5141.3
Policy
Instruction
Dispensing Medications
The administration of medication at school is strongly
discouraged except when necessary for the student's health or education. The dosage intervals of many medications can
be adjusted so the times for taking the medication come outside school
hours. When possible, interval
adjustment should be considered before administering medication at school. All medications administered by school
district personnel shall be administered in accordance with the Medication Aide
Act.
A. Authorizations
for Prescription Medications.
Prescription medications which must be administered during school hours
may be administered when the following are on file at school:
1. Physician’s
Authorization: A physician's signed, dated authorization including name of
the medication, dosage, administration route, time to be given at school, and
reason child is receiving the medication.
2. Caretaker’s
Authorization: A caretaker's signed and dated authorization or permission
to administer the medication during school.
(Note: All references to “caretaker” in this policy shall mean a parent,
foster parent, family member, or legal guardian who provides care for the
student for whom medication is to be administered. The laws include a “friend”
as a caretaker, but the school will not ordinarily recognize such an individual
as a “caretaker” for the purposes of medication administration).
3. Original
Packaging: The medication is in its original packaging and is labeled as
dispensed by the prescriber or pharmacist.
The label must name the child and identify the medication, strength,
time interval and route to be administered.
Two labeled containers may be requested:
one for home and one for school.
If needed, the physician may be contacted for clarification on
medication administration.
B. Authorizations
for Non-Prescription Medications. If
a student must take non-prescription medication during school, procedures 2 and
3 above are to be followed before administration.
C. Renewal
of Authorizations. Medication
authorizations must be renewed annually and updated immediately as changes
occur.
D. Documentation
of Administration of Medication. The
school district shall keep and maintain accurate medication administration
records. A record of each dose of medication administered shall be documented
reflecting the student's name, and the name of the medication, date, time,
dosage, route, the signature and title of the person administering the
medication and any unusual observations, and any refusal by the recipient to
take and/or receive the medication.
Medication documentation shall be kept confidential in accordance with
the policies and practices concerning student records, provided that medication
administration records shall be available to the Department of Education and
the Department of Health and Human Services Regulation and Licensure for
inspection and copying according to the Family Education Rights and Privacy Act
(FERPA) requirements. Such medication
administration records shall be maintained for not less than two (2) years.
E. Storage
of Medications. Medication shall be
stored in a locked or otherwise secure area in accordance with the
manufacturer’s or dispensing pharmacist’s instructions or temperature, light,
humidity, or other storage instructions.
Only authorized school personnel who are designated by the
administration of the school district for administration of medications shall
have access to the medications. The
school nurse shall establish procedures for monitoring the storage and handling
of medication, the medication's expiration date, and the disposal of
medication.
F. Receipt
and Disposal of Medications.
Medication shall be delivered to school personnel and picked up by the
parent. When medication is received, the
amount received should be documented.
Medication which is either past the expiration date or not claimed by
the parent by the end of the school year shall be destroyed. Procedures for destroying medication shall
include witness and documentation.
G. Administration
of Medication by School Personnel.
1.
Administration of Medication: Administration of
medication includes, but is not limited to:
a.
Providing
medications for another person according to the “five rights” (getting the
right drug to the right recipient in the right dosage by the right route at the
right time);
b. Recording
medication provision; and
c. Observing, monitoring, reporting, and
otherwise taking appropriate actions regarding desired affects, side effects,
interactions, and contraindications associated with the medication.
2.
Authorized School Personnel: Administration of
medication shall only be done by the following school personnel:
a. Health Care Professionals (School
Nurses). This means an individual who holds a current license from the
Department of Health and Human Services Regulation and Licensure for whom
administration of medication is included in the scope of practice. For purposes of this Policy, such individuals
are referred to as “school nurses.”
b. Medication Competent Staff. This means a staff member of the school who
has been determined to be competent to administer medication by: (i) a
recipient with capability and capacity to make an informed decision about
medications (at a minimum, the recipient must be age 19 or older), (ii) a
caretaker for the student, or (iii) by the school nurse.
(1) Determination of Competency by School
Nurse: A staff member may be determined to be competent by a school nurse to
administer medication where the staff member:
(i) passes
a competency assessment every 3 years
(ii) that demonstrates the staff member can
follow the minimal competencies
(iii) to the satisfaction of the school nurse
(school nurses are the school district’s designated health care professionals).
Training is not required. The school nurse shall, however, provide such
training as the school nurse determines in the exercise of professional
judgment to be appropriate given the experience level of the staff member and
the anticipated medication administration for which the staff member will be
responsible.
(2)
Competency Certificate: Upon successful completion of the competency assessment,
the school nurse shall give the Principal and the medication competent staff
member written documentation of successful completion of competency
assessment. The documentation may be by
letter, certificate, or other written memoranda and shall include: the name of
the school staff member who successfully completed the competency assessment;
the date the competency assessment was conducted; and, the name, profession,
and license number of the school nurse who conducted the competency
assessment.
(3)
Maintain Records of Assessments: The school shall maintain written documentation of
successful completion of competency assessments, identification of the
individual providing direction and monitoring, and acceptance of the
responsibility for direction and monitoring for a minimum of two (2) years.
(4)
Direction and Monitoring: A medication
competent staff member is to be subject to direction and monitoring, which
involves responsibility for observing and taking appropriate action regarding
any desired effects, side effects, interactions, and contraindications
associated with the medication.
Direction and monitoring is to be done by a recipient with capability
and capacity to make an informed decision about medications, a caretaker, or
the school nurse. The school nurse is
identified as a person being responsible for direction and monitoring and for
each medication competent staff member is to accept responsibility for
direction and monitoring of medication competent staff member in writing.
(5)
Errors. Medication competent staff members are to
promptly report any medication errors or concerns to the school nurse.
3. Minimum
Competencies:
The minimum competencies to be
demonstrated by medication competent staff and to be implemented in practice by
all school personnel engaged in medication administration are:
(1) Maintaining confidentiality.
(2) Complying with a competent recipient’s
right to refuse to take medication and, in the case of a non-competent,
recognize the requirement to seek advice and consultation with the physician,
physician’s designee, or caretaker of the student providing direction and
monitoring regarding the procedures and persuasive methods to be used to
encourage compliance with medication provision.
Recognizing that persuasive methods should not include anything that
causes injury to the recipient.
(3) Maintaining hygiene and current accepted
standards for infection control.
(4) Documenting accurately and completely.
(5) Safely providing medications according
to the “five rights” (“five rights” means getting the right drug to the right
recipient in the right dosage by the right route at the right time).
(6) Having the ability to understand and
follow instructions.
(7) Practicing safety in application of
procedures for storage, handling and administration of medications.
(8) Complying with limitations and
conditions under which school personnel may provide medications.
(9) Having an awareness of abuse and neglect
reporting requirements.
(10) Recognizing general unsafe conditions
indicating that the medication should not be provided including change in
consistency or color of the medication, unlabeled medication or illegible
medication label, and those medications that have expired.
(11) Recognizing that unsafe conditions should
be reported to the caretaker, physician or physician's designee for direction
and monitoring thereof.
(12) Recognizing general conditions which may
indicate an adverse reaction to medication such as rashes/hives, and general
changes in recipient's condition which may indicate inability to receive
medications, and that all such conditions shall be reported to the caretaker,
physician or physician's designee responsible for providing direction and
monitoring.
4. Routes
of Medication Administered by School Personnel:
a. Routine Medication via Oral,
Inhalation, Topical, and Instillation Routes: School nurses and medication
competent staff may provide routine medications (meaning the frequency of
administration, amount, strength, and method are specifically fixed) by the
following routes:
(1) Oral,
which includes any medication given by mouth including sublingual (placing
under the tongue) and buccal (placing between the cheek and gum) routes and
oral sprays;
(2) Inhalation, which includes inhalers, and
nebulizers. Oxygen may be given by
inhalation;
(3) Topical application of sprays, creams,
ointments, and lotions and transdermal patches; and
(4) Instillation by drops, ointments, and
sprays into the eyes, ears, and nose.
b. Administration of Medication via
Additional Routes, PRN Medication, and Observing and Reporting: School
nurses and medication competent staff may provide medication by additional
routes not listed in subparagraph “a” above (“additional routes”), provide PRN
medication (PRN medication means an administration scheme in which a medication
is not routine, is taken as needed, and requires assessment for need and
effectiveness), or participate in observing and reporting for monitoring
medications only under the following conditions:
(1) In the case of a medication competent
staff member, a determination has been made by the school nurse or by the
student’s physician or duly licensed health care professional that that these
activities can be done safely for the specified recipient by the medication
competent staff member and the determination is placed in writing.
(2) Directions for additional routes must be
for recipient specific procedures and must be in writing.
(3) Directions for PRN medication must be in
writing and include parameters for provision of PRN medication.
(4) Directions for observing and reporting
for monitoring medication must be in writing and include the parameters for the
observation and reporting.
(5) School personnel administering the
medication shall comply with the written directions.
c. Injections: School nurses will ordinarily be responsible
for medications that must be provided or administered by injection. A
medication competent staff member will not ordinarily administer medications by
injection without specific training on injection administration. Students may be authorized to self-administer
medication as hereafter provided.
5. Refusal to Administer Medication:
School personnel may refuse to give a medication at school if after a
reasonable and prudent research by a school health care professional as set
forth in subparagraph "e" below, a decision has been made that the
dosage prescribed exceeds that which is recommended in the Physician's Desk
Reference, Mosby’s Nursing Drug Reference, the most recent edition of the
Nursing Drug Handbook, or other pharmaceutical manuals handbook; or when a drug
or substance is not currently approved by the FDA. When school personnel refuse to carry out a
request to administer medication, the following procedure shall be followed:
a.
Notify
the nursing supervisor who will notify Superintendent.
b.
Notify
attending physician by phone with follow-up in writing:
(1) State concern for dosage or particular
medication, etc.
(2) Make every attempt to work out a
suitable solution - Example: Change of time of administration, change of
dosage, change of medication;
(3) Follow-up in writing.
c.
Meet
with parents:
(1) State
concern for dosage or medication;
(2) Offer alternatives - Example: Change of
time so as not to be given during school hours.
d.
Consult
with Nebraska State Board of Health for current procedures regarding refusal to
follow written physician
e.
Research
by health care professional:
(1) Collect research articles from
professional journals, organizations, etc.;
(2) Contact other physicians requesting
their professional opinions and ask them to review current research;
(3) Contact state licensing boards and
school nurse consultant;
(4) Consult with district
(5) Assemble all data for review;
(6) Present data to review team organized by
the Superintendent;
(7) Decision rendered and implemented;
(8) Parents and physician contacted in
writing; and
(9) Alter and update policies and procedures
as needed.
[Sections on
Self-Administration and Hypodermic
Syringes Deleted from Policy Adopted October 18, 1999]
Legal Reference: Neb.
Rev. Stat. §§ 71-6718 to 71-6742; NDE Rule 59
Date of
Adoption: October 18, 1999
Revised: June 19, 2006
CARETAKER
AUTHORIZATION FOR
ADMINISTRATION OF
PRESCRIPTION MEDICATION TO STUDENT
The undersigned(s) is/are the caretaker(s), parent(s),
guardian(s), or person(s) in charge of _______________________________(“the
Student”).
It is necessary that the Student receive
____________________ (medication), a physician-prescribed medication, during
school intervals beginning on ______________ (date) and continuing through
______________ (date).
CHECK ONE (1) OF
THE FOLLOWING BOXES
______I hereby authorize [NAME] Public Schools to allow the
Student to administer the above-described medication to himself/herself without
monitoring or supervision by school personnel.
______I hereby request NAME] Public Schools, or its
authorized representative, to administer the above-named medication to the
Student, in accordance with the prescribing physician’s instructions, and agree
to:
1. Submit
this request to the principal or school nurse.
2. Make
certain the Physician’s Request for the Administration of Prescription
Medication by School Personnel is submitted to the principal or school nurse.
3. Make sure personally that the
medication is received by the principal or school nurse and/or county nursing
services administering it, in the container in which it was dispensed by the
prescribing physician or licensed pharmacist.
4. Make sure personally that the
container in which the medication is in is marked with the medication name,
dosage, interval dosage, and date after which no administration should be
given.
5. Submit a REVISED STATEMENT signed by the
physician prescribing the medication to the principal or school nurse IF ANY OF
THE INFORMATION PROVIDED BY THE PHYSICIAN CHANGES.
6. Provide directions to the school
personnel providing the medication.
7. Provide monitoring of the medication
I understand that unlicensed school personnel may be
assigned to provide medication to the Student and hereby release the School
District and the Board of Education of the School District and all employees,
agents, and representatives of the School District from any liability
concerning the providing or non-providing of the medication to the Student.
DATED this _____ day of ___________________, 200_.
_________________________
Work Telephone Number Name
of Student
_________________________
Home Telephone Number Parent/Guardian
_________________________
Alternate Number for
Parent Parent/Guardian
PROVISION OF MEDICATION TO STUDENT
PHYSICIAN'S
REQUEST FOR ADMINISTRATION OF PRESCRIPTION
MEDICATION
BY SCHOOL PERSONNEL
Date _________________
(Student's full name)
is under my care and must take medication which I have prescribed during the
school day.
Name of medication (as it appears on container in which the
medication is stored) ____________
______________________________________________________________________________
Dosage and time ________________________________________________________________
Date provision of medication is to begin
_____________________________________________
Date after which the medication should not be provided
________________________________
Possible adverse reactions to be reported to physician __________________________________
_____________________________________________________________________________
Special instructions for the provision and storage of the
medication _______________________
_____________________________________________________________________________
___________________________
Print or Type Name of
Physician Primary
Phone Number
___________________________
Signature of Physician
Secondary
Phone Number
RECORD OF THE PROVISION OF PRESCRIPTION MEDICATION
Parent
Name of Student Grade ______________
Medication Date to Begin Date to End _________
Dosage Time ____________________________________
Doctor Phone #1 Phone #2 ______________
Possible Adverse Reaction:
_______________________________________________________
______________________________________________________________________________
Person(s) Authorized to Administer Medications:
_____________________________________
______________________________________________________________________________
Date Provided |
Time Provided |
Medication Name |
Dosage Provided |
Route |
Refused Medication |
Signature of Employee Providing
Medication |
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