Medication Administration Policy

POLICY:

The purpose of a medication administration policy is to safeguard and guarantee that students attending WSSB are receiving medication in accordance with "best practices" and state guidelines, which are designed to provide for a safe environment.  WSSB nurses are the primary caregivers.

The term ʺparentʺ as used in this policy means a parent, guardian or person having legal custody of a child. If the student is eighteen (18) years or older, or is legally emancipated, the procedures for the parent in this policy may be exercised by the student. WSSB recognize the fact that students may require prescribed and/or over-the-counter medication at school.

Whenever a health condition requires that a student take prescription or non-prescription oral medication, use an inhaler, or administer epinephrine auto injectors during school, written authorization shall be received from the student's parent together with written orders and instructions signed by the student's licensed health professional prescribing within the scope of their prescribing authority before administering such medication. No school district personnel shall administer oral medication except with the written authorization from the student's parent and written instructions from the student's licensed health professional prescribing within the scope of their prescribing authority. The orders shall be current, obtained at least yearly, and reviewed and updated whenever there is significant change in the student's school activity program.

Legal Reference: RCW 18.71.030, RCW 28A.210.260, RCW 28A.210.270

Student Medication in the School

I. Definitions

The following definitions apply within this regulation.

A. “Licensed health professional” means an individual health professional prescribing within the scope of his/her prescribing authority.

B. “Non-prescription medications” are those medications available over–the-counter without a prescription, and include, but are not limited to, aspirin, ibuprofen (i.e., Advil, Motrin), acetaminophen (i.e., Tylenol), non-aspirin (i.e., Midol, Anacin 3), decongestants, vitamins, cough syrups and cough drops.

C. “Oral medications” are those medications administered by mouth by either swallowing or inhaling, and may include administration by mask if the mask covers the mouth or mouth and nose.

D. A “parent” for the purpose of this regulation means a parent, guardian, or person having legal custody of a child. If the student is eighteen (18) years or older, or is legally emancipated, the procedures for the parent in this regulation may be exercised by the student.

E. “Topical Medications” are medications applied to the skin on a definite or localized part of the body.

F. A Parent Designated Adult (PDA) means a volunteer, who may be a school employee, who receives additional training from a health care professional, school nurse or expert in epileptic seizure care, and who provides care for the child consistent with the individual health plan.   To be eligible to be a PDA, a school employee not licensed under chapter 18.79RCW must file, without coercion by the employer, a voluntary written, current and unexpired letter of intent “Designation of a Parent Designated Adult” stating the employee’s willingness to be a PDA. If any school employee who is not licensed under 18.79RCW chooses not to file a letter under this section, the employee shall not be subject to any employer reprisal or disciplinary action for refusing to file a letter.

II. Medication Administered at School

A. Every effort will be made by the school to encourage parents and licensed health professionals to administer medication outside of school hours. Whenever a health condition requires that a student receive prescribed medication during school, the student’s parent shall submit a signed the Authorization for Administration of Medication in School section of the parent consent form. This authorization shall be accompanied by written orders signed by the licensed health professional. The orders will include dosage, frequency, duration of administration and instructions.

B. Medication must be in original containers, unexpired, labeled by a licensed health professional or pharmacist, and brought to school by the parent or proper school personnel.

C. If the medication is to be discontinued after the school has begun administering medication in conformance with a parent’s “Authorization for Administration of Medication in School,” the parent must provide written notice to the school.

III. Staff Persons Authorized to Administer Medication

A. Oral or Topical Medications, Eye Drops and Ear Drops

1. School personnel, designated and trained as indicated below, may administer prescription and non-prescription oral or topical medications, eye drops or ear drops.
2. WSSB shall designate and authorize staff members who provide direct service to students to administer prescription or non-prescription oral or topical medications, eye drops or eardrops. These employees shall annually participate in an in-service training session under the direction of the school nurse. No substitute employees shall administer medication unless they have received training from the school nurse. Prior to administering medications to students, employees shall receive training, including:

a)   WSSB policies and procedures governing the administration of oral and topical medications;

b)   Procedures to follow in administering medication, including the description of when not to administer a medication;

c)   Procedures to follow in the event of a medication error, missed dose, or delayed dose;

d)   Required charting;

e)   When to contact the school nurse and/or summon emergency services; and

f)   Confidentiality issues regarding the administration of medications and student health information.

B. Medication Other Than Oral, Topical, Eye Drops or Ear Drops

Medication, which is administered other than orally or topically or other than eye drops or eardrops, may only be administered by a registered nurse or licensed practical nurse, except epinephrine in auto injectors as specified below in section V.A. Additionally, insulin and epilepsy medication may be administered by parent-designated adults.

C. Nasal Sprays (containing prescription drugs or controlled substances)

1. If a school nurse is on the premises, a nasal spray that contains a legend drug or a controlled substance must be administered by the school nurse.
2. If there is not a school nurse on the WSSB premises, a nasal spray that contains a legend drug or a controlled substance may be administered by a WSSB trained staff person while at WSSB.
3. When on field trips, if a nurse is present, the nurse will administer the nasal spray that contains a legend drug or a controlled substance. When a nurse is not available, a trained WSSB staff person may administer a nasal spray that contains a legend drug or controlled substance if within the State of Washington.  A parent may choose to send a Parent Designated Adult (PDA) to administer a nasal spray that contains a legend drug or controlled substance when on field trips outside the state of Washington. If neither a school nurse, trained WSSB staff person within the State of Washington nor PDA are available, staff will summon emergency assistance.
4. If a PDA or other non-nursing WSSB staff administers a nasal spray that contains a legend drug or a controlled substance, emergency services must immediately be summoned.
5. If neither a school nurse nor a designated adult are available, school staff should care for the student as directed in the students individual health plan.

IV. Care of Student with Epilepsy

A.  The school nurse will coordinate care and consult with parents and health care providers. Nurse will train and supervise school employees on the appropriate care of students with epilepsy.

B.  A PDA caring for students with epilepsy, who are not WSSB employees are required to show evidence of comparable training as a school employee and meet WSSB requirements as a volunteer.

1. PDA(s) will receive additional training from a parent selected health care professional or expert in epileptic care to provide the care requested by the parent.
2. The school nurse is not responsible for the supervision of the procedures authorized by the parent and carried out by the parent-designated adult.

V. Student Authorization for Self-medication

A. Epinephrine: Epinephrine may be administered by the student him/herself or by a designated staff person who has received training by the school nurse. Epinephrine shall be administered by school personnel only through the use of “epinephrine auto injectors.” Epinephrine auto injectors may be carried and administered by the student with the approval of the building principal on advice of the school nurse. Epinephrine administered by inhalation, rather than injection, may be a treatment option. This would be a decision of the licensed health professional.

B. Inhaler: With written parental authorization, and orders of the prescribing licensed health professional, and consultation with the school nurse, a student may carry and use an inhaler.

C. Prescriptions and Non-prescription Medication Generally

1. With written parental authorization, written instruction from a licensed health professional, and written clearance from the school nurse, students in grades nine (9) through twelve (12) may carry and self-administer prescribed medications at school, except for those considered to be controlled substances by federal law.
2. Under special circumstances and upon the discretion of the school nurse, students in grades six (6) through eight (8) may also self-administer prescribed medication following this procedure.
3. Under no circumstances may a student give medication, prescription or non-prescription, to another student.

D. Revocation of Authorization for student self-administration of medication is subject to review by the school nurse. Violations of any conditions placed on the student permitted to carry and self-administer medication may result in revocation of that permission, as well as the imposition of discipline when appropriate.

VI. Storage and Record Keeping

A. All medications must be in locked medication cabinets at all times, except when the student is attending an authorized off-campus school activity under the supervision of school personnel. During such off-campus activities, designated personnel accompanying the student shall have control of the medication, except when the student has been given permission to self-medicate under this regulation.

B. A record of the medication administered shall be recorded, when given, on the student's medication record by the person administering the medication. At the end of the school year, the medication record shall be filed in an annual student medication file, which shall be maintained for eight (8) years. This annual medication file shall be the responsibility of the school nurse, principal or designee.

C. Administration of medication must be recorded each day on the WSSB Medication Administration Record or delegation envelope by the person administering the medication.

D. Student medication shall not be kept by the schools for more than one (1) year.

1. Parents shall be notified by the school to pick up student medication at the end of the school year.
2. Unclaimed student medication shall be disposed of by the school if not claimed by October 30 of the following school year.
3. Accountability shall be ensured by the school nurse, and one other staff person, counting, sealing, and recording the unclaimed medication.
4. The Safety Office shall account for, and dispose of, the medication in an environmentally safe manner and in accordance with law enforcement guidelines for controlled substances.

VII. Medication Administered During Field Trip and School-Sponsored Extra-Curricular

Activities

A. All of the requirements and guidelines pertaining to student in-school medication, including this regulation, must be met on the field trip or extracurricular activity, i.e., staff must be trained by a school nurse as is required when giving medication at school. Students normally taking medication at home may need to take medication while on a field trip or school sponsored extracurricular activity extending beyond the normal school hours.

B. If parents indicate that medication not routinely given at school will need to be given on the field trip or during a school sponsored extra-curricular activity, the “Authorization for Administration of Medication” form must be completed and signed by the parent and licensed health professional prior to the field trip or school sponsored extra-curricular activity. The medication must be supplied by the parent in the original pharmacy bottle.

C. The medication will be carried on the field trip or school sponsored extracurricular activity by the designated staff person in a secure container with access limited to those giving the medication. The medication should be either in the original pharmacy-labeled container or the number of doses required during the field trip or school sponsored extra-curricular activity are put in a properly labeled, sealed plastic bag. In the latter instance, the school nurse and the designated staff person shall place the medication in the envelope and record and sign a form with the name of the medication, the strength per dosage unit, the quantity and the date. The envelope should have the following information:

1. name of student,
2. medication name,
3. dosage of medication to be given and dose per unit of medication,
4. time medication is to be given,
5. a space for the designated and trained staff person to sign his/her name, date, and the time the medication was given to the student. (This information could be put on a medication log sheet instead of the envelope.)

D. At the earliest possible time after returning to school from the field trip or school sponsored extra-curricular activity, the signed envelope or log sheet and any left over medication is returned to the school nurse, who will transfer the information to the regular school medication log for the student.

Legal Reference: RCW 28A.210.260

RCW 28A.210.270

RCW 28A.155.020