Guidelines for Medication Administration in Schools
Frequently Asked Questions
1. Who is authorized to administer medication in schools?
A variety of individuals can administer medication in school (e.g., licensed school nurses/registered nurses, licensed practical nurses, unlicensed assistive personnel, secretaries, teachers, and principals). Parents/legal guardians are to provide the school with written authorization for school personnel to provide medication to their students.
2. What is nursing delegation?
According to the National Council of State Boards of Nursing (1997), delegation is “Transferring to a competent individual the authority to perform a selected nursing task in a selected situation.” The council also states that, “The nurse retains accountability for the delegation.” The tasks delegated can, in the opinion of the nurse, be properly and safely performed by the person without jeopardizing the student’s welfare. The statutes indicate that both professional and practical nursing include, but are not limited to, the performance of acts or functions that are delegated to the nurse by another health care professional. However, only the registered nurse (RN) has the direct statutory authority to delegate to others, and the unlicensed assistive personnel (UAP) may carry out only those nursing acts or functions that have been delegated by an RN.
3. Is every school system required to employ a school nurse?
No. Minnesota Statutes § 121A.21 specifies that all schools need to provide services to promote the health of their students. Minnesota Statutes § 121A.21 states that school districts “with 1,000 pupils or more in average daily membership in early childhood family education, preschool handicapped, elementary, and secondary programs” are required to have a school nurse.
4. Does a school board have to approve a policy regarding medication administration?
Yes; Minnesota Statute 121A.22, subd. 4, specifies that drugs and medicine must be administered according to the directions on the label and, to the extent possible, in accordance with policies and rules of local boards of education and developed with health expertise.
5. May a school district apply for a variance from the requirements of the Nurse Practice Act?
No. School districts should examine existing policies, procedures, and practices to ensure compliance with the Nurse Practice Act. Questions regarding compliance with the act can be directed to the Minnesota State Board of Nursing.
6. Can parents/legal guardians authorize school personnel to give medications to their child?
Yes. According to Minnesota Statutes § 121A.22, subd. 1, school personnel can administer prescription drugs or medicine to a child at the request of the parent. The request can be either oral or in writing, but an oral request must be reduced to writing within two school days.
7. Is it permissible for parents to come to school to give medication?
Yes, but only for their child. However, parents cannot be required to come to school to perform the child’s procedure.
8. Can an LSN/RN provide OTC medication to students upon a parent’s request, according to labeling but without a prescriber’s authorization?
Yes, according to the Minnesota Attorney General’s Office (copy can be requested from email@example.com). It is important to note, however, that the school nurse has the ultimate authority and responsibility to reject a parent’s request and to decline to administer an OTC medication if the nurse believes that such medication is unnecessary, inappropriate, or could lead to patient harm. Alternatively, the school nurse and/or school policy could require a physician’s order to administer the OTC medication.
9. Can parents train school staff on medications related to their child’s specific diagnosis (e.g., diabetes, epilepsy, asthma, or allergies)?
Parents/legal guardians can be a great source of knowledge regarding their individual child’s health condition and when the student needs and how the student takes his or her own medications. Parents/legal guardians have received information and education when their child was diagnosed and prescribed the medication; they live with and provide for the child at home; and they might have attended workshops or belong to advocacy organizations. It is appropriate for the schools to listen to and utilize parents’ knowledge to help accommodate their child in the school setting.
10. Can a teaching assistant or secretary administer medication?
Yes. A secretary or other school personnel can administer medication or assist a child in the self-administration of medication when an LSN/RN has delegated medication administration to that person and guidelines are followed, including receipt of oral or written permission from a parent/legal guardian. A parent permission form should include the student name, date, medication name, amount, and instructions on dose, route, and when to take the medication (see sample form in appendices). If the school has no nurse on staff, school policies and sound medical procedures must be developed to comply with Minnesota Statutes § 121A.22, subd. 4. See #1 Legal Considerations 1.2 School District Policies for details.
11. Can a teacher or other personnel administer epinephrine in an emergency if a child has an allergic reaction to a bee sting?
Yes, with or without delegation and with appropriate training and supervision. Minnesota Statutes § 144.344 allows health services “to be rendered to minors of any age without the consent of a parent or legal guardian when, in the professional’s judgment, the risk to the minor’s life or health is of such a nature that treatment should be given without delay and the requirement of consent would result in delay or denial of treatment.”
12. What is the principal’s role in medication administration?
The principal’s responsibility is to assist the school board with development of the health policy according to Minnesota Statutes § 121.A22, subd. 4; hire appropriate staff members; and supervise the policy’s implementation in the school, ensuring the safety of students.
13. How do you determine if a child is competent to self-administer medications?
Things to be considered include a physician’s evaluation and/or nursing assessment, parental authorization, and the student’s physical and mental development and age.
To assist in determining if a student is competent to self-administer medication, it might be useful to list criteria in Minnesota Rules 9505.0335, subp. 1(A): “Capable of directing his or her own care” refers to a recipient’s functional impairment status as determined by the recipient’s ability to communicate: (1) orientation to person, place, and time; (2) an understanding of the recipient’s plan of care, including medications and medication schedule; (3) needs; and (4) an understanding of safety issues, including how to access emergency assistance.
14. Is training required for persons assisting with self-administration of medications?
Yes; training must be considered when a registered nurse delegates such assistance. Training is an essential part of delegation. Training ensures consistent and safe care of students. It is recommended that back-up personnel be trained at each school site. Training must be provided for school personnel who administer emergency medications such as rescue inhalers, Diastat™, Epi-pen™, and Glucagon™.
15. Must the delegating nurse provide all the training of the UAP?
No. Some educational institutions and community colleges provide in-service or orientation programs that include the information and skills training needed to perform medication administration. The delegating nurse should ensure the competency of the individual trained; documentation of training and competencies should be in the delegatee’s personnel file.
16. Can a student who has diabetes perform his/her own glucose monitoring and insulin administration, either by syringe or pump?
Yes. If not done by the student, it may be performed by an LSN/RN or delegated to others who are trained to assist in the procedure. Consider the development of an IHP to better communicate actions and expectations.
17. As an LSN/RN, am I accountable for the acts of a UAP when I delegate medication administration to that individual?
Delegation standards require LSNs/RNs, in keeping with their nursing scope of practice, to assess the student, determine the care needs of the student, determine whether the particular function is appropriate to delegate, determine whether the trained UAP has the skills needed to safely perform the task, and determine whether the appropriate supervision is available.
The trained UAP is responsible for performing the activity according to the directions of the LSN/RN. If the UAP deviates from proper procedure and it is determined that the LSN/RN has appropriately delegated and trained the medication administration activity, the LSN/RN has fulfilled the duties of proper delegation.
18. May an LPN supervise or direct the nursing practice of LSNs/RNs?
No. Supervision of nursing personnel is not within the legal scope of practice of the LPN.
19. Can an LPN delegate medication administration to a UAP?
Delegation is not within the LPN’s scope of practice.
20. Must medication administration be re-delegated each day?
No. When medication administration is delegated, the LSN/RN should periodically assure the medication administration delegated is completed as directed.
21. Why is so much documentation required?
Documentation can be critical evidence in the event the delegation or delegated services are challenged legally. Appropriate documentation serves as additional protection for the delegating nurse, the UAP, and the student receiving the medication.
22. When the health records of students do not impact the students’ education or academic performance, does being a member of the school staff automatically qualify as “a legitimate need to know”?
No. The FERPA regulations say student records may be released to school officials “whom the agency or institution has determined to have legitimate educational interests.” See 34 C.F.R. § 99.31 (2004). Not all school staff will have “legitimate education interests” in the information. The school district must set policy on release of information, within the limits of the FERPA regulations.
23. Can the task of medication administration by gastrostomy-tube, insulin pump, or injection be delegated?
Yes, by delegation from an LSN/RN and the student’s 504 plan, IEP, or IHP. The LSN/RN will train and supervise the person to whom the medication administration is delegated. If the school has no nurse on staff, school policies and sound medical procedures must be developed in adherence to Minnesota Statutes § 121A.22, subd. 4.
24. Can a volunteer administer medication on a field trip?
Yes. Each school district should have a set of policies on medication administration that can be followed on school-sponsored field trips.
One option is to take the medication in its original container and put it in a small, zip-lock bag along with a copy of the prescriber’s orders and a copy of the parent authorization form. Send that package with the person who is delegated or designated to administer medications on the field trip. The school district should establish a document and process for check-in and check-out of medications for field trips.
A second option is that the parent/legal guardian provide the required amount of medication (depending on the length of the trip) in a separate container with an original label (i.e., an extra from the provider or pharmacist), with a copy of the prescriber’s orders and a copy of the parental authorization form specific to the event or trip. This may be useful for any trips that exceed one day in length.
A third option is that the policies may allow the preparation of a supply of medications by the LSN/RN or parent/legal guardian, not to exceed the duration of the trip, in paper envelopes or other more suitable containers for use by a student temporarily off-campus. A container may hold only one medication. A label on the container must include the date, the student’s name, the school, the name of the medication, its strength, dose, and time of administration, pharmacy, pharmacy phone number, prescription number, and the initials of the person preparing the medication and label. Accompanying the envelope will be a copy of the prescriber’s orders and the parental authorization form. Note that the additional steps involved in transferring medication to an envelope present another opportunity for medication error.
Some schools provide a designated volunteer with appropriate health information on students requiring medication administration, medication in properly labeled bottles, and forms on which to document medication administration. The school should provide a job description for the medication administration volunteer, make sure the volunteer has the education and training necessary to safely administer the medication, verify and document his or her competencies, and provide procedures for how medication administration is handled on field trips. The volunteer needs to follow the procedures.
When a volunteer is used, parents must be informed and sign a health data privacy release form. Some experts (Schwab, 2001) recommend the volunteer be paid, even nominally, as a school employee, perhaps as a substitute. In so doing, the volunteer becomes a school employee and is bound by policies on medication administration including documentation and data practices.
Although parents can accompany students on field trips, it is not a requirement for students with medication needs. Staff designated the responsibility for medication administration should be trained and accompany the student and ensure that all the medical supplies are brought along and appropriate documentation is completed.
The plan for coverage and care during extracurricular activities sponsored by the school that take place outside of school hours should be carefully set out in the student’s health/education plan (504, ECP, IEP, or IHP).
25. Does the school district medication administration policy apply to summer school?
Yes, unless the school district has a separate policy specific to summer-school activity.
26. Are schools and school systems required to make reasonable accommodations for students who require medication administration during on-site sporting activities?
Yes. Federal law requires student accommodation.