Q&A: Best practices for administration of medication in schools
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Key takeaways:
- Medication errors that happen in schools are the same that occur in other settings, an expert said.
- New AAP guidance has 11 practice recommendations for safely administering medication to students.
An updated AAP policy statement has new guidance for the safe administration of medication in schools.
The guidance, meant for school physicians, community prescribers, school nurses and other school health professionals, was authored by members of the AAP Council on School Health, in partnership with National Association of School Nurses.
The statement underscores why robust medication administration systems are also an equity issue because students with less access to appropriate medical care or treatment are more likely to miss school and experience poor health and academic outcomes.
We spoke with Mary Beth Miotto, MD, MPH, FAAP, assistant professor of pediatrics at UMass Chan Medical School and co-author of the policy report, told Healio.
Healio: The guidance is for school physicians, nurses and others involved in school health activities. The AAP also supports collaboration with parents and students. Who is ultimately responsible for managing the storage and administration of medication in schools for students?
Miotto: The direct administration of medications, whether prescription or over the counter, ultimately rests with school nurses and those whom school nurses delegate to administer the medications. This delegation, as well as the training and supervision of other school professionals, can be performed safely when there are robust protocols and policies supporting them. Patient safety comes first, of course. There are many partners in the “supporting cast”: parents, community prescribers, school administration and school boards, and we all need to come together to ensure there is proper clinical staffing and processes.
Healio: What are some common issues that get in the way of this?
Miotto: Errors in medication administration are the same in school as they are in health care and home settings: systems that are not built on sound processes and strong communication. In school administration of medication, the protocol and steps must be laid out by state- and district-level policies, the proper orders must be provided to the school by the community prescriber, and the school nurse or other staff should consider implementing the “6 Rights” that ensures the right dose, the right time, the right student and a number of other “patient safety rights.” Finally, we are all human, and sometimes there is miscommunication. Building strong communication means prescribers and school health staff being able to talk or securely message when questions arise. When all these safeguards are in place, our students can access necessary medications at school safely and that will improve general health and maybe even increase school attendance rates!
Healio: How does the guidance tackle unconventional therapeutics, such as cannabis?
Miotto: In an era when federal, state, and local regulations may differ on therapeutics such as cannabinoids, it is vital that the patient safety protocols be just as rigorous for these substances, whether they are FDA regulated, prescribed or over the counter. Appropriate labeling, packaging, tracking documentation and school regulations on self-administration and self-carry by students should be carried through to all medications on the school campus. School health staff, school policymakers, community prescribers, parents and students can work as a team to keep the youths and their classmates safe and well through following robust medication safety protocols.
Healio: What are a few key recommendations in the guidance for school physicians and nurses?
Miotto: We included 11 practice recommendations and 12 advocacy recommendations, so let me pick a few top items that impact school nurses and community prescribers:
- When community prescribers consider sending a medication order to school, they should work with families on practical dosing intervals and consider the benefits and risks of medication use outside the home.
- Commit to updating the school order on a timely basis when a medication dosing interval or other medication detail changes or the medication is discontinued. Build the school medication order process into your electronic health record workflow and your annual preventive encounter workflow to make it easy and safe.
- For youths with chronic conditions, school nurses and community prescribers should try to communicate about who might be administering the medication regularly. Is it a school nurse or a nonclinical school staff member, and if it is not a nurse, is it appropriate to ask for clinical decision-making that is required with an as-needed order?
This policy statement has many resources on medication safety in chronic conditions, tables on how to determine if a student can self-administer medication, and other tools that can support school nurses, prescribers and policymakers. At a time when school nurses and community medical teams are so rushed, it may seem as if picking up the phone to iron out a medication question for one patient may take too much time, but my experience is that 5 minutes talking saves me hours over the course of a school year and is obviously the best road to patient safety. We all can take time to advocate for funding for safe clinical staffing in school health offices and other processes that keep children healthy and in school.
Reference:
Miotto MB, et al. Pediatrics. 2024;doi:10.1542/peds.2024-066839.
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