Background
Medications are often stored and administered in a variety of non-health care settings. These settings include:
- Elementary and secondary schools
- Elementary and secondary schools
- Higher education student health centers
- Corporate office “clinics”
- Child day care centers
- Summer camps
- Adult day service centers (adult day care)
- Group homes for the disabled
- Assisted living/Residential care
- Board and care homes
- Institution correctional facilities (e.g., jail, prison, or youth detention facility)
In these settings, employees frequently are responsible for handling and administering prescription and over-the-counter medications to clients or residents. Some organizations may employ licensed health professionals to directly manage the medication administration process. However, many of these settings have no licensed health professionals involved.
Anecdotal reports and results of state licensure surveys indicate that medication errors can be a significant problem in these settings. In the absence of licensed health professionals, and without adequate training for personnel involved in managing or administering medications in these settings, medication errors often go undetected or unreported.
Without adequate safeguards and supervision, medications can present significant risks including:
- Medication errors. Medication errors may result if doses of medication are omitted, if medications are administered to the wrong person, or if the wrong medication or dose is provided.
- Medication diversion. Controlled medications (e.g., Ritalin, morphine) may be stolen or diverted if there is a lack of secured storage and/or accountability.
- Medication administration of expired drugs. Medications are given that outdated, due in part to a failure to have systems in place to inventory on a routine basis.
Settings in which these activities are conducted often are regulated and/or licensed by the state in which they are located, but those requirements and oversight vary substantially from state to state.
Recommendations
These recommendations apply to non-health care settings regardless of whether licensed health professionals are involved in managing medications. Staff should comply with existing state laws and use these recommendations as supplemental guidance, as appropriate.
In these non-health care settings, the Council has developed these recommendations as guidance to non-health care settings to help ensure protection of clients, residents, and others who depend on assistance for medication management and include the following:
- Where medications are stored and administered to individuals, policies and procedures should address the following:
- Medication Management
- Acquisition of medications (e.g., from parents, caregivers, pharmacies)
- Routine, consistent processes for inventory of stored medications (e.g., to validate expiration dates)
- Disposition of medications that are no longer needed or in use
- Specification of which personnel are allowed access to medications and allowed to administer medications to students, clients or residents
- Labeling and packaging of medications managed for students, clients or residents
- Medication Storage
- Storage of medications, including medications that may require refrigeration, and back-up systems should a power outage or refrigeration failure occur when the setting is not occupied (e.g., a weekend when an office may be closed)
- Secure storage for all drugs to prevent tampering and access by those not allowed with lock and key or password (especially in group homes) and accountability of controlled substances
- Limitations on the type(s) of medications permissible for use or storage in the organization
- Medication Administration
- Establish policies/procedures to ensure proper use (e.g., give with food, insulin pen devices, split tablets, open capsules, etc.)
- Processes are in place to minimize distractions within the medication area and during administration
- Administration of medications (including double-checking by another staff person when feasible)
- Medication Documentation
- Documentation of medication order from licensed practitioner when applicable
- Documentation of medication administration
- Documentation and reporting of medication errors and adverse drug reactions
- Medication Management
- Where medications are stored and administered, training should be provided to personnel with responsibilities related to medication management. The training should correspond to the written policies and procedures, and the person's scope of duties associated with medications.
- Establish a standardized training curriculum for staff on how to safely administer drugs including emergency care scenarios that includes competency evaluation and future revaluation.1
- Maintain medication records that include the patient’s personal info (e.g., allergies) list of prescription and nonprescription medications and dietary supplements (including strength, dosing, frequency, dosage form, etc.), and list of known and/or commonly reported side effects associated with the medication.
- Where controlled medications are stored and/or administered, safeguards should be in place to prevent and detect theft and diversion of controlled drugs.
- When a medication error occurs, evaluate possible causes in order to improve the facility's system for medication management, staff education, and to prevent future errors.
- Encourage the reporting of medication errors and associated investigations to the reasons for the errors to appropriate state and national medication error reporting programs. These medication error reports may be used to educate others why errors are occurring and how to prevent similar errors.
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