CONTACT: DEREK MAURER
Iowa City IA 52242
(319) 335-8964; fax (319) 335-8034
Release: Nov. 30, 2000
More children, more health concerns mean more school medication errors,
UI study finds
IOWA CITY, Iowa -- Nearly half of the school nurses surveyed for a recent
University of Iowa study reported medication errors in their schools in the
past year. The most common error was a missed dose. Also, three quarters of
the nurses reported that unlicensed personnel such as school secretaries,
health aides and teachers dispense medications to students in their school
The findings are contained in a study led by Ann Marie McCarthy, Ph.D.,
associate professor of nursing at the UI, and published in the November issue
of the Journal of School Health. The survey, which was completed by 649 school
nurses throughout the United States, looked at medication administration in
schools, including policies and guidelines governing the dispensing of drugs
to students, the types of medication commonly administered, and which school
personnel were authorized to dispense medications.
Co-investigators of the study were Michael W. Kelly, Pharm. D., assistant
professor (clinical) of pharmacy at the UI, and David Reed, Ph.D., assistant
research scientist at the UI College of Nursing. The project was funded by
Glaxo Wellcome, a pharmaceutical company, and the Midwest Nursing Research
According to the study, school nurses estimated an average of 5.6 percent
of students in grades kindergarten through 12 receive medications on a typical
school day, with the majority -- 3.3 percent -- receiving medication for attention
deficit hyperactivity disorder (ADHD). Other common medications include over-the-counter
medications, analgesics, asthma and anti-seizure medications.
Of the school nurses who reported mistakes in administering medications
to students in the past year, nearly 80 percent said the errors included missed
doses. Other errors included giving an overdose or double dose (22.9 percent),
giving medicines without authorization (20.6 percent), giving the wrong medicine
(20 percent) or unspecified mistakes (29.8 percent).
McCarthy said few if any national studies have looked specifically at the
administration of medications in schools. "The larger context is that
there simply are more children in school with health conditions requiring
medication now than in the past," McCarthy said. "Children with
complex health care needs used to be kept at home or placed in separate classrooms,
but now they are integrated into regular classrooms."
McCarthy also noted the rise in the number of children diagnosed as having
ADHD and being medicated to control it. "That's a relatively recent phenomenon,"
"When you put it all together -- more children, more health problems
and more medications -- there are more opportunities for errors to occur,"
The study used statistical methods to estimate the likelihood that various
factors were related to medication errors in schools. Foremost among them
was the use of so-called "unlicensed assistive personnel" such as
school secretaries, health aides, teachers, parents and even other students
to administer medications to students. Medication errors were 3.1 times more
likely to occur with the use of unlicensed personnel to dispense medications
to students, the study found. Just under
25 percent of the nurses surveyed said they administered all the medications
in their schools.
In schools where unlicensed personnel dispense drugs to students, the individuals
most commonly performing that function were secretaries (66.2 percent), health
aides (39.7 percent), teachers (37.9 percent) and others (37.7 percent), the
survey found. While three quarters of the schools had training programs for
such individuals, the majority of programs were two hours or less in length.
Most of the programs did, however, include information on such topics as oral,
topical and inhalant medications and the use of emergency medications. Most
of the in-service programs also were reviewed at least yearly, according to
McCarthy believes nurses are uncomfortable about how medications are administered
in their schools, particularly the use of unlicensed personnel to dispense
"The response rate to our survey, almost 65 percent, was well above
what we expected, and many of the nurses included medication guidelines and
written comments as well," McCarthy said. "That tells me they're
quite concerned about this issue."
Despite its findings regarding medication errors, the study provides a great
deal of encouragement to nurses, parents, teachers and others, McCarthy said.
"On the whole, we didn't find that children were being overmedicated,"
she said. "The rate at which students are receiving medication in school
is consistent with the prevalence of health conditions requiring pharmacological
management for those age groups."
McCarthy also noted that nearly all the nurses had written guidelines for
administering medications in their schools. More than 93 percent of the school
systems represented in the survey required written orders from a health provider
in order to dispense prescription drugs, and even greater percentages required
authorization from parents to dispense prescription drugs or nonprescription
medications. Almost all the nurses reported they document the dispensing of
drugs to students, including the student's name, the name of the medication,
the dose, the time given and who administered the medication.
"There are a lot of good, solid practices going on," McCarthy
said. "Errors are always a topic of concern, but it's important to remember
they're a relatively small part of the picture."
The wide variance of standards -- both among states and within states --
for medication administration in schools points to the need for national guidelines,
the study concludes.
"As we learn more about how medications actually are administered in
schools throughout the country, we can begin to identify the best practices
and use these to establish standards to improve health and safety for all
students," McCarthy said.