPut on gloves

D.D. If needed, clean the entry to the ear canal If needed, clean the entry to the ear canal with a tissue. with a tissue.


Otic (Ear) Medication Otic (Ear) Medication Administration Administration continuedcontinued

E.E. DO NOT touch the dropper against anything, DO NOT touch the dropper against anything, including the earincluding the ear

F.F. Pull the mid-outer ear gently back and up Pull the mid-outer ear gently back and up

G.G. Put the prescribed number of drops into the ear Put the prescribed number of drops into the ear – Encourage student to remain with head tilted Encourage student to remain with head tilted

position for 2-3 minutesposition for 2-3 minutes– If ordered, may place a cotton ball loosely in If ordered, may place a cotton ball loosely in

the ear canal for 30-60 minutesthe ear canal for 30-60 minutesReturn to the Basic Guidelines for Medication Return to the Basic Guidelines for Medication Administration Procedure and complete steps Administration Procedure and complete steps

10-14 10-14


Nasal (Nose) Medication Nasal (Nose) Medication AdministrationAdministration


Medication Administration Procedure, then:Medication Administration Procedure, then: A.A. Compare medication container label and Compare medication container label and

Medication Administration Record (MAR) Medication Administration Record (MAR) ((33rdrd check check))


C.C. Give tissue for potential excess dripping Give tissue for potential excess dripping on face on face – Tell student not to blow nose for at least 15 Tell student not to blow nose for at least 15

minutes after medication administrationminutes after medication administration


Nasal (Nose) Medication Nasal (Nose) Medication AdministrationAdministration

D.D. Put drops in nose per manufacturer’s instructionsPut drops in nose per manufacturer’s instructions– If using nasal spray, follow manufacturer’s If using nasal spray, follow manufacturer’s

instructionsinstructions

F.F. Again, remind student not to blow nose for at Again, remind student not to blow nose for at least 15 minutes after medication administrationleast 15 minutes after medication administration

Return to the Basic Guidelines for Medication Return to the Basic Guidelines for Medication Administration Procedure and complete steps Administration Procedure and complete steps

10-14 10-14


Topical (Skin) Medication Topical (Skin) Medication AdministrationAdministration


Medication Administration Procedure, then:Medication Administration Procedure, then: A.A. Compare medication container label and MAR Compare medication container label and MAR (3(3rdrd

check)check)


C.C. If needed, remove dressing or medication patch If needed, remove dressing or medication patch carefully so as not to tear skincarefully so as not to tear skin– Dispose of properlyDispose of properly

D.D. If ordered, wash the area with soap and water If ordered, wash the area with soap and water and dry welland dry well


Topical (Skin) Medication Topical (Skin) Medication Administration Administration continuedcontinued

E.E. Put on medication according to prescriber and Put on medication according to prescriber and manufacturer directionsmanufacturer directions

– If directed, put the new patch or dressing in a If directed, put the new patch or dressing in a different placedifferent place

F.F. If the patch or dressing falls off before it is due If the patch or dressing falls off before it is due to be replaced, notify the appropriate health to be replaced, notify the appropriate health care professional or supervisor for instructionscare professional or supervisor for instructions

Return to the Basic Guidelines for Medication Return to the Basic Guidelines for Medication Administration Procedure and complete steps 10-14 Administration Procedure and complete steps 10-14


Rectal Medication Rectal Medication AdministrationAdministration


Medication Administration Procedure, then:Medication Administration Procedure, then: A.A. Compare medication container label and MAR Compare medication container label and MAR

(3(3rdrd check) check)

B.B. Ask the student to urinate and/or move Ask the student to urinate and/or move his/her bowels, if possible, before inserting his/her bowels, if possible, before inserting suppository suppository

C.C. Provide privacyProvide privacy

D.D. Encourage relaxation while speaking calmlyEncourage relaxation while speaking calmly

E.E. Put on glovesPut on gloves


Rectal Medication Rectal Medication Administration Administration continued continued

F.F. Unwrap suppository or prepare cream/gel Unwrap suppository or prepare cream/gel with applicator as directedwith applicator as directed

G.G. Lubricate the suppository or applicator tip Lubricate the suppository or applicator tip with a water-soluble gelwith a water-soluble gel

H.H. Position student according to directions Position student according to directions – If instructions do not specify, have If instructions do not specify, have

student lie on left side facing you student lie on left side facing you

I.I. Lower clothing to expose the buttocks Lower clothing to expose the buttocks


J.J. Position, keeping lower leg straight and upper Position, keeping lower leg straight and upper leg bent forwardleg bent forward

K.K. Separate the buttocks to further expose the Separate the buttocks to further expose the rectumrectum

L.L. Gently insert the suppository with a finger or Gently insert the suppository with a finger or insert applicator until suppository or applicator insert applicator until suppository or applicator passes through the rectal sphincter muscle passes through the rectal sphincter muscle

– Approximately ½ inch in children under age Approximately ½ inch in children under age 12 or 1 inch for student over age 1212 or 1 inch for student over age 12

Rectal Medication Administration Rectal Medication Administration continuedcontinued


M.M. If applicator is used to insert medication, push the plunger If applicator is used to insert medication, push the plunger to insert the medication and gently remove, holding the to insert the medication and gently remove, holding the student’s buttocks together for 3 to 5 minutesstudent’s buttocks together for 3 to 5 minutes

– Encourage the student to hold the medication inside Encourage the student to hold the medication inside the rectum (without moving bowels) for as long as the rectum (without moving bowels) for as long as possible, or according to the health care provider or possible, or according to the health care provider or medication directionsmedication directions

– Observe student according to health care provider Observe student according to health care provider instructionsinstructions

N.N. Wipe the buttocks with a tissue if needed and dispose of Wipe the buttocks with a tissue if needed and dispose of applicator.applicator.

Return to the Basic Guidelines for Medication Administration Return to the Basic Guidelines for Medication Administration Procedure and complete steps 10-14 Procedure and complete steps 10-14

Rectal Medication Administration Rectal Medication Administration continuedcontinued


Inhaler Medication Inhaler Medication AdministrationAdministration

Follow steps 1-8 of the Basic Guidelines for Follow steps 1-8 of the Basic Guidelines for Medication Administration Procedure, Medication Administration Procedure,

then:then: A.A. Compare medication container label and MAR Compare medication container label and MAR

(3(3rdrd check) check)

B.B. Ensure that student is in upright positionEnsure that student is in upright position

C.C. Shake inhaler well for 2-5 secondsShake inhaler well for 2-5 seconds

D.D. Have student take a deep breath and exhale Have student take a deep breath and exhale completelycompletely

E.E. Press lips firmly around inhaler or holding Press lips firmly around inhaler or holding device device


Inhaler Medication Administration Inhaler Medication Administration continuedcontinued

1.1. Inhale slowlyInhale slowly

2.2. As student is inhaling, press down on As student is inhaling, press down on canistercanister

3.3. After pressing down, have student continue After pressing down, have student continue to inhale for 5 seconds to inhale for 5 seconds

4.4. Hold breath for additional 10 secondsHold breath for additional 10 seconds

5.5. Remove mouth piece Remove mouth piece

6.6. Exhale slowly Exhale slowly

F. Instruct student as follows:


I.I. Have student inhale deeply and slowlyHave student inhale deeply and slowly

1.1. ALERT: If student inhales too quickly ALERT: If student inhales too quickly through the spacer, the device will make through the spacer, the device will make a whistling sound. If whistling sound a whistling sound. If whistling sound occurs, remind student to inhale more occurs, remind student to inhale more slowlyslowly

2.2. Have student hold breath for 10 seconds Have student hold breath for 10 seconds and exhale slowly and exhale slowly

3.3. Inhale and exhale once more with spacer Inhale and exhale once more with spacer intactintact

If Using Inhaler with Holding Device If Using Inhaler with Holding Device (Spacer or Chamber) (Spacer or Chamber) continuedcontinued


Inhaler Medication Administration Inhaler Medication Administration continuedcontinued

J.J. If more than one puff is ordered If more than one puff is ordered – Wait 1-2 minutes between puffsWait 1-2 minutes between puffs– Repeat steps on previous slidesRepeat steps on previous slides

Return to the Basic Guidelines for Return to the Basic Guidelines for Medication Administration Medication Administration

Procedure and complete steps 10-Procedure and complete steps 10-14 14

Emergency Medication Emergency Medication AdministrationAdministration

Some students have a condition that might Some students have a condition that might require administration of emergency require administration of emergency medicationsmedications

These students should have an Individualized These students should have an Individualized Healthcare Plan (IHP) and Emergency Action Healthcare Plan (IHP) and Emergency Action Plan (EAP) written by the school nurse with Plan (EAP) written by the school nurse with the parents, staff and prescriberthe parents, staff and prescriber– The EAP tells school staff how to recognize The EAP tells school staff how to recognize

an emergency situation and how to take an emergency situation and how to take care of the student in that situationcare of the student in that situation



Common types of illnesses that might Common types of illnesses that might require emergency medication require emergency medication administration include:administration include:– AsthmaAsthma– DiabetesDiabetes– AllergiesAllergies– EpilepsyEpilepsy

Emergency medications may be inhaled, Emergency medications may be inhaled, injected or given rectally or nasallyinjected or given rectally or nasally

All school staff should be trained to All school staff should be trained to administer emergency medicationadminister emergency medicationOhio Department of Health Medication Administration in Ohio Schools: Training for School

Personnel


Ohio law permits some students to self-carry Ohio law permits some students to self-carry selected emergency medicationsselected emergency medications– You must know which students self-carry their You must know which students self-carry their

medications and where they carry themmedications and where they carry them– You must know where the emergency You must know where the emergency

medications are for students who do not self-medications are for students who do not self-carrycarry

– Current law allows students to self-carry Current law allows students to self-carry asthma inhalers and epinephrine autoinjectors asthma inhalers and epinephrine autoinjectors

– Must have MAR in school clinic to self-carryMust have MAR in school clinic to self-carry



ORC 3313.716 Inhaler PossessionORC 3313.716 Inhaler Possession If conditions are met, the student may If conditions are met, the student may

possess and use the inhaler at schoolpossess and use the inhaler at school Recommend back up inhaler at school Recommend back up inhaler at school

(not required)(not required) Click on the link to view how to Click on the link to view how to

administer an inhaler. administer an inhaler. Administering an inhaler with a spacer.



ORC 3313.718 Epinephrine ORC 3313.718 Epinephrine Autoinjector PossessionAutoinjector Possession

If conditions are met, the student may If conditions are met, the student may possess and use the epinephrine possess and use the epinephrine autoinjector (Epi-pen) in schoolautoinjector (Epi-pen) in school

Law Law requires requires back-upback-up epinephrine epinephrine autoinjector at schoolautoinjector at school

Law states Law states must must always call 911 after always call 911 after use--no exceptionsuse--no exceptions

Recommend all school staff be trained Recommend all school staff be trained for emergency epinephrine usefor emergency epinephrine use




then: then: A.A. Compare medication container label and MAR Compare medication container label and MAR (3(3rdrd

check)check) – Do not prepare Glucagon until ready to useDo not prepare Glucagon until ready to use


C.C. Get Glucagon Emergency Kit from locked storage areaGet Glucagon Emergency Kit from locked storage area

D.D. Remove the flip-off seal from the bottle (vial) of Remove the flip-off seal from the bottle (vial) of Glucagon powderGlucagon powder

E.E. Wipe rubber stopper on bottle with alcohol swabWipe rubber stopper on bottle with alcohol swab

Medication Administration: Medication Administration: Glucagon InjectionGlucagon Injection


Medication Administration: Medication Administration: Glucagon Injection Glucagon Injection continuedcontinued

F.F. Remove the needle protector from the syringeRemove the needle protector from the syringe

G.G. Inject the entire contents of the syringe into the Inject the entire contents of the syringe into the bottle of Glucagonbottle of Glucagon

H.H. Swirl bottle gently until Glucagon dissolves Swirl bottle gently until Glucagon dissolves completelycompletely– DO NOT USE unless the solution is clear and DO NOT USE unless the solution is clear and

of a water-like consistency of a water-like consistency – Draw all solution from the vial into the syringeDraw all solution from the vial into the syringe

I.I. Remove syringe from the bottleRemove syringe from the bottle


Medication Administration: Medication Administration: Glucagon Injection Glucagon Injection continued continued

Inject Glucagon immediately after mixingInject Glucagon immediately after mixing

J.J. Clean injection site on buttock, arm or thigh Clean injection site on buttock, arm or thigh with alcohol swabwith alcohol swab

K.K. Insert the needle into the loose tissue under Insert the needle into the loose tissue under the cleaned injection sitethe cleaned injection site

L.L. Inject all of the Glucagon solution Inject all of the Glucagon solution – There is no danger of overdoseThere is no danger of overdose


Medication Administration: Medication Administration: Glucagon Injection Glucagon Injection continued continued

M.M. Apply light pressure at the injection site and Apply light pressure at the injection site and withdraw the needlewithdraw the needle

N.N. Press an alcohol swab on the injection site Press an alcohol swab on the injection site

O.O. Turn the student on his/her sideTurn the student on his/her side– When an unconscious individual awakens, When an unconscious individual awakens,

he/she may vomithe/she may vomit– Turning the student on his/her side will Turning the student on his/her side will

prevent him/her from chocking when prevent him/her from chocking when vomitingvomiting


P.P. Unless you have other orders, feed the student AS Unless you have other orders, feed the student AS SOON as he/she awakens and is able to swallowSOON as he/she awakens and is able to swallow– Give the student a fast-acting source of sugar Give the student a fast-acting source of sugar

(such as a regular soft drink or fruit juice) AND a (such as a regular soft drink or fruit juice) AND a long-acting source of sugar (such as crackers and long-acting source of sugar (such as crackers and cheese)cheese)

Q.Q. Contact Emergency Medical Services (EMS-911) and Contact Emergency Medical Services (EMS-911) and parents immediately. parents immediately. Refer to prescriber’s orders Refer to prescriber’s orders for the student. for the student.

Return to the Basic Guidelines for Medication Return to the Basic Guidelines for Medication Administration Procedure and complete steps 10-Administration Procedure and complete steps 10-

14 14

Medication Administration: Medication Administration: Glucagon Injection Glucagon Injection continuedcontinued


Medication Administration: Medication Administration: Autoinjector (Epi-Pen)Autoinjector (Epi-Pen)

Epinepherine is a medication used to treat Epinepherine is a medication used to treat SEVERE allergic reactions. SEVERE allergic reactions.

Signs of a SEVERE allergic reaction areSigns of a SEVERE allergic reaction are Frequent clearing of the throat and or Frequent clearing of the throat and or

wheezing with breathingwheezing with breathing Swollen lips/tongueSwollen lips/tongue Severe stomach crampsSevere stomach cramps Pale colored skinPale colored skin




then: then:

A.A. Compare medication container label and Compare medication container label and MAR MAR (3(3rdrd check) check)


The following instructions are for the Epi-The following instructions are for the Epi-pen. If you have a student with another pen. If you have a student with another brand of epinephrine — please follow brand of epinephrine — please follow those manufacturer’s instructionsthose manufacturer’s instructions



C.C. Remove from protective carrier caseRemove from protective carrier case

D.D. Grasp unit with the orange tip pointing Grasp unit with the orange tip pointing downwarddownward

E.E. Form fist around the unit (orange tip Form fist around the unit (orange tip down)down)

F.F. With the other hand, pull the blue safety With the other hand, pull the blue safety releaserelease


G.G. Hold orange tip near outer thighHold orange tip near outer thigh

H.H. Swing and firmly push the Epi-pen against outer Swing and firmly push the Epi-pen against outer thigh until it clicksthigh until it clicks– Should be perpendicular (at 90 degree angle) Should be perpendicular (at 90 degree angle)

against thigh against thigh – It is designed to inject through clothingIt is designed to inject through clothing

I.I. Hold firmly against thigh for approximately 10 Hold firmly against thigh for approximately 10 secondsseconds

J.J. Remove unit from thigh (the orange needle Remove unit from thigh (the orange needle cover will extend to cover needle) and massage cover will extend to cover needle) and massage the injection site for 10 secondsthe injection site for 10 seconds



K.K. Always call 911 and seek medical Always call 911 and seek medical attention following administration, even if attention following administration, even if the student seems better. Send the used the student seems better. Send the used auto injector with the student to the auto injector with the student to the hospital.hospital.

Return to the Basic Guidelines for Return to the Basic Guidelines for Medication Administration Procedure Medication Administration Procedure

and complete steps 10-14 and complete steps 10-14

Autoinjector (Epi-Pen), Autoinjector (Epi-Pen), continuedcontinued



ORC 3313.718 Epinephrine ORC 3313.718 Epinephrine Autoinjector PossessionAutoinjector Possession

If conditions are met, the student may If conditions are met, the student may possess and use the epinephrine possess and use the epinephrine autoinjector (Epi-pen) in schoolautoinjector (Epi-pen) in school

Law Law requires requires back-upback-up epinephrine epinephrine autoinjector at schoolautoinjector at school

Law states Law states must must always call 911 after always call 911 after use--no exceptionsuse--no exceptions

Recommend all school staff be trained Recommend all school staff be trained for emergency epinephrine usefor emergency epinephrine use

Thank you for your attention!Thank you for your attention!Please click on this link for a Please click on this link for a

Medication quiz You will need to print the You will need to print the quiz and answer the questions. Give the quiz and answer the questions. Give the completed quiz to the school nurse (Beth completed quiz to the school nurse (Beth Stoller MSN RN). When you are ready to Stoller MSN RN). When you are ready to meet with the school nurse for your final meet with the school nurse for your final

check-off, please schedule a meeting check-off, please schedule a meeting time by calling ext. 1315 or via email to time by calling ext. 1315 or via email to

[email protected][email protected]

ohio department of health medication administration in ohio schools: training for school personnel...

Documents

ohio schools

odh medication administration

ohio school children

school personnel goal

school employees

school day

training course

ohios schools