Appendix E

Guidelines for Assessing Competency of Medication Aides:

These guidelines have been published by the Department of Health and Human Services, Regulation and Licensure, Credentialing Division list Law 4 Rule 59 and are being made available for use by individuals and/or entities to assist with determining competency of medication aides related to the required 14 competency standards. These examples are provided to give you some suggestions regarding the types of questions, knowledge and skills that could be utilized in order to assess competency of a medication aide. These are not intended to be all-inclusive and can be used as is or changed/deleted in any way to meet the needs of the individual medication aide and/or employment situation. Please note, however, that a medication aide must demonstrate competency in all 14 competency standards. Also included for your use, if you want, is a form for documenting the competency assessment of individuals for your records. Please do not submit this form to the department.

Published June, 1999
Nancy Holmgren RN, BSN
HHS Regulation and Licensure
Credentialing Division
Nursing and Nursing Support

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Unlicensed school staff who are assigned to assist in providing medication to students must demonstrate the following minimum competency standards:

RECOGNIZE THE STUDENT'S PROPERTY RIGHTS AND PHYSICAL BOUNDARIES

• Do not share student's medications or equipment with others.
• Safeguard student's personal property. Report any missing medication promptly to parent/caretaker.
• Respect student's personal space and personal preferences regarding touch (hugs, pats on back, etc.)
• Be aware of cultural differences regarding personal space and touch.
• Safeguard from physical abuse, improper touching.

RECOGNIZE THE STUDENT'S RIGHT TO PERSONAL PRIVACY REGARDING HEALTH STATUS, DIAGNOSIS AND MEDICATION THERAPY

• Do not share diagnosis, health status, prognosis without written permission of the parent/guardian and student (if appropriate)
• Do not discuss the reasons for medication therapy nor the kind/name of medication provided with anyone except the school nurse, parent or provider (if directed by the person monitoring the medication effects) without written permission of. the parent/guardian and student (if appropriate). Family Educational Rights and Privacy Act (20 U.S.C. 1243g)
• Interdisciplinary school team may need access to pertinent information. Request approval by parent/caretaker and student (if appropriate)
• Be sensitive to maintaining appropriate privacy when providing medication therapy.

RECOGNIZE AND HONOR THE STUDENT'S RIGHT TO REFUSE MEDICATIONS, BUT ALSO THE REQUIREMENT TO SEEK ADVICE FROM THE PROFESSIONAL OR PARENT/CARETAKER PROVIDING DIRECTION AND MONITORING REGARDING PROCEDURES OR PERSUASIVE METHODS TO ENCOURAGE

• A student has the right to refuse a medication
• Never use abusive methods to persuade a student to take medication
• Try to determine why the student is refusing, e.g., Difficulty. swallowing due to sore throat; Nausea,' afraid of vomiting; Medication is causing side effect, like dizziness, blurred vision, anxiety, hives, etc.
• Call the professional or parent directing and monitoring the provision of medication.
• Report refusal, and possible reasons.
• Document directions received from nurse/parent.
• Document outcome.

FOLLOW STANDARDS OF HYGIENCE AND INFECTION CONTROL, INCLUDING HAND WASHING

• Handwashing is the most effective means of preventing the spread of germs
• Review the proper handwashing guide
• Handwashing must occur before and after the provision of medication to students.
• Students should wash their hands before taking medication.
• Observe universal precautions:
• Wear gloves when applying ointments, lotions
• Dispose of kleenex, cotton balls, q-tips, dressings, needles/syringes according to guidelines for blood borne pathogens
• Discard medications dropped on floor/document

FOLLOW DISTRICT POLICIES/PROCEDURES REGARDING STORAGE AND HANDLING OFMEDICATION, EXPIRATION DATE, AND DISPOSAL TO SAFEGUARD MEDICATION PROVISION

• All medications must be kept under lock and key
• Exceptions: emergency medications
  • (Oxygen, Epi-pens)
• Those ordered specifically for self-care administration
  • (Inhalers, Epi-pens)
• Medications requiring refrigeration should be stored in a small locked container
• All medications should be counted when received
• Controlled substances should be counted and documented when received, and at the time of Administration
• Check expiration date/do not give if expired
• Unused medications are retrieved by the parent/guardian or destroyed by the nurse (with a witness).

RECOGNIZE UNSAFE CONDITIONS INDICATING A MEDICATION SHOULD NOT BE PROVIDED TO A STUDENT

• Do not give if not in pharmacy labeled or manufacturer labeled container, or if
  student's name or medication label is illegible
• Do not give if change in consistency or color
• Do not give if after expiration date
• Do not give an adult dose to a child without consulting with the nurse, or without orders from a medical provider
• Do not give a medication if an allergic reaction is suspected. Be alert to allergy to latex
• Report to licensed professional or parent/caretaker responsible for providing direction and monitoring

ACCURATELY DOCUMENT MEDICATION NAME, DOSE, ROUTE AND TIME GIVEN, OR REFUSAL

• Print the student's name on the documentation form
• Print the medication name, dose, route and-time on the documentation form
• Sign your name at the bottom of the form
• Before giving medication, check the month/date box on the form to be sure someone else has not given the medication already
• Initial the correct month/date box immediately after providing the medication to the student
• If the medication is not provided, document why using the key on the bottom of the form
• Document on the back of the form the reason for the omission.

PROVIDE THE RIGHT MEDICATION, TO THE RIGHT STUDENT, AT THE RIGHT TIME, IN THE RIGHT DOSE, AND BY THE RIGHT ROUTE
Follow the "FIVE RIGHTS"

• RIGHT STUDENT - Ask name/Repeat name
  • Consider placing photo on documentation record
• RIGHT MEDICATION - Compare Rx label to medical/parental order
  • Read label 3 times before providing to student: before opening container, when preparing medication, when replacing container in cabinet
• RIGHT DOSE - Give exact amount specified by medical/parental order and medication label
  • If parental request conflicts with label, do not give; Consult nurse or administrator
• RIGHT TIME - check medical/parental order, label, and recording document for correct time
  • Giving more than 30 minutes before or after is generally considered a medication error
• RIGHT ROUTE - check how medication is to be given
  • By mouth, inhalation (mouth or nose), instillation (ear), applied to skin

PROVIDE MEDICATION ACCORDING TO THE SPECIALTY NEEDS OF STUDENTS BASED UPON AGE, SWALLOWING ABILITY, AND ABILITY TO COOPERATE

• Children's dosages differ from adults; check recommended dose of OTC medications especially
• Dosage is related to body weight
• Procedure for ear drops differs for children under 3 years of age
  Students with special health care needs may require special techniques/positioning to assist with swallowing
• Nurse/parent should demonstrate
• Take extra time with these children
• Be sure they have swallowed the medication
• Monitor closely for side effects since they may not be verbally expressive
• IHPs and Emergency Care. Plans may be required for students with complex health care issues

RECOGNIZE GENERAL CONDITIONS WHICH MAY INDICATE AN ADVERSE REACTION TO MEDICATION
Observe for -

• Rashes/hives
• Tingling/itching/swelling of lips, tongue, cheek
• Any difficulty with breathing
• Recognize changes in a student's condition which may indicate inability to receive medications
• Altered state of consciousness
• Inability to swallow
• Vomiting
• Allergic response

SAFELY PROVIDE MEDICATIONS FOR ALL AGES OF STUDENTS BY 4 ROUTES:

• ORAL -
  • Tablets -
  • Chewable
  • Scored if cutting permitted
  • Crushing may be allowed
  • Capsules
  • Sprinkling allowed if labeled
  • Syrups/Elixirs
  • Clear liquids
  • Suspensions
  • Need refrigeration
  • Separates, shake bottle 5 seconds
  • Student should drink a full glass of water following taking oral meds, unless contraindicated (eg., cough syrup)
• TOPICAL - Ointments applied to the skin
• INSTILLATION
  • Eye or Ear Drops/ointments
• INHALATION
  • Nasal sprays, metered dose inhalers
  • Nebulizers (with IHP)

RECOGNIZE LIMITS/CONDITIONS BY WHICH UNLICENSED PERSONS MAY LEGALLY PROVIDE MEDICATIONS
Direction and monitoring must be provided by:

• Licensed health care professional (RN, Pharmacist, MD, PA, LPN's under direction of RN or MD)
• Or -- parent/caretaker of the student

Three additional activities may be permitted:

• 1) PRN (as needed) medications.
• 2) Additional routes, including but not limited to, gastrostomy tube, rectal.
• 3) Participation in monitoring.

Before any additional activity may be provided by an unlicensed person, these conditions must be met for each:

• Obtain a student-specific, written statement from a licensed health care professional stating it is safe for an unlicensed person to provide the identified additional activity.
• (Exception: non-prescription medication with parental/guardian monitoring)
• Obtain written statement of competency determination from a licensed health care professional or parent/guardian.
• Competency determination is student and individual staff member-specific, not by title nor job description.
• Written, student-specific direction for each additional activity is provided by school nurse or parent/guardian to assure student safety.
• Parental direction and monitoring must be student-specific, and should be stated on the medication permission form.

Use of a Metered Dose Inhaler
A metered dose inhaler (MDI) is a device used to deliver asthma medication directly to the lungs. In order to ensure effective administration of the medicine, the following steps should be performed:

1. Remove the cap and hold inhaler upright.

2. Shake the inhaler.

3. Tilt the head back slightly and breathe out.

4. Position the inhaler in one of the following ways:

A. Open mouth and hold inhaler 1 to 2 inches away
B. Use spacer (recommended with young children)
C. Put in the mouth. - (A is optimal, but C is acceptable if a student has trouble with either A or B)

5. Press down on inhaler to release medication as you start to breathe in slowly.

6. Breathe in slowly (3 to 5 seconds).

7. Hold breath for 10 seconds to allow medicine to reach deeply into lungs.

8. Repeat puffs as directed. Waiting 1 minute between puffs may permit the second puff to penetrate the lungs better.

Source. Managing Asthma: A Guide or Schools. National Heart, Lung, and Blood
Institute (NHLBI), National Institutesof Health US. Department of Health and Human Services, and the fund for the Improvement and Reform of Schools and Teaching, Office of Educational Research and Improvement (OERI). U.S. Department of Education. September 1991. NIH Publication No. 91-2650.

FIELD TRIP MEDICATIONS
Field Trip Medications may be handled as follows:

1. Teachers need to provide the date of their planned field trip at least 3 days in advance to the school nurse, or school personnel with current medication training.

2. The school nurse or medication trained school personnel will provide a form for the teacher with the following information:

a. Name of student
b. Teacher
c. Grade
d. Medication to be given
e. Dosage of medication
f. Time medication is to be given
g. Copy of the log to record medication was given

3. On a field trip all medications should be kept in a secure area.

4. The school nurse or trained health room para/secretary will put the required type(s) of medication and medication form in the envelope/zip lock bag/etc. and seal it.

5. Upon returning to the school following the field trip, the teacher will return the signed form and envelope to the school nurse or trained health room para/secretary.

6. The teacher, school nurse or trained school personnel will record the medication given on the student's school medication record. The teacher must initial the medication log for the day and time the medication was given to the student.

7. If it is a liquid medication, the same information is to be written on a form. The medication bottle, a measuring device. and the form are to be put in a baggie for the teacher to take on the field trip. Upon returning to school, the teacher is to return the bottle of liquid medication to the school nurse or trained health room para/secretary and follow the same procedure as described above.

8. The school nurse is strongly encouraged not to delegate preparing medications for field trips but rather to prepare the medication herself. Furthermore. teachers who regularly schedule field trips are strongly encouraged to have medication administration training.

Field Trips & Medications

• Each classroom has a list of students who take daily medications.
• Field trip permission slips include questions about medications.
• Prepare an envelope or the original container in a ziploc bag with a form identifying the medication and the time it needs to be given.
• Designated person gives medications & documents on the form provided.
• Upon return, document on the original log & return original container.

MEDICATIONS W/SPECIAL CONSIDERATIONS

*Injectables (Insulin, EpiPen, Glucagon)

*Oxygen Therapy

*Heart Medications (Digoxin/Lanoxin)

*Medications Given by Gastrostomy Tube

*PRN Prescription Medications (Nebulizer Treatments)

A licensed health care professional must determine it is safe for an unlicensed person to provide the medication to the student. A student-specific IHP must be in place to guide the individual staff member delegated to provide the medication to the individual student.