The Relentless School Nurse: A Collaborative Approach to Safe School Medication Management

Ensuring that students can properly take their prescribed medications while at school is crucial for managing chronic health conditions and avoiding disruptive absenteeism. However, navigating the complex web of school policies, personnel, and procedures around medication administration can be challenging. The American Academy of Pediatrics (AAP) has issued new guidance to help pediatricians, school nurses, school staff, and policymakers promote safe and equitable medication ordering, storage, and administration for students. The updated policy statement emphasizes the need for robust collaboration between all stakeholders involved in student health.

The School Health Team

At the center of the school medication process is the school health team, which includes the student, parents/guardians, school nurses, unlicensed assistive personnel (UAP) like teachers or aides, school-based health center staff, and community prescribers like pediatricians. School nurses play a vital role, serving as the bridge between the education and healthcare worlds. They develop individualized health plans, train staff on medication administration, and monitor students for side effects and treatment effectiveness.

However, school nurse staffing varies widely across the country. This underscores the importance of clear communication and collaboration between all members of the school health team, including community prescribers.

Writing Clear Medication Orders

Prescribers must provide detailed, written instructions on medications, dosages, routes, and timing for school administration. Avoiding PRN or “as needed” orders that require clinical judgment is crucial, as UAPs cannot make those decisions. It’s also critical for prescribers to understand the school’s policies on medication delegation. Some schools allow nurses to assign certain medication administration tasks to Licensed Practical Nurses (LPNs), Licensed Vocational Nurses (LVNs), or UAPs under their supervision. Prescribers should learn which staff can administer different medications.

Engaging Families and Students

Prescribers should discuss any logistical or social challenges families face in adhering to medication regimens at home. They should provide education on the importance of controller and rescue medications for conditions like asthma. Additionally, assessing whether students are developmentally able to self-carry and self-administer medications at school with proper training is important. Respecting applicable privacy laws while fostering students’ growing autonomy in managing their health needs is also essential.

Advocating for Resources

The policy statement encourages prescribers to advocate for adequate school health staffing, supplies like stock emergency medications, and standardized medication order forms and procedures. They should work with state agencies and school boards to promote evidence-based best practices around medication safety. Supporting efforts to apply an equity lens, ensuring students can access needed medications regardless of socioeconomic status or disability, is crucial.

Evolving Challenges

As new therapeutic products emerge, such as cannabis derivatives, school health teams will need guidance on developing administration policies through the same safety lens used for all medications. The AAP opposes unregulated “medical marijuana” but recognizes that FDA-approved cannabinoid medications may be prescribed. Explicit policies on proper prescriber orders, storage, and staff training would be needed for any state-approved, non-FDA-regulated cannabis product administered at school.

Key Actions for Pediatricians

By understanding school resources, policies, and personnel, pediatricians can collaborate effectively with school health teams. This open communication, along with clear orders and advocacy for staffing and training, is key to ensuring the safe and equitable administration of medications so all students can thrive. Here are some specific actions pediatricians can take:

1. Engage School Nurses and Staff:

   • Pediatricians should contact the school nurse to discuss the child’s health needs and ensure medications are administered properly.
   • Developing a medication administration plan that includes dosages, timing, and specific instructions for use during school hours is essential.

2. Education and Training:

   • Educating parents and students on the importance of medication adherence and proper usage techniques is crucial.
   • Providing training for students who are developmentally able to self-administer their medications is important.

3. Regular Communication:

   • Maintaining regular communication with the school nurse to monitor the effectiveness of the medication plan and make adjustments as needed is vital.
   • Pediatricians should schedule follow-up appointments to review the child’s medication adherence and overall health status.

4. Advocacy:

   • Advocating for policies that ensure adequate staffing and resources for school health teams is necessary.
   • Supporting initiatives that promote equity in medication access and administration for all students, regardless of their background or socioeconomic status, is essential.

5. Policy Compliance:

   • Staying informed about local and state policies regarding medication administration in schools is important.
   • Ensuring all medication orders comply with these policies and providing clear, detailed instructions for school staff is crucial.

By taking these proactive steps, pediatricians can help create a safe and supportive environment for students to manage their health conditions effectively while at school. The updated AAP policy statement serves as a comprehensive guide to achieving this goal, emphasizing the importance of collaboration, clear communication, and ongoing advocacy in promoting student health and well-being.

References:

AAP News: Policy outlines steps to take when students need medicine at school