Providing Safe Health Care:
The Role of Education Support Professionals

Section 3: Training ESPs to Administer Medication and Perform Health Care Procedures

School support employees care for students with special health care needs in schools every day. More and more, ESPs are asked to administer medication and perform complex health care procedures-procedures like clean intermittent catheterization, gastrostomy feedings, and tracheotomy suctioning. If school districts had unlimited resources, such procedures would be provided only by a licensed nurse. In reality, many districts have growing populations of students with special health care needs and consistent or shrinking resources for staff to care for them. In these settings, ESPs are called on to fill the gap. The safety of students with special health care needs demands that non-medical personnel who are asked to provide health care receive proper training and supervision.

Education Support Professionals who are directed to administer medication and perform complicated health care procedures should-and in some cases must-have a school nurse or other licensed health care provider train them. Training should take place before support personnel administer medication or perform health care procedures.

Curriculum for ESP Training

The curriculum of a thorough training includes:

• The five "rights" of medication administration. Every ESP learns and uses them as a safety checklist when caring for students who take medication. The ESP must identify:
  • The right medication. Is this the correct medication for this child?
  • The right dose. Is this the correct amount of medication for this child?
  • The right time. Is this when the child should receive the medication?
  • The right student. Is this the student who should be given this medication?
  • The right route to administer the medication. Am I using the correct technique for this medication? Should it be administered orally, through injection, as eye or ear drops, or as a suppository?
• The specific needs of individual students. Training includes a focus on the individualized nature of health care. Support personnel learn what to do for each student in their care. This includes becoming familiar with each student's IHP, which provides written guidance for educational support staff in providing health care for students. You should be involved in creating the IHP for each student you will work with.
• How to document medication administration or health care procedures. Keeping written records of health care is essential for students' safety and for your own protection. ESPs learn what forms their district and state require them to complete to keep track of health care provided. This includes training the ESP to look for and record students' specific physical, behavioral, or medical changes.
• Proper protocol for emergencies. ESPs learn what steps to take to ensure that a child in the midst of a medical emergency receives appropriate care. ESPs must know protocol for their schools and districts, including what situations call for emergency assistance and who seeks such aid. In addition, ESPs must become familiar with each student's medical protocol list, so they can notify the appropriate people in order of importance.
• How to store medication. Medication must be stored in the original, properly labeled pharmacy containers, which must be kept in a locked cabinet or refrigerator for safety. Local pharmacists can provide helpful guidance in setting up proper storage, often free of charge.
• Information about legal issues affecting ESPs who provide health care. This includes information about:
  • Sexual harassment laws that might pertain to specific health care procedures. For example, it would be unwise for an ESP to perform certain procedures without a witness.
  • Liability. (See above.)
  • What to do when ordered to perform a service if it endangers the student. (See above.)
  • Confidentiality. ESPs must be trained to follow FERPA (Family Educational Rights and Privacy Act) guidelines so that students' medical conditions remain confidential. (See above.)
  • Chain of command. ESPs must know who is responsible for each aspect of a student's health and education plans, and to whom they should report for guidance and supervision. This is important to each of the members of a student's education and health team. (See Section 2.)

Conditions for ESP Training

To be most effective, training should ensure that procedures are learned adequately for children's safety, and take place in conditions that facilitate learning.

• Training should be offered in an environment and at a time when trainees are free from other job assignments and can concentrate on what they are learning without the usual day-to-day distractions. Five minutes of training in the middle of a hectic day-"Here's the medication, this is what it does, and here's what to do."-is never acceptable when dealing with the safety of students. Once trainees learn the procedures, they should demonstrate the procedures back to a licensed health professional for documented approval to perform the procedure on students. Then the trainer should observe the ESP performing the procedure on a student.
• Training should be provided before an ESP administers medication or performs health care procedures. The trainer should observe the ESP demonstrating the procedure before documenting in writing that he or she is ready to work with a student.
• Training should be paid for by the school district.
• Training should be documented, and the ESP should have the option of receiving credit (Continuing Education Units) for it.

Context for ESP Training

A thorough training will only lead to safe health care in a context that includes:

• Communication among all members of a student's educational team. The ESP is a valuable contributor to the medically fragile student's education, and the student benefits when the ESP, school nurse, special education teacher, regular classroom teacher, parents and administrators all work together. (See Section 2.))
• Knowledge that providing health care is a requirement of many school support jobs. Employers should make an employee's job expectations clear upon hiring. If special training is above and beyond the duties of the currently employed ESP, the school district and the local Association should consider a new job classification.
• Appropriate matching of ESP to student and health care procedures. The IEP team must make thoughtful decisions about which school employees should work with which student. ESP should advocate to be part of the decision-making process, and matching should be done with particular attention to age and gender appropriateness.
• Establishment of a back-up list of care providers. The school nurse or licensed health care provider should determine who will administer medication or perform health care procedures if the ESP (or other principal provider) is, for some reason, unavailable. Trained back-ups can help to ensure a student's safety.
• Ongoing supervision and training updates. After the training, the school nurse should be available to supervise the support employee and answer any questions or concerns that come up in the course of caring for students with special health care needs. He or she should also provide additional training should new medication or health care procedures be introduced.

When ESPs are trained-with this curriculum, under these conditions, and in this context-they can do their job well, and ensure student safety. As an unlicensed employee, you should get orders only from a licensed health care provider. Any administrator who directs you to administer medication or perform health care procedures without training is practicing nursing without a license and could be fined. The training described in this section is ideal. Establishing such a training provides an excellent goal when you take action!

To Section 4