Regulations for BOE Policy 7513
SUBJECT: GUIDELINES FOR ADMINISTERING MEDICATION IN SCHOOLS
Certain drugs with abuse
potential that are regulated by State and Federal Government in a manner
more restrictive than other drugs. A complete list of controlled substances
in New York is set forth at New York State Public Health Law, Section 3306.
A system of two separate locks to secure medications,
especially controlled substances (i.e., a locked box within a locked
Licensed Practical Nurse
An individual licensed
pursuant to Article 139 of the Education Law ("The Nurse Practice Act")
performing tasks and responsibilities within the framework of case finding,
health teaching, health counseling and the provision of supportive and
restorative care under the direction of a registered professional nurse or
licensed physician, dentist or other licensed health care provider.
Health care professionals who have authority to
prescribe medications in their practice including physicians, dentists,
podiatrists, nurse practitioners, physician assistants or specialist
assistants, optometrists, and midwives.
As used in
these guidelines will refer to both prescription and nonprescription drugs.
Medications which may be obtained over the
counter without a prescription. These medications are sometimes referred to
as over-the-counter (OTC) drugs and include, but are not limited to, oral,
inhalation, and topical forms.
requiring a written order for dispensing signed by a licensed prescriber.
Route of Administration
through the body whereby a medication is administered including oral,
subcutaneous, intramuscular, intravenous, inhalant.
Registered professional nurses licensed pursuant to Article
139 of the Education Law including school nurses, school nurse-teachers,
school nurse-practitioners, or other specialty nurse practitioners employed
by the School District or BOCES pursuant to Education Law Section 902.
An individual who is capable and competent to
understand a personal care procedure, can correctly administer it to
himself/herself each time it is required, has the ability to make choices
about the activity, understands the impact of these choices, and assumes
responsibility for the results of the choices.
Under the Direction
"Under the direction" means that a registered professional nurse should
be present on the premises or will immediately respond by written and/or
verbal communication when professional services are rendered by a licensed
practical nurse. The degree of supervision shall be appropriate to the
circumstances. This term implies an active process of directing, guiding and
influencing the outcome of an individual's performance of an activity.
"Under the direction" is generally categorized as onsite (the registered
professional nurse is physically present or immediately available while the
activity is being performed) or off-site (the registered professional nurse
has the ability to provide direction through written and/or verbal
communications). The degree of direction is appropriate to the circumstance.
A program for the administration of medication to
students in school must be managed and supervised by school nursing
1) Only those medications which are necessary to
maintain the student in school and which must be given during school hours
should be administered. Any student who is required to take medication
during the regular school day or while participating in school-sponsored
activities (e.g., field trips, athletics) should comply with all procedures.
2) Any prescribed medication which requires administration through a
subcutaneous, intramuscular, intravenous or rectal route or prescribed
medications being administered through pumps, tubes or nebulizers; or oral,
topical or inhalant medication needed by non-self-directed students must be
given by school nursing personnel or licensed practical nurses under the
direction of school nursing personnel. Administration of such prescribed
medications may not be performed by unlicensed persons.
persons in the school setting, following assignment and in conjunction with
approval by school nursing personnel, may assist self-directed students with
the taking of their own oral, topical and inhalant medication. School
nursing personnel and the administration should assure that the unlicensed
person receives the training and supervision needed to perform these tasks
in a safe and effective manner.
4) Best practices indicate that all
schools should be staffed with a registered professional nurse.
written order from a duly licensed prescriber and written parental
permission to administer the medication are required.
From a Licensed Prescriber Is Required
All medications, including
nonprescription drugs, given in school shall be prescribed by a licensed
prescriber on an individual basis as determined by the student's health
1) Written orders for prescription and nonprescription
medications should minimally include:
a. Student's name and date of
c. Name of medication.
d. Dosage and route of
e. Self-administration orders -- if indicated.
Frequency and time of administration.
g. For prn (as necessary)
medications -- conditions under which medication should be administered.
h. Potential adverse reactions - if indicated.
i. Date written.
j. Prescriber's name, title, and signature.
k. Prescriber's phone number.
2) Special considerations
a. Medication orders must be renewed
annually or when there is a change in medication or dosage.
pharmacy label does not constitute a written order and cannot be used in
lieu of a written order from a licensed prescriber.
c. When a
properly labeled medication comes to the health office accompanied by a
written request from the parent/person in parental relation for
administration of the medication, but without a written order from a
licensed prescriber, the following procedure should be followed:
Contact parent/person in parental relation regarding need for written order
from a licensed prescriber.
(2) Contact licensed prescriber to obtain
verbal permission to administer medication.
(3) Request fax or
written orders to be received within forty-eight (48) hours.
Contact parent/person in parental relation and discontinue medication if
written orders are not received in forty-eight (48) hours.
Document above steps.
Written Statement from Parent or Guardian Is
A written statement from the parent or person in parental
relation requesting administration of the medication in school as ordered by
the licensed prescriber is required. The parent or person in parental
relation must assume responsibility to have the medication delivered
directly to the health office in a properly labeled original container.
1) Prescription medications
The pharmacy label
a. Student name.
b. Name and phone number of
c. Licensed prescriber's name.
d. Date and number of
e. Name of medication/dosage.
f. Frequency of administration.
g. Route of administration and/or other directions.
Over-the-counter medications must be in the original manufacturer's
container/package with the student's name affixed to the container. The same
applies to drug samples.
3) For certain medications, especially
controlled substances, the school registered professional nurse should count
the medication upon receipt from the parent/person in parental relation and
periodically thereafter. This is not a legal requirement but constitutes a
sound practice when handling controlled substances. Discrepancies should be
reported to the parent immediately. The school administration should be
informed of any discrepancies when such discoveries occur. Close supervision
of the taking of controlled medication is advised.
should not be transported daily to and from school. Parents/persons in
parental relation should be advised to ask the pharmacist for two (2)
containers - one to remain at home and one at school.
to be stored in a locked cabinet or separate locked drawer in the health
office. Medication requiring refrigeration should be refrigerated in a
All students requiring
medication during school hours should receive their medication in the health
office except in those instances where students are allowed to carry their
own medication and self-administer.
School nursing personnel may receive a
request to permit a student to carry and self-administer his/her own
medication. Under certain conditions this may be allowed. Such decisions
should be made on an individual basis. The criteria for determining when a
student can self-administer medication are:
1) Severity of health
care problems, particularly asthmatic or allergic conditions.
Licensed prescriber's order directing that the student be allowed to carry
his/her medication and self-administer.
3) Parent/person in parental
relation 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 his/her person or keeping in school or physical
5) School nursing assessment that student is
self-directed to carry and self-administer his/her medication properly.
6) Parent/person in parental relation contact made to clarify
parental/person in parental relation responsibility regarding the monitoring
of the child on an ongoing/daily basis to ensure that the child 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/persons in parental relation should be notified. In some instances
school administration should also be informed. Periodic reevaluation of the
effectiveness of the procedure should be instituted.
The requirements allowing registered professional nurses
to administer agents used in the emergency treatment of anaphylaxis include:
1) Following non-patient specific standing orders and
protocols authorized by a physician or a nurse practitioner.
Maintaining or ensuring the maintenance of a copy of the standing order(s)
and protocol(s) that authorizes them to administer anaphylactic treatment
However, the administration of emergency medication
(injectable and/or oral) to a student for extreme hypersensitivity may be
performed by any school staff member responding to the emergency. Such a
response would fall under the "Good Samaritan Act" for rendering emergency
care during a life threatening situation.
Procedures for Taking Oral,
Topical or Inhalant Medications Off School Grounds or After School Hours
While Participating in a School-Sponsored Activity
The school nursing
personnel should assure:
1) Oversight of self-administration to:
a. Student who is self-directed;
b. Voluntary staff member who
has been appropriately instructed by the school nursing personnel to assist
self-directed student. (Note: Consistent with good practice, the employee's
willingness to perform the task should be considered in making the
2) Preparation of medication
When oral medication
is to be given off school grounds or after school hours, it should be placed
in a single dose medication envelope by school nursing personnel and
properly labeled with:
a. Student's name.
b. Name of
medication and dosage.
c. Date and time to be given.
e. Possible side effects.
oral, topical or inhalant medications to non-self-directed students and
injectable medications to any one must remain the responsibility of the
school registered professional nurse, licensed practical nurse under the
direction of a school's registered professional nurse, physician, or
parent/person in parental relation. However, Epi-Pen type injectables may be
administered by an LPN in the absence of an RN. Epi-pens must be
pre-measured and self-inject in emergency situations.
Remedies, Dietary Supplements, Natural Products and Other Non-FDA Sanctioned
Requests for use of herbal remedies, dietary supplements and
natural products do not need to be honored by a school district or school
registered professional nurse as they are not sanctioned by the FDA. Such
matters should be explained to the parent and their cooperation sought to
have such medications administered outside of school. An appropriate
notation should be made on the student's health record.
Building Evacuation and Medications
Good nursing practice dictates
that each health office be supplied with a readily accessible, easily
carried, and recognizable emergency pack that includes supplies for basic
first aid, including supplies for infection control, a stock Epi-pen with
non-patient specific orders and a glucose source, such as glucose gel or
honey sticks. A plan for communicating with the principal should be
established. A list of all students with significant medical conditions and
medical orders for prescription medication, including emergency contact
numbers, should be kept in the emergency pack.
School Nursing Personnel
1) Facilitate policies and
procedures regarding the administration of medication in schools.
Ensure proper and appropriate techniques for the administration of
medication in schools.
3) Provide and/or document adequate in-service
education for unlicensed persons assisting students with self-medication.
4) Maintain adequate and secure storage of all medications.
Document or assure documentation by other licensed or unlicensed persons for
each dose of medication given or taken on a daily log and periodically
summarize in each student's cumulative health record.
intermittent evaluation of the practices and procedures related to the
administration of medications and modify as needed.
Specific for each
1) Observe and evaluate the student's health status and
response to medication, informing parents/persons in parental relation or
prescriber as deemed necessary.
2) Educate the student regarding the
importance of medication and encourage the student's self-directed
involvement in the process including coming to the health office on time and
receiving or taking medications. If a student forgets, it is recommended
that the school registered professional nurse call for the student to ensure
that medication is not missed. Parents/persons in parental relation should
be advised if their child is not fully participating in the established
3) Involve school staff only as needed to ensure
student safety and only where disclosure of the health information is
permitted by law.
Storage of Medication
No medication should
be brought into school without knowledge of the health office. Publicized
procedures that facilitate this practice so that parents and students do not
feel the need to hide medication or to circumvent cumbersome procedures are
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. Controlled substances must always be secured and must
never be left open or accessible to the public at any time. Even
self-directed students should not be given unsupervised access to controlled
substances under the care of the school.
medication storage units ideally should be secured to the wall or floor, and
should not have breakable glass doors. Ideally, all medications should be
stored in a health office. However, there may be instances when either
requests are made by a parent and physician for a student to carry and
self-administer medications because of the emerging nature of the health
problem or the severity of the health condition.
Disposal of Medications
If a medication regimen is changed or
discontinued, and/or at the end of each school year, the medication must be
returned to the parent/person in parental relation or disposed of.
Parents/persons in parental relation should be notified of options such as:
1) Disposal of medication by flushing in presence of witness; or
2) Parent/person in parental relation or responsible designee picking up
medication from health office.
Disposal of Needles and Syringes
Needles and syringes should be disposed of in a manner consistent with
the following guidelines:
1) Needles should not be recapped and
should not be purposely bent or broken.
2) Disposable syringes and
needles (and other sharp items) should be placed in approved sharps'
containers and labeled "BIOHAZARD."
3) Arrangements should be made
with custodial staff or an appropriate agency to dispose of containers at
periodic intervals according to established procedures of the school
regarding regulated medical waste.
nursing personnel should maintain accurate records of the medication
administered, any special circumstances related to the procedure, and
The following procedure for record
keeping is recommended:
1) Retain the written order from the
2) Retain the parent/person in parental relation request
3) Retain pertinent information about medication on
cumulative health record.
4) Maintain an
individual daily medication record for each student taking medication during
time frame medication is being given.
5) Periodically summarize daily
medication record on cumulative health record.
School nursing personnel can avoid many
communication problems by widely circulating the requirements for
administration of medication in school. Suggestions for publicizing the
requirements for administration of medication in school include:
2) School publications/calendars.
4) Insert with report cards.
5) Mailing to
physicians and/or local medical societies.
6) Individual parent or
person in parental relation/student counseling.
Reviewed: April 7, 2009