Medication Administration Procedures

MEDICATION ADMINISTRATION PROCEDURES

Rights of Medication Administration EVERY time medication is given, the 8 Rights should be reviewed. Following this procedure will prevent medication errors. 1. Right student . Check the name on the Medication Form and the student. . Ask patient to identify himself/herself.

2. Right medication . Check the medication label. . Check the Medication Form.

3. Right dose . Check the medication label. . Check the Medication Form.

4. Right route . Again, check the Medication Form and medication label. . Check to make sure the student is able to take the medication as ordered.

5. Right time . Check the frequency of the ordered medication. . Double-check that you are giving the ordered dose at the correct time. . Confirm when the last dose was given.

6. Right reason . Confirm the rationale for the ordered medication on the Medication Form. Why is he/she taking this medication? If the medication is “as needed” (PRN), is the student exhibiting the symptoms that indicate that this medication is needed? . Revisit the reasons for long-term medication use.

7. Right documentation . Document administration AFTER giving the ordered medication and confirming that the student took the medication. . Document on the Student Medication Form.

8. Right response . Make sure that the drug led to the desired effect, for example that the student’s breathing is improved after taking an asthma inhaler. . Be sure to document your monitoring of the patient and any other interventions that were provided. Before administering any medication, best practice dictates that school staff who is administering medication should wash hands with warm water and soap before and after administering or assisting with medication and review the 8 Rights of Medication Administration.

Student, Family and Community Support Department 2017-2018 School Health Manual Medication Administration Procedures – By Type/Route of Medication

Oral Medication Administration

a. Oral bottled medication (tablets, capsules, etc.) a. Remove bottle cap and hold the cap in one hand and bottle in the other hand. b. Pour the prescribed dose into the cap. c. Transfer medication from cap to the student (or medicine cup if necessary, give to student) d. Give with a full glass of water unless otherwise indicated. Follow special labeled instructions (e.g., take with milk, take with lunch, shake). e. Verify the student swallowed the medication. f. Recap the bottle and return it to the secure locked place.

b. Oral individually wrapped medications (blister packs) Remove or tear off number needed and give to student. Blister packs are usually dated; push out proper date when administering.

c. Oral liquids or powders: (Verify directions, these may need to be stored in the refrigerator)

a. Shake medication per label instructions. b. Pour liquid from side of bottle opposite the prescription label into graduated medicine cup so dripping will not obscure the medication label. c. Use calibrated medicine dropper or syringe to measure small amounts of liquid. d. Pour medication at eye level and directly in front of eyes. e. Measure the dosage at the bottom of the disc that forms at the surface of the liquid (meniscus). f. Wipe off any medication on the outside of the container. g. Do not pour different liquid medications into the same medicine cup or container. h. Give cough syrup undiluted and do not follow with water.

4. Troubleshooting with oral medication administration

a. Refusal of Medication - Report immediately to the administrator/parent/guardian. b. Vomiting Medication – Report immediately to the administrator/parent/guardian: students name and age, medication and dosage, time lapse since administration and if medication was intact. c. Suggestions for students with difficulty swallowing: i. position student for medication administration ii. give one medication at a time with adequate fluids iii. place medication on back of tongue iv. give liquid medications slowly d. Watch for choking. Verify that the student swallowed the medication. Before administering any medication, best practice dictates that school staff who is administering medication should wash hands with warm water and soap before and after administering or assisting with medication and review the 8 Rights of Medication Administration.

Student, Family and Community Support Department 2017-2018 School Health Manual e. Give medications with other food or crushed, as directed.

Skin/Topical Medications

a. Gather necessary equipment: tongue blade, gauze, tape, cleansing material and cotton- tipped applicator. For broken skin or open lesions, use gloves. b. Document condition of affected area. If unusual, report to the administrator before applying medication. c. Cleanse the skin, remove previously applied medication. d. Apply medication in a thin layer or as ordered. e. Document any changes seen in skin area being treated. Cover if directed.

Eye/Ophthalmic

Only use preparations (drops or ointments) labeled for ophthalmic use.

Eye Drops

a) Gather necessary equipment: eye pads, tissue or gauze, medication and gloves (if infectious process exists). b) Observe affected eye(s) for any unusual condition and report/document before applying medication. c) Cleanse eye by wiping once from inside to outside. Use clean pad for each eye. d) Position student with head tilted back and eyes looking up. e) Open eye by gently pulling lower eye lid down to expose the inside of eyelid. f) Approach the eye from outside the field of vision. g) Drop the medication gently into the lower eyelid, not directly on the eyeball, with the drop not falling more than l" from eye. Do not touch the dropper to the eye. Wait 1-5 minutes between instillations if more than one application is ordered. h) Gently release eyelid to close eye. Ask student to keep eye closed for a few minutes. i) Blot the excess medication with a new clean pad or tissue.

Eye Ointment

a) Gather necessary equipment: eye pads, tissue or gauze, medication, and gloves (if infectious process exists). b) Observe affected eye(s) for any unusual condition and report/document before applying medication. c) Cleanse eye by wiping once from inside to outside Use a clean pad for each eye. d) Position student with head tilted back and eyes looking up. e) Open eye by gently pulling lower eye lid down to expose the inside of eyelid. f) Approach the eye from outside the field of vision. Before administering any medication, best practice dictates that school staff who is administering medication should wash hands with warm water and soap before and after administering or assisting with medication and review the 8 Rights of Medication Administration.

Student, Family and Community Support Department 2017-2018 School Health Manual g) Apply in a thin layer along the inside lower lid or as ordered. h) Hold lid open a few seconds. i) Gently release eyelid to close eye. Ask the student to keep eyes closed for a few minutes. j) Blot the excess medication with a new clean pad or tissue.

Ear Drops

a. Gather necessary equipment: cotton balls, tissue or gauze, and medication. b. Position the student. a. If sitting in chair, tilt head sideways until ear to be treated is horizontal and facing the ceiling. b. If lying on a cot, turn face to opposite side. c. Cleanse entry to ear canal with a clean cotton ball or cotton pad, as needed. d. Observe affected area for any unusual condition. If an unusual condition exists, report to Administrator and parent/caregiver, and document. e. Straighten the ear canal by pulling earlobe gently down and back (ages 3 and under) or pulling upper part of ear (pinna) up and back (older children). f. Place the prescribed number of drops on the side of the external ear canal. Avoid the dropper touching anything. g. Instruct the student to maintain the required position for 1 minute. Gently rub the skin in front of the ear to help the medication flow to the inside of the ear canal. h. If the other ear is to be treated, reposition student and repeat procedure after 1 minute. i. Loosely place a cotton ball in the ear if ordered.

Medication inhaler with spacer

Follow the individualized healthcare or emergency care plan. a) Remove plastic caps from inhaler and spacer. (see diagrams in School Health Manual, Section C) b) Attach mouthpiece of inhaler which contains the medicine to end of spacer opposite to mouthpiece c) Stand up or sit up straight. d) Shake inhaler for approximately five seconds. e) Place mouthpiece of spacer in mouth and form tight seal with lips around the mouthpiece. f) Breathe out naturally and completely. g) Press the inhaler once and at the same time breathe in deeply and slowly. h) Hold breath as long as possible up to 10 seconds to allow medication to settle as deeply as possible into and onto air passages. i) Exhale slowly. Wait approximately 1 minute, and repeat the process as written on emergency care plan. This technique should allow delivery of medication into air passages opened by first inhalation.

Before administering any medication, best practice dictates that school staff who is administering medication should wash hands with warm water and soap before and after administering or assisting with medication and review the 8 Rights of Medication Administration.

Student, Family and Community Support Department 2017-2018 School Health Manual Auto-injector medication

An auto-injector is a disposable injection device with a spring activated, concealed needle used for emergency self-administration of epinephrine in individuals with potentially fatal allergic reactions.

Follow the individualized healthcare or emergency care plan.

a) Pull off safety cap. b) If time permits, cleanse with alcohol or soap and water but injector can be used through clothing c) Firmly and quickly press auto-injector against thigh until mechanism activates. There will be an audible click to indicate needle has been released. Hold in place for 10 seconds for EpiPens or 5 seconds for AviQ. d) Remove needle and gently massage the area to ensure the medication is absorbed. e) Call 9-1-1 and follow any other instructions on the emergency care plan. f) Used auto-injectors can be returned to the safety holder and given to Emergency Medical Service personnel to be transported with the student to the Emergency Room for follow up.

To request staff training or for any consultation, please call the Nurse of the Day @ 415-242-2615.

Before administering any medication, best practice dictates that school staff who is administering medication should wash hands with warm water and soap before and after administering or assisting with medication and review the 8 Rights of Medication Administration.

Student, Family and Community Support Department 2017-2018 School Health Manual