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Schools need our help in preventing medication errors

April 10, 2006|Valerie Ulene | Special to The Times

Schools are under an incredible strain to simply educate children -- let alone medicate them -- so it's hardly surprising that dispensing drugs at school leads to an alarming number of errors. The surprise is that parents and doctors don't work harder to prevent them.

The laws requiring schools to dispense drugs were designed to protect children with medical problems, such as asthma and diabetes. Such kids wouldn't be safe at school if their medications weren't available.

But a large, and growing, number of children are taking a wide variety of medications, including psychoactive drugs, that frequently have little to do with safety. Instead, the drugs are often prescribed -- at least in part -- to improve attentiveness and concentration and to enhance academic performance.

The resulting burden for schools is enormous. About 5% of children receive medication during a typical school day. Each year, the Los Angeles Unified School District dispenses about 450,000 doses of medications.

Despite strict guidelines, drugs dispensed in the school setting are accompanied by a high rate of errors. In one survey of about 600 school nurses, published in 2000 in the Journal of School Health, almost half reported that medication problems had occurred in their schools during the previous year.

"One of the biggest errors in schools is missed doses," says Ann Marie McCarthy, a professor in the College of Nursing at the University of Iowa who helped conduct the survey.

Also, 11% of the nurses responded that a student had received a higher dosage of medication than he or she should have, and close to 10% said that at least one student had received the wrong medicine.

Some people blame the large number of medication errors on a shortage of school nurses and the schools' reliance on other staff members to administer medications. In the survey conducted by McCarthy, errors were about three times more common when nonmedical personnel dispensed medications.

Although it is clearly the schools' responsibility to develop reliable and safe ways to deliver medications, it is unrealistic -- and unfair -- for them to shoulder the responsibility alone. Parents should not ask the schools to provide nonessential medications. Use of over-the-counter products such as pain relievers and decongestants, for example, should be severely limited. If parents choose to use them, they should be administered before school starts. If a child is unable to get through the day without more medicine, parents need to consider whether the child is too sick to attend school.

When a child requires medication, the child's doctor should select -- whenever possible -- a drug that does not need to be administered in the middle of the day. In some cases, extended-release formulations of the same medicine are available.

Sometimes, of course, children will need medication at school. Then, the child's doctor should provide the school with a written statement authorizing the staff to dispense the medication as well as information about possible side effects. Medication changes should be reported immediately to the school.

Unless a school is directly notified about a change by a physician, a child may continue to get a medication that has been discontinued or school personnel may overlook a switch in dosage.

"Parents really need to understand that there's not a miracle system out there," says Julia Lear, director of the Center for Health and Health Care in Schools, a policy resource center at George Washington University. Considering that many schools seem to be struggling to educate children, they probably shouldn't be counted on to medicate them as well.


Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. She can be reached at

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