Medication management in primary and secondary schools

Medication Use in Schools

This article serves as a Position Statement of the Pediatric Pharmacy Association (PPA), which supports safe and effective medication use in schools. PPA recommends that schools develop comprehensive medication use policies to support safe and appropriate administration of both chronic and emergency medication in schools. These policies must address issues specific to pediatric patients, including off-label and over-the-counter medication use, various pediatric dosage forms, as well as appropriate medication storage, administration, and disposal practices. PPA also advocates for continued staff development and education regarding laws, regulations, and policies surrounding medication use in school to ensure safe and effective care of children and adolescents in the school setting.

Medication management in Minnesota schools: The need for school nurse-pharmacist partnerships

BACKGROUND

Pharmacist participation in school medication management (MM) is minimal. School nurses are responsible for increasingly complex medication administration and management in schools.

OBJECTIVES

The purpose of this study was to 1) assess the MM needs of school nurses in Minnesota, and 2) determine if and how interprofessional partnerships between nurses and pharmacists might optimize MM for students.

METHODS

Researchers from the University of Minnesota College of Pharmacy, School Nurse Organization of Minnesota, and Minnesota Department of Health conducted a 32-item online survey of school nurses.

RESULTS

Nurses administered the majority of medications at their school (69.9%) compared with unlicensed assistive personnel (29%). Stimulants (37.7%), asthma medications (25.7%), over-the-counter analgesics (17.8%), and insulin (6.6%) were the most commonly administered drug therapies. A clear majority of school nurses were interested in partnering with pharmacists: 90.3% thought that a pharmacist could assist with MM, 80% would consult with a pharmacist, and 12.3% reported that they already have informal access to a pharmacist. Topics that nurses would discuss with a pharmacist included new medications (71.6%), drug-drug interactions (67.1%), proper administration (52%), and storage (39.4%). The top MM concerns included 1) availability of students' medications and required documentation, 2) health literacy, 3) pharmacist consultations, 4) lack of time available for nurses to follow up with and evaluate students, 5) family-centered care, 6) delegation, 7) communication, and 8) professional development.

CONCLUSION

Although the majority of school nurses surveyed indicated that partnerships with pharmacists would improve school MM, few had a formal relationship. Interprofessional partnerships focused on MM and education are high on the list of services that school nurses would request of a consultant pharmacist. Study results suggest that there are opportunities for pharmacists to collaborate with school nurses; further study is necessary to advance high-quality MM for students in Minnesota schools.

Medications at school: disposing of pharmaceutical waste

BACKGROUND

This project quantified and categorized medications left unclaimed by students at the end of the school year. It determined the feasibility of a model medication disposal program and assessed school nurses' perceptions of environmentally responsible medication disposal.

METHODS

At a large urban school district all unclaimed medications were collected at the end of a school year to determine the extent and nature of this problem. Nurses documented unclaimed medications and transported them to a central district location. An environmentally responsible medication disposal program, consisting of sealed containers bound for a local hospital's disposal system, was implemented.

RESULTS

In a school district of approximately 133,000 students, there were 926 different medications abandoned at the end of a school year brought to a central disposal area. Nurses complied with the newly implemented protocol. Information collected from nurses indicates acceptance of the program. Disposal of unclaimed medications at a central location, use of secured containers, and transportation to a hospital for environmentally responsible disposal proved to be feasible and acceptable to the staff.

CONCLUSIONS

Unclaimed medications at school each year pose a potentially huge environmental risk when disposed of improperly. It is feasible to implement an environmentally responsible medication disposal protocol at schools.

Medication Management in Primary and Secondary Schools: Assessing the Practices and Opinions of Pediatricians

OBJECTIVES 1)To assess the awareness of pediatricians regarding the potential problems caused by children taking their medications before or during school hours 2) To identify the types of interventions pediatricians use to manage these issues 3)To assess the views of pediatricians regarding how well the process of medication management is handled by the schools that their patients attend.

METHODS Thirty-five pediatricians completed a questionnaire inquiring about their prescribing habits for children under the age of 18, their views on the possible effects medications may have on children while at school, and what they do to minimize problems that may be associated with taking or being under the influence of medications while at school.

RESULTS The largest group of responding physicians (42.9%; n = 15) selected “Somewhat Common” when asked how common it is that they prescribe medications that must be used before or during school hours. The majority of responding pediatricians surveyed (62%; n = 21) believe that taking medications at school can create special problems. The majority of respondents (59.4%; n = 19) disagree with the statement that “Medications in Illinois schools are well managed by a trained agent. These pediatricians utilize a variety of strategies to minimize problems caused by medication use during or before school, and the most common of these is the prescribing of sustained release products.

CONCLUSIONS Pediatricians who responded to a survey are aware of potential problems associated with children being under the influence of, or taking medications during school hours. As a result, many have devised ways to ameliorate and/or prevent potential problems.

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.

Family perceptions of medication administration at school: errors, risk factors, and consequences

Medications are administered every day in schools across the country. Researchers and clinicians have studied school nurses' and educators' experiences with medication administration, but not the experiences of children or their parents. This study examined medication administration from the child and parent perspectives to (a) determine problems children experience with medicines at school, (b) clarify risk factors for medication errors, and (c) examine the perceived impact of medication errors on school performance and social relationships. Participants included children ages 8 to 18 years (n=157) being treated at a large Midwestern Children's Hospital in diabetes, asthma, and Attention Deficit Hyperactivity Disorder (ADHD) clinics. Findings suggest that forgetting a dose and running out of medication were the most common problems. Missing a dose was more frequent in students with ADHD than in students with diabetes or asthma. Medication nonadherence at school, which includes medication administration errors such as missing a dose, may potentially lead to a variety of educational, social/emotional, and physical consequences. These results indicate that the impact of missing medication on children with ADHD appeared to have a greater effect on schoolwork and friendships, while the physical consequences appeared to vary widely based on health condition. Interestingly, children with more self-responsibility for medications were less likely to report medication errors. School nurses will want to include students when planning for medication management at school.