In a recent study assessing the medication administration practices of school nurses, medication errors emerged as a rising concern among the 649 school nurses who completed the survey for the study, which appeared in the November issue of the Journal of School Health. The nurses, all members of the National Association of School Nurses (NASN), estimated that on a typical school day 5.6% of children receive medication, with 3.3% receiving medications for attention deficit and hyperactivity disorder. Others include non-prescription medications, analgesics, asthma medications, and antiseizure medications. Although over 90% of nurses reported having drug administration guidelines, almost half reported medication errors in their schools in the past year (see Medication Errors in School, at right). FIGURE
The reasons for the errors varied, with the use of unlicensed assistive personnel (UAPs) estimated to be the primary factor-an error was 3.1 times more likely to occur when UAPs were used. Approximately 75% of the nurses in the study reported using UAPs, including secretaries, health aides, teachers, parents, and students. Among other factors contributing to errors were a larger number of students, precarious medication storage, and student self-administration practices.
The researchers noted that school nurses' delegation of medication administration to UAPs is likely due to the increasing number of school children with serious health problems (an estimated 10% to 15% of children have chronic health conditions, and 1% have severe chronic health conditions). And while the NASN recommends a ratio of one registered nurse to 750 school children, the ratio in the United States is estimated to be one nurse to between 1,300 and 1,400 children. The researchers urge the development of national guidelines for medication administration in schools.