Minnesota Guidelines for Medication Administration in Schools - May 2005

(Updated: September 2005)

Maternal and Child Health Section graphic of an outline of a parent with a child in the middle of the outline of Minnesota.



Support from the Literature with Selected Annotations for the Minnesota Medication Administration Guidelines for Schools.

MacArthur, C. (1996). Children, insulin pens and self-injection at school. Professional Care of Mother & Child. 6, 6:158-160.

MacLeod, B.A., Seaberg, D. C., & Paris, P.M. (February 1990). Prehospital Therapy Past,
Present, and Future. Emergency Medical clinics of North America, 8, 1: 57-74.

Madden, J. (2000). Managing asthma at school. Educational Leadership, 57, 50-52.

Magruder, L. (2001). Asthma inhalers in the classroom, or not? Journal of Law and Education, 30, 171-79.

This article examined which and how major national laws––the Individuals with Disabilities Education Act (IDEA), Section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act (ADA)––affect use of asthma medications in schools. The author concluded with brief recommendations for schools and for parents.

Maine Department of Education & Maine Department of Human Services. (2000). Coordinating school health programs: A guide for Maine schools. Augusta: Maine Department of Education & Maine Department of Human Services.

Maine School Health Advisory Committee. (1999). School health manual: School physicians. Retrieved May 17, 2004, from http://www.state.me.us/education/sh/school%20physicians.htm.

Marx, E., Wooley, S., & Northrop, D. (1998). Health is academic: A guide to coordinated school health programs. New York: Teachers College Press.

Mann, R. (August 15, 2000). Vitamins, Minerals & Herbs. Cub Pharmacy. Presentation at East Lake Community Library. Minneapolis, MN.

This article is a five-page list of vitamins, minerals, and herbs with indications for use and cautions. This would serve as a quick reference guide only, since it lacked detail, failed to describe side effects or frequency of use, and did not offer sources of the information presented.

Mann, R. (10-3-2000). Over the Counter, Buyer Beware! Cub Pharmacy. Presentation at East Lake Community Library. Minneapolis, MN.

Manthei, G. (1999). Asthma self management in Wisconsin schools. Journal of the Pharmacy Society of Wisconsin, 2, 26-32.

Marks, A. (2000). Schoolyard hustlers' new drug: Ritalin. Christian Science Monitor.

This article reported the increasing illicit use of Ritalin throughout the country. In some schools, Ritalin was being stolen and then used in large quantities to achieve a high similar to that of substances such as cocaine. It highlighted the debate among professionals whether prescription drug use leads to illegal drug use and abuse. Rep. Henry Hyde of Illinois suggested that there should be legislation that would provide guidelines for handling of prescription drugs on school grounds. Gretchen Feussner, a Ritalin expert for the Drug Enforcement Administration, stated, “The concern is that once the medication is given to children, it’s actually taken by the individual that it’s prescribed for . . . and once it’s in school, it should be secured in a place other than in a drawer or a teacher’s desk.”

Marshik, P., Borrego, M., Baldonado, E., Baur, K., Cipa, G., & George, L. (2001). New Mexico public school practices regarding use and administration of asthma medications. Pediatric Asthma, Allergy & Immunology, 1, 31-41.

This article reported on a study of New Mexico schools and their medication practices related to asthma. A 15-question survey was used to collect data from a random sample of schools. Recommendations for improvement in asthma care in public schools included the implementation of a statewide policy providing guidelines for asthma management and medication administration.

Massachusetts Department of Public Health. (n.d.). Appendix L: State medication administration regulations and school district medication policy. Boston: Massachusetts Department of Public Health.

Massachusetts Department of Public Health. (n.d.). State medication administration regulations and school district mediation policy, 105 CMR 210.000: MGL c. 94c, 7(g); c 71, 54B. Boston: Massachusetts Department of Public Health.

Massachusetts Emergency Medical Services. (n.d.). 5.2 Pediatric anaphylaxis. Retrieved September 7, 1999, from http://www.moondragon.org/ems/pedianaphylaxis.html.

Massachusetts school nurse organization legislative news. (2002). Retrieved June 12, 2002, from http://msno.org/laws.html.

Maryland Board of Nursing. (n.d.). Over-the-counter products. Retrieved August 22, 2002, from http://www.mbon.org/main.php?v=norm&p=0&c=practice/over_the_counter.html.

Maryland Board of Nursing. (2002). Fact sheet: Medication administration training program required for registration as a medication assistant. Baltimore: Maryland Board of Nursing.

Maryland Board of Nursing. (2001). Medication assistant registry. Baltimore: Maryland Board of Nursing.

Maryland Board of Nursing. (1999). Fact sheet: Complementary/alternative/holistic/ integrated therapies. Baltimore: Maryland Board of Nursing. Updated February 23, 2001.

Maryland Board of Nursing. (1991). Declaratory ruling 91-2: School health nurse, registered nurse, supervision and monitoring of unlicensed personnel in the performance of tracheotomy suctioning and tracheostomy tube change/replacement procedures. Baltimore. Maryland Board of Nursing.

Maryland Board of Nursing. (1990). Guidelines, role and responsibilities of the school nurse (registered nurse) and the child with special health needs. Baltimore: Maryland Board of Nursing.

Maryland RN standards of practice, standards of Care, draft. (n.d.). Baltimore: Maryland Department of Education.

Maryland state school health services guideline: Medication assistant training for school health staff. (n.d.). Baltimore: Maryland State Board of Nursing.

Maryland State Guidelines: Management of the Needs of the Oxygen Dependent Student. (June
2002). Maryland State Department of Education, Maryland Department of Health and
Mental Hygiene and Maryland State School Health Council.

Maurer, D. (November 30, 2000). More children, more health concerns, more school medication errors. University of Iowa Health Center. The Journal of School Health, November 2000.

This press release announced the results of a University of Iowa (UI) study. Nearly half of the school nurses surveyed reported medication errors in their schools in one year. The most common error was a missed dose. Three quarters of the nurses reported that unlicensed personnel such as school secretaries, health aides, and teachers dispensed medications to students in their school systems. Led by an associate professor of nursing at the UI, the study used surveys of 649 school nurses throughout the United States.

McCarthy, A., Kelly, M., & Reed, D. (2000). Medication administration practices of school nurses. Journal of School Health, 70, 371-6.

This study showed school nurses were concerned that medication administration guidelines were inadequate to address all issues encountered, especially delegation, medication errors, and practice guidelines.

McDowell, V. (2002). Schools in Affton alter policy on medications; students prohibited from carrying drugs, parents must deliver them. St. Louis Post-Dispatch.

Affton School District’s new regulations on handling of prescription and over-the-counter drugs required that parents bring medications to school during regular school hours or mail prescriptions to the school. Over-the-counter medications could be brought to school by students and then immediately delivered to a nurse. If parents did not comply, it was not the student who would be disciplined, but the parents would be called.

McGhan, S., Reutter, L., Hessel, P., Melvin, D., & Wilson, D. (March-April 2002). Developing A School Asthma Policy. Public Health Nursing. 19, 2: 112-123.

Meckler, L. (2003, January 17). More young people abusing prescription drugs, report says. Associated Press.

This article provided statistics on the growing problem of teenagers and young adults abusing prescription drugs. It highlighted an education and awareness program being undertaken by the NHS and the Food and Drug Administration. Estimates were that 3 million young people (12-17 years old) had used prescription medicines for non-medical reasons at least once in 20001.
Medication administration. (n.d.). Salem: Oregon Department of Education.

Medication Administration in Missouri Schools Recommended Policies and Procedures. (1996). Jefferson City, Missouri: Missouri Department of Health.

Medication administration in the school setting: Guidelines. (2003). Denver: Colorado Department of Education.

Medication and Vaccine Administration Policy. (February 2002). Wyoming Department of Health.

A medication error trifecta! (2004). Nurse Advise – ERR, 2(8).

Medication Errors. (November 119, 2002). U.S. Food and Drug Administration, Center for Drug Evaluation and Research. Retrieved November 20, 2002, from http://www.fda.gov/cder/drug/MedErrors/default.htm.

Medications in school. (2000). Retrieved December 6, 2004, from http://www.state.me.us/education/sh/medications.htm.

Medications: Using Them Safely. (2002). KidsHealth. Retrieved November 25, 2002, from http://www.kidshealth.org/parent/firstaid_safe/home/medication_safety.html.

Medicines in Schools. Implementing Good Practice in Mainstream Schools – A Guide for Pharmacists. (1997). Pharmaceutical journal. 258: 69-72.

Meng, A. (March 2000). A School-Based Asthma Clinic: A Partnership Model for Managing Childhood Asthma. Nurse Practitioner Forum. 11, 1: 38-47.

Michigan Department of Education & State Board of Education. (2002). School nurse certification rules. Retrieved August 19, 2002, from http://www.michigan.gov/mde/1,1607,7-140-5234_5683_14796-33246--,00.html.

Michigan school health services report. (1998). Lansing: Michigan Department of Education.

Michigan Revised School Code 380.1178. (2000). Retrieved August 19, 2002, from
http://www.nasbe.org/HealthySchools/States/Michigan.html.

Miele, M.F. & Schoessler, S.Z. (2002). Students with a Peanut Allergy Need Careful Monitoring. National PTA. Our Children, 28,3: 7.

Minneapolis Public Schools Health Related Services. Delegation of nursing care in Minneapolis Public Schools. Minneapolis, MN.

Roles and terms pertaining to delegation of selected nursing tasks in the school setting were defined. Guidelines were given to assist the licensed school nurse in making decisions about and implementing the delegation of tasks. The role of those delegated to, along with the rights and responsibilities they have, were reviewed.

Minnesota Bar Association. (2003). MSBA lawyer referral system, youth Minnesota legal connection. Minneapolis, MN: Author.

Minnesota Board of Nursing. (n.d.). Nurses and prescribing. Minneapolis: Minnesota Board of Nursing.

Minnesota Board of Nursing. (n.d.). Use of Protocols, Implementation of a protocol which results in a prescription: What should a nurse consider? Minneapolis: Minnesota Board of Nursing.

Minnesota Board of Nursing. (2003). Statement of accountability for utilization of integrative therapies in nursing practice. Minneapolis: Minnesota Board of Nursing.

Minnesota Board of Nursing. (1999). Nurse practice act. Minneapolis: Minnesota Board of Nursing.

Minnesota Board of Pharmacy. (October 19, 1995). Letter to Rost M. Jost, City of Bloomington, Minnesota.

Minnesota Department of Administration. (2000). School district general record retention schedule. St. Paul, MN: Author.

Minnesota Department of Administration. (1999). Model educational data sharing/access policy. Retrieved November 24, 2004, from http://www.ipad.state.mn.us/policy.html.

Minnesota Department of Health. (2004). Managing asthma in Minnesota schools. St. Paul: Minnesota Department of Health.

Minnesota Department of Health. (2004). Policy statement: Provision of medications for clients receiving services from an assisted living home care provider. St. Paul: Minnesota Department of Health.

Minnesota Department of Health. (2003). Access to health records: Notice of rights. St. Paul: Minnesota Department of Health.

Minnesota Department of Health Maternal and Child Health Section. (2002). Report to the Minnesota Legislature: Medications dispensed in schools study. St. Paul, MN: Author.

The report was requested by the Minnesota Legislature to look at school medication dispensing practices. The Minnesota Department of Health Commissioner gave three recommendations to the legislature: (1) design a statewide system for medication administration with one entity in charge, (2) convene a work group to provide input into development of a statewide system, and (3) provide the legislature with any needed changes to implement a safe medication administration system.

The report also discussed the work group convened to develop these recommendations, their principles, and information on school medication administration, nurse practice, and state statutes. Among other documents in this packet were work group notes and principles, the Minnesota Nurse Practice Act, and a letter from the State Attorney General’s Office about non-prescription medications.

The need for standards and guidelines is to keep children safe.

Minnesota Department of Health. (2005). Support from the Literature with Selected Annotations for the Minnesota Medication Administration Guidelines for Schools. Retrieved from /divs/fh/mch/schoolhealth/medadmin/annotated.html.

Minnesota Department of Health & Minnesota Department of Children, Families and Learning. (1996). Nursing practice in the school setting: Minnesota school health guide. St. Paul: Minnesota Department of Health & Minnesota Department of Children, Families and Learning.

Minnesota Department of Health. (1992). Delegation, monitoring and supervision related to school health services. St. Paul: Minnesota Department of Health.

Minnesota Legislature. (2002). Minnesota Statutes 2002, Table of Contents (121A). St. Paul: Office of the Revisor.

This addresses three Minnesota statutes pertinent to health care in schools. 121A.21 states that all schools with more than 1,000 students must have a nurse or public/private health organization coverage at the level of 1 FTE. 121A.221 addresses the use of asthma inhalers in schools. 121A.22 focuses on administration of drugs and medicines in schools, including exclusions and labeling requirements.

Minnesota Medical Association. (2002). Management of physician office medical records. Minneapolis: Minnesota Medical Association.

Minnesota Nurses Association (2001). Position Statement: Role of the registered nurse in safe administration of medications. St. Paul: Minnesota Nurses Association.

This statement is exactly about what its title is––the role of the registered nurse in safe administration of medications.

Minnesota Nurses Association. (1997). Position paper: Delegation and supervision of nursing activities. St. Paul: Minnesota Nurses Association.

Minnesota Nurses Association. (1992). Report of the Minnesota nurses association task force on assistive personnel. St. Paul: Minnesota Nurses Association.

The Minnesota Nurses Association’s Task Force on Assistive Personnel was established in April 1990. The issues addressed by this group included: the proliferation of assistive personnel (resulting in a decrease in the quality of patient care); the confusion about roles, proper delegation by registered nurses, and supervision of assistive personnel; and the registered nurse’s accountability under the law for the actions of the assistants.

Minnesota Office of the Attorney General. (February 14, 2000). Letter to R. Christofferson, Supperintendent, Minnesota ISD # 390 Re: Authority of School Nurses to Provide Non-Prescription Medications. AG:357648, v 01.

Minnesota Rules 6800.6500, Consulting Services to Licensed Nursing Homes. (2003). Retrieved July 26, 2004, from http://www.revisor.leg.state.mn.us/arule/6800/6500.html.

Minnesota Statutes 121A.21, 121A.22, 121A.2205, 121A.221. (2004). Retrieved from http://www.revisor.leg.state.mn.us/stats/121A/21.html.

MSBA/MASA Model Policy 516. (2004). St Peter: Minnesota School Board Association.

Mississippi Board of Nursing rules and regulations. (2004). Retrieved August 8, 2004, from
http://www.msbn.state.ms.us/pdf/RulesRegs.pdf.

Missouri Department of Elementary and Secondary Education. (2003). Self-carry guidance. Jefferson City: Missouri Department of Elementary and Secondary Education.

Missouri Department of Elementary and Secondary Education. (n.d.). Title 5 – Department of elementary and secondary education. Retrieved June 25, 2002, from http://www.dese.state.mo.us/schoollaw/rulesregs/6090010.htm.

Missouri Department of Health. (n.d.). School Health Manual. Retrieved from http://www.dese.state.mo.us/divimprove/curriculum/hp/manualshlhealth/manualindex.html.

Missouri Revised Statutes Chapter 335, Nurses Section 335.016. (2001). Retrieved August 15, 2002, from http://www.moga.mo.gov/statutes/C300-399/3350000016.HTM.

Missouri Revised Statutes Chapter 335, Nurses Section 335.017. (2001). Retrieved August 15, 2002, from http://www.moga.mo.gov/statutes/C300-399/3350000017.HTM.

Missouri Revised Statutes Chapter 516, Statute of Limitation Section 516.105. (2001). Retrieved August 15, 2002, from http://www.moga.mo.gov/statutes/C500-599/5160000105.HTM.

Missouri State Board of Nursing. (n.d.). Position statement: Utilization of unlicensed health care personnel. Retrieved August 15, 200, from http://pr.mo.gov/nursing-focus-position.asp.

Missouri Task Force on Misuse, Abuse and Diversion of Prescription Drugs. (2001). A guide to prescribing, administering, and dispensing controlled substances in Missouri. Jefferson City: Bureau of Narcotics and Dangerous Drugs.

Mitchell, A. (2001). Challenges in pediatric pharmacotherapy: Minimizing medication errors. Medscape Pharmacists, 2.

Administration of medication to children has many challenges, such as the inability to implement existing Food and Drug Administration (FDA) rules or requirements, the wide variety of sizes and weights in children, the insufficient ability or capacity of children to metabolize drugs as adequately as adults do, prescribing errors by prescribers, dispensing errors, and administrative errors. These challenges are complex. Some solutions lead to different types of challenges. The solutions should address the unique needs of each child.

Model procedures for the education of children with disabilities: Index version. (2003). Retrieved July 26, 2004, from http://www.neoserrc.k12.oh.us/IndexVersion.pdf.

Mofenson, H.C., McFee, R., Caraccio, & T., Greenssber J. (November 1998). Letters:
Combined antipyretic therapy: Another source of chronic acetaminophen toxicity. The
Journal of Pediatrics. 133
,5: 712-713.

Moore, V. (January/February 2000). School-Based Asthma Management Policies and Practices: A Regional Survey. Journal for Healthcare Quality. 22, 1: 10-16.

Montana Board of Nursing. (2004). Typical practice statements made by the BON office. Retrieved July 26, 2004, from http://www.discoveringmontana.com/dli/bsd/license/bsd_boards/nur_board/pdf/practice_statements.pdf.

Montana Code Annotated 2003: 2-15-1734. (2003). Retrieved July 26, 2004, from http://data.opi.state.mt.us/bills/mca/2/15/2-15-1734.htm.

Montana Code Annotated 2003: 20-3-324. (2003). Retrieved July 26, 2004, from
http://data.opi.state.mt.us/bills/mca/20/3/20-3-324.htm.

Montana Code Annotated 2003: 37-8-102. (2003). Retrieved July 26, 2004, from http://data.opi.state.mt.us/bills/mca/37/8/37-8-102.htm.

Montana Code Annotated 2003: 39-31-103. (2003). Retrieved July 26, 2004, from http://data.opi.state.mt.us/bills/mca/39/31/39-31-103.htm.

Montana Code Annotated 2003: 39-71-116. (2003). Retrieved July 26, 2004, from http://data.opi.state.mt.us/bills/mca/39/71/39-71-116.htm.

Moore, V. (2000). School-based asthma management policies and practices: A regional survey.
Journal for Healthcare Quality 22, 10-16.

This article reported on a study involving 29 school districts representing 679,631 students. The study’s questions were about school health personnel, identification and monitoring of students with asthma, staff training, self-carry policies, and smoking-on-campus policies. Key findings were more positive than expected.

Morris A. J. (September 1996). Complementary medicine and allergy – an evaluation of the facts. Current Allergy and Clinical Immunology. Retrieved September 4, 2002, from http://zingsolutions.com/ALLSA/alternative.htm.

Muirhead, G. (1999). Herbal medicines you can recommend with confidence. Patient Care, 76-94.

Munoz-Furlong, A. (September 1999). A principal's guide to children's allergies. National Association Elementary School Principals (NAESP) - Principal Magazine. Retrieved from http://www.naesp.org.comm.p00999a.htm.

This article reviewed the types of major allergies affecting children, including allergic rhinitis, asthma, atopic dermatitis, food allergies, and anaphylactic shock. It gives a review of each with common treatments. The role of the principal was to be familiar with allergies and treatments and to work with the parent and physician to determine the best management system. They should also keep parents and physicians informed if medication appears to be interfering with learning. It suggested interventions such as no furry classroom pets, no food trading, and caution on field trips to reduce allergy triggers. It also cautioned about allergy harassment from other students. Clear physician instructions for medication administration in schools was recommended, and the Asthma and Allergy Foundations could provide individualized Student Action Cards for this purpose. The Food Allergy Network had the same for food allergies. Both need review each year and distribution to all teachers of the student with allergies.

Musser, C., Ahmann, P., Theye, F., Mundt, P., Broste, S., & Mueller-Rizner, N. (1998). Stimulant use and the potential for abuse in Wisconsin as reported by school administrators and longitudinally followed children. Journal of Developmental and Behavioral Pediatrics, 19, 187-92.

This summarized results of a 1996 Wisconsin-based survey of school administrators regarding attention deficit hyperactivity disorder (ADHD) medication awareness and potential for abuse and their pertinent school policies and procedures. Also included were results from a small student survey of ADHD medications users in some schools regarding self-reported use, abuse, and storage practices. Data suggested little, if any, evidence of ADHD medication abuse, but did suggest that potential access to ADHD medications existed due to insecure storage methods and wide variations in school distributions methods.

 

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