Body Wise

Rx for School Medication Safety

by Kathy Sena

If your child must take prescription medication while at school, it's important that you, your child's doctor and your school nurse work together to ensure success, because mistakes do occur.

Surveyed in a University of Iowa study, nearly half of 649 school
nurses across the U.S. reported medication errors in their schools during the previous year. The most common error was a missed dose.

The school nurses estimated an average of 5.6 percent of students in grades kindergarten through 12 receive medications on a typical school day, with the majority receiving medication for attention deficit hyperactivity disorder (ADHD). Other common medications include over-the-counter medications, analgesics, asthma and anti-seizure medications.

Medication Errors
Of the school nurses who reported mistakes in administering medications, nearly 80 percent said the errors included missed doses. Other errors included giving an overdose or double dose (22.9 percent), giving medicines without authorization (20.6 percent) and giving the wrong medicine (20 percent).

Most common among the factors related to errors was the use of school secretaries, health aides, teachers, parents and even other students to administer medications to students. Medication errors were 3.1 times more likely to occur with the use of unlicensed personnel to dispense medications to students, the study found.

Three quarters of the nurses reported that unlicensed personnel, such as school secretaries, health aides and teachers, dispense medications to students in their school
systems.

Just under 25 percent of the nurses surveyed said they administered all the medications in their schools. The wide variance of standards for medication administration points to the need for national guidelines, the study concluded.

Obviously, communication with your school nurse is critical, as is finding out exactly who is responsible at your child's school for dispensing medication to students. Along with a list of medications, allergies and other essential information, you'll want to include a description of your child's medical condition plus details about when the medication should be given and the dosage. Also include your emergency contact information and pediatrician's phone number.

You might also want to give the school nurse a photo of your child if he attends a large school. It's just one more way to prevent mix-ups. According to USA Today, one study found that the average ratio of children to school nurses was almost twice the National Association of School Nurses' recommendation of one for every 750 children. That's a lot of little faces to remember.

Ensuring Accuracy
Here are some additional tips from the American Academy of Pediatrics and Medco Health Solutions:

Retain original containers. Many school districts require this. Ask your pharmacist to split your child's prescription into two bottles and to label one for school and one for home.

Make sure the doctor's orders are complete. The American Aca?demy of Pediatric urges doctors to be specific about medications, dosages, time of day, frequency and length of treatment. Many school systems require this level of detail, but occasionally physicians don't complete school forms or write the orders without complete information,.

Schools and school nurses then need to follow up with the physician's office. According to the National Association of School Nurses' policy, information on the container must include the name of the drug, dosage, route of administration and the time interval of dose. Prescriptions must include the student's name and the name of the prescribing licensed healthcare provider.

Inform your child. She should know when, where and from whom she'll be receiving the medication at school. Ask questions and follow up to make sure your child is receiving the medication correctly.

Know the rules. Find out who is authorized to give your child medications. Currently, each school district has its own policy. Remain in regular contact with that person.

Push the paper. In addition to standard health and emergency forms, you'll want to provide a specific request for the medication to be given, plus info on the condition being treated, potential adverse reactions and storage requirements.

Discuss plans for self-medication, if appropriate. According to the National Association of School Nurses, a school nurse may monitor a student's self-administration of certain medications (for example, insulin, epinephrine or inhalers) using an Individual Health Care Plan.

Written direction for student self-administration of medications must be obtained from the licensed health-care provider along with written permission from the parent or guardian. Guidelines must be developed for evaluation and monitoring by the school nurse. Self-administration must be permissible under state laws and school policy.

Plan ahead. Answers to questions such as where the medication will be stored and who will carry the medication for field trips should be determined in advance.

Kathy Sena is freelance writer specializing in children's and women's health issues.