Each school principal in consultation with the school nurse shall authorize at least two staff members to administer prescribed or over the counter (OTC) medication. The school nurse is responsible for the delegation and supervision of the administration of medications by school staff. At the start of each school year the registered nurse at each school will provide staff training, as appropriate.
For purposes of this procedure, "medication" means oral medication, topical medication, eye or ear drops and nasal spray. This definition DOES NOT include over-the-counter topical sunscreen products regulated by the US Food and Drug Administration (see Sunscreen section below). Oral medications are administered by mouth either by swallowing or by inhaling and may include administration by mask if the mask covers the mouth or mouth and nose.
Medication may be dispensed to students on a scheduled basis upon written authorization from a parent/guardian with a written request by a licensed health professional prescribing within the scope of their prescriptive authority. If the medication is to be administered for more than fifteen (15) consecutive days, the written request must be accompanied by written instructions from a licensed health professional. Requests will be valid for not more than the current school year. The prescribed or non-prescribed medication must be properly labeled and be contained in the original container.
The dispenser of prescribed or non-prescribed oral medication shall:
A. Collect the medication directly from the parent/guardian (students should not transport medication to school except for medications needed for the treatment of medical emergencies), collect an authorization form signed by the parent/guardian and the prescribing health professional, and collect instructions from the prescribing health professional if the medication is to be administered for more than fifteen (15) consecutive days;
B. Count the medication and record the number pills or amount of liquid medication received, with initials and date received, on the medication log. It is preferable to have two people count and initial; Counting of controlled substances at least weekly as recommended by the Board of Pharmacy. On weekly medication counts, the nurse must have assistance and a witness to the actual count of the medications.
C. School staff must store the prescription or non-prescribed oral medication (not more than a twenty (20) day supply) in a locked, substantially constructed cabinet or limited access area;
D. Maintain a daily record which indicates that the prescribed or non-prescribed oral medication was administered. If the dose is missed, note the reason;
E. Medications may not be given after the date specified on the authorization form or expiration date on the label;
F. Report medications errors to the school nurse immediately; and
G. Provide a copy of this policy and procedure to the parent/guardian upon request.
Prescribed and over-the-counter oral or topical medications, eye drops, ear drops, or nasal spray may be administered by a registered nurse, licensed practical nurse, or an authorized staff member who has been delegated to, trained, and supervised by the registered nurse.
No medication will be administered by injection by unlicensed staff except when a student is susceptible to a predetermined, life-endangering situation (e.g., medication administered to counteract a reaction to an insect sting). The parent/guardian will submit a written statement that grants a staff member the authority to act according to the specific written orders and supporting directions provided by the licensed health professional prescribing within their prescriptive authority. Such mediation will be administered by staff trained by the supervising registered nurse to administer such an injection.
Written orders for emergency medication, signed and dated, from the licensed health professional prescribing within his or her prescriptive authority shall:
A. State that the student suffers from an allergy which may result in an emergency;
B. Identify the drug, the mode of administration, the dose. Epinephrine administered by inhalation, rather than injection, may be a treatment option. This decision must be made by the licensed health professional prescribing within his or her prescriptive authority;
C. Indicate when the medication shall be administered based on anticipated symptoms or actual symptoms;
D. Recommend follow-up after administration, administration of additional medications, transport to hospital; and
E. Specify how to report to the health professional prescribing within his or her prescriptive authority and any record keeping recommendations; and
F. Only be effective for one school year.
If a health professional and a student’s parent/guardian request that a student be permitted to carry his/or her own medication and/or be permitted to self-administer the medication, the principal may grant permission after consulting with the school nurse. The process for requesting and providing instructions will be the same as established for oral medications. The principal and nurse will take into account the age, maturity, and capability of the student; the nature of the medication, the circumstances under which the student will or may have to self-administer the medication and other issues relevant in the specific case before authorizing a student to carry and/or self-administer medication at school. Except in the case of multi-dose devices (like asthma inhalers), students will only carry one day’s supply of medication at a time.
Violations of any conditions placed on the student permitted to carry and/or self-administer his or her own medication may result in termination of that permission, as well as the imposition of discipline when appropriate.
Students in any grade may carry and self-administer OTC sunscreen at school. Students may not share sunscreen with other students. Parents/guardians should write their child’s name on the sunscreen container. Only rub-on sunscreen is permitted; spray sunscreen is not allowed.
Violations of any conditions placed on the student permitted to carry and/or self-administer his or her own sunscreen products may result in confiscation and termination of that permission, as well as the imposition of discipline when appropriate.
Parent-Designated Adult Care of Students with Epilepsy or Diabetes
The policy and procedure for parent designated adults caring for students with epilepsy or students with diabetes are:
· 3411 – Accommodating Students with Seizure Disorders or Epilepsy
· 3415 – Accommodating Students with Diabetes
Disposal of Medications
At least two weeks prior to the end of the school year, or when medication is discontinued, the parent/guardian of students with leftover medication will be notified and provided an opportunity to pick up any unused medication. Medication will not be stored over the summer.
If the parent/guardian does not pick up the medication by the specified date, the medication should be counted by two school district staff and properly disposed. The disposal should be documented and include the name of the medication, the amount of the medication disposed, the date, and signatures/electronic note of two staff members. It is recommended that one of the staff members witnessing the disposal be a nurse.
Before discarding a medication container, scratch out all identifying information on the container as this helps protect the student’s identity and the privacy of their personal health information.
Disposal of medication should be completed properly to maintain safety and the environment. Facilities may be contacted for pick up and disposal or other community drug take-back programs that allow the public to bring or mail unused medications may be used.
Other options for medication disposal:
· For pills: Pour into wet coffee grounds and let pills dissolve.
· For liquids: Pour into coffee grounds or kitty litter and mix thoroughly.
· After pills dissolve and or liquids are mixed thoroughly, put in a sealable bag or other container to prevent the medications from leaking before placing it in the garbage can.
· Inhalers: DO NOT THROW THEM INTO THE GARBAGE- Utilize take-back location/events or mail-back programs (i.e., MED-Project or Inar).
· Prefilled syringes: If there is a needle on the empty syringe it should be placed in a sharp’s container (Note: do not remove needle from syringe or attempt to re-cap). The auto injectors should be left in their original plastic container and put into a sharps or bio-hazard container for disposal.[BL1]
Reporting Medication Errors
The correct medications must be administered to the correct student at the correct time (within 30 minutes before or after the prescribed dose is ordered for) in the correct dosage, by the correct route, with accurate documentation. Deviation from this standard may constitute a medication error. All medications errors must be documented and reported.
Medication error incident reports will be reviewed to determine any changes that may be necessary to prevent future events. The intent of reporting errors is to improve processes and systems and promote a culture that focuses on safety.
Refusing medication is not considered a medication error and the refusal should be documented on or in the Medication Administration Record as a “refused” medication and reported to the school nurse and parent/guardian as it is possible.
When an error has occurred staff should:
· Document and report the error to the school nurse as soon as possible or within 24 hours. Serious errors that result in potentially life-threatening concerns, injury, or emergency response must be reported immediately to the school nurse.
· The school nurse will assess the level of severity of the medication error and immediately needed next steps to support student health and safety. The school nurse should notify the parent/guardian, the school administrator, and the Director of Health Services.
· If the error is committed by a licensed provider, and there is injury to the student, or causes the student to be seen by emergency services, the incident must be reported to the LHP, parent/guardian, school administrator, and the Washington State Nursing Care Quality Assurance Commission per WAC 246-840-730.
· If the error is committed by an unlicensed staff member and there is injury to the student, or causes the student to be seen by emergency services, the incident must be reported to the LHP, parent/guardian, school administrator, and the Washington State Department of Health, Unlicensed Practice Unit
· All actions taken as a result of the medication error are to be accurately documented.
· Medication administration incident reports will be maintained for eight years after the incident.
Highline School District 401
Approved by the Superintendent: August 28, 1985
Revised by the Superintendent: 9.90, 3.92, 6.06, 11.17, 6.23