Approximately 27% of the 52 million K-12 school-age children (5-18 years) in the United
States experience at least one chronic medical condition (CCMC) requiring them to receive
medication during the school day. Adherence to the medications and their scheduled dosing is
crucial for the CCMC’s health and academic progress. However, primary schools are an
understudied community healthcare setting with school nurses (SNs) as the main healthcare
provider. Widespread budgetary cuts have left 18% of schools across the nation with no
designated SN,2,6 leaving the vast majority (78%) of medication administrations to unlicensed
assistive personnel (UAP). Because these individuals are not healthcare providers, medication
errors are three times higher when administered by UAP than by a SN. To reduce medication
errors in schools, we propose a technology-assisted system to help SNs and UAP with
medication administration and documentation. Our proposed computer-based system, the
Electronic School Medication Administration Record (eSMAR). Our system prototype was tried
in simulated environment. Therefore, the purpose of this demonstration project is to implement
eSMAR in a real-world setting (grade schools) and to evaluate the usability and effectiveness of
eSMAR on medication administration and documentation in schools.
Aim 1: Implement and evaluate the usability of eSMAR in a select sample of K-12 schools
in the Iowa City Community School District (ICCSD).
We will achieve this aim by analyzing data from a) usability surveys from SNs and UAP, b)
eSMAR system usage reports, c) observation, filed notes, and semi-structured interviews during
site visits, and c) parent satisfaction survey.
Aim 2: Understand contextual factors influencing eSMAR implementation.
We will achieve this aim by conducting site visits using rapid ethnographic assessment (REA).
Consolidated Framework for Implementation Research (CFIR) and EPIS domains will inform the
development of the REA measures. Data from Aims 1&2 will be triangulated to deepen our
understanding of contextual variables influencing eSMAR implementation.
Aim 3: Evaluate the effectiveness of eSMAR (number of errors intercepted).
We will achieve this aim by analyzing data from the eSMAR reports for the number, type, and
frequency of errors intercepted by eSMAR. We will compare data on users (SNs vs. UAP), type
of medication, time, medical condition, child’s age and grade level. Data from ICCSD incident
reports will be collected to identify types of errors not prevented by the eSMAR system.
