1. Online Medication Administration Management Technology to Support Student Safety Presented by Vicki Taliaferro RN, BSN, NSNC Peggy McCarthy MBA Carol Damm MA
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9. Examining the Data Collected Quality Assurance General categories of failure to administer meds as scheduled n=646 events %
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11. Examining the Data Collected Trend Data Medication dosage formulations by category as scheduled by School Nurses n=158 formulations (type of medication and dose)
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13. Examining the Data Collected Trend Data n=111 Study participants by Job Title Job Title No. of Non-licensed Admin. Assistant 3 Asst. Principal 1 Asst. Teacher 1 Clerical Asst. 13 Health Aide 18 Principal 3 Secretary 23 Teacher 6 Other 6 Unknown 37
14. Examining the Data Collected Staff Development Needs Study participant certification attempts of educational training n=452
15. Examining the Data Collected Staff Development Needs Study participant certification attempts of clinical training n=535
16. Examining the Data Collected Staff Development Needs General categories of failure to administer and document medications as scheduled n=646 events %
One of the advantages of this program is the not only the documentation feature, but the data that is collected. Some examples of the way in which the data can be used include: QA – How many errors are being made and what are the implications of those errors? Trend Data – just what meds are being administered and by whom? What’s the implication for the program? SDN – Based on the data, what additional SDN are identified? More training in the clinical or educational components? Marketing – how can you use the data to market the importance of what school nurses provide?
A major reason for failure to administer meds was technical error. Often the PDA was simply not turned on by the SN/PA/UAP or, in a few cases, a phone signal was not available. This latter problem was solved by replacing the phones with those from a different provider. One district’s problem was solved by providing PDAs using an alternative data transfer service. These results speak to a need for more training for how to use the device to document and the next iteration of MedsRight program will address those needs. But as a nurse/nursing supervisor – it would indicate a need to address participants comfort and knowledge of technology tools. Examining the Data Collected
Need to stress that the clinical return demonstration is essential in the training. In this particular study, the amount of school nurses who reported using the clinical demonstration tool was less than expected. Begs further examination – did they neglect to record the use of the tool, did they not perform it? Were there time constraints to the study? In future iterations of the program, MedsRight will require the completion of the return demonstration and its documentation before a certifcation of “complete” will be issued.
OK so now let’s examine some of the reports from the study – we’ll look at the actual data gathered from the study and its implications, but also how a report such as this might assist you in your programs. Let’s examine failure to give medications. This report indicates the major reason for failure to administer meds was student error . Often students were unavailable for various reasons. Many medications were administered late or the staff person claimed timely administration but failure to document at the time of administration. Obviously the goal here is that medication is administered correctly 100% of the time. If this was a report you received for your program what might be the implications? These results speak to the need to examine other issues. Are students forgetting to come down to the health office for their meds? How can that be addressed? No meds available – what steps can the nurse take to ensure that that doesn’t continue to be a barrier? Examining the Data Collected
Of the medications scheduled, nearly 40% were administered and documented correctly using the PDA; over 60% medications were either administered incorrectly or not at all. Implications here are to further examine why the majority of meds were not administered correctly. Again is it technical or more serious issues?
Let’s look at this report. Clarify definition - formulation brand plus dose. What are your general observations? Reports can address a variety of issues. One observation: A significant amount of ADHD medication was given. Given that the amount of ADHD medication given at school has supposedly decreased with the introduction of SR meds such as Concerta – this stat surprised me. Why are these schools receiving orders for medication for ADHD to be given at school? Physician’s preference? Parent’s preference? Cost of the drug? It would indicate to me as a supervisor or school nurse that further investigation might need to take place. Another observation: Mental health meds lower than anticipated. Another assumption one may have is that we are seeing more psychotropic drugs given at school. Yet the data here might indicate that is not the case. Remember though, that we don’t have any stats to compare it to. Could it be more than the last several months, than last year’s? The value of collecting the data is that you can validate assumptions and watch for trends. Lesson learned: In the next version of the program, the medication names and dosages will be in dropdown menus for ease in inputting the names and for accuracy to avoid misspellings and incomplete information. Examining the Data Collected
This report indicates that the majority of meds were administered by unlicensed school staff. Following this data to establish a trend in who is administering medication will be interesting – will school nurses continue to take this task on or will more UAPs be assigned this task? Does the number of SNs administering meds change when the number of SNs increases or decreases? Do the numbers reflect SNs comfort level with delegation? While this slide represents our study participants and is skewed by the fact that this participants opted to delegate meds – this type of report for your individual school district would be helpful in just establishing clearly who is administering meds. It may validate what you believe is happening in the field, but may surprise you.
Who is administering medications by job title? This report indicates in our study the breakdown of staff. As one might suspect – it is the secretaries that were the largest group of UAPs selected to take on the task of the medication administration, followed closely by health aides and clerical assistants. Will this change over time? Examining the Data Collected
This data allows the school nurse or supervisor to examine how well UAPs are absorbing the information. If a particular area of the training is not being passed without several trials i.e. ADHD it may indicate a need for additional training in this category – perhaps a separate training just on this category. It would also be important to take a second look at those UAPs who took several attempts to pass – are there other barriers such as reading handicaps, English speaking needs, fear of tests. It may indicate a need to be especially diligent in the return demonstration component of the training and perhaps indicate a need to do more frequent observations of these UAPs initially.
This report reflects the clinical training component of the study. Again, I would look to who was not passing and evaluate if it was lack of comprehension or other issues that caused the failure. Cite the one participant who indicated she learns slower… Another observation, diabetes management was done by a large number of the participants almost equal to oral medications. It also appears to take the majority longer to absorb the information – not too surprising.
Let’s look at this data report again. Reports from participants indicated that students did not receive medications for a variety of reasons - they were dismissed, absent, couldn’t find, self-administered, observed, moved, came late. Once the data has been evaluated, staff training needs can be established. If this was a report that you received form your school/district it would indicate perhaps more instruction on how to handle a situation where a student doesn’t show up for meds or if meds are not sent in. Does it need to be addressed in policy as well? What we know about these specific results from the study is that absences were not reflected. Lesson learned: In future versions we’ll insert a pull down menu to offer further clarification.
So how can this data assist with demonstrating the value of the school nurse/school nurse program? Size: It can promote the fact that SNs are either administering or have oversight of the medication administration program. How many meds are administered? Quality: Emphasis the quality of the training the UAPs are receiving. The fact that errors are being monitored. Significance: What kinds of meds are being administered? Who’s administering? SHARE THE DATA!
Examining the Data Collected
Add solutions underneath Medication administration documentation can be a hit or miss task at schools. Examining the Data Collected
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