Hillcrest Educational Centers does not allow students to self-administer medication.
1. After the doctor’s order has been reviewed/ verified by the head nurse and consent from parent/guardian has been obtained, the prescribed medication shall be ordered and obtained from the Lenox Integrative Pharmacy. Doctor’s orders may be written, verbal or electronic. They must be complete and include the name of the medication, strength and time to be given. Any questions regarding this information should be clarified with the physician. Standing orders for particular medical conditions are included in the policy and procedures. They are periodically reviewed and approved by the agency Medical Director. Administration of these medications will also follow the guidelines stated below.
2. Medication must be purchased from the contracted pharmacy with these exceptions: STAT medication that is ordered on a weekend, evening or holiday and the contract pharmacy is closed or the medication is not immediately available there. If that is the case, the nurse on duty will order the medication (not more than 3-7 day supply) from a local retail pharmacy.
3. Nursing staff administering medications will adhere to the following guidelines:
a. Nurses will gather all necessary supplies for the medication pass prior to the students arriving
b. Nurses will wash hands with soap and water/ hand sanitizer before each med pass
c. Nurses will not begin medication administration until the students are orderly and attentive
d. Nurses will verify the identity of the student by asking the student their full name, verifying the name with other staff, or referring to the photo in the EMF
e. Nurses will always check the following prior to administering medication:
i. Correct order
ii. Correct medication
iii. Correct dosage
iv. Correct route
v. Correct student
f. Nurses will ensure that the student remains in front of them while receiving medication with both hands visible at all times
g. Nurses will open the packet and place oral medication in water cup; the student will place the medication in their mouth. Water/juice will be poured into the cup so the student may swallow the medication with the fluid provided. The student will be observed as they take and swallow the medication
h. Nurses will perform a standard “mouth check” visualizing the student’s entire mouth for any medication before the student leaves the designated medication area
i. If the nurse is not satisfied that the student has swallowed the medication, the youth will not be permitted to leave the area and staff will perform a search of the youth
4. If the treatment team or physician identifies a student as high risk for med non-compliance, an individualized safety protocol will be initiated by the treatment team. This protocol will include all of the above guidelines in addition to other specifics such as sitting with staff for 5 minutes, drinking multiple glasses of fluid, liquid medication, apple sauce, eating etc. The safety protocol will remain in place until the student has been reassessed as low risk for med non-compliance.
5. All medications will be documented at the time of administration
6. Nurses will utilize the current monthly administration record (MAR) for this documentation
7. Nurses will initial the record for the specific date and time the medication was given. The nurse’s signature will be recorded in the designated signature area of the record
8. Nurses will chart the medication using the following:
a. “H”- Medication held
b. “R”- medication refused
c. “P”- Packed for off campus
d. “Nurse initials”- medication given
i. When charting “H” or “R” the nurse must document the reason and any notifications made on the MAR and electronic progress notes.
ii. If a student refusal reflects a health risk, the nurse will notify the prescribing psychiatrist or physician as well as the head nurse. Documentation of the notification will be noted in the progress notes.
Medication Errors
9. Nurses will accurately and timely report any errors to the appropriate practitioner and immediately to the Head Nurse
10. The Head Nurse will inform the Nursing Coordinator and ensure that a Medication Error Report Form is accurately completed by the nurse discovering the error and forwarded to the Coordinator
a. A review of the error will take place with the Nursing Coordinator and campus Head Nurse
11. The procedure described above will also be followed when dispensing any PRN medications.
12. All trained non-licensed staff certified in medication administration will also follow these procedures.
13. All medication will be kept in a locked, secured cabinet and labeled with the student’s name, the name of the medication and directions for the administration.
14. All medications provided by the pharmacy (one week supply) will be checked by two nurses at time of delivery for accuracy to the current physician orders.
15. Provisions will be made for any medication needing refrigeration when necessary.
Medical Verbal Orders
Medical verbal orders are to be taken only by an authorized nurse who has a current license to practice in the state of Massachusetts.
1. The licensed nurse will identify the caller from whom she/he will take the verbal order.
2. After identifying the caller, the nurse will write the order down as given on the physician order sheet.
3. The nurse will read back the order to the prescriber to verify the order is correct and complete. The order must include the name of the medication, strength and time to be given. Any questions should be clarified by the physician before the call is ended.
4. The nurse taking the verbal order will write the date, prescriber’s name, and his/her name after the order.
5. The nurse will call the parent/guardian for a verbal consent, Witnessed by a nurse on the speakerphone. Only then will the nurse call the pharmacy for the medication to be ordered.
6. Verbal orders will be authenticated by the prescriber during their next visit.