Medication Administration Practices : SchoolNurse.com

Medication Administration Practices

A study completed by 649 of 1000 randomly selected school nurse members of National Association of School Nurses assessed current practices and concerns regarding medication administration in schools. Consistent with other studies, they reported 5.6% of students receive medication daily. Specifically, 3.3% of students receive medication for attention deficit-hyperactive disorder (ADHD), followed by non-prescription medications (1.5%), asthma medications (1.1%), analgesics (0.9%) and anti-seizure medications (0.6%) in a typical day.
Most nurses have written guidelines (98%) and state guidelines (91.9%).

A written order from the health care provider is required by 93.5% for prescription medication; one-fourth accept a prescription label as an order. Some (22.7%) reported that medications were removed from the original container to another (weekly dispenser or envelope) before administration.

Most nurses routinely document medication administration with student name, medicine name, dose, time and who administered the medication, but only 20% include possible side effects.

One fourth of the nurses give all the medications in their schools, while the remainder use unlicensed assistive personnel (UAP)- secretaries (66%), aides (40%), teachers (38%), parents (18%) and students (16%). Of those who use UAP, 80% indicated that in-service education is provided. About half (45.2%) who use UAP are comfortable with the practice, but one-third are uncomfortable. Nineteen percent did not know if their state nurse practice act permitted delegation.

Among all the respondents, 48% reported at least one medication error had occurred in the past year. The types of errors were: missed dose (reported by 89.7%), not documented (29.8%), over or double dose (22.9%), given without authorization (20.6%), and wrong medication (20%). Further analysis suggested that an error was three times more likely with the use of an UAP and more likely with high numbers of students assigned. Student self-administration was not related to the occurrence of errors.

Despite having guidelines, nurses struggle with delegation and monitoring for errors and side effects. Suggested strategies for improvement included consulting with a pharmacist about such issues as storage and analyzing factors associated with errors to reduce the occurrences. The authors recommended national guidelines, noting that practices varied within states not just among states.

(McCarthy A et al. J Sch Health 2000;70(9):371-376)

Comment: It was not stated if administration by "student" was limited to self-administration which is my hope. This national sample can be used to compare local practices for quality improvements. It also raises important concerns, such as the practice of allowing non-original containers and uncertainty about state nurse practice act regarding delegation. -J.O.






			Medication Administration Practices A study completed by 649 of 1000 randomly selected school nurse members of National Association of School Nurses assessed current practices and concerns regarding medication administration in schools. Consistent with other studies, they reported 5.6% of students receive medication daily. Specifically, 3.3% of students receive medication for attention deficit-hyperactive disorder (ADHD), followed by non-prescription medications (1.5%), asthma medications (1.1%), analgesics (0.9%) and anti-seizure medications (0.6%) in a typical day. Most nurses have written guidelines (98%) and state guidelines (91.9%). A written order from the health care provider is required by 93.5% for prescription medication; one-fourth accept a prescription label as an order. Some (22.7%) reported that medications were removed from the original container to another (weekly dispenser or envelope) before administration. Most nurses routinely document medication administration with student name, medicine name, dose, time and who administered the medication, but only 20% include possible side effects. One fourth of the nurses give all the medications in their schools, while the remainder use unlicensed assistive personnel (UAP)- secretaries (66%), aides (40%), teachers (38%), parents (18%) and students (16%). Of those who use UAP, 80% indicated that in-service education is provided. About half (45.2%) who use UAP are comfortable with the practice, but one-third are uncomfortable. Nineteen percent did not know if their state nurse practice act permitted delegation. Among all the respondents, 48% reported at least one medication error had occurred in the past year. The types of errors were: missed dose (reported by 89.7%), not documented (29.8%), over or double dose (22.9%), given without authorization (20.6%), and wrong medication (20%). Further analysis suggested that an error was three times more likely with the use of an UAP and more likely with high numbers of students assigned. Student self-administration was not related to the occurrence of errors. Despite having guidelines, nurses struggle with delegation and monitoring for errors and side effects. Suggested strategies for improvement included consulting with a pharmacist about such issues as storage and analyzing factors associated with errors to reduce the occurrences. The authors recommended national guidelines, noting that practices varied within states not just among states. (McCarthy A et al. J Sch Health 2000;70(9):371-376) Comment: It was not stated if administration by "student" was limited to self-administration which is my hope. This national sample can be used to compare local practices for quality improvements. It also raises important concerns, such as the practice of allowing non-original containers and uncertainty about state nurse practice act regarding delegation. -J.O.



All Rights Reserved ©Copyright 1999, 2000 ®School Health Alert