Managing, Monitoring, and Administering Medications at Camp

by Mary Marugg, RN

The phrase “medications at camp” brings to mind different scenes for different individuals. Camp nurses may remember a favorite camper clutching a Ziplock bag (the gallon size!) packed full of asthma medications, on opening day. Parents may envision a pharmacy stocked with rows of bottles: pills ready to be dispensed to their child for this ache or that pain. A trip leader may recall a first aid kit containing over-the-counter remedies for headaches and blisters. Each is a valid scenario, evidence of different aspects of medications at camp.

When addressing the subject of medications, remember that this term includes prescription medications such as antibiotics and asthma inhalers, as well as over-the-counter drugs such as Tylenol® or Advil®, vitamins, and homeopathic remedies.

Managing medications at camp usually indicates a wide scope of practice, to include:

  • Communicating with parents before a camper arrives, regarding medications
    and/or over-the-counter remedies being sent to camp. This may include
    gathering specific written permission to administer over-the-counter treatments
    for common ailments.
  • Anticipating medication needs of campers and staff and making decisions (in collaboration with the camp’s physician advisor) regarding what medications
    should be stocked at camp.
  • Coordinating with the camp's advising physician to have written guidelines
    in place for dispensing all medications at camp, to include over-the-counter medications. If campers bring medications from home, written instructions 
    should be on the health form.
  • During opening day screening, processing medications (both prescription and over-the-counter drugs) brought to camp with campers or staff. This would
    include at least:

    – verifying the information provided about the medication(s) by physician and  
       parents, including how long the individual has been on this medication, at
       this specific dose. (Note: See the Winter 2000 issue of The CampLine for 
       information on emotional disorders and psychotropic medications.)
    – assessing the individual’s knowledge of his/her medication.
    – checking that the number/ amount of medication is sufficient for the entire
       stay at camp.
    – confirming storage instructions, such as refrigeration or exposure to light.
    – documenting medications turned in to the health care provider.
    – documenting any limited amounts of medication for life-threatening conditions
       that may stay with campers or staff (e.g., bee sting kits, inhalers).

     

  • Storing medications in a controlled area, to comply with ACA and state 
    regulations.
  • Informing appropriate staff of medication needs of campers for whom they
    are responsible.
  • Administering routine medications to campers and staff, or delegating 
    (and supervising) this responsibility.
  • Assessing each camper and staff when they have a health concern (such as a headache or cough), making decisions regarding over-the-counter medications
    or prescription medications that are to be given on an as needed basis.
  • Documenting medication administration – both routine and as needed.
  • Monitoring and documenting the therapeutic effect of the medication.

Who should manage medication in camp?

The credential an individual must hold to manage medications at camp is state specific. Medication management decisions are influenced by pharmacy regulations, the State’s Nurse Practice Act, the physician’s regulatory body and/or regulations for ancillary healthcare providers (e.g. EMT’s) used by the camp. Usually a physician is the only one who can determine what medication is to be used, and under what circumstances. A physician can delegate medication decision-making to a registered nurse through medical protocols.

Camps without a physician or RN on site should have health care policies and procedures, reviewed by a physician or registered nurse, that specify medication management procedures consistent with the level of training of the health care provider. Treatment procedures, including use of over-the-counter remedies for common illnesses and injuries, must be reviewed annually by a licensed physician.

Administering Medications

Administering individual doses of medications to staff and campers is a more specific skill. “Giving a medication” may be done by an individual who has been delegated by the credentialed health care provider (usually a registered nurse) who is managing the medications. Again, some states specify to whom this task may be delegated. The task of “giving a medication” does not include making medication decisions.

Recognizing that an RN or physician will not be with all the campers all the time to administer individual doses of medication, some states are implementing Medication Administration courses. Frequently written and/or approved by the state’s Board of Nursing, these are short courses (often four to eight hours in length) covering the basics of administering medications. They are not courses for managing medications, or making medication decisions, but rather courses covering the basics of administering a medication properly.

In states that are implementing medication administration courses, camps are impacted, as this includes any circumstance where the nurse is not available. Potentially, a camp nurse may not be available to campers for: day activities on a remote area of the camp property, overnights, out of camp activities or trips, or times when the nurse is busy with a health care emergency with other campers or staff. In these circumstances, it is appropriate for a nurse to delegate an individual with training to administer a single dose of medication at a specific time.

Monitoring Medications

The nurse should retain the assessment and decision-making regarding the medication, and monitoring the therapeutic effect of the medication. Ancillary staff may collect data, but it is the RN’s task to make decisions on what the information indicates.

Camps utilizing RN’s to manage medications should be on the right track to complying with state regulations. Part of the job of “managing camp health” should be to explore and understand regulations which impact camps regarding medications.

As the number of campers with medication continues to rise, all camps must be sure that procedures are in place to be sure that staff are appropriately trained and supported. The system must define roles and responsibilities, and assure that any individual administering a medication has some basic knowledge of safe medication management.

References
Ebner Erceg, L. (1999). Medication Management, CompassPoint, 9, (3), 5-8.

Lishner, K.M., & Bruya, M.A. (1994). Creating a healthy camp community: A nurses role.  
   Martinsville, IN: American Camping Association.

Teems, B. (1997). Medical Screening and Admissions in the Nineties. Wilderness Risk
   Managers   Conference Proceedings. 53-54.

 

Originally published in the 2000 Spring issue of The CampLine.
 

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