Nash Rocky Mount Public Schools Medication Administration Procedure

Student Health Services In compliance with Policy Code # 6125

Administering Medications to Students

Every attempt must be made by the student’s parent and healthcare provider to have medications administered at home
during non-school hours. When this is not possible a complete Medication Administration Authorization Form must be
provided for all medications to be administered during school hours and school-sponsored activities.

Staff Training for Medication Administration

 School personnel shall not administer medication until after having successfully completed the District
Medication Administration Training.
 Every time a medication is given, all designees will use the universal medication safety precautions, known as The
Six Rights of Medication Administration. Before administering medication, check each of the following and
document on the Medication Administration Log:
 Right student Right medication Right dose Right time Right route write on Med. Log
 A 30-minute window is allowed for administration of medication at school. The medication may be administered
30 minutes before or 30 minutes after the ordered time. Medication administered outside the 30-minute
window is a medication administration error.
 For concerns or questions about administering a medication, contact the school nurse.
 School staff are not permitted to administer narcotic medication, non-FDA approved, or unregulated medications
to students at school.

NRMPS Medication Administration Authorization Form

 School personnel may not administer medication unless the parent presents the school with a completed
Medication Administration Authorization Form signed by the parent/guardian and the healthcare provider.
 Medication Administration Authorization Forms are only valid for the current school year.
 Only the most recent NRMPS Medication Administration Authorization Form will be accepted.
o The parent/guardian must sign the Form, providing the required request and permission to administer
the medication as well as the agreement of understanding to meet his/her responsibilities for
medication to be administered by school staff.
o The healthcare provider must sign the Form, providing specific orders as well as the “Certificate of
Necessity” for medication needing to be administered at school.
 All Medication Administration Authorization Forms are to be submitted to and reviewed by the school nurse prior
to any medication being administered to students.
o The school nurse will complete a Medication Administration Record/Log for school staff and a copy of
the Form will be attached.
o The original Form must be kept in the Individualized Health Record. (IHR).
o At the conclusion of the school year, or when the medication is discontinued, the copy of the Form is to
be shredded.
o The Medication Administration Record/Log is to be attached to the original Medication Administration
Authorization Form and filed in the student’s Individual Health Record.
 In an emergency situation a Medication Administration Authorization Form can be faxed to the healthcare
provider and returned by fax to the school nurse.
 Prescription medication must be received in a pharmacy-labeled container with the student’s name, healthcare
provider’s name, pharmacy name and phone number, name of medication, directions for dosage, and date of
prescription.
 Only one (1) daily or PRN “as needed” medication may be prescribed on the NRMPS Medication Administration
Authorization Form.
o The NRMPS Medication Administration Authorization Form, completed by the healthcare provider and
parent is required for all over-the-counter medications.
o Non-prescription (over-the-counter) medications must be received in the original container and labeled
with the student’s name.
 More than one (1) emergency medication may be prescribed on the Medication Administration Authorization
Form (e.g., rescue inhaler, epinephrine auto-injector, and/or seizure medication).
 Any changes in the type, dosage, frequency, and/or time in the original medication order will require a new
Medication Administration Authorization Form to be completed by the healthcare provider and signed by the
parent and another Medication Administration Record/Log will need to be completed by the school nurse.
 Nash Rocky Mount Public Schools Medication Administration Procedure
Student Health Services In compliance with Policy Code # 6125
Administering Medications to Students

oThe original Medication Administration Authorization Form and accompanying Medication

Administration Record/Log as well as the medication will need to be submitted to the School Nurse.
o The Medication Administration Authorization Form with associated changes must comply with the
requirements of signatures of the parent/guardian and healthcare provider and may be faxed to the
School Nurse.
o The School Nurse will complete a Medication Administration Record/Log to comply with the updated
orders by the healthcare provider and provide to the staff for medication administration at school.
 When medication administration orders are discontinued:
o Write the date discontinued on the Medication Administration Authorization Form.
o Code as “D” on the Medication Administration Record/Log in the appropriate block.
o Make a notation in the “comments” section of the Medication Administration Record/Log.
o Notify the School Nurse.
o The school nurse will date and initial the discontinuation date.
o The school nurse will file the Medication Administration Record/Log with the original
Medication Administration Authorization Form in the in the student’s Individual Health Record.

Receiving Medications
 Two (2) signatures are required to document the receiving of medication on the Medication Administration
Record/Log:
o A school representative to document the name, dosage, and amount of medication received.
o The parent/guardian or designated, adult representative must sign as witness.
 Medications are to be brought to school by the student’s parent/guardian (or designated adult, as described
below) in the original container. If prescription medication, it must be properly labeled and not expired; if over-
the-counter, it must be labeled with the student’s name.
o Medications are not to be transported on a school bus, unless the student is accompanied by personnel
trained to administer the medication or the student is approved to self-carry and self-administer
emergency medication; i.e. inhalers or Epi- Pens.
o In the event that transmittal of the medication to school presents an undue hardship for the
parent/guardian, arrangements should be made with the school nurse for an alternate way to secure the
medication. For example, the bus driver may obtain authorization to transport the medication and
another staff member designated to receive the medication upon arrival at the school.
o A written agreement with the parent/guardian is needed and should specify that school
personnel are acting as agents of the school and the student.
o The amount of medication provided for transport should be noted and then verified when the
medication is logged in at school.
o The medication should be placed in a sealed envelope and the amount of medication should be
recorded on the outside of the envelope by the parent/guardian, i.e. 20 pills, 1 inhaler, 1 epi
pen.
o The parent/guardian should place their initials over the seal of the envelope.

Medication Storage
 All daily, non-emergency medication must be kept in a secure, locked location.
 Emergency medication must be stored in a readily accessible location and never locked.
o Staff will be made aware of the location of emergency medications.
o Location of emergency medication will be documented on the student’s Emergency Action Plan.
 For students who self-carry emergency medication (rescue inhaler, epinephrine auto-injector):
o The parent/guardian must provide a back-up medication to be stored at the school.
o The location of emergency medication and back-up medication will be documented on the student’s
Emergency Action Plan.

Pick-up of Medication
It is the responsibility of the parent/guardian pick-up unused medication at the conclusion of medication administration to
the student – at the end of the school year and/or during the school year, if discontinued by the healthcare provider.
 Daily and/or PRN medications
 Nash Rocky Mount Public Schools Medication Administration Procedure
Student Health Services In compliance with Policy Code # 6125
Administering Medications to Students

o Two (2) signatures are required to document the pick-up, wasting, and/or disposal of medication on the
Medication Administration Record/Log – a staff member and the parent/guardian or parent
representative.
o Document the date, name of medication, dosage, amount of medication picked-up.
 Emergency medications (inhalers, epinephrine auto-injectors, Diastat, etc.)
o Inhalers can be sent home with students on the last day of school.

Disposal of Unused and/or Expired Medication by the School Nurse

If the parent/guardian does not come to school to pick up the medication by the last day of school, the school nurse will
contact the parent/guardian. A “last day” to pick-up the medication will be provided. The parent will also be informed
that if the medication will be discarded, if not picked-up by the given date.
 Daily/PRN medications
o Discard the medication in accordance with FDA guidelines for disposal of unused medication.
o Document on the Medication Administration Record/Log:
 Date, name of medication, dosage, and amount discarded.
 Signatures of the school nurse and a staff member as witness.
 Emergency medications
o Discard the medication in accordance with FDA guidelines for disposal of unused medication.
o Document electronically, “office visit” section in Power School – the date and type of medication
discarded.

Students with a One-on-One Nurse employed by Contract Agency

 The contract agency/contract nurse is solely responsible for medication administration to the student, obtaining
orders, and documentation.
 Communication between the contracted nurse and the school nurse is needed so that the school nurse is aware
of the special health needs of the student, medications, procedures, and other health-related services provided
for the student at school.

Medication Administration Record (MAR)/Log

Note: These terms are interchangeable.

 The Medication Administration Record/Log is a legal document.

o In legal cases brought against the district regarding medication administration issues, the Log will be
retrieved/provided to the district’s attorneys.
 Documentation on the Medication Administration Record/Log must be completed daily, using permanent ink.
o Every block on the Medication Administration Record/Log must be filled – no blank spaces.
o Doses administered: document time and initial.
 Acceptable time frame for administering medication is 30 minutes before or after the time
prescribed on the Medication Administration Authorization Form.
o Doses missed: document appropriate code and initial.
o Corrections need to be crossed through with a single line and initialed.
 Example: 9:15 a.m. CHE
 Correction fluid, erasures, correction tape, or similar items are not to be used.
 Spaces are not to be whited or blacked out.
o Medications received, picked-up, wasted, and/or discarded must be documented, using the guidelines
described in the Medication Administration Procedure.
 The following must be documented in the comments section of the Medication Administration Record/Log by the
staff members designated to administer medication:
o All parent notifications/attempts to contact by school staff and/or school nurse.
o All healthcare provider/pharmacy notifications/attempts to contact by school nurse.
o All staff member notifications/attempts to contact the school nurse/administrator.
o Other contacts made and associated information, as needed.
 The School Nurse may document the above-mentioned notifications electronically.
 Nash Rocky Mount Public Schools Medication Administration Procedure
Student Health Services In compliance with Policy Code # 6125
Administering Medications to Students

o Electronic notations regarding medication administration must be printed and placed with the
Medication Administration Record/Log at the conclusion of the school year and/or when the medication
is discontinued.

Daily and as needed (PRN) medications

 The school nurse will transcribe the healthcare provider’s order and instructions onto a Medication
Administration Record/Log.
o The Medication Administration Authorization Form should be checked carefully for the name of the
student, name of the medication, dosage to be given, time to be administered, route to administer,
healthcare provider’s signature, and parent/guardian signature.
o A new Medication Administration Record/Log is required whenever a revised Medication Administration
Authorization Form is received.
 A copy of the Medication Administration Authorization Form will be attached to the Medication Administration
Record/Log and kept with the student’s medication.
o The staff member who is designated to administer the medication will maintain and store the
medication.
o The original Medication Administration Authorization Form is maintained in the health room.
o At the conclusion of the school year, or when the medication is discontinued, the original is filed in the
student’s Individual Health Record.
 If a medication dose is omitted for any reason:
o Notify the School Nurse as soon as possible.
o Notify the parent/guardian. If unable to reach parent/guardian by phone to give a verbal description,
send a written note home with notification that the dose was omitted, the reason, and what actions
were taken.
o Document on the Medication Administration Record/Log:
 Write the code “O” in the dated block and initial.
 Provide explanation in the comments section of the Medication Administration Record/Log that
the dose was not administered, the reason, actions taken, and parent notification. Add date
and signature.
 Parent/guardian requests to hold medications must be submitted in writing with specific dates, times, and
signature.
o Notify the school nurse immediately if a request is received.
o The original request should be kept with the Medication Administration Authorization Form in the
student’s Individualized Health Record.
o A copy of the request should be placed with the Medication Administration Record/Log.
o Document on the Medication Administration Record/Log:
 Write the code “O” in the dated block and initial.
 Make notation in the comments section of the Medication Administration Record/Log that the
parent/guardian sent a written request for the medication to be placed on hold. Note the name
of the parent/guardian who made the request.

Emergency Medications and Emergency Action Plans

Students who are at risk for medical emergencies must have an Emergency Action Plan (EAP) developed and updated each
school year to address administration of emergency medication(s). The school nurse will develop an Emergency Action
Plan, based on the Medication Administration Authorization Form, using the designated, district’s forms for severe
allergies, asthma, and/or seizures.
 The Emergency Action Plan
o Upon receipt of the Medication Administration Authorization Form, the school nurse will give the
parent/guardian the appropriate Emergency Action Plan to review, add individualized actions
applicable to the student, approve, and sign.
 Reasonable attempts will be made by the school nurse to obtain the parent/guardian
signature.
 Document the contacts/attempts to contact electronically, in the office visit section of
PowerSchool or in the student’s Individualized Health Record.
 Nash Rocky Mount Public Schools Medication Administration Procedure
Student Health Services In compliance with Policy Code # 6125
Administering Medications to Students

 Notations must also be made as to whether or not the EAP was returned to the school.
o Location of the student’s emergency medication, self-carry approvals, and location of the back-up
medication (provided by the parent/guardian) will be noted on the Emergency Action Plan.
o The original Emergency Action Plan will be placed in the student’s Individualized Health Record.
o A copy will be placed in the EAP notebook in the health room.
o A copy of the EAP, along with the emergency medication (in a zip-lock bag), will be placed in an
unlocked, easily accessible site.
 Emergency Medications
o Must be easily accessible and never locked-up.
o Location/storage of emergency medications must be determined by, and is at the discretion of, the
school nurse. Options include:
 Elementary: Classroom First-Aid Emergency Bag
 Middle/High: Centralized location that is accessible to staff in the event of an emergency.
o School staff will be made aware of the location of emergency medications.
 Self-carry emergency medications (inhalers, Epi-Pens, and Diabetes medications only)
o The school nurse must approve and will complete the self-carry medication section on the
Medication Administration Authorization Form.
o The student must demonstrate understanding of the Emergency Action Plan, competency in self-
administering the medication, and sign the “Student Agreement” section on the Medication
Administration Authorization Form.

Special Considerations: Students with orders for rectal Diastat

For students with seizures and rectal Diastat ordered as the emergency medication, guidelines for the bus have been
developed and listed below.
 A separate EAP will be developed for use while the student is being transported to and from school and
school activities.
 A meeting with the parent/guardian and school nurse will take place and include:
o Making the parent/guardian aware of the safety concerns for their child and bus-driver staffing.
 No medical personnel available on the bus.
 Limited space and privacy for administering medication.
 Other safety concerns.
o At the conclusion of the session, the parent/guardian will determine the actions they prefer
regarding administration of rectal Diastat while their student is in transit to and from school on the
bus.
 The parent/guardian’s preference will be noted on the EAP.
 The parent will sign the EAP.
o The parent is encouraged to inform the student’s health care provider of their decision.
o The school nurse will document the counseling session electronically, in PowerSchool and/or in the
student’s Individualized Health Record.
 Should the parent/guardian request Diastat administration while being transported on the school bus, the
nurse will contact the EC Department and Transportation Department so that personnel can be identified to
be trained in seizure recognition, emergency procedure and medication administration. The parent/guardian
will be made aware that this process may take 1-2 weeks to complete. Until completed, 911 will be utilized.

Field Trip Procedures for Medication Administration

If a student requires medication to be administered during a field trip the following procedures must be implemented:

 A list of the upcoming field trips and students participating should be made available to the school nurse at the
beginning of the school year and throughout the year as field trips are planned. The nurse will sign off on the
Field Trip Request form as required.
o If the trip extends beyond regular school hours, parents/guardians are responsible for obtaining another
Medication Administration Authorization Form with specific instructions for the extended hours. This
requirement must be communicated to the parent/guardian.
 Nash Rocky Mount Public Schools Medication Administration Procedure
Student Health Services In compliance with Policy Code # 6125
Administering Medications to Students

 Extended overnight and out of state field trips will require additional planning involving the
school nurse, field trip advisor and parent/guardian.
 One adult (plus one or two back-ups if needed) will assume the duty as the “medication and first aid provider”.
*If present on the field trip- the adult who normally administers the daily medication will administer the
medication.
o This person must have completed district medication administration training
o If possible, this person should also have completed district first responder training
 The school nurse will identify any students who need routine daily medication during the field trip as well as any
student needing access to emergency “prn” medications.
 The school nurse will prepare the student’s daily dose for the field trip.
o The Board of Pharmacy recommends that only school nurses “repackage a day’s” worth of medication
for a field trip. In addition, the NC Board of Nursing states “unlicensed personnel may not perform pre-
filling and labeling of medication holders”.
o If the school nurse is not available to re-package medications for a daily dose, then the entire properly
labeled medication container must be taken by the school staff member/” med/first aid provider” for
this event.

School Nurse Preparation of medication for field trip for each individual student:
 Remove the number of doses needed for the field trip from the original pharmacy-labeled bottle and place in an
individual dose packet (example: a small zip-lock bag or envelope). Label each dose packet with the student’s
name, name of medication, time to receive the medication, and any instructions, such as to be taken with plenty
of water or taken with food or taken on an empty stomach.
o Provide a list of daily medication doses, emergency medications and any special instructions/directions
to the “med/first aid provider” and/or the student teacher.
o Provide a one-page instruction list stating who to call at school if questions arise, the Six Safety Rights
and general do’s and don’ts. [Available in Forms Section on Website]
o Make copies of any Emergency Action Plans for the “med/first aid provider” and/or the student’s
teacher.
 The field trip “med/first aid provider” consults the school nurse for assistance if specific skills or training are
needed by the field trip staff prior to the day of the field trip. This is to assure staff are prepared for students who
may need emergency medication or who are at known risk for certain health emergencies. Also, consult
parent/guardian, when needed, to ensure that all field trip staff are adequately prepared to care for any student
with special needs on the field trip.
 The “med/first aid provider” identifies who to call and how to reach them (such as the school nurse) if telephone
consultation may be needed while on the field trip.

On the day of the field trip:

 The field trip “med/first aid provider” will pick up all student medications, any emergency medications, copies of
medication authorizations and emergency action plans and first aid supply box at the school from the school
nurse.
 All medications and forms will be kept secure from possible theft or loss. Medications may be kept by the
“med/first aid provider” in a locked box, or by wearing a back pack to ensure that medications and information
sheets are never left unattended or out of sight at any time.
 The field trip “med/first aid provider” or student teacher will assure that each student receives his/her doses at
the correct time and by the correct route according to the school Medication Administration Authorization Form.
(check this form prior to giving the medication to prevent risk of error).
 The field trip “med/first aid provider” will note any errors or incidences about the medications if not given or if
given incorrectly for any reason.
 The field trip “med/first aid provider” or student teacher will keep all student-labeled empty packets, all unused
emergency medications, and all student information sheets to return to school after the field trip is over.

Upon return to school after the field trip:
 Nash Rocky Mount Public Schools Medication Administration Procedure
Student Health Services In compliance with Policy Code # 6125
Administering Medications to Students

 The field trip “med/first aid provider” or student teacher will return all student-labeled empty packets, any
medications not taken, all emergency medications, all student information forms, and all unused first aid supplies
to the school nurse.
 The field trip “med/first aid provider” or student teacher will record all doses given on each student’s MAR
witnessed by the school’s daily medication staff member (if different from person administering on field trip)
 The field trip “med/first aid provider” will give written error or incidence reports that may have occurred on the
field trip to the school nurse.
o All medication errors or incidences will be reported to the school nurse for prompt follow-up or prompt
parent notification if needed.
 The school nurse will check the field trip list to assure that all student medication logs are documented for the
field trip day and that all emergency medications and single doses are accounted for.

Medication Errors
Medication errors mainly occur if a misstep is made in following the Six Rights of Medication Administration, such as:
 Wrong medication  Wrong student  Wrong time
 Wrong dose  Missed dose  Blank spaces on Medication Administration Record/Log

If a medication error occurs, follow these steps:

 Notify the school nurse.
 Notify the principal or principal designee.
 Notify the parent.
 Complete the Medication Error Report with the School Nurse.
o Send the original report to the Assistant Superintendent, Student Services.
o Send copy of report to the Coordinator of Student Services.
o Maintain a copy at the school, for school nurse records.
o Do not file in the student’s IHR or with the Medication Administration Record/Log.
 The school nurse will counsel the staff member, review proper medication procedures, and provide retraining as
needed.
If the error involves giving the wrong medication, the wrong dose, the wrong route, or giving a medication to the wrong
student, follow these steps:
 Contact the school nurse immediately. If unavailable, contact the Coordinator of Student Health; if she is
unavailable, contact the Assistant Superintendent of Student Services.
 The following actions may be implemented by the school nurse or designee, upon assessment of the student:
o Contact Poison Control 1-800-222-1222, for possible adverse side effects
o Contact the student’s healthcare provider and/or parent.
 Keep the student under observation for possible adverse reactions, until the situation has been resolved.
 Call 9-1-1 for severe adverse reactions; e.g., difficulty breathing, tongue or facial swelling, difficulty swallowing,
vomiting, lethargy, etc.
 Document communications and actions in the comments section of the Medication Administration Record/Log
If the error involves a late or missed dose:
 Call the parent/guardian for recommendations on how to proceed.
 Document the communication and actions taken in the comments section of the Medication Administration
Record/Log.
Anyone can make an error, even when being most careful. There are some positive steps that can be taken to minimize
the possibility of a medication error.
 Take your time. Don’t allow yourself to be rushed
 Concentrate on what you are doing. Avoid distractions
 Work with one student at a time
 Check the identity of the student and the medication three (3) times before administering it
 Document that you gave the medication on the MAR immediately after administering the medication

Medication Audit
 Nash Rocky Mount Public Schools Medication Administration Procedure
Student Health Services In compliance with Policy Code # 6125
Administering Medications to Students

A medication audit will be conducted on all medications administered daily or PRN. The audit will be performed a
minimum of once a semester using the medication audit form by a team of 2 school nurses. The school nurse will
maintain the audits in a notebook or folder at the school.

Medication Administration - Instruction List for Field Trip

Class/Group: Date of Trip:
School Nurse: Phone #:

6 Rights of Medication Administration – Safety Checks

 Right student Right medication  Right dose Right route Right time Right documentation “Write”
Daily Medications [Medication Authorization Form/Orders Attached]
Student Name of Medication Time to Give Time Administered Initials

Emergency Medications (inhalers and epi-pens) - Emergency Action Plan Attached

Student Name of Medication Location of Medication / Notes [e.g., Allergic to …]

Special Instructions
Student Instructions

After the Field Trip Reminders 1) Record medications administered on the log. 2) Return Medical Information Folder to School Nurse.

Attachment A [Also available on website to download and edit to make applicable to each field trip.]
Nash Rocky Mount Public Schools Medication Administration Procedure
Student Health Services In compliance with Policy Code # 6125
Administering Medications to Students

Field Trip
Medical Information
Return Folder to the School Nurse at Conclusion of Trip
 Nash Rocky Mount Public Schools Medication Administration Procedure
Student Health Services In compliance with Policy Code # 6125
Administering Medications to Students

Effective Date Section(s) Revised Author/Reviewer

April 9, 2019 Original Deb Terrell, Elizabeth Jenkins, Paulette
Langley, Sandra Bass, Kendree Adkins, Sherri
Smith, Sarah Williford, Jamie Perry, Carol
Eatman
May 10, 2019 Edited to provide organization of topics, Carol Eatman and Deb Terrell
remove duplications, and develop Attachment
A for the Field Trip Medical Information Form
for posting/publication on the Website