Medications

Question: Is there a specific age at which a student can be determined to be self-directed as it relates to medication administration?Is there a specific age at which a student can be determined to be self-directed as it relates to medication administration?

Answer: There is no chronological age that determines self-direction.  Each student and situation should be assessed on a case by case basis.  There are a few kindergartners who could be considered self-directed and some older students who should not be considered self-directed.

 

Question:   How should an epinephrine auto-injector be disposed of in a school Health Office?

Answer:   The epinephrine auto-injector, whether used or expired, should be disposed of in an appropriate sharps container for disposal with other sharps/medical waste.

 

Question:  When administering medications in the school, what is the difference between a student being self-directed and a student being allowed to self-administer and self-carry their medication?

 

            Answer: A student is considered self-directed if they can do the following:

·         Identify the correct medication (e.g., color, shape)

·         Identify the purpose of the medication (e.g., to improve attention)

·         Determine the correct dosage is being administered (e.g., one pill)

·         Identify the time the medication is needed during the school day (e.g., lunch time, before/after lunch)

·         Describe what will happen if medication is not taken (e.g., unable to complete school work)

·         Refuse to take medication if student has any concerns about its appropriateness.

This means that a student needs only to be able to state something similar to: “I take one yellow pill.  It helps me focus on my work.  I take it at lunch and if I don’t take it I can’t do my work.”  To complete being self-directed the student would need to refuse the medication if offered the wrong color pill.  Many young students can be taught to be self-directed.  The definition can be found on page 3 of the Medication Guidelines on our Laws and Guidelines page.  Self-direction can be determined by the school nurse or with input from the private provider. IF a physician specifically writes an order related to self direction that the school nurse is concerned about, then the school should determine on a case by case basis in conjunction with the medical director whether or not that is an appropriate order.

 

Self-administer, self-carry permission involves a much more mature, independent individual.  If school nursing personnel receive a request from a parent and licensed prescriber to permit a student to carry and self-administer her/his own prescribed medication, such decisions should be made on an individual basis and in accordance with the following criteria:

 

1.      Severity of health care problems, particularly asthmatic or allergic conditions.

2.  Licensed prescriber's order directing that the student be allowed to carry her/his medication and self-administer.

3.  Parent statement requesting compliance with licensed prescriber's order.

4.  Student has been instructed in the procedure of self-administration and can assume responsibility for carrying properly labeled medication in original container on her or his person or keeping in school or physical education locker.

5.  School nursing assessment that student is self-directed to carry and self-administer her/his medication properly.

6.  Parent contact made to clarify parental responsibility regarding the monitoring of the student on an ongoing/daily basis to insure that the student is carrying and taking the medication as ordered. This contact should be documented.

 

Any student self-administering medication without proper authorization should be counseled by the school nursing personnel.  In addition, the parents and school administration should be notified.  Periodic reevaluation of the effectiveness of the procedure should be instituted.

 

Question:  Can students carry and self-administer medication other than inhalers and epi-pens in the school setting?

 

Answer:  The Medications Guidelines 2002 defines Self-Carry and Self-Administer this way: 

If school nursing personnel receive a request from a parent and licensed prescriber to permit a student to carry and self-administer her/his own prescribed medication, such decisions should be made on an individual basis and in accordance with the following criteria:

• Severity of health care problems, particularly asthmatic or allergic conditions.
• Licensed prescriber's order directing that the student be allowed to carry her/his medication and self-administer.  
• Parent statement requesting compliance with licensed prescriber's order. 
• Student has been instructed in the procedure of self-administration and can assume responsibility for carrying properly labeled medication in original container on her or his person or keeping in school or physical education locker. 
• School nursing assessment that student is self-directed to carry and self-administer her/his medication properly.
• Parent contact made to clarify parental responsibility regarding the monitoring of the student on an ongoing/daily basis to insure that the student is carrying and taking the medication as ordered. This contact should be documented.

 

Question: Can nurses leave their buildings to cover another building if that school's nurse is out?

Answer:  School nurses are not currently mandated in New York State, so a nurse is not required to be in each building and may move between buildings to care for students as needed.  A district policy should be put in place to address the care needs of medically fragile students in the event a nurse is not available for the building, especially in light of the pandemic flu outbreak, where we may see a number of school nurses become ill.

The Medication Guidelines and other state guidance documents do still need to be adhered to and district practice and policy must reflect that.

Question: Should school nurses have non-prescription medications available for staff members to use?

Answer:   When it comes to the use of stock medications for the faculty, special considerations should be taken by nursing personnel.  When at work, a licensed nurse is not able to administer a medication without a prescriber's order.

It is our recommendation that the staff member keep their own medication in a safe place out of the reach of students and that school nurses do not engage in health related consulting with the school staff unless it is a part of your contractual responsibilities.

 

Administering medications to staff could become problematic for a school nurse.  

Please consider the following:

• If a teacher were to take something from your office independently, the staff member could take an inappropriate dosage and potentially have a reaction.
• If a teacher came into the busy Health Office and complained of a headache, took some Advil or Tylenol from your office and suffered a stroke two hours later, there could be serious implications for the staff member, school nurse and school.  

Question:  When and how is a student determined to be self-directed when related to medication administration?

Answer:  Whether a student should be considered self-directed should be based on the student’s cognitive and/or emotional development rather than age or grade.  Factors such as age of reason and mental/emotional disability are additional considerations in determining a student’s ability to be self-directed.  Usually a student may be considered to be self-directed if he/she is consistently able to do all of the following:

·         Identify the correct medication (e.g., color, shape)

·         Identify the purpose of the medication (e.g., to improve attention)

·         Determine the correct dosage is being administered (e.g., one pill)

·         Identify the time the medication is needed during the school day (e.g., lunch time, before/after lunch)

·         Describe what will happen if medication is not taken (e.g., unable to complete school work)

·         Refuse to take medication if student has any concerns about its appropriateness

Question: Do medication orders extend through summer school?

Answer:  Physician orders for medications should be renewed annually (page 5 of the Administration of Medication in the School Setting Guidelines).  Please check your local district policy regarding medication order renewal and summer school.  It may be advantageous to add a statement to your medication permission form that states that a medication order is valid for the school year and summer school as needed (it may be late to add this notation for this year, but it could be added for subsequent years).

Question:   Can a school nurse take telephone/verbal orders from a healthcare provider?

Answer:   Verbal/telephone orders may be obtained from a licensed health care provider with a follow up written order within 48 hours.

It is advisable to have two people listen to the verbal order to ensure accuracy. 

Question: Can the school nurse train all faculty and staff to administer epinephrine and glucagon to any student who might need it?

Answer: The school nurse must take care in training unlicensed persons to administer emergency medications.  While we have permission in memos from the Office of Professions of the NY State Education Department to train unlicensed personnel to administer these two medications in the event of an emergency, the training of personnel must be done on a student specific/ medication specific basis. 

For example:

A student has an order for glucagon to be given in an emergency. 

The school nurse MAY train that student’s teachers or aides to give the glucagon to that particular student in accordance with an Emergency Care Plan written by the school nurse. 

The school nurse MAY NOT train the entire faculty at a faculty meeting to give glucagon to any student.

Memos for review:

• Training of Unlicensed Individuals in the Injection of Glucagon in Emergency Situations - Memo (March 2004)
• Use of Epinephrine Auto-Injector Devices in the School Setting - Memo  (June 2002) 

Question:    May a teacher or other school employee administer an "Epi-pen" to a student having an anaphylactic reaction?

Answer:    Yes, any school employee who volunteers to be trained by a Licensed Health Care Provider may administer an Epi-pen which has been prescribed by a licensed prescriber to a student with a known allergy in a life threatening anaphylactic reaction when the Registered Professional Nurse is not immediately available.

Question:    May a non-licensed person administer an "Epi-pen" in an emergency situation?

Answer:    Yes. The "Good Samaritan Law" covers the liability of the non-licensed person when responding to an emergency situation.

(Refer to NYSED Guidelines for Administration of Medication in Schools, April 2002, p. 5)

Question:   Who is the appropriate person to prepare medications for short out of school activities such as field trips?

Answer:   When oral medication is to be given off school grounds or after school hours, the school nurse may prepare the medication.

(Refer to NYSED Guidelines for Administration of Medication in Schools, April 2002, Section C, #2)

Question:    May a non-licensed person administer medications to a non self-directed student?

Answer:    No, any prescribed medication which requires administration in the school setting to a non self-directed student must be administered by a licensed health care provider.

(Refer to NYSED Guidelines for Administration of Medication in Schools, April 2002, p. 10)

Question:     May a non-licensed person assist a self-directed student in taking their own medications?

Answer:    A non-licensed person who has been trained may observe or assist (i.e., open bottle) a self-directed student in taking their own medication. A non-licensed person cannot administer medication in the school setting.

(Refer to NYSED Guidelines for Administration of Medication in Schools, April 2002, p.5)

Question:  May an unlicensed individual administer Benadryl to students with severe allergies when there is an order to administer antihistamine in conjunction with epinephrine as part of emergency care?

Answer: It is only appropriate for an unlicensed person to assist a self-directed student with a student specific order for Benadryl as a part of an Emergency Care Plan with appropriate direction and guidance from the building school nurse.   If a student is non self-directed, an unlicensed person may not administer Benadryl to the student as a part of emergency care.      (NY State Board of Nursing)

Question:   Do parents need to be notified when their child misses a medication dose at school?

Answer:    If the medication has not been given for any reason within the prescribed time frame, the school must make all reasonable efforts to notify the parents/ guardians that day.

(Refer to NYSED Guidelines for Administration of Medication in Schools, April 2002, p.7)

Answer:    No, only health care professionals who have the authority to prescribe medication in their practice may write medication orders (i.e., physicians, dentists, podiatrists. nurse practitioners, physician assistants or special assistants, optometrists, and midwives).

(Refer to NYSED Guidelines for Administration of Medication in Schools, April 2002, p. 3)

Answer:    Yes, a prescription for OTC is required from a student's Primary Health Care Provider along with written parent permission. The OTC medication must be in the original manufacturer’s container/package with the student’s name affixed to the container. The same applies to drug samples.

(Refer to NYSED Guidelines for Administration of Medication in Schools, April 2002, p. 6)

Question:    How should medications be stored in the school health office?

Answer:   All medications, except as otherwise arranged should be properly stored and secured within a health office cabinet, drawer or refrigerator designated for medications only. This site must include a lock for the cabinet, drawer and refrigerator, as well as a lock to the outside health office door.

(Refer to NYSED Guidelines for Administration of Medication in Schools, April 2002, p.8)

Question:    What is a double lock system and is it a requirement?

Answer:    A double lock system consists of two separate locks to secure medication, especially controlled substances (i.e. a locked box within a locked cabinet). This is a best practice recommendation.

(Refer to NYSED Guidelines for Administration of Medication in Schools, April 2002, p.2)

Question:    How should medication errors be managed?

Answer:   School districts should establish a protocol for managing medication errors. A medication error includes any failure to administer medication as prescribed for a particular student. Medication errors should be addressed immediately. School nursing personnel should assess the student, notify the parent, and if appropriate, notify the supervisor, school administrator and or school physician. The licensed prescriber should also be notified. School nursing personnel need to complete a written medication error incident report

(Refer to NYSED Guidelines for Administration of Medication in Schools, April 2002, p.10-11)