FAIRFIELD SCHOOL HEALTH PROGRAM PROCEDURE: Administration of Oral, Topical or Inhalant Medications by Principals and Teachers 1. Obtain key Access to all stored medications is limited to persons authorized to administer Medications. 2. Check physician s order. Ascertain that the order is current (Check date). 3. Check parent/guardian authorization. Ascertain that the authorization is current (check date) and applies to the medication (check name) to be administered. 4. Check school nurses plan/schedule for the administration of this medication. 5. Wash hands. 6. Unlock cabinet. 7. Locate medication to be given. All medications, prescriptions and non prescription, shall be stored in their original containers. 8. Remove medication from cabinet. 9. Relock cabinet. 10. Check medication container label against physician s order. a.) WHO Be sure the student s name on medication container matches that on physician s order sheet. b.) WHAT Check that the name on the medication is the same on both the medication container and the physician s order sheet. c.) AMOUNT Check the dosage to be given on the medication container and the physician s order sheet. d.) ROUTE Determine in what manner (oral, topical, inhalant) the medication is to be given. Both the container and the physician s order sheet should say the same. e.) WHEN Check that the medication is being given no more than one-half (1/2) hour prior to or after the time stated on the nurse s administration schedule. If the drug is a PRN (to be given as needed) check the student s medication administration record to be sure the prescribed amount of time has elapsed since the last dose. 11. Ask the student to state his/her full (first and last) name. 12. Administer medication Oral medication a.) Pill or Tablet* Source: Technical Assistance Materials State of CT Dept. of Health Services Pour medication into container cap and then into student s palm. Give student water or other appropriate liquid to drink with medication. Observe student taking medication. For students who have difficulty swallowing or who must have medication specially prepared (e.g. crushed) or placed directly into their mouths, follow specific instructions provided by nurse. These instructions should appear on student s Medication Administration Record. b.) Liquid* Source: Whaley, Lucille F. et.al. Essentials of Pediatric Nursing. St. Louis. The C.V. Mosby Co. 1985 Pour out exact amount of medication into disposable calibrated plastic med cup holding cup at eye level. Use your thumb to mark off the correct level on the cup. When pouring
2. PROCEDURE: Administration of Oral, Topical or Inhalant Medications by Principals and Teachers. the medication into the cup, read the level at the bottom of the meniscus to ensure accuracy. Observe student taking medication directly from calibrated cups. If a liquid medication is measured in drops, use only the dropper that comes with it. Administer medication directly from dropper. The dropper should be placed along side of the tongue and the medication administered slowly to prevent causing the student to choke. For very small amounts of liquid medication, i.e., less than 5cc, when no dropper is provided, use a disposable plastic syringe (without the needle) to accurately measure and administer the medication directly into the student s mouth. The syringe should be placed along the side of the tongue and the medication administered slowly to prevent causing the student to choke. For students who must have liquid medication specially prepared, follow specific instructions provided by nurse. These instructions should appear on the student s Medication Administration Record. Eye Medications* *Source: Whaley, Lucille F. Essentials of Pediatric Nursing. St. Louis. The C.V. Mosby Co. 1985: Nurse s Reference Library Series Procedures,Springhouse, P.A. Intermed Communications 1983 a.) Eye Drops Have the patient sit or lie in the supine position. Instruct him to tilt his head back and toward the side of the affected eye so excess solution can flow away from the tear duct, preventing systemic absorption through the nasal mucosa. Remove the dropper cap from the medication container. Be careful to avoid contaminating the bottle top. Fill the dropper, as necessary. Before instilling the eye drops, instruct the patient to look up and away. This moves the cornea away from the lower lid and minimizes the risk of touching the cornea with the dropper if the patient blinks. Gently pull down the lower lid to expose the conjunctival sac. To instill eye drops: Steady the hand in which you are holding the dropper against the patient s forehead. Then, with your other hand, gently pull down the lower lid of the affected eye and instill the drops in the conjuctival sac. Never instill eye drops directly onto the eyeball. Instruct the patient to close his eyes gently, without squeezing the lids shut. Tell the patient to look in all directions to help distribute the medication over the surface of the eyeball. Remove any excess solution or ointment surrounding the eye with a clean tissue. Use a separate tissue for each eye.
3. PROCEDURE: Administration of Oral, Topical or Inhalant Medications by Principals and Teachers Some students may require special or additional intervention when eye drops are administered (e.g., replacement of an eye dressing). Follow specific instructions of nurse. These instructions should appear on student s Medication Administration Record. b.) Eye Ointment Have student sit or be supine with head tilted back. Gently pull down the lower lid to expose the conjuctival sac. Squeeze a small ribbon of medication onto the conjuctival sac from the inner to the outer chantus. Avoid touching the eye with the end of the tube. Cut off the ribbon by turning the tube. If needed, steady your hand holding the medication tube by bracing it against the student s forehead or cheek. Instruct the student to close his eyes gently, without squeezing the lids shut. Tell him to look in all directions to help distribute the medication over the surface of the eyeball. Remove any excess ointment surrounding the eye with a clean tissue. Use a separate tissue for each eye. Some students may require special or additional interventions when eye ointments are administered (e.g., replacement of an eye dressing). Follow specific instructions of nurse. These instructions should appear on the student s Medication Administration Record. Topical Medication (ointment)* *Source: Nurse s Reference Library Series Procedures Springhouse, P.A. Intermed Communications 1983 Wear gloves. First remove any previously applied ointment to prevent skin irritation from an accumulation of ointment. Ointment may be removed by gently wiping area with sterile gauze. Do not rub hard as this could irritate the skin. Open the container of ointment and place the lid upside down on a clean surface to prevent contamination of the inside. Use a tongue depressor and cover one end with ointment from the tube, or lift out a dollop from the jar. Then, transfer the ointment from tongue depressor to your gloved hand. Apply the ointment to the affected area with long, smooth strokes that follow the direction of hair growth. This prevents medication from being forced into hair follicles, which and cause irritation and lead to folliculitis. Avoid excessive pressure, which could abade the skin. To prevent contamination of the ointment, use a new tongue depressor each time you remove ointment from the container. Some students may require additional or special interventions when topical medication is administered (e.g., application of a dressing ). Follow the specific
4. PROCEDURE: Administration of Oral, Topical or Inhalant Medications by Principals and Teachers. instructions of the nurse. These instructions should appear on the student s Medication Administration Record. Inhalant Medication Metered Dose Inhalers* *Source: Mendoza, Guillermo, MD et als. Asthma in the School. Health Scan. Inc. 1989 Some students may require special interventions or techniques for administration of inhalant medications (e.g., use of holding chambers or spacers as with Inhal Aid and Inspir Ease or use of nebulizers). Follow specific instructions of nurse. These instructions should appear on the student s Medication Administration Record. Technique for using metered-dose Inhalers: When one is using metered-dose inhalers, proper technique is very important to assure that the medication reaches the lungs and thus is maximally effective. Poor inhaler technique results in deposition of the drug on the tongue and back of the throat rather than in the airways. To use the inhaler correctly, the student should follow these simple steps: 1. Shake the canister. 2. Hold the inhaler so that the mouthpiece is 1 to 2 inches in front of the open mouth. This allows the particles to slow down after they are discharged before they enter the mouth. 3. Exhale and then begin to breathe in as slowly and as deeply as possible and get ready to actuate the canister. 4. Actuate the inhaler just after you begin to inhale. 5. Hold your breath for 10 seconds if possible to allow the particles to settle on the lining of the airways before you breathe out. 13. Wash Hands. 14. Document a.) The following information should be recorded on the student s Medication Administration Record in ink. 1. Date. 2. Time and medication given. 3. Dosage of medication given. 4. Legal signature and title of principal or teacher administering medication. 5. Amount of control drug remaining (if applicable). b.) If an error in documentation is made, draw a single line through the entry and sign it. Record the correct data on the next line. c.) If for some reason the student does not take a poured medication: the student refuses; medication is lost or spilled; medication is spoiled or outdated, record on the student s Medication Administration Record, and NOTIFY THE SCHOOL NURSE. 15. If a medication administration error is made, follow the school s policy/procedure regarding notification and documentation of such errors. 16. Replace medication. 17. Re-lock cabinet. 18. Monitor student s progress. If student should return to the office complaining of side effects, follow physician s plan for management and school policy and procedure for Medication Emergencies.