Self-Directed Administration of Medication by WSSB Students (Procedure)

PROCEDURE

Responsibility:  Nurses

Action

1. Decide if student is ready to begin the Novice level of self-directed administra­tion of medication program.
2. Ensure medications accurately reflect written orders of WSSB consulting or family physician.
3. Provide appropriate residential and educational staff with a comprehensive list of students participating in the self-directed medication program and their current level of program participation.
4. Provide appropriate staff with training in program level procedures, monitoring, and proper documentation. If needed, provide the purpose of medication(s) and potential side effects.
5. Complete self-directed medication program criteria form and place in the student’s chart.

LEVEL 1 - BEGINNER

Responsibility:  Nurses

Action

1. Ensure self-directed medication criteria are met and the form is completed and signed by the student and nurse.
2. Instruct students weekly in the Health Center in proper procedures for self-administering medication and required documentation. 
3. Discuss medication purpose and potential adverse reactions with students on an individual basis.  Instruct student in medication identification and labeling techniques.
4. Regularly assess the student to ensure proper procedures are understood and followed by student. 
5. Provide student with appropriately labeled weekly pill container, lockbox, and calendar MAR in the most appropriate format for the student (braille, large print, etc.).
6. Monitor student’s self-directed administration of medication.  Oversee and/or assist with self-directed medication charting, as needed.  Appropriately document on Health Center MAR.

Responsibility:  Nurses/Student

Action

1. Determine a secure location within the Health Center that will be reserved for the student’s lock box. 
2. Choose a combination number for the lock box for the entire year that will be documented on the MAR or choose a safe place for the key to the lockbox.

Responsibility:  Student

Action

1. Take medications as prescribed.
2. Chart on student calendar MAR that medication was taken.
3. Keep lockbox locked at all times.

Responsibility:  WSSB Staff

Action

1. Assist in training the student to go to the Health Center at the correct time. (Staff are not expected to take responsibility for the student medication time but to train the student to take on that responsibility.)
2. Report to the nurse if the student is consistently forgetting medication time without staff reminders.

LEVEL 2 – INTERMEDIATE

Responsibility:  Nurses

Action

1. Document the student’s lockbox location and combo code/key on Health Center MAR.
2. Coordinate a minimum of one to two spot checks per week of lock box to ensure medications are being properly stored and taken. 
3. Documents spot checks and weekly refills on MAR.
4. Determine when student is ready for program Level 3

Responsibility:  Student

Action

1. Obtains key or combination code from Health Center and determines safe place to keep key for entire year.   
2. Takes medication without supervision and completes charting without staff assistance. 
3. Attends weekly medication refills at the Health Center with little or no prompting from staff.  Completes and delivers calendar MAR to Health Center.

Responsibility:  WSSB Staff/Student

Action

1. Determine a secure location in the cottage staff office to store the lock box.  Convey this information to the nurses.

LEVEL 3 – ADVANCED

Responsibility:  Nurses

Action

1. Documents weekly medication refills on the Health Center MAR. 
2. Checks lock box security at a minimum of once a month, student calendar charting, and medication to ensure that the self-directed administration methods are being followed correctly.  Documents the lockbox checks on the Health Center MAR along with any discrepancies or issues. 

Responsibility:  Student

Action

1. Self-administers medications, maintains lock box security, and completes calendar MAR without supervision or assistance.
2. Attends weekly medication refills in the Health Center with no prompting from staff.  Delivers completed calendar MAR to Health Center without prompting.

Responsibility:  WSSB Staff/Student                   

Action

1. Determine a secure location in student’s room to store the lockbox.

Loss of Lock Box Privilege

Responsibility:  Nurses           

Action

1. Reduce or remove lock box privileges.  Reduction or removal will occur if a student is exhibiting behaviors that indicate they are not capable of performing the current level of the self-directed medication program. Reduction of lock box privileges may include but is not limited to: increase in lock box checks, requiring the student to call to verbally confirm that he/she has taken the medication and has charted it appropriately, reducing the number of medications that are self-administered.
2. Document the reason for med box removal or decrease in privileges and follow-up plan.
3. Regularly re-evaluate self-directed medication program participants including their ability to follow through with current level of the self-directed medication program and ability to move to next level.