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Medications
Since many students with multiple disabilities take multiple medications, there are not specific medications for them to take. Here are some suggestions on how to administer medications in school:
Many students with exceptionalities, particularly those with developmental disabilities or emotional or behavior disorders (EBD), take medication to help them function. Drug therapy is generally intended to complement other interventions to improve a child’s quality of life.
Use of such medications has grown significantly over the last 20 years; for example, approximately 75 percent of children with EBD now take prescribed medication, making it the most common EBD intervention. There are too many on the market to name, but popular drugs include Ritalin and Strattera for attention deficit and hyperactivity disorder (ADHD); Prozac to treat depression; Anafranil to treat obsessive-compulsive disorder; and Risperdal to treat aggressive behavior associated with autism.
What starts as a family decision becomes a school responsibility when a child needs to take medication regularly at school, which nearly 6 percent of all school-age students do, according to a 2000 study published in the Journal of School Health. Some drugs have short half-lives and require administration throughout the day. Under the Americans with Disabilities Act (ADA) and the Individuals with Disabilities Education Act (IDEA), schools are obligated to accommodate children and youth with disabilities, which includes administering medicine prescribed to manage their conditions.
This job usually falls to the school nurse, but in times of staff shortages, personal absences, or emergencies, special educators may become the second line of defense. It is not uncommon for several schools to share a nurse, who is therefore only present in a given school one or two days a week. In its position statement on medication administration in schools, the National Association of School Nurses confirms that school nurses are increasingly required to delegate these duties to unlicensed assistive personnel, i.e., teachers, administrative assistants, and aides.
It is therefore critical that all teachers, special educators in particular, have sufficient knowledge of their students’ medications and the best practices for administering them. Yet, many special educators feel unprepared to handle these responsibilities. Following proper guidelines will help teachers deliver medication with greater confidence and, more importantly, ensure that children with disabilities—and all students—safely receive the treatment they need.
Establishing School Policies
Staff Training
Preparing to Dispense Medication at School
When a student begins taking medication, either short- or long-term, his or her parent should provide the school with the following:
These actions should be taken even if the medication requires no mid-day dose; the school should be made aware of side effects and drug interactions and should be prepared to step in if the morning dose is missed at home.
The same rules apply when a child is deemed responsible enough to self-administer medication, whether it be over-the-counter or prescribed. Students with asthma or diabetes, for example, may be permitted to carry inhalers or blood sugar testing kits.
Remember to use discretion when asking or reminding students about taking their medication, so as not to embarrass them or discourage them from taking it.
Preventing Errors
In a recent large survey of school nurses, 50 percent of respondents reported at least one medication error in the prior school year. Such errors can include overdoses, skipped doses, and medication given without authorization or to the wrong student. While everybody makes mistakes, they can be avoided. (Ideally, liability coverage is provided to all school staff.)
The best systems are designed to prevent error by reducing a school’s reliance on individuals’ memory and vigilance and fostering the best possible outcomes for students.
Communicating with Parents
Many students with exceptionalities, particularly those with developmental disabilities or emotional or behavior disorders (EBD), take medication to help them function. Drug therapy is generally intended to complement other interventions to improve a child’s quality of life.
Use of such medications has grown significantly over the last 20 years; for example, approximately 75 percent of children with EBD now take prescribed medication, making it the most common EBD intervention. There are too many on the market to name, but popular drugs include Ritalin and Strattera for attention deficit and hyperactivity disorder (ADHD); Prozac to treat depression; Anafranil to treat obsessive-compulsive disorder; and Risperdal to treat aggressive behavior associated with autism.
What starts as a family decision becomes a school responsibility when a child needs to take medication regularly at school, which nearly 6 percent of all school-age students do, according to a 2000 study published in the Journal of School Health. Some drugs have short half-lives and require administration throughout the day. Under the Americans with Disabilities Act (ADA) and the Individuals with Disabilities Education Act (IDEA), schools are obligated to accommodate children and youth with disabilities, which includes administering medicine prescribed to manage their conditions.
This job usually falls to the school nurse, but in times of staff shortages, personal absences, or emergencies, special educators may become the second line of defense. It is not uncommon for several schools to share a nurse, who is therefore only present in a given school one or two days a week. In its position statement on medication administration in schools, the National Association of School Nurses confirms that school nurses are increasingly required to delegate these duties to unlicensed assistive personnel, i.e., teachers, administrative assistants, and aides.
It is therefore critical that all teachers, special educators in particular, have sufficient knowledge of their students’ medications and the best practices for administering them. Yet, many special educators feel unprepared to handle these responsibilities. Following proper guidelines will help teachers deliver medication with greater confidence and, more importantly, ensure that children with disabilities—and all students—safely receive the treatment they need.
Establishing School Policies
- Policies for administering medications in the school setting vary by state and even by district in terms of procedures enforced and the staff training required. According to the Center for Health and Health Care in Schools in Washington, DC, 64 percent of states and 94 percent of school districts have formal requirements. CEC’s own professional standards, the sixth edition of which will soon be published, state that special education professionals may administer medication where state/provincial policies do not preclude such action and only when they are qualified and properly trained to do so.
- With or with state-level guidance, every school needs to have a clear accountability policy in place that indicates the primary staff member responsible for dispensing medicine onsite; who should serve as back-up in the case of that person’s absence; procedures for reporting and managing errors; and procedures for handling medications on field trips and other outings in beyond the regular school day.
Staff Training
- Giving a child a pill to swallow may seem simple enough, but delivering medication to students with exceptionalities can be more involved, which is why teachers and support staff should receive proper health training. Some medications are not taken orally; for example, adrenaline pens to treat anaphylactic shock must be injected into the skin.
- Training courses can teach non-medical personnel about safe nursing practices, applicable state laws and regulations, how to monitor responses to medication, and more. In best-case scenarios, teachers receive this pharmacological training while obtaining their degree. But there are also professional development seminars available, which can range from a two-hour session covering the basics to more intense weekend-long courses. State requirements may vary based on whether a teacher works with mild, moderate, or severe disabilities.
Preparing to Dispense Medication at School
When a student begins taking medication, either short- or long-term, his or her parent should provide the school with the following:
- A signed parental consent form.
- The medication in its original labeled container.
- The name and contact information of the prescribing health care provider.
- The prescribed dose and administration time(s).
- Which behaviors or symptoms the medicine targets.
- The anticipated results of treatment.
- The potential side effects (these can range from drowsiness to loss of appetite to irritability to stomach aches).
- Instructions for storage (e.g., refrigeration) and proper disposal.
- What to do in case of overdose or other emergency.
These actions should be taken even if the medication requires no mid-day dose; the school should be made aware of side effects and drug interactions and should be prepared to step in if the morning dose is missed at home.
The same rules apply when a child is deemed responsible enough to self-administer medication, whether it be over-the-counter or prescribed. Students with asthma or diabetes, for example, may be permitted to carry inhalers or blood sugar testing kits.
Remember to use discretion when asking or reminding students about taking their medication, so as not to embarrass them or discourage them from taking it.
Preventing Errors
In a recent large survey of school nurses, 50 percent of respondents reported at least one medication error in the prior school year. Such errors can include overdoses, skipped doses, and medication given without authorization or to the wrong student. While everybody makes mistakes, they can be avoided. (Ideally, liability coverage is provided to all school staff.)
The best systems are designed to prevent error by reducing a school’s reliance on individuals’ memory and vigilance and fostering the best possible outcomes for students.
- Provide a secure (locked) cabinet or refrigerator for all children’s medication. According to the Center for Health and Health Care in Schools, only three-fourths of schools have a locked medical supply cabinet and only slightly more than half have a refrigerator devoted to health services.
- Restrict the number of staff members allowed to administer to only a few qualified people.
- Maintain a central, preferably electronic, log for recording the details each time medicine is administered.
- Tape a photograph of the child on each prescription bottle to make certain it is never accidentally given to someone else.
Communicating with Parents
- As with most aspects of education, communicating with parents is crucial. Because special educators interact with their students for so many hours a day, they are in a unique position to observe and monitor the physical, behavior, and academic effects of prescribed medications that parents are less likely to witness. Teachers may even be called upon to correspond with a prescribing physician. Indeed, parents, physicians, and educators can collaborate on an interdisciplinary and multi-faceted approach to treating disabilities.
- If the medication is new, has the child’s condition improved? If the dosage has recently been adjusted, has he or she responded as expected? Teachers may even determine optimal times for instruction, based on a child’s peak-and-valley reactions to his or her medication. Teachers may also be the first to notice signs that a student has outgrown his or her treatment, as well as when a child is abusing prescribed medicine.
- But keep in mind that a teacher’s role in these situations is still to be objective: leave medical decisions to physicians, just as they leave educational decisions to you. Even if you have had thorough pharmacological training, resist the urge to provide anything beyond anecdotal information.