Articles Posted in Medications in Schools

A grand jury in Kern County, California recently asked an emergency juvenile shelter to report on how its staff handles prescription and over-the-counter medications for children that are sheltered there. It also called on the county’s Department of Human Services to make a registered nurse available at the shelter 24 hours a day. The grand jury’s actions came after news of medication errors appeared, along with allegations that the shelter is violating state regulations by having staff members provide medications to children without oversight by medical professionals. The dispute has also sparked a debate over semantic issues of who may “dispense” medications.

The A. Miriam Jamison Children’s Center is a 24-hour emergency shelter for “abused, neglected and exploited children” operated by the Kern County Department of Human Services. It provides temporary shelter for children in the protective custody of law enforcement or social services. Over the past year, news of several errors in providing medications to children at the shelter reached the director of the Department of Human Services. Errors have included incorrect doses of medications and incorrect medications. No serious injuries have been reported, but the risk of injury is certainly present. Children have had to go to Kern Medical Center (KMC) because of medication errors at least twice.

After officials put an employee on administrative leave for a medication error, some shelter employees began to refuse to handle medications for children. The Service Employees’ International Union (SEIU) also stepped in, arguing that employees who were not registered nurses could not legally give medications to children under state nursing regulations. Additionally, the shelter reportedly has an agreement with KMC, which sends nurses to the shelter for children’s medical issues, that shelter employees will not deal with children’s medications.

The grand jury’s investigation centers around state regulations and the shelter’s agreement with KMC, but it has also sparked a debate over exactly what activities by shelter staff are prohibited. State law says that only registered nurses may “dispense” or “administer” medications. Pharmacists “dispense” medications by counting and packing pills. Nurses “administer” medications by giving doses directly to patients. The Department of Human Services argues that shelter employees do not do either of these, but rather “deliver” medications to children by taking them from a labeled container, following the container’s directions, and giving them to the children to take.

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The Philadelphia School District laid off 141 employees at the end of 2011, including forty-seven school nurses. Schools across the country, facing budget shortfalls, are turning to layoffs. Many schools now have no full-time nurses, relying instead on other staff, including coaches and teacher’s aides, to dispense medications to students during the school day. Nurses, teachers, and others have complained that this puts students at greater risk of injury due to medication errors. School nurses deal with more than just scraped knees. Many students require careful administration of medications for asthma, diabetes, seizure disorders, attention deficit disorder, and more.

The district’s largest union, the Philadelphia Federation of Teachers (PFT), filed a formal complaint at the end of January, alleging that the use of non-nurse staff to dispense medications to students violates state law. Some nurses, the PFT says, must cover multiple schools, meaning that students have long wait periods for functions schools are required to perform under the Department of Health’s Guidelines for Pennsylvania Schools for Administration of Medications and Emergency Care. Staff members who do not have training and certification in nursing do not always know what sort of care students need, and they are more likely to make mistakes.

The Philadelphia Inquirer has run a series of stories about the risks students face with limited nursing staff available in schools. Accounts of errors range from missed dosages of medicine to accidental administration of the wrong medication. In several instances, staff members confused the drug methyphenidate, the generic name for the ADD drug Ritalin, with the narcotic pain medication methadone. The two drugs have similar names, but very different purposes and effects.

According to the Inquirer, research has suggested that use by schools of “unlicensed assistive personnel” (UAP’s), meaning staff members who are not licensed nurses, makes medication errors three times more likely than when a nurse is available. Schools also take an increasingly active role in medical care for students, as more and more children receive treatment for diabetes and other chronic illnesses, and more students report problems with food allergies. A study from the University of Iowa cited by the Inquirer found that 5.6 percent of children in the surveyed schools received medications in school on a daily basis, with 3.3 percent receiving ADD medications. Nearly half of the nurses reported encountering medication errors. The most common error was missing a dosage that a student should have gotten, but nurses also encountered children receiving someone else’s medication and staff administering medications incorrectly (such as ear drops going in the eye). Most of these errors involved UAP’s.

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As our attorneys reported in a recent Rockville, Maryland pharmacy misfill blog post, according to the National Consumers League (NCL), around three out of four consumers in this country admit they don’t take their prescription drug medication as directed—causing an increase in medication error and injury that has a huge impact on patients and the healthcare industry.

To combat medication error, the NCL has launched a national multi-media medication adherence campaign this month with the Agency for Healthcare Research and Quality (AHRQ), that will aim to raise patient awareness on the importance of taking medication as directed.

According to the NCL, when consumers fail to take medications as instructed by their healthcare professionals, it creates a problem that impacts not only the patient, but the caregivers, employers, researchers, health care practitioners, and tax payers as well. Nonadherence to prescribed medications can also result in injury or death.

Research presented by the league shows that one in three prescriptions never get filled, with 1/3 and 2/3 of hospital admissions linked to medication errors that stem from poor drug adherence. The total cost for nonadherence leads to a reported $300 billion a year.

The campaign will strive to enhance patient safety and improve the healthcare system, encourage health practitioners to properly and effectively communicate the importance of prescription medication adherence to patients, and raise awareness of the problem through public education and a national campaign.

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In recent pharmacy injury news, that our Baltimore, Maryland attorneys at Lebowitz and Mzhen Personal Injury Lawyers have been interested in, the U.S. Drug Enforcement Agency (DEA) recently held a nationwide prescription drug “take-back” day. The event was designed to curb health hazards and medication errors that can occur when people hold on to expired medications or throw away unwanted drugs.

According to the DEA, prescription drugs in home medicine cabinets are at great risk for misuse, abuse and theft, as reports show that a large majority of prescription medication errors and abuse come from the drug cabinets of friends and families. The initiative was also striving to combat drug abuse with kids, who are reportedly finding old unused drugs in homes, and bringing them to school, or parties to get high—resulting in tragic drug error injury.

Last week in a medication error in Washington State, nine teenagers were hospitalized after taking prescription medications that were found in homes and passed around at a school bus stop. The kids reportedly took painkillers and anti-depressants. In another case in Philadelphia, an 18-year old accidentally overdosed on a pain reliever medication found at home.

The DEA initiative set up around 4,000 “take-back” drop off sites across the country to encourage people to drop off drugs, where no questions were asked. People were encouraged to either remove the medication labels or to cross out personal information before dropping the drugs at the site.

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As the parent of children in elementary school, I recently received a call from the school nurse who reported that one of my kids was sick. I was impressed with the professionalism and competence shown by the school nurse.

When I was in the nurse’s office, with children as young as age 5, I noticed how careful school nurses must be to make sure that these young children receive only the appropriate medicines. The nurses must make their decisions based upon their knowledge, training and experience, and must carefully consider the prior authorizations and advice given by the parents who might have anticipated school house illnesses of their children.

The Maryland State Department of Education has adopted policies regarding the role of school nurses as developed by the American Academy of Pediatrics (“AAP”).

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