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File: JLCD-R – Procedures for Administration of Medication

Download File: JLCD-R

I. DEFINITIONS

  • “Administration” means the provision of prescribed medication to a student or other persons according to the orders of a health care provider.
  • “Designated school personnel” are unlicensed school personnel who have completed such training in administration of medication as may be required by Maine statutes or DOE rules and who have been authorized by the school nurse to administer medication.
  • “Diabetes Care plan” means an individual health plan document that specifies the diabetes-related services needed by a student at school and at school-sponsored activities and which may include an emergency action plan.
  • “Emergency action plan” means a document that provides guidelines to prepare school personnel to respond to a serious life-threatening injury or medical emergency.
  • “Health care provider” means a medical/health practitioner who has a current license in the State of Maine with a scope of practice that includes prescribing medication.
  • “Indirect supervision” means the supervision of an unlicensed school staff member when the school nurse or other health care provider is not physically available on site but immediately available by telephone.
  • “Medication” means prescribed drugs and medical devices that are controlled by the U.S. Food and Drug Administration and are ordered by a healthcare provider. It includes over-the-counter medications prescribed through a standing order by the school physician or prescribed by the student’s health care provider. For the purpose of this procedure, “medication” includes epinephrine, naloxone hydrochloride and other non-injectable opioid overdose-reversing medications, and glucagon, but does not include medical cannabis.
  • “Parent” means a natural or adoptive parent, a guardian, or a person acting as a parent of a child with legal responsibility for the child’s welfare.
  • “School nurse” means a registered professional nurse with Maine Department of Education certification for school nursing.
  • “Self-administration” is when the student administers medication independently to him/herself under indirect supervision of the school nurse.
  • “Standing order” is an order written by a healthcare provider (as defined in this procedure) for the entire population of students or subset thereof rather than written for a specific named individual. 
  • “Undesignated ready to-use glucagon rescue therapy” means a USDA-approved glucagon rescue therapy that does not require reconstitution for the treatment of severe hypoglycemia, in a dosage form that can be rapidly administered in an emergency, including prefilled injectable or nasally administered glucagon.
  • “Unlicensed school personnel” are persons who do not have a professional license that allows them, within the scope of that license, to administer medication.

II. ADMINISTRATION OF MEDICATION BY SCHOOL PERSONNEL

A. Parental Request

In the event that no reasonable alternative exists, the parent/guardian may request in writing that medication be administered to the student during the school day. The written request must include an acknowledgement and agreement that unlicensed personnel may administer the medication as per the health care provider’s instructions. In addition, the request shall indicate that information regarding the student’s medication may be shared with appropriate school personnel. Parents may provide the reason (diagnosis) requiring the administration of medication.

Requests shall be valid for the current school year only.

B. Health Care Provider’s Order

All parental requests must be accompanied by a written order from the student’s health care provider substantiating the fact that the administration of a particular medication during the school day is necessary for the student’s health and attendance in school. Such order must include:

  1. The student’s name;
  2. The name of the medication;
  3. The dose;
  4. The route of administration (e.g., tablets, liquid, drops); and
  5. Time intervals for administration (e.g., every four hours, before meals);
  6. Any special instructions; and
  7. The name of the prescribing health care provider.

It is the responsibility of the school nurse to clarify any medication order that they believe to be inappropriate or ambiguous. In accordance with Department of Education Rule Chapter 40 § 2(B), the school nurse may decline to administer a medication if they believe such administration would jeopardize student safety. In this case, the school nurse must notify the parent, the student’s health care provider and the school administrator (i.e., building principal or designated administrator).

C. Renewal of Parent Permission Requests/Forms and Health Care Provider Orders

Written parental permission requests/forms and health care provider orders must be renewed at least annually. Health care provider orders must be renewed whenever there are changes in the order.

D. Delivery and Storage of Medication

The student’s parents shall deliver any medication to be administered by school personnel to the school in its original container and properly labeled. In the event that this is not practical, the parent must contact the school to make alternate arrangements.

No more than a 20-day (one month) supply of medication shall be kept at school, excluding inhalers and epinephrine autoinjectors. The parent is responsible for the replenishment of medication kept at school.

If the health care provider’s order/prescription is for a medication regulated by Schedule II of the Controlled Substances Act (21 USC §812) (e.g., Ritalin and Adderall) no more than a one-week supply shall be kept at school.

The parent is responsible for notifying the school of any changes in or discontinuation of a prescribed medication that is being administered to the student at school. The parent must remove any medication no longer required or that remains at the end of the school year.

The school nurse shall be responsible for developing and implementing procedures for the appropriate and secure storage of medications kept at school, and all medications shall be stored in accordance with this procedure. 

E. Recordkeeping

School personnel and the student’s parent shall account for all medication brought to school. The number of capsules, pills or tablets, and/or the volume of other medications brought to school shall be recorded.

School staff administering medication shall document each instance the medication is administered including the date, time, and dosage given.

The school nurse shall maintain a record including the parent’s request, physician’s order, details of the specific medications (including dosage and timing of medication), and documentation of each instance the medication is administered.

Records shall be retained according to the current State schedules pertaining to student health records.

F. Confidentiality

To the extent legally permissible, staff members may be provided with such information regarding medication and its administration as may be in the best interest of the student. 

G. Administration of Medication

Medication may be administered during the school day by licensed medical personnel acting within the scope of their licenses.

The school nurse, under the administrative supervision of the Superintendent, will provide direction and oversight for the administration of medication to students.

All unlicensed personnel (principals, teachers, education technicians, school secretaries, coaches, bus drivers, etc.) who administer medication must receive training before being authorized to do so.

Based upon the documentation of training and competency in the administration of medication, the school nurse will make recommendations to the Superintendent/designee pertaining to authorization of unlicensed persons to administer medication. Training that shall be acceptable for the purpose of authorization of unlicensed personnel is addressed under the section of this procedure titled “Required Training of Unlicensed Personnel to Administer Medication.” 

H. Administration of Medication During Off-Campus Field Trips and School-Sponsored Events

The school will accommodate students requiring administration of medication during field trips or school-sponsored events as follows:

The school nurse, principal, and, as appropriate, the school unit’s Section 504 Coordinator and/or IEP, will determine whether an individual student’s participation is contraindicated due to the unstable/fragile nature of his/her health condition, the distance from emergency care that may be required, and/or other extraordinary circumstances. The student’s parent and primary care provider will be consulted in making this determination. The decision will be made in compliance with applicable laws, including the IDEA, § 504 and the Americans with Disabilities Act (ADA).

The parent must provide the appropriate number of doses needed for the duration of the field trip or school-sponsored event.

When there are no contraindications to student participation, an appropriately-trained staff member will be assigned to administer medication. The parent will be encouraged to accompany the student, if possible, to care for the student and administer medication.

All provisions of this procedure shall apply to medications to be administered during off-campus field trips and school-sponsored events. As practicable, the administration of medication on a field trip will duplicate as much as possible the guidelines found in the Medication Administration Handbook for Unlicensed School Personnel.

Specific guidelines for the administration of medication during off-campus field trips and school-sponsored events:

  1. Any unlicensed personnel administering medications must hold documentation of their training in the administration of medication, including personnel administering medication on a field trip.
  2. There must be written permission from the parent/guardian providing consent to administer the medication in school and a written physician’s order and/or an appropriately labeled, original medication container.
  3. Either a standardized, preprinted medication label or preprinted envelope containing the information described below or medication in its original container will be used for students attending a field trip.
  4. When using a preprinted label or preprinted envelope, the school nurse shall transfer the prescribed amount of medication needed for the field trip from the original medication container into the approved envelope and fill in the appropriate information on the envelope.
  5. The envelope will be provided to the trained personnel for administration during the trip.  The school nurse will provide a review of the medication and its administration to the trained personnel on an as needed basis.  All trained personnel administering medication must understand what to do in an emergency.
  6. The medication will be transported and stored in compliance with any special directions for the medication and will be secured as safely as possible.
  7. The administration of medication on a field trip will duplicate as much as possible the guidelines found in the “Guidelines for Training of Non-Licensed Personnel in Medication Administration.”  This will include consideration of student privacy and cleanliness of area where medications are administered.
  8. Medication will be administered to the student to assure that the right student receives the right medication, with the right dose, at the right time, by the right route.  The trained personnel administering the medication will double-check the student with the medication label and will double-check the dose.  The medication will be given within 30 minutes either side of the prescribed time.
  9. Each school district will develop a method of documenting medications administered on the field trip, recording any unexpected occurrences, and a method of returning any medication not administered.

    The medication envelope or label will contain the following information:
  • Date to be administered.
  • Name of the student.
  • Name of the medication.
  • Dose to be given.
  • Time to be given.
  • Physician prescribing the medication.
  • Special directions.
  • Phone number of school nurse.
  • Emergency directions.

I. Student Self-Carry/Self-Administration of Medications for Chronic Conditions

Students with chronic conditions (such as anaphylaxis allergies, asthma, or diabetes) may be authorized by the building principal, in consultation with the school nurse, to possess and self- administer emergency medication. Emergency medication may include, but is not limited to, epinephrine, asthma inhalers, insulin or glucagon. Pre-approved medications may be self- administered during the school day, during field trips, school-sponsored events, or while on a school bus. The student shall be authorized to possess and self-administer if the following conditions have been met.

  1. The parent (or student, if 18 years of age or older) must request in writing authorization for the student to self-administer medication.
  2. The student must have the prior written approval of their primary health care provider and, if the student is under the age of 18, the prior written approval of their parent/guardian. The written notice from the student’s primary care provider must specify the name and dosage of the medication, frequency with which it may be administered, and the circumstances that may warrant its use.
  3. The student’s parent/guardian must submit written verification to the school from the student’s primary care provider confirming that the student has the knowledge and the skills to safely possess and use the medication.
  4. The school nurse shall evaluate the student’s technique to ensure proper and effective use of an epinephrine autoinjector or asthma inhaler taking into account the maturity and capability of the student and the circumstances under which the student will or may have to self-administer the medication.
  5. The parent will be informed that the school cannot accurately monitor the frequency and appropriateness of use when the student self-administers medication, and that the school unit will not be responsible for any injury arising from the student’s self-medication.

Authorization granted to a student to possess and self-administer medication shall be valid for the current school year only and must be renewed annually.

A student’s authorization to possess and self-administer medication may be limited or revoked by the building principal after consultation with the school nurse and the student’s parents if the student demonstrates inability to responsibly possess and self-administer such medication.

To the extent legally permissible, staff members may be provided with such information regarding the student’s medication and the student’s self- administration as may be in the best interest of the student.

Sharing, borrowing, or distribution of medication is prohibited. The student’s authorization to self-administer medication may be revoked and the student may be subject to disciplinary consequences for violation of this procedure.

J. Administration of Glucagon Rescue Therapy

The school nurse or designated trained unlicensed school personnel may administer undesignated ready-to-use glucagon rescue therapy to a student with a known diagnosis of diabetes, as specified in the student’s Individual Health Plan (IHP)/Diabetes Care Plan, if the student’s prescribed glucagon is not available on site or has expired. Glucagon therapy may be administered in school buildings, on school grounds, playground, on school buses as well as on field trips or school-sponsored excursions.

The Plan will include a current school year written request/permission and acknowledgment that glucagon rescue therapy may be administered by unlicensed school personnel.

The school will provide an emergency action plan to a school employee who transports a student for school-sponsored activities. The emergency action plan must identify the student with diabetes, the potential emergencies that may occur as the result of the student’s diabetes and provide the school’s emergency contact information and diabetes care plan.

Immediately after the administration of glucagon rescue therapy to a student, a school employee must call for emergency assistance, notify the school nurse, and follow the emergency action plan.

K. Dispensation of Over-the-Counter Medications

With prior written parent permission, students may receive certain over the counter medications at school, e.g., Tylenol, Ibuprofen, Tums, cough drops, etc. pursuant to a standing order from the school physician/school health advisor.

L. Sunscreen

Students may possess and self-administer topical sunscreen without a signed order from a health care provider under the following conditions:

  1. Sunscreen is to be in its original container, labeled with directions of use and warnings. Because it may adversely affect students with asthma and/or allergies, aerosol and spray sunscreens will not be allowed in schools.
  2. The student must have written permission from their parent.
  3. School nurse or other school personnel may inspect sunscreen products for safety and proper FDA labeling.
  4. There is no expectation that school staff will apply sunscreen to students.
  5. There is no expectation that the school will supply sunscreen to all students.
  6. A student who is unable to physically apply sunscreen may be assisted by school personnel when directed to do so by the student, if permitted by a parent or guardian and authorized by the school.

M. Required Training of Unlicensed Personnel to Administer Medication

Unlicensed school personnel who administer medication to students in a school setting (at school, on school transportation to or from school, on field trips, or during school-sponsored events) must be trained in the administration of medication before being authorized to carry out this responsibility. Such training must be provided by a registered professional nurse or physician and include the components specified in Department of Education Rules Chapter 40 and other applicable Department of Education standards, recommendations, programs, and/or methodologies.

The trainer shall document the training and competency of unlicensed school personnel to administer medication. Based upon a review of the documentation of training and competency in the administration of medication, the school nurse will make recommendations to the Superintendent/designee pertaining to authorization of such unlicensed personnel pertaining to authorization to administer medication.

Following the initial training, a training review and information update must be held at least annually for those unlicensed school personnel authorized to administer medication. 

LEGAL REFERENCE:

  • 20-A MRSA §§ 254(5); 4009(4); 4502 (5)(N); 6305; 6308
  • Me. Dept. of Ed. Rule Ch. 40
  • 21 USC §801 et. seq. (Controlled Substances Act)
  • 28 C.F.R. Part 35 (Americans with Disabilities Act of 1990)
  • 34 C.F.R. Part 104 (Section 504 of the Rehabilitation Act of 1973)
  • 34 C.F.R. Part 300 (Individuals with Disabilities Education Act)

CROSS REFERENCE:

  • JLCD – Administration of Medication to Students 

REVIEWED: January 12, 2017
AMENDED: December 12, 2024