Each school principal, in consultation with the school nurse, shall authorize at least two staff members to administer prescribed or over‑the‑counter (OTC) medications. The school nurse is responsible for delegating this task and supervising staff who administer medications. At the start of each school year, the registered nurse assigned to the school will provide appropriate training to designated staff.

For purposes of this procedure, "medication" includes 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 inhalation and may include administration by mask when 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(s)/guardian(s) 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 administrator of prescribed or non‑prescribed oral medication must:

1. Obtain the medication directly from the parent(s)/guardian(s). Students should not transport medication to school unless it is required for emergency medical treatment. Secure a completed authorization form signed by both the parent(s)/guardian(s) and the prescribing health professional. If the medication will be administered for more than fifteen (15) consecutive days, also obtain written instructions from the prescribing health processional.
    
2. Count the medication upon receipt and document the number of pills or the volume of liquid medication on the medication log, including initials and the date received. When possible, two individuals should perform and initial the count. Controlled substances must be counted at least weekly, as recommended by the Board of Pharmacy. During weekly counts, the nurse must be assisted by another staff member who witnesses the count.
    
3. School staff must store prescription and non-prescription oral medication (not more than a twenty (20) day supply) in a locked, well-constructed cabinet or limited access area.
    
4. Staff must maintain a daily log documenting when prescribed or non-prescribed oral medications is administered. If a dose is missed, the log must note the reason.
    
5. Staff must maintain a daily log documenting when prescribed or non-prescribed oral medications is administered. If a dose is missed, the log must note the reason.
    
6. Medication errors must be reported to the school nurse immediately.
    
7. A copy of this policy and procedure must be provided to the parent(s)/guardian(s) upon request

Prescribed and over-the-counter oral or topical medications – including eye drops, ear drops, and 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

Unlicensed staff may not administer medications by injection unless the student is at risk for a known, life‑threatening condition (for example, an injectable medication used to treat a severe allergic reaction to an insect sting). In these cases, the parent/guardian must provide a written statement authorizing designated staff to act according to the specific written orders and instructions from the licensed health professional with prescriptive authority. Any injectable medication covered under this exception will be administered only by staff who have been trained by the supervising registered nurse.

Emergency Medications

Written orders for emergency medication, signed and dated by a licensed health professional acting within their prescriptive authority, must:

A. State that the student has an allergy or condition that may result in a medical emergency.

B. Identify the medication, including the name of the drug, mode of administration, and dosage. Epinephrine administered by inhalation may be considered as an alternative to injection, but this determination must be made by the prescribing health professional.

C.  Specify when the medication should be administered, based on anticipated or actual symptoms.

D. Provide recommendations for follow‑up care after administration, which may include additional medications or transport to a hospital.

E. Describe how and when staff should report back to the prescribing health professional and include any record‑keeping requirements.

F. Be valid for one school year only.

If a licensed health professional and a student’s parent(s)/guardian(s) request that the student be allowed to carry their own medication and/or self‑administer it, the principal may grant permission after consulting with the school nurse. The process for submitting the request and providing instructions will follow the same procedures established for oral medications.

Before approving a student to carry or self‑administer medication, the principal and school nurse will consider the student’s age, maturity, and ability to manage the medication safely; the nature of the medication; the circumstances under which the student may need to self‑administer; and any other factors relevant to the individual situation. Except for multi‑dose devices (such as asthma inhalers), students may carry only a one‑day supply of medication at a time.

Violations of any conditions placed on a student who is permitted to carry and/or self‑administer medication may result in the termination of that permission and, when appropriate, disciplinary action.

Sunscreen

Students in any grade may carry and self-administer nonprescription sunscreen at school. Students may not share sunscreen with other students. Parent(s)/guardian(s) 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 their own sunscreen products may result in sunscreen being confiscated and the permission revoked. Disciplinary action may also be taken 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 upon discontinuation of a medication, parent(s)/guardian(s) of students with remaining medication will be notified and provided the opportunity to pick up unused medication.

Medication that is not expected to expire during the summer months may be retained and made available for use at the beginning of the following school year. Medication that is expected to expire during the summer and is not retrieved by parent(s)/guardian(s) will be disposed of appropriately.

Disposal of medication will be conducted and documented by two school district staff members. Documentation will include the name of the medication, the amount disposed, the date of disposal, and the signatures or electronic attestation of both staff members. It is recommended that one of the staff members involved be a nurse.

Options for Safe Medication Disposal

• Pills:
  Pour pills into wet coffee grounds and allow them to dissolve.
   
• Liquids:
  Mix liquid medications thoroughly with coffee grounds or kitty litter.
   
• After mixing:
  Place dissolved pills or mixed liquids into a sealable bag or other secure container to prevent leaks, then place the container in the garbage.
   
• Inhalers:
  - Do NOT throw inhalers in the garbage.
  - Use approved take‑back locations, disposal events, or mail‑back programs (e.g., MED‑Project or Inmar).
   
• Prefilled syringes:
  – If the syringe has a needle attached, place the entire device in a sharp’s container. Do not remove the needle or attempt to recap it.
  – Auto‑injectors should remain in their original plastic container and be placed in a sharps or biohazard container for appropriate disposal.

Reporting Medication Errors

Medication must be administered to the correct student, at the correct time (within 30 minutes before or after the ordered dose), in the correct dosage, by the correct route, and with accurate documentation. Any deviation from this standard may constitute a medication error. All medication errors must be documented and reported.

Medication error incident reports will be reviewed to identify any changes needed to prevent future errors. The purpose of reporting errors is to improve processes, strengthen systems, and promote a culture of safety.

Refusal of medication is not considered a medication error. Medication refusals must be documented in the Medication Administration Record as “refused” and reported to the school nurse and the parent/guardian as soon as 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 to the school nurse immediately.
• The school nurse will assess the severity of the error and determine the immediate steps needed to support the student’s health and safety. The school nurse will notify the parent/guardian, the school administrator, and the Director of Health Services.
• If the error is committed by a licensed health provider and results in injury or requires emergency services, the incident must be reported to the licensed health professional (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 results in injury or requires 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 in response to the medication error must be documented accurately.
• Medication administration incident reports will be retained for eight years following 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, 2.26