A = Within Scope of <strong>Practice</strong>S = Within Scope of <strong>Practice</strong> with supervisionD = Delegated task with supervisionEM = In emergenciesX = Cannot performProcedureNURSING TASKSProvider OrderRequiredProvider = Person w/legal authority to prescribe – M.D.,APN with prescriptive authority, Dentist, PhysicianAssistant with prescriptive authority, etc.RNLPN/ LPTNUnlicensed AssistivePersonnel6.2 Percussion Yes A S D X6.3 Suctioning6.3.1 Pharyngeal Yes A S D X6.3.2 Tracheostomy Yes A S D X6.4 Tracheostomy Tube Replacement Yes A EM EM EM6.5 Tracheostomy Care (clean/dress) Yes A S D X7.0 Screenings7.1 Growth (height/weight) A S D S7.2 Vital Signs A A S X7.3 Hearing A S D X7.4 Vision A S X X7.5 Scoliosis A S D X8.0 Specimen Collecting/Testing8.1 Blood Glucose Yes A S D S8.2 Urine Glucose/Ketone Yes A S D S9.0 Other Healthcare Procedures9.1 Seizure Safety Procedures A S D X9.2 Pressure Ulcer Care Yes A S D X9.3 Dressings, Sterile A S D X9.4 Dressings, Non-sterile A S D S9.5 Vagal Nerve Stimulator Yes A S D X10.0 Developing Protocols10.1 Healthcare Procedures A X X X10.2 Emergency Protocols A X X X10.3 Individualized Healthcare Plan A X X XSelfRN Scope of <strong>Practice</strong>: The delivery ofhealth care services which requireassessment, diagnosis, planning,intervention, <strong>and</strong> evaluation.LPN Scope of <strong>Practice</strong>: The delivery ofhealth care services which are performedunder the direction of the professionalnurse, licensed physician, or licenseddentist, including observation,intervention <strong>and</strong> evaluation.21
Medication AdministrationThe Delegation Chapter of the Arkansas State Board of Nursing Rules <strong>and</strong> Regulations lists medicationadministration as a task that shall not be delegated to unlicensed persons. It is recognized that in the school,camp, day care center <strong>and</strong> juvenile detention center settings, the patient/client condition is generally stable, onroutine or occasional as needed medications <strong>and</strong> the parent would medicate them in the same manner, if theparent were present. The licensed school nurse is responsible for the administration of medications. Duringtimes when the school nurse is not present, the administration of medications may be delegated to personsidentified in the table for delegating specific tasks. A provider order <strong>and</strong>/or written permission from theparent/guardian must be on file for all medications administered “in loco parentis,” in the place of the parent.The licensed nurse is responsible for identifying qualified persons to be trained to administer medicationsin the nurse’s absence. After training <strong>and</strong> documentation of the unlicensed person’s competency,administering medications may be delegated as indicated in the nursing task chart <strong>and</strong> following the Principle’sof Delegation <strong>and</strong> the Five Rights of DelegationEach facility (school, camp, day care center, juvenile detention center, etc.) shall have a written policyregarding the administration of medication. The policy should include at least the following:• A provider order is required for all prescription medications. A label on a prescription bottle may serveas the prescription, if acceptable to the facility.• Written parental permission is on file for all over the counter medications that are to be taken by theminor. Permission slips may be time limited, such as, the school year, a semester, one month, or oneweek, depending on the governing body policy.• All medications must be in the original container.• The container must specify special storage instructions if appropriate (insulin needs to be refrigerated.)• Prescription medications are to be labeled with the student’s legal name (on record with the facility),date Rx was filled, ordering provider name, name of medication, dose, route, <strong>and</strong> frequency.• All medications will be given according to labeling directions on the container. Deviations from labeldirections will require a written provider order.• Procedure for administering <strong>and</strong> documenting medications during field trips <strong>and</strong> extra curricularactivities.• Documentation methods for the receipt of medication <strong>and</strong> the administration of medication.• Methods by which nurse will receive medication e.g., students may bring medication in with writtenauthorization from parent/guardian or parent is required to deliver medication to the school nurse.• Storage <strong>and</strong> security of medications.• Access to medications in the absence of the school nurse.• Accountability methods for controlled substances.• Arkansas Department of Health – Pharmacy Services Rules requires controlled substances be kept underdouble locks.• <strong>Nurse</strong>s must establish a counting system to document the number of doses of a controlled substancebrought to the school, such as counting the number of doses at the time they are delivered by the parentor student in the presence of the parent or student. Both must document the number delivered to theschool. A count should be done periodically to verify the medication can be accounted for bydocumentation <strong>and</strong> the number on h<strong>and</strong> for the specific student. Access to controlled substances is to belimited to as few personnel as possible. When possible the licensed nurse is to access <strong>and</strong> administercontrolled substances.22
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