Medication Assistant
Training
• Lawrence County School Health Services
1
Medication in the School Setting

The goal for assisting students with
medication during the school day helps
the students to remain in school, helps
with their health status, & can help
improve their learning.
2
Confidentiality & Privacy

Confidentiality is a violation of the students
privacy. Discussing any students diagnosis or
medications is a violation. In the school
setting Teachers of the student are allowed to
know about the students medication.

Privacy is essential in health care. Always
assist students with their medications
individually.
3
Confidentiality & Privacy
4
Acts & Laws

The Americans with Disabilities Act is a federal
law that prohibits discrimination against the
disabled.

Family Education Rights & Privacy Act
(FERPA) provides parents with access to
school educational & health records. In order
to release the records outside of the school
system you must obtain consent.
5
Acts & Laws

The Registered Nurse (R.N.) & the Licensed
Practical Nurse (L.P.N.) are required to have a
license issued by the Alabama Board of
Nursing. This license indicates that the RN or
LPN has specialized knowledge, independent
judgment, & the capacity to practice nursing.

The Alabama Board of Nursing’s legal
mandate is the protection of the publics health,
safety, & welfare.
6
Delegation

Some medications may be delegated in the school setting.
Delegation is defined in the Board of Nursing regulations as the
act of authorizing a competent individual to perform acts
supportive to the RN or LPN in selected situations.

Designated school personnel will complete a 12 hour educational
course.

Receive School specific, Student specific, training from the RN or
LPN prior to assisting students with medications.

Will pass a 50 question Medication Administration test.

Will maintain confidentiality.
7
The Role of the Medication
Assistant

As a Medication Assistant you must notify the School
Nurse any time a new medication is brought in by a
parent/guardian.

Accept medication & controlled substances from the
parent/guardian according to state & local policies.

COUNT (Controlled Substances), LABEL ALL
MEDICATION, check the expiration date &
document appropriately.

Report any discrepancies in the quantity of a
controlled substance to the school nurse, principal, &
other authorities.
8
The Role of the Medication
Assistant

A Medication Assistant may assist students with the
following medications: Oral, Topical, Ear, Eye, Nose,
Inhalers, Nebulizers, & Epi-Pens.

Have a knowledge of potential side effects & adverse
reactions.

Always IMMEDIATELY NOTIFY the School Nurse if
the wrong medication, or wrong amount of medication
is given to a student.

It is the responsibility of the Medication Assistant to
communicate to the School Nurse to ensure
understanding of responsibilities.
9
Parent/Prescriber Authorization

In order to give a prescription medication
you must have a Doctor signed PPA form that
includes:
 Student Name & date of birth.
 Name of medication with dosage, route, &
reason.
 Beginning & Ending date of medication.
 Frequency & time the medication is to be
given.
 The Parent must also sign the PPA form.
10
PPA

For ALL MEDICATIONS
the PPA form must be
completed, AND attach
the MAR to the back.

Use only BLACK ink.
11
Parent/Prescriber Authorization

Over the Counter Medication does not require
the Physician to sign UNLESS the
medication exceeds the students age or
weight parameters. Example: Excedrin
Migraine, Label directions is for 18 & over.

The parent/guardian must always sign the
PPA form for ANY MEDICATION.

You are required to have a new PPA form for
each medication or anytime the dosage
changes.
12
Parent/Prescriber Authorization

If the Doctor signs stating that a student can
“Self Administer” a medication (Inhalers
usually) then the Parent/Guardian must sign
both sections on the PPA. (Parent
Authorization & Self Administration
Authorization)

Self Administration means the student is able
to consume, inject, instill, or apply medication
as directed without the assistance of the
School Nurse or Medication Assistant.
13
Medication Administration Record

The M.A.R. is the form you will document
on if you ever give a medication.

In the school setting we have:
 Daily Medications
 As Needed (PRN) Medications
 Emergency Medications
14
Medication Administration Record
15
Medication Administration Record

When giving a Daily Medication:
 Only initial the box for the correct date
 Initial & sign the bottom

When giving a PRN or Emergency
Medication:
 Initial the box for the correct date, put the time,
& quantity of medication given in the box.
 Initial & sign the bottom.
16
Medication Administration Record
(Page 2)
17
Medication Administration Record
(Page 2)

Page 2 on the M.A.R. is used to document when you
receive or return a controlled substance.

Make sure the prescription label is on the
container/packaging.

Count the medication with the Parent/Guardian.

Both parties will sign verifying the count is correct.

Lock medication in the medication cabinet & notify the
School Nurse.
18
Medication on Field Trips

Only the School Nurse or Medication Assistant can
assist students with medication on a field trip.

Do not repackage medication. Medication must be
taken in the original container.

Document on the field trip MAR.

In the event of an overnight field trip the School Nurse
will provide you with additional forms for
documentation & guidelines.
19
Unusual Occurrence Report

In the event that a
student is given the
wrong medication or
wrong dosage
NEVER LEAVE THE
STUDENT ALONE &
IMMEDIATELY
NOTIFY THE
SCHOOL NURSE.
You also will be
required to fill out an
Unusual Occurrence
Report.
20
7 “RIGHTS” of Medication
Administration
Right Medication
Check the 7 RIGHTS
when:
Right Documentation
Right Dose
Right Student
Right Reason
• When pouring the
medication
Right Time
Right Route
• Taking medication from
the cabinet
• When returning the
medication to the
cabinet
21
Medication Administration

All medication must be stored in a securely locked cabinet used
exclusively for medication. Excludes medication being kept “On Person”.

Any medication requiring refrigeration must be stored in a separate
refrigerator.

Liquid medication must be measured by a calibrated medicine cup,
calibrated spoon, or calibrated syringe.

Any medication brought to the school must be in the prescription bottle,
or over the counter bottle. The labels must be intact & the medication
must not be expired. For OTC medications you must write the students
name on the bottle.

The school DOES NOT STOCK ANY MEDICATION. Any medication
needed by a student must be brought by a parent/guardian & the
appropriate documentation must be provided or filled out.
22
Medication Administration

Always wash your hands before giving any
medication to a student.

If the student will touch or handle the
medication, the student should wash his/her
hands first.

At no time is it acceptable for the Nurse or
the Medication Assistant to touch the
student’s medication with their bare hands.
23
Medication Administration

Oral Medications

Pills/Tablets/Capsules: Pour the medication into a medicine cup, the
cap of the medication bottle, or a small paper cup.

Ask the student to pick up the medication and put into his/her mouth.


The student should follow the medication with 6-8 ounces of water.
If the student is not physically able to pick up the medication and you
have to place the medication inside the student’s mouth, you should put
on gloves to avoid transferring any infection to the student or to yourself.

Throw away gloves after each use (these are now contaminated).

Make sure that the student swallowed the medication.

Wash your hands.

Record results.
24
Medication Administration

Liquid Medication

Liquid medications must be precisely measured. DO NOT USE
SILVERWARE OR PLASTIC SPOONS—these are not accurate
measuring tools. Use a calibrated medicine cup, spoon or syringe.

When using a measuring cup, place it on a flat surface and read it at eye
level for accuracy.

Pour the liquid from the side of the medicine bottle opposite the label (to
protect the label). Clean the outside of the bottle if needed after pouring.

Ask the student to pick up the medication cup and swallow all of the
medication.
25
Medication Administration

Liquid Medication Continued

If the student is not physically able to pick up the medication and
you have to place the medication inside the student’s mouth, you
should put on gloves to avoid transferring any infection to the
student or to yourself.

Throw away gloves after each use (these are now contaminated).

Make sure that the student swallowed all of the medication.

Wash hands.

Record results.
26
Medication Administration

Nasal Medications

Check order form and pharmacy label for instructions.

Instruct the student to gently blow the nose (except in case of nosebleeds or other
contraindications.)

Assemble necessary equipment.

Wash hands and apply gloves to both hands.

Drops: Draw the medicine into the dropper. To properly regulate dosage, draw
only the amount to be administered.

Spray: Prepare the spray container as directed on label.

Have the student lie down and tilt the head backward by elevating the shoulders.
27
Medication Administration

Nasal Medications Continued

Insert the dropper into the nasal passage and instill the medicine or assist the
student in self-administering if a nasal spray.

Wipe the dropper off with a clean gauze pad to remove mucus.

Have the student remain in this position for several minutes to allow the
medication to be absorbed.

Note results.

Instruct the student not to blow his or her nose unless absolutely necessary.

Discard gloves and wash your hands.

Record results.
28
Medication Administration

Eye Drops

Check the order form and pharmacy label. Read the instructions carefully. Be certain you
know which eye is to be treated.

Initials may be used to specify the eye that requires treatment. O.D. = right eye; O.S. = left
eye; O.U. = both eyes

Assemble the necessary equipment.

Wash hands and apply gloves to both hands.

Explain the procedure and instruct the student that vision may be blurred temporarily after
applying this medication.

Have the student assume a comfortable position, either lying down or sitting in a chair with
support for the neck.

Gently wipe the area around the eye(s) to be treated with a gauze pad that has been
moistened with normal saline or water to remove drainage. Use a clean pad for each wipe and
stroke from the nose outward.

Ask the student to tilt the head back and to look up at the ceiling.
29
Medication Administration

Eye Drops Continued

Gently pull the lower lid of the affected eye down and out, to form a pocket.

Holding the dropper near the lid, gently drop the prescribed number of drops into the pocket.
To prevent the dropper from being thrust into the individual’s eye, it is good practice to support
your hand by placing a finger on the individual’s forehead.

Press the inner corner (where the eyelids meet) to prevent medication from entering the
respiratory system.

Note: Avoid touching the eyelid or lashes with the dropper. Avoid dropping the solution on
the sensitive cornea (the clear, transparent front part of the eye).

Ask the student to close the eye, blink several times but not to rub the eye.

Discard gloves and wash your hands.

Record results.
30
Medication Administration

Eye Ointment

Check the order from the pharmacy label. Read the instructions carefully. Be certain you know
which eye is to be treated.

Initials may be used to specify the eye that requires treatment. O.D. = right eye; O.S. = left
eye; O.U. = both eyes

Assemble the necessary equipment.

Wash hands and apply gloves to both hands.

Explain the procedure and instruct the student that vision may be blurred temporarily after
applying this medication.

Have the student assume a comfortable position, either lying down or sitting in a chair with
support for the neck.

Gently wipe the area around the eye(s) to be treated with a gauze pad that has been
moistened with normal saline or water to remove drainage. Use a clean pad for each wipe and
stroke from the nose outward.
31
Medication Administration

Eye Ointment Continued

Ask the student to tilt the head back and to look up at the ceiling.

Gently roll the tube of medication between the palms of both hands. This aids in warming the
ointment so it can cover the eye evenly.

Gently pull the lower lid of the affected eye down and out, to form a pocket.

Beginning at the inner corner of the eye (next to the bridge of the nose) and working toward
the outer eye, gently squeeze a thin ribbon of the medication on the surface of the lower lid.

To prevent the tube from being thrust into the student’s eye, it is good practice to support your
hand by placing a finger on the student’s forehead.

Have the student close the eye(s) and massage the area gently to spread the medication
across the entire eye.

Note: Avoid touching the eye or the eyelid with tube.

Discard gloves and wash your hands.

Record results.
32
Medication Administration

Ear (Otic) Drops

Check the order form and pharmacy label. Read instructions carefully.

Be certain you know which ear(s) is to be treated (right, left, or both).

Assemble the necessary equipment.

Wash your hands.

Explain the procedures to the student.

Warm the medication to body temperature by holding it in your hands for several
minutes.

Ask the student to lie on one side with the ear to be treated facing upward or, if
sitting, to tilt the head away from the affected ear.
33
Medication Administration

Ear (Otic) Drops Continued

Clean the outer ear carefully and thoroughly with cotton.

Draw the medication into the dropper. To properly regulate dosage, draw only the
amount to be administered.

Gently, pull the cartilage part of the outer ear BACK AND UP. Place the
prescribed number of drops into the ear canal without touching the dropper to the
ear.

Advise the student to remain in the same position for a few minutes following to
avoid leakage of drops from the ear, and then cleanse the external ear with dry
cotton balls.

Wash your hands.

Record results.
34
Medication Administration

Topical Medications

Read the order form and pharmacy label. Follow instructions carefully.

Wash hands and apply gloves.

Apply small amount of cream to tips of gloved fingers or a Q-Tip.

Apply medicine to designated part of body.

Discard gloves and wash your hands.

Contact the delegating RN if you have questions or concerns.

Record the results.
35
1-800-222-1222
Like a Good
Neighbor, They’re
there when you
need them!
36
Infectious Agents
Some common infectious agents are:
 Bacteria
 Viruses
 Fungi
 Animal Parasites
Infectious Disease may occur by airborne
droplets, direct contact, & ingestion.

37
ANAPHYLAXIS
38
Anaphylaxis

Anaphylaxis is a serious life threatening emergency.
Students may have multiple allergies.

There are food allergies, environmental allergies, drug
allergies, & contact allergies (latex).

It occurs rapidly & can close off the breathing
passages. If instant treatment does not occur it can
be fatal.

Always notify the School Nurse if a student has any
sign or symptoms of anaphylaxis.
39
Anaphylaxis – Common Allergens
40
ANAPHYLAXISSIGNS/SYMPTOMS













TINGLING SENSATION IN THE MOUTH
SWELLING OF THE TONGUE AND THROAT
HIVES
VOMITING OR ABDOMINAL CRAMPS
WEAKNESS OR DIZZINESS
SHALLOW RESPIRATIONS
FEELINGS OF APPREHENSION
DIFFICULTY BREATHING
ITCHING
CHEST PAIN
DROP IN BLOOD PRESSURE
WHEEZING
LOSS OF CONSCIOUSNESS
41
FIRST AID FOR
ANAPHYLAXIS
ADMINISTER EPI-PEN—Students
who carry an Epi-Pen should keep it in
their purse or backpack at all times.
 Remember that there is little
downside to administering an Epi-Pen.
When in doubt—ADMINISTER.
Untreated reactions can be fatal.
 Activate EMS (call 911), call the
School Nurse and notify the
parent/guardian.

42
Epinephrine Auto-injectors: Epi-pen
43
Epinephrine Auto-injectors: Epi-pen
44
Epinephrine Auto-injector: Auvi-Q
45
Epinephrine Auto-injector: Auvi-Q
46
Epinephrine Auto-injector: Twinject



Twinject has two
dosages of epinephrine
in one injector
Only the first dosage is
an auto-injector
The second injection
must be administered by
the School Nurse or
qualified family member

0.15mg – green

0.3mg - blue
47
Epinephrine Auto-injector: Twinject
How to administer



Prepare & deliver the first dose
Step A
Pull off the GREEN end cap labeled "1." You will now see a rounded RED tip. Never put
your thumb, finger, or hand over the rounded tip.
Pull off the GREEN end cap labeled "2."
Step B
Put the rounded RED tip against the middle of the outer side of thigh (upper leg) as shown.
It can go through clothes.
Press down hard until the needle enters thigh (upper leg) through skin. Hold it in place
while slowly counting to 10.
Remove the Twinject from thigh.

Check the rounded RED tip. If the needle is exposed, dose was delivered. If the needle is
not visible, repeat FIRST DOSE Step B.

Get emergency medical help right away. Call 911.

It is very important to monitor symptoms closely after the first dose is given, including
watching for new symptoms. If new symptoms have appeared or symptoms have not
improved within about 10 minutes, a second dose is needed. The second dose can
only be administered by the School Nurse or qualified family member.
48
ASTHMA
Chronic lung disease, which is characterized
by attacks of breathing difficulty
 Caused by spasms of the muscles in the
walls of the air passages to the lungs.
 Asthma attacks may occur at any time.
 Rescue inhalers are prescribed to alleviate
symptoms and make breathing easier.

49
Asthma
50
Asthma Triggers
51
Asthma Attack

SIGNS/SYMPTOMS OF ASTHMA ATTACK
 wheezing
 tightness
or pain in the chest
 coughing constantly
 difficulty breathing
 shortness of breath
 little energy
52
Asthma Inhalers

Inhaler

Inhaler with spacer
53
Medication Administration










Asthma
Read the order form and pharmacy label and follow the instructions
carefully.
Wash your hands.
Assemble the inhaler properly; observe the student assemble if selfadministered.
Remind the student to keep the tongue flat in the mouth. Otherwise, the
medication will spray directly on the tongue.
Shake the cartridge to mix the medication.
Remove the cap and hold the inhaler upright.
Place the cartridge (with spacer if indicated) to the student’s lips and tell
the student to exhale through the nose.
Remind the student to exhale only enough to get the air out of the lungs
(so that the medication can get in. Forcing air out of the lungs will
collapse the airways even further).
Have the student press down firmly on the cartridge while taking a deep
breath.
54
Medication Administration












Asthma Continued
Tell the student to breathe slowly and deeply. Rapid or shallow breaths will not carry the
medication into the lungs.
Press the cartridge when the student starts to inhale. Timing is important. Do not press hard.
The dose is predetermined, so only one dose will be released, regardless of the pressure
applied.
Remove the inhaler and tell the student to hold his or her breath and count to 10. This will let
the medication settle on the surface of the airways and prevent the student from exhaling it
immediately.
Tell the student to exhale slowly with the lips pursed.
Have student rinse mouth.
After the treatment, clean the inhaler thoroughly by removing the metal canister, then rinsing
the plastic container under warm water and drying thoroughly.
Note: If the student takes more than one or a combination of medications by inhaler, there
must be directions to indicate which medication is taken in what order. Your delegating school
nurse should provide the directions.
Wash your hands.
Record results.
NOTE: Most students will be able to self-administer inhaler medicines with little to no
assistance from an adult.
The delegating RN will provide specific guidance to the medication assistant.
55
Common Side Effects of Asthma
Medications
Tremors
 Nervousness
 Irritability
 Dry mouth/throat
 Insomnia
 Headache
 Increased Heart Rate

56
FIRST AID FOR ASTHMA
If the student does not have an
inhaler on person, contact the School
Nurse.
 Help the student to sit in a relaxed
position, leaning forward with elbows
on knees.
 Talk reassuringly and calmly.

57
WHEN TO CALL 911 FOR
ASTHMA






If the student has used their rescue inhaler
and has had no improvement after 10-15
minutes.
The student does not have an inhaler and
you have been unable to contact a
parent/guardian or emergency contact.
Student is coughing constantly
Difficulty breathing with: chest and neck
pulled in with breathing, Stooped body
posture, Struggling or gasping
Trouble walking or talking
Lips or fingernails are grey or blue
58
ADHD & Anxiety Disorders







ADHD is treated with a number of
medications. Some common medications
used are:
Ritalin
Adderall
Vyvanse
Focalin
Concerta
Strattera
59
ADHD & Anxiety Disorders

Students in the school setting may be
faced with anxiety disorders & may
require medication.

Always remember ADHD & Anxiety
medications are controlled substances.
You MUST ALWAYS count the number
of tablets with the parent/guardian &
document it on the appropriate forms.
60
Diabetes

Type I Diabetes (Juvenile Onset) is a condition in which
the body cannot produce enough insulin. Insulin is the
key for the body to use sugars that are in the blood,
which is the result of food digestion. This provides
energy for all of our cells. Without insulin, high levels of
sugar build in the blood stream (hyperglycemia) and too
little sugar can get into the cells. Insulin is given to
correct high blood sugar and help to make sugar
available to the cells. Insulin is given based on a formula
of how much food will be eaten and the normal
activity. But, insulin can also cause all the sugar in the
bloodstream to be used up if for any reason the formula
did not work. When all the sugar is used up, no energy
is available for the cells and vital organs. This is called
an insulin reaction or hypoglycemia. Hypoglycemia can
be life threatening because the only energy source for
the brain is blood sugar.
61
Diabetes

Type II diabetes still produces insulin but the body
doesn't respond to it normally. Glucose is less able to
enter the cells and do its job of supplying energy (this is
called insulin resistance). This causes the blood sugar
level to rise, making the pancreas produce even more
insulin. Eventually, the pancreas can wear out from
working overtime to produce extra insulin and may no
longer be able to produce enough insulin to keep blood
sugar levels normal. People with insulin resistance may
or may not develop type 2 diabetes. It all depends on
whether the pancreas can produce enough insulin to
keep blood sugar levels normal. Repeatedly high blood
sugar levels are a sign that a person has developed
diabetes. Diet, exercise and the use of oral antidiabetic
medication (Glucophage, Glucotrol) is often used to
help lower the increased blood sugar level.
62
Hypoglycemia



Hypoglycemia – low blood sugar
Onset is sudden, and if not treated promptly can
become an emergency.
CALL SCHOOL NURSE if the nurse is unavailable
ALWAYS FOLLOW THE STUDENTS EMERGENCY
CARE PLAN!
63
Hypoglycemia
64
Hypoglycemia - Causes
 Too
much insulin (drug used to
control blood sugar)
 Eating less than usual
 Increased exercise or activity
 Illness
 Stress
65
HYPOGLYCEMIA
LOW blood sugar may cause:
MILD Symptoms
Hunger
Sweating
Shakiness Drowsiness
Weakness Paleness
Anxiety
Irritability
Personality Change
Inability to
concentrate
MODERATE
Headache Weakness
Confusion Blurred vision
Slurred speech
Behavior change
Poor coordination
SEVERE Symptoms
Loss of consciousness
Seizure
Inability to swallow
66
Hypoglycemia - Symptoms
67
Hypoglycemia – First Aid

Check blood sugar, if
not possible go
ahead and treat
 Treatment:
Blood sugar < 80
 When in doubt,
always treat for
HYPOGLYCEMIA!

Step 1: Give a fast acting
sugar: 4 glucose tabs OR 4
oz of juice OR 4 oz soda

Step 2: Retest blood sugar in
15 minutes. If BS < 80, repeat
Step 1 and retest blood sugar
in 15 minutes. If BS > 80, go
to Step 3

Step 3: Give a long acting
carbohydrate: 4 peanut butter
crackers OR 4 cheese
crackers
68
Hypoglycemia – When to call 911








EMERGENCY: CALL 911
Student is disoriented, combative, unable to
swallow, seizure activity, or unconscious
Squirt glucose gel in cheek and massage
If student has insulin pump, disconnect insulin
pump or turn pump off
Call School Nurse to administer glucagon per
orders
Place student on side (may vomit)
Monitor student until EMS arrives
Notify family emergency contact
69
Seizures
The term "seizure" refers to sudden,
uncontrolled episode of abnormal
behavior related to abnormal
electrical discharges in the brain.
 Only in rare cases do seizures require
emergency intervention.
 Most seizures are over in a few
minutes and do not need medical follow
up.

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Seizures
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Seizures - Symptoms
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FIRST AID FOR SEIZURE











Time the seizure
Do not restrain student or use force
Ease student to lying position, Turn on side (may vomit)
Protect student, Cushion head, Clear surrounding area
DO NOT put anything in student’s mouth
Loosen restrictive clothing
Talk softly and reassure student
Monitor breathing, Initiate CPR if indicated
Call the School Nurse: some students may have an order
for diastat, an ER medication for seizures that can only
be administered by the School Nurse
Allow seizure to end without interference
Notify family emergency contacts
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Seizures - CALL 911 IF……..





No history of
seizures
Seizure lasts
longer than 5
minutes
Multiple seizures
Difficulty
breathing
Sign of injury or
sickness
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Certification of a Medication
Assistant

To Complete the 12 hour Medication Assistant
course please go see the School Nurse

Take the 50 Question Medication Assistant
Test & Score 100


Complete a Skills Observation
Complete a School / Student Specific
Orientation
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Certification of a Medication
Assistant

To maintain certification





Yearly Review Of Skills
Yearly review of the Medication Curriculum
Yearly Review Of School / Student Specific Orientation
Medication Assistants are monitored on a continual basis
throughout the school year.
If you move schools within our system you may still serve as a
Medication Assistant at the New School
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Gratitude

Thank you from all of the School Nurses in Lawrence County for
your willingness to serve as a Medication Assistant.
Sherry McWhorter, R.N., Lead Nurse
o Tonya Burch, R.N., MES
o Amy Vaughan, L.P.N., MMS
Jane Carroll, R.N., LCHS, LCCT, JJLC, COPS
o Tammy Suski, L.P.N., ELES
o Benita Craig, R.N., ELMS, ELHS, LCDC
o Michelle Dotson, L.P.N., ELHS/Travel
o Lea Ann Garner, R.N., Hazelwood
o Mayme Hamilton, R.N., R.A.H.H
o Lynn Louallen, R.N. HES, HMS, HHS
o Stana Bolton, L.P.N., Mt. Hope/Travel
o Kim Sutton, L.P.N., Speake
o
o
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