Medication Training

The district is authorized by RCW 28A.210.260-270 and RCW 18.71.030(3) to administer prescribed oral medications to students during school hours or while students are in the custody of the district. The district will authorize its employees to administer prescribed oral medications to students only when the student requires such medication in order to attend school, school sponsored activities, or when the student is susceptible to a predetermined life endangering situation.

A. Definitions

1. Prescribed oral medication: all prescribed or over the counter oral medication dispensed to student on a scheduled or as needed basis upon written authorization from a parent and accompanied by written instructions from a licensed health care provider.
2. Licensed professional: a registered professional school nurse licensed pursuant to chapter 18.88 RCW and employed by the district.
3. Designated personnel: those district employees described in Section B below.
4. Parent: parent, legal guardian, or person having legal control over the student.
5. Current: each school year.
6. Licensed health care provider: any person listed in RCW 188.79.040 with prescriptive authority (eg. physician, dentist, osteopaths, PA, ARNP, naturopaths, and chiropractors).

B. Designated Personnel

1. The principal, secretary and clerk are to be trained annually in the administering of oral medication .
2. The building principal may request that additional staff members be authorized to administer prescribed oral medication
   1. The request should be submitted in writing, along with the reason for the request, to the school nurse.
   2. The person must be trained prior to administering oral medications.
3. In addition to those staff members authorized to administer oral medications, the building principal may request specific staff members to be authorized to administer medications in specific situations (i.e. field trips, some classrooms for the disabled, emergency medications). a. The request should be submitted in writing to the school nurse and should include the names and positions of the staff members the principal would like to designate along with the reason for the request. b. Staff designated to administer medications in a specific situation may only administer such medication within the specific situation.
4. Only employees of the district may be designated to dispense medications.

C. Training and Supervision

1. The district’s school nurse shall, under the general direction of the director of special services, train and supervise designated personnel in the proper administration of prescribed oral medication.
2. Only designated personnel who have received such training and licensed professionals shall administer prescribed medication.
3. The district’s school nurse shall also, under the general direction of the director of special services, provide training and supervision to those staff authorized to administer prescribed oral medication in specific situations.
4. All training shall occur as requested by the building principal and approved by the director of special services.
5. The district’s school nurses shall supervise designated personnel by conducting periodic reviews of medication administration procedures.

D. Procedures

1. Designated personnel shall administer prescribed medications to students only when the district has received (see Attachments 15 and 16, Authorization for Administration of Oral Medication at School):
   1. Parent/legal guardian request and instructions
      1. Such request must be made in writing. The request must be current and unexpired.
      2. The request must be signed by a parent/legal guardian.
   2. Health care provider requests and instructions
      1. The request must be made in writing and signed by the student’s health care provider. The request must be current and unexpired.
      2. The request must state that a valid health reason exists which makes administration of the prescribed oral medication advisable during school hours or during such time that the student is under the supervision of school officials.
      3. Written, clear, legible, current, and unexpired instructions must be obtained from the student’s current health care provider regarding the administration of prescribed oral medications for students.
      4. These instructions must be nondiscretionary.
      5. Both the request for administration or medication as well as the written instructions from the health care provider must be received by the school prior to the delivery of medication.
   3. Medication
      1. The medication must be furnished in an original container from the pharmacy with the student’s name, the name of the medication, dosage and the amount to be given.
      2. All medications should be in a form ready to be administered and should not require any preparation by the designated personnel.
      3. It is the parent/guardian(s) responsibility to deliver and maintain an adequate supply of medication at school. The medication may not be delivered by the child or school bus driver.
      4. The principal’s designee will attempt to notify the parent when the medication supply is low or completely out.
      5. If there is a need to change the student’s dosage and/or time of administration, the health care provider must submit a new written request. If there is a dosage change, a newly labeled original container from the pharmacy shall be provided to the school.
   4. Inhalers
      1. In most cases, inhaled medications will be administered in the school office or health room under oral medication procedures.
      2. In the event that the health care provider and parent indicate that a student in grades four through twelve (4-12) must carry their metered dose inhaler on their person, the authorization form must be on file in the office.The student must demonstrate to the professional registered nurse at the school the skill level necessary to use the medication and any device that is necessary to administer the medication as prescribed.
      3. The staff will not be held responsible to record daily dosages.
   5. Self Medication
      1. In the event a health care provider and parent/guardian request that a student be allowed to self medicate at school, the health care provider and/or parent/guardian shall complete an Authorization for Self Administration of Oral Medication at School Form.
      2. The original of this form, signed by the health care provider and/or parent/guardian, will be on file in the school prior to the student initiating self medication.
      3. All students who are authorized to medicate themselves at school shall carry only one day’s dosage of the medication.
      4. A copy of the completed Authorization for Self Administration of Medication at School form, signed by the health care provider (prescription and/or over-the-counter medications) and/or parent/guardian must be on file in the school’s office.
      5. The following age appropriate guidelines should be followed taking into account the developmental level of the students:
         • scheduled prescription drugs (Ritalin, methylphenidate): grades 9-12;
         • metered dose inhalers (provental, albuterol): grades 4-12;
         • oral medication (Tylenol, aspirin, Motrin): 7-12 grades;
         • non-oral medications (insulin, eye drops, ear drops, topical ointment):
         • grades 7-12.
2. The district will assume no responsibility or liability for the administration of the medication should a student medicate himself/herself at school or at school sponsored activities.
3. If a student is noncompliant with self medication procedures, the principal will follow the procedure for unauthorized drugs on school grounds or use professional judgment to determine action to be taken (see Administrative Procedures No. 3200 P-1).

E. Procedures for Administration of Prescribed Oral Medication

In addition to compliance with all other requirements set forth in this procedure, the principal/designee shall:

1. Administer prescribed oral medication in substantial compliance with the written instructions of the student’s health care provider. This shall include, but not be limited to, the administration of medication not earlier than one half hour before and not later than one half hour after the time designed by the health care provider.
2. Examine the prescribed oral medication before administration to determine if it appears to be in the original container and is properly labeled.
3. Keep an accurate record of all prescribed oral medication using district recording forms (see Attachment 18, Written Record For Dispensing Oral Medication).
4. Follow hygienic practices when administering any medication (e.g., direct handling of oral medication should be avoided).
5. Destroy all medication left at the end of the school year which has not been picked up by the parent.
   1. The school nurse shall provide general direction to the designated personnel on the most appropriate way to destroy the medications. In every case, the oral medication shall be:
      1. Destroyed by one of the individuals authorized to administer oral medications;
      2. Witnessed by another member of the building staff;
      3. Documented using an appropriate district form which shall be maintained in the school office; and
      4. Medication records shall be kept for eight (8) years following the last dose.

F. Medication Error

1. In the event a medication error should occur (e.g., an incorrect dosage, time, or incorrect medication), the staff member who administered the medications shall immediately call the school nurse assigned to the building and notify the building principal. They shall follow the Guidelines for Handling Medication Errors (see Attachment 19) and the appropriate action shall be taken.
2. The employee responsible for the incident shall complete a Medication Incident Report form (see Attachment 20), documenting the error that occurred, the action taken by the school personnel, the persons contacted as well as recommendations to prevent such an error from occurring in the future. A copy of the report shall be sent to the director of special services, the building’s school nurse, and the original will be kept in the building where the incident occurred.
3. In every instance of medication error, the student’s parents and the building administrator shall be notified.

G. Safekeeping of Prescribed Oral Medication

Designated personnel shall assure safekeeping of prescribed oral medication by:

1. Keeping all medication in the original container;
2. Storing the medication in an appropriately sized, secured and locked cabinet located in the school office area or when necessary within a locked container within a school refrigerator; and
3. Keeping no more than a one month supply of such medication at school at one time.
4. Only designated personnel shall have access to a school’s medicine storage cabinets.

H. Student Participation

1. It is expected that students will cooperate with the district’s designated personnel in administering prescribed oral medications.
2. Any student who repeatedly fails to cooperate will be subject to discontinuation of medication at school.
3. Keeping no more than a one month supply of such medication at school at one time.
4. Only designated personnel shall have access to a school’s medicine storage cabinet.

I. Discontinuance of Medication

1. All health care provider authorizations will automatically expire at the end of the school year and are subject to renewal in the succeeding year.
2. The district is not required by RCW 23A.210.260 to administer oral medication to students. If for any reason the building principal, school nurse, or staff with the responsibility for the administration of medications believe that the school should discontinue administration of medication to a student, they shall:
   1. Convene a committee consisting of the building principal, parent/guardian, school nurse, and staff member with the responsibility for administration of medications;
   2. Present the reasons for their concern and what action(s) they have taken in response to the concern; and
   3. Decide what action, if any, will be taken.
3. If it is the committee’s decision that the district should exercise its discretion and discontinue the administration of medication, the committee shall:
   1. Document their decision using a district Discontinuance of Medication Form.
   2. Forward a copy of the Discontinuance of Medication Form to the director of special services.
4. The committee’s decision may be appealed by the parent to the director of special services.

J. Field Trips

While students are in the custody of the school district, but away from the school building, medication will be administered according to the medication policy and procedure with the following modifications.

1. Designated personnel will be trained by the school nurse to administer the medication.
2. Medication if needed must be kept on the person designated (e.g., fanny/back pack) or with a designated adult.
3. A copy of the health care professional’s directions must be with the medication.
4. Medication is in a labeled container. The container must be clearly marked with: Childs name; medication name; amount to be given; time to be given.
5. Medication must be examined before leaving school grounds to assure proper dosage is given.
6. Designated personnel will be responsible to see that the container returns to school.
7. The designated personnel who administers that medication shall be responsible for documenting administration on the permanent medication record at school.

K. Epinephrine/Anaphylaxis

1. No medications shall be administered by injection by school personnel except under extreme conditions.
2. If a student has a known allergy to bee stings/food and may need an emergency injection, the following procedures will be followed:
   1. Parents and health care providers will complete an Individual Health/Auto Injectors Plan Allergy/Anaphylaxis Secondary to Bee Stings or Individual Health Plan Allergy/Anaphylaxis Secondary to Food Allergy (see Attachments 22 and 23).
   2. The parent/guardian will be notified if epinephrine dosage is administered and 911 will be called.
   3. The principal is responsible to see that the epinephrine accompanies the student if the student leaves school for a school activity.
   4. Epinephrine must be in auto injection form.
   5. Only staff trained by the school nurse may administer EpiPen® to a student in an emergency. (see Attachment 24)
   6. The principal/designee will notify the school nurse if a student registered in the building has a known life threatening allergic condition and has an epinephrine dose at school.
3. Upon request, the building principal will provide a copy of this procedure to the parents for administration of medication in the schools.