2/1/2018 Massachusetts Department of Public Health Medication Administration in Schools: What School Nurse Managers Need to Know Mary Ann Gapinski, MSN, RN, NCSN Director of School Health Services School Nursing Courage Conviction Compassion 1
2/1/2018 Prerequisite for this workshop Completion of SHIELD online course Course Objectives ◦ Describe the role and responsibilities of the school nurse manager in the medication administration program in schools ◦ Collaborate with school district administration and school physician to assess, develop, revise and implement medication administration program policies and procedures that meet federal, state, and local laws and regulations. ◦ Establish systems to evaluate, verify, and communicate ongoing competence in medication administration and delegation for RNs and delegates. ◦ Explain and implement the process for registration with MDPH of the school’s or school district’s medication administration program 2
2/1/2018 MEDICATION ADMINISTRATION IN THE SCHOOL SETTING Overview Massachusetts Laws and Regulations Affecting Medication Administration and Delegation 3
2/1/2018 Massachusetts Laws and Regulations Affecting Medication Administration and Delegation MGL 94 C MGL C112 Section 80B MGL C71 S54B BORN: 244 CMR 3.00 (Nurse Practice Act and Regulations) BORN 244 CMR 9.00 (Standards of Conduct) 105 CMR 210.000 http://www.mass.gov/legis/laws/mgl/index.htm Purpose of the Regulations “…to provide minimum standards for the safe and proper administration of prescription medications to students in the Commonwealth’s public and private primary and secondary schools. The regulations permit school nurses to delegate responsibility for administration of prescription medications to trained, nursing- supervised school personnel, provided the school district or private school registers with the Department of Public Health. The aim of 105.CMR 210.000 is to ensure that students requiring prescription medication during the school day will be able to attend school and to ensure that prescription medications are safely administered in schools. 105 CMR 210.000 encourages collaboration between parents and guardians and the school in this effort.” 4
2/1/2018 Definition of the School Day per 105 CMR 210.001 Purpose: The purpose of 105 CMR 210.000 is to…… ensure that students requiring prescription medication administration during the school day will be able to attend school and to ensure that prescription medications are safely administered in schools… The School Day The “school day” as defined for the purpose of 105 CMR 210.000 is any part of a day, including a partial day that students are in custody of the school, whereby the school has the authority and duty to provide care and protection of students. 5
2/1/2018 Options For Medication Administration in the School Setting Permitted by Law and Regulations All medication administered by licensed personnel Registration for Delegation to unlicensed school staff by the school nurse: Residential Schools Public and Private Day Schools Self administration with parental permission and approval by the school nurse Options (continued) Training of unlicensed personnel in the administration of epinephrine via an auto-injector to those with a prescription (requires registration) Requires: Agreement at the school district level by the School Nurse, School Physician, Superintendent (Administrator) and School Committee (Directors). Registration with the Department of Public Health after certain conditions are met. 6
2/1/2018 Medication Administration Program: Management All public school systems/non-public schools in the Commonwealth are required to comply with regulations 105 CMR 210.00: The Administration of Prescription Medications in Public and Private Schools. Management (continued) Only certain licensed professionals such as School Nurses (RNs), described n M.G.L. Chapter 94C, may administer prescription medications in Massachusetts public school systems/non-public schools unless the school is approved for registration with the Massachusetts Department of Public Health (MDPH) School Health Unit and MPDH Drug Control Program (DCP) for the handling and storage of medications by unlicensed school personnel. 7
2/1/2018 Management (continued) The School Nurse Manager is responsible for the management of the medication administration program in all public/non-public schools. School Nurse Manager Roles and Responsibilities 8
2/1/2018 School Nurse Manager Responsibilities for the Administration of Medications Within the School System ◦Collaborates with school committee/ administrators/ school physician to establish policies that: ◦Establishes protocols for administration of all medication in the school setting; ◦Defines which medications may be delegated; School Nurse Manager Responsibilities (continued) ◦Designates who may administer; ◦Ensures training of designees; ◦Supervises and evaluates total program ◦Establishes record-keeping system. 9
2/1/2018 BORN Advisory: Verification of Orders Nurse Manager The School Nurse Manager must develop and implement the necessary measures to promote the delivery of safe nursing care in accordance with accepted standards of care. BORN Advisory: Verification of Orders The School Nurse Manager must ensure: ◦Infrastructure that is consistent with current standards of care to minimize errors ◦School policies reflect student safety concerns ◦Orders are obtained in an acceptable method (whether verbal, electronic, written or standing) and in what circumstances which method can be used. 10
2/1/2018 School Nurse Manager Responsibilities for Delegation The School Nurse Manager (Leader/Contact Nurse) is accountable for: Establishing systems to evaluate ongoing competence of all nursing and UAP staff Developing policies and protocols Ensuring standards of practice are established and maintained (NCSBN 2009) School Nurse Responsibilities For each individual student the School Nurse : Completes the IHCP including medication administration plan (MAP) in collaboration with student’s prescriber; Gives first dose of medication/ first treatment (medication or treatment that has not been initially administered in another setting should not be administered in the school setting); 11
2/1/2018 School Nurse Responsibilities (continued) Determines whether to delegate administration and/ or treatments and to whom. Evaluates student ability to determine readiness for self-administration in the school setting. BORN Advisory: Verification of Orders School Nurse The School Nurse is accountable to ensure that the order: • Originated from an authorized prescriber • Is reasonable, based on nurse’s knowledge and student needs • Is compliant with school policy and protocols (putting student safety first) • Is current and evidence-based • Reflects student allergy concerns 12
2/1/2018 School or District Responsibilities for Delegation The School District is accountable for providing: • Sufficient resources • Sufficient staffing • Documentation of employee competencies • District policies on medication administration and delegation (NCSBN 2009) 13
2/1/2018 Policies Discussion SELF ADMINISTRATION IN THE SCHOOL SETTING 14
2/1/2018 210.006: Self-Administration of Medications by Students DELEGATION IN THE SCHOOL SETTING 15
2/1/2018 FIELD TRIPS AND OTHER SHORT TERM EVENTS 16
2/1/2018 TRAINING OF UNLICENSED PERSONNEL The training of unlicensed school personnel in the handling, storage, administration and disposal of medications shall be provided under the direction of the School Nurse Manager (RN). The training must follow the content outline, and use the competency test provided by the School Health Institute. There must be plans for an annual review and update for unlicensed school personnel. TRAINING (continued) Must indicate which category(s) of unlicensed school personnel may be delegated the responsibility for medication administration in your school system /school as approved by the School Committee or Board of Trustees and in accordance with 105 CMR 210.004, (B), (1), (2): • Administrative Staff • Health Aides • Teaching Staff • Secretaries 17
2/1/2018 TRAINING (continued) A current listing of all unlicensed school personnel who have been trained by the School Nurse in the administration of medications shall be maintained in each school. Upon request, a parent shall be provided with the name(s) of school personnel authorized to administer medications. Medication Administration Training Manual Available on SHIELD Website 18
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