Minnesota Guidelines for Medication Administration in Schools - May 2005
(Updated: September 2005)
Support from the Literature with Selected Annotations for the Minnesota Medication Administration Guidelines for Schools.
Abrunzo, T., Gerardi, M., Dietrich, A., Lampeli, M., Sanford, W., &
(2003). The role of emergency physicians in the care of the child in school. Annals of Emergency Medicine 35, 155-161.
At the time this was written, more than 10 million children lacked health care insurance. When they needed medical care they were twice as likely to seek care in an emergency room. Emergency physicians need to be involved in establishing health care programs in school. Schools may end up being the sites of both primary and emergency care. The article provided descriptions of the types of school emergencies possible and how to plan for them. Emergency room doctors are a vital resource to the school district in establishing appropriate school-based emergency response plans.
Accountability in our Schools. (2003) Alliance for Student Achievement.
Adelman, H., Taylor, L. (2003). Involving teachers in collaborative efforts
to better address the
barriers to student learning. Preventing School Failure 42, 55-60.
This article is about the work with collaborative effects between disciplines, including teachers, parents, students, and special educators. For a child to succeed in a public school setting requires a group effort.
Adelman, H. Taylor, L. (January 2003). A Resource Aid Packet on: Students and psychotropic medication: the school's role. Center for Mental Health in Schools at UCLA, Los Angeles, CA.
This resource provided an overview, guidelines, and tools related to a school’s role in administering and monitoring medications and educating school staff about medications, as well as the role of students on medication. Also included in this resource was information on major medications and their side effects, particularly those medications prescribed for students with ADHD, CD, anxiety, and depression. The final section outlined additional resources related to students. Included in the appendix was a copy of sample policies and procedures from the state of Maine.
Administering medicines in schools. (1999). Newcastle: Catholic Schools Office, Diocese of Maitland-Newcastle.
The administration of medication: Oral medication. (2002). Retrieved June 20, 2002, from http://www.education.tas.gov.au/equitystandards/drug-ed/tasguide/attach8.htm.
Administrative rules of Montana. (n.d.). Retrieved July 26, 2004, from http://arm.sos.state.mt.us/8/8-1025.htm.
Agency for Healthcare Research and Quality. (September 2002). Patient fact sheet. AHRQ pub no. 02-P034. www.ahrq.gov.
Agency for Healthcare Research and Quality. (January 6, 2003). Avoid
medial mistakes in kids.
Agency for Healthcare Research and Quality. (September 2002). What are medical errors? Patient fact sheet: 20 Tips to Help Prevent Medical Errors in Children. AHRQ Publication #02-P034, Rockville Maryland. www.ahrq.gov/consumer/20tipkid.htm.
Alabama Board of Nursing. (2001). Chapter 610-X-6: Standards of nursing practice. Montgomery: Alabama State Board of Nursing.
Alaska Board of Nursing. (1995). Position Statement: Regarding delegation by nurses of nursing tasks to unlicensed assistive staff of assisted living homes. Juneau: Alaska Board of Nursing.
Alaska Board of Nursing. (1993). Position Statement: Activities of unlicensed assistive personnel. Juneau: Alaska Board of Nursing.
Alaska Board of Nursing. (1983). Position Statement: Registered Nurse and Advanced Nurse Practitioner Scopes of Practice. Juneau: Alaska Board of Nursing.
Alaska Department of Education and Early Development . (n.d.). Standards
for Alaska’s schools.
Juneau: Alaska Department of Education and Early Development.
Allen, J. (2001, January 14). Guidelines for dispensing medication. Star Tribune.
These guidelines of the Office of School Health at the University of Colorado were released in 1990. They describe how medicine should be stored and dispensed and discuss parental involvement.
American Academy of Allergy Asthma & Immunology. (2000). Media Resources: Position statement 18 - the use of inhaled medications in school by students with Asthma. http://www.aaaai.org/media resources/position_statements/ps18.stm.
This is the American Academy of Allergy, Asthma and Immunology (AAAAI) policy statement on inhaled medications in schools. Among its recommendations for school policy are that students with asthma should have possession of their inhaled medication to facilitate timely treatment when it is needed. The statement discusses the role of school officials working with parents and physicians and the role of the student (should be sufficiently responsible and discreet in medication use), but does not directly discuss the licensed school nurse’s role.
American Academy of Allergy Asthma & Immunology. (2003). Media Resources: AAAAI Position Statement - The use of epinephrine in the treatment of Anaphylaxis.
This is a position paper for epinephrine from the American Academy of Allergy, Asthma and Immunology (AAAAI). The risk of not using epinephrine outweighs the risks. Statistics were given to support the above statement. The AAAAI stated that school personnel and health professionals should be educated.
American Academy of Allergy Asthma & Immunology. (September 2001). Topic of the Month: September 2001: Back to School with Food Allergies. Retrieved March 2, 2003, from http://www.aaaai.org/careermd/public/topicofthemonth/0901/default.stm.
American Academy of Allergy Asthma & Immunology. (1998). Media Resources: AAAAI Position statement - anaphylaxis in schools and other child-care settings. March 26, 2003, from http://www.aaaai.org/media/resources/position_statements/ps34.stm.
This article discussed anaphylaxis in school settings. It stressed the importance of appropriate people knowing about students’ allergies, avoidance of triggers, and prompt treatment with epinephrine.
American Academy of Family Physicians. (1996). Alternative medicine. Leawood: American Academy of Family Physicians.
American Academy of Pediatrics. (October 2001). Clinical Practice Guidelines: Treatment of the School-Aged Child with Attention-Deficit/Hyperactivity Disorder. Pediatrics.
American Academy of Pediatrics. (n.d.). Consulting with schools on health. Retrieved May 10, 2004, from http://www.schoolhealth.org/trnthtrn/section2/main2.html.
American Academy of Pediatrics. (2003). AAP releases guidelines for administration of medication in school. Health and Health Care in Schools, 4.
The article reviewed the policy statement made by the American Academy of Pediatrics (September 2003) regarding guidelines for children who take medications required during the school day. The statement was designed to guide prescribing physicians, school administrators, and health staff on administration of medication to students in school. The article addressed over-the-counter products, herbal medicines, experimental drugs, emergency medications, and principles of student safety. There were warnings for physicians about prescribing “as needed” medications and directions to school districts and administrators about adhering to federal, state, and district regulations and seeking legal advice when developing policy.
American Academy of Pediatrics. (2003). Herbal remedies and children: Are they safe, effective? Health and Health Care in Schools, 4.
American Academy of Pediatrics. (2003). Policy statement: Guidelines for the administration of medication in school. Pediatrics, 112(3), 697-699.
American Academy of Pediatrics. (2004). Medications - Taking Medicine Correctly. Retrieved January 23, 2005, from http://www.medem.com/pat/medlib_entry.cfm?article_ZZZYLAKE
This was written by the American Academy of Pediatrics for parents regarding how to correctly administer over-the-counter medication (OTCs) to children. The author noted that research indicated up to half of children who take medications did not take them correctly. The article addressed schedule, giving the right amount of medication, dosing OTCs by weight, taking the full course of medication, safety tips to prevent overdose poisoning, strategies for administering medication to a child, chewables vs. liquids, and discussing any questions, changes in how a child is feeling, and reactions with the child’s pediatrician.
American Academy of Pediatrics. (2003). Policy statement: Out-of-School
Expulsion. Pediatrics, 112, 5: 1200-1206.
American Academy of Pediatrics, American Public Health Association & National Resource Center for Health and Safety in Child Care. (2002). Caring for our children. Elk Grove Village, IL: Author.
American Academy of Pediatrics. (2001). The role of the school nurse in providing school health services. Pediatrics, 108(5), 1231-1232.
The authors described how school nurses are crucial to maintaining proper health care for all students. The nurse has an important role on a school health services team; providing acute, chronic, episodic, and emergency health care; meeting all qualifications set forth by the National Association of School Nurses; and providing mandated screening and immunization clinics, a process also for identification and resolution of students’ health care needs that affect educational achievement. Recommendations for professional preparation and staff development of school nurses were also made.
American Academy of Pediatrics. (2000). Health, mental health, and safety in schools. Retrieved May 10, 2004, from http://www.schoolhealth.org/hmhs.htm.
American Academy of Pediatrics Committee on School Health. Guidelines for the administration of medication in school. (1993). Pediatrics, 92, 499-500.
This three-page set of guidelines of the American Academy of Pediatrics (AAP) focused on school policy, physician-prescribed medications, parent- or self-prescribed medications, and security and storage of medication. Among the recommendations were that the school board and superintendent, in conjunction with other school personnel and in collaboration with the physician or medical advisory committee for each school or district, develop a policy for the administration of medication. School districts should seek the advice of counsel as they assume responsibility for giving medications during school hours. The AAP also recommends that all prescription and over-the-counter medication administration be well documented.
American Academy of Pediatrics, Committee on Pediatric Emergency Medicine. (1999). Emergency preparedness for children with special health care needs. Pediatrics 104, 53-58.
American Academy of Pediatrics & American College of Emergency Physicians. (2000). Emergency information form. Retrieved on November 30, 2004, from http://www.aap.org/advocacy/blankform.pdf.
American Association of Diabetes Educators. (1999). Position statement: Management of children with diabetes in the school setting. The Diabetes Educator, 25.
This position statement of the American Association of Diabetes Educators summarized forms of diabetes and discussed how diabetes can be controlled and the roles of students, parents, school personnel, and health care providers when monitoring and treating diabetes in the school setting.
American College of Emergency Physicians. (1998). Policy statement: Emergency information form for children with special health care needs. Dallas: American College of Emergency Physicians.
American Diabetes Association. (2003). Care of children with diabetes in the school and day care settings. Diabetes Care, Supplement I 26.
This article pointed out that, to control their blood sugars, students with diabetes are entitled to accommodations in school settings. Appropriate care is necessary for student safety, long-term well-being, and optimal academic performance.
American Diabetes Association. (2002). Diabetes and the school community. Health in Action.
Diabetes is a serous chronic disease and schools have the legal responsibility to provide students with a medically safe environment. Information was included on type 1 and type 2 diabetes and the role of the school and its personnel.
American Federation of Teachers. (5-1997). The medically fragile child in the school setting, 2nd edition. American Federation of Teachers Ad Hoc Committee on Health Care Responsibilities in Special Education, #451-a, Washington D.C.
The article looked at many issues relating to the medically fragile student in school, including: (1) legal issues, (2) Individuals with Disabilities Education Act (IDEA), (3) the role of personnel working with the child, (4) school records, (5) do-not-resuscitate (DNR) instructions, (6) non-supervising personnel, (7) health and safety issues, and (8) inclusion. No information about administration of medications was presented.
American Federation of Teachers Healthcare (1995). Policy statement: Statement on the use of unlicensed assistive personnel. Retrieved April 15, 2002, from http://www.sft.org/healthcare/policy/usaspers.html.
This article summarized the varied uses of both licensed school nurses and unlicensed assistants. According to the American Federation of Teachers (AFT), the best interest for schools, staff members, and parents is met by having separate duties for school nurse and assistants. Medication errors were more likely to occur when medications were administered by unlicensed personnel rather than school nurses. One major pressure was the financial burden on school districts to hire appropriately trained nurses.
American Federation of Teachers, Council for Exceptional Children, National Association of School Nurses, & National Education Association. (1990). Guidelines for the delineation of roles and responsibilities for the safe delivery of specialized health care in the educational setting - abridged.
This article offered guidelines for teachers, related service staff, and paraprofessionals regarding a wide range of medical procedures. There were only six states that had written guidelines for eight selected health care procedures in schools, so several organizations (AFT, CEC, NASN, and NEA) formed this task force and developed a chart to identify the responsibility level for each staff member and procedure.
American Federation of Teachers. (October 1995). Statement on the Use of Unlicensed Assistive Personnel. AFT Health Care, Policy Statements. Retrieved April 15, 2002, from http://www.aft.org/healthcare/policy/unaspers.html.
American Federation of Teachers. (2001). New Study Shows Medication Errors High Among School Nurses. AFT Health Care, School Nurse News. Retrieved June 17, 2002, from http://www.aft.org/healthcare/schoolnurses/news.html.
American Nurse’s Association. (2003). Code of Ethics for Nurses with Interpretive Statements. Washington DC: American Nurse’s Association.
American Nurse’s Association. (n.d.). National center for school health nursing excellence: Advancing excellence in school health nursing practice. Washington DC: American Nurse’s Association.
American Nurse’s Association (1997). Position statement: Registered nurse utilization of unlicensed assistive personnel. Washington, DC: American Nurse’s Association.
The position statement of the American Nurses Association (ANA) recognized the need for the unlicensed assistive personnel (UAPs) due to changing conditions. The concern was to maintain public safety and stay within the legal standards of the Nurse Practice Act. The purpose of the statement was to explain ANA’s standards with the use of UAPs in direct and indirect patient care under the direction of the registered nurse. The article also included definitions and standards.
American Nurse’s Association. (1992). Position statement on registered nurse utilization of unlicensed assistive personnel. Washington, DC: American Nurse’s Association.
American Nurse’s Association. (2004). Nursing Scope and Standards of Practice. Washington DC: American Nurse’s Association.
American Nurse’s Association. (2003). Nursing’s Social Policy Statement, 2nd edition. Washington DC: American Nurse’s Association.
American School Health Association. (2002). Diabetes is a chronic, manageable,
disease. Health in Action. www.ashaweb.org.
Anderson, M., Vu, C., Derby, K, Goris, M., & McLaughlin, T. (2002). Using Functional Analysis Procedures to Monitor Medication Effects in an Outpatient and School Setting. Psychology in the Schools. 39: 73-76.
Anderton, J. & Broady J. (October 27, 1999). Improving schools’ asthma policies and procedures. Nursing Standard. 14, 6:34-38.
Anthony, M., Casey, D., Chau, T., & Brennan, P. (November/December 2000). Congruence Between Registered Nurses’ and Unlicensed Assistive Personnel Perception of Nursing Practice. Nursing Economics. 18, 6.
Arent, S. (2003). Needed protection for students with diabetes. NASN Newsletter, 14-15.
This short 2003 commentary from the perspective of the American Diabetes Association (ADA) said that the needs of students with diabetes were often unmet. The ADA hears from families of students with diabetes who face real barriers to diabetes care at school. Stories include children being excluded from their neighborhood schools, parents quitting jobs to be available to provide diabetes care at school, high school students who must miss valuable class time to check blood glucose levels, and students who are not permitted to participate in field trips or extracurricular activities.
The ADA supports efforts to increase the number of school nurses and would like to see a full-time nurse in every school building. It sees a more fundamental problem, that the school nurse generally is not available for field trips or school-sponsored before and after school activities. The ADA stance is that adequate diabetes management at school cannot be accomplished without staff trained in proper diabetes care to supplement the school nurse.
Arizona Secretary of State. (1995). Arizona administrative code: Title 4. professions and occupations. Retrieved August 20, 2002, from http://www.azsos.gov/public_services/Title_04/4-19.htm.
Arizona State Board of Nursing. (1988). Advisory opinion: Medication, carrying by licensed nurses. Retrieved August 20, 2002, from http://www.azbn.org/documents/advisory_opinion/AO%20MEDICATIONS%20CARRYING%20BY%20RNs.pdf.
Arkansas Code ACA 6-18-704 School Nurse; 6-18-1005(a) Health Services. (n.d.). Little Rock: Arkansas Department of Education.
Arkansas Code ACA 20-13-401 Emergency Treatment Act. (n.d.). Little Rock: Arkansas Department of Health.
Arkansas Department of Education. (1996). Resource guide: Developing school policies on children with special health care needs. Little Rock: Arkansas Department of Education.
Arkansas State Board of Nursing. (n.d.). School nurse qualifications. Little Rock: Arkansas State Board of Nursing.
Arkansas State Board of Nursing. (n.d.). The practice of nursing. Little Rock: Arkansas State Board of Nursing.
Arkansas State Board of Nursing. (2001). Arkansas state board of nursing rules and regulations. Little Rock: Arkansas State Board of Nursing.
Arkansas State Board of Nursing. (2000). School nurse roles & responsibilities: Practice guidelines. Retrieved July 28, 2003, from http://www.arsbn.org/pdfs/schoolnurseguidelines.pdf.
Arkansas State Board of Nursing. (1999). Application of guidelines for decision making. Little Rock: Arkansas State Board of Nursing.
Arkansas State Board of Nursing (1999). Position statement 99-2: Delegated medical acts. Little Rock: Arkansas State Board of Nursing.
Arkansas State Board of Nursing. (1997). Position statement 97-2: Assistance with self medication for unlicensed persons. Little Rock: Arkansas State Board of Nursing.
Arkansas State Board of Nursing. (1996). Delegation model. Little Rock: Arkansas State Board of Nursing.
Arkansas State Board of Nursing & Arkansas School Nurses Association. (2000). School nurse roles & responsibilities practice guidelines. Retrieved August 20, 2002, from http://www.arsbn.org/pdfs/schoolnurseguidelines.pdf.
Arnold, M.J. & Silkworth, C.K. (ed.). (1999). Volume II. The School Nurse’s Source Book of Individualized Healthcare Plans. Issues and Applications in School Nursing Practice. Sunrise River Press. North Branch, MN.
Assessing Health Services Delivery for Children with Special Health Care Needs (CSHCN) in School. (Spring 1993). The Networks (A newsletter of the National MCH Center At Children’s Hospital) Special Edition. 4, 1: 1-5.
Assisting children with medications at school: A guide for school personnel, a videotape-training program and viewer’s guide. (1996). Denver: University of Colorado Health Sciences Center, School of Nursing.
Asthma Education: An Integrated Approach, Ideas for Elementary Classrooms. (1998). Project Accord, Minnesota Department of Health, St Paul, MN.
Awbrey, L. & Juarez, S. (2003). Developing a nursing protocol for over-the-counter medications in high school. The Journal of School Nursing, 19, 12-15.
The article was based on using the Nurse Practice Act of California and several other California Education Codes that are not detailed in this article. However, it did detail collaborative efforts required to implement changes in the way medications are managed in the school setting. The protocols developed were based on best practice standards for the health and safety of students. Standardized nursing protocol and over-the-counter medication protocols allow the school nurse to provide non-prescription medication for common complaints such as headaches and menstrual discomfort. Readers might disagree with the suggestion that schools provide a stock supply of medications.