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Date_________________
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there has been clarification regarding medication. Clarification should be sought according to school policy (e.g., contact the Licensed School Nurse/Registered Nurse. Wash hands. Put on gloves. Identify the student to receive the medicine. Call the student by name and check with picture ID if available. Explain to the student you are giving his/her medication for that specific time. Know what the student is taking the medication for. Ask the student about any side effects of the medication. Tell the student the name of medication and its purpose when you give the mediation to him/her. Obtain medication cup using separate cup for each student. a. If a pill or capsule, pour the correct amount of medication from the medication bottle to the cap of the bottle. Then place the pill or capsule from the cap into a medication cup. OR b. If the medication is liquid pour the correct amount of liquid medication from the medication bottle directly into a measured medication cup or dropper. Hand or give medication to student. Be certain the medication was taken. Check medication label and
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return container to secure storage area. Dismiss the student to class or appropriate school activity. Documentation & Communication: Document in ink. Document appropriately for the specific hour and date. This indicates you have given the medication for that time. ***If medication has varying or range of amounts that might be given record the amount administered. Write initials, full name, and title in space provided for signatures. Return equipment to storage area. Wash hands before contact with another student. Report any problems or concerns to the school nurse. Note: If a dose of mediation is missed for any reason, documents the time & date of the dose missed, documents the reason for the missed dose on the medication administration sheet, notifies the Licensed School Nurse/Registered Nurse of the missed medication and the reason (e.g., the medication was unavailable, etc) as they will need to notify the parent/legal guardian. Long fingernails may interfere with or make it difficult to administer medications properly and interfere with cleanliness. Additional comments:
Evaluation results (check and provide information as appropriate): Successfully completed skill checklist: ____ Needs to review and repeat: ____ Areas that need review:
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Date of next review: ____________________________ School Staff Signature______________________________________________ School Nurse/Trainer Signature_______________________________________
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