FASA Handbook - Chapter 4 MEDICATION Purpose: To create a uniform policy to promote continuity in the Clark County School District (CCSD) Health Services department regarding Medication Administration for students. Additional Authority: Nevada Revised Statutes (NRS), Nevada Administrative Code (NAC), Nevada State Board of Nursing (NSBN), School Nurse Regulation and Advisory Opinion, CCSD Regulation 5150 Health and Welfare: Students, Academic Unit Administrative Reference: Policy-Medication During School Hours; and, National Association of School Nurses (NASN). Scope: This policy applies to all CCSD personnel who administer medication to students. Responsible Party: Director of Health Services Distribution: Health Services Coordinators, School Nurses, Specialized Procedure Nurses (SPNs), First Aid Safety Assistants (FASAs), and Unlicensed Assistive Personnel (UAPs) 1.0 Policy Statement POLICY 1.1 Clark County School District Regulation 5150, Health and Welfare: Students, outlines the procedure for the administration of medication to students during school hours. School personnel designated to assist students with medications must adhere to the regulation which specifically delineates procedures for students in grades pre-kindergarten through grade 12. 1.2 District policy allows students in Grades 6-12 to self-medicate with parent/guardian permission, except for controlled substances. Students who self-medicate will not be tracked or monitored by health office
personnel. Students in grades 6-12, who require monitoring by district personnel and/or assistance with medication administration, are subject to all of the requirements in Regulation 5150, Section III. Medication during School Hours. 1.2.1 FASAs are to follow the medication administration guidelines and procedures in this section, and in the Medication Administration Training Packet (HS). 1.2.2 Students are allowed to self-medicate for asthma or anaphylaxis according to NRS 392.425. A completed Request to Authorize Student Self Administration (HS) must be completed by the parent/guardian, licensed health care provider and School Nurse. 1.3 Designated personnel assisting with medication must pass the medication test prior to administering medications to students. A FASA or designated health office backup that was trained in the past school year may assist with medication administration, for the first two weeks of school, until current annual training is complete. 1.3.1 The School Nurse must verify completion of medication training and maintain a record of completion in the Medication Notebook. 1.4 It is the responsibility of the site administrator to assign a minimum of two designated back up personnel to provide relief coverage for FASA lunches, breaks, duty assignments, and absences (Academic Unit Administrative Reference: Medication During School Hours, Regulation 5150 Health and Welfare: Students).
1.5 The FASA and School Nurse will have a plan in place to ensure prompt communication regarding all medications. This would include: 1.5.1 All new medications for administration at school 1.5.2 Whenever a refill medication looks different than original medication 1.5.3 Any change in an existing prescription or written communication received from a licensed health care provider 1.5.4 Any request to discontinue medication 1.5.5 Any question or concern regarding a medication 1.6 The FASA is responsible to complete required medication documentation forms upon receipt of new medications or medication refills. 1.7 Ensure that students receive their daily medication as prescribed by the licensed health care provider at the prescribed time. 1.7.1 The FASA and designated personnel must be familiar with the location of medications, the Medication Notebook and have access to the medication cabinet. 1.7.2 School Nurses will review certain emergency medication procedures with the FASA and designated back-up personnel monthly and document the review. 1.7.3 Keys to the medication cabinet must be secured in a confidential location. 1.7.4 District Issued Epinephrine Auto-injector 1.7.4.1 Each school has district issued stock epinephrine auto-injectors for use in case of anaphylactic shock.
1.7.4.2 Verification of training will occur monthly under the supervision of the School Nurse. 2.0 Procedure 2.1 When a medication is brought to the health office, the FASA will: 2.1.1 Contact the School Nurse. 2.1.2 The FASA will give the parent/guardian a Parent/Guardian Request for Medication Assistance (CCF), and have them complete the parent/guardian section. The FASA will complete the bottom portion, CCSD Personnel to Complete This Section. 2.1.3 If the medication is in tablet or capsule form, the FASA will count with another adult (parent/guardian or staff member), document, and sign on the Inventory Control form (HS). 2.1.4 Complete Temporary New Medication Worksheet (HS) and utilize for documentation until medication is entered by the School Nurse into the electronic medical record. 2.1.5 When a refill is brought in by the parent, if the pills are noted to be different in color, shape or design than previous medication, the FASA is to notify the School Nurse prior to administering the medication. 2.1.6 If clarification of the medication order is needed, the FASA is to contact the School Nurse. 2.1.7 The FASA must check the label on the medication bottle to ensure the prescription is not expired and that all information provided on
the Parent/Guardian Request for Medication Assistance (CCF). If there is any discrepancy, contact the School Nurse for further direction. 2.1.8 An over-the-counter medication must be in the original container and must be accompanied by a LHCP order for school personnel to administer the medication at school (See Regulation 5150 Health and Welfare: Students). 2.1.9 All initial medications, changes in medications or deletions are entered into the electronic medical record by the School Nurse. The Temporary New Medication Worksheet (HS) is to be utilized by the FASA and health office backups until the School Nurse has entered the medication into the electronic medical record. 2.1.10 A parent/guardian or LCHP may request that a medication be discontinued. Record on the Inventory Control (HS) the number of medication tablets/pills returned to the parent/guardian. The FASA will notify the School Nurse of discontinued medications. The School Nurse will then discontinue it in electronic medical record. 2.2 When a medication is administered: 2.2.1 Follow all procedures for assisting with medication administration contained in the Medication Administration Training Packet (HS) or the online medication training modules.
2.2.2 All school staff assisting with medication administration will do so in accordance with the guidelines established in the Medication Administration Skills Checklist (HS) 2.2.3 The FASA and School Nurse should establish a routine system for assisting with medications. This should include having cups ready, instructing students to wash their hands, line up, and identify themselves by stating their full names. Familiarize designated backup personnel with the established routine. 2.2.4 Check medication schedule throughout the day to ensure that student(s) have reported for their medication. 2.3 Inventory Control of Medication - All pill form medication must be counted by two adults. One of the adults must be a trained district employee. If a second adult is not available, it is permissible for the secondary student and a trained adult to count. 2.4 Change in Medication 2.4.1 Verbal parent/guardian requests for medication changes cannot be implemented. Advise the School Nurse of the request immediately. 2.4.2 A new Parent/Guardian Request for Medication Assistance (CCF) must be initiated and signed at the time any new medication or LHCP order is received. 2.4.3 If a change in orders is received by fax, the medication container must reflect the change or a copy of the medication clarification must be available for immediate review.
2.4.3.1 The original pharmacy label cannot be altered. 2.4.3.2 Consult the School Nurse for specific directions. 2.5 Prescribed Medication Time 2.5.1 Every effort should be made to give medication at the time prescribed by the LHCP. This does not allow district personnel to change medication time on a routine basis. 2.5.1.1 However, medication may be given up to one hour before or one hour after the prescribed time without being considered a medication error to accommodate changes in student schedules. 2.5.2 Certain medications must be given exactly at the time specified by the LHCP order. An example of this includes inhalers ordered to be given prior to PE. 2.6 Students who do not report to the health office at the prescribed time must be called to the health office. 2.7 Multiple Medication/Doses 2.7.1 If two strengths of one medication are ordered to be given at the same time, then a Parent/Guardian Request for Medication Assistance (CCF) must be completed for each strength of medication. 2.8 Special Method for Medication Administration - Confer with the School Nurse regarding any special methods of administering medications to students with special needs, (i.e., crushing, mixing, or sprinkling).
2.9 Refrigerated Medication 2.9.1 If a student s medication must be refrigerated, the medication must be secured. 2.9.1.1 *NAC 444.5684(2) Any Medications Stored in a Health Room states, Any medications that are stored in a health room must be accessible only to authorized members of the staff of the school. 2.9.1.2 Maintain a locked box for medications and store in refrigerator. 2.10 Field Trip Medication Procedure: During School Hours 2.10.1 If a student is attending a field trip away from school during his/her scheduled medication time, or may require an as needed medication, a staff member will be designated to administer the medication and be trained by School Nurse. 2.10.2 The teacher should notify the School Nurse/ FASA of a scheduled field trip 30 days prior to field trip. FASA, under the direction of the School Nurse will review student list for medications/ health conditions and present to School Nurse for review. 2.10.3 Staff members who will be administering field trip medication will be trained by the School Nurse regarding appropriate procedure. Training may not be done by the FASA. 2.10.4 The FASA will copy the Prescription Record Detail (HMS) and prepare the medication. Medication must be in an appropriately
labeled container (envelope or baggie) with student s name, medication name, dose, and time with specific instructions regarding administration. Do not send the prescription bottle. Send only enough medication for the dose needed. 2.10.4.1 Sample Field Trip Medication Label For Envelopes may be utilized. 2.10.5 The teacher or designated school personnel will pick up the student s medication(s) on the day of the field trip from the Health Office. It will be the responsibility of the teacher or designated personnel to keep the medication on their person. 2.10.6 The teacher or designated school personnel will document the time and initial after administration on the copy of the Prescription Record Detail, (HMS). 2.10.7 Upon return from the field trip, teacher or designated personnel will return medications and documentation of medication administration to the health office. Medication must be checked in by two school staff members. Returned medications will be locked in the medication cabinet. 2.10.8 The FASA will document field trip medication administration into the electronic medical record. 2.10.9 Field trip documentation of administered medication(s) will be maintained in the Medication Notebook, in the Student Medication Information section.
2.11 Request for Non-Routine Doses 2.11.1 Occasionally a parent/guardian will request that school personnel provide a dose of medication not usually received at school. Generally, this is because a student has forgotten to take a morning dose at home. Follow the guidelines below: 2.11.2 Unlicensed personnel, such as FASAs and office staff are to notify the School Nurse of any request of a non-routine dose of medication. If unable to contact the School Nurse, contact a Schoool Nurse back up; the health services coordinator, or Health Services Department. 2.11.3 Only a parent/guardian may request a non-routine dose of medication be administered. Requests made by students or teachers are NOT to be honored. Verification of missed dose must be made by a telephone call to the parent/guardian. 2.11.4 A non-routine dose may be provided at school at the direction of the School Nurse, only if the medication label states the medication can be taken at that time (i.e., "at 8:00 a.m.", "take with breakfast".) 2.11.4.1 The School Nurse will advise the FASA or back-up personnel regarding any change in the time of the regular school dose. 2.11.4.2 Documentation of the non-routine dose will be recorded by the FASA or backup personnel on the New Medication Temporary Worksheet (HS). The nurse will enter
the medication as a one-time dose in the electronic medical record, and adjust the medication inventory of the daily medication. 2.12 Medication Errors 2.12.1 Medication errors include, but are not limited to, the following: 2.12.1.1 Wrong student 2.12.1.2 Wrong medication 2.12.1.3 Wrong dose 2.12.1.4 Wrong time (or frequency). Medication must be given within a one (1) hour period before or after the prescribed time. 2.12.1.5 Wrong route 2.12.1.6 Omission or duplication of administration 2.12.2 Notify the School Nurse. The School Nurse will determine if the licensed health care provider needs to be notified. If unable to reach School Nurse contact team School Nurse back up. If unable to reach either, contact the Health Services Coordinator. 2.12.3 If a medication error has occurred, follow the procedures listed below. The School Nurse must review all Medication/Procedure Errors. 2.12.4 Monitor student for adverse side effect(s). 2.12.4.1 Poison Control may be contacted at the direction of the School Nurse.
2.12.4.2 Follow emergency procedures if student s condition worsens. 2.12.4.3 Notify the site administrator/designee. 2.12.4.4 Notify the parent(s)/guardian(s) of the involved student(s). 2.12.4.5 Documentation of error is recorded in electronic medical record as outlined in shoms. 2.12.4.6 School Nurse remediates staff member and completes training as needed. 2.13 Tuberculosis Medication 2.13.1 Contact the School Nurse for specific direction prior to administration. 2.14 Dropped/Spilled Medication - Dispose of any medication which is dropped or spilled on the floor. If it is a tablet or capsule, have another staff member witness the disposal and record on the Inventory Control form. Notify the parent/guardian, and contact the School Nurse so that the inventory may be adjusted in electronic medical record. 2.15 Disposal of Medication - The Southern Nevada Water Authority (SNWA) and the Southern Nevada Health District (SNHD) have developed procedures for the proper disposal of medications, and Health Services has incorporated this information in the following procedure: 2.15.1 Medication disposal may occur in the following situations: 2.15.1.1 A medication is dropped on the floor.
2.15.1.2 Send a Medication Removal Letter (HS) home to the parent/guardian two weeks before the end of the school year. Maintain a copy of the letter in the Medication Notebook. Dispose of medication not claimed at the end of the school year if unable to contact the parent/guardian after two (2) attempts. No medication should be left in the health office. 2.15.1.3 Discard needles, syringes, empty glass medication containers, and lancets in the sharps container. Do NOT recap, remove, or bend needles. Students in grades 6-12 who self-medicate with injectable medication should be instructed to dispose of sharps in the health office or in an approved sharps container. 2.15.1.4 Sharps containers are brought to the Health Services Department office for disposal. Notify School Nurse when Sharps container is ¾ full. 2.15.1.5 Place solid medication in a sealable plastic bag. Crush the medications using a heavy object. Add an absorbent product, such as moisture/odor absorbent powder (available from the custodian) or used coffee grounds. Pour any liquid medications into the bag, seal shut and place in the trash. 2.15.1.6 Do not dispose of medication in the toilet.
2.15.1.7 Do not dispose of oral medication in the sharps container. 2.15.1.8 Dispose of inhalers in the trash. 2.15.1.9 Students who self-medicate must confer with the School Nurse to ensure safe disposal of medication. 2.15.1.10 Document disposal on the Inventory Control form.(hs) 2.15.1.11 Disposal of medication requires 2 school staff. 2.16 Work with the School Nurse to determine a system of medication reminders which can be used to remind students and teachers. 3.0 References, Sources, Bibliography 3.1 School Nurse Handbook 3.2 Shoms.ccsd.net 4.0 Authorizations Health Services Director (Print) Signature Date *Medical Consultant (Print) Signature Date *Optional