PROTOCOL FOR ADMINISTERING MEDICINES TO STUDENTS

The school nurse shall be the supervisor of the medication administration program in the school.

Medication Orders/Parental Consent

The school nurse shall ensure that there is a proper medication order from a licensed prescriber, which is renewed as necessary, including the beginning of each academic year. A verbal order for any change in medication shall be received only by the school nurse, and must be followed by a written order within three school days. The medication order shall contain:

  1. the student’s name;
  2. the name and signature of the licensed prescriber and business and emergency numbers;
  3. the name of the medication;
  4. the route and dosage of medication;
  5. the frequency and time of medication administration;
  6. the date of the order and discontinuation date;
  7. a diagnosis and any other medical condition(s) requiring medication, if not a violation of confidentiality or if not contrary to the request of a parent, guardian or student to keep confidential;
  8. specific directions for administration.

Every effort shall be made to obtain from the licensed prescriber the following additional information, if appropriate:

  1. any special side effects, contraindications and adverse reactions to be observed;
  2. any other medications being taken by the student;
  3. the date of the next scheduled visit, if known.

Special Medication Situations

  1. For short-term medications, i.e., those requiring administration for ten school days or fewer, the pharmacy-labeled container may be used in lieu of a licensed provider’s order; if a nurse has a question, she may request a licensed prescriber’s order and parent signature. The amount of medication that is needed for school shall be kept in the school in the pharmacy labeled container. The remainder of the prescription shall be kept at home.
  2. For “over-the-counter” medications, i.e., non-prescription medications, the school nurse shall administer over-the-counter medications according to the Leicester policy for administering over-the-counter medications.
  3. Investigational new drugs may be administered in the schools with (a) a written order by a licensed prescriber, (b) written consent of the parent or guardian, and (c) a pharmacy-labeled container for dispensing. If there is a question, the school nurse may seek consultation and/or approval from the school physician to administer the medication in the school setting.

The school nurse shall ensure that there is a written authorization by the parent or guardian, which contains:

  1. the parent or guardian’s printed name, signature and an emergency phone number;
  2. a list of all medications the student is currently receiving, if not a violation of confidentiality or contrary to the request of the parent, guardian or student that such medications not be documented;
  3. approval to have the school nurse or school personnel designated by the school nurse administer the medication;
  4. persons to be notified in case of a medication emergency, in addition to the parent or guardian and licensed prescriber.

Medication Administration Plan

The school nurse, in collaboration with the parent or guardian whenever possible, shall establish a medication administration plan for each student receiving a medication. Whenever possible, a student who understands the issues of medication administration shall be involved in the decision-making process and his/her preferences respected to the maximum extent possible.

Prior to the initial administration of the medication, the school nurse shall assess the child’s health status and develop a medication administration plan which includes:

  1. the name of the student;
  2. an order from a licensed prescriber, including business and emergency numbers;
  3. the signed authorization of the parent or guardian, including home and business telephone numbers;
  4. any known allergies to food or medications;
  5. the diagnosis, unless a violation of confidentiality or the parent, guardian or student requests that it not be documented;
  6. the name of the medication, the dosage, frequency and route of administration:
  7. possible side effects, contraindications, adverse reactions
  8. required storage conditions; location where medication will be administered;
  9. duration of the prescription;
  10. unlicensed persons who may give the medication if the nurse is not available to attend a field trip (EpiPen & Prescription Medication only); per Partial Delegation Certificate
  11. appropriate personnel to be notified of medication administration and possible adverse effects;
  12. a list of other medications being taken by the student, if not a violation of confidentiality;
  13. a plan for monitoring the effects of the medication;
  14. the school nurse will make the decision regarding the presence of a nurse on field trips for medication administration

A procedure will be developed to ensure positive identification of the student who receives the medication.

The school nurse will communicate significant observations relating to medical effectiveness and adverse reactions to the child’s parent/guardian and/or licensed prescriber.

In accordance with standard nursing practice, the school nurse may refuse to administer any medication which, based on her professional judgment, has the potential to be harmful, dangerous, or inappropriate. In these cases, the school nurse shall notify the school physician, parent/guardian and licensed prescriber immediately and the reason for refusal explained.

The school nurse shall have a current pharmaceutical reference available for her use.

Self Administration of Medications

“Self administration” means that the student is able to take the medication in the manner directed by the licensed prescriber, without additional assistance. Only inhalers, insulin, glucose tabs and EpiPens will be carried and administered outside of the nurse’s office, with written permission by the prescriber and the parent/guardian (grades 6– 12 only).

A student may self administer medication after the school nurse has determined that the following requirements are met:

A. the student’s health status and abilities have been evaluated by the school nurse who then deems self administration safe and appropriate;

B. a procedure will be developed for assessing and documenting self administration;

C. the student’s self administration is monitored based on his/her abilities and health status;

D. with parent/guardian permission, the school nurse may inform appropriate faculty/staff that the student is self-administering a medication.

Handling, Storage, and Disposal of Medications

A parent/guardian or designated adult shall deliver all medications to school personnel. Students who self-administer EpiPens and inhalers may bring these medications to school. The medication must be in a pharmacy or manufacturer labeled container, with the student’s name on it. The school nurse or other responsible person receiving the medication shall document the quantity of medication delivered.

All medications shall be stored in their original pharmacy or manufacturer labeled container. Expiration dates shall be checked.

Medications shall be kept in a securely locked cabinet or box, used exclusively for medications. This cabinet will be kept locked except when opened to administer medications. Medications that need to be refrigerated shall be kept in the refrigerator. Access to medication will be limited to persons authorized to administer medications. Access to keys and knowledge of the location of keys will be restricted to the maximum extent possible.

Parents/guardians may retrieve the medication from the school nurse at any time. Parents shall be notified of the time when left over medication may be picked up at the end of the school year. If medication is not picked up, the school nurse will dispose of it in accordance with MDPH, Division of Food and Drugs, policy.

Documentation and Record Keeping

Each school nurse shall maintain a medication administration record for each student who receives medication during school hours. The record shall include a daily log, the medication order, the individual medication care plan, and parent/guardian authorization. The individual medication care plan shall include the information described in Section 210.005 (E) of the Regulations Governing the Administration of Prescription Medications in Public and Private Schools. The daily log shall contain:

a. the dose or amount of medication to be administered;

b. the date and time of administration or omission, including the reason for omission;

c. the full signature of the nurse administering the medication. If the nurse administers subsequent doses, she shall initial the record subsequent to signing a full signature.

d. The nurse shall document significant observations of the medication’s effectiveness, as appropriate and any adverse effects noted.

e. All documentation shall be recorded in ink or in the computerized record and shall not be altered.

The school district shall comply with the Department of Public Health’s reporting requirements for medication administration in schools. The Department of Public Health may inspect any individual student medication record or record relating to the administration or storage of medications without prior notice to ensure compliance with the Regulations governing the Administration of Prescription Medications in Public and Private Schools.

Reporting and Documentation of Medication Errors

A medication error includes any failure to administer medication as prescribed for a particular student, including failure to administer the medication within appropriate time frames; in the correct dosage; in accordance with accepted practice; or to the correct student.

In the event of a medication error, the school nurse shall notify the parent or guardian immediately. (The school nurse shall document the effort to reach the parent or guardian.) If there is question of potential harm to the student, the nurse shall also notify the student’s licensed prescriber or school physician.

Medication errors shall be documented on the Medication Error Report (attached). The original report will be sent to Administration. A copy will be given to the building administrator, and a copy will be kept in the medication error file in the nurse’s office.

The school nurse shall review reports of medication errors and take necessary steps to ensure appropriate medication administration in the future.

Response to Medication Emergencies

The school nurse shall develop procedures for responding to medication emergencies.

Dissemination of Information to Parents or Guardians Regarding Administration of Medications

Such information shall include an outline of these medication policies and shall be available to parents and guardians on request.

Policy Review and Revision

Review and revision of these policies shall occur as needed but at least every two years.
References: 105 CMR 210.000
Goodman, I. F., & Sheetz, A. H. (Eds.). (2007). The Comprehensive School Health Manual. Boston, MA: Massachusetts Department of Public Health.
ADOPtED: August 19, 2014