Each school district should have policies governing the handling and administration of medication that is in accordance with all other applicable state and federal laws and rules regarding medications. These policies regarding medication should require a signed licensed medical provider’s order and written parental consent.
Licensed medical provider’s orders should include the student’s name, date, the medication, dosage and possible side effects. Any order for an “as needed” (PRN) prescription must be accompanied by very specific instructions from the licensed medical provider.
It is recommended that school district medication policies require:
- Current, signed parent or guardian consent
- Current, signed licensed medical provider’s order
- Properly labeled pharmaceutical container
- Initial dose to be administered at home, licensed medical provider’s office or hospital
- Renewal of parent/guardian consent and licensed medical providers order at the start of each school year
- Plan for any required training (including merely informing)
- Clear statement of supply responsibility
- Strategy for dealing with problems caused by failure to receive medical supplies that parents/guardians are responsible for providing
- Emergency plan consistent with school’s general emergency plan
- Medication should be stored under proper temperature and maintained in a locked storage
Q. What is the school’s responsibility if the parent does not meet their responsibility of providing required medical supplies or medications?
A. First, meet with the parents to try to resolve the situation. If the problem persists and there is a safety risk to the student, the school should call the Department of Public Health and Human Services (DPHHS).
Q. Is a school district responsible for purchasing and supplying medication?
A. No. It is the parents’ responsibility to purchase and supply the medications for their student at school.
Q. Does the school have a responsibility for ensuring that a student remembers to take medication at school?
A. Not necessarily. However, a student’s age and disability may be factors the school needs to consider when developing the student’s health care plan. For some students there may need to be procedures implemented to help ensure the student receives needed medications.
Q. Is it permissible to change the dosage of medication at the request of a parent, even though the licensed medical provider’s (with prescriptive authority) order on the medication is different?
A. No. If the dosage of medication is to be changed, it must be changed by a licensed medical provider.
Q. Can the school require a parent to have a student placed on medication in order to attend school?
A. No. However, if in the judgment of the nurse who provides services in the school, a student’s life or health is in danger without medication, adequate steps should be taken to inform the parents and encourage them to seek medical care.
Q. When is it appropriate for a student to perform self-administration of medication?
A. The school should consider all of the following factors when allowing a student to self-administer medication:
1. Licensed medical provider recommendation;
2. The student’s competency and age to perform the procedures; and
3. The school district policy on self-administration and controlled substance.
The following activities are not the sole practice of nursing, and therefore do not require delegation. These activities may be performed by anyone trained to do so.
Assisting with medications by:
- Prompting or reminding a student to take his meds;
- Handing a pre-filled, labeled medication holder, labeled unit dose container, or original marked, labeled container from the pharmacy to the student;
- Opening the lid of a container for a student;
- Assisting with the removal of the med from a container or package;
- Guiding the student’s hand to self-administer; and
- Holding and assisting the patient in drinking fluid to assist in swallowing oral meds.
A. School Administered Medications (Prescription, Non-Prescription, or “Over-the-Counter”)
- All prescriptions or non-prescription medications shall be
a. Accompanied by written parental consent.
b. Accompanied by current written orders (directions and prescription) from the student’s licensed medical provider, dentist, nurse practitioner, or licensed medical provider’s assistant. Orders shall indicate the student’s name, medication, dose, route, time of administration, medication’s purpose, a statement that the medication is necessary during school hours, and any possible side effects and procedures to follow if a severe reaction occurs.
c. Sent in a pharmacy or manufacturer’s labeled container. The pharmacy label shall include the student’s name, name of medication, dose, time, and route. Students on more than one medication (or requiring different dosages of the same medication) shall provide separate pharmacy or manufacturer labeled containers for each medication.
d. Kept in a locked cabinet or drawer with the information described in 1.a. and 1.b. above.
e. Recorded on the Medication Record Form by the designated school employee who administers the medication.
f. Administered by a principal-designated school employee who shall receive annual training by a nurse in medication protocol and precautions.
- For parents who request that their elementary students carry their own Epipens, insulin, or asthma inhalers, the licensed medical provider’s order must include a statement that the student is capable of carrying and self-administering his/her own medications and that it is medically necessary for them to keep the medication with him/her at all times.(Authorization to Posess Form)
- Written orders must be presented to the school office at the beginning of each school year and as medication is prescribed or changed. Requests for changes in dosage, time, or route for any medication shall be accompanied by a written order (see 1.b. above) and new appropriately labeled containers with updated information. Requests to discontinue medication shall be accompanied by a written parent request and written licensed medical provider’s order. A copy of these instructions shall be kept on file with the designated school employee.
- Students with diabetes, seizure disorders, or severe allergic disorders that require emergency medication shall have written instructions from their health care provider, written instructions from parents, and names and telephone numbers of emergency contact persons. A nurse shall review the procedure for administering emergency medications with a school administrator and school personnel, as appropriate.
- All medication that is to be given at school must be furnished by the parent or guardian and delivered to the school by a responsible adult. Unused medication must be picked up by a responsible adult within two weeks following the last dose administered. Medication remaining at the school after this time should be destroyed according to the direction of the nurse.
Self-Administered Medications or Other Substances
- Secondary students may retain and self-administer medications subject to the following:
a. Medication, prescription or non-prescription, shall be taken only as directed by prescription or manufacturer’s directions; and
b. Medication, prescription or non-prescription, shall not be sold, shared, or otherwise given to others.
- A responsible adult must transport syringes (insulin pens excepted) to and from school, and they must be kept in a locked cabinet or drawer in the
- The school district may withdraw authorization for self-administration of medication at any time, in accordance with school district policy with parental notice.
- Violation of the district’s medication policy may be regarded as substance abuse and could result in disciplinary action pursuant to the school district’s policies and procedures regarding substance abuse.
- Forms and sample letters to assist with the administration of medication and communication with parents about this memorandum are available from the school district’s administration.
American Nurses Association. (1994). Registered professional nurses & unlicensed assistive personnel (Position Statement). Washington DC: Author.
National Association of School Nurses (2002). Using Assistive Personnel in School Health Services Programs (Position Statement). Scarborough, ME: Author.
Haynie, Marilyn (1997) Students and Youth Assisted by Medical Technology in Educational Settings-Guidelines for Care. A Manual for: Educators, School Nurses, and Parents
American Academy of Pediatrics (1997). Policy Statement. Guidelines for the administration of medication in school (RE9328). Pediatrics, 92(3), 499-500. Retrieved on May 13, 2003 from http://www.aap.org/policy/04524.html
Awbrey, L.M. & Juarez, S.M. (2003). Developing a nursing protocol for over-the counter medications in high school. Journal of School Nursing, 19(1), 12-15.
Dockrell, T.R. & Leever, J.S. (2000). An overview of herbal medications with implications for the school nurse. Journal of School Nursing, 16(3), 53-58.
McCarthy, A.M., Kelly, M.W., & Reed, D. (2000). Medication administration practices of school nurses. Journal of School Health, 70(9), 371-376.
National Association of School Nurses (1999). Position Statement: The use of asthma inhalers in the school setting. Available at: http://www.nasn.org/positions/asthma.htm
National Association of School Nurses (2000). Position Statement: Epinephrine use in life-threatening emergencies. Available at: http://www.nasn.org/positions/Epinephrine.htm
National Association of School Nurses (2000). Position Statement: Out-of-school education: Field trips and camps. Available at: http://www.nasn.org/positions/outofschool.htm
National Association of School Nurses (2001). Position Statement. Alternative medicine use in the school setting. Available at http://www.nasn.org/positions/ altermedi.htm
National Association of School Nurses (2001). Position Statement: Research medications in the school