Policy 5141.21(a)
Administering of Medications
The purpose of this policy is for the Board of Education (Board) to determine who may administer medication to students in school and under what circumstances the self-administration of medication by students shall be permitted.
The Board allows students to self-administer medication and school personnel to administer medication to students in accordance with the established procedures, and applicable state regulations, sections 10-212a-1 through 10-212a-10 inclusive. Regulations to accompany this policy shall establish procedures for the administration of medication to District students.
In order to provide immunity afforded to school personnel who administer medication, the Board, with the advice and approval of the School Medical Advisor and the Coordinator of School Nursing, shall biennially review and revise, if warranted, this policy and regulation concerning the administration of medications to District students by a nurse, or in the absence of a nurse, by qualified personnel for schools.
Definitions
Administration of medication means any one of the following activities: handling, storing, preparing or pouring of medication; conveying it to the student according to the medication order; observing the student inhale, apply, swallow, or self-inject the medication, when applicable; documenting that the medication was administered; and counting remaining doses to verify proper administration and use of the medication.
Advanced practice registered nurse means an individual licensed pursuant to C.G.S. 20-94a.
Authorized prescriber means a physician, dentist, optometrist, advanced practice registered nurse or physician assistant and for interscholastic and intramural athletic events only, a podiatrist.
Before- and after-school program means any child care program operated and administered by a local or regional Board or municipality exempt from licensure by the Office of Early Childhood. Such programs shall not include public or private entities licensed by the Office of Early Childhood or Board enhancement programs and extra-curricular activities.
Board of Education means a local or regional Board of Education, a regional educational service center, a unified school district, the regional vocational-technical school system, an approved private special education facility, the Gilbert School, the Norwich Free Academy, Woodstock Academy or a non-public school whose students receive services pursuant to Section 10-217a of the Connecticut General Statutes.
5141.21(b)
Definitions (continued)
Carrier means any school district, educational institution, or person, firm or corporation under contract to such district or institution engaged in the business of transporting students. (C.G.S. 14-212 (2)).
Cartridge injector means an automatic prefilled cartridge injector or similar automatic injectable equipment used to deliver epinephrine in a standard dose for emergency first aid response to allergic reaction.
Coach means an athletic coach as defined in Connecticut General Statutes Section 10-222e as any person holding a coaching permit issued by the State Board of Education who is hired by a local or regional board of education to coach a sport for a sport season as part of intramural or interscholastic athletics for a school or school district.
Controlled drugs means those drugs as defined in Connecticut General Statutes Section 21a-240.
Cumulative health record means the cumulative health record of a student mandated by Connecticut General Statutes Section 10-206.
Director means the person responsible for the operation and administration of any school readiness program or before- and after-school program.
Eligible student means a student who has reached the age of eighteen or is an emancipated minor.
Error means:
- the failure to do any of the following as ordered:
- administer a medication to a student;
- administer medication within the time designated by the prescriber;
- administer the specific medication prescribed for a student;
- administer the correct dosage of medication;
- administer medication by the proper route; and/or
- administer the medication according to generally accepted standards of practice; or
- the administration of medication to a student which is not ordered by an authorized prescriber, or which is not authorized in writing by the parent or guardian of such student, except for the administration of epinephrine for the purpose of emergency first aid pursuant to Section 10-212a-2 of the Connecticut General Statutes and subsection € of Section 10-212a-2 of the Regulations of Connecticut State Agencies.
5141.21(c)
Administering of Medications
Definitions (continued)
Extracurricular activities means activities sponsored by local or regional Boards of Education that occur outside of the school day, are not part of the educational program, and do not meet the definition of before-and after-school programs and school readiness programs.
Guardian means one who has the authority and obligations of guardianship of the person of a minor, and includes: (1) the obligation of care and control; and (2) the authority to make major decisions affecting the minor’s welfare, including, but not limited to, consent determinations regarding marriage, enlistment in the armed forces and major medical, psychiatric or surgical treatment.
Intramural athletic events means tryouts, competition, practice, drills, and transportation to and from events that are within the bounds of a school district for the purpose of providing an opportunity for students to participate in physical activities and athletic contests that extend beyond the scope of the physical education program.
Interscholastic athletic events means events between or among schools for the purpose of providing an opportunity for students to participate in competitive contests which are highly organized and extend beyond the scope of intramural programs and includes tryouts, competition, practice, drills, and transportation to and from such events.
Investigational drug means any medication with an approved investigational new drug (IND) application on file with the Food and Drug Administration (FDA), which is being scientifically tested and clinically evaluated to determine its efficacy, safety and side effects and which has not yet received FDA approval.
Licensed athletic trainer means a licensed athletic trainer employed by the Board of Education pursuant to Chapter 375a of the Connecticut General Statutes.
Medication means any medicinal preparation including over-the-counter, prescription and controlled drugs, as defined in Connecticut General Statutes Section 21a-240. This definition includes Aspirin, Ibuprofen or Aspirin substitutes containing Acetaminophen.
Medication emergency means a life-threatening reaction of a student to a medication.
Medication plan means a documented plan established by the school nurse in conjunction with the parent and student regarding the administration of medication in school. Such plan may be a stand-alone plan, part of an individualized health care plan, an emergency care plan or a medication administration form.
5141.21(d)
Administering of Medications
Definitions (continued)
Medication order means the written direction by an authorized prescriber for the administration of medication to a student which shall include the name of the student, the name and generic name of the medication, the dosage of the medication, the route of administration, the time of administration, the frequency of administration, the indications for medication, any potential side effects including overdose or missed dose of the medication, the start and termination dates not to exceed a 12-month period, and the written signature of the prescriber.
Nurse means an advanced practice registered nurse, a registered nurse or a practical nurse licensed in Connecticut in accordance with Chapter 378 of the Connecticut General Statutes.
Occupational therapist means an occupational therapist employed full time by the local or regional board of education and licensed in Connecticut pursuant to Chapter 376 of the Connecticut General Statutes.
Optometrist means an optometrist licensed to provide optometry pursuant to Chapter 380 of the Connecticut General Statutes.
Paraprofessional means a health care aide or assistant or an instructional aide or assistant employed by the local or regional Board of Education who meets the requirements of such Board for employment as a health care aide or assistant or instructional aide or assistant.
Physical therapist means a physical therapist employed full time by the local or regional Board of Education and licensed in Connecticut pursuant to Chapter 376 of the Connecticut General Statutes.
Physician means a doctor of medicine or osteopathy licensed to practice medicine in Connecticut pursuant to Chapters 370 and 371 of the Connecticut General Statutes, or licensed to practice medicine in another state.
Physician assistant means an individual licensed to prescribe medications pursuant to Section 20-12d of the Connecticut General Statutes.
Podiatrist means an individual licensed to practice podiatry in Connecticut pursuant to Chapter 375 of the Connecticut General Statutes.
Principal means the administrator in the school.
Qualified medical professional, as defined in C.G.S. 10-212, means a physician licensed under Chapter 370, an optometrist licensed to practice optometry under Chapter 380, an advanced practice registered nurse licensed to prescribe in accordance with Section 20-94a or a physician assistant licensed to prescribe in accordance with Section 20-12d.
5141.21(e)
Definitions (continued)
Qualified personnel for schools means a qualified school employee who is (A) (i) a full time employee, or (ii) a coach, athletic trainer or school paraprofessional, or (B) for school readiness programs and before-and-after school programs, means the director or director’s designee and any lead teachers and school administrators who have been trained in the administration of medication.
Qualified school employee, as defined in C.G.S. 10-212, means a principal, teacher, licensed athletic trainer, licensed physical or occupational therapist employed by a school district, coach or school paraprofessional.
Regular school hours means the hours specified in the teacher’s contract for the normal school/employment day in terms of hours. This does not include after-school activities.
Research or study medications means FDA-approved medications being administered according to an approved study protocol. A copy of the study protocol shall be provided to the school nurse along with the name of the medication to be administered and the acceptable range of dose of such medication to be administered.
School means any educational facility or program which is under the jurisdiction of the Board excluding extracurricular activities.
School medical advisor means a physician appointed pursuant to C.G.S. 10-205.
School nurse means a nurse appointed in accordance with Connecticut General Statutes Section 10-212.
School nurse supervisor means the nurse designated by the local or regional Board of Education as the supervisor or, if no designation has been made by the Board, the lead or coordinating nurse assigned by the Board.
School bus driver means any person who holds a commercial driver's license with a public passenger endorsement to operate a school bus pursuant to subsection (a) of C.G.S. 14-44.
School readiness program means a program that receives funds from the State Department of Education for a school readiness program pursuant to subsection (b) of Section 10-16p of the Connecticut General Statutes and exempt from licensure by the Office of Early Childhood pursuant to subdivision (1) of subsection (b) of Section 19a-77 of the Connecticut General Statutes.
5141.21(f)
Administering of Medications
Definitions (continued)
Teacher means a person employed full time by a Board of Education who has met the minimum standards as established by that Board for performance as a teacher and has been approved by the School Medical Advisor and school nurse to be designated to administer medications pursuant to the Regulations of Connecticut State Agencies Sections 10-212a-l through 10-212a-7.
General Policies on Administration of Medication
Except for the administration of epinephrine as emergency first aid to students who do not have prior written parental authorization or a written medical order as provided in this policy, no medication may be administered to any student without (1) the written order of an authorized prescriber, and (2) the written authorization of the student’s parent or guardian or eligible student, and (3) the written permission of the parent for the exchange of information between the prescriber and the school nurse necessary to ensure the safe administration of such medication.
A school nurse, or in the absence of a school nurse, any other nurse licensed pursuant to the provisions of Chapter 378 of the Connecticut General Statutes, including a nurse employed by, or providing services under the direction of the Board at a school-based clinic, may administer medication to students in accordance with all state laws and regulations and this policy and its regulations including those provisions related to required training and criminal background checks.
Absent the availability of a school nurse or other licensed nurse, certain qualified school employees including paraprofessionals, coaches and licensed athletic trainers, and others as specified in this policy and its regulations who have been properly trained may administer medication to students. Administration shall be in accordance with this policy, its regulations, state and federal law and state regulations for the administration of medication.
Prescribed medication shall be administered to and taken by only the student for whom the prescription has been written.
In compliance with all applicable state statutes and regulations, parents or guardians may administer medications to their own children on school grounds.
For any FDA-approved medications being administered according to an approved study protocol, a copy of the study protocol shall be provided to the school nurse along with the name of the medication to be administered and the acceptable range of dose of such medication to be administered.
5141.21(g)
General Policies on Administration of Medication (continued)
Investigational drugs or research or study medications may not be administered by qualified personnel for schools.
Self-Administration of Medication by Students
Self-administration of medication by a student may be allowed when prescribed in writing by a licensed physician/APRN/PA or dentist with the written authorization of a parent/guardian, after evaluation by the school nurse for safety and appropriateness. An individualized written health care plan (HCP) must be developed by the school nurse and approved by the school Principal.
Students may be permitted to self-administer medication only in accordance with this policy, its regulations, state law and state regulations governing the administration of medication.
Self-testing of blood glucose level by a child with diabetes
A child with diabetes may test his/her own blood glucose level per the written order of a physician stating the need and the capacity of such child to conduct self-testing along with written authorization of the parent/guardian. Such self-testing shall be pursuant to guidelines promulgated by the Connecticut Commissioner of Education. The time or place where a student with diabetes may test his/her blood-glucose level on school grounds shall not be restricted provided the student has written parental/guardian permission and a written order from a physician licensed in Connecticut.
Self-administration by a child diagnosed with asthma or diagnosed with a life-threatening allergic condition
A child diagnosed with asthma or a diagnosed life-threatening allergic condition, pursuant to State Board of Education regulations, may possess, self-administer or possess and self-administer medicine administered through the use of an asthmatic inhaler or an EpiPen or similar device in the school at all times or while receiving school transportation services if he/she is under the care of a physician, physician assistant, or advanced practice registered nurse (APRN) and such practitioner certifies in writing to the Board that the child needs to keep an asthmatic inhaler or EpiPen at all times to ensure prompt treatment of the child's asthma or allergic condition and protect the child against serious harm or death. A written authorization of the parent/guardian is also required.
Administration of Medication by a School Nurse
A school nurse may administer medication to any student pursuant to the written order of an authorized prescriber (physician, dentist, optometrist, an advanced practice registered nurse, or a physician assistant and for interscholastic and intramural athletic events only, a podiatrist)
5141.21(h)
Administration of Medication by a School Nurse (continued)
and the written authorization of a parent or guardian of such child or eligible student and the written permission of the parent/guardian for the exchange of information between the prescriber and the school nurse necessary to ensure the safe administration of such medication.
Administration of Medication in the Absence of a School Nurse
In the absence of a school nurse, any other nurse licensed pursuant to the provisions of Chapter 378, including a nurse employed by, or providing services under the direction of the Board at a school-based clinic may administer medication to any student. Qualified school personnel who have received the requisite training in the administration of medication in accordance with state law, received approval of the School Medical Advisor and the school nurse and who have satisfactorily completed a required criminal background check may administer medication to any student in accordance with state law and regulations and this Policy and its regulations and any medication administration plan for the student.
Medications with a cartridge injector may be administered by qualified personnel for schools only to a student with a medically diagnosed allergic condition which may require prompt treatment to protect the student against serious harm or death. Qualified personnel for schools, as defined, may administer oral, topical, intranasal, or inhalant medication in the absence of a licensed nurse. Investigational drugs or research or study medications may not be administered by qualified personnel for schools.
Coaches and licensed athletic trainers during intramural and interscholastic events may administer medications pursuant to Section 10-212a-9 of the Regulations of Connecticut State Agencies and as described in this policy and in the administrative regulations to this policy.
Administration of Medication by Paraprofessionals
A specific paraprofessional, through a plan approved by a school nurse and School Medical Advisor, may be designated to administer medication including medication administered with a cartridge injector, to a specific student with a medically diagnosed allergic condition that may require prompt treatment in order to protect the student against serious harm or death pursuant to Section 10-212a-9 of the Regulations of Connecticut State Agencies and as described in the administrative regulations. The approved plan also requires the written authorization of the student's parent/guardian and pursuant to the written order from the student's authorized prescriber licensed to prescribe medication.
5141.21(i)
Administration of Medication in School Readiness Programs and Before- and After-School Programs
Directors, or their designees, who may include lead teachers or school administrators, who have been properly trained, may administer medications to students as delegated by the school nurse or other registered nurse, in school readiness programs and before- and after-school programs that are child care programs. Such programs must either be District-administered or administered by a municipality exempt from licensure by the Department of Public Health and are located in a District public school. Medicine may be administered pursuant to the Regulations of Connecticut State Agencies, Section 10-212a-10, to children enrolled in these programs.
Administration of medications shall be provided only when it is medically necessary for program participants to access the program and maintain their health status while attending the program. A child attending any before- or after-school program, defined as any child care program operated and administered by the Board in any building or on the grounds of any district school, upon the request and with the written authorization of the child's parent/guardian and pursuant to the written order from the student's authorized prescriber, will be supervised by the District staff member (Director or designee, lead teacher, school administrator) trained to administer medication including a cartridge injector. Such administration shall be to a particular student medically diagnosed with an allergy that may require prompt treatment to avoid serious harm or death.
Investigational drugs or research or study medications may not be administered by Directors or their designees, lead teachers or school administrators.
Properly trained Directors, Directors' designees, lead teachers or school administrators may administer medications to students as delegated by the school nurse or other registered nurse. They may administer oral, topical, intranasal, or inhalant medications. No medication shall be administered without the written order of an authorized prescriber and the written approval of the parent/guardian.
The selected staff member shall be trained in the use of a cartridge injector by either a licensed physician, physician's assistant, advanced practice registered nurse or registered nurse. (Optional: The selected staff member is also required to complete a course in first aid offered by the American Red Cross, the American Heart Association, the National Ski Patrol, the Department of Public Health or any Director of Health.)
The administration shall determine, in cooperation with the School Medical Advisor and school nurse [supervisor] whether additional school nursing services/nurses are required based on the needs of the program and the participants in the program. This determination shall include whether a licensed nurse is required on site. The recommendation shall be subject to Board approval.
5141.21(j)
Administration of Medication in School Readiness Programs and Before- and After-School Programs (continued)
The Board will allow students in the school readiness and before- and after-school programs to self-administer medication according to the student's individual health plan and only with the written order of an authorized prescriber, written authorization of the child's parent or guardian, written approval of the school nurse (The nurse has evaluated the situation and deemed it appropriate and safe and has developed a plan for general supervision of such self-medication.), and with the written permission of the parent or guardian for the exchange of information between the prescriber and the school nurse necessary to ensure the safe administration of such medication.
An error in the administration of medication shall be reported immediately to the school nurse, the parents/guardians and the prescribing physician. In case of an anaphylactic reaction or the risk of such reaction a school nurse may administer emergency oral and/or injectable medication to any child in need thereof on school grounds, or in the school building, according to the standing order of the School Medical Advisor or the child's private physician. However, in an emergency any other person trained in CPR and First Aid may administer emergency oral and/or injectable medication to any child in need on school grounds, or in the school building. In addition, local poison control center information shall be readily available at the sites of these programs. The Program Director or his/her designee shall be responsible for decision making in the absence of the nurse.
In the event of a medical emergency, the following will be readily available: (1) local poison information center contact information; (2) the physician, clinic or emergency room to be contacted in such an emergency; and (3) the name of the person responsible for the decision making in the absence of a school nurse.
All medications shall be handled and stored in accordance with the provisions of subsection (a) to (k) inclusive of the Regulations of Connecticut State Agencies, as outlined in the accompanying administrative regulation to this policy.
Where possible, a separate supply of the child's medication shall be stored at the site of the before- or after-school program or school readiness program. If this is not possible, a plan should be in place to ensure the timely transfer of the medication from the school to the program and back on a daily basis.
Documentation and record keeping shall be done in compliance with the stipulations outlined in the administrative regulation accompanying this policy.
THE PORTION OF THIS POLICY PERTAINING TO THE ADMINISTRATION OF MEDICATION IN SCHOOL READINESS PROGRAMS AND BEFORE- AND AFTER-
5141.21(k)
Administration of Medication in School Readiness Programs and Before- and After-School Programs (continued)
SCHOOL PROGRAMS SHALL BE REVIEWED BY THE BOARD ON AN ANNUAL BASIS WITH INPUT FROM THE SCHOOL MEDICAL ADVISOR OR A LICENSED PHYSICIAN AND THE COORDINATOR OF NURSING.
Administration of Medication by Coaches and Licensed Athletic Trainers during Intramural and Interscholastic Events
During intramural and interscholastic athletic events, a coach or licensed athletic trainer who has been trained in the general principles of medication administration applicable to receiving, storing, and assisting with inhalant medications or cartridge injector medications and documentation, may administer medication for select students for whom self-administration plans are not viable options as determined by the school nurse.
The medication which may be administered is limited to: (1) inhalant medications prescribed to treat respiratory conditions and (2) medication administered with a cartridge injector for students with a medically diagnosed allergic condition which may require prompt treatment to protect the student against serious harm or death.
The school nurse is responsible for the student's individualized medication plan and shall provide the coach with a copy of the authorized prescriber's order and the parental/guardian permission form. Parents are responsible for providing the medication, such as the inhaler or cartridge injector, to the coach or licensed athletic trainer, which shall be kept separate from the medication stored in the school health office during the school day.
Medications to be used in athletic events shall be stored in containers for the exclusive use of holding medications; in locations that preserve the integrity of the medication; under the general supervision of the coach or licensed athletic trainer trained in the administration of medication; and in a locked secure cabinet when not in use at athletic events.
The agreement of the coach or licensed athletic trainer is necessary for the administration of emergency medication and the implementation of the emergency care plan.
Coaches and athletic trainers are required to fulfill the documentation requirements as outlined in the administrative regulations accompanying this policy. Errors in the administration of medication shall be addressed as specified in Section 10-212a-6 of the Regulations of Connecticut State Agencies, and detailed in the administrative regulation pertaining to this policy. If the school nurse is not available, a report may be submitted by the coach or licensed athletic trainer to the school nurse on the next school day.
5141.21(l)
Storage and Use of Epinephrine Cartridge Injectors (Emergency Administration of Epinephrine to Students without Prior Written Authorization)
A school nurse or in the absence of a school nurse, a qualified school employee who has completed the annual training required by Section 10-212a, of the Connecticut General Statutes, as amended from time to time, shall maintain epinephrine in cartridge injectors for the purpose of emergency first aid. EpiPens expire yearly. Therefore, schools are responsible for refilling their prescriptions annually and for maintaining an adequate supply of EpiPens for emergency first aid to students without prior authorization.
The school shall fulfill all conditions and procedures promulgated in the regulations established by the State Board of Education for the storage and administration of epinephrine by school personnel to students for the purpose of emergency first aid to students who experience allergic reaction and do not have prior written authorization for epinephrine administration.
The school nurse or school principal shall select qualified school employees who voluntarily agree to be trained to administer such epinephrine as emergency first aid. There shall be at least one such qualified school employee on the grounds of each District school during regular school hours in the absence of the school nurse. Each school must maintain a supply of epinephrine in cartridge injectors (epipens) for such emergency use.
During regular school hours, when the school nurse is absent or unavailable, qualified school employees who have completed the annual training required by Section 10-212a, of the Connecticut General Statutes, as amended from time to time, may administer epinephrine as emergency first aid to students who experience allergic reactions and who do not have prior written authorization of a parent or guardian or prior written order of a qualified medical professional for the administration of epinephrine.
For the purpose of administration of epinephrine to students without written authorization who are experiencing a life-threatening allergic reaction, qualified school employees refers to principal, teacher, licensed athletic trainer, licensed physical or occupational therapist employed by the school district, coach or school paraprofessional.
The parent or guardian of any student may submit, in writing, to the school nurse or School Medical Advisor that epinephrine shall not be administered to such student pursuant to this section. The school nurse shall notify selected and trained personnel of the students whose parents or guardians have refused emergency administration of epinephrine. The Hamden Public Schools shall annually notify parents or guardians of the need to provide such written notice.
5141.21(m)
Administration of Glucagon to a Specific Student with Diabetes
Qualified school employees may administer glucagon within injectable equipment used to administer glucagon in an appropriate dose for emergency first aid response to students with diabetes in the event that there is written authorization of a student’s parent or guardian and the school nurse and School Medical Advisor have attested in writing that the qualified school employee has completed the annual training and voluntarily agrees to serve in this capacity. Authorization of injectable glucagon is limited to situations when the school nurse is absent or unavailable. For purposes of emergency medication administration of glucagon, the term qualified school employee refers to a principal, teacher, licensed athletic trainer, licensed physical or occupational therapist employed by the school district, coach or school paraprofessional.
Administration of Anti-Epileptic Medications to Students
With the written authorization of a student's parent/guardian, and pursuant to the written order of a physician, a school nurse and the School Medical Advisor shall select and provide general supervision to a qualified school employee, who voluntarily agrees to serve as a qualified school employee, to administer anti-epileptic medication, including by rectal syringe, to a specific student with a medically diagnosed epileptic condition that requires prompt treatment in accordance with the student's individual seizure action plan. Such authorization is limited to situations when the school nurse is absent or unavailable. No qualified school employee shall administer such medication unless he/she annually completes the training program developed by the State Department of Education, in consultation with the School Nurse Advisory Council.
In addition the school nurse and School Medical Advisor shall attest, in writing, that such qualified school employee has completed the required training. The qualified school employee shall also receive monthly reviews by the school nurse to confirm his/her competency to administer anti-epileptic medication. For purposes of the administration of anti-epileptic medication, a "qualified school employee" means a principal, teacher, licensed athletic trainer, licensed physical or occupational therapist employed by the District, coach or school paraprofessional.
Required Training for School Bus Drivers
School transportation carriers must provide training to all school bus drivers, including instruction on (1) identifying the signs and symptoms of anaphylaxis, (2) administering epinephrine by a cartridge injector ("EpiPen"), (3) notifying emergency personnel, and (4) reporting an incident involving a student's life-threatening allergic reaction. Such training can be completed online, provided the online module fulfills legislative requirements.
Each carrier must provide the training to school bus drivers (1) following the issuance or renewal of a public passenger endorsement to operate a school bus for carrier employees, and
5141.21(n)
Required Training for School Bus Drivers (continued)
(2) upon the hiring of a school bus driver who is not employed by such carrier (e.g., subcontractor), except a driver who received the training after the most recent issuance or renewal of his or her endorsement is not required to repeat it.
(cf. 5141 Student Health Services)
Legal References:
Connecticut General Statutes
10-206 Health Assessment
10-212 School nurses and nurse practitioners. Administration of medications by parents or guardians on school grounds. Criminal history; records check
10-212a Administration of medications in schools. (as amended by PA 99- 2, and June Special Session and PA 03-211, PA 04-181, PA 07-241, PA 07-252, PA 09-155, PA-12-198, PA 14-176, PA 15-215 and PA 18-185)
10-212c Life-threatening food allergies and glycogen storage disease: Guidelines; district plans (as amended by PA 18-185)
10-220j Blood glucose self-testing by children. Guidelines. (as amended by PA 12-198)
19a-900 Use of cartridge injector by staff member of before- or after- school program, day camp or day care facility
20-12d Medical functions performed by physician assistants. Prescription authority
20-94a Licensure as advanced practice registered nurse
21a-240 Definitions
5141.21(o)
29-17a Criminal history records checks. Procedure. Fees
52-557b Immunity from liability for emergency medical assistance first aid or medication by injection. School personnel not required to administer or render. (as amended by PA 05-144, An Act Concerning the Emergency Use of Cartridge Injectors and PA 18-185)
PA 07-241 An Act Concerning Minor Changes to the Education Statutes
PA-12-198 An Act Concerning the Administration of Medicine to Students with Diabetes, the Duties of School Medical Advisors, the Availability of CPR and AED Training Materials for Boards of Education and Physical Exercise During the School Day
PA 14-176 An Act Concerning the Storage and Administration of Epinephrine at Public Schools
PA 15-215 An Act Concerning Various Revisions and Additions to the Education Statutes
PA-18-185 An Act Concerning the Recommendations of the Task Force on Life-threatening Food Allergies in Schools Connecticut Regulations of State Agencies 10-212a-1 through 10-212a-10, inclusive
Federal Law
Code of Federal Regulations: Title 21 Part 1307.2
| Policy adopted: | March 10, 2020 | ||
| HAMDEN PUBLIC SCHOOLS | |||
| Hamden, Connecticut |
Regulation
5141.21 (a)
Students
Administering of Medications by School Personnel
Administration of Medication
The administration of medication in District schools shall be in accordance with Board Policy 5141.21 and these regulations, as well as in accordance with the state of Connecticut State Department of Education regulation on the Administration of Medications by School Personnel in Connecticut. This will be amended in accordance with changes in state guidelines.
The administration of medication includes the following activities: handling, storing, preparing, and pouring of medication; conveying it to the student according to the medication order; observing the student during administration; documenting that the medication was administered; and counting remaining doses to verify proper administration and use of the medication.
Prescribed medication should not be administered during school hours if it is possible to achieve the desired effect for the student by home administration outside of school hours.
To receive medications at school, a student must have a current Medication Authorization Form.
a. The form must be completed by: a physician, dentist, optometrist, podiatrist, advanced practice registered nurse or physician assistant.
b. The medication that is ordered must include the name of the medication, the desired dose, route, time of administration and the frequency (PRN vs. daily). The start and stop dates of administration must also be included (not to exceed 365 days). The prescriber should also include information in regards to possible side effects and allergies to other medications.
c. The authorization form must be signed by the parent/guardian before it can be accepted.
A Medications Authorization Form is required for both prescribed medications and medications received “over the counter” (OTC) such as Acetaminophen or Ibuprofen.
The medication in question must be delivered to the school by an adult in the pharmacy container that includes the pharmacy label, with the name of the medication, the dose and the name of the student. In the event of an “OTC” medication, it must be in an unopened, labeled container. Only a three month supply will be accepted at school.
The nurse may request additional information from the health care provider and/or parent if indicated.
In the event of an untoward medication reaction, the provider should be contacted for specific management or follow-up instructions.
5141.21 (b)
Students
Administering of Medications by School Personnel
DESIGNATION OF WHO CAN ADMINISTER MEDICATIONS
The school nurse will be the primary individual to administer medications. In the nurse’s absence or for special situations (field trips, before and after school events, intramural events or school readiness), individuals can administer medications if they are, certified staff – teachers, administrators and social workers who are employed by Hamden Public Schools. In addition, Physical Therapists, Occupational Therapists, coaches, school readiness teachers/administrators and paraprofessionals can also administer medications.
The medications can be administered once the individuals have been instructed yearly (or monthly with some medications) by the school nurse. This training must include: location and storage of the medication, review of individual medication orders, expected effects of medication and review of possible side effects, and documentation of the administration of the medication. Documentation of who has been instructed must be onsite at the school.
Investigational medications can only be administered by the school nurse with the appropriate paperwork/guidelines.
SELF ADMINISTRATION OF MEDICATIONS
Self-administration of medication involves:
1. The physician and parent have authorized the student to carry and administer their medication at school.
2. Authorization is generally for students with the knowledge to safely administer the medication themselves (generally students in middle and high school).
3. Students who have the authorization may transport their medication and carry it throughout the school day. This includes students with diabetes who test their blood glucose in the classroom and carry and administer medications. Likewise students with rescue medications for allergic reactions, inhalers and OTC medications will carry their medication throughout the school day. However, controlled medications cannot be transport to and from school, nor carried by a student during the school day.
5141.21 (c)
Students
Administering of Medications by School Personnel
Self-Administration of Medication continued
4. The student who will self -carry and administer their medication must be able to:
a. Identify the medication
b. Identify when the medication is indicated
c. Be able to safely administer the medication
d. Be able to identify the time and frequency of when the medication is to be administered
e. Identify the expected effects of the medication in addition to possible side effects.
f. Have knowledge of when to seek assistance
g. Will carry medication on field trips or activities before or after school.
5. A back up supply of the medication may be located in the health office in the event the student forgets to carry their medication.
6. The school nurse will communicate with appropriate staff students who have the authorization to self -carry and administer their medication.
HANDLING AND STORAGE OF MEDICATIONS
1. All medication that will be administered at school must:
a. Be transported by an adult to and from the school premises.
b. Be delivered to the school nurse or in the absence of the nurse to an individual who has been trained to administer medication.
c. Be in their original container with the student’s name, a pharmacy label, or with OTC be in a clearly labeled and unopened container.
d. Medication will be counted by the individual accepting the medication and the parent/guardian and documented on the Individual Student Medication Record (ISMR). A new ISMR will be developed for refills.
e. No more than a three month supply will be accepted at the school.
2. Medication will be stored in a locked cabinet for the exclusive storage of medication. The cabinet in which inhalers and rescue medication for allergic reactions are stored will remain unlocked during the school day. At the end of the school day this cabinet will be locked.
3. Controlled medications, schedule II-V, will be stored in a separate, and secure, substantially constructed, locked metal or wood cabinet in accordance with state regulations. Schedule II medications will be secured with two locks and schedule III and above will be secured with one lock at all times.
5141.21 (d)
Students
Administering of Medications by School Personnel
Handling and Storage of Medication continued
4. There will be two sets of keys to medication cabinets. One will be in the control of the school nurse at all times and the other in the control of the school principal. Only staff that is authorized to administer medication will be allowed access to the medication keys.
5. Medications that require refrigeration will be stored in a refrigerator at 36-46 degrees Fahrenheit in the health office. Controlled medications that require refrigeration must be stored in a locked box that is affixed inside the refrigerator.
STORAGE AND USE OF EPINEPHRINE (EMERGENCY ADMINISTRATION OF EPINEPHRINE TO STUDENTS WITHOUT PRIOR WRITTEN AUTHORIZATION)
Epinephrine is a rescue medication to treat serious allergic reactions. It is usually in a cartridge with a set dose of medication (adult vs. junior). For students that have an identified possible serious allergic reaction, physicians will authorize the use of the medication with guidelines as to when it should be administered. An emergency care plan will be developed for students who may require Epinephrine at school. This medication can be administered by the school nurse or individuals who have been trained by the school nurse.
For individuals who have a serious allergic reaction who have not either been identified or have not had Epinephrine ordered, Epinephrine is available for use (adult and junior doses). This is stored in an area either in or near the health office of the school. This storage container will remain unlocked at all times. The medication will be monitored by the school nurse and replaced as needed.
The school nurse, administrator and school employees who have volunteered to administer Epinephrine will be instructed in the use of Epinephrine: the indications – signs and symptoms
of an allergic reaction, administration to include administration of the correct dose, as well as when to re-administer, care of the individual before and after the administration, and the activation of the EMS system by calling 911. This is in accordance with the state of Connecticut regulations and the guidelines of the School Medical Advisor.
For parents/guardians who do not want to have Epinephrine administered as allowed by state regulations, they must submit a form that states this to the school nurse yearly. This form must be on file with the school nurse, building administrator and stored with the Epinephrine that is used for this purpose.
5141.21 (e)
Students
Administering of Medications by School Personnel
DOCUMENTATION AND RECORD KEEPING
1. Medication received at school will be documented either electronically or on an Individual Medication Administration Record (ISMR) (see appendices). This documentation will be in black ink.
2. The ISMR documentation, or its electronic counterpart, will include: the name of the medication, the dose and route of the medication, time of administration and frequency; the name of the prescriber and their contact information; duration for administration (up to and including 12 months); possible side effects and any other pertinent information such as indications and/or allergies.
3. The amount of the medication received will be recorded on the ISMR. For controlled medications, the amount received will be counted and cosigned by the school nurse and parent/guardian or witnessed and cosigned by a staff member who has been authorized to administer medications.
4. Controlled medications will be counted and documented weekly and signed by the nurse and cosigned by a witness.
5. Administration of the medication will be documented promptly on the ISMR. Medication administered by a staff member on a field trip will be documented on the ISMR on return to the school building.
6. Documentation of medication administration on the ISMR will include the name of the authorized individual who administered such medication indicating their first and last name, either in ink or electronically. Furthermore, this documentation must include the dose and time administered and any other information pertinent to the administration.
7. When the authorized medical provider prescribes that a student be administered a medication daily during school hours, that student’s absence will be documented on the ISMR to indicate why no medication was administered per the medication authorization instructions.
8. The ISMR along with the student’s associated Medication Authorization form will be filed together in a Medication Binder. At the end of the school year, the authorization form will be filed in the Cumulative Health Record (CHR) and a summary of the medication order, the amount of usage and effects of administration will be recorded in the CHR. The ISMR can then be destroyed.
9. According to state statute 10-212a(b), for all controlled medications (schedule II-V) a copy of the Medication Authorization Form and the original ISMR will be filed separately in a folder and kept in the Health Office for three years. The original Medication Authorization form will be filed in the student’s CHR and the summary of usage will be documented.
5141.21 (f)
Students
Administering of Medications by School Personnel
Documentation and Record Keeping continued
10. In the event of a Medication Error or Omission, the appropriate Medication Error form will be completed and filled in the CHR. The parent and medical provider will be notified and a note will be entered into the student’s CHR.
11. In the event that a controlled medication is lost or missing, this will be verified by the school nurse and a witness and documented on the ISMR. Such event will be reported to the school principal, the lead nurse (who if indicated will contact the Director of Pupil Personnel Services), the medical provider and the Drug Control Unit at the Connecticut Department of Consumer Protection. The local police department may also need to be contacted.
12. Verbal orders: are permitted in emergency situations providing the verbal order is communicated from an authorized medical provider directly to a school nurse. Only the school nurse can accept a verbal order. This will be followed within three days with a written authorization. Parents will be notified promptly that the nurse received a verbal order. In the event of a child with diabetes, parents can communicate with the school nurse as to recommended changes in the care of their child.
13. Standing orders: will be followed per the guidelines of the School Medical Advisor; parents will be notified if possible prior to the administration of this medication. The administration will be recorded in the CHR.
ADMINISTRATION OF ANTI-EPILEPTIC MEDICATIONS
Anti-seizure medications, if a schedule II-V medication, will be stored in the appropriate locked cabinet for controlled medications. A seizure emergency plan will be developed by the school nurse for these students.
Anti-seizure medications may be administered in the absence of the school nurse by school staff that have volunteered and have been adequately trained by the school nurse. They will administer the medication –orally, nasally or rectally according to the plan of care. The staff that is trained to administer this medication must be taught following the guidelines established by the state and this training must be reviewed monthly.
ADMINISTRATION OF GLUCAGON
Students with diabetes will have medication in school for the treatment of high and low blood glucose levels. One such medication is Glucagon, an injection, ordered by a medical provider for the emergency care of a student with low blood glucose. The school nurse will develop a
5141.21 (g)
Students
Administering of Medications by School Personnel
Administration of Glucagon continued
plan of care that delineates the indications for its administration. School staff must be instructed by the school nurse according to the guidelines established by the state and will be reviewed yearly or more often if indicated.
ADMINISTRATION OF NALOXONE (NARCAN)
Naloxone (Narcan) is a rescue medication for opioid overdose. This medication will be available primarily at the middle and high school. The BOE Policy that governs its administration will be followed.
FIELD TRIPS
Students who require medication during a field trip (either within district or out of district) will have a current authorization form signed by the medical provider and the parent. If a child has a Medication Authorization order in school, but no medication has been provided by the parent/guardian, that child will not be allowed to attend any field trips until the medication is delivered to the school.
Staff who have been instructed in the administration of medication will be responsible for the transportation and delivery of the medication. Medication cannot be delivered to staff that have not been trained in the administration of medication. For out of state field trips or international field trips, the nurse is to follow the guidelines established by the state.
INTRAMURAL SPORTS:
A coach or licensed athletic trainer may administer medication to be inhaled or injected (as with allergic reactions). The medication must be accompanied by a current Medication Authorization Form signed by the provider and parent. The parent must provide the medication, or if a student is able to self-administer the medication they must carry the medication.
Coaches and athletic trainers must be instructed in the administration of the medication and the required documentation and storage. The administration of medication record must be submitted to the school at the end of the sport season and documented in the CHR.
5141.21 (h)
Students
Administering of Medications by School Personnel
BEFORE-AND-AFTER SCHOOL PROGRAMS AND SCHOOL READINESS PROGRAMS:
Directors and lead teachers may administer medications to students in their program. If the school nurse is present the child should be assessed by the school nurse before administration.
Instruction of staff will occur yearly and will include the paper work that is required, review of the medication and its administration and the documentation of such.
Staff will follow the policies that are in place for the above program. Guidelines set down by the state for the administration of medications will be followed.
DISCONTINUATION/DISPOSAL OF MEDICATIONS:
At the end of the school year or whenever a student’s medication is discontinued, the parent or guardian will be contacted and requested to pick up the medication within 7 days of notification. Medication that is not picked up will be sent to the school health office at the end of the year for disposal. Disposal will follow the guidelines as outlined in the Connecticut Department of Environmental Protection, Office of Pollution Prevention.
SUPERVISION AND TRAINING:
1. The school nurse is responsible for the annual or as indicated, training and supervision of the administration of medications in the schools serviced by the Hamden Public Schools.
2. The school nurse will review orders or changes in orders, develop a plan and schedule to ensure that medications are administered as ordered, and will communicate these changes to the appropriate personnel. This will include staff who have been trained to administer medication in the absence of the school nurse.
3. The school nurse will implement policies and procedures regarding the receipt, storage and administration of medications and will provide on- site observation when possible of medication administered by staff who have been authorized.
4. The nurse will provide monthly review of all documentation and periodically review medication with the student’s teachers if indicated.
REVIEW OF POLICY/PROCEDURE:
The lead nurse and the School Medical Advisor shall review and the revise the policies and procedures concerning the administration of medications by school personnel as needed.
5141.21 (i)
Students
Administering of Medications by School Personnel
Review of Policy/Procedure continued
Whenever revised, they shall be forwarded to the Hamden Board of Education for approval. The School Medical Advisor will provide a signed approval for the Hamden Board of Education records.
| Regulation approved: | March 10, 2020 | ||
| HAMDEN PUBLIC SCHOOLS | |||
| Hamden, Connecticut |