JLE-P1 - Administration of Prescribed Medication

Introduction

This policy reflects the guidelines and procedures outlined in the provincial Unified Referral and Intake System (URIS).

Prairie Spirit School Division recognizes that some students with special Health Care needs require medication or procedures for the medical management of chronic disabilities and illnesses, in order to attend and benefit from an educational program.  There are, as well, rare occasions when emergency procedures are required in life-threatening situations.

To ensure the safety and protection of students, staff and parents, this policy must be followed by all trained divisional personnel who are assigned to administer medication or medical procedures to students within the Division.

In order for prescribed medication to be administered in the school, either by self-administration or by school personnel, parents/guardians must comply with the procedures outlined in this policy.  Failure to do so will result in the refusal by divisional staff to administer medication, or the student being requested to remain at home.  Parents must advise the School Principal of any incidental use of, or change in transportation of the student to and from school.

For purposes of this policy, herbs and other homeopathic products and natural remedies are not considered to be medication, unless officially prescribed by a qualified physician.

Conditions for accepting prescribed and over-the-counter medication for administration by school personnel

When it becomes necessary for a student to take medication during school hours, it shall be in accordance with the following conditions.

Authorization for the Administration of Medication form shall be completed by the parent/guardian. This form is completed for every new school year and/or for each medication that requires administration by the school.

The Administration of Medication Record shall be completed by staff that is designated to administer the medication to the student. These records shall be maintained for one year.

The first dosage of medication shall not be administered at school. It is the parent’s/guardian’s responsibility to ensure the first dose has been well tolerated prior to coming to school and no adverse reactions have occurred. Medication that may be required urgently (e.g. adrenaline auto-injector for anaphylaxis, reliever medication for asthma, rescue medication for seizures) is exempt from this condition.

Prescribed medication shall be delivered to the school by the parent/guardian or designated adult in the original pharmacy labeled container which identifies clearly the information listed below.

• Date the prescription was filled

• Name of the student

• Name of the prescribing physician

• Name of the pharmacy

• Name of the medication

• Dose and route

• Frequency and method of administration

The pharmacy label shall be on the container itself, such as medication bottle, tube, inhaler, etc., and not merely on the package. If requested, pharmacies will provide two original pharmacy labeled containers so that one container may be used exclusively in the school setting and the other one at home.

Over-the-counter medication shall be delivered to the school by the parent/guardian or designated adult in the original container along with written instructions from the child’s physician that clearly identifies the information listed below.

• Date

• Name of prescribing physician

• Name of the student

• Name of the medication

• Dose

• Frequency and method of administration

This information may be provided on a pharmacy label, by written instructions signed by the prescribing physician OR by including the physician’s signature on the Authorization for the Administration of Medication form.

Medication shall be sent to the school in the proper dosage. If pills are to be taken in a dosage that is less than one pill, they must be cut to the appropriate size before being delivered to the school. Liquid medication shall be brought to school accompanied by a measuring device which shall provide the exact dosage.

The school personnel shall only administer the medication at the time of day specified on the Authorization for the Administration of Medication form.

Parent/Guardian responsibilities

1. The parent/guardian is to make every effort to make arrangements with the student's physician to have medication taken outside of school hours. When this is not possible parents/guardians are responsible for:

2. Complete the Authorization for the Administration of Medication form.

3. Ensure that the first dose was administered and well tolerated prior to coming to school. Medication that is prescribed for an emergency situation is exempt from this condition.

4. Share accurate information regarding medication and notifying the school in writing of any changes in dosage or time of administration of medication.

5. If appropriate, ensure that their child has been made aware of their responsibility to report at the designated time and location in order for their medication to be administered.

6. If appropriate, ensure that their child has received the necessary information and training if they are to be responsible for the administration and/or storage of their own medication.

7. Ensure that an adequate supply of medication in the proper dosage is at the school or is brought to school each day and that it is replaced prior to expiry date. Ideally, a one-month supply of medication should be provided to the school when medication is to be given over an extended period of time.

8. Ensure the child has been supplied with the medication when he/she is responsible to carry the medication on their own.

9. Pick up unused medication at the end of the school year.

Principal (or designate) responsibilities

1. Identify a minimum of two school personnel each year that shall be responsible for the administration and management of medication on a regular basis for students who do not have an individually assigned school personnel. Preferably the school personnel assigned to administer medication shall do so on a voluntary basis. Medication cannot be administered by another student including the student’s sibling.

2. Ensure that all school personnel designated to administer medication are knowledgeable about this policy and its procedures.

3. Ensure that written records are maintained including:

• Authorization for the Administration of Prescribed Medication form

• Administration of Medication Record

4. Distribute this policy to parents/guardians.

Personnel assigned to administering medication responsibilities

1. Students that require complex administration of medication (i.e. via infusion pump, nasogastric tube, injection other than adrenaline auto-injector) shall be administered by a health care professional. In circumstances in which a medication must be administered by a health care professional, and that health care professional and appropriate substitute or delegate are absent for any reason, the student shall not attend the school setting. The child shall remain at home in the care and control of the parent/guardian. In the event that the child has already arrived at school, the parent/guardian or emergency contact person will be notified to pick up the child.

2. School personnel shall receive training by a URIS nurse to administer medication by:

• gastrostomy tube

• inhaled medication for asthma

• Other URIS Individual Health Care Plan medical interventions such as: 

  • adrenaline auto-injector for anaphylaxis

  • sublingual lorazepam and intranasal midazolam for seizures

  • Blood glucose monitoring support and intervention

3. School personnel that are knowledgeable on the needs of the student, the medication prescribed to the student and the regulations outlined in this policy may administer medication by:

• oral route

• instillation of medication (i.e. eye/ear drops)

• topical medication (i.e. ointment)

4. All school personnel responsible for administering medication shall be aware of the location of medication, Authorization for the Administration of Medication forms and Administration of Medication Record forms.

5. School volunteers will not administer medication to students. Exceptions may occur during school excursions at the discretion of the school administrator.

Storage

1. Medications administered by school personnel shall be stored in a locked location with the exception of medication that may be required urgently (see #2 below).

2. Medication that may be required urgently shall be carried by the student at all times or in the case of a student not developmentally able to carry his/her own medication, it shall be kept in an unlocked, safe and accessible location. Such medication includes, but is not limited to inhalers, adrenaline auto-injector and rescue medication (e.g. lorazepam, midazolam).

3. A locked location may be a cabinet, cupboard, drawer, steel box or other similar arrangements.

4. If a medication requires refrigeration, the locked location shall be, or shall be within, an operating refrigerator.

5. The key to the locked location shall be in the care and control of the person(s) responsible to administer the medications.

6. Regardless of the foregoing, the key to the locked location shall remain on the premises of the school all times.

7. A spare key to the locked location shall be reasonably available, and every designated school personnel who administers medication shall be made aware of the location of the spare key.

8. Medications shall be stored separately and apart from any other material, supply or objects in the locked location.

9. Medications for more than one student may be stored in one locked location. Each medication shall be separated by a clear physical means such as metal partitions, sealable plastic jars or boxes, individual plastic bags or appropriate equivalent. Each physical separation shall be clearly labeled with the student's name.

Safety

1. School personnel designated to administer medication shall be trained on the procedures outlined in this policy on a yearly basis.

2. School personnel designated to administer medication shall be fully aware of:

• specific details of medication administration for a student

• location of the spare key to the locked storage location

• location of the Authorization for the Administration of Medication form and Administration of Medication Record for a student

• emergency procedures relevant to the medication and student.

3. To prepare for administration of medication, school personnel shall:

• wash their hands and implement procedures of routine practice

• prepare supplies (e.g. measuring devices, installation appliances, etc.)

• for each and every administration assure themselves of,:

  • the right medication

  • the right student

  • the right dose

  • the right time

  • the right route

4. School personnel shall read the label three times

• when removing the medication from the locked storage location

• before the medication is removed from its container

• after the medication is removed from its container but before it is administered to the student

5. The Administration of Medication Record shall be stored in the area where the medication is dispensed.

6. Medications shall be returned to the locked storage location immediately after administration.

7. School personnel shall clean/wash any supplies, devices or appliances used in the administration of medication.

8. School personnel shall wash their hands and implement procedures of routine practice as appropriate.

Record keeping

1. Each student who is administered medication shall have a separate Administration of Medication Record for each medication administered.

2. The Administration of Medication Records shall be stored in the area where the medication is dispensed.

3. Each record shall include the:

• name of the student

• name of school personnel administering the medication

• date and time of the administration

• outcome of the administration

  • successful

  • refused

  • missed

  • otherwise unsuccessful

    • e. reason for unsuccessful administration and/or other comments (See next section entitled Unsuccessful administration).

4. Medication shall not be initialed as given until complete.

5. The Administration of Medication Record shall be completed immediately following each administration.

Unsuccessful administration

1. At times, the administration of medication may be unsuccessful. Some possible instances of unsuccessful medication administration include:

• refusal by the student

• failure to administer medication

• overmedication

• incorrect medication

• incorrect medication time (more than 30 minutes before or after the designated time of administration)

2. Parent/guardian shall be contacted and informed of the error in medication administration (can occur before or after administration).

3. A course of action shall be determined in consultation with the parent/guardian. When incorrect medication or overmedication has been administered, actions may include contacting the student's physician, contacting Poison Control Centre and/or calling 911/EMS.

4. If the parent(s)/guardian agency cannot be contacted, the school will contact the prescribing physician, the dispensing pharmacist, the emergency contact listed for the student and/or the Poison Control Centre.

Excursions

1. Students that require medication to be administered at school may attend excursions outside the school building. This medication administration policy may be adapted to permit students with medication administration needs to be safely included on an excursion.

2. Note: There may be instances where medical services/emergency response cannot be provided in a timely and appropriate manner. In these individual cases, the school team and/or the parent/guardian may choose not to have the student participate in the excursion.

3. The school administrator will exercise his/her discretion to determine if volunteers may administer medication during an excursion.

4. In general, consideration should be given to:

• necessity – medication should only be administered during an excursion if it is necessary

• care and control – medication shall be in the care and control of a responsible adult except for emergency medication (e.g. adrenaline auto-injector, asthma reliever medication) which shall be carried by the student.

• storage – Authorization for the Administration of Medication and medication shall be carried and completed by the adult responsible for administering the medication during the excursion.

• record keeping – the Administration of Medication Record shall be carried and completed by the person responsible for administering the medication during the excursion.

• emergency communication – there should be reasonable and appropriate access to a telephone, cellular telephone or radio communication during the excursion

• emergency medical response – emergency medical response must be determined and considered reasonable by the parent/guardian and administrator of the school, in consultation with medical team members, if requested.

Expiration and disposal

1. Medications have a finite usable period of effectiveness. The parent/guardian shall be responsible for replacing expired medications, as well as the removal and disposal of expired medication.

2. It is expected that medication(s) will be taken home by the parent/guardian or another responsible adult for any school closure or student absence exceeding two weeks.

3. The school will dispose of any medication remaining at the school after June 30th in accordance with Workplace Hazardous Materials Information Systems (WHMIS) guidelines.

Self administration

1. When a student requires medication (prescribed or over the counter) to be administered at school on a regular basis and is able to safely, competently and consistently manage his/her own medication administration, self administration is possible under the following conditions.

• The parent/guardian completes the Authorization for Self Administration of Medication form.

• Prescribed medication is brought to the school in a pharmacy labeled container. Over-the-counter medication is brought to the school in its original container.

2. Students in elementary and middle school shall be required to have controlled substance medications (e.g. codeine, morphine) brought to the school by the parent/guardian or designated adult and stored in the school office or other adult only accessible locked location.