The fact that a student has sustained an injury is determined by the need for either first aid or some type of medical treatment, other than diagnostic procedures. The purpose of body checks and diagnostic procedures (e.g., examination, x-rays, etc.) is to determine whether an injury has occurred, and/or the extent or severity of an apparent injury.
If neither first aid nor medical treatment is required, there is no injury.
If it is determined by a medical provider that the student has sustained an injury, it still must be determined whether the injury is a minor or a major injury.

a. MINOR INJURY
A minor injury is defined as”…one which requires only first aid to be provided on site”.
(OCCS communication, March 2000).

According to this definition, if on site (e.g., nurses station) first aid (non-diagnostic procedures) is necessary for the injury (e.g., ice pack, Bandaid), the student has received a “minor injury”.
If the student does not require first aid, even if a body check or examination has been conducted, the student has not received a minor injury.

b. SERIOUS OR MAJOR INJURY
A serious or major injury is defined as “…one which requires a visit to a physician, ER or hospitalization”. (DEEC communication, March, 2000).

If it is determined that the student should be sent to a community physician or to the ER to determine if an injury has been sustained, and the extent of that possible injury, the act of sending that student to a community provider does not in and of itself result in a classification of “major injury”.
If the student receives a diagnostic examination and either receives subsequent medical treatment for an injury that goes beyond first aid, or is hospitalized for medical treatment of an injury (rather than for additional diagnostic work), the student has received a “major injury”.
If the student receives a diagnostic examination without receiving medical treatment because no injury was sustained, the student has not received a major injury.

If the student receives a diagnostic examination and, subsequently, only first aid because the injury was minor, the student has received a “minor in jury”, and not a “major injury”.

c. DOCUMENTING RESTRAINT RELATED BODY CHECKS AND INJURIES
1. The injury notation on the Physical Intervention form should be completed in a manner consistent with these definitions.

2. It is sometimes necessary to restrain a student more than once and sometimes with little time in between restraints and before a body check can be conducted. In such cases the body check and finding (e.g. “minor injury”) will be documented only on the most recent or last Physical Intervention Report form for the series, even though there will be a PI form completed for each restraint (incident).
On the most recent or final PI form in a series, the nurse conducting the body check will include the following note: “Body check for multiple physical interventions”.
On all other PI forms in that same series, the nurse conducting the body check will include the following note: “See the most recent PI form” with both date and time of the final PI form noted.
Sequential PI forms should be clearly marked to show the sequence of events.

3. If the student is sent to a community physician or to the ER for diagnosis and/or treatment of possible injury, the nurse does not complete the PI form related to injury until the final determination has been made by the community based provider as to whether an injury occurred and the extent of any injury.
In this case, the Nurse notes the action in the Medical Attention comment section (e.g., sent for X-Ray on 5/12/07) and circles the right hand section regarding injuries. She/he does not check off any injury box until the form is retuned for completion and the determination is made as to whether there was an injury.
The form is then circulated as usual.
Given these types of notations, after signing off on the form, the last person to review the form returns the form to the Nursing for completion.
When the form returns to Nursing, the nurse will complete the form in a manner consistent with the findings, including any explanatory notes and check offs (no injury – in which case the entire section is Xed out, minor injury or major injury), and the form is routed to the person who enters PI/injury data before the form is filed.

A. Associated With Restraints and Altercations

A body check of the student is to be conducted by the nurse within 24 hours or sooner if indicated, whenever any of the following conditions are met.
1. A physical intervention has been “difficult”, severe or such that injury may have occurred, regardless of the duration of the hold or restraint e.g., the student has struggled and the staff has had to apply some degree of force to maintain safety.
2 The student has been involved in a “floor restraint” (i.e., prone, on the floor–not seated).
3. The restraint exceeds 20 minutes.
4. The student reports any pain or discomfort, or the student appears to be in pain or uncomfortable, regardless of whether or not he/she reports or confirms pain or discomfort.
5. After a physical altercation between students that meets any of the criteria outlined above (i.e., difficulty, severity or duration of physical altercation; report or appearance of injury, pain or discomfort).

If there is no nurse on duty at the time of the incident, the on call nurse will be consulted by telephone. If it is determined that the on call nurse need not come to program to do a body check, the body check will be done as soon as possible at the beginning of the next nurse’s shift on campus.

B. Prior To and On Return from Unsupervised Leave Of Absence

A body check is also done prior to, and upon returning from, an unsupervised home visit or an unsupervised off-campus visit. This is not a contraband check; it is a visual inspection looking for signs of illness or injury.

C. Student Refusal

If a student refuses a body check, the supervisor is notified, and the event is documented on the Incident Report form and in the case record Progress Notes. Additional attempts are made until body check is completed.

A. Schedule and Availability
A Registered Dietitian (RD) is available to evaluate the nutritional requirements of students as referred by the nursing staff or the pediatrician. The Dietitian works with the Director of Food Services and the Nursing Department; he/she is available for consultation when needed.
The Dietitian covers all campuses and accommodates the needs of all students. The Dietitian reports to the Nursing Office on each campus to address all nutritional consultation issues.
The Dietitian also helps to insure that Nutrition Services meet or exceed applicable state regulations and JCAHO standards.

B. Levels of Care

1. Using data obtained during the nutrition assessment, a nutrition level of care (LOC) is assigned. The LOC may be changed after meeting with the student; meeting with clinical and medical staff; guardian; or at the discretions of the RD. In all situations, the RD needs to use his/her professional judgment to provide the appropriate and highest of quality nutritional care. In all situations this must take into consideration the medical, social, and environmental needs of the student and be consistent with the services provided at Hillcrest Educational Centers.
2. Students will receive ongoing nutritional care consistent with the standards specified for the assigned level of care.

C. Criteria for Levels:
a. Level of Care 1
Any student in need of a specialized or modified diet due to a chronic nutrition-related condition or acute malnutrition will be classified as Level of Care 1: (LOC 1)
a. Including but not limited to the following diagnoses:
1) active eating disorder
2) uncontrolled diabetes
3) malnutrition
4) malabsorption
5) enzyme deficiency (excluding lactose intolerance)

Level 1 Nutritional Care Standard:
1. When referred, the Registered Dietitian will complete a nutrition assessment. The assessment is documented in the student’s master medical file under Nutrition. The Dietitian will use his/her professional judgment as to whether a specific nutrition care plan is needed at this time and a treatment plan will be documented in the student’s medical record.
2. Follow-up nutrition care and documentation will be completed at least monthly thereafter for as long as the RD working in conjunction with the Medical team determines it necessary. Follow-up nutrition care will include re-evaluation of LOC.

2. Level of Care 2
Any student with one or more of the following criteria will be classified as Level 2:
a. Abnormal Growth- including but not limited to the following:
1) Obesity
2) Weight for Length >95% or Body Mass Index (BMI) = >95%
3) Growth Failure – also known as Failure to Thrive (FTT)
• Weight for Length <5%
• Unexpected weight loss or inability to maintain an appropriate weight
b. Fasting blood cholesterol on admission exceeding 199
Policy: Hypercholesterolemia (I. – below)
c. Abnormal Nutrition related lab values on admission- including but not limited to the following:
1) Albumin less than 3.2
2) Anemia related lab values: Hct, Hgb, MCV
d. Documented food allergies/intolerance that may put a student at risk for malnutrition or require a significantly modified diet (other than sick day diet)
e. Non-insulin dependent Diabetes
f. Anorexia (Vs. Anorexia Nervosa)
g. Unmanaged lactose intolerance
h. Any diagnosed condition in which the RD and Medical team deem it necessary for close nutrition follow-up.

Level 2 Nutritional Care Standard
1. When referred, the registered dietitian will complete a nutrition assessment. The assessment is documented in the student’s Electronic Progress Notes under Nutrition. The dietitian will use his/her professional judgment as to whether a specific nutrition care plan is needed at this time and a treatment plan will be documented in the student’s medical record.
2. Follow-up nutrition care and documentation will be completed at least quarterly thereafter for as long as the RD working in conjunction with the Medical team determines it necessary. Follow-up nutrition care will include re-evaluation of LOC.

The dietitian and nurse will develop a Treatment Plans for students with a level of care of 1 or 2, as deemed necessary. The treatment plan will be part of the student’s medical chart.
Treatment Plans are designed to satisfy the student’s special diet requirement and may include exercise goals as well. These plans must also take into consideration the medical, social, and environmental needs of the student and be consistent with the services provided at the Hillcrest Educational Centers. These plans are updated and reevaluated quarterly to coincide with each student’s quarterly reviews.

3. Level of Care 3

Students considered to be at minimal nutritional risk upon admission are classified as Level 3 (LOC 3). (Regular Diet)

Level 3 Nutritional Care Standard
Screening will be provided only at RN or MD’s request. Staff should be encouraged to write down their concerns and submit them to the Nursing Department for review, as they are the campus’s link to medical/clinical providers.

D. Assessment of Students
Nutritional assessment is done by nursing on every student upon admission and will be reviewed by the pediatrician with referral to the RD as indicated.

E. Dietitian Role and Responsibility
1. The Registered Dietitian assists the Director of Food Services in providing students with safe and nutritionally adequate meals. He/she provides nutritional assessment, and evaluations of student as needed, and consults with the medical, clinical, educational, and administrative community at Hillcrest Educational Centers to help foster the highest quality of healthcare to our students.

The responsibilities of the R.D. include but are not limited to:
a. To serve as a consultant to the Food Service Director, Nursing Dept., and other involved staff.
b. To approve all menus in accordance with the diet manual.
c. To participate in the development and ongoing monitoring and evaluation of departmental Quality Improvement indicators.
d. To periodically observe the serving of meals.
e. To review special diets and provide nutritional counseling as needed.
f. To review food acceptance survey results and aid in determining the response to students’ requests for menu changes.
g. To act as a resource for the Education Dept., to support health teachers in their role as nutrition educators.
h. To review student medications for drug nutrient interaction, implications and providing nutrition information and counseling where needed.

2. Nutrition Counseling/Education
The R.D. is responsible for nutrition counseling and diet instruction for students that are in need of this type and degree of instruction. All staff are encouraged and expected to support each student’s nutritional goals. The goal for the diet instruction is to involve the student in learning simple concepts about the diet and to become responsible, to some extent, for self-care of the component of his/her treatment. The degree to which each student can participate in his or her nutritional care plan is dictated by the stage of his or her treatment and may vary greatly from student to student.
a. Upon receipt of a physician’s request for a consultation or diet modification, the R.D. will review the medical record, access the patient’s nutritional status, consult with the physician and other treatment team members, and develop a nutrition care plan which includes appropriate nutrition counseling.
b. Appropriate written instructions should accompany a verbal instruction. Where indicated, other staff (i.e., teachers, Youth Development Professionals) shall become involved in student education and/or implementation of special diet.
c. Follow-up visits should be made to each student receiving instruction in order to evaluate the effectiveness of the instruction.
d. All diet instructions should be documented in the medical record, including a description of the diet instructions and materials given to the student, a summary of the diet history, an assessment of their diet knowledge, and a recommendation for post-discharge follow-up, as appropriate.

F. Diet Orders
1. The attending physician orders a regular or special diet upon admission or at any other time during a student’s placement that is deemed necessary by the medical team. The Food Service Dept. receives the order from Nursing. The R.D. acknowledges implementation of the diet in the student’s chart in the nutrition assessment and progress note section. Any change in the diet order is documented by the nursing staff and forwarded to the Dietary Department.
2. The dietitian will meet with all students on special diets. Special diets are identified in the student’s medical record chart and in his/her Treatment Plan.
3. Food service staff are informed of students’ dietary needs, and direct care staff are notified as well.
4. At the time of discharge the student’s current diet plan is included in the student’s discharge summary.

G. Consumer Satisfaction Surveys
Food will be prepared in an environment suitable for safe food production and served in an atmosphere suitable for the students. To monitor quality and overall food service acceptance, at least annually a consumer satisfaction survey will be utilized to address food service and nutrition issues. The Food Service Director will oversee the monitoring; the Registered Dietitian will consult when necessary.
1. Approved CSQ forms are used. (See Attachment 7 – B)
2. All students are given the opportunity to complete the CSQ annually.
3. Results are reviewed. Corrective Action reports are discussed, and menus are revised and circulated through the Dietitian, FSD, Program Director and Cooks as needed.

H. Off Campus Meal Policy
The following policy applies to all students and all meals when it is deemed necessary to provided meals in the community, away from a Hillcrest campus.

Hillcrest Educational Centers
Off-Campus Meal Policy

Students under 10 years:
1 burger or sandwich 1 small fry
1 medium non-caffeinated beverage

Students over 10 years:
2 burgers or 2 sandwiches 1 medium fry
1 large non-caffeinated beverage

Points to remember:
Foods and/or beverages may have an effect on medication utilization in the body.

No Caffeinated Beverages, which may include:
 Soda
 Coffee
 Sports Drinks that contain:
 Caffeine  Mau Hung
 Ephedrine

Excessive amounts of high fat foods, high calorie foods are not appropriate for anyone. No super-size meals.

High sugar items should be kept to a minimum.

All foods are acceptable in moderate amounts.

Please contact student’s Clinician and Nursing if you note any of the following:
 Individuals hoarding food
 Consuming excessive amounts  Consuming food in an abnormally rapid fashion
 Refusal to eat at multiple or consecutive meals

I. Hypercholesterolemia Policy

Goal: The reduction of elevated cholesterol levels in our students.

Definition: hypercholesterolemia will be defined by a fasting cholesterol level greater than 199.

Procedure: all students will have a fasting cholesterol test upon admission and follow up testing annually. If an elevated level (greater than 199) is found the level will be repeated in three-month intervals and assessment for referral to endocrinologist will take place.

Evaluation Process:

1. Fasting cholesterol will be ordered and completed as part of admission process.

2. Medical Director, Registered Dietitian, and Registered Nurse will review all Cholesterol studies.

3. An elevated (over 199) cholesterol level will be repeated in three months.

4. In the case of hypercholesterolemia the Medical Director will review and consult with RD and Nurse. The following considerations shall be made:
• R/T medication
• Family history, if possible
• Dietary intervention
• Lipid profile
• Cholesterol lowering medication

5. After careful review and consideration for the student’s age, independence, maturity, diagnosis, current medications, history, and the effects of additional medication a treatment plan will be established.
• There will be documentation in progress note of the plan regarding hypercholesterolemia.
• Reviews for students with hypercholesterolemia will take place quarterly.

6. When the cholesterol level has returned to less than 200 or when deemed appropriate by the RN, RD, or MD the time between testing will be modified.

A. Department Philosophy
In addition to servicing and treating health problems, the medical component of the Hillcrest program, teaches the students to maintain a healthy life-style, to recognize illness when it occurs, and to appropriately access community medical systems when necessary.
HEC provides nursing coverage at all campuses. Each campus nursing department consists of a registered nurse as head nurse and staff nurses, consisting of registered nurses and licensed practical nurses. A Coordinator of Nursing Services oversees the campus nursing services.

B. Health Care Providers
Physicians on staff of Hillcrest Educational Centers include a Director of Psychiatry and Consultant Psychiatrists; a Medical Director and one or more Consultant Physicians and Nurse Practitioners. On an as needed basis, the agency uses the services of specializing physicians who maintain private practices in the community. Additional, non-routine medical treatment is provided when indicated by order of the medical director. In addition, as noted above, Hillcrest provides nursing coverage at all campuses.
The agency also has healthcare related consultants on staff including a Registered Dietitian.

C. On-Call Nursing Coverage Procedure
On-call nursing coverage is provided when there is not a nurse physically present on campus. The on-call nurse, when contacted, will make a medical assessment of the situation based upon the information provided by campus staff. Based on the information provided, the on-call nurse will either give instructions to the staff or will travel to the campus to make an in person assessment of the situation.
On-call nurses can give phone authorization for administration of certain medications. This policy does not include medications that have to be signed for or IM medications. It is also limited to medications approved in the standing orders.
The on-call nurse will return to campus under circumstances including, but not limited to, the following:
1. Assessment of illness or injury in which an adequate medical judgment cannot be made through telephone consultation.
2. Medical or psychiatric situations requiring the administration of medication by a licensed nurse.
3. Immediate assessment following student incidents involving sexually inappropriate behavior that warrants physical assessment.
4. Immediate assessment following suspected physical abuse.
5. If injury occurs or may have occurred during a physical intervention.
6. The request of the Program Director/Manager or on-call administrator.
7. Restraint situations requiring the assessment of an independent licensed practitioner.

In order to maintain uniform standards of care, a procedure manual and physician’s standing orders are maintained in each campus nursing office. Standing orders are reviewed once yearly by the Medical Director.

A. Pharmacy Standard
A registered pharmacist or designee will review the medication cart, emergency box and documentation once every three months. The date of the next inspection will schedule in writing with the Head Nurse prior to the inspector leaving. Head Nurses will notify the CNS if any inspections are not done on the specified day. The CNS will immediately contact the pharmacy owner should this occur. A registered pharmacist will provide Four hours of in-service education to the nursing department.

B. Nursing Standard
All personnel administering medication will be accurate in terms of right medication, dose, time, route, site and documentation. Each student will have an accurate physical assessment completed within 24 hours of admission by a registered nurse. Each student on medication will be observed on a daily basis and any adverse reaction to medication will be documented and reported to the prescribing physician.

C. Psychiatric Standard
Each student will have an assessment completed by a licensed psychiatrist within 7 days of admission; within 72 hours for the ITU. All students will be seen every eight weeks. Each student receiving medication will be seen and his/her medication regime will be reviewed at a minimum of every eight weeks by a licensed psychiatrist.

The “Nursing Occurrence” form (see Attachment 7-A) must be completed whenever the medication administration procedure is not followed.

A. Reporting Pharmacy Errors
At the time a pharmacy error is discovered, the following steps are to be taken:
1. Notify the pharmacy.
2. Notify your charge nurse and the Coordinator of Nursing Services.
3. If there has been a medication error, an Occurrence Form is to be completed. Send a copy to your Coordinator of Nursing Services.
4. Make a report about the pharmacy error in narrative format, sign it and include the following:
a. Dates
b. Personnel involved
c. Sequence of events
d. Corrective actions and resolution.
e. Copy the original pharmacy order. Copy any supporting evidence. Send note and copies to your Nursing Coordinator.

These steps are to be completed by the nurse discovering the error before the end of his/her shift.

The Coordinator of Nursing Services will notify the Executive Vice President, or, in the absence of the Executive Vice President, the CEO/President

(Also see Section 5, URGENT EVENTS AND EMERGENCIES, Chemical Restraint)

1. Policy
Hillcrest does not perform Chemical Restraints. As stated by the Massachusetts Department of Early Education and Care (DEEC) in policy statement number P-OCCS_R&P-02 (revised 1/05/04): “Chemical restraint is defined as the administration of medication for the purpose of restraint. Medication administered according to requirements and procedures for treatment authorized by a court (a Rogers order) is not a chemical restraint. …a PRN …taken voluntarily is not a chemical restraint. A psychotropic medication administered involuntarily in an emergency to prevent immediate, substantial and irreversible deterioration of serious mental illness is not a chemical restraint.”

According to DEEC a program may request a variance to use chemical or mechanical restraint.

1. Notification
The Supervisor or Nurse will contact the on call Administrator to inform him/her of the situation which constitutes an immediate danger presented by a student, and to describe interventions which have been attempted to deal with the danger. If the on call Administrator determines that the situation constitutes an immediate danger of serious harm to the student and/or others, and that other interventions have been properly employed but have not been successful, he/she will instruct the onsite or on call Nurse to consult an agency physician.

Final notification routes for each occurrence will depend on the urgency of the situation and other current conditions.

2. Determination of Need for involuntary anti-psychotic medication
Through first hand, on site assessment, or through telephone consultation with a physician or nurse who is present at the site of the emergency, the agency physician will determine whether involuntary psychotropic medication administration is the least intrusive intervention necessary to prevent further deterioration of a student’s emotional/psychological well-being.

3. Administration
Only a physician, or a nurse acting on an order from a licensed physician, will administer the medication. He/she will monitor the student in person immediately afterward for negative effects, and will reassess the student’s condition 15 minutes after the administration. The student receiving the medication will continually remain in the presence of an assigned staff member trained in assessing for distress. The practitioner who administered the medication will inform the assigned staff member of any possible negative effects of the medication and the amount of time necessary for the student to remain in close supervision.

4. Documentation
The time and date of the order for involuntary anti-psychotic medication administration must be documented on the doctor’s order sheet by the physician, or documented by a licensed nurse as a telephone order from the physician. The use of medication will be documented in the student’s case record with at least the following information:
a) A description of the precipitating incident or series of incidents, the alternative interventions attempted including all efforts to prevent the use of chemical restraint, and the reasons the medication was necessary.
b) The fact that involuntary medication was the least restrictive alternative and why.
c) The time and from whom the order for administration was obtained, and the names and titles of all other persons notified and/or involved in the decision.

5. Incident Review/Treatment Planning:
At all Hillcrest sites except for the Intensive Treatment Unit (ITU), the use of an involuntary PRN requires a Special Team Meeting to discuss the circumstances of the event and revise the student’s crisis intervention plan accordingly. A second involuntary PRN for the same student requires an Emergency Team Meeting to determine the student’s appropriateness of placement.

The ITU may request a waiver by D.E.S.E. to allow involuntary PRN’s as a part of a student’s intervention plan for severe cases. In such cases, a monitoring plan must be incorporated into the student’s Comprehensive Treatment Plan to assure frequent and proper assessment of the intervention’s benefit. Without such a waiver in place, the ITU must follow the general protocol described above.

List of High Alert medications and management

High-alert medications are those mediations involved in high percentage errors and/or sentinel events, as well as medications that carry a higher risk for abuse or other adverse outcomes. It is the policy of HEC to obtain monthly vital signs and weight on a monthly basis. The commonly used high-alert medications and the management plans in our population are:
Atypical Antipsychotics: All students on this class of medication are monitored with blood tests. This includes prolactin levels every 6 months, glucose and insulin levels every three months and lipid profile annually unless otherwise ordered by physician
Clozapine – Additional weekly CBC done for evaluation of white blood cells and entered into the national database. Regular EKG with additional testing such as echocardiogram may be ordered.
Risperdal
Zyprexa
Seroquel- Additional eye exam every 6 months
Geodon
Abilify
Mood stabilizers/ antiseizure: All students on this class of medications have levels and various blood tests on a regular basis.
Tegretol-Blood level, CBC and LFT (Liver function tests) every 6 months
Lithium- Blood levels, TSH ( thyroid) and BUN, Creatinine (kidney function) every 3 months
Depakote- Blood level, CBC, LFT every 3 months
Dilantin- Blood level, CBC and LFT every 3 months

The following medications are used in our population for aggression and hyperactivity but may affect blood pressure or heart rate. Baseline EKG is obtained with annual follow up unless otherwise ordered by physician.
Clonidine
Tenex
Effexor (antidepressant)

Stimulants- For all students on this class of medication, family history of underlying heart disease or sudden cardiac death is obtained at time of consent. A baseline EKG is obtained on admission or when stimulant is started with annual follow up.
Adderal
Concerta
Dexadrine
Vyvanse
Ritalin
Focalin
Metadate

Other medications
Wellbutrin – Review of history for seizures
Metformin- Glucose and insulin levels are obtained as ordered by physician. Additional daily testing of blood glucose may also be ordered.

https://www.ismp.org/sites/default/files/attachments/2018-08/highAlert2018-Acute-Final.pdf

https://www.cdc.gov/niosh/docs/2016-161/pdfs/2016-161.pdf?id=10.26616/NIOSHPUB2016161

https://www.ismp.org/sites/default/files/attachments/2017-11/tallmanletters.pdf

MEDICATION DISPOSAL

Policy:

Medication disposal should follow federal and state laws for all prescription, controlled, vitamins, minerals, herbal supplements and over-the-counter medications.

Practice:

Medications that are no longer needed by the student, have been discontinued, and are unable to be returned to the pharmacy should be disposed of according to applicable laws and guidelines. The Office of National Drug Control Policy (ONDCP) and the Environmental Protection Agency (EPA) jointly released guidelines for disposal of prescription medications. Controlled Substances must be destroyed so that they are unusable by another person to prevent diversion of the drugs.

d. Two nurses will verify the medications being disposed of and a
documentation of the disposal will be kept in the controlled
substance logbook.

e. Two nurses will then place all medications to be disposed of into a
2-millimeter, zip-lock bag. Hot tap water will then be added and
bag sealed. Let the medications dissolve for 5-15 minutes before
adding Absorb-all. Manipulate the sealed bag and its contents until
all moisture is absorbed.

f. Place the sealed bag and its contents into a garbage container in
the nursing area. Housekeeping can then discard the garbage bag
into the campus dumpster.

9. The 2-millimeter, zip-lock bags should be obtained through the food service supplier (Eastern Bag Company).

10. The Absorb-All should be obtained through the maintenance department supplier (Burnell Auto Parts).

1. Student Vacations/Leaves
Upon notification of an upcoming leave or student vacation, nursing orders a supply of medication from the pharmacy for the length of the leave plus two extra days to cover loss, spillage or extra days added onto the leave. Nursing packs medications and documents all those sent on the Medication Administration Log
All medications and instructions will be reviewed by nursing with staff or parent responsible for transport. Staff will review with parent/guardian upon arrival for visit.
When student travels unaccompanied, one of the three following options will be exercised:
Prescription for vacation medications will be mailed to student’s parent/guardian in time for it to be filled at a local pharmacy. A copy of the student’s insurance card will be sent with the prescription.
In an emergency, and as permitted by state law, physician may call prescription in to local pharmacy.
Medications can be mailed via Federal Express overnight service. Parents should be notified as to when medications are due to arrive.

2. Procedure for Dispensing by Non-Licensed Personnel
Medications cannot be dispensed by unlicensed personnel without their successful completion of the “Medication Certification Program” given by HEC registered nurses.
Staff will supervise medication administration only when an off-campus trip is necessary and student involved is unable to return to campus at medication time or when a nurse is not available.

Procedure for certifying staff is as follows:
1) Staff must have been employed by Hillcrest Educational Centers for at least three months to be considered for certification. He/she must have current certification in First Aid and CPR.
2) The decisions about whom to credential will be made by the head nurse of each campus after having consulted with the Program Director/Manager, supervisors, and others who might be in a position to evaluate the capabilities of that staff member.
3) Only R.N.s may certify staff.
4) Training sessions for certifying staff will include:
a) Review of medication procedure by nurse trainer.
b) Administration of test to staff: Staff must pass test with 100% correct score. If staff fails to pass test, nurse trainer may review missed material and re-administer test one time. If second attempt failed, staff must wait for at least one month and begin procedure again. If, after one month staff fails test again, he/she will no longer be considered eligible for credentialing.
5) When staff successfully passes training, nurse trainer will complete the “Certificate of Credential and Privilege to Supervise Medication Administration. Trainer will keep that record with guidelines in a special file in the nurses’ station. A copy of the certificate, along with guidelines will also be kept in the staff’s personnel file. Training coordinator should be notified of training. Recertification takes place on a yearly basis.

6) In the event that certified staff fails to follow medication procedure, an incident report and Medication error report must be filled out by the staff involved in the incident. Immediate notification of the circumstance must be provided to the supervisor on duty and the nursing department. Depending on the nature of the error and the staff understanding, certification can be withdrawn at any time.

3. Medication Refusal
When a student has failed or refused to take his/her medication, the refusal is documented in the student’s record, including the student’s stated rationale for refusing. When indicated, the nurse notifies the prescribing physician. The neurologist is notified of all refusals involving anti-convulsant medication. In addition, direct care staff is informed of any related safety concerns.

– are to be up-dated according to Mass State Regulations, which follow.

Immunizations

Immunization Catch Up Schedule