STUDENTS 5142

Administration Of Medication By School Personnel

The Manchester Board of Education recognizes the need to administer medication as a program adjustment to meet the health needs of individual students. Medication prescribed by an authorized prescriber licensed in this or any other state shall be given by a licensed registered nurse or, in her/his absence, it may be given by a trained principal or teacher. Students shall be allowed to self-medicate prescribed, non-controlled medications if the student meets the criteria outlined in the administrative guidelines.

Medication will be administered in compliance with Connecticut General Statutes Sec. 10-212a and Regulations Section 10-212a-1 to 10-212a-7 effective June 26, 1989.

Adopted: May 29, 1990
Reviewed: July 13, 1992
Reviewed: October 24, 1994
Revised: November 12, 1996
Reviewed: November 9, 1998

Guidelines:

Sec. 10-212a-2 Administration of Medication

I. Prescribed medications should be not administered during school hours if it is possible to achieve the desired effects by home administration. If such a medication is prescribed during the school day, the school nurse will contact the physician and parent to arrange for home administration.

II. If a prescribed medication must be given during the school day, it will be given by a licensed registered nurse (RN) or, in his/her absence, a trained principal or teacher. The prescribed medications include controlled drugs listed in Schedules II-V of the DEA. The trained principal or teacher may give oral, topical, intranasal or inhalant medications. Individuals who have had added instruction in injectable medication will be allowed to give injectable medication for a medically diagnosed allergic condition only. All investigational drugs shall be administered only by the RN.

III. Students who meet the criteria for self-medication and have the appropriate medication authorization form completed by a physician may give their own medication with the guidance of the school nurse. See Section 10-212a-4

IV. A written order on a standard form must be completed by an authorized prescriber licensed to practice in this or any other state is required before a medication can be given. No telephone orders will be accepted.

This form shall include:

Name of Student
Diagnosis for which the medication is prescribed
Duration of order
Name of drug and method of administration
Dosage
Time of administration
Side effects to be observed
State DEA number if a controlled substance
Signature of the physician and parent

These forms shall be available in Manchester physician's offices, walk-in clinics and school health offices. (The prescribed medication shall be administered to and taken only by the person for whom the prescription is written. Siblings shall not share medication.) This form shall be renewed annually.

V. Any drug listed in the PDR must be administrated under the Medication Administration Policy. If the substance is not found in the PDR, it is not a medication and it will be handled as a food substance.

VI. If a student has an adverse reaction to a medication, the following emergency procedures will be followed:

1. If anaphylaxis occurs, refer to emergency procedure. This procedure is outlined in the Manchester School Health Manual and shall be posted in the Health Office.

2. If the individual develops symptoms which are not life threatening, the following procedure will be used:

The nurse will complete an evaluation of the student and contact the prescribing physician and parent. If the nurse if not available, the building administrator shall contact the backup nurse to complete the evaluation. If the physician is not available, the Poison Control Center (1-800-222-1222) shall be called and their advice shall be followed. If the nurse cannot reach anyone in the Poison Control Information Center, Manchester Memorial Hospital Emergency Room
(647-4777) will be contacted. These emergency numbers shall be posted on the phone or adjacent to the phone. All information and actions shall be documented in the Cumulative Health Record.
A written report shall be submitted to the School Nurse Supervisor.

Section 10-212a-3 Training of School Personnel

All principals and teachers giving medications when the school nurse is not available shall complete a medication-training course provided by the school health coordinator or the school nurse.

I. Program content:

1. General overview of procedural aspects of medication administration.

2. Method of administration including oral, topical, and inhalants

3. Giving of injectable adrenalin for medically diagnosed anaphylaxis

4. The storage of medications

5. Recording of medications

6. Review of medication idiosyncrasies, adverse effect, contraindication and desired effects

7. Return demonstration for each method of administering medication

Upon completion of this program, the trained principal and teachers will meet with the school nurse in their building to review individual plans for students who receive medication.

II. Names of trained principals and teachers will be kept on file in the superintendent=s office.

Sec. 10-212a-4 Self-medications

The orders for self-administration of medications must be updated yearly.

I. The authorized prescriber and parent shall complete the form for self-administration of medication.

This form shall include:
8. Name of student
9. Condition for which medication is prescribed
10. Dose and frequency
11. Relevant side effects and management
12. Authorized prescriber=s statement that the student has been appropriately instructed regarding self-administration and that the authorized prescriber has conferred with the student=s parents.
13. Parents permission with a statement that the student has permission to self-administer medication.

II. The school nurse shall evaluate the student=s ability to self-administer medications. This evaluation shall include, but not limited to, student=s age, development, type of medication and potential hazards to other students.

14. If the school nurse determines that the student can safely self-administer medication, a contract shall be developed. This contract shall include; when and where the student will keep the medications; backup medication if necessary; supervision schedule; and method of evaluation. A copy of the evaluation shall be sent to the parent and the authorized prescriber at the end of the school year.

2. If the nurse determines that the medication cannot be safely administered, the plan will be reviewed by the supervising school nurse. If the supervisor agrees, the authorized prescriber and parent will be notified. If the situation cannot be resolved, the school medical advisor will determine if the student can safely self-administer medication.
Administration of Medication by School Personnel Guidelines (4)

3. If, during the evaluation, the school nurse determines that the student is not continually in compliance, the school nurse shall contact the prescribing person and, if necessary, the order for self-medication may be withdrawn.

III. The school nurse will contact the student=s teachers that the student has permission to self-administer his/her medication. A list of students shall be submitted to the building administrator. This list shall be updated as necessary.

Sec. 10-212a-5 Handling, Storage and Disposal of Medication

I. All medications, except those approved for transporting by students for self-medication, shall be delivered to school by a responsible adult. If medication is brought in by the student, the school nurse shall contact the parent, and the parent must personally identify the medication brought in by the student.

II. All medication must be in a pharmacy labeled bottle, which includes:

15. Name of student
16. Name of medication and method of administration
17. Strength of medication and dosage
18. Date of issue
19. Instructions for administration
20. Name of authorized prescriber

Any medication which is delivered in any other way than a properly labeled bottle shall not be given. The parent will be contacted and the medication guidelines shall be reviewed with the parent.

The medication will be returned to the parent or a responsible adult selected by the parent.

III. When the medication arrives at school, the school nurse shall examine on site the medication, medication order and permission form. If all is in order, the nurse shall develop a medication administration plan.

This plan shall include:
1. The medication
2. Side effects
3. Special directions
4. Mode of administration
5. Time of administration
6. Backup system if nurse is absent

Administration of Medication by School Personnel Guidelines (5)
The school nurse shall count pills and record the amount on the documentation form.

IV. Storage

21. All medications, except those approved for keeping by the student for self-medication, shall be kept in their original containers in a locked area. The supervising nurse shall ensure that each school has a locked cabinet for the storage of medication only.
22. Controlled drugs shall be kept separate from non-controlled drugs in a permanently fixed cabinet. Only trained school personnel will have access to the keys to the storage areas.
23. The school nurse shall keep a list of school personnel who are trained to give medication.
24. Medications requiring refrigeration shall be kept in a refrigerator in its original container and at a temperature 36 degrees - 46 degrees F. This refrigerator shall be in the school health office and not in a staff room.
25. No more than a forty-five (45) school day supply of medication shall be stored.
26. No medication shall be stored in school unless a current written order from an authorized prescriber is on file.

V. Disposal

27. All controlled, unused, discontinued or obsolete medications shall be returned to the parent. If the parent does not pick up the medication within three school days after discontinuance, the school nurse shall contact the Office of Consumer Protection (713-6065) and make arrangements for surrendering the controlled medication.
2. The School Health Coordinator will pick up any controlled drugs left over at the close of school. A Medication Destruction Form must be completed. The bottle will be numbered according to the line on the form. For example, if the student's name is listed on line one, that student's medication bottle will be labeled one.

Sec. 10-212a-6 Documentation and Record keeping

I. All medications given during the school day shall be recorded in the following manner:
28. Name of student
29. Name of medication
30. Dosage and frequency of medication
31. Route of administration
32. Name of the authorized prescriber
33. Date the medication was ordered
34. Quantity received
35. Date the medication is to be reordered
Administration of Medication by School Personnel Guidelines (6)

36. Student allergies to food or medicine
37. Date and time of administration or omission including the reason for the omission
38. Prescribed dosage
39. Full legal signature of the nurse or principal or teacher giving the medication

II. Transactions shall be recorded in ink and cannot be altered.

III. All medication records and permission forms shall be placed in a three-ring notebook which shall be made available to the State Health Department for their review. At the end of the school year, the medication record and all permission forms shall be placed in the Cumulative Health Record.

IV. The original prescription authorization form shall remain at the school. A copy will be sent to the transfer school. The copied prescription form will be attached to the copies of the documentation sheet.

V. For controlled medications, the school nurse shall keep the white copy of the documentation sheet. The yellow copy will be placed in the health record. For non-controlled medications, make a copy and attach the copy to the prescription authorization form. Document the medications on the health record. All documentation sheets must be kept for three years and then they may be destroyed.

VI. The same documentation sheet may be used until the prescription number changes. If the prescription number remains the same, one does not need to make out a new documentation sheet.

VII. Controlled medications do not have to be counted daily. However, the school nurse is accountable if any medications are missing or if there is an error in the number of pills. Each time a new supply arrives at school, the medication must be counted and the accurate number be inserted in the appropriate space on the documentation form. The number must be the same as the number of pills sent in by the parent. If there is a discrepancy in the number, contact the parent immediately. If the problem is not resolved, contact the School Health Coordinator immediately.

VIII. If one pill is dropped, it may be destroyed. The principal or teacher who is trained in medication administration must countersign the documentation sheet. A Medication Error Form must be completed. The original form is placed in the health record and a copy is sent to the School Health Coordinator. The parent is notified. If more than one pill is dropped the School Health Coordinator is notified and he/she will contact the Drug Enforcement Agency.

IX. An error in medication means that one failed to complete the order as written. Errors will be documented on the Cumulative Health records and a copy of the Error Report Form will be kept on file. If one of the following events occurs, a Medication Error Report Form shall be submitted to the nursing supervisor:

40. Failure to give the medication when student is present in school
41. Failure to give the medication within one-half hour before or one-half hour after the prescribed time
42. Failure to administer the specific medication prescribed for a student
43. Failure to administer the correct dosage of medication
44. Failure to administer the proper routine
45. Failure to administer according to generally accepted standards of practice.

The parent and, if needed, the prescribing physician shall be notified by telephone or by letter. A copy of the incident report may be sent to the authorized prescriber.

Sec. 10-212a-7 Supervision

I. The school nurse is responsible for general supervision of administration of medications in the schools to which the school nurse is assigned. When the school nurse is not in the building, the trained principal or teacher will be responsible for the daily administration of medications.

II. When a medication arrives at school, the principal or teacher shall contact the school nurse immediately. The school nurse will complete the following tasks prior to the person giving the medication.

The school nurse shall:

46. Review the medication forms
47. Check the medication bottle for proper label
48. Check the contents of the bottle to be sure it is the proper medication and note the amount of medication on the medication log
49. Initiate the individual medication log
50. Develop or review the drug data card with the person giving the medication
51. Develop a medication plan which includes the person responsible for the medication, the time the medication is given and a phone number where the trained principal or teacher can reach the school nurse

III. The school nurse shall review with the person responsible for giving the medication:

Administration of Medication by School Personnel Guidelines (8)

52. Proper handling and storage of medication
53. Proper documentation
54. Drug data card
55. Development of communication system for:

Questions about medication
Change in behavior or physical status
Error in administration of medication
Changes in appearance of medication
Failure of the student to comply with medication protocol
Missing medications

IV. The school nurse shall:

56. Observe the new person giving medication for the first time
57. Review monthly all medication documentation
58. Observe the effects of medication, especially medication given to alter classroom behavior
59. Communicate with the authorized prescriber

V. The school nurse shall attend CST/PPT meetings for any child placed on long-term medication.

The policy and administrative guidelines shall be reviewed biannually by the school medical advisor and the supervising school nurse. Whenever they are revised, the Director of Pupil Personnel Services shall forward them to the State Department of Health for review and approval.

Revised: March 10, 2003