In general, prescribed medication, regardless of the route of administration, must be administered by school nurses. Unless otherwise permitted by this policy, administration of prescribed medications may not be performed by unlicensed persons. Unlicensed persons in the school setting, following directives and in conjunction with approval by school nursing personnel, may assist self-directed students with taking their own oral, topical, and inhalant medication.

Responsibilities of School Nursing Personnel

 

School nursing personnel will be responsible for the following:

 

1)      Coordinating with District administration, as appropriate, regarding policies and procedures for the administration of medication in schools;

 

2)      Ensuring proper and appropriate techniques for the administration of medication in schools;

 

3)      Providing appropriate supervision and documenting adequate in-service education for unlicensed persons assisting students with self-medication;

 

4)      Maintaining adequate and secure storage of all medications;

 

5)      Documenting or assuring documentation by other licensed or unlicensed persons for each dose of medication given or taken on a daily log;

 

6)      Performing intermittent evaluation of the practices and procedures related to the administration of medications and modifying them as needed; and

 

7)      Publicizing the requirements for administration of medication in school.

 Written Order From a Licensed Prescriber Is Required

 All medications, given in school including nonprescription drugs, must be prescribed by a licensed healthcare professional on an individual basis as determined by the student's health status.

 1)     Written orders for prescription and nonprescription medications should minimally include:

            a.      Student's name and date of birth. 

            b.      Name of medication.

            c.      Dosage and route of administration.

            d.      Self-administration orders -- if indicated.

            e.       Frequency and time of administration.

            f.       For prn (as necessary) medications -- conditions under which medication should be                             administered.

            g.      Date written.  

            h.      Prescriber's name, title, and signature; and

            i.       Prescriber's phone number.

 

2)      When a properly labeled medication comes to the Health Office accompanied by a written request from the parent/person in parental relation regarding its administration, but without a written order from a licensed prescriber, the following procedure should be followed:

 

a.      Contact parent/person in parental relation regarding the need for a written order from a licensed prescriber;

 

b.      Contact licensed prescriber to obtain verbal permission to administer medication;

 

c.      Request fax or written orders to be received within 48 hours;

 

d.      Contact parent/person in parental relation and discontinue medication if written orders are not received in 48 hours; and

 

e.      Document above steps.

 Special considerations

1)         Prescription medications must display the original pharmacy label.

2)         Over-the-counter medications must be in the original manufacturer's container/package with the student's name affixed to the container. The same applies to drug samples.

3)         For certain medications, especially controlled substances, the school nurse should inventory the medication upon receipt from the parent/person in parental relation and periodically thereafter. Discrepancies should be reported to the administration and parent(s) immediately. 

4)      Medications should not be transported daily to and from school unless the student is self-directed or self-carrying as identified by his or her healthcare provider and the school nurse.

 

Medication Administration

 

All students requiring medication during school hours should receive their medication in the Health Office except students who are allowed to carry their own medication and self-administer.

 

Carry and Self-Administer Medication

Students may be permitted to carry and self-administer medications under certain conditions. The criteria for determining when a student can self-administer medication are:

 

1)      Severity of health problems, particularly asthmatic or allergic conditions;

 

2)      Licensed prescriber's order directing that the student be allowed to carry his/her medication and self-administer;

 

3)      Parent or person in parental relation request for compliance with licensed prescriber's order;

 

4)      Student has been instructed in the procedure of self-administration and can assume responsibility for carrying properly labeled medication in the original container on his or her person or in a school or physical education locker;

 

5)      School nurse assessment that the student is self-directed to carry and self-administer his or her medication properly; and

 

         6)  Documented Parent or person in parental relation to  clarify their responsibility to         monitor the child on an ongoing basis to ensure that the child is carrying and taking the          medication as ordered.

Procedures for Taking Oral, Topical, or Inhalant Medications Off School Grounds or After School Hours While Participating in a School-Sponsored Activity

 

The school nursing personnel should assure:

 

1)      Oversight of self-administration to:

 

a.      Any student who is self-directed;

 

b.      Voluntary staff members, if any, have been appropriately instructed by school nursing personnel to assist self-directed students. (Note: consistent with good practice, the employee's willingness to perform the task should be considered in making the assignment.)

2)      Preparation of medication

When oral medication is to be given off school grounds or after school hours, the medication may be prepared by the school nurse for short out-of-school experiences. Students requiring medication on extended trips must have their medication in a properly labeled container.

 

3)     The school registered professional nurse or licensed practical nurse, under the direction of the school registered professional nurse or physician, will administer oral, topical, inhalant, or injectable medications to non-self-directed students; however, EpiPen type injectables may be administered by an LPN or a trained voluntary staff member, in the absence of a registered nurse.

Herbal Remedies, Dietary Supplements, Natural Products and Other Non-FDA Sanctioned Requests

The District will not honor requests to administer herbal remedies, dietary supplements, or natural products as they are not sanctioned by the FDA. The District will note these requests on the student's health record.

Emergency Building Evacuation and Medications

Each health office will be supplied with a readily accessible, easily carried, and recognizable emergency pack that includes supplies for basic first aid, including supplies for infection control, a stock EpiPen with non-patient specific orders, and a glucose source, such as glucose gel or honey sticks. The health office will establish a plan for communicating with the principal during emergencies. A list of all students with significant medical conditions and medical orders for prescription medication, including emergency contact numbers, will also be kept in the emergency pack.

Storage of Medication

All medications, except as otherwise arranged (trips), will be properly stored and secured within a health office cabinet, drawer, or refrigerator designated for medications only. This storage site, in addition to the outside health office door, must include a lock. Whenever possible, medication storage units will be secured to the wall or floor, and will not have breakable glass doors. Controlled substances must always be secured and never left open or accessible to the public.

Disposal of Unused Medications

 Any unused medication (including, but not limited to, expired prescription and nonprescription drugs) must be returned to the parent/person in parental relation by the end of each school year. If the parent/person in parental relation does not retrieve the unused medication by the end of the school year, then the school nurse or designated school health office personnel must document that the medication was abandoned and properly dispose of the unused medication.

 

Actual means or methods of disposal of unused medication may vary and the following should be considered by the District:

 

1)      Certain drugs are considered by the U.S. Food and Drug Administration to pose such a risk of harm that they should be flushed down a sink or toilet. These drugs include high-potency opioids and certain other controlled substances that may be deadly in a single dose if taken by someone other than the person for whom they were prescribed. The FDA maintains a list of these medications, "Medicines Recommended for Disposal by Flushing" on its website;

 

2)      To dispose of medication that is not recommended for disposal by flushing, and if a drug take-back or hazardous waste collection program is not available, then the following protocol should be observed:

 

a.      Mix the drug with an undesirable substance, such as cat litter, sawdust or used coffee grounds;

 

b.      Place the mixture into a disposable container with a lid or into a sealable bag;

c.      Conceal or remove any personal information, including the prescription number, on the (now-empty) original drug container; and

 

d.      Place the sealed container with the mixture, and the empty original drug containers, in the trash.

Disposal of Needles and Syringes

 Needles and syringes should be disposed of in a manner consistent with the following guidelines:

 1)     Needles should not be recapped and should not be purposely bent or broken.

 2)     Disposable syringes and needles (and other sharp items) should be placed in approved sharps' containers and labeled"BIOHAZARD."

 3)     Arrangements should be made with custodial staff or an appropriate agency to dispose of containers at periodic intervals according to established procedures of the school regarding regulated medical waste.

 Record Keeping

 School nursing personnel will maintain accurate records of the medication administered, any special circumstances related to the procedure, and students’ reactions/responses. The school nursing personnel will retain, at a minimum, the written order from the prescriber and the parent or personal in parental relation request letter. Additional information will be retained in the student’s cumulative health record as appropriate.