516 Procedure: Student Medications

I.    PURPOSE

The purpose of these procedures is to set forth expectations that must be followed when managing and administering medications to students at school.

II.    DEFINITIONS

A. Controlled Substance: means any substance listed under Minnesota Statute § 152.02 as a “scheduled”              substance.

B. Over-the-counter medication (OTC): is a drug product marketed for use by the consumer without the intervention of a health care professional in order to obtain the drug.

C. Parent: means a parent, guardian, or other person having legal custody of the student. For students 18 years of age and older, the student may act as the parent, unless a court of competent jurisdiction has appointed a guardian to make health/medical decisions on behalf of the student. 

D. Prescription Medication: means a prescription drug order that is written or printed on paper, an oral order reduced to writing by a pharmacist, or an electronic order. To be valid, a prescription must be issued for an individual patient by a practitioner within the scope and usual course of the practitioner's practice, and must contain the date of issue, name and address of the patient, name and quantity of the drug prescribed, directions for use, the name and address of the practitioner, and a telephone number at which the practitioner can be reached. A prescription written or printed on paper that is given to the patient or an agent of the patient or that is transmitted by fax must contain the practitioner's manual signature. An electronic prescription must contain the practitioner's electronic signature. Prescription medication as used in these procedures does not include any form of medical cannabis as defined in Minnesota Statute.

E. School Health Personnel: includes LSNs, RNs, LPNs and UAPs (unlicensed assistive personnel who have been properly delegated a nursing function).  

 

III.      REQUIRED PROCEDURES FOR MEDICATION MANAGEMENT

The following procedures must be followed when managing and administering student medications at school:

A. Written Authorization: No prescription medication may be administered without the written order of a physician/licensed health care prescriber. The administration of prescription medication or drugs at school also requires a completed signed request from the student’s parent. An oral request from the parent must be reduced to writing within two school days, provided that the school health personnel may rely on an oral request until a written request is received. A “Medication Administration Authorization Form” must be completed annually (once per school year) and/or when a change in the prescription or requirements for administration occurs. The school nurse may request to receive further information about the prescription, if needed, prior to administration of the substance. For drugs or medicine used by children with a disability, administration may be as provided in the IEP, Section 504 plan or IHP. [From Minn. Stat. 121A.22 (b); MDH Guidance Pg. 34; MSBA Model Policy]

B. Record Keeping: School health personnel must maintain accurate records specific for each student receiving prescription medications, including parental consent forms, authorization from licensed prescribers, individual documentation and emergency procedures. Documentation must contain student name and identification number; name of medication; purpose, dosage; route; date and time given; beginning and end dates; any special circumstances related to the procedure, the student’s unusual reactions or responses, omissions, absences, or refusals, name of the individuals giving the medication, and count of controlled substances. Documentation should be done in unalterable ink (no erasing, no deleting/white out). [From MDH Guidance Pg. 39-40]

If the administration of a drug or medication described in this procedure requires the school district to store the drug or medication, the parent must inform the school if the drug or medication is a controlled substance. For a drug or medication that is not a controlled substance, the request must include a provision designating the school district as an authorized entity to transport the drug or medication for the purpose of destruction if any unused drug or medication remains in the possession of school personnel. For a drug or medication that is a controlled substance, the request must specify that the parent is required to retrieve the drug or controlled substance when requested by the school.[From Minn. Stat. 121A.22 Subd. 1(b) & MSBA Model Policy]

C. Container: Prescription medications must be provided to school directly by the parent in the original container labeled for the student by a pharmacist in accordance with law and must be administered in a manner consistent with the instructions on the label. [From Minn. Stat. 121A.22 Subd. 3;

D. Storage of Medications: All medications should be stored on school property, in a locked drawer or cabinet used exclusively for medications and kept no longer than the medication expiration date or end of the school year, whichever is sooner. Cabinets should not contain glass doors and should be anchored securely to a solid surface. Access to stored medication and medication cabinet keys must be limited to school personnel authorized to administer medications. Medication requiring refrigeration should be stored in a locked refrigerator or in a locked container in the refrigerator specifically for medications. [From MDH Guidance Pg. 38]

E. Student Refusal: School Health Personnel will make a reasonable attempt to provide mediation to students as prescribed.  If a student refuses medication the parent or guardian will be notified. If there are safety concerns the physician’s order will be reviewed with the physician for clarification.

F. Student Possession: Prescription medications are not to be carried by the student but will be left with the appropriate school district personnel. Exceptions to this requirement are: prescription asthma medications self-administered with an inhaler (See IV C below), and non-controlled prescription medications which are approved by the prescribing health care provider, parent and school LSN or RN for self-carry by the student or as specified in the student’s IEP, Section 504 plan, or IHP (individual health plan). [From MSBA Policy]

G. Medication Management for Field Trips: For school district field trips of one school day or less where the prescription medication needs to be administered during the school day while on the field trip, the school LSN/RN, delegated staff or parent will prepare a supply of medications not to exceed the duration of the trip and will place the required amount of medication in the pharmacy labeled container. The excess medication will be temporarily stored in a separate paper envelope(s) or other more suitable container and the temporary container(s) will labeled with the student’s name, name of the medication, strength, medication count, name of the person preparing the medication.

For school sponsored field trips of more than one day, the parent will be expected to provide the required amount of medication in a separate pharmacy container with an original label (i.e., an extra from the provider or pharmacist), with a copy of the parental authorization form specific to the event or trip. [From MDH Guidance 26 & 27]

H. Changes in Medication Administration: The school must be notified immediately by the parent of any change in the student’s prescription medication administration. A new Medication Administration Authorization Form and properly labeled container is required before implementing the change. [From MSBA Model Policy]

I. Over-the-Counter: School health personnel will not administer over-the-counter medication to a student at the parent's request. An over-the-counter medication may be administered to a student where the student’s physician and parent have completed a Medication Administration Authorization Form and the medication has been provided by the parent in its original container.

J. Nonprescription Pain Medication: A secondary student may possess and use nonprescription pain relief in a manner consistent with the labeling, if the school district has received written authorization from the parent permitting the student to self-administer the medication. The parent must submit written authorization for the student to self-administer the medication each school year. The school district may revoke a student’s privilege to possess and use nonprescription pain relievers if the school district determines that the student is abusing the privilege. This provision does not apply to the possession or use of any drug or product containing ephedrine or pseudoephedrine as its sole active ingredient or as one of its active ingredients. [From Minn. Stat. 121A.222 & MSBA Model Policy 516]

 

IV.    EMERGENCY MEDICATIONS

A. Emergency Medications Generally: Students with known chronic health conditions sometimes need emergency medications to prevent or treat anaphylaxis, respiratory distress, diabetic hypoglycemia, seizures, and cardiac incidents. Emergency medications may be used in these situations where, in the judgment of the school personnel who are present or available, the risk to the student’s life or health is of such a nature that drugs or medicine should be given without delay, regardless of specific provisions of the procedures set forth in Section II above. In an emergency, if two or more people are available, one can administer the emergency medication while the other calls 911. If only one person is available, that person should first administer the medication and then call 911. [From MDH Guidance Pg. 40-41]

B. Epinephrine Administration: At the start of each school year or at the time a student enrolls in school, whichever is first, a student’s parent, school staff, including those responsible for student health care, and the prescribing medical professional must develop and implement an individualized written health plan for a student who is prescribed epinephrine auto-injectors that enables the student to:

1. Possess epinephrine auto-injectors; or
2. If the parent and prescribing medical professional determine the student is unable to possess the epinephrine, have immediate access to epinephrine auto-injectors in close proximity to the student at all times during the instructional day. For purposes of this section the “instructional day” begins at the start of the student’s first hour of class and ends at the end of the student’s last hour class.  

The plan must designate the school staff responsible for implementing the student’s health plan, including recognizing anaphylaxis and administering epinephrine auto-injectors when required, consistent with state law.  This health plan may be included in a student’s § 504 plan. [From Minn. Stat. 121A.2205 & MSBA Policy]

C. Student Administration of Asthma Medication: Drugs or medicines that are prescription asthma or reactive airway disease medications can be self-administered by a student with an asthma inhaler if:

1. the school district has received a written authorization from the parent permitting the student to self-administer the medication;
2. the inhaler is properly labeled for that student; and
3. the parent has not requested school personnel to administer the medication to the student.

The parent must submit written authorization for the student to self-administer the medication each school year. The school nurse or other appropriate party must assess the student’s knowledge and skills to safely possess and use an asthma inhaler in a school setting and enter into the student’s school health record a plan to implement safe possession and use of asthma inhalers. [Minn. Stat. 121A.221 & MSBA Model Policy]

D. Student Seizure Action Plan: School health personnel must implement seizure action plans and training to meet the needs of students with a seizure disorder and who may need seizure rescue medication administration. The action plan must:

1. Identify a school nurse or a designated individual at each school site who is on duty during the regular school day and can administer or assist with the administration of seizure rescue medication or medication prescribed to treat seizure disorder symptoms approved by the United States Food and Drug Administration.
2. Require training on seizure medications for an employee identified under clause (1), recognition of signs and symptoms of seizures, and appropriate steps to respond to seizures.
3. Be maintained on an accessible data base or filed in the health office.

A school district employee or volunteer responsible for the supervision or care of a student with a diagnosed seizure disorder must be given notice and a copy of the seizure action plan, the name or position of the employee identified under clause D1 and the method by which the trained school employee may be contacted in an emergency.

 

V.  EXCEPTIONS

The requirements set forth in this procedure do not apply to the following situations:

A. Special health treatments and health functions such as catheterization, tracheostomy suctioning, and gastrostomy feedings;

B. Drugs or medicine provided or administered by a public health agency to prevent or control an illness or a disease outbreak;

C. Medications that are used off school grounds; that are used in connection with athletics or extracurricular activities; or that are used in connection with activities that occur before or after the regular school day;

D. Sunscreen products applied or used during the school day while on school property or at a school-sponsored event without a prescription, physician’s note, or other documentation from a licensed health care professional. School personnel are not required to provide sunscreen or assist students in applying sunscreen.

[From Minn. Stat. 121A.22 Subd. 2 & 6; 121A.223 and MSBA Model Policy]

 

VI.  REQUIRED PROCEDURES FOR UNCLAIMED MEDICATIONS

Before the transportation of any prescription drug or medication under this policy, the school shall make a reasonable attempt to return the unused prescription drug or medication to the parent. Transportation of unclaimed or unused prescription drugs or medications will occur at least annually but may occur more frequently at the discretion of the school site.

If the unclaimed or abandoned prescription drug is not a controlled substance as defined under Minnesota Statutes § 152.01, subdivision 4, or is an over-the-counter medication, the school site will either designate an individual who shall be responsible for transporting the drug or medication to a designated drop-off box or collection site or request that a law enforcement agency transport the drug or medication to a drop-off box or collection site on behalf of the school.

If the unclaimed or abandoned prescription drug is a controlled substance as defined in Minnesota Statutes § 152.01, subdivision 4, school personnel is prohibited from transporting the prescription drug to a drop-off box or collection site for prescription drugs identified under this paragraph. The school district must request that a law enforcement agency transport the prescription drug or medication to a collection bin that complies with Drug Enforcement Agency regulations, or if a site is not available, under the agency’s procedure for transporting drugs.

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Legal References
M.S. 151.01, Subd. 5-6 - Pharmacy; Definition
M.S. 121A.22 - Administration of Drugs and Medicine
M.S. 121A.21 – School Health Services

Cross References
Policy 541 – Chemical Use and Abuse
Policy 506 – Student Discipline