Safe medication administration

[NicoleRNGonzaga]

Hello! I'm in grad school and for my current course I have to identify an area needing improvement in an institution and address it using Positive Deviance.

My topic is medication administration in public schools. Locally, I am finding it hard to get "official" data regarding medication errors. I am however, very close to a number of school nurses. Unofficially, I have heard stories ranging from overdosing, poor record keeping, wrong student given meds, meds not being given at all, forged records and a whole host of other issues. The big concern my friends have is that there are 5 full time RNs for 20 schools. Unlicensed assistive personnel are trained and signed off by a nurse, who delegates the medication administration to that person. And then of course eats the liability.

It's not working well in our district and my brilliant friends are attempting to solve it hands on, but for my assignment I am to seek out other districts who have similar resources and are doing it well with few errors and protocols in place. The idea of Positive Deviance is to fine unusual methods or work arounds which have been adapted by peers to make med administration safe.

So, if you work in a district with a bad ratio of nurses to students, how do you safely make sure medications are administered. And if you don't, do you have out of the box ideas we could present?

Thanks so much!

[schooldistrictnurse]

Just FYI, in the State of WI UAPs can administer meds by law, it is not a delegated task. I don't know how many other States have similar laws.

[NicoleRNGonzaga]

That's interesting! I'm in Washington state, where it is delegated. A whole can of worms in my opinion! The delegating nurse is in charge of their UAP's training, which is good. But we kind of have revolving door nurses and very little time to do additional training.

[GrapeRN]

Hello!

In my district we have a fabulous administration- we have one RN to every building. That leaves me with about 350 students, 10 of which take meds. I document electronically and on paper, keep strict inventory counts, and do not allow anyone else to give meds. If we have a sub, I have a few checks in place to make sure the right student is getting the right med. I have a daily schedule printed for all medications ordered. Next to the order, I have a picture of the student with the name, grade, dr's information, and instructions. The sub initials on the med card and writes her full name on the back of the card.

The only time we run into issues is on field trips when the nurse is not going (very rare). In this case we have to train a specific staff member (usually teacher) to give the medication. We make sure they have knowledge of the medication before going (reason the child is getting the med, any possible side effects, etc.). The teachers in my school are great about this. We do not send standing order OTC medications on field trips as (in my opinion) that requires a nursing judgement call.

Let me know if I can be of any assistance!

[bell1962]

In NYS only nurses can give meds to students..exceptions being: epipens and glucagon which nurses can train unlicensed staff to administer. The other exception is for self-directed students, who with permission from their physicians and their parents, may take their own meds with assistance from unlicensed staff. It does create issues with getting sub nurses for non self-directed students going on field trips. I feel this is a much better system..less room for errors. I do realize that not all states work this way though, unfortunately.

[coughdrop.2.go, BSN, RN]

I am one nurse for 3 high schools so there are unlicensed personnel to do daily meds. Since I have high schools, there isn't many meds because a lot of students carry and a lot of my Diabetics are independent. I'm in California by the way. For my staff that administer medication they are to be trained every year. However, I am not their supervisor. As long as my training is accurate and complete I am not liable for any mistakes they have/do because legally their supervisor determines their competency. We have paper charting and I will keep the logs for 5 school years. The medication logs are kept in a binder which I inspect every so often to make sure everything is on the up and up. So far I haven't have a situation of wrong med, overdosing, etc. but I will be implementing a medication error policy next year just in case.

[NicoleRNGonzaga]

Thank you for the feedback! It seems we have a wide variety of different methods situations. One nurse per school would be wonderful and I think high school would be easier from the med administration perspective (oh, but not from the hormonal one!)

We live in one of the poorest communities in Washington state and as such our funding is very poor. One thing that's done here is there is one elementary school with a full time nurse where most diabetics and complex needs kids go. She's in charge of 50 pretty high needs kids. We rely on our unions many times to push legislation through but school nurses here are represented by the teachers union.

I just fear fear it's going to take a mistake with fatal consequences to get our laws safer for students and nurses. Why do I always choose projects this complex? I'm jealous of my classmate who is try to change hospital policy about pre-op shaving.

[Flare, ASN, BSN]

i don't have any issues with meds (except the parents sending meds in their kids back packs and violating THAT policy and/or sending meds without orders... but that's a whole 'nother topic). I use computer charting with a back up med binder incase i'm out or for the rare times that the website for my charting is giving me problems (which never happens - the only issue i had was a data issue related to a different website... it's a bit complicated to explain). Meds get put on the computerized site which i'm looking at all day and a task list gets populated. I essentially am starting at my task list. Barring me getting pulled out of my office - which yes does happen from time to time, as i'm the lone cowboy in this ranch, meds go off on time. I am familiar with my students by now, but if i'm not familiar with the student, i ask for an identifier - verify their name and address (as written on the bottle) or check their photo in the computer.

[MsAng]

We all know that Rights for safe medication administration. These rights are taught to reduce medication errors. Unfortunately, many errors occur due to negligence in utilizing these rights. I give 16 kids daily medications at an elementary school. Each and every kids must tell me their name, then point out their name on the Rx bottle, and describe their pill (ex: one blue pill, or white one half pill) every time, every day. They moan and groan and get tired of it, but they WILL KNOW if they are not given the right medicine because of this repetition, especially if I am not there and someone else not familiar is giving out medicine. It literally takes 5 seconds to do this and will prevent wrong student/medication errors. Teachers and other staff members are permitted to give medication under the condition they have taken an annual medication administration class given by myself or our district nurse.