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Medications
In School
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The numbers and types
of prescription and non-prescription medications administered at school
were identified in a one-week survey conducted during two winter months
in 36 public and six private elementary, secondary and two special schools
in one Florida county. Typically, school nurses did not administer medications
other than in the special schools, so the types of school personnel handling
medications were also identified.
Of 28,000 students, 931 (3.5%) in public school and 84 (4.2%) in private
school received 5,411 recorded doses of medications from persons assigned
by campus principals. Another 140 students had medications for PRN use,
e.g., bronchodilators. Not surprisingly, in the two special schools, 20%
of the developmentally delayed and 56% of the students with emotional/behavioral
problems received medications, chiefly Ritalin, anti-convulsants and anti-hypertensives
(usually clonidine).
Boys were 2.5 times more likely than girls to take medication at school
. There were no differences based on student ethnicity (White or African-American)
or economic status, i.e., free or reduced lunch rates.
The most frequently administered medication was methylphenidate (Ritalin),
accounting for 54% of the medications. In public elementary schools, Ritalin
represented 66% of the doses. Three percent of the public elementary school
population received Ritalin. An unknown number of students received medication
outside of school or received other types of medication , e.g., a different
CNS stimulant or clonidine for ADHD.
Bronchodilators were the second most common type of medication given (
9% in public schools compared to 4.6% in private schools). Analgesics
were the second most common in private schools, representing 15% of all
medications as compared to 7% in public schools.
The researchers noted that several staff who administered medications
did not know the actual product name ; they recorded manufacturer or distributor
names. This generated a safety concern - if staff do not know what they
are giving students, they are less likely to know side effects or to securely
store controlled substances. The authors advised that assistants directly
trained by the school nurse would be safer than office staff.
(Francis E et al. J Sch Health 1996; 66: 355-358)
Comment: A similar survey in your
schools may find differences among schools and provide a useful profile
of medicine use and handling. States' nursing practice acts vary with
respect to RN delegation and supervision of medication administration
by unlicensed personnel. Some believe that the RN cannot be accountable
for errors if the person giving medication reports to the principal; others
believe the RN must assure competency and report unsafe practices. - J.O.
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