Elementary School Secretaries' Experiences and Perceptions of Administering Prescription Medication
Price, James H., Dake, Joseph A., Murnan, Judy, Telljohann, Susan K., Journal of School Health
Children attending school often require prescription medication either as part of an acute illness (episodic care) or for chronic illnesses (long-term basis). A study of stimulant medication at two Virginia school districts found that between 8% and 10% of second- through fifth-grade students were taking such medications. (1) A survey in Maryland reported that 3.7% of public elementary school children took stimulant medication. (2) An article in the Chicago Tribune in 1998 claimed that 3% to 5% of students in Illinois schools received some form of medication, and a national survey of school nurses found an average of 5.6% of children received medication at school during a typical day. (3) Such a prevalence of medication use at school by children requires an accurate understanding of school medication policies, experiences of school personnel administering children's medication, and medication training needs of school personnel. (4)
Administration and management of medication in the public schools by school personnel can be problematic. (5) The right drug in the right amount must be given to the right student at the right time. (6) School nurses are the primary health professionals who manage student health and the administration, tracking, and storage of children's prescription medication. (7) However, decreasing budgets for school systems often mean that school health services, and thus school nurses, are not seen as a primary mission of schools. Thus, while it might be ideal for all prescription medication to be given in schools by school nurses, this likely will not happen nationally in the foreseeable future. School nurses are usually limited in numbers, and often given the responsibility to cover more than one school. This approach results in a high nurse-to-student ratio, which makes it impossible for school nurses to meet all the medication administration needs of students. (8)
Limited school expenditures for school nursing services has resulted in unlicensed assistive personnel (principals, teachers, secretaries) being delegated the task of dispensing medication. (9) The School Health Policies and Programs Study (SHPPS) found that 92% of states, 94% of school districts, and 97% of schools allowed school faculty and staff to administer prescription medication to students as long as it was properly documented. (10) Use of unlicensed personnel has created concern over student well-being and legal ramifications should errors occur in administration of medication. (11,12) While state nursing regulations permit delegation of nursing tasks to personnel trained under certain guidelines, this process remains controversial. (13,14) A national study of medication practices among school nurses found that 75.6% of nurses delegated medication administration to other school personnel, with school secretaries the most common (66%) group taking that responsibility. (9)
To date, no one has published a study on school secretaries' concerns and experiences administering student prescription medication. This study assessed a national random sample of elementary school secretaries regarding their experiences and perceptions with prescription medication. The survey offers further insight regarding whether such delegation compromises health care received by elementary school children.
Potential participants were selected from the complete list of US public schools (n = 96,570) available from the US Department of Education. (14) The list initially was refined to include only schools located within the 50 United States, classified as regular schools, and with traditional elementary school grades (pre-K, K, or grade 1 through grades 5 or 6). The list was further refined by eliminating the upper and lower extremes (+/- 2 standard deviations from the mean) regarding school size. The final result was a potential population of 35,160 from which a sample of 600 schools was randomly selected. …