Protocol for Medication Related Reactions, Medication Errors or Unusual Circumstances

The school or program must have an emergency protocol for that result in  medication-related reactions, medication errors, or unusual circumstances. 

Medication Reactions: are unwanted, negative or unexpected effects from taking a medication.

Unusual Circumstances: Situations might include when a medication is refused, vomited, not administered, not swallowed, spilled, or lost.

• 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.
• Refusal: 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.
• 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.
• 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 parents 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.
• 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.
• 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.

Medication Errors: Medication errors can occur anytime with human care. Once an error has occurred, the most dangerous thing for a child's well-being and safety is to ignore it or not tell someone. If an error does occur,  communicating and following the correct procedures can prevent serious problems from developing. Good people make mistakes and it is important to enhance knowledge and learn from errors. The school and program create a culture of safety by communicating errors when they happen, by being honest and transparent with parents, and providing an opportunity to learn from one another. 

Types of medication errors include:

• Administering medication to the wrong learner
• Administering medication at the wrong time
• Forgetting to administer medication
• Administering the wrong medication
• Administering the wrong dose
• Administering medication by using the wrong route  
• Incorrectly preparing the medication

Action steps for all situations:

• Observe the situation and remain calm.
• Communicate for all adverse reactions, errors or unusual circumstances. The five points to communication if an error occurs includes the 5 R’s:
  • Recognize the medication error and any adverse outcomes
  • Regret is shown by offering empathy
  • Responsibility is demonstrated by explaining how the event happened
  • Remedy is explained by providing next steps to correct and prevent another medication  error or reoccurrence
  • Remaining engaged with parents by communicating to build trust in your care of their children
• If contacting the Poison Control Center for instructions:
  • give the name and dose of the medication taken in error
  • give the student’s age and approximate weight, if possible
  • give the name and dose of any other medication the student receives, if possible
  • Follow instructions from the Poison Control Center, if possible.
    1. If unable to follow their instructions, explain the problem to the Poison Control Center to determine if the student should be transported for emergency care
• Notify the registered nurse, the school nurse supervisor, the authorized prescriber (if applicable), school or program leadership and the parent as soon as possible.
• Follow the nurse’s instructions to notify the child's health provider as appropriate if the nurse is not available.
• Follow any additional school or program procedure.
• Document the communication and situation in the medication administration record regarding the adverse reaction, unusual circumstance or error and in accordance with the school or program procedure. 
• Debrief with the school nurse.