Self-Administration of Medications Program



Self-Administration of Medications Program

The ultimate goal of Perkins School for the Blind is to allow and foster maximum independence by each student. The School strives to create an environment that promotes the practical application of academics, social skills and daily living skills. Self-medication is an important skill necessary for independent living. Perkins Health Services staff have developed a program that applies this philosophy in guiding students to achieve greater independence in attending to their medical needs, in particular, the self-administration of medications.

Medication administration is an important self-responsibility with implications, not only for the ability to live independently, but also for the person’s health and safety. For these reasons, decisions regarding a student’s readiness to self-administer will be made on a case-by-case basis taking into account the student’s health status, abilities, and knowledge of their medications. As we strive towards the goal of full self-administration, many students will require teaching, supervised practice and monitoring to achieve this goal. For those students who may not achieve this goal, the intent is to assist them to make strides towards active participation in the process of taking their medications to the fullest of their potential. For many students medication administration, as with other self-care skills, will continue to be a life-long learning process.

Team members involved in the decisions around self-administration include the parent(s)/guardian(s), program nurse, and involved program staff. Parents/guardians area asked to provide signed consent to participation in a self-administration of medication program. Consent is also obtained from the primary health care provider.

Program nurses together with other team members will assess the students to determine their level of understanding and skill utilizing the Self-Administration Assessment Tool. Based upon assessment results some students will demonstrate the potential for working towards full independence in self-administration of medications and other students will work on more basic functional skills level to learn simple steps towards a greater participation, but not full independence, in taking medications. Learning objectives and individualized teaching plans, that may include pre-requisite skills or actual medication pouring skills, will be developed based upon the results of the assessment. Where possible, the skills taught should be consistent with or complement skills being taught for other learning objectives.

Once pre-requisite skills have been mastered and the decision has been made that a student is capable of achieving independence in the self-administration of medications, the team will develop a medication administration plan that contains the elements necessary for safe self-administration and medication storage. The student may then begin a progressive process at their own pace of working through three phases leading to independence.

It is expected that the student will have ongoing discussions with team members who have been involved in this process of self-administration of medications. Students and staff need to understand that self-administration consists of important and complicated skills needed for independent living which have many health and safety concerns. Therefore, nurses, Coordinator/Assistant Coordinators of Residential Living (CRL/ACRL) and other involved team members need to be available to provide “spot checks” assistance and guidance as necessary to the student and will intervene rapidly when the student demonstrates unsafe practices. The intent is to help the student learn from the lapse, prevent errors and resume safe practice. When a student has pattern of using unsafe practices it require a reassessment of the student’s self-administration status and an increase in staff participation, supervision, monitoring and teaching to help the student avoid unsafe practice. Hopefully the increase in supports will be a temporary situation, but not necessarily. At no time will punitive or disciplinary actions be taken against a student who has struggled to be consistent in maintaining safe self-administration practice.

Phases of Self-Administration of Medication Teaching Program

Phase 1: Learning about the medications he/she is taking

Phase 2: Supervised self-administration of medications

Phase 3: Demonstration of independent self-administration skills

Phase 1: Learning about the medications he/she is taking

The program nurse will organize and implement the first phase. The student will meet with the program nurse on a regular basis to learn the following:

• The name of each medication

• The reason he/she takes each medication

• The frequency and specific times each medication needs to be taken

• The correct dosage (the strength of each pill and the number of pills) of each medication

• Identify each medication container visually or tactilely

• Store medications in a safe manner

• Prepare medications for self-administration in a safe manner

• The common side-effects

• Can indicate knowledge of PRN (as needed) medications, when, why (symptoms), and how to take the med, can identify the response to the PRN medication

• Can describe situations in which he/she needs to seek assistance from a staff member or a health care provider for questions or problems related to regular medications, PRN medications or changes in health status

The student must be able to demonstrate the above knowledge successfully on at least four separate occasions over a four week period in order to progress to phase 2.

Phase 2: Supervised self-administration of medications

The medication cleared ACRL,CRL under the direction of the program nurse will implement the second phase.

The objectives for completion of this phase are:

• The student will seek out the houseparent, without prompting, at the appropriate times for taking medications

• The student must organize his/her medications by using an approved system and pour out the proper dose successfully on a daily basis for at least one month.

Supervision during this phase will include:

• House parents will directly observe the student self-administration and documentation in the medication administration record (MAR).

• The program nurse will do initial and periodic observations of the student’s self-administration to monitor progress.

• The program nurse and other team members will provide consultation to the ACRL/CRL and students as necessary during this phase in order to problem solve areas of difficulty.

Phase 3: Demonstration of independent self-administration skills

In the third phase the student will demonstrate his/her ability to practice safe, accurate, timely and responsible self-administration of medications. Independent skills include:

• Consistent self-administration, requiring no more than infrequent reminders

• Pours and takes the correct medications at the correct times

• Safe medication storage

• Ability to place an order for medication refills at a pharmacy

• Appropriate use of PRN medications

• The ability to seek assistance from a responsible staff or health care provider when necessary

Procedures

For All students:

• Learning about medications and participation in medication administration will be part of a transition plan.

• Teaching will begin at the elementary age and level appropriate to the student and will continue throughout the school experience.

• Students will be assessed to determine the most appropriate teaching objectives and strategies around self-administration or other medication-related skills.

For Students Participating in a Self-Administration of Medication Teaching Program:

• Students with objectives for full self-administration will be selected based on the team’s agreement that the student has mastered pre-requisite skills and is ready to self-administer medications.

• Staff will provide ongoing teaching, supervision and monitoring.

• Students in self-administration programs will have an order to allow self-administration from their primary care provider and consent from the parent/guardian or where applicable, themselves.

• Students will be able to demonstrate knowledge of medications, both routine and PRN.

• Students will be able to take responsibility for obtaining medications from the pharmacy (pick-up in Health Services) and ordering refills, with decreasing need for staff assistance and supervision.

• Students will be able to administer their own medications on an ongoing and consistent basis with decreasing need for staff assistance and supervision until only periodic monitoring is necessary.

• When medication changes or problems around medications arise, the student will receive addition teaching and supports as warranted.

• Students will receive a certificate of accomplishment after completing each phase of the self-administration program.

Documentation and Storage of Medication Administration for Self-Administration Programs:

• Student documentation of self-administration will be determined on a case-by-case basis and will be based upon the student’s needs for daily documentation as a strategy for maintaining ongoing consistency.

• When a student is in a teaching phase of self-administration, the houseparent will put an S in the appropriate box on med sheet. If staff pour the medication, they will put their own initials in the box.

• Assistive devices or modifications such as use of Braille, large print or voice recorders will be used based upon need.

• Medication containers and systems will be determined by the team to best meet the needs of the individual student.

• During the initial teaching phases all medications will remain the locked medication closet.

• As the student moves through the phases of the program and is able to demonstrate responsibility with storage, medications will be locked in their rooms, initially on a week by week basis.

• Most students will learn to use the weekly pill boxes and will pre-pour their medications into them.

• Initially the boxes will be filled by the program nurse with the student observing and then students will assume responsibility with decreasing amounts of assistance and supervision.

Special Statutory Rights

Perkins School for the Blind follows the statutory requirements in permitting qualified students to self-administer medications.

Department of Public Health regulation 109.0/185226.1

Special rights for students the following medical conditions:

“No school district shall prohibit students with asthma or other respiratory diseases from possessing and administering prescription inhalers in accordance with Department of Public Health regulations concerning students’ self-administration of prescription medications.

No school district shall prohibit students with cystic fibrosis from possessing and administering prescription enzyme supplements in accordance with Department of Public Health regulations concerning students’ self-administration of prescription medications.

A school district shall not prohibit a student with diabetes from possessing and administering a glucose monitoring test and insulin delivery system, in accordance with Department of Public Health regulations concerning students’ self-administration of prescription medications.“

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