And we wonder why the students can't follow directions...

[Purple_Scrubs, BSN, RN]

...because their teachers can't!!!!!! I had a teacher approach me weeks ago about a field trip during which one of her kids will need his meds. I told her I will get the paperwork together and she can stop by and I will train her to administer meds. Well, the field trip was cancelled due to weather, and I find out this morning that it was rescheduled for TODAY with no warning to me! No problem, I drop everything and get the paperwork ready to document that I trained this teacher, got the meds ready, and walked them to her classroom. I was explicit with the instructions and reiterated everything at least twice. She was distracted due to an issue with another student who did not want to go on the field trip because "his feet hurt", but he was cleared medically by myself and a note from a physician stating no physical activity restrictions AND his mother wanted him to go. She still did not want him to go because she did not want to deal with him. Needless to say he did go on the trip.

Because of that mess, I made sure to have her verbalize understanding to the instructions and sign the documents stating I trained her. They were to leave at 10:30 and have lunch on the field trip (it is a lunchtime med). The student came to me at 10:20 with the empty pill bottle and the MAR, which was signed at the top but not dated and initialed that she gave the med. I asked him what happened, who gave him the med, etc. because I was confused about why he got it early. Apparently she did not want to deal with it on the field trip so she gave him an apple and his pill Now, he usually gets it at 11:20, so 10:20 is not a disaster, but still I was seriously miffed. I sent him back with the paperwork with a sticky note that she needs to initial and put the time she gave it. He came back minutes later and said she would not do it and that she already signed it (inidicating the top where you sign your full name). At this point I am fuming. I put another sticky note on top of the other one stating THIS IS REQUIRED and an arrow pointing to the box that you initial and time (which I had already highlighted and explained in the first place). She finally initialed and wrote the time after all that.

I mean, seriously! We expect these kids to follow basic and sometimes complex instructions all the time, and yet some of the teachers cannot do it themselves or else they refuse to! How hard is it to initial and write the time on a little box when you have had written and verbal instructions on what to do??? For that matter, how hard is it to give the med ON TIME and as ordered, when the improtance of this has been stressed to you??? AAAARGHHH!

OK, rant over. Thanks for listening.

[caliotter3]

I just love it when somebody is very agreeable and tells you they are going to do something or not do something, as required, then when the time comes, they do the exact opposite of what they assured you. They obviously excel in lack of integrity, because you believed every word out of their mouth.

[bergren]

Administering a medication 90 minutes early is a medication error and warrants an incident report.

[LACA, BSN, LPN, RN]

Since it was an hour early, is that still considered a medication error? What is the time frame on when it's too early/too late to safely give a med?

[bergren]

According to this NIH document, 60 minutes - Detection and Prevention of Medication Errors Using Real-Time Bedside Nurse Charting

This is a state of Tennessee document for child medications and it also cites 60 minutes: http://www.fosteringconnections.org/tools/assets/files/20.59-Medication-Error-Guidelines.PDF

In the 4 Children's Hospitals I have worked in, it is a 30 minute before and after, so a 60 minute window. A noon dose would be OK if administered between 11:30 - 12:30

What do most of your schools consider a medication error? How early, how late?

[BunnyBunnyBSNRN, ASN, BSN]

What do most of your schools consider a medication error? How early, how late?

Our P&P manual says 30mins before/after is considered on time. (Smaller school district in San Antonio)

[Purple_Scrubs, BSN, RN]

It was 60 minutes early because his normal lunchtime is 11:20 and the orders state give with lunch.

[bergren]

What is ontime according to your school policy?

[Jolie, BSN]

Perhaps part of the problem is "deputizing" a teacher to administer a medication on short notice or on an occasional basis. That doesn't seem like a good method of adequately covering medication safety or documentation, let alone possible side-effects, etc.

We conduct a 3+ hour class on medication administration at the beginning of each school year, which includes a final exam. This is required by our state BON in order for non-nurses to administer meds in the school setting.

Obviously, not every teacher can or should attend this class. It is up to each principal to strategically plan and assign faculty and staff members to attend med. class so that there is adequate coverage in each building for daily meds when the nurse is not present, field trips, athletics and other activities.

Our system is not fool proof either, but at least gives us (the nurses) the opportunity to heavily stress the responsibilities and legal isues that go with administering medication in the school setting. I can't imagine a teacher blatantly disregarding medication instructions in our district and living to see another day.

[tencat]

Jolie's school has it right! That is such a good idea. Let those who feel comfortable go ahead and be trained to give medications for just such a situation.

Playing devil's advocate here. 30-50 screeching, crazy kids on a field trip....one is trying to run in front of a bus, one is poking at the walls of the Alamo with a pencil, ten are pushing and shoving each other into the roped-off area....oh yeah, Johnny needs his pills. NOT going to be a teacher's priority.

In fact, I really don't think it should be the teacher's responsibility for a number of reasons, the least of which is he/she is NOT a licensed medical professional and giving a medication to a child is completely out of a teacher's realm of practice. What if Johnny had had a reaction to the medication? When I was a teacher I would have flat out said, 'um....NOT A CHANCE!' even though I was a licensed EMT at the time as well. Too much liability for everyone concerned, including the school nurse, I would imagine. The teacher in your school should have immediately told you that he/she wasn't going to do it, in a nice way of course. A better solution might have been to have mom, dad, or guardian be a chaperone on the trip and let them give the meds. What happened goes to show why it is a BAD idea to have unlicensed personnel give medications to students. The kid wasn't hurt, but if he had been, you all would have been in deep doo-doo.

[noreenl]

I m just wondering what constitutes the need for a trip nurse in this school district. Any "Procedure" that is done by a nurse at school, ie. give meds, must be done by a nurse on a trip. therefore a trip nurse must be requested and assiged to the trip in advance. +

[schooldistrictnurse]

My state (WI) has a new law in effect as of March, 2011 that requires all UAP (teachers included) who administer medication to students to have taken a DPI approved course. It's done on-line. We have started including a notation about meds and trained personnel for field trips in IHPs, IEPs, and 504s. With proper training, UAPs are competent to administer meds.