Medication management in primary and secondary schools

Current Asthma Management Practices by Primary School Teaching Staff: A Systematic Review

BACKGROUND

The likelihood of children with asthma experiencing an exacerbation at school is significantly high when considering that they spend a substantial part of their day at school. This study, therefore, aimed to systematically review the literature to determine current asthma management practices by primary school teaching staff and any existing supporting legislation/policies/guidelines.

METHODS

Search terms were adapted to search literature across databases: CINAHL, Cochrane Library, Education Database-ProQuest, IPA, MEDLINE, SCI. Primary research studies, reviews, systematic reviews, and meta-analyses in English about primary school teaching staff dated between 2007 and 2017 were included. Primary outcomes comprised teaching staff' practices regarding asthma management and supporting guidelines, policies, or legislation.

RESULTS

Analysis of the 13 papers eligible for full review identified that: teachers were unable to deal with an asthma exacerbation; they lacked knowledge regarding exercise-induced asthma and that there was poor communication between schools and parents of children with asthma. The only documented relevant asthma legislation found pertained to New York schools.

CONCLUSIONS

Limited evidence regarding asthma management practices and inadequate asthma management knowledge amongst teaching staff highlight the need for supporting teaching staff with asthma policies and guidelines to minimize risks associated with inappropriate asthma management.

Policy statement--guidance for the administration of medication in school

Many children who take medications require them during the school day. This policy statement is designed to guide prescribing health care professionals, school physicians, and school health councils on the administration of medications to children at school. All districts and schools need to have policies and plans in place for safe, effective, and efficient administration of medications at school. Having full-time licensed registered nurses administering all routine and emergency medications in schools is the best situation. When a licensed registered nurse is not available, a licensed practical nurse may administer medications. When a nurse cannot administer medication in school, the American Academy of Pediatrics supports appropriate delegation of nursing services in the school setting. Delegation is a tool that may be used by the licensed registered school nurse to allow unlicensed assistive personnel to provide standardized, routine health services under the supervision of the nurse and on the basis of physician guidance and school nursing assessment of the unique needs of the individual child and the suitability of delegation of specific nursing tasks. Any delegation of nursing duties must be consistent with the requirements of state nurse practice acts, state regulations, and guidelines provided by professional nursing organizations. Long-term, emergency, and short-term medications; over-the-counter medications; alternative medications; and experimental drugs that are administered as part of a clinical trial are discussed in this statement. This statement has been endorsed by the American School Health Association.

Medication management in primary and secondary schools: assessing the knowledge and opinions of parents

OBJECTIVES

To assess the knowledge and opinions of parents regarding medication management in their children's schools and to evaluate roles for pharmacists in this area.

METHODS

Cross-sectional survey of individuals caring for children between 5 and 18 years of age who take prescription medications at five community pharmacies, one daycare center, and one university. Main outcome measures were the opinions and level of understanding of parents regarding the medication management-related policies of their children's schools and how pharmacists can help the medication behaviors of children before or during school hours.

RESULTS

86 surveys were collected. Of participants, 89.5% reported the name of at least one prescription or over-the-counter (OTC) medication that their child was taking. The most common medications mentioned (40.5%) were those for asthma and/or allergies. More than 45% of children were taking at least two medications. Almost 27% of the medications were taken at school. More than 60% of participants indicated that a nurse was present at their child's school every school day. Of parents, 28.2% and 38.8% did not know whether prescription and OTC products, respectively, were allowed on school premises. The most common relevant service reported to be offered at community pharmacies was an additional labeled prescription container (22.1%), which was also a service that many parents would like to have pharmacies offer (39.6%). Many parents also desired to have a second inhaler for their child at school (34.9%) and that the pharmacy place a label on the inhaler and not just its box (37.2%). These two services were less commonly reported as being offered at pharmacies (22.1% and 12.8%, respectively).

CONCLUSION

Many participants in the current study were unaware of important school policies related to medication management. Also, the parents surveyed seemed to desire and felt they would benefit from services that community pharmacists could provide in a relatively simple way.

Survey of administration of medicines to pupils in primary schools within the London area

OBJECTIVE

To examine the policy, administration, and supervision of medicine administration in primary schools within the Greater London area (GLA).

DESIGN

A prospective survey using postal questionnaires sent to 172 randomly selected primary schools within the GLA.

PARTICIPANTS

Head teachers of primary schools.

RESULTS

Some 65% of head teachers replied. Less than 50% of responding head teachers had actually read the national guidelines Supporting Pupils with Medical Needs and only 30% of respondents were aware of other members of staff who had read the document. A total of 95% of respondents followed a policy/procedure in caring for the medical needs of pupils. Over 80% of respondents had staff handling the pupils' medical needs, staff handling access to stored medicines, and prior arrangements for staff training. However, it is worrying that a quarter of the schools did not keep a written record of medicines given to children in schools. The majority of staff with responsibility for medicine administration in schools are support staff. The most encouraging findings were that for the majority of schools with children using the EpiPen and rectal diazepam, there were trained staff to administer these medicines.

CONCLUSIONS

The majority of schools had a policy in place to deal with medicine administration, although further work should be conducted to analyse the content of such policies. It is very important that training is directed at staff responsible for medicine administration and not just at teachers. Most schools were willing to administer rectal diazepam and EpiPen treatment in an emergency.

Elementary school secretaries' experiences and perceptions of administering prescription medication

This study assessed elementary school secretaries' (n = 385) experiences and perceptions with student prescription medication. Sixty-nine percent (n = 246) reported dispensing student medication, and this group represents the focus of this study. One in four secretaries reported not receiving any training regarding administration of student medication. Of those who were trained, 28% received training of less than one hour, and 24% received training of one to two hours duration. Secretaries generally disliked the responsibility of dispensing medication to students, but felt prepared to do so. Most (63%) administered student medication five days per week. The most commonly administered categories included attention deficit/hyperactivity medication (92%), asthma medication (87%), and antibiotics (68%). Most (85%) reported they had made no medication errors during the past year.

Issues of medication administration and control in Iowa schools

Who is responsible for medication administration at school? To answer this question, a descriptive, self-administered survey was mailed to a random sample of 850 school principals in Iowa. The eight-page, 57-item, anonymous survey was mailed first class, and a follow-up reminder post card was mailed two weeks later. Descriptive analyses were conducted, with type of respondent (principal versus school nurse), grade level, and size of school examined to explore differences. A 46.6% response rate was obtained; 97% of respondents indicated their schools had written guidelines for medication administration. Principals (41%) and school nurses (34%) reported that they have the ultimate legal responsibility for medication administration. Policies for medication administration on field trips were available in schools of 73.6% of respondents. High schools were more likely to allow self-medication than other grade levels. "Missed dose" was the most common medication error. The main reasons contributing to medication administration errors included poor communication among school, family, and healthcare providers, and the increased number of students on medication. It remains unclear who holds ultimate responsibility for medication administration in schools. Written policies typically exist for medication administration at school, but not field trips. Communicating medication changes to schools, and ensuring medications are available at school, likely can reduce medication administration errors.

Medication administration in day care centers for children

OBJECTIVE

To determine the frequency with which children attending day care centers (DCCs) receive medications, what types of medications are administered, whether standardized procedures are used in the dispensing of medications, and whether any self-reported errors occur.

DESIGN

Cross-sectional descriptive survey.

SETTING

DCCs in eastern Iowa licensed by the Iowa Department of Health and Human Services.

PARTICIPANTS

Day care supervisors at DCCs.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Descriptive, self-reported information, including frequency of medication administration on-site, types of medications administered, procedures for storing and dispensing medications, record keeping, and training of staff.

RESULTS

Response rate was 38.9% (82 of 227 mailed surveys were returned completed). On average, 5.5% of children received medications while attending a DCC during a 2-week period. DCCs administered the following medications during the year preceding the survey: antibiotics (86.5% of DCCs reporting having administered), cold medications (85.0%), analgesics (78.0%), and attention-deficit/hyperactivity disorder medications (67.0%). The two most common errors reported were missed dose (55.6% of DCCs reporting having happened) and medication not available for administration (50.6%). All DCCs surveyed reported having written policies for medication administration, but staff at only 50.0% of DCCs received special training on medication administration.

CONCLUSION

Medications are often administered in DCCs, and the types of medications administered in this setting have the potential to pose significant risks if their use is not monitored properly. DCC staff receive little, if any, education regarding proper storage, handling, and administration of medications. Pharmacists should take an active role in providing education to this poorly served group to help reduce risks of medication misadventures.