4-608 - Administration of Medications by School Personnel

Policy 4-608

4-608 
ADMINISTRATION OF MEDICATIONS BY SCHOOL PERSONNEL 

The Board of Education recognizes that the administration of prescription and non-prescription medications by school personnel is a program adjustment to meet the health needs of a student only pursuant to the written order of a physician licensed to practice medicine, licensed dentist, licensed optometrist, license podiatrist,physician's assistant (with M.D.'s stamp) or licensed advanced practice registered nurse and must be administered during school hours and school sponsored field trips. 

The attached procedures outline the process for administering prescription and non-prescription medications.  In the absence of a nurse, the building principals or designated teachers, a licensed physical or occupational therapist employed by the district and coaches of intramural and interscholastic athletics of the school district, pursuant to the regulations of the State Board of Education, who are trained through involvement of a physician, nurse supervisor, or qualified school nurse may administer medicinal preparations to students, as set forth in the attached administrative procedures.  Medicinal preparations must be accompanied by the authorization of the student’s parents/guardians and the written order from a licensed physician, a licensed 
dentist, an optometrist licensed to practice optometry in this state under Chapter 380, a licensed podiatrist under Chapter 375 pursuant to the regulations of theState Board ofEducation,or a physician assistant licensed to prescribe in accordance with C.G.S. Section 20-12d, or an advanced practice registered nurse licensed to prescribe in accordance with C.G.S. 20-94a. 

A specific paraprofessional, through a plan approved by the Nurse Supervisor and School Medical Advisor, may be designated to administer medication with a cartridge injector, to a particular student diagnosed with an allergy that may require prompt treatment to avoid serious harm or death.  For the purposes of this p9olicy, “cartridge injector” means an automatic prefilled cartridge injector or similar automatic injectable equipment used to deliver epinephrine in a standard dose for emergency first aid response to allergic reactions.  The nurse Supervisor and School Medical Advisor along with the school nurse may jointly approve a plan and provide general supervision and training to an identified school paraprofessional to administer the cartridge injector.  The plan may only be approved with the written authorization of the student’s parents/guardians and pursuant to a written order from the student’s licensed physician, and APRN or a PA authorized by law to prescribe medication.  Also, no such person shall be liable to such student, parent, or guardian of such student for civil damages for any personal injuries which result from acts or omissions of such person administering a medical preparation which may constitute ordinary negligence.  This immunity shall not apply in acts or omissions constituting gross, willful, or wanton negligence. 

Reference: CGS 10-212a, 52-557b, 20-12d, 20-94a
Adopted 3/13/79  
Revised 7/10/79, 12/9/86, 4/14/87, 5/8/90, 5/24/94, 10/10/95, 6/9/98, 3/21/00, 1/20/04, 
8/28/06, 12/16/08 

Administration of Medications 

1.  Licensed physician, physician's assistant (with M.D.'s stamp), advanced practice registered nurse, dentist, licensed optomtetrist, or licensed podiatrist orders for medicinal preparations to be administered shall specify in writing the name of the drug, reason for administering, dosage, side effects, and duration, and shall be renewed each school year. 

2.  Since prescriptions for controlled substances have time limitations and because individual patients vary in their response to medications, the school nurse will seek to maintain regular contact when necessary with the prescribing physician, physician's assistant, advanced practice registered nurse, dentist licensed optometrist or license podiatristfor confirmation or change of the order. 

3.  Upon admission to school each year, an inquiry should be made by the school nurse or building principal as to medications and allergies and the required procedures to be observed for those students requiring medicinal preparations as prescribed by a licensed physician, physician's assistant (with M.D.'s stamp), advanced practice registered nurse, dentistlicensed optometrist, or licensedpodiatrist. In support of such required procedures there shall be on file: 
a.   The written order with a plan of care from the physician for the student and 
b.   The written authorization of the student's parent or guardian, which shall be included in the student's cumulative health record and kept for               a minimum of three years. 
 
4.   In absence of a licensed nurse only principals, designated teachers, licensed physical or occupational therapists employed by the district, or coaches of intramural and interscholastic athletics of the school who have been properly trained as determined by the school supervising nurse and are under the general supervision of a school nurse may administer oral, topical, or inhalant medications to students.  Injectible medications may be administered by a 
principal, teacher, coach or paraprofessional only to a student with a medically diagnosed allergic condition which may require prompt treatment to protect the student against serious harm or death.  Investigational drugs may not be administered by principals, teachers, occupational or physical therapists, 
coaches or paraprofessionals.
 
5.   In some instances the self-administration of medication by a student may be authorized in a written statement by both a licensed physician,  
physician's assistant (with M.D.'s stamp), advanced practice registered nurse, dentist licensed optometrist, or licensed podiatrist and the parent or guardian. The school nurse shall evaluate the situation to determine if it is safe and appropriate and develop a plan for general supervision of the self- 
medication. The statement to be kept in the student’s cumulative health record should include information on diagnosis, drug, dosage, and frequency to be taken. The school nurse and teacher, when appropriate, should counsel the student on the importance of taking medications as prescribed. The medication, when appropriate, should be kept in the school nurse’s office or with the teacher. 

6.   A student with diabetes may test his/her blood glucose level per written order of a physician or an advanced practice registered nurse stating the need for and that the student is able to self-test.  CGS 10-220j 

7.   Acetaminophen/Tylenol may be administered by the school nurse or designated school personnel with the written permission of the parent/guardian under the orders of the school medical advisor. 

8.   Students shall not be denied access to transportation solely due to such student's need to carry a cartridge injector.  CGS 10-220i 

Administration of Herbal Medications/Preparations 

Licensed physician's orders for herbal medications/preparations to be administered shall adhere to all of the school's medication standards/regulations and shall specify in writing: 
1.   Name of medication/preparations 
2.   Name and quantity of ingredients 
3.   Dosage   
4.   Expected   results   
5.   Side   effects   
6.   Contraindication   
7.   Name and dosage of any drugs taken concurrently 
8.   Potential interactions with drugs taken concurrently 
9.   Reason why drug requires administration during school hours 
10. Reference with source of drug safety 
 
Medication Emergencies 

The school nurse will administer appropriate emergency care, record first aid treatment administered, notify the parents or guardian and if necessary contact the EMS. When the nurse is not readily available or when emergencies occur after school hours, appropriate emergency care may be administered by a building principal or designated teacher.  Parents and administrators shall be notified immediately. 

Each school shall ensure the following information is readily available. 
 
1.   The local poison information center telephone number 
2.   The physician, clinic or emergency room to be contacted in the event of medication emergencies 
3.   The name of the person responsible for decision-making in the absence of the school nurse. 

Training of School Personnel 

Only principals, designated teachers, occupational or physical therapists, coaches or paraprofessionals who have received appropriate training from the school nurse or school physician shall be allowed to administer medications to students.  If a school chooses to train administrators and teachers for this purpose, it is recommended that the number of trained people be in the range of 2-4 per building. 

This training shall include but not be limited to: 

1.   The procedural aspects of medication administration, the safe handling and storage of medications, and recording. 
2.   The medication needs of specified students, medication idiosyncracies, and desired effects, potential side effect or untoward reactions. 

The training program and procedures shall be written and specific, describing the training and the frequency with which it is done. 

Annually each principal shall provide in writing to the office of the Assistant Superintendent documentation that such training has been provided and names of staff members inthe building who have received such training. Annually the Nurse Supervisor shall provide an informational update to principals and teachers trained in the 
administration of medications. 

Handling, Storage and Disposal of Medications 

1.   All medications, except those approved for transporting by students for self-medication, shall be delivered by the parent or other responsible adult and shall be received by the nurse assigned to the school. The nurse must examine on site any new medication, medication order and permission form and develop a medication administration plan for the student before any medication is given by any school personnel. 

2.   All medications, except those approved for student self-medication, shall be kept by the nurse in a designated locked container, cabinet or closet used exclusively for the storage of medication. In the case of controlled substances, they shall be stored separately from other drugs and substances in a separate, secure, substantially constructed, locked metal or wood cabinet. 

3.   Access to all stored medications shall be limited to persons authorized to administer medications.  Each school shall maintain a current list of those 
persons authorized to administer medications

4.   All medications, prescription and nonprescription, shall be stored in their original containers and in such a manner as to render them safe and effective. 

5.   Medications requiring refrigeration shall be stored in a refrigerator at no less than 36 degrees fahrenheit and no more than 46 degrees fahrenheit. 

6.   All unused, discontinued or obsolete medications shall be removed from storage areas and either returned to the parent or guardian or, with the permission of the parent or guardian, destroyed: 
a. Noncontrolled drugs shall be destroyed in the presence of at least one (1) witness; 
b. Controlled drugs shall be destroyed in accordance with part 1307.21 of the code of federal regulations or by surrender to the Commission of the 
               Department of Consumer Protection. 

7.   No more than a forty-five school day supply of a medication for a student shall be stored at the school. 

8.   No medication for a student shall be stored at a school without a current written order from a physician, physician's assistant, advanced practice registered nurse, or dentist. 

Recordkeeping

Each school shall maintain a medication administration record for each student who receives medication during school hours. Such record shall include: 
1.   The name of the student 
2.   The name of the medication 
3.   The dosage of medication 
4.   The rout of administration 
5.   The frequency of the administration 
6.   The name of the prescribing physician, physician's assistant (with M.D.'s stamp), advanced practice registered nurse, or dentist and the name of the          parent or guardian requesting that the medication be given 
7.   The date the medication was ordered 
8.   The quantity received 
9.   The date the medication is to be reordered 
10. Any student allergies to food or medicine 
11. The date and time of administration or omission including the reason for the omission 
12. The dose or amount of drug administered 
13. The full legal signature of the nurse, principal, teacher or paraprofessional administering the medication.

Transactions shall be recorded in ink and shall not be altered. The written order of the physician, physician's assistant (with M.D.'s stamp), advanced practice registered nurse, dentist, licensed optometrist, or licensed podiatrist,the written authorization of the parent or guardian, and the completed medication administration record for each student shall be filed in the student's cumulative health record. A physician's verbal order, including a telephone order, for a change in any medication can be received only by a school nurse.  Any such verbal order must be followed by a written order within three school days. If errors occur in the administration of medication to students, it shall be reported immediately to the school nurse, the prescribing physician and the parent or guardian. The school nurse shall determine if additional medical treatment is required as a result of the error. 

A report shall be completed using an accident/incident report describing the error. Any error in the administration of medication shall be documented in the student's cumulative health record. 

Supervision 

The school nurse is responsible for general supervision of the administration of medications in the schools to which that nurse is assigned. This shall include, but not be limited to: 
1.   Availability on a regularly scheduled basis to: 
a.   Review the orders or changes in orders and communicate those to personnel designated to give medication for appropriate follow-up. 
b.   Set up a plan and schedule to ensure medications are given. 
c.   Provide training to principals, teachers, other licensed nursing personnel, occupational or physical therapists, coaches and paraprofessionals in the administration of medications. 
d.   Support and assist other licensednursing personnel, principals, teachers, occupational or physical therapists, coaches and paraprofessionals    to prepare for and implement their responsibilities related to the administration of specific medications during school hours. 
e.   Provide consultation by telephone or other means of telecommunication.  In the absence of the school nurse, a licensed physician or nurse may provide this consultation. 

2.   Implementation of policies and procedures regarding receipt, storage and  administration of medications. 
3.   Monthly review of all documentation pertaining to the administration of medications for students. 
4.   Work-site observation of medication administration by teachers, principals, occupational or physical therapists, coaches and paraprofessionals who            have been newly trained. 
5.   Periodic review, as needed, with licensed nursing personnel, principals, teachers, occupational or physical therapists, coaches and paraprofessionals regarding the needs of any student receiving medication. 

Liability 

Nurses and trained personnel are protected from liability claims by the Connecticut General Statute 10-235 and the Board of Education liability insurance coverage. The Medication Administration Policy must be in accordance with Connecticut State Law CGS Section 10-212a as well as Regulations of the Connecticut State Agencies Section 10-212a-1 to 10-212a-7, inclusive and must be approved by the Board of Education and School Medical Advisor or other qualified license physician every two years. 

Reference 10-235, 10-212a, 10-212a-1, 10-212a to 10-212d 
Revised 11/13/01, 1/20/04, 8/28/06, 12/16/08