Policy 7513

Administration of Medication

The school’s registered professional nurse and/or license practical nurse may administer medication to a student during school hours under certain conditions. (For the purpose of this policy “medication” includes prescription and over the counter medication which is supported by medical documentation). Per New York State Education Department (NYSED) requirements, the school must receive the following before medication is given to a student:

  • a) The original written order from the student’s physician stating the name of the medication, precise dosage, frequency and time of administration at the start of every school year
  • b) A written, signed consent from the student’s parent or legal guardian requesting the administration of the medication, as prescribed by the physician, to the student in school; and
  • c) The medication, in its original pharmacy container with the original pharmacy label affixed, must be delivered to the School Health Office by the student’s parent or legal guardian. A student is not permitted to carry any medication on his/her person in school, or on the school bus, or keep any medication in his/her school locker(s). An exception to this policy may apply for inhaled rescue medications, epinephrine auto-injectors, and insulin, glucagon and other diabetes supplies to manage diabetes, which a student may carry under certain conditions.

All medication orders must be reviewed annually or whenever there is a change in dosage.

Procedures governing the School District’s receipt, storage and disposal of medication, as well as those pertaining to the administration of medication to a student after school hours and/or off school grounds during a school-sponsored activity will be in accordance with NYSED guidelines.

Student Function Categories

Pursuant to NYSED guidelines, each student who is administered medication during the school day, at school-sponsored activities, or during after-school activities must be assigned one of three categories of student functioning related to their medication.  The School Nurse is responsible for communicating these standards and definitions to the student’s providers and parents in order to secure appropriate information for function category assignment.

  • 1. Nurse Dependent – A student who cannot self-administer their own medication and cannot be considered in need of supervision according to the criteria for Supervised Students, are therefore dependent on another person administering the medication to them.  Such Nurse Dependent Students must have their medication administered to them by an appropriate licensed health professional.
  • 2. Supervised Student – A student who has been determined to need supervision (previously self-directed) by nurse or provider and may be assisted by trained, unlicensed personnel to self-administer their medication.
    • a. Assistance may only be at the direction of the student (e.g. open the bottle, remove the number of pills directed by the student, etc.).
    • b. If the student is unable to direct the unlicensed person, they may not proceed with self-administration, and a licensed health professional must assist and notify parents/guardians and/or contact EMS as needed.
    • c. This function category takes into account a student’s cognitive and/or emotional development, rather than grade or age. A supervised student must be able to:
      • i. Administer the medication via the correct route.
      • ii. Identify the correct medication (color/shape is sufficient).
      • iii. Identify the purpose of the medication.
      • iv. Identify the correct dosage if handed to them.
      • v. Identify the time the medication is needed.
      • vi. Know the parameters or conditions under which the medication needs to be taken, and refuse to take the medication if the parameters are not met.
      • vii. Describe what will happen if the medication is not taken.
      • viii. Refuse to take medication if the student has any concerns about its appropriateness.
    • d. This determination should also take into account the student’s particular illness and the severity of the health care problems, including requirements for rapid administration of medication.
  • 3. Independent Student – A student who can administer his/her own medication without any assistance as documented in the required attestation form.
    • a. Medication may be kept in the health office for the student to obtain and administer themselves.
    • b. If they are permitted to carry their own medication, the provider must attest that they have determined the student may self-administer effectively and must have parent consent for the student to self-carry.
    • c. If the student can self-carry, they are not required to go to the health office to take medication and may carry their medication anywhere in the school or at school functions.
    • d. Medication administration by independent students is not documented by the school and the parent/guardian assumes responsibility for their child’s self-administration and follow-through with medication with periodic monitoring by school health office personnel.

Administration for Anaphylaxis Using Epinephrine

The administration of emergency epinephrine (injectable, including “EpiPens,” and/or oral) to a student for an allergic reaction may be performed by a school staff member responding to an emergency situation when such use has been prescribed by a licensed prescriber. However, a registered professional nurse/nurse practitioner/physician/physician’s assistant must have trained the staff member to administer the emergency medication for that particular emergency situation and given him/her approval to assist the student in the event of an emergency anaphylactic reaction. Such a response would fall under the Good Samaritan exemption for rendering emergency care during a life threatening situation.

A licensed healthcare professional (RN, LPN, NP, Physician, PA) may administer epinephrine under a non-patient specific order to any person who appears to be suffering from anaphylaxis.

Use of Asthma Inhalers in Schools

A student may carry and use an inhaled rescue medication if the School Health Office has the following on file:

  • a) The physician’s written order/diagnosis that the student has a severe asthma condition and may be subject to sudden and debilitating asthmatic attacks, and which attests that the student can self-administer the medication effectively; and
  • b) Written permission from the student’s parent or legal guardian.

Upon written request of the student’s parent or legal guardian, the school must allow a student to maintain an extra asthma inhaler in the care and custody of the school’s registered professional nurse.

Health Office personnel will maintain regular parental contact in order to monitor the effectiveness of such self-medication procedures and to clarify parental responsibility as to the daily monitoring of their child to ensure that the medication is being utilized in accordance with the physician’s or provider’s instructions. Additionally, the student will be required to report to the Health Office on a periodic basis as determined by Health Office personnel so as to maintain an ongoing evaluation of the student’s management of such self-medication techniques, and to work cooperatively with the parents and the student regarding such self-care management.

Students who self-carry and self-administer medication without proper authorization, under any circumstances, will be referred for counseling by school nursing personnel. Additionally, school administration and parents will be notified of such unauthorized use of medication by the student, and school administration may also be involved in determining the proper resolution of such student behavior.

Blood Glucose Monitoring

Children with diabetes have the right to care for their diabetes at school in accordance with the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973 which provide protection against discrimination for children with disabilities, including diabetes.

Accordingly, blood glucose monitoring must be allowed in the school setting at any time, within any place, and by anyone necessitating such testing. Children must receive assistance if needed with the procedure.

The school nurse shall oversee any arrangements that need to be made for testing and a system to report the results to the nurse as needed. Proper arrangements should be made for the disposal of sharps.

Alcohol-Based Hand Sanitizers

Alcohol-based hand sanitizers are considered over-the-counter (OTC) drugs by the United States Food and Drug Administration. However, due to the fact that careful hand-washing and sanitation is the most effective way to control the recent spread of Methicillin-Resistant Staphylococcus Aureus (MRSA) in schools, the New York State Education Department (NYSED) has allowed a medical exemption to the requirements for OTC preparations in the school setting to permit the use of alcohol-based hand sanitizers.

The School Medical Director may approve and permit the use of alcohol-based hand sanitizers in the District’s schools without a physician’s order. Parents may provide written notification to the school in the event that they do not wish to have their child use this product.

It should be noted that hand sanitizers which contain alcohol are flammable and shall not be placed in hallways or near an open flame or source of sparks.

Sunscreen

Although the Food and Drug Administration (FDA) technically considers sunscreen an over-the-counter drug which would require a doctor’s prescription, New York Education Law Section 907 allows students to carry and use topical sunscreen products approved by the FDA for over-the-counter use for the purpose of avoiding overexposure to the sun and not for medical treatment of an injury or illness. A parent/guardian of the student must provide written permission which shall be maintained by the school. A student who is unable to physically apply sunscreen may be assisted by unlicensed personnel when directed to do so by the student, if permitted by a parent or guardian and authorized by the school.

Disposal of Unused Medication

Any unused medication (including, but not limited to expired prescription and nonprescription drugs) must be returned to the parent/person in parental relation by the end of each school year. If the parent/person in parental relation does not retrieve the unused medication by the end of the school year, then the School Nurse or designated School Health Office personnel must document that the medication was abandoned and dispose of the unused medication following Department of Environmental Conservation guidelines.