No Emergency first aid or medical treatment will be administered to a student without written consent* from the students’ parent/guardian.
* For Massachusetts students only, such written consent shall be renewed annually as required.
1. Policy for Use of Automatic External Defibrillator (AED)
The AED is a self-testing, battery operated automated external defibrillator. After applying the AED pads to the patient’s chest, The AED automatically analyzes the patient’s EKG and advises the operator to push the button to deliver a shock or delivers a shock itself, if needed. The AED guides the operator through the rescue using a combination of voice prompts and text.
Purpose: To resuscitate a person who is in cardiac arrest.
Location of AED: Highpoint and ASD / Center campuses – Main Lobby and Brookside ITU Campus – Supervisor’s Office and Main Lobby
Delivery of AED to Scene: Supervisor, designee, or Nurse on campus
Authorization to Use: Any staff or nurse who has been trained and certified to operate the AED
Procedure when Nurse is on campus:
1. Assess the scene for safety before approaching victim (i.e. downed electrical wires, chemical spills, etc.)
2. Call Supervisor and Nurse via phone or radio and inform them of the situation. They will bring the AED to the scene.
3. Assess responsiveness of the victim. (Shake and shout his/her name)
4. If unresponsive, check for pulse and breathing.
5. If there is no pulse and/or breathing, initiate CPR and designate someone to call 911 immediately..
6. Continue with CPR until AED is applied to victim.
7. Follow protocol for AED use.

AED Use:
1. Open AED lid.
2. Remove clothing from the victim’s chest area.
3. Ensure that the skin of the chest is clean and dry.
4. Shave excessive hair, if necessary.
5. Tear open pad package and remove pads.
6. Peel off plastic backing from pads and place AED pads properly on chest (see diagram for proper placement).
7. Listen to and follow instructions from automated voice of AED
• “Do not touch patient! Analyzing rhythm.”
• “Shock advised. Charging.”
• “Stand Clear! Shock will be delivered in…”
• “Three, Two, One.”
• “Shock delivered.”
• It is now safe to touch the patient.”
• OR “Rhythm changed, shock cancelled.”
8. Continue with AED protocol- when instructed, begin CPR
• Give 30 compressions followed by 2 breaths
• At the end of CPR, the voice prompts will direct you to repeat steps as necessary.
9. Continue following AED instructions until EMS arrives.

Procedure when Nurse is NOT on campus:
1. Assess the scene for safety before approaching victim (i.e. downed electrical wires, chemical spills, etc.)
2. Call Supervisor via phone or radio and inform them of the situation. They will call for additional staff and bring the AED to the scene.
3. Assess responsiveness of the victim. (Shake and shout his/her name)
4. If unresponsive, check for pulse and breathing.
5. If there is no pulse and/or breathing, initiate CPR.
6. When additional staff arrives on scene, have them call 911 immediately.
7. Continue with CPR until AED is applied to victim.
8. Follow protocol for AED use.

AED Use:
1. Open AED lid.
2. Remove clothing from the victim’s chest area.
3. Ensure that the skin of the chest is clean and dry.
4. Shave excessive hair, if necessary.
5. Tear open pad package and remove pads.
6. Peel off plastic backing from pads and place AED pads properly on chest (see diagram for proper placement).
7. Listen to and follow instructions from automated voice of AED
• “Do not touch patient! Analyzing rhythm.”
• “Shock advised. Charging.”
• “Stand Clear! Shock will be delivered in…”
• “Three, Two, One.”
• “Shock delivered.”
• It is now safe to touch the patient.”
• OR “Rhythm changed, shock cancelled.”
10. Continue with AED protocol- when instructed, begin CPR
• Give 30 compressions followed by 2 breaths
• At the end of CPR, the voice prompts will direct you to repeat steps as necessary.
11. Continue following AED instructions until EMS arrives.

2. Emergency First Aid & Care
a. At regularly scheduled times during the year, direct care staff participate in formal training in first aid and CPR provided by an instructor who is certified by the Red Cross
b. First aid supplies are kept in secured areas in each dorm, the gym and the supervisor’s office and include, but are not limited to, the following:
Band-Aids
Gauze
Adhesive tape
Antibiotic ointment
Gloves
Cleaning solutions.
Additional first aid supplies are located in the nursing office at each program site.
d. The HEC Emergency Manual and associated phone numbers are kept in specific locations on each campus (reception area, supervisors and nursing office). Telephone numbers of the fire and police departments, Poison Control Center, hospital ER and ambulance service are included, along with the numbers for Berkshire Search & Rescue, Hillcrest nurses, administrators, the head of maintenance and other agency staff.

3. Serious illness and/or medical emergency
a. Serious illness and/or a medical emergency include any medical problem requiring hospitalization or emergency room visit. In the event of serious illness and/or emergency medical situation where a student cannot be treated by the onsite nurse, the student will be taken to the hospital.
If the student’s condition clearly indicates that the student can be moved, the student will be transported in an agency vehicle or other approved vehicle. If there is a doubt about whether the student can or should be moved, or if a student falls from a height of more than fifteen feet, an ambulance is called. An ambulance may also be called if it is believed that the student’s safety requires ambulance transportation.
A nurse on campus, supervisor or administrator will make the determination of need to call an ambulance.
Ambulances can be reached by calling 911, or by calling local ambulance services which are listed with ER phone numbers at the various sites.
b. In the event of major illness or emergency medical treatment, the student’s parent/guardian will be notified by telephone by the nurse, administrator and/or attending physician as soon as possible. In the event that the parent/guardian cannot be reached immediately by telephone, a nurse or administrator may send an email or may contact state funding agency, Dept. of Children and Families, Dept. of Early Education and Care, etc., depending on the nature of the illness or emergency. The parent/guardian will be informed of the nature or circumstances of the illness or injury and the student’s medical treatment will be explained.
In life-threatening situations, where no parent/guardian is available, the physician or Hillcrest administrator will take responsibility for making medical decisions.
c. State funding agencies, Dept. of Children and Families, Dept. of Early Education and Care, Dept. of Elementary and Secondary Education, and any other agency that is responsible for the student will be informed of the emergency hospitalization by the Program Director or designee.

4. Plan for Managing Potential Emergencies
Assignment of personnel to specific tasks and responsibilities in emergency situations:
a. Youth Development Professionals  ensure that all students are assembled in a safe area and that the student roster is brought to that area so that attendance may be taken. Once in the assembly area, Youth Development Professionals group students in a manner that will facilitate answering to the roll call. Youth Development Professionals ensure the safety of students in the assembly area. If necessary, a designated senior Youth Development Professional may perform the functions of a child care supervisor.
b. Child Care Supervisors direct and oversee the orderly movement of staff and students to the safe assembly area, taking attendance once assembled. Supervisors may perform the functions of administrators if necessary.
c. Administrators coordinate with supervisors to ensure the orderly evacuation, movement and assembly of staff and students to a safe area. The administrator contacts Alarms of Berkshire County and/or police as a follow-up to any alarm or emergency. If necessary, and conditions permitting, administrators notify the CEO, Executive Director, and/or Senior Vice President, the funding school district, and/or social service agencies. Administrators and/or community officials will determine when the evacuated area may be reoccupied.
d. Nurses remove emergency medical information from the building and ensure that students in need of medical attention receive necessary care. Nurses will coordinate with doctors or medical facilities, if necessary, to provide for more extensive care. Student records and daily medications are also removed to a safe area, if possible.

5. Notification of Appropriate Persons.
In the event of an emergency, staff utilize the chain of command until the Program Director or his/her designee is notified. The Program Director, guided by Hillcrest policies and existing conditions, will determine what further notification is necessary and possible. Notification may include, but is not limited to student’s family, funding agency, Dept. of Children and Families, Dept. of Early Education and Care, Dept. of Elementary and Secondary Education, Hillcrest senior administrators, local police and fire department.

6. Psychiatric Emergencies; Emergency team Meetings
If a student is in acute psychiatric crisis the student’s Clinician or the program’s Director of Clinical Services will utilize the following protocols related to an Emergency Team Meeting:
a. The Program Director and/or the on campus will call the Clinical Director to confer about the need for an Emergency Team, and they will decide.
b. The Program Director will notify the Psychiatrist if Special Team or Emergency Team is necessary.
c. The Program Director will notify Executive Director and/or Senior Vice President if Emergency Team is necessary.
d. If it is decided that an Emergency Team is indicated, the Lead Clinician will contact the Head Nurse, the ITU representative, and if a transfer may be considered, the representative from that campus.
If a student requires placement at the ITU, the sending campus will readmit that student once the placement at the ITU is no longer necessary.
e. Emergency Team Criteria
Membership: YDP-Day & Residential, ITU, Clinical Director, Nurse, Clinician, Lead Clinician, Program Director or APD, Executive Director and/or Senior Vice President, Teacher & TA, Supervisor or Asst. Supervisor. The Psychiatrist will be notified and will participate if possible.

Conditions:
1) Student is in acute crisis.
2) Student is at imminent risk to themselves or others.
3) Student is being considered for transfer to a more restrictive environment Or for discharge.
f. Following the Emergency Team, the parent/guardian will be notified and informed of the sequence of events leading to any new recommendation for treatment. As appropriate, the nurse, administrator or clinician who is best informed of the situation will contact the parent/guardian. All medical questions are referred to nursing; clinical questions to clinicians; and administrative questions to the Program Director. Each department is responsible for notifying designated Central Office administrative staff.

Policy:

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

Practice:

5. 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.

6. 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.

a. Two nurses will verify the medications being disposed of and a
documentation of the disposal of controlled medications will be kept in the controlled
substance logbook. This will be signed off by both nurses when destruction is completed.

b. 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.

c. 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.

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

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

Checking for expired medications and equipment

Purpose: To ensure the accurate and timely disposal of all expired medications and equipment used in the nursing department.

Procedure:
On the first of each month a designee of the nursing department reviews the expiration dates of all prescription and over the counter medications kept in the nursing department or supervisor’s office. At this time any equipment with expiration dates such as blood tubes, needles, urine stix or other laboratory equipment is also checked.

A colored sticker will be placed on any item that will expire prior to the next check. This will bring attention to the item and will be disposed of when it expires.

No expired medication or equipment is kept past the recommended date. All expired medication or equipment is disposed of in the proper manner following policy.

The monthly check is recorded on the attached flow sheet with the signature of the designated staff checking the dates. This flow sheet is kept in an area designated by the head nurse.

Residential Programs:
Lenox Integrative Pharmacy’s pharmacist conducts a check of expiration dates quarterly. This inspection is recorded on the pharmacy checklist and signed by the pharmacist and a member of the nursing department. These documents along with the flow sheets are retained for periodic review by the Nursing Director.

Housatonic Academy:
The Nursing Director conducts a quarterly inspection of medications for expiration dates. This check is recorded on the pharmacy checklist and signed by the Nursing Director. This document along with the flow sheets are retained for any necessary review.

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FLOW SHEET FOR REVIEW OF EXPIRED MEDICATION & EQUIPMENT

DATE Prescription OTC Equipment Signature Comments
medications medications checked
checked checked

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Form- Notification of Medication Adjustment

Form- Consent For New Medication

Students who reside at Hillcrest Educational Centers are in our care but are not in our custody. Many times their guardians are social workers from state agencies such as Department of Social Services in, New York or Rhode Island, or the Department of Children and Families in Massachusetts and Connecticut. In some cases, parents or relatives may be guardians.
Please refer to the student’s contact form available in the Nurse’s Office to determine the identity of the child’s guardian. These forms can be found in a binder with the latest updated face sheets.
If a student is in the custody of a person other than the parent and prescribed an antipsychotic medication, the referral source or placement agency will be notified and judicial approval (Roger’s Order) will be sought for Massachusetts students.

The Hillcrest psychiatrist rounds weekly at each campus and is responsible for medication reviews, orders and changes of all prescribed psychiatric medications.

After orders are written by the doctor, a nurse will transcribe the order onto the Medication Administration Record (MAR) with a post-it note attached (indicating the status of consent for a specific medication.
When consents are obtained from the guardian, the medication order should then be faxed to the pharmacy.
A verbal consent from the guardian that is witnessed by another nurse can be processed but should also be followed by obtaining written permission from the parent/guardian. This will be accomplished by faxing/mailing the consent form (see attached) to the appropriate person and receiving a signed form to be filed in the student record.
If after placing multiple calls to the parent or guardian agency each day, and a reply is not received within 72 hours, then the Program Director at the Hillcrest campus must be notified. An attempt to reach the guardian should also be attempted via fax or mail.
Additionally, the social worker of an involved agency may also be helpful in contacting a parent. A call should be placed to the social worker explaining the current status of the situation with a request for assistance.
The consent for a specific medication should include the dosage range noted by the prescribing psychiatrist. This along with the expected outcome and side effects should be explained to the parent when the consent is verbally obtained which is then followed by a signature on the consent form. If the dosage is changed to exceed what is noted on the original consent, then a new consent should be obtained.
Students under the guardianship of Connecticut DCF have a specific department to handle medication consents. A form provided by the department should be completed and faxed to the APRN who will review the request and fax her recommendations to the appropriate campus. A notification form along with a call should also be sent to the social worker involved with the student so they remain informed of any medication changes.
In the event that a consent is already on file for a specific medication and a change of dosage (falling within the range previously consented) is ordered by the psychiatrist, a phone call to the guardian explaining the change and reminding the guardian that a signed consent is already in place is required. A written notification must also be mailed or faxed as a follow-up to verbal notification.
There is no need to wait for a response or signature to this form if the consent is on file. The medication can be administered as soon as the pharmacy makes a delivery.
A note of explanation along with the notification form should be mailed/faxed even of no verbal contact is achieved.
All medication changes or new medication orders will be explained to the student prior to or at the time of administration.

All students 18 years of age or older and who have not been deemed incompetent in court may sign the consent for medication. In this case, the referring agency or parent should still be notified of the change or new medication.

Authorization will be renewed annually; consents and physician orders are valid for one year unless otherwise noted by physician.

EXCEPT IN CASES OF EMERGENCY, MEDICATION MAY NOT BE GIVEN UNTIL VERIFICATION OF CONSENT IS ON FILE.

1. Two nurses will check all medications delivered to a campus for identity and accuracy. This check will include a visual inspection of every medication for any unusual color, particles and expiration date.
2. The nurse will check with the parent/guardian while obtaining consent for any known adverse reactions to the prescribed medication.
3. In the event that there is an adverse reaction to a medication, the nurse will call the physician for further orders and notify the parent/guardian of the reaction and alternative treatment.
4. All adverse reactions will be noted and reported in the nursing department campus quarterly IOP report

Policy:

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

Practice:

1. 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.

2. 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.

a. Two nurses will verify the medications being disposed of and a
documentation of the disposal of controlled medications will be kept in the controlled
substance logbook. This will be signed off by both nurses when destruction is completed.

b. 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.

c. 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.

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

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

Checking for expired medications and equipment

Purpose: To ensure the accurate and timely disposal of all expired medications and equipment used in the nursing department.

Procedure:
On the first of each month a designee of the nursing department reviews the expiration dates of all prescription and over the counter medications kept in the nursing department or supervisor’s office. At this time any equipment with expiration dates such as blood tubes, needles, urine stix or other laboratory equipment is also checked.

A colored sticker will be placed on any item that will expire prior to the next check. This will bring attention to the item and will be disposed of when it expires.

No expired medication or equipment is kept past the recommended date. All expired medication or equipment is disposed of in the proper manner following policy.

The monthly check is recorded on the attached flow sheet with the signature of the designated staff checking the dates. This flow sheet is kept in an area designated by the head nurse.

Residential Programs:
Lenox Integrative Pharmacy’s pharmacist conducts a check of expiration dates quarterly. This inspection is recorded on the pharmacy checklist and signed by the pharmacist and a member of the nursing department. These documents along with the flow sheets are retained for periodic review by the Nursing Director.

Housatonic Academy:
The Nursing Director conducts a quarterly inspection of medications for expiration dates. This check is recorded on the pharmacy checklist and signed by the Nursing Director. This document along with the flow sheets are retained for any necessary review.