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HISTORY:
Medication administration is one of the most common health-related activities performed in schools. Historically, administering medications within the school setting has been a school nurse responsibility. Because the number of students needing medication administration has grown, school nurses increasingly are required to delegate medication administration to unlicensed assistive personnel (UAP) (McCarthy, Kelly, & Reed, 2000).
DESCRIPTION OF ISSUE:
The safe and effective use of medications for the treatment of certain medical conditions and illnesses has enabled many children to attend school and achieve academic success. Students receive medications at school for a variety of reasons ranging from treatment of acute conditions to chronic illnesses to complex disabilities. Some students may require medications for life-threatening emergencies (American Academy of Pediatrics, 1997).
Important issues confronting the school nurse regarding the administration of medications include, but are not limited to the following:
- Safe administration of the medications
- Adherence to safe nursing practice, state practice acts, and the applicable state laws and regulations
- Ongoing monitoring of therapeutic benefits, adverse reactions and any side effects associated with the medications
- Appropriate communication with the student, family, school personnel and health care providers
- Proper documentation
- Use of alternative and homeopathic remedies for self-limiting conditions
- Management of both over-the-counter (OTC) medications and prescription medications
- Self administration of medications by students
- Need for delegation of medication administration to UAP within the school setting
- Confidentiality
- Ongoing attempts by legislative bodies to change any part of the policies regarding the administration of medications in schools
RATIONALE:
The school nurse has the educational background, knowledge, and licensure that provide the unique qualifications to direct the administration of medications in the school setting. As the school staff member most involved in this issue the school nurse must have input into school district policies and procedures relating to medication administration. These policies should be developed considering the safety of all students and staff. School nurses may be able to increase resources available to them by developing partnerships with local pharmacists and/or health care providers. At the state level, the school nurse should be an integral part of the legislative process before any changes or modifications to a state’s current laws are addressed.
CONCLUSION:
It is the position of the National Association of School Nurses that school districts develop policies and procedures to address medication administration in accordance with federal and state laws and guidelines. NASN recommends that the school nurse, as well as to other school district personnel, parents, school medical advisors, pharmacists, and legal counsel, be included in policy development to ensure that the numerous issues surrounding medication administration are addressed. Confidentiality must be a priority for the school nurse and any designees that administer medications to students in the school setting.
The school nurse can administer medication safely and effectively under the following guidelines, at a minimum:
- Adherence to school policies, school nurse standards of practice, state nurse practice acts and state laws governing these practices.
- The medication is in the original container if over-the-counter (OTC) or in a properly labeled prescription container, subject to state Board of Pharmacy regulations. In some states, a licensed healthcare provider may package and label the medication.
- Information on the container must include the student’s name, the name of the drug, dosage amount, route of administration, the time interval of the dose, and the name of the prescribing licensed healthcare provider.
- The parent/guardian must request in writing that the medication be administered at school.
- The school nurse, based on nursing assessment, determines that the medication can be given at school.
- The administration of medication in no way violates nursing protocols or standing orders.
- The school nurse is aware of and has access to current reliable information regarding the safe use of the medication including side effects and toxicity, possible drug interactions, adverse effects and expected outcomes.
- Medications are stored in a locked cabinet.
- Procedures must be in place for receiving, administration of, and accountability for all medications in the school setting.
The implementation of appropriate guidelines will assist the school nurse in conjunction with the local education agency in meeting their responsibility to foster the protection of the health, safety, and welfare of the students, school personnel, and general public during the administration of medications in the school setting.
References/Resources:
American Academy of Pediatrics (1997). Policy statement. Guidelines for the administration of medication in school (RE9328). Pediatrics, 92(3), 499-500. Retrieved on May 13, 2003 from http://www.aap.org/policy/04524.html
Awbrey, L.M. & Juarez, S.M. (2003). Developing a nursing protocol for over-the-counter medications in high school. Journal of School Nursing, 19(1), 12-15.
Dockrell, T.R. & Leever, J.S. (2000). An overview of herbal medications with implications for the school nurse. Journal of School Nursing, 16(3), 53-58.
McCarthy, A.M., Kelly, M.W., & Reed, D. (2000). Medication administration practices of school nurses. Journal of School Health, 70(9), 371-376.
National Association of School Nurses (1999). Position statement: The use of asthma inhalers in the school setting. Available at http://www.nasn.org/Default.aspx?tabid=202
National Association of School Nurses (2000). Position statement: Epinephrine use in life-threatening emergencies. Available at http://www.nasn.org/Default.aspx?tabid=222
National Association of School Nurses (2000). Position statement: Out-of-school education: Field trips and camps. Available at http://www.nasn.org/Default.aspx?tabid=235
National Association of School Nurses (2001). Position statement. Alternative medicine use in the school setting. Available at http://www.nasn.org/Default.aspx?tabid=199
National Association of School Nurses (2001). Position statement: Research medications in the school setting. Available at http://www.nasn.org/Default.aspx?tabid=244
National Association of School Nurses (2001). Position statement: The role of school nurses in allergy/anaphylaxis management. Available at http://www.nasn.org/Default.aspx?tabid=198
Reutzel, T.J. & Rinku, P. (2001). Medication management problems reported by subscribers to a school nurse listserv. Journal of School Nursing, 17(3), 131-139.
Adopted: 1993
Revised: September 1997
Revised: June 2003 |