Necessary KnowledgeNecessary Knowledge for Medical Assistants for Medical Assistants

Types of Medications How they are packaged

Routes of Administration

Steps to administering oral medications

Knowledge of potential side effects and adverse reactions

• No prescription medication may be No prescription medication may be given without:given without:– parent authorization, parent authorization, – a healthcare provider order, and a a healthcare provider order, and a – pharmacy label. pharmacy label.

• Review local policies. Review local policies.

Specific Rules Related to Specific Rules Related to Prescription MedicinePrescription Medicine

• Under no circumstancesUnder no circumstances should the school stock should the school stock over-the-counter (OTC) medicines, such as over-the-counter (OTC) medicines, such as Tylenol, for student or staff use. Tylenol, for student or staff use.

• OTC must be provided by the parent in the OTC must be provided by the parent in the original container with original container with specific instructionsspecific instructions as to as to when or why such medicines may be necessary. when or why such medicines may be necessary.

• The delegating RN must evaluate and approve The delegating RN must evaluate and approve all OTC medicines and parental instructions. all OTC medicines and parental instructions.

• The delegating RN will determine if the OTC The delegating RN will determine if the OTC medicine is appropriate and whether a provider medicine is appropriate and whether a provider order is also necessary.order is also necessary.

Specific Rules Related to OTC Specific Rules Related to OTC MedicineMedicine

No Injections by No Injections by Non-Licensed Person!Non-Licensed Person!

Only allowed in case of pre-measured emergency allergy medication like EPI-Pen

How to Assist Students with How to Assist Students with Particular Types of MedicationsParticular Types of Medications•When the Board of Nursing established When the Board of Nursing established regulations that allowed school nurses to delegate regulations that allowed school nurses to delegate certain medications to an unlicensed school certain medications to an unlicensed school employee or teacher—employee or teacher—

– the route of the medication was specified rather than the route of the medication was specified rather than the names of medicines. the names of medicines.

•An An absolute prohibitionabsolute prohibition exists for exists for injectableinjectable medications. medications. •School nurses are prohibited from delegating School nurses are prohibited from delegating assisting with medications that must be delivered assisting with medications that must be delivered by injection except for pre-mixed anti-allergy by injection except for pre-mixed anti-allergy injections (Epi-pen.) injections (Epi-pen.)

Delegation by School NursesDelegation by School NursesThe specific delegated tasks shall not require the The specific delegated tasks shall not require the exercise of independent nursing judgment or exercise of independent nursing judgment or intervention. Specific tasks that require independent intervention. Specific tasks that require independent nursing judgment or intervention that nursing judgment or intervention that shall notshall not be be delegated include, but are not limited to:delegated include, but are not limited to:

• Catheterization, clean or Catheterization, clean or sterile. sterile.

• Administration of Administration of injectable medications, injectable medications, other than premeasured other than premeasured medication for allergic medication for allergic reactions (i.e., EpiPenreactions (i.e., EpiPen).).

• Administration of Administration of rectal rectal or or vaginal medications.vaginal medications.

• Calculation of medication Calculation of medication dosages other than dosages other than measuring a prescribed measuring a prescribed amount of liquid medication amount of liquid medication or breaking a scored tablet.or breaking a scored tablet.

• Tracheotomy care, Tracheotomy care, including suctioning. including suctioning.

• Gastric tube insertion, Gastric tube insertion, replacement, or replacement, or feedings. feedings.

• Invasive procedures or Invasive procedures or techniques. techniques.

• Sterile procedures. Sterile procedures. • Ventilator care. Ventilator care. • Receipt of verbal or Receipt of verbal or

telephone orders from a telephone orders from a licensed prescriber.licensed prescriber.

• Importance of Importance of checking the Six Rightschecking the Six Rights each each and every time medication is given: and every time medication is given: – (1) when taking medication from the cabinet, (1) when taking medication from the cabinet, – (2) when pouring the medication, and (2) when pouring the medication, and – (3) when returning the medication to the cabinet.(3) when returning the medication to the cabinet.

• Appropriate, accurate, timely documentation. Appropriate, accurate, timely documentation.

• How to obtain assistance from the school How to obtain assistance from the school nurse and/or other healthcare professionals. nurse and/or other healthcare professionals.

• Understanding of local policies. Understanding of local policies.

Necessary KnowledgeNecessary Knowledge

Remember! Check the Label Remember! Check the Label ThreeThree Times! Times!

1. When removing from the locked 1. When removing from the locked cabinetcabinet

2. When pouring the medication2. When pouring the medication

3. When replacing the medication 3. When replacing the medication

Responsibilities Related to Responsibilities Related to Controlled SubstancesControlled Substances

• Identifies controlled substances and stores Identifies controlled substances and stores in a secure location according to state and in a secure location according to state and local policies. local policies.

• Documents the receipt, number, and Documents the receipt, number, and return of controlled substances according return of controlled substances according to state and local policies. to state and local policies.

• Reports discrepancies in the quantity of a Reports discrepancies in the quantity of a controlled substance to the school nurse, controlled substance to the school nurse, principal and other authorities according principal and other authorities according to state and local policies. to state and local policies.

Oral Medications can be : Oral Medications can be : pills/tablets/caplets pills/tablets/caplets

Medications

Tablets Gel-Caps Capsules

Can Not be Crushed Do not open!

Do not try to cut with a knife or break!

Gel- CapsGel- Caps

Gel Caps should be swallowed whole unless opening is ordered by the physician!

Tablets Only crush if the physician orders it!

Should only be cut into if scored!

Should only be cut using a pill splitter.

OnlyOnly scored tablets are made scored tablets are made to be cut in half to obtain a to be cut in half to obtain a smaller dose!smaller dose!• Example, the tablet is 10 milligrams, Example, the tablet is 10 milligrams,

but the order says the student takes but the order says the student takes only 5 milligrams. This requires cutting.only 5 milligrams. This requires cutting.

• If a medication must be cut , If a medication must be cut , the nursethe nurse should use a pill splitter to cut the pill.should use a pill splitter to cut the pill.

• Coated tablets should be swallowed Coated tablets should be swallowed whole and not chewed.whole and not chewed.

Necessary knowledgeNecessary knowledge

•Do not take capsules apart, Do not take capsules apart, crush, or let the student chew crush, or let the student chew them!them!

CapsulesCapsules Remember!

Capsules should never be opened except by a doctor’s order!

Always consult the nurse, the pharmacist If you have a question!

Liquid Medications

Always use a calibrated medication spoon or cup for measuring!

Do Not Change the form of aDo Not Change the form of a Medication! Medication!

• This can only be done with the order This can only be done with the order from the physician and by the nurse.from the physician and by the nurse.

• Cutting >>>Cutting >>>

• Crushing>>>>Crushing>>>>

• Or sprinkling >>>>> All of these are Or sprinkling >>>>> All of these are examples of changing the form of an examples of changing the form of an oral medication.oral medication.

Assisting with Oral Assisting with Oral MedicationsMedications• Check order form and pharmacy label Check order form and pharmacy label

for instructions.for instructions.

• Assemble necessary equipment.Assemble necessary equipment.

• ALWAYSALWAYS wash your hands before wash your hands before giving any medication to a student. giving any medication to a student.

• If the student will touch or handle the If the student will touch or handle the medication, they should wash their medication, they should wash their hands. hands.

Read the Label!Read the Label!

• Always read the entire label on the Always read the entire label on the medication.medication.

• Make sure the directions for taking the Make sure the directions for taking the medication is specific as to the type and medication is specific as to the type and the route that the medication is to be the route that the medication is to be taken.taken.

• If any doubts, Do Not Give! Call the nurse. If any doubts, Do Not Give! Call the nurse.

Assisting with Oral Assisting with Oral MedicationsMedicationsPills/Tablets/CapsulesPills/Tablets/Capsules::

– Pour the medication into a medicine cup, the cap of the Pour the medication into a medicine cup, the cap of the medication bottle, or a small paper cup. medication bottle, or a small paper cup.

• Ask the student to pick up the medication himself Ask the student to pick up the medication himself or herself and put into his/her mouth followed by or herself and put into his/her mouth followed by 6-8 ounces of water. 6-8 ounces of water.

• If the student is not physically able to pick up the If the student is not physically able to pick up the medication and you have to place the medication medication and you have to place the medication inside the student’s mouth, you should put on inside the student’s mouth, you should put on gloves to avoid transferring any infection to the gloves to avoid transferring any infection to the student or to yourself.student or to yourself.

• Throw away gloves after each use (now contaminated). Throw away gloves after each use (now contaminated). • Make sure that the student swallowed the medication.Make sure that the student swallowed the medication.• WashWash your hands. your hands. • Record results.Record results.

Assisting with Oral Assisting with Oral MedicationsMedications• If the student is not physically able to pick If the student is not physically able to pick

up the medication and you have to place up the medication and you have to place the medication inside the student’s mouth, the medication inside the student’s mouth, you should put on gloves to avoid you should put on gloves to avoid transferring any infection to the student or transferring any infection to the student or to yourself. Throw away gloves after each to yourself. Throw away gloves after each use (now contaminated). use (now contaminated).

• Make sure that the student swallowed all Make sure that the student swallowed all of the medication.of the medication.

• WashWash hands. hands. • RecordRecord results. results.

Assisting with Oral Assisting with Oral MedicationsMedicationsLiquids: Liquids: • Liquid medications must be precisely measured. Liquid medications must be precisely measured.

– DO NOT USE SILVERWARE OR PLASTIC SPOONS—these are DO NOT USE SILVERWARE OR PLASTIC SPOONS—these are not accurate measuring tools. not accurate measuring tools.

• Use a calibrated medicine cup, spoon or syringe. Use a calibrated medicine cup, spoon or syringe. • When using a measuring cup, place it on a flat When using a measuring cup, place it on a flat

surface and read it at eye level for accuracy. surface and read it at eye level for accuracy. • Pour the liquid from the side of the medicine bottle Pour the liquid from the side of the medicine bottle

opposite the label (to protect the label). opposite the label (to protect the label). • Clean the outside of the bottle if needed after Clean the outside of the bottle if needed after

pouring. pouring. • Ask the student to pick up the medication cup Ask the student to pick up the medication cup

himself or herself and swallow all of the medication.himself or herself and swallow all of the medication.

Test is next!Test is next!

• This information taken from This information taken from curriculum developed by the curriculum developed by the Alabama Board of Nursing & the Alabama Board of Nursing & the Alabama Board of EducationAlabama Board of Education