Procedure for Unusual Circumstance, Medication Action or Omission

Table of Contents

The school nurse should have procedures for situations where medication is not administered. Other situations might include when a medication is refused, vomited, not administered, not swallowed, spilled, or lost. This should also include a procedure for a medication action that falls outside of safe medication administration. School nurses who delegate medication administration maintain accountability, have the ability to communicate with qualified school personnel and must supervise, monitor and evaluate delegated tasks for safety.

The following four general action steps for all situations includes the delegatee agreeing to:

  1. Observe the situation and remain calm.
  2. Notify the registered nurse, the school nurse supervisor, the authorized prescriber and the parent as soon as possible for all unusual circumstances, errors or omissions.
  3. Understands what are examples of an unusual circumstance:
    1. Vomiting: Notify the nurse or nurse supervisor. Include the student’s name, age, medication, dosage, time lapse since medication administration and vomiting, and if the medication was visible or intact in the vomitus. Notify the student’s parent and healthcare provider if instructed to do so by the nurse, document the circumstances in the medication record or incident form. If the medication is in whole form in the vomitus and you are directed to give the child an additional dose, then it is not an incident and complete medication administration record to reflect the disposal of the wasted dose.
    2. Refusal: Qualified personnel should notify the nurse or nurse supervisor. Notify the student’s parent if instructed to do so by the nurse, document the refusal in the medication administration record and incident form, if available. If the student does not report to the designated area to take medication, find the student and request that the student report to the area. If the student does not then come to the area or refuses to take medication, report to the nurse, school administration, or nurse supervisor. Describe the circumstances. Notify the student’s parent and healthcare provider if instructed to do so by the nurse.
    3. Not administered (omission): For medications that are not administered during their designated time when the student is at school, file a medication error report for the omission and carefully document in the medication administration record. Parents should be notified. It is not a medication error if there is a lack of supply of medication provided by the parent, or a medication is held by a parent.
    4. Not Swallowed: If a student has difficulty swallowing medication, personnel can retry by giving one medication at a time with adequate fluids and different technique, such as: placing the medicine on the back of the tongue, giving medications in a small amount of food or crushed (only if directed by the pharmacist/label). Report to the nurse or nurse supervisor, and describe the circumstances. Notify the student’s parent if instructed to do so by the nurse. Document the circumstances in the medication administration record and complete an incident form, if available. If the student is unable to swallow the medication or tolerate the medication, follow the steps above and complete documentation of circumstance on the medication record.
    5. Spilled: Report to the nurse. Describe the circumstances. Notify the student’s parent or healthcare provider if instructed to do so by the nurse. Document the incident in the medication administration record. Complete a medication incident report, if available.
    6. Unaccounted Medication: Report to the school nurse and school administration immediately. School administration may choose to file a report with law enforcement for potential, diverted controlled substances or other medications.
  4. Follow the nurse’s instructions to notify the administrator, parent and health provider as appropriate if the nurse is not available.
  5. Follow any additional school or program procedure.
  6. Document the situation in the medication administration record, incident report, if available, or medication error report.