Guidelines for Medication Administration in Schools

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Glossary

The following definitions are pertinent to medication administration in schools and specific to the contents of this document. These terms might be defined differently in other situations.

Administration, to administer: Accepted nursing practice holds that “to administer” medication in schools means to select the right student, right time, right medicine, right dose, right route, and right documentation.

Complementary and alternative medicines/practices (CAMs): A broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historic period.

Minnesota Statutes § 146A.01, subd. 4(a), states that, “ ‘Complementary and alternative health care practices’ means the broad domain of complementary and alternative healing methods and treatments, including but not limited to: (1) acupressure; (2) anthroposophy; (3) aroma therapy; (4) ayurveda; (5) cranial sacral therapy; (6) culturally traditional healing practices; (7) detoxification practices and therapies; (8) energetic healing; (9) polarity therapy; (10) folk practices; (11) healing practices utilizing food, food supplements, nutrients, and the physical forces of heat, cold, water, touch, and light; (12) Gerson therapy and colostrum therapy; (13) healing touch; (14) herbology or herbalism; (15) homeopathy; (16) nondiagnostic iridology; (17) body work, massage, and massage therapy; (18) meditation; (19) mind-body healing practices; (20) naturopathy; (21) noninvasive instrumentalities; and (22) traditional Oriental practices, such as Qi Gong energy healing.”

Controlled substance or controlled drug: Centrally acting medication, such as stimulants and depressants, including narcotics and some sedatives, as designated by the Drug Enforcement Administration of the Department of Justice.

Delegation: According to the National Council of State Boards of Nursing, 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.” In the opinion of the nurse, the delegated tasks can be properly and safely performed by the person without jeopardizing the student’s welfare.

Drug: Per Minnesota Statutes § 151.01, subd. 5, drugs are “all medicinal substances and preparations recognized by the United States Pharmacopoeia and National Formulary, or any revision thereof, and all substances and preparations intended for external and internal use in the diagnosis, cure, mitigation, treatment, or prevention of disease in humans or other animals, and all substances and preparations, other than food, intended to affect the structure or any function of the bodies of humans or other animals.”

Emergency: A serious situation that arises suddenly and threatens the life, limb, or welfare of one or more persons; a crisis.

Emergency medications: Those medications that don’t have a regular administration schedule but are to be administered when the student displays a set of symptoms or a certain response that requires immediate intervention to maintain his or her safety.

Guideline: A statement of advice or instruction pertaining to practice. It originates in an organization with acknowledged professional standing. A guideline is developed in response to a stated request or perceived need for advice or instruction.

Health/education plans

Emergency care plan (ECP) or emergency information form for children with special health care needs (EIF): An ECP or EIF includes specific information about a child’s medical condition and history, current and emergency medications, and appropriate emergency intervention. When an emergency occurs, school nurses, school personnel, and emergency care providers have the information needed to provide appropriate care to the child without delay. The ECP or EIF may be a part of an IEP or IHP.

504 plan (Section 504 of the Rehabilitation Act of 1973):
A 504 plan describes:

  1. the disabling condition,
  2. the major life function affected by the condition in the school setting,
  3. how the major life activity within the school setting is limited, and
  4. the services to be provided by the school district to meet the need(s) identified (e.g., ADHD – difficulty learning, staying on task, paying attention).
Service provided by the school district will include a medication administration and monitoring program.

Individualized education plan (IEP): Based on Public Law 94-142 (PDF: 4MB/24 pages), passed in 1975 and ultimately renamed the Individuals with Disabilities Education Act (IDEA) in 1990, a service plan developed at the onset of special education services by a multidisciplinary team that addresses the child’s unique needs, including learning strengths and weaknesses, special education and support services required and projected educational goals (Illinois Department of Human Services and Illinois State Board of Education, 2000). In Minnesota, we also use the Individual Family Service Plan (IFSP) for children up to two years old, and the Individual Interagency Intervention Plan (IIIP) for children requiring services from two or more state agencies. When a student has a health problem that requires the administration of medication or treatment during the school day, the IEP may contain a health care plan for the student. The IEP serves as a written contract describing what services the school district will provide for the student.

Individualized health plan (IHP): A plan written to meet the education-related health needs of a student. The plan includes information about the primary medical provider, history and current status of the health concern, planned accommodations and health procedures to be done at school, steps to follow in the event of an emergency, and who is responsible for care at school. Another student-specific health plan is the Behavior Intervention Plan (BIP).

Investigational drug: A drug that is not yet approved for public distribution, but is being utilized in research trials with certain individuals who might benefit from such drugs. The drug’s positive and negative side effects may be unconfirmed; effects are closely monitored. In 21 C.F.R. 312.3 (b), the Food and Drug Administration defines investigational drug as “a new drug or biological drug that is used in clinical investigation.”

Legitimate educational interests: The Family Educational Rights and Privacy Act (FERPA) states that “school officials with legitimate educational interests” may be given access to personally identifiable information about students. Agencies or schools maintaining personally identifiable data about students should have written criteria for determining which school officials have a legitimate educational interest in specific education records because this must be included in the annual notification to parents, as specified in FERPA.

Licensed practical nurse (LPN): An individual licensed by the Minnesota Board of Nursing to practice practical nursing.

Practice of practical nursing: The definition according to the Minnesota Nurse Practice Act (Minnesota Statutes §§ 148.171-148.285) is “the performance for compensation or personal profit of any of those services in observing and caring for the ill, injured, or infirm, in applying counsel and procedure to safeguard life and health, in administering medication and treatment prescribed by a licensed health professional, which are commonly performed by licensed practical nurses and which require specialized knowledge and skill such as are taught or acquired in an approved school of practical nursing, but which do not require the specialized education, knowledge, and skill of a registered nurse.”

Licensed prescriber (practitioner): A physician or provider as defined in the Minnesota Pharmacy Law, (Minnesota Statutes § 151.01, subd. 23, as a “Practitioner.” “ ‘Practitioner’ means a licensed doctor of medicine, licensed doctor of osteopathy duly licensed to practice medicine, licensed doctor of dentistry, licensed doctor of optometry, licensed podiatrist, or licensed veterinarian. For purposes of: § 151.15, subdivision 4; § 151.37, subdivision 2, paragraph (b); and § 151.461; ‘practitioner’ also means a physician assistant authorized to prescribe, dispense, and administer under Chapter 147A, or an advanced practice nurse authorized to prescribe, dispense, and administer under § 148.235.”

Licensed school nurse (LSN): A bachelor’s degree prepared public health nurse with current licensure as an RN who is also licensed as a school nurse by the Minnesota Board of Teaching. Specifically, their rules (Minnesota Rules 8710.6100, subp. 2 (2003)) state: “A candidate for licensure as a school nurse shall:

(A) hold a baccalaureate degree in nursing from a regionally accredited college or university,

(B) be currently registered in Minnesota to practice as a licensed registered nurse under the Board of Nursing, and

(C) be currently registered in Minnesota as a public health nurse under the Board of Nursing.”

Medication: Both prescription and non–prescription drugs, including complementary and alternative medicines.

Medication error/incident: An irregularity involving medication, including omitting a medication, administering medication to the wrong student, administering an incorrect dose of medication, administering the wrong medication to a student, administering a medication at the wrong time, administering a medication by the wrong route, and either not documenting or documenting incorrectly.

Medication record: The individual medication record or medicine log used to record the medication given to a student.

Monitoring: According to the Minnesota Nurse Practice Act, monitoring is the periodic inspection by an RN or LPN of a directed function or activity and includes watching during performance, checking, and tracking progress, updating a supervisor of progress or accomplishment by the person monitored, and contacting a supervisor as needed for direction and consultation.

Non-prescription drugs: Medications, including complementary and alternative medications that may be obtained over the counter without a prescription from a licensed prescriber.

Parent/legal guardian: An individual(s) who is (are) legally responsible for the care of a minor.

Policy: A framework for operational decisions, which specifies a recommended course or direction consistent with the intent of the organization. A policy is an understanding by members of a group that make the actions of each person more predictable.

Prescription: According to Minnesota Statutes § 151.01, subd. 16, a prescription is “a signed written order, or an oral order reduced to writing, given by a practitioner licensed to prescribe drugs for patients in the course of the practitioner’s practice, issued for an individual patient and containing the following: the date of issue, name and address of the patient, name and quantity of the drug prescribed, directions for use, and the name and address of the prescriber.”

Prescription drugs: Medication requiring a prescription.

PRN (as needed) orders: Orders by a licensed prescriber to administer a specific medication for a specific student under certain circumstances (e.g., an inhaler for an acute asthma episode).

Procedure: Specific steps outlining how to implement policy, a way of telling how to perform activities or tasks (e.g., who does what and when).

Registered nurse: An individual licensed by the Minnesota Board of Nursing to practice professional nursing.

Practice of professional nursing: According to Minnesota Statutes § 148.171, subd. 15, the practice of professional nursing means “the performance for compensation or personal profit of the professional interpersonal service of:

(1) providing a nursing assessment of the actual or potential health needs of individuals, families, or communities;

(2) providing nursing care supportive to or restorative of life by functions such as skilled administration of nursing care, supervising and teaching nursing personnel, health teaching and counseling, case finding, and referral to other health resources;

(3) evaluating these actions. The practice of professional nursing includes both independent nursing functions and delegated medical functions which may be performed in collaboration with other health team members, or may be delegated by the professional nurse to other nursing personnel. Independent nursing function may also be performed autonomously. The practice of professional nursing requires that level of special education, knowledge, and skill ordinarily expected of an individual who has completed an approved professional nursing education program as described in Minnesota Statutes § 148.211, subdivision 1.

Student self-administering medication: Student who is capable of and takes his or her own medication as directed and who may be supervised by an LSN/RN.

Supervision: According to Minnesota Statute 148.171 Subd 23,, ‘Supervision’ means the guidance by a registered nurse for the accomplishment of a function or activity. The guidance consists of the activities included in monitoring as well as establishing the initial direction, delegating, setting expectations, directing activities and courses of action, critical watching, overseeing, evaluating, and changing a course of action.

Unlicensed assistive personnel (UAPs): Individuals who are trained to function in an assistive role to an LSN/RN or to others in the provision of student medication administration activities.

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