Medication Management in Minnesota schools: A Unique Partnership Opportunity

Brittany Thelemann, PharmD, New Ulm Medical Center

Background: In 2012, nearly 10 million children nationwide experienced a health problem that required a prescription medication for at least 3 months. Ideally, these prescriptions would be managed at home (e.g. before and after school). However, a large responsibility falls on school nurses when medications are required to be administered during the school day. The National Center for Health Statistics reported that selected prescription drug classes used in the past 30 days for those younger than 18 years from 2009 to 2012 included: bronchodilators, leukotriene modifiers, respiratory inhalant products, psychostimulants, and antidepressants. School nurses are responsible for increasingly complex medication management (MM) and administration in schools.

Objectives: The purpose of this study was to assess the MM needs of school nurses in Minnesota and determine if opportunity exists for collaboration between nurses and pharmacists to optimize MM for students.

Methods: The University of Minnesota (UMN) College of Pharmacy researchers partnered with the School Nurses Organization of Minnesota (SNOM) and the Minnesota Department of Health to conduct a 32-item online survey. The survey was created with the use of the Qualtrics system sponsored by UMN and consisted of the following question types: demographic, yes or no, rank order, open-ended, and defined selection options. A link to the online survey was distributed to the SNOM listserv via email. The email is estimated to have reached 200 SNOM members. Respondents received a gift card for participation.

Results: A total of 155 survey responses (77% response rate, estimated) were submitted. Minnesota nurses administered the majority of medications at their school (70%) compared with unlicensed assistive personnel (29%). Similar to national statistics, stimulants (38%) and asthma medications (26%) were the most common classes of medications administered in Minnesota schools; others included over-the-counter analgesics (18%) and insulin (7%).

The top MM concerns included 1) availability of students' medications and required documentation, 2) health literacy, 3) pharmacist consultations, 4) lack of time available for nurses to follow up with and evaluate students, 5) family-centered care, 6) delegation, 7) communication, and 8) professional development. The main barriers identified included delayed ordering or transport; missing prescriber or parent documentation; lack of care coordination among multiple providers; and lost, stolen, or diverted medications from students transporting medication to school.

Most of the nurses expressed interest in interprofessional partnerships with pharmacists: 90% reported that a pharmacist could assist them with MM, 80% would consult with a pharmacist if one were available, and 12% had informal access to a pharmacist. Topics that nurses anticipated discussing with a pharmacist included new medications (72%), drug-drug interactions (67%), proper administration (52%), and storage (39%). However, nurses emphasized a need for better understanding among pharmacists of school nurse practice and the potential benefits of interprofessional MM.

Conclusion: While a clear majority of school nurses were interested in partnering with pharmacists to improve school MM, few had an established collaboration to do so. Results from this study indicate opportunity exists for collaboration between school nurses and pharmacists. Interprofessional partnerships focused on MM and education were the most requested pharmacy services by school nurses. While the results from this study were helpful, the authors discussed the need for future studies to incorporate the survey results into practice. 

References:

  1. Weller L, Fredrickson DD, Burbach C, Molgaard CA, Ngong L. Chronic disease medication administration rates in a public school system. J Sch Health. 2004;74(5):161e165.

  2. Little MM, Eischens S, Martin MJ, et al. Medication management in Minnesota schools: The need for school nurse-pharmacist partnerships. J Am Pharm Assoc. 2018;58(1):67-72.e1.