5141.21

Students

Administering Medications 

Medicinal preparations shall be administered in school (1) only upon written authorization of the attending physician, dentist, advanced practice registered nurse or nurse anesthetists, or licensed physician assistant and written authorization of the parent or guardian and (2) when it is not possible to achieve the desired effects by home administration during other than school hours.

Administration of medicines shall be by the school district medical advisor (M.D.), a school nurse (RN), or a licensed practical nurse (LPN.) if approved to do so by the school district medical advisor or school nurse.  In the absence of these medical personnel, the Principal or a teacher designated in writing by the Principal shall be permitted to administer authorized medicinal preparations  upon completion of training in the safe administration of medicinal preparations and knowledge of related policy and regulations.  Coaches are also authorized to administer medication to students participating in intramural and interscholastic athletics.  School health aides are not allowed to administer medicinal preparations.  In an emergency, if the student’s physician or the school district medical advisor is not immediately available, any physician (M.D.) may be called for assistance.

Students in grades 7 and 8 may carry and self-administer medicinal preparations, provided that:

A.  A physician, dentist, advanced practice registered nurse or nurse anesthetists, or licensed physician assistant provides written orders for self-administration of medication;

B.  There is written authorization for self-administration of medication from the student’s parent or guardian;

C.  The school nurse has evaluated the situation and deemed it to be safe and appropriate; has documented this on the student’s cumulative health record; and has developed a plan of general supervision of such self-medication;

D.  The student and school nurse have developed a plan for reporting and supervising self-administration of medications by students and teacher notification;

E.  The Principal and appropriate teachers are informed that the student is self-administering prescribed medication;

F.  Medication is transported and maintained under student control within guidelines.  Authorized medicinal preparations may be administered during school activities as well as during school hours.

In compliance with all applicable state statutes and regulations, parents/guardians may administer medications to their own children on school grounds.

The Board of Education with the advice and assistance of the school district medical advisor and the school nurse supervisor, shall review and revise this policy, and its attendant regulation, as necessary and at least biennially and submit it to the Connecticut Department of Health Services as required by Connecticut Regulations of State Agencies.

Each school wherein any controlled drug is administered under the provisions of this policy shall maintain such records as are required of hospitals under the provisions of subsections (f) and (h) of section 21a-254 and shall store such drug in such a manner as the Commissioner of Health Services shall, by regulation, require.

Legal Reference:   Connecticut General Statutes

10-212a Administration of medicines by school personnel. (as amended by PA 99-2, and PA 01-1 of Special Session)

52-557b Immunity from liability for emergency medical assistance, first aid or medication by injection.  School personnel not required to administer or render.

20-12d Medical functions performed by physician assistants. Prescription authority.

20-94a Licensure as advanced practice registered nurse

Connecticut Regulations of State Agencies 10-212a-1 through 10-212a-7

Policy adopted:  7/11/05

Students

Administering Medications to Students

Students may self-administer medication and school personnel may administer medication to students in accordance with the following established procedures. These procedures shall be reviewed and/or revised by the school medical advisor, the school nurse and the Board of Education and then submitted to the Connecticut Department of Health Services biennially as required in C.G.S. 10-212a-1 to 10-212-7.

A student who is required to receive medication or wants to take aspirin, ibuprofen, or an aspirin substitute containing acetaminophen during school hours must provide:

A.  The licensed physician's or dentist's orders for medication or aspirin on a school district form specifying the student's name, condition for which the drug is being administered, name of drug and method of administration, and the drug dosage. Also required on the medication order for students to receive medication at school or school activities are (1) the duration of the order, (2) the time of administration, (3) possible side effects to be observed (if any) and management of such effects, and (4) student allergies to food and/or medicine. This medical order must be renewed yearly.

B.  Written authorization is required from the student’s parent or guardian allowing school personnel to administer said medication. This authorization shall be renewed yearly and shall also include parental consent for school personnel to destroy said medication if not repossessed by the parent or guardian within a seven (7) day period of notification by school authorities.

C.  The medication must have its original correct label from the pharmacy or manufacturer.

Students who are able to self administer medication may do so provided:

A.  A physician or dentist provides a written order for self administration of said medication.

B.  There is written authorization for self administration of medication from the student's parent or guardian.

C.  The school nurse has evaluated the student’s circumstances and (1) has deemed the administration of the prescribed medication it to be safe and appropriate; (2) has documented this on the student's cumulative health record, and (3) has developed a plan for general supervision.

D.  The student and school nurse have developed a plan for reporting and supervision of self-administration and notification of teachers.

E.  The Principal and appropriate teachers are informed that the student is self administering prescribed medication.

F.  Such medication is transported to the school and maintained under the student's control within these guidelines.

Medication may be administered by a licensed nurse, or in absence of such licensed personnel, Principals and teachers. They shall not be held liable for any personal injuries which may result from acts or omissions constituting ordinary negligence.

A licensed practical nurse may administer medications to students if she can demonstrate evidence of one of the following:

A.  Training in administration of medications as part of their basic nursing program;

B.  Successful completion of a pharmacology course and subsequent supervised experience;

C.  Supervised experience in medication administration while employed in a health care facility.

Medication will be administered according to the following procedures:

A.  The school nurse will develop a medication administration plan for each student before medication may be administered by any staff member. The school nurse will also review monthly all documentation pertaining to the administration of medication for students.

B.  The Principals and teachers approved by the school medical advisor and school nurse will be formally trained by the school nurse prior to administering medication. The school nurse, acting as designee and under the direction of the chief medical officer, will annually instruct such staff members in the administration of medication. The training will include:

1.  Review of state statute and school regulations regarding administration of medication by school personnel.

2.  Procedure for administering the medication, safe handling and storage of medication, and recording.

3.  Medication needs of specific students, medication idiosyncrasies, desired effects, potential side effects, untoward reactions and other observations.

C.  A list of Principals and teachers successfully trained and approved to administer medication along with documentation of the annual update of trainees shall be submitted to the Superintendent by the nursing supervisor on October 31 of each year.

D.  Coaches are also authorized to administer medication to students participating in intramural and interscholastic athletics.

E.  A current list of those authorized to give medication shall be maintained in the school.

Handling and Storage of Medications 

All medication, except those approved for keeping by students for self medication, must be delivered by the parent or other responsible adult and shall be received by the nurse assigned to the school. The school nurse must:

A.  Examine any new medication to insure that it shall be properly labeled with dates, name of student, medication name, dosage and physician's name, and that the medication order and permission form are complete and appropriate.

B.  Develop a medication administration plan for the student before any medication is given by school personnel.

C.  Record on the Student's Individual Medication Record the date the medication is delivered and the amount of medication received.

D.  Store medication requiring refrigeration at 36 F - 46 F.

E.  Store prescribed medicinal preparations in securely locked storage compartment. Controlled substances shall be contained in separate compartments, secured and locked at all times.

All medication, except those approved for keeping by students for self medication, shall be kept 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.

The school Principal or designee (who has been trained to administer medication) shall be responsible for the key/s to the locked cabinet/s.

No more than a forty-five (45) school day supply of a medication for a student shall be stored at the school. All medications, prescriptions and nonprescription, shall be stored in their original containers and in such a manner as to render them safe and effective.

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.

Destruction/Disposal of Medication

At the end of the school year or whenever a student's medication is discontinued by the prescribing physician, the parent or guardian is to be contacted and requested to repossess the unused medication within a seven (7) school day period. If the parent does not comply with this request, all medication is to be destroyed by the school nurse in the presence of witness (school physician, Principal, teacher) according to the following procedures:

A.  Medication will be destroyed in a non-recoverable fashion.

1.  Liquid medication should be poured into a sink or water closet.

2.  Any medication in pill or tablet form should be crushed and poured into a sink or water closet.

B.  The following information is to be charted on the student's health folder and signed by the school nurse and witness:

1.  Date of destruction.

2.  Time of destruction.

3.  Name, strength, form and quantity of medication destroyed.

4.  Manner of destruction of medication.

C. Controlled substances shall not be destroyed by the school nurse. In the event that any    controlled substance remains unclaimed, the supervisor of nursing shall contact the Connecticut Commissioner of Consumer Protection to arrange for proper disposition.

Documentation and Record Keeping

Record keeping of medication administration shall be in ink on the individual student's medication record form which, along with the parental authorization form and the physician's order, becomes part of the student's permanent record. Records shall be made available to the Connecticut Department of Health Services upon request.

Controlled Substances

Records of controlled substances shall be entered in the same manner as other medications with the following additions:

A.  The amount of controlled drug shall be counted and recorded on the individual student medication record form after each dose given.

B.  A true copy (carbon or NCR) of the forms shall be retained by the school for 3 years and the original filed in the student's permanent health record.

C.  Loss, theft or destruction of controlled substances shall be immediately, upon discovery, reported to the supervisor of nursing services who will contact the Connecticut Commissioner of Consumer Protection.

Required Entries in Medication Administration Records

A.  Name of student;

B.  Name of medication;

C.  Dosage of medication;

D.  Route of administration;

E.  Frequency of administration;

F.  Name of prescribing physician, or in the case of aspirin, ibuprofen, or an aspirin substitute containing acetaminophen being given to a student, the name of the parent or guardian requesting the medication to be given;

G.  Date medication was ordered;

H.  Quantity received;

I.  Date medication is to be reordered;

J.  Student allergies to food and/or medicine;

K.  Date and time of administration or omission including reason for omission;

L.  Does of amount of administered;

M.  Full legal signature of the nurse (RN), Principal, or teacher administering the medication.

A record of the medication administered shall be entered in ink on an individual student medication record form and filed in the student's cumulative health folder.  If the student is absent, it shall be so recorded.  If an error is made in recording, a single line shall be run through the error and initialed.

A physician's verbal order, including a telephone order, for a change in any medication may be received only by a school nurse. Such verbal order must be followed by a written order within three (3) school days.

Medication Errors

A.  An error in the administration of medication shall be reported to (1) the school nurse (who will initiate appropriate action and documentation in a student incident report and on his/her cumulative record), (2) to the parent, and (3) to the prescribing physician.

B.  Untoward reactions to medication shall be reported to the school nurse, the parent, and the student's physician.

In case of an anaphylactic reaction of the risk or such reaction, a school nurse or any other person trained in CPR and First Aid, may administer emergency oral and/or injectable medication to any student in need thereof on the school grounds, in the school building, or at a school function according to the standing order of the chief medical advisor or the student's private physician.

In the absence of a licensed nurse, only Principals and teachers who have been properly trained may administer medication to student. Principals and teachers any administer oral, topical, or inhalant medications.  Injectable medications may be administered by a Principal or teacher 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 or teachers.

Administration of Emergency Medication under CGS 10-221a 

In the absence of a school nurse, the administrator or teacher may give emergency medication orally or by injection to students with a medically diagnosed allergic condition which would require such prompt treatment to protect the child from serious harm or death so long as the administrator or teacher has completed training in administration or such medication.

In the event of a medication emergency, the following will be readily available:

A.  The local poison information center;

B.  The physician, clinic or emergency room to be contacted in such an emergency;

C.  The name of the person responsible for the decision making in the absence of the school nurse.

Legal Reference:   Connecticut General Statutes

10-212a Administration of medicines by school personnel. (as amended by PA 99-2, An Act Concerning Public Health Expenditures)

52-557b Immunity from liability for emergency medical assistance first aid or medication by injection. School personnel not required to administer or render.

Connecticut Regulations of State Agencies

10-212a-1 - 10-212a-7 Administration of medicines by school personnel.

1307.21 Code of Federal Regulation

Regulation approved:  7/11/05

FORM #1

Individual Student Medication Record

          Controlled Substance

          Non-Controlled Substance

FORM #2

AUTHORIZATION FOR THE ADMINISTRATION OF MEDICINES

BY SCHOOL PERSONNEL

The Connecticut State Law and Regulations require a physician's or dentist's written order and parent or guardian's authorization for a nurse to administer medications or in her absence the principal or teacher to administer medications. Medications must be in pharmacy prepared containers and labeled with name of child, name of drug, strength, dosage, frequency, physician's or dentist's name and date of original prescription.

PHYSICIAN OR DENTIST'S ORDER

Name of Child _______________________________________Date _______________________________

Date of Birth ___________________________________

Condition for which drug is being administered during school hours___________________________________

_______________________________________________________________________________________

DRUG: name, dose and method of administration

Time of administration______________________________________________________________________

Medication shall be administered from ________________________to_________________________

                                                                        (Date)                                             (Date)

Relevant side effects to be observed, if any ________________________________________________________

_________________________________________________________________________________________

If there are side effects, plan for management_______________________________________________________

_________________________________________________________________________________________

Is this a controlled drug? _______________________If yes, DEA number ________________________________

Physician's/Dentist's Name_____________________ Tel.___________________________________

   (Type or print)

Address___________________________________________________________________________________

Physician or Dentist's Signature _________________________________ Date __________________

Nurse/Principal/Teacher _______________________________________ Date __________________

AUTHORIZATION BY PARENT/GUARDIAN FOR THE ADMINISTRATION OF THE ABOVE MEDICATION BY SCHOOL PERSONNEL:

                                                                                      Date:_____________________

To School Personnel:

I hereby request that the above medication, ordered by the physician/dentist for by child ______________, be administered by school personnel. I understand that I must supply the school with the prescribed medication in the original container dispensed and properly labeled by a physician or pharmacist and will provide no more than a 45 school day supply of said medication.

I understand that this medication will be destroyed if it is not picked up within one week following termination of the order or one week beyond the close of school.

Name: ______________________________

               (Type or Print)

Signature:_______________________________ Relationship to child: ___________________________

Address: ________________________________ Telephone: ___________________________________

FORM #3

MEDICATION ERROR OR INCIDENT REPORT

Date or Report ___________ School     ______________________ Prepared by ___________________

Name of Student: _________________________________________ Grade _______________________

Home Address:_____________________________________________ Phone _____________________

Date error occurred: ______________________________________ Timed noted: __________________

Person Administering Medication _________________________________________________________

Prescribing ______________________________________________________________Practitioner: 

Reason medication was prescribed:________________________________________________________

Date of Order:     ______________________Instructions for Administration:__________________________

Describe the error and how it occurred (use reverse side if necessary)

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Action Taken:

Prescribing practitioner notified:    Yes        No        Date           Time ___________________________

Parent notified   Yes        No        Date                          Time ___________________________________

Outcome: _________________________________________________________________________

_________________________________________________________________________________

__________________________________________________________________________________

Name: _____________________________________________________________________________

             Print or Type                                                        Signature                             Title                      Date 

Form #4

Record of Education/Supervision for Principals/Teachers in Medication Administration

Year:                         School Building:                                          Responsible School Nurse _____________________

Form# 5

Record of Training of School Personnel in the Administration of Medicines

______________________________                                                                                                    

School Building                                       Responsible School Nurse

*Directions: Check (x) when completed.