5330.02 Medication Administration Procedures

Authorization for School Personnel to Administer Medication to Students

The Building Principal, in consultation with the Director of Pupil Services, shall designate, in writing, the names of appropriate school personnel (including employees, registered nurses serving the district, volunteers and/or licensed school bus drivers) who will have the authority to administer medications to students in a manner consistent with all relevant policies and procedures.

• The principal may make a general designation of authority (1) for any registered nurse serving the District to administer any medication by any means permitted within the scope of the individual’s nursing license; and (2) for other school personnel, in conjunction with the school nurse, to administer medication via ingestion, eye drops, ear drops, topical application, an inhaler, and/or an epinephrine auto-injector, provided that the individual has completed any applicable state-mandated training. Nothing in this paragraph prevents, in certain cases, a principal or registered nurse serving the schools from expressly limiting the personnel who will have authority to administer particular medication to a particular student.
• In the event any school personnel other than a registered nurse will be asked to administer other medication to students not covered by a general designation under the previous paragraph, the principal shall make case-by-case determinations of the school personnel who will have the authority to administer such medications, and ensure that such personnel have completed applicable state-mandated training. A registered nurse serving the school or other health care professional shall assist the principal in ensuring that such personnel receive any additional instruction, support and supervision as may be appropriate. School personnel should complete the knowledge portion of the medication administration training for required routes (non-oral) at least every four years and more frequently if needed as provided on the DPI website. Skill training for the required routes of administration must occur at initiation of the medication assignment and should be repeated annually. This training is provided by the district. Upon completion of the SPI-approved training, the school employee shall submit the certificate of completion to the school nurse. The school nurse will forward the certificate to the District office for filing in staff personnel files. Nothing in this paragraph prevents, in certain cases, a principal or registered nurse serving the schools from expressly limiting the personnel who will have authority to administer particular medication to a particular student.
• No school personnel, other than a health care professional, shall be involuntarily required to administer medication to students by any means other than ingestion. However, a registered nurse serving the school must decline to perform any medical act or service which the nurse is not competent to perform due to lack of education, training or experience.
• If a student requires assistance from school personnel in the administration of any medication or through any means that constitutes the delegation of a nursing act, as defined under applicable state law and regulations, the registered nurse delegating the act shall ensure that all applicable nursing standards regarding training, instruction, supervision, and assessment have been met.
• Students requiring medication to be administered by school personnel shall be identified by their parents or guardians to the school nurse. Adult students may self-identify their needs to the principal.

Administration of Prescription Medication

Authorized school personnel will administer a prescription drug to a student only if all of the following conditions are met:

• The school has received written consent from the student’s parent(s) or guardian(s) for designated school personnel to administer medication to the student in the dosage prescribed by the health care practitioner. “Health care practitioner” is defined as any physician, dentist, optometrist, physician assistant, advanced practice nurse prescriber or podiatrist.
• The school has received written instructions from the student’s health care practitioner regarding the administration of the prescribed medication. These instructions shall include the student’s name and date of birth, medication name, dose, route, frequency, time/conditions, duration and the health care practitioner’s name and contact information. Where applicable or where requested by school personnel, such instructions may also include relevant precautions, information about possible reactions and/or interventions, and the circumstances under which the health care practitioner should be contacted.
• The prescription medication is supplied to the school in the original pharmacy-labeled package and it specifies the name of the student, the name of the prescriber, the name of the prescription drug, the dose, the effective date, and the directions in a legible format. All controlled substances must be delivered to the school by a parent/guardian/ or other adult at the parent/guardian designation. The school nurse should be informed by school personnel of all students receiving medication and any changes in dosage. The school nurse will review the medication record periodically and use professional judgment in contacting the practitioner, school personnel, or parent/guardian to resolve inconsistencies in administration directions.
• If the prescription medication is required to be injected into the student, inhaled by the student, rectally administered to the student, or administered into a nasogastric tube, a gastrostomy tube or a jejunostomy tube, the school personnel designated to administer the medication to the student has completed any DPI-approved training required for administering medication through that particular means prior to administering the medication to the student. Such training is not required for health care professionals (e.g., registered nurses).

Administration of Nonprescription (Over-the-Counter) Medication

Authorized school personnel will administer nonprescription drug products, which are FDA approved, to a student only if all of the following conditions are met:

• The parent or guardian has provided the appropriate school personnel with written consent and instructions.
• If the nonprescription medication is supplied by the student’s parent or guardian, it is supplied in the original manufacturer’s package, and the package lists the ingredients and recommended therapeutic dose in a legible format. School personnel may administer nonprescription medication to a student in a dosage other than the recommended therapeutic dose only if the request to do so is accompanied by the written approval of the student’s health care practitioner.
• If the nonprescription medication is required to be injected into the student, inhaled by the student, rectally administered to the student, or administered into a nasogastric tube, a gastrostomy tube or a jejunostomy tube, the school personnel designated to administer the nonprescription medication to the student has completed any DPI-approved training that is required for administering medication through that particular means prior to administering the medication to the student. Such training is not required for health care professionals (e.g., registered nurses).

Alternative Medications

For the safety and protection of all students, alternative medications (i.e. food supplements and natural products) will NOT be given in the school setting.

Stock Epinephrine Auto Injectors

Stock Epinephrine Auto-Injectors may be available in District school buildings for the health and safety of all individuals with known and unknown allergic reactions to foods or other environmental items.

A stock epinephrine auto-injector should be retrieved for use when symptoms of anaphylaxis are identified:

• Difficulty swallowing or tightening of the throat.
• Difficulty breathing
• Nausea and vomiting
• Swelling of the face or extremities
• Skin rash, hives

Available doses are the adult (0.3mg) dose and the pediatric (0.15mg) dose. If an individual appears to be experiencing a severe allergic reaction, the protocol is to dial “911” or the emergency medical service provider. Any individual who is trained to use an epinephrine auto-injector to administer epinephrine may do so to the individual experiencing the severe allergic reaction. Individual receiving the epinephrine injection should be transported to the local emergency department by ambulance.

Student Possession and Use for Self-Administration of Inhalers and Epinephrine Auto-Injectors

An asthmatic student may possess (carry) and use a metered dose inhaler or dry powder inhaler while in school or at a school-sponsored activity under the supervision of a school authority if all of the following conditions are met:

• the student uses the inhaler before exercise to prevent the onset of asthmatic symptoms or uses the inhaler to alleviate symptoms;
• the student has the written approval of the student’s physician and, if the student is a minor, the written approval of the student’s parent or guardian; and
• the written approval(s) are on file in the school records.

A student may possess (carry) and use an epinephrine auto-injector (e.g., Epipen®) if all of the following conditions are met:

• the student uses the epinephrine auto-injector to prevent the onset or alleviate the symptoms of an emergency situation;
• the student has the written approval of his/her physician and, if the student is a minor, written approval of the student's parent or guardian; and
• the written approval(s) are on file in the school records.

When providing the required approvals to the school nurse for students to possess and use their inhalers or epinephrine auto-injectors, parents and guardians and physicians should consider the student's knowledge of his/her medication and his/her ability to use the inhaler or epinephrine independently. If the physician or parent or guardian determines that it is appropriate to have assistance from school personnel in administering the inhaler or epinephrine auto-injector medication to the student in any emergency or non-emergency situations, the medication must be administered in accordance with procedures outlined above for the administration of prescription medication.

Student Possession and Use of Other Prescription and Nonprescription Medication

The District may permit responsible students, as determined in advance by the agreement of the parent or guardian and building principal (in consultation with a nurse serving the school as needed), to possess and self-administer medications other than asthma inhalers and epinephrine auto-injectors. The following factors, among others, will be considered in determining whether a student will be granted this permission:

• The type of medication;
• The reason for medication and the need to administer the medication during the school day;
• The age of the student; and
• The responsibility level of the student, including but not limited to the student’s ability to understand and regularly comply with all dosage and administration instructions provided by the manufacturer and/or the student’s practitioner, compliance with all school rules and regulations relating to the presence of drugs in the schools, and the student’s ability to provide for the safe and appropriate storage of the medication. 
• The District will require the student/parent to provide written approval or other information from the student’s physician, in the case of prescription medication. The student should possess no more than the daily supply of the medication at a time and the medication must be in the original pharmacy labeled package.
• Although exceptions may be considered, this section regarding permission for self- administration of medication is intended to apply primarily to such requests by high school students. For students under the age of 18, a parent or guardian will provide the District with a signed, written statement of consent for self-administration by the student that identifies the name of the medication. A student who is at least 18 years old may provide the written statement himself/herself.
• Any permission granted under this section may be revoked by the District, or withdrawn by the parent or guardian, at any time.

Expired Medication

Parents/guardians Parents/guardians are strongly encouraged to supply a medication that will not expire during the school year. For the safety of our students, expired medications should not be administered at school.

Administration of Medication for Field Trips

Field Trip may include school sponsored activities off school ground, athletics, student groups or clubs, and any overnight events/field trips where a student has a medication on file that may need to be given. If a student is receiving medication at school on a daily basis, or on an as-needed basis, it is the responsibility of the staff person who is organizing the field trip to ensure that the student receives the medication per the parent/guardian/physician consents, and as indicated by the parent on the field trip permission slip. 

All information regarding student medication administration is confidential and must be protected accordingly. 

The procedures below outline the steps to ensure that students receive their required medication:

Field Trips – Regular School Day
Prior to the Field Trip

• A minimum of one staff person who is attending the field trip must have successfully completed the applicable DPI approved training depending on the medication needs of the students and the LCASD skills training checklist with the school nurse. Current training documentation must be on file with the District prior to the date of the field trip.
• The staff person organizing the field trip must provide a list of participating students to the school secretary or designee two weeks prior to the event. The school secretary or designee will review the list of students and determine which students have medications at school.
• Parents/guardians are required to complete the medication portion of the field trip permission slip indicating if medications are required.

Day of the Field Trip

• The medication will be prepared by the school secretary or designee. The daily medication dose will be put into an envelope with the student’s name, date, medication name, dosage and time of administration. The envelope will include a field tip medication form with the student’s name, name of medication, dose and time to be given, special instructions if applicable. The staff member giving the medication should sign on the envelope when the medication is given as proof that it was given.
• It is the responsibility of the organizing staff person to see that the medication is given on time and that the child takes the medication. The organizing staff person must confirm that the medication was administered. As needed medication, such as asthma inhalers, if used by the student, will follow the same procedure.

After the Field Trip

• The organizing staff person will return all forms and all medication to the school secretary or designee promptly upon return to school.
• The school secretary or designee will document on the medication record that the medication was administered during the field trip. The field trip envelope should be stapled to the medication record if returned. If it is not returned the staff person who administered the medication should sign the form and initial in appropriate box, the time that medication was given.

Field Trips – Extended Beyond the Regular School Day

Field Trips that extend beyond the regular school day may require more doses of a medication to be administered that are not normally given during the school day. If additional medication and/or doses are required, consents for those medications must be on file prior to departure. High School Students, when requested by parent and physician for prescription medications, may self-carry and/or self-administer medications with the completion of the proper paperwork and principal approval. The principal may consult with the school nurse regarding types of medications. Please see section eight of the rule for more detailed information. 

• The parent/guardian must provide the medication in a pharmacy labeled bottle (prescription) or over the counter packaging (non-prescription). The required paperwork must be completed indicating all doses and times the medication is to be administer. Only the amount of medication needed on the field trip should be sent.
• The school secretary or designee may consult with the school nurse regarding questions/organization of the medication.
• It is the responsibility of the organizing staff person to see that the medication is administered on time and that the student successfully takes the medication. The staff person administering the medication on the field trip will document on the field trip form all doses of medication that are administered. The Regular School Day “Prior to the field trip” protocols (detailed above) must be completed prior to the field trip.
• Emergency medications (i.e., asthma inhalers, Epi Pens, glucagon) should be accessible to the student while on a field trip.
• Upon return from the field trip, forms and medication will be returned to the school secretary or designee. Empty bottles may be destroyed if approved by parent.
• The school secretary or designee will ensure that the documentation of the medication administration has been completed on the medication record. If not completed by the staff person, will ensure that this is completed before filing paperwork.

Medication Storage and Disposal

• All prescription and nonprescription student medication in the District’s possession shall be kept in a safe and secure location(s). Medication will be stored to maintain quality in accordance with the manufacturer’s or health care practitioner’s storage instructions. Medication which needs to be accessible to the student will be stored in an appropriate location per student need.
• For field trips and other co-curricular or extracurricular activities held off school premises, student medication will be stored in a secure location determined appropriate by the activity supervisor, keeping in mind the manufacturer’s or health care practitioners storage instructions.
• Parents and guardians will be asked to pick up any unused portions of prescription and nonprescription medications by the last day of the school year or when the student’s medications have been discontinued. Unused medications will not be sent home with students.
• Student medications that have reached their expiration date and medications that have not been picked up by the student’s parent or guardian will be disposed of in a safe and proper manner in accordance with DPI’s Guidelines for Disposal of Medications in the Schools.

Recordkeeping

• The Director of Pupil Services or his/her designee is responsible for maintaining written records of the school personnel who have been authorized to administer medication to students and of documentation of staff completion of all required training courses (including the dates on which such training occurred).
• Upon receipt of a student’s medication at the school, school personnel will document the date of receipt, the type of medication, and verify the amount of medication supplied to the school. The person receiving the medication shall ensure that the student’s name is affixed to the package of any nonprescription drug product.
• The written consents and instructions from the student’s parent or guardian and from the health care practitioner, the medication supply receipt documentation, and the staff training documentation required above will be kept on file in the school. The school nurse, or a designee who has been authorized to administer medication to students, will review the medication administration instructions received from the health care practitioner and/or parent or guardian prior to school personnel administering medications to help ensure the safety of students. A registered nurse serving the school will review the medication administration instructions received from the health care provider and/or the parent or guardian (1) within two weeks of receiving a new or substantially modified order; and (2) at least annually thereafter.
• School personnel designated to administer medication to students, whether at school or during co-curricular or extracurricular activities, shall do the following:
  • Record each dose of prescription or nonprescription medication administered to a student on the medication administration log, including the date and time given. If the medication is not administered to the student as scheduled, the reason shall be noted on the log (e.g., student was absent from school, the student refused to take the medication, lack of supply of the medication from the student’s parent or guardian).
  • Document any medication administration that deviates from the instructions of the health care practitioner and parent or guardian (medication administration error) on the medication administration log. Some examples of medication errors include: administration of a medication to the wrong student, administration of the wrong medication to a student, administration of the wrong dosage of medication to the student, administering the medication via the wrong route, administration of the medication at the wrong time, and failure to administer a medication in accordance with the appropriate health care practitioner and parent or guardian instructions. Any such incident shall be documented on the student’s medication administration sheet and/or in the appropriate student information system. The first concern in regard to any such error/incident is for the health of the child, and staff should immediately consider whether it is appropriate to contact emergency medical services or poison control. The staff member(s) with knowledge of the incident/error shall also ensure that the school notifies the student’s parent/guardian, the school principal, and the District’s Director of Pupil Services.
  • The above documentation should occur immediately after the medication is administered to the student to assure accuracy and safety.
• School personnel shall maintain the confidentiality of student health and medication administration-related records in accordance with applicable state and federal laws and regulations and the District’s student records policy and procedures.