Functions of school nurses and health assistants in U.S. school health programs

Medication Administration Practices in United States' Schools: A Systematic Review and Meta-synthesis

Schools often provide medication management to children at school, yet, most U.S. schools lack a full-time, licensed nurse. Schools rely heavily on unlicensed assistive personnel (UAP) to perform such tasks. This systematic review examined medication management among K-12 school nurses. Keyword searches in three databases were performed. We included studies that examined: (a) K-12 charter, private/parochial, or public schools, (b) UAPs and licensed nurses, (c) policies and practices for medication management, or (d) nurse delegation laws. Three concepts were synthesized: (a) level of training, (b) nurse delegation, and (c) emergency medications. One-hundred twelve articles were screened. Of these, 37.5% (42/112) were comprehensively reviewed. Eighty-one percent discussed level of training, 69% nurse delegation, and 57% emergency medications. Succinct and consistent policies within and across the United States aimed at increasing access to emergency medications in schools remain necessary.

School Nurses’ Experiences With Medication Administration

This article reports school nurses’ experiences with medication administration through qualitative analyses of a written survey and focus groups. From a random sample of 1,000 members of the National Association of School Nurses, 649 (64.9%) school nurses completed the survey. The quantitative data from the survey were presented previously. However, 470 respondents provided written comments on the survey. Comments on the eight items that had the most written comments were qualitatively analyzed. In addition, to clarify information obtained from the surveys, two focus groups with local school nurses were conducted. A constant comparative method of analysis was used, and results were combined from the two data sources. The combined analyses resulted in six final categories of concern: (a) delegation of medication administration, (b) comfort with delegation, (c) self-administration of medication, (d) medication administration errors, (e) storage of medication, and (f) administration policies. The findings suggest that school nurses across the country have similar concerns regarding the administration of medications in the school setting.

Comparing the Number of Ill or Injured Students Who Are Released Early From School by School Nursing and Nonnursing Personnel

There is a growing demand for research linking specific educational services with positive student outcomes. Little empirical evidence exists to show that school nursing services improve student success. School attendance is one of many factors that has been associated with improved learning; school nurses can affect that factor. This study compared the number of students in a Midwest urban public school district who were dismissed from school early for illness or injury with and without interaction with a school nurse. A student sign-out and sign-in log identified the number of students who left school prior to the official dismissal time, and a school nurse activity log indicated the students who were dismissed early from school after contact with a school nurse. Analysis of these data indicates that 57% fewer students left school early with school nurse contact compared with those who left school early without such contact. The results of this study indicate school nurses may positively influence student school success by reducing avoidable early release from school for ill or injured students.

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.

Medication management in primary and secondary schools: evaluation of mental health related in-service education in local schools

An increasing number of students are taking medications while they are in school or are under the influence of medication during school hours. In a novel effort, clinical pharmacists and mental health therapists worked together to provide "mini-in-service" educational programs on psychological disorders and medications used to treat these disorders. The purpose of this study was to implement and evaluate the effectiveness of these educational programs presented to school nurses, teachers, school administrators, and other personnel. The study compared participant responses before and after attending a medication in-service session on a psychological disorder and its related medications. Results indicated that in-service education on attention deficit/hyperactivity disorder (ADHD) and depression improved the knowledge and confidence levels of school personnel regarding medications and symptoms. Feedback indicated school personnel wanted longer educational sessions and more information on these disorders and treatments. School nurses working with health professionals can improve education for staff, families, and students about mental health disorders and their treatment.

Medication management in primary and secondary schools

OBJECTIVES

To identify whether and how pharmacy faculty members are addressing the issue of medication management in primary or secondary schools in their teaching, research, and service activities, and to ascertain the extent to which they think the issue is an important one.

METHODS

Four hundred ninety-nine faculty members completed a questionnaire inquiring about the research, teaching, and service activities in which they participated that related to medication management in schools.

RESULTS

Only 33 subjects (6.6%) addressed the topic of medication management in schools in their courses; only 13 (2.6%) conducted research on the topic; and only 30 (6%) were involved in service in this area. On the other hand, 432 respondents (86.6%) believed that the issue of medication management in schools was either somewhat or extremely important.

CONCLUSIONS

There is a large gap between the number of subjects that think medication management in schools is an important topic and the number who actually include the topic in teaching, research, and or service.

Parent knowledge and opinions of school health services in an urban public school system

Health services, provided through schools for more than 100 years, increasingly have expanded to meet preventive as well as acute health care needs of children. This article reports on a survey of parents of third-grade children in an urban public school system. The authors examined what parents know about school health services, what value they place on the services, and what barriers exist to health care access. Results indicated parents place a high value on health services offered in schools, but they know little about service availability and use. Parents often were unaware their children received many of the services listed, such as review of school health records, vision and hearing screening, and health education by school nurses.

Medication management problems reported by subscribers to a school nurse listserv

Given the potentially serious consequences of suboptimum medication management practices in elementary and secondary schools and the fact that this topic has been subject to little empirical inquiry, the purpose of this study was to obtain a preliminary understanding of the types of medication management problems that school nurses face, as well as the strategies they use to solve those problems. An analysis of messages related to medication management that appeared on the SCHLRN-L listserv (a 1,400-member discussion group for schools nurses) was performed. All messages sent to the listserv during a 5-month period were monitored. Any discussion thread that began during this time period and addressed the management of medications was selected for possible inclusion in the study. The result was a group of 71 threads. The listserv participants described a wide array of medication management problems and suggested numerous strategies for solving them. This study shows that serious medication management problems exist in schools and that school nurses make use of various strategies or "tricks of the trade" to handle these problems. This research highlights the need for a contribution from the pharmacy profession in this important and neglected area of drug therapy.

Medication management in primary and secondary schools

OBJECTIVE

To summarize present knowledge about medication management in primary and secondary schools; to place this knowledge in its drug use and organizational contexts; and to provide a foundation for studying the problem and developing policy- and practice-level interventions aimed at alleviating it. To offer recommendations for practitioners, policy makers, and health professions educators aimed at improving the situation.

DATA SOURCES

MEDLINE database (1966-1998); International Pharmaceutical Abstracts database (1977-1998); complete Medscape full-text search; contents of the Journal of School Nursing and the Journal of School Health (1966-present).

STUDY SELECTION

We reviewed 95% of all articles, books, and reports identified using the search terms elementary school, middle school, junior high school, high school, primary school, secondary school, school nurse, school health, and schoolchildren.

DATA EXTRACTION

The literature on this topic includes background material describing the nature of the problem and its political and organizational context and implying its significance; summaries of regulations, guidelines, and recommendations regarding medication management in the schools; and empirical studies. Few articles address pharmacist involvement in medication management in schools.

DATA SYNTHESIS

Although approaches to this important problem vary widely, a set of core medication management guidelines is identifiable. Formal research is sparse, but it shows that medication use is widespread in schools and carries significant therapeutic and safety consequences.

CONCLUSION

Pharmacists and school nurses must cross professional borders if they wish to play a role in solving this important drug therapy problem. Pharmacists can provide therapeutic and contextual perspectives on the problem, while school nurses can implement solutions within the schools.

Medication administration practices of school nurses

This study assessed the medication administration practices of school nurses. From a random sample of 1,000 members of the National Association of School Nurses, 649 (64.9%) completed the survey developed for the study. These school nurses report that during a typical day, 5.6% of children receive medication in school, with 3.3% receiving medications for ADHD. Almost all the school nurses follow written guidelines for administering medication. Potential problems were identified in documenting side effects of medications, storage of medications, student self-administration practices, and appropriate authorization of nonprescription drug use. Most nurses (75.6%) delegate medication administration to unlicensed assistive personnel (UAP), with secretaries (66.2%) the most common UAP. Discomfort with delegation and confusion over state nurse practice laws were noted. Errors in administering medications were reported by 48.5% of the school nurses, with missed dose (79.7%) the most common error. Factors identified as contributing to errors included use of UAP and responsibility for large numbers of students.

Medication administration in schools: the Massachusetts experience

In 1991, the School Health Unit of the Massachusetts Department of Public Health defined medication administration as a priority policy development area for school health. The decision was based on: a) the increased numbers of children requiring medications during the school day; b) a lack of consistent standards within Massachusetts schools; c) the need to update an outdated statute concerning psychotropic medications; and d) the more than 50 weekly telephone calls from school health personnel regarding this subject. This article describes the Massachusetts experience of developing medication administration regulations for public and private schools and implementing the regulations throughout the commonwealth. The Massachusetts experience may provide guidance to other states, cities, and towns as they address this important child health issue.