Administering Medication to Students
NEPN/NSBA Code: JLCD
The School Committee acknowledges that in certain circumstances it may be necessary for a student to have medication administered while in attendance at school. The school committee discourages administration of medication on school premises when other options exist. Whenever possible, it is recommended that the first dose of a newly-prescribed medication be given at home. The school will not deny educational opportunities to students requiring the administration of medication in order to remain in attendance and participate in the educational program.
The intent of this policy is to promote the safe administration of medications (including emergency/rescue medications) to students by school personnel and to provide for authorization of student emergency self-administration of medication from asthma inhalers and epinephrine autoinjectors.
This policy does not apply to medical marijuana, which is addressed in the School Committee’s policy JLCDA, Medical Marijuana in Schools.
This policy authorizes the adoption of a collaborative practice agreement for the purposes of stocking and administration of epinephrine autoinjectors by the school nurse or designated trained school personnel to any student during school or a school-sponsored activity under emergency circumstances involving anaphylaxis.
This policy also authorizes the adoption of a collaborative practice agreement to provide for the possession and administration of naloxone hydrochloride or other noninjectable opioid overdose-reversing medication by the school nurse or designated trained school personnel to students, staff, or visitors during school or a school-sponsored activity or otherwise on school grounds in emergency circumstances involving an opioid overdose or apparent opioid overdose.
The School Committee encourages collaboration between parents/guardians and the schools in matters involving student medication.
The School Committee disclaims any and all responsibility for the diagnosis, prescription of treatment, and administration of medication for any student, and for any injury arising from a student’s self-administration of medication.
This policy authorizes the school unit and its schools to obtain a standing order for undesignated ready-to-use glucagon rescue therapies and permits the school nurse or designated trained unlicensed school personnel to administer glucagon rescue therapy to a student with a known diagnosis of diabetes if the student’s prescribed glucagon is not available on-site or has expired. The glucagon must be stored in a secure location, immediately accessible to the school nurse and designated trained unlicensed school personnel, and maintained according to the manufacturer’s instructions.
I. DEFINITIONS
“Administration” means the provision of prescribed medication to a student or other persons according to the orders of a health care provider.
“Collaborative practice agreement” means a written and signed agreement between a physician licensed in Maine or a school health advisor, as defined in 20-A MRSA §6402-A, and a school nurse that provides for the prescription of epinephrine autoinjectors by the physician or school health advisor and administration of epinephrine injectors by the school nurse or designated school personnel to students during school or a school-sponsored activity under emergency circumstances involving anaphylaxis; or as defined in 20-A MRSA § 6307 that provides for the prescription of naloxone by the physician or school health advisor and the administration of naloxone by the school nurse or designated school personnel to students, staff, or visitors during school or a school-sponsored activity or otherwise on school grounds under emergency circumstances involving an opioid overdose or apparent opioid overdose.
“Designated school personnel” are unlicensed school personnel who have completed such training in administration of medication as may be required by Maine statutes or DOE rules and who have been authorized by the school nurse to administer medication.
“Diabetes Care plan” means an individual health plan document that specifies the diabetes-related services needed by a student at school and at school-sponsored activities and which may include an emergency action plan.
“Emergency action plan” means a document that provides guidelines to prepare school personnel to respond to a serious life-threatening injury or medical emergency.
“Health care provider” means a medical/health practitioner who has a current license in the State of Maine with a scope of practice that includes prescribing medication.
“Indirect supervision” means the supervision of an unlicensed school staff member when the school nurse or other health care provider is not physically available on site but immediately available by telephone.
“Medication” means prescribed drugs and medical devices that are controlled by the U.S. Food and Drug Administration and are ordered by a health care provider. It includes over-the-counter medications prescribed through a standing order by the school physician or prescribed by the student’s health care provider. For the purpose of this policy, “medication” includes epinephrine, naloxone hydrochloride and other noninjectable opioid overdose-reversing medications, and glucagon, but does not include medical marijuana.
“Parent” means a natural or adoptive parent, a guardian, or a person acting as a parent of a child with legal responsibility for the child’s welfare.
“School nurse” means a registered professional nurse with Maine Department of Education certification for school nursing.
“Self-administration” is when the student administers medication independently to him/herself under indirect supervision of the school nurse.
“Standing order” is an order written by a health care provider (as defined in this policy) for the entire population of students or subset thereof rather than written for a specific named individual.
“Undesignated ready to-use glucagon rescue therapy” means a USDA-approved glucagon rescue therapy that does not require reconstitution for the treatment of severe hypoglycemia, in a dosage form that can be rapidly administered in an emergency, including prefilled injectable or nasally administered glucagon.
“Unlicensed school personnel” are persons who do not have a professional license that allows them, within the scope of that license, to administer medication.
II. ADMINISTRATION OF MEDICATION BY SCHOOL PERSONNEL
A. Parental Request
In the event that no reasonable alternative exists, the parent/guardian may request in writing that medication be administered to the student during the school day. The written request must include an acknowledgment and agreement that unlicensed personnel may administer the medication as per the health care provider’s instructions. In addition, the request shall indicate that information regarding the student’s medication may be shared with appropriate school personnel. Parents may provide the reason (diagnosis) requiring the administration of medication. Requests shall be valid for the current school year only.
B. Health Care Provider’s Order
All parental requests must be accompanied by a written order from the student’s health care provider substantiating the fact that the administration of a particular medication during the school day is necessary for the student’s health and attendance in school. Such order must include:
1. The student’s name;
2. The name of the medication;
3. The dose;
4. The route of administration (e.g., tablets, liquid, drops); and
5. Time intervals for administration (e.g., every four hours, before meals);
6. Any special instructions; and
7. The name of the prescribing health care provider.
It is the responsibility of the school nurse to clarify any medication order that they believe to be inappropriate or ambiguous. In accordance with Department of Education Rule Chapter 40 § 2(B), the school nurse may decline to administer a medication if he/she believes such administration would jeopardize student safety. In this case, the school nurse must notify the parent, the student’s health care provider and the school administrator (i.e., building principal or designated administrator).
C. Renewal of Parent Permission Requests/Forms and Health Care Provider Orders
Written parental permission requests/forms and health care provider orders must be renewed at least annually. Healthcare provider orders must be renewed whenever there are changes in the order.
D. Delivery and Storage of Medication
The student’s parents shall deliver any medication to be administered by school personnel to the school in its original container and properly labeled. In the event that this is not practical, the parent must contact the school to make alternate arrangements.
No more than a 20-day (one-month) supply of medication shall be kept at school, excluding inhalers and epinephrine autoinjectors. The parent is responsible for the replenishment of medication kept at school.
If the health care provider’s order/prescription is for a medication regulated by Schedule II of the Controlled Substances Act (21 USC §812) (e.g., Ritalin and Adderall) no more than a twenty (20) days’ supply shall be kept at school.
The parent is responsible for notifying the school of any changes in or discontinuation of a prescribed medication that is being administered to the student at school. The parent must remove any medication no longer required or that remains at the end of the school year. Remaining medication may be discarded.
The school nurse shall be responsible for developing and implementing procedures for the appropriate and secure storage of medications kept at school, and all medications shall be stored in accordance with this procedure.
E. Recordkeeping
School personnel and the student’s parent shall account for all medication brought to school. The number of capsules, pills or tablets, and/or the volume of other medications brought to school shall be recorded.
School staff administering medication shall document each instance the medication is administered including the date, time, and dosage given.
The school nurse shall maintain a record including the parent’s request, physician’s order, details of the specific medications (including dosage and timing of medication), and documentation of each instance the medication is administered.
Records shall be retained according to the current State schedules pertaining to student health records.
F. Confidentiality
To the extent legally permissible, staff members may be provided with such information regarding medication and its administration as may be in the best interest of the student.
G. Administration of Medication
Medication may be administered during the school day by licensed medical personnel acting within the scope of their licenses.
The school nurse, under the administrative supervision of the Superintendent, will provide direction and oversight for the administration of medication to students.
All unlicensed personnel (principals, teachers, education technicians, school secretaries, coaches, bus drivers, etc.) who administer medication must receive training before being authorized to do so.
Based upon the documentation of training and competency in the administration of medication, the school nurse will make recommendations to the Superintendent/designee pertaining to authorization of unlicensed persons to administer medication. Training that shall be acceptable for the purpose of authorization of unlicensed personnel is addressed under the section of this policy titled “Required Training of Unlicensed Personnel to Administer Medication.”
H. Administration of Medication During Off-Campus Field Trips and School-Sponsored Events
The school will accommodate students requiring administration of medication during field trips or school-sponsored events as follows:
The school nurse, principal, and, as appropriate, the school unit’s Section 504 Coordinator and/or IEP, will determine whether an individual student’s participation is contraindicated due to the unstable/fragile nature of his/her health condition, the distance from emergency care that may be required, and/or other extraordinary circumstances. The student’s parent and primary care provider will be consulted in making this determination. The decision will be made in compliance with applicable laws, including the IDEA, § 504 and the Americans with Disabilities Act (ADA).
The parent must provide the appropriate number of doses needed for the duration of the field trip or school-sponsored event.
When there are no contraindications to student participation, an appropriately trained staff member will be assigned to administer medication. The parent will be encouraged to accompa