Medication Administration - OCDC

Oregon Child
Development Coalition
PRACTICE GUIDELINES
Reviewed by: HSAC 2001
Updated 2006
MEDICATION
ADMINISTRATION
Performance Standards
References
1304.22(c)(1-6)
Agencies must establish and
maintain written procedures
regarding the administration,
handling, and storage of
medication for every child
[including:]
• Labeling and storing…and
refrigerating [medications]
• Designating trained staff
or school nurse to
administer, handle and
store child medications
• Obtaining physicians’
instructions and written
parent [authorizations]
• Maintaining a record [and
review with parents] of all
medications dispensed
• Recording changes in a
child’s behavior; assisting
parents in communication
with [physicians]
• Ensuring that [staff] can
demonstrate proper
techniques for
administering, handling,
and storing medication
(Guidance pages 89-92)
Other References
Oregon Nurse Practice Act,
Division 47
MEDICATION ADMINISTRATION
To promote self-care and avoid the risk of medication error,
parents should give (especially once-per-day) medications at
home whenever possible. However, medications may be given at
OCDC centers if the following guidelines are observed. These
guidelines should be updated annually or more often as needed
with input from the HSAC and the Oregon Nursing Board.
Written Authorization for Medication Administration
‣ A Medication Consent Form must be completed and signed by
the parent or legal guardian for each medication.
‣ Written instructions and permission from the prescribing
medical provider is required for all medications--prescription,
non-prescription, herbal or traditional. A typed, dated label,
affixed by the pharmacist to the medicine container, with the
child’s name, birth date, medication name, administration
instructions and prescribing medical provider’s name can
serve as the prescribing provider’s instruction/permission.
‣ Standing orders for the administration of Tylenol and Lice
Shampoo must be renewed annually in conjunction with the
signing medical provider in local communities.
Who Can Give Medications at OCDC?
Because high numbers of children need medications (as many as
30 per day) it is important to have OCDC staff appropriately
trained to administer all the needed medications on a given day.
‣ If the Family and Health Services Supervisor have a current
RN license then they can provide medication administration
oversight. The RN is the person of choice to give medications
but if they cannot safely give all the medications needed, he or
she may designate the administration of non-injectable
medications and subcutaneous injectable medications to a
specific child to a few 1 non-licensed staff members, who:
1. have been specifically selected and designated by the RN
2. have completed OCDC-specific medication training
3. have passed the OCDC medication quiz
4. have been approved by the RN to administer medications
‣ To prevent errors, parents may not administer medications to
their child at the center unless they first clearly communicate
their intent with the child’s usual medication administrator.
1 The Nursing Board suggests limiting medication administrators to the
number that can be well trained, monitored and supervised by the RN.
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Oregon Child
Development Coalition
PRACTICE GUIDELINES
MEDICATION
ADMINISTRATION
(Continued)
Other References
(continued)
Oregon Revised Statutes
433.800-830
OCDC Care Plan
Development Practice
Guidance
OCDC Training Summary and
Medication Forms
‣ The RN who originally delegated medication administration
has the authority to rescind delegation (to withdraw
permission to administer medications) at any time.
‣ If no RN is on staff, the Family and Health Services
Supervisor and Program Director must have a contract with a
medication administrator that must be a RN or a licensed
health provider. The medication administrator will oversee
medication administration, including designation, training,
monitoring and consultation as needed. The contracted
medication administrator must provide proof of liability
insurance coverage and a current license.
Medication Administration Training
OCDC Medication Administration Training Must Include
1. Review of OCDC Medication Administration Guidelines
2. The “Five R’s” of giving medication (right medication, right
dosage, right child, right time, right route)
3. What to check before giving medications
(Five R’s, allergies, parental permission, and written
orders/permission from the prescribing medical provider)
4. Proper medication storage and transportation
5. Medication administration (hygiene, measurement, how to
administer oral, eye, ear medications, salves, inhalants,
subcutaneous injectables, and lifesaving treatments)
6. Common childhood illnesses treated with medications
7. Medications commonly given at OCDC
8. Potential side effects
9. How to read prescription labels and define abbreviations
10. Reasons why providers and parents should be notified after
medication has begun, and who and when to call
11. Parent-Center-Provider communication about medications
12. OCDC medication administration documentation rules and
how to complete OCDC forms
13. Demonstration and return demonstration of medication
administration skills
14. Medication Administration Quiz
The medication administrator who conducts the training must
ensure that the group size allows adequate interaction with each
participant and an effective evaluation of each individual’s
demonstration of knowledge/skills.
Documentation
Every medication given must be immediately and accurately
documented. See guidance related to Medication Administration
Logs.
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Oregon Child
Development Coalition
PRACTICE GUIDELINES
MEDICATION
ADMINISTRATION
(Continued)
Monitoring Medication Administration
The medication administrator is responsible for monitoring and
documenting the performance of all medication administrators at
least every 60 days. Monitoring of medication administration
skills should include:
1. Random review of medication documentation
2. Observation of administration techniques
3. Review any errors, incidents, or questions
“P.R.N.” pro re nata Medications (to be given as needed)
The administration of p.r.n. medications may be assigned to an
unlicensed caregiver by the medication administrator. Detailed
written parameters must be in place to clarify the physician’s or
nurse practitioner’s p.r.n. order and leaves guidelines which are so
specific that the unlicensed caregiver uses no discretion in
administering the p.r.n. medication. Teachers should be informed
of the signs and symptoms that indicate the medication is needed.
Delegation of Special Tasks of Client/Nursing Care (including
the administration of subcutaneous injectable medications):
The medication administrator who originally delegated
medication administration will delegate specific to one child after
completing the following conditions:
(a) Perform a nursing assessment of the [child’s] condition:
(b) Determine that the [child’s] condition is stable and
predictable prior to deciding to delegate;
(c) Consider the nature of the task, its complexity, the risk
involved and the skills necessary to safely perform the
task;
(d) Determine whether or not an unlicensed person can
perform the task safely without the direct supervision of a
RN;
(e) Determine how often the [child’s] condition needs to be
reassessed;
(f) Evaluate the skills, ability, and willingness of the
unlicensed person;
(g) Provide initial direction by teaching the task of nursing
care, including:
i. The proper procedure/technique
ii. Why the task is necessary
iii. The risk associated with the task
iv. Anticipated side effects
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Oregon Child
Development Coalition
PRACTICE GUIDELINES
MEDICATION
ADMINISTRATION
(Continued)
v. The appropriate response to untoward or side
effects
vi. Observations of the [child’s] response
vii. Documentation of the task
(h) Observe the unlicensed persons performing the task to
ensure that they perform the task safely and accurately.
(i) Leave procedural guidance for performance of the task for
the unlicensed persons to use as a reference, [including:]
i. Specific outline of how the task is to be
performed, step-by-step;
ii. Signs and symptoms to be observed; and
iii. Guidelines for what to do if signs and symptoms
occur.
(j) Instruct the unlicensed persons that the task being
taught and delegated is specific to this [child] only and
is not transferable to other [children] or taught to
other care providers
Lifesaving Treatment
The administration of epinephrine (for severe allergic reaction) or
glycogen (for severe hypoglycemia) may be required in case of
emergency in an OCDC center. Pursuant to ORS 433.800-830,
Epinephrine and Glycogen are the only two intramuscular
injections that may be delegated from a licensed medical
professional to an unlicensed caregiver.
OCDC staff must have been properly trained in the delegation of
special tasks of client/nursing care (see above) before
administering lifesaving treatment. In addition, a written care
plan must be in place for any child who has been prescribed a
lifesaving treatment (See Care Plan Practice Guideline).
If a Medication Error Occurs
‣ A Medication Error Report must be completed and signed by
the medication administrator within 24 hours.
‣ The person who made the error must sign the report and add
his or her narrative account of what occurred.
‣ The report must be submitted to the Program Director, who
should keep a copy (confidentially) filed and send a copy to
the Human Resources Director to be (confidentially) filed.
‣ The event must be documented in the child’s file, including
the name of the medication, side effects the child experienced,
instructions or information given to parents, medical provider
response, and any follow-up necessary.
‣ The child’s parent or legal guardian must be notified of the
event as soon as possible. The Family and Health Services
Supervisor/Medication Administrator and Program Director
will decide who is the most appropriate person to inform the
parents.
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