Medication Administration: Best Practices and School Policies
When you think of someone with a chronic condition, you may picture an adult with heart disease, cancer, or obesity.
But children have special health care needs, too. According to the National Library of Medicine, about 20% live with chronic conditions that require medicine or therapy. Managing this type of care is challenging! In a private or independent school with 300 students, up to 60 children may need daily medication that is specific to their needs — a number that continues to rise with pandemic-induced mental health issues. Health offices must coordinate closely with parents and other school staff to care for these children.
School nurses lean on each other to brainstorm ideas and create strategies for administration of medication in schools. We recently spoke with a panel of nurses and health directors who shared their best practices and school policies.
Tracking Medication Frequency, Dosage, and Storage
Most nurses lock up prescriptions for students who take medication during the school day. They may also secure over-the-counter (OTC) medications, referring to a list of approved treatments for each child. Some nurses also provide “bump” medications after lunch if students stay after school for activities.
Who May Administer Medications?
Sporting events and field trips complicate nurses’ abilities to administer medications. Some schools allow coaches, trainers, and chaperones to give medications to students off-campus, often requiring medication administration training for school personnel. They also learn how to store medicines, give dosages, and chart activities.
On campus, the health office may also train the school psychologist and other staff to help with medication administration.
“We’re a small school,” said Anna Jette, school health clinic nurse at Wooster School in Connecticut. “Sometimes, I’m not available to give medication so I’ve trained certain individuals to do so.”
Boarding School Implications
Boarding schools present different scenarios. Donna David is the Director of Health Services at Belmont Hill School in Massachusetts. As her students live at school five days a week, some must take daily medication they would typically take at home.
“Anyone on a controlled medicine has to come (to the health clinic) in the morning at breakfast time and take it with us,” she said.
David doesn’t allow students to keep medication in their dorm rooms unless the health office approves it.
Dorm faculty carry kits with thermometers and OTC medications for students who get sick after hours. But they must get approval from the health office before giving the student access to medicine.
“If a student is ill or having issues, they have to call,” said David. “I talk to the student on the phone. If I have to come in, I will, but otherwise, I say (the student) can go into the kit and take a pack of Tylenol and I will see them in the morning.
Tracking Medications With Magnus Health
Health offices that use Magnus Health find it easier to keep tabs on medication administration. They can rely on the health record software to track each student’s dosage and frequency of medication. Coaches, counselors, and chaperones can check the app for required medications no matter where they are. The health office also notifies parents through Magnus Health when supplies run low.
Coordinating Medications With Parents
Most health offices agree that working with parents regarding student medications starts with education at the beginning of the school year.
“We provide a handout with very explicit instructions regarding how we handle medications as a school,” said Jette. “If anybody has questions, I’m more than happy to meet with them.”
An article from the Journal of Pediatric Pharmacology and Therapeutics gives the same advice. Health offices must guide parents on required documentation and supply preparation at the beginning of the year. Families should also receive reminders about the school’s policy in case students start medications later in the year.
School nurses urge parents and students to take ownership of medication administration. They also ask parents to share every detail about their students’ requirements for transparency. Students who are old enough to self-carry must also take responsibility for medication administration.
“I ask the students to actually show me how to self-administer epinephrine,” said Jette. “I can document that I have gone through it with them and also determine whether they need a little more education.”
Coordinating Medications With Magnus Health
Through Magnus Health, parents may request notification after their child receives their daily medication. When the supply drops below 25%, the dosage counter turns red and prompts the nurse to send a refill reminder. Parents also learn about missed doses and any administration of emergency medications via Magnus Health.
Managing Emergency Medications
Storing Emergency Medications
EpiPens and asthma inhalers are the most common emergency medications used in schools. Other rescue medicines nurses may keep on hand include seizure and diabetes medications, and in light of the opioid crisis, at least twenty states also allow schools to administer naloxone (NARCAN).
Health offices don’t store EpiPens and inhalers like daily medications as these treatments must be readily available in case students need them.
“We have them in hanging shoe racks,” said Christina Heinroth, clinic director at Duchesne Academy of the Sacred Heart in Texas. “Inside the shoe holder is a large Ziploc bag with their rescue med and their action plan, which also has their photo on it.”
Many nurses keep extra rescue medications in their offices and across campus. Instead of leaving these expensive medicines out in the open, many lock the devices in a cabinet with the keys nearby. This precaution allows the medications to be accessible yet deters unauthorized access.
Tracking Emergency Medications Off Campus
Emergencies may arise where students need to take medications during field trips or sporting events. Health offices must therefore develop methods to make rescue medicines available to children away from school.
For off-campus activities, school nurses send pre-packaged emergency medications with documentation for relevant students. The health office keeps a list of the rescue medications they issue so they know which medicines students or supervising adults must return once the event ends.
Some nurses experience difficulty getting emergency medications back to school after sending them off campus.
“Our athletics often travel overnight, and even when they don’t, they travel to games,” said Heinroth. “We have only one rescue medication (per student) on campus, and we release it to the coach for the game. We may not get it back until noon the next day, or we find out that it was left somewhere.” To ease this challenge, Heinroth encourages parents to ask their children’s doctors about self-carry.
Managing Emergency Medications With Magnus Health
Magnus Health helps nurses manage emergency medications on and off campus. They pull electronic health records and gather data to share with faculty about medical issues like asthma or allergies.
Health offices can also export details from Magnus software to the school’s student information system (SIS). With its role-based security capability, school staff members may also receive direct access to Magnus Health on an as-needed basis. During an off-campus emergency, the app provides faculty with essential information.
Establishing Self-Administration Medication Policies
Health offices must have documentation to allow students to self-carry and self-administer medication when doctors and parents agree that the child may take medication independently.
Some nurses ask doctors and parents to fill out separate forms at the beginning of the school year. Others require both signatures on the same document.
“Doctors need to fill out the top portion with the directions for the medication and sign it,” said Jenn Sezonov, school nurse at Wheaton Academy in Illinois. “Then the parents fill out the bottom portion, stating that they’re aware the students will self-carry, and the parent signs it at the bottom too.”
Most self-administration documents are valid for a year, and nurses may consider new requests as they arise during the school year. Health offices usually review their self-administration policies once a year with consulting physicians.
Establishing Self-Administration With Magnus Health
Nurses use Magnus Health to keep track of self-administration forms as well as notes during evaluations. They notify parents if the student may self-carry/self-administer or if the student requires more training. Health offices also provide self-administration information to faculty so they know which students self-carry.
Managing School Medications With Magnus Health
At the end of the day, communication is key. When doctors, parents, and school staff work together, students get the best outcome, and the health office can ensure the safety of their school community.
Interested in learning more? Watch our Medication Administration: School Policies, Best Practices, and Lessons Learned webinar or request a customized demo to learn how Magnus Health can support your school.