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.
Log medication immediately after administering it.
Always use the five rights.
Medication errors include
Wrong or missed dose
If medication error occurs
Notify the student’s parent
Notify the principal or principal designee
Notify risk management
Notify Health Education Services
Complete the Report of Medication Error and forward a copy to Health
Complete the District Student Accident Report Form and forward a copy to
If the error is giving the wrong medication or
dose or giving medication to the wrong student
Contact the Poison Control Center at 1-800-222-1222 for possible adverse
Contact the student’s healthcare provider if necessary
Keep the student under observation for possible adverse side effects
until the situation has been resolved
Call 9-1-1 for severe adverse reactions i.e. difficulty breathing,
tongue or facial swelling or difficulty swallowing
If the error involves a late or missed dose
Handling Unexpected Situations
Encourage student to take the
Do not force the student to take
Document that student refused the
Check for signs of communicable
Students with Asthma, Diabetes and severe
allergic reactions can self administer their medications. They are also
permitted to carry their medications with them at all times with the
Requires completed Authorization for Medication/Treatment form
Form must be signed by the healthcare provider and the parent
Form should state student has been trained to administer the medication.
You do not need to document on the Student
Medication Log when a student is self-administering medications. The
parent still needs to initially bring the medication to the school for you
to log in but then the student may keep the medication with them and
administer it as needed.
Florida Statute FS 1002.20
It is the parent’s responsibility to transport,
provide and maintain all medications and supplies, equipment and snacks
needed by the student. Supplies needed are blood glucose monitor with test
strips, lancets, and extra batteries, insulin and syringes and glucose
tablets or gel. They will also need to provide student snacks as needed.
Students with insulin pumps will also need extra tubing and batteries for
Parents are responsible for having the student’s
healthcare provider compete the Diabetes Medication/Treatment
Authorization Form. If the student is using an insulin pump, the parent
must also have the healthcare provider complete the Insulin Pump
Medication/Treatment Authorization Form.
The healthcare provider should
State the specific time frame in which the student should check his/her
blood glucose level
Identify symptoms of high or low blood glucose levels specifically
demonstrated by each diabetic student and preferred treatment for both
high and low blood glucose levels.
Specify any limitations in physical activity they may have
Note food that the student may need to eat when blood glucose level is
State if the student is able to test his/her blood glucose levels and
administer his/her own insulin
Students who self-administer their insulin may
keep insulin and syringes and blood glucose monitoring equipment and lancets
with them at all times. If students wish to do so, they may do all diabetes
related tasks (blood glucose monitoring and insulin administration ) in the
The insulin pump, which is approximately the
size of a beeper, is like a small computer and needs to be programmed to
administer insulin. It does this in two methods, basal and bolus. The basal
rate is the amount of insulin delivered continuously. The bolus rate is the
amount that is given to cover the amount of food the student is going to
eat. Therefore, every time the student eats a snack or meal, he/she needs
to check his/her blood glucose and then program the pump to deliver the
correct bolus amount of insulin.
The pump must be worn at all time. Students
usually inject the needle under the skin on their abdomen or upper hips and
wear the pump on their belt. If the needle becomes dislodged, apply a
band-aid to the site and notify the parent immediately. If the tubing is
disconnected from the pump but the catheter is intact, the student may
reconnect the tubing. You should notify the parent so the tubing can be
changed at home. Exercise or increased activity may warrant increased food
intake without extra insulin. Students using insulin pumps are still
susceptible to high and/or low blood glucose levels.
It is the parent’s responsibility to provide the
school with the number of carbohydrates in the food that the student will
possibly eat for the day. School personnel or the student will calculate
what was actually eaten and the amount of insulin for the student’s bolus.
The Physical Education staff is to be informed
if the Healthcare provider has stated the student has any physical
limitations. Staff should be aware of students with diabetes and what to do
should an emergency arise. Students with diabetes should have juice or
another type of fast acting glucose with them when participating in recess
and/or physical education.
A plan of action should be discussed about
educating staff with the specific information needed to assist the diabetic
student. The assigned school nurse should plan to provide a scheduled
in-service to the personnel including teachers, bus drivers and school food
The parent must be given an Authorization for
Medication/Treatment Form for medication that must be given during school
hours. Should a physician prescribe the use of a metered dose inhaler,
he/she needs to complete the section on the Authorization for
Medication/Treatment Form stating the student has been trained in the proper
use and administration of the inhaler. The student should be allowed to
keep the inhaler in his/her possession if the student’s physician requests
this. Otherwise it should be kept in a locked cabinet in the clinic . The
school should have a backup inhaler in case of loss or unexpected depletion
. Parents must provide the back up inhaler.
Should a physician prescribe the use of a
nebulizer for breathing treatments, he/she needs to complete the Authorization for Medication/Treatment Form, stating that the student has
been trained in the proper use of the nebulizer. If the student has not been
trained, someone at the school will assist the student to administer the
treatment. Parents are responsible for providing all supplies,
medication and equipment needed.
Each student with asthma has a different
capacity to exercise. Running can trigger an episode in over 80% of students
with asthma. Swimming seems to be the least asthma producing sport. Warm up
exercises often help ward off episodes caused by activity. Students should
learn to pace themselves. Bronchodilator medications used before exercise
can prevent most episodes. Most students can participate fully in physical
activities. The student’s healthcare provider should state on the
Authorization for Medication/Treatment Form when the student should
administer a medication prior to physical activity. The healthcare provider
should also state any of the student’s limitations, such as avoiding
prolonged running, or avoiding sports in cold or extremely hot weather.
Staff should be alert as to what symptoms to
look for in order to prevent upper respiratory distress. Early detection of
symptoms and an appropriate response can prevent the need of a 9-1-1
Students wishing to participate on a field trip
must have an Authorization for Medication/Treatment Form for any medication
needed during a scheduled field trip.
The “Open Airways for Schools” program by the
American Lung Association provides asthma health education program to help
children, teachers and parents become more knowledgeable about asthma and
learn ways to better control it. The principal or assigned school nurse can
arrange for this in-service by contacting Health Education Services at
Extreme hypersensitivity to insect and bee
stings and certain foods are a potentially life-threatening situation.
Severe allergic reaction (anaphylaxis) can be fatal within minutes if not
quickly and properly treated. Many healthcare providers require these
students carry an emergency kit containing injectable adrenaline
(epinephrine) and/or an oral medication. There are several types of kits
available, which are designed for self-injection, and it is the
responsibility of the student’s parents to provide the school with the kit.
A student with extreme hypersensitivity to an
allergen must have a completed Authorization for Medication/Treatment Form
on file stating that the student has been trained to use the self-injecting
emergency kit. The kit should always be in a place immediately accessible by
the student or responsible adults as well as any other instructions that
must be done as part of the emergency care for this student. It is
preferable for a student to perform self-injection because this can be a
life long problem.
Notify the school nurse to set up an immediate
training program for staff who have contact with the student, especially the
classroom teacher, physical education teacher, principal designee for
administering medications, the bus driver and any special teachers who work
with the student.
Training should include symptoms of anaphylaxis,
immediate emergency measures, how to administer emergency injection, calling
9-1-1 and parent, side effects of epinephrine, and the importance of
monitoring the student until help arrives. Remember, even though a student
has been trained to self-administer emergency epinephrine, in an emergency,
they may not be able to do so. An adult must be trained to assist students
with this procedure.
Maintain a list of students with severe allergic
reactions. Copies of this list should be given to all teachers,
administrative staff and the school nurse. Staff should be aware of 9-1-1
procedures. Emergency posters should be completed and posted in obvious
locations with current information.
Periodically, the principal should have the
playground, fields and buildings inspected for beehives, wasp nests and red
ant colonies. These should be properly treated and removed as soon as
possible. All school staff should know that the swarming season for bees
and wasps in South Florida is between October and June. Therefore no time
is a safe time for students with allergies to insect stings. Caution should
be taken with any classroom activities that will use any bees, wasps or
Children with severe food allergies should not
be given any food unless you are certain of all ingredients. This includes
food sent to school by parents for classroom parties.
When students with seizures have orders for
Diastat remember the following:
Diastat is NOT a routine medication given daily for seizures
Diastat is given only when students have prolonged seizures
Diastat is given rectally to students during a seizure
Child specific training is required for all students with orders for
Not all students who have seizures will have an order for Diastat