“Over the past century, the role of the school nurse has expanded to include critical components such as surveillance, chronic disease management, emergency preparedness…extensive care management, and much more” (AAP Policy Statement 2016, Role of the School Nurse in Providing School Health Services). Despite this ever changing role, the focus has remained consistent: keeping students healthy and in school to ensure academic success. Among the duties of chronic disease management is the dispensing of medications. As children with increasingly complex medical illnesses are present in schools, this task becomes more of a challenge. Fortunately, the American Academy of Pediatrics (AAP), National Association of School Nurses (NASN), and American Nurses Association (ANA) recognize and address the importance of standardizing safety measures for medication administration in the school setting and the training of support staff as well.
According to the AAP 2009 Policy Statement titled Guidance for the Administration of Medication in School, “Having full-time licensed registered nurses administering all routine and emergency medications in schools is the best situation.” However, this is not always feasible in all schools. For this reason, the AAP and NASN support the use of Unlicensed Assistive Personnel (UAP’s) for delegated nursing tasks, namely the administration of medication. UAP’s are typically health aids trained in basic first aid who receive training and direction from the licensed certified school nurse or licensed Registered Nurse (RN). The RN also performs medication audits and continues to provide refresher training for UAP’s throughout the school year. Unfortunately, despite these procedures of training and supervision, NASN notes in their 2017 Position Statement titled Medication Administration in the School Setting that, “… it is not uncommon for students to receive medication from non-nursing school employees who have had no medical training. This trend has caused an alarming increase in the number of medication errors made by UAP.” For this reason, having standardized policies and procedures developed by licensed nurses and physicians is critical to ensure student safety.
Policies and procedures should address the following concepts (adapted from NASN Position Statement and AAP Policy Statement)
- documentation of medication administration (specifically for the purpose of quality improvement, especially to reduce medication errors and to verify controlled substance counts.)
- delegation (when permissible by state law), training and supervision of unlicensed assistive personnel (UAP), typically by the licensed RN or certified school nurse
- student confidentiality
- medication orders with clear directions from the authorized prescriber and signed by the parent (name of student, name of drug, dose, time of administration, and diagnosis or reason for medication to be taken)
- medication doses that exceed manufacturer’s guidelines
- proper labeling, storage, disposal, and transportation of medication to and from school
- rescue and emergency medications for both during and after school hours, and the concept of self-carry for responsible students
- off-label medications and investigational drugs
- prescription and over-the-counter (OTC) medications, the later of which should be limited in terms of duration to prevent authorized prescriber oversight
- complementary and alternative medications
- psychotropic medications and controlled substances
Although not specifically addressed above, the AAP has also released a set of health appraisal guidelines for day camps and resident camps. Similar to the recommendations put forth for schools regarding medication administration, the AAP recommends that all camps have health care personnel with the proper knowledge and training to safely store and administer medications. Furthermore, there should be protocols in place for the transportation of medication on off-site trips, and it is the responsibility of the camp health care provider to determine the ability of other camp personnel to safely administer these medications during excursions.
Having an electronic health record system, such as those provided by SchoolDoc and CampDoc, is an easy way to simplify yet raise the standard of care provided in the school and camp setting. Our Electronic Medication Administration Record (eMAR) greatly reduces the risk of medication errors. It allows standardized and legible documentation of when medications are administered to students or campers, and it also aids health care personnel in the “5 rights” of medication administration: right patient, right drug, right dose, right time, right route. The system even provides alerts if a medication has not been given. Visit our websites today to learn more about how you can make health care at school or camp more efficient and safe!