Delegation and supervision in school settings. Standards, issues, and guidelines for practice (Part 2)

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.

A plan for the delegation of epinephrine administration in nonpublic schools to unlicensed assistive personnel

Professional nurses in nonpublic schools address variables in their practice that are different from nurses in a public school setting. These may include lack of funds for full-time nursing, different educational requirements, incorporation of religious beliefs into the social milieu, and inadequate peer or union support. These variables are problematic when public law health statues require change in school/parent/student relationships. New Jersey's Public Law 1997, Chapter 368 (N.J.S.A. 18A:40-12.5 and 12.6), hereafter referred to as P.L. 1997, c. 368, was enacted because school nurses may not always be available to assess students who are experiencing severe allergic reactions. Since allergies in the school population are common and can lead to anaphylaxis which is life threatening (Smith, 1999), P.L. 1997, c. 368, requires each educational board or chief school administrator/principal of public and nonpublic schools to develop a policy governing epinephrine administration. This article describes how public health nurses, the director of public health nursing, and a faculty consultant in the Bergen County Department of Health Services worked together to produce strategies for the safe implementation of this law. These strategies may provide a template for consideration by other public health nurses who serve the student population.

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.