Policy Details

5141.21 REGULATION Procedures for Administering Medications

5141.21

Administrative Regulation

STUDENTS

Administering Medication to Students

Regular School Day

The Board of Education (Board) allows students to self-administer medication and qualified personnel for schools to administer medication to students in accordance with the following established procedures. These procedures shall be reviewed and/or revised and approved by the School Medical Advisor, the school nurse and the Board of Education. The District's School Medical Advisor (or other qualified physician) will approve this policy, its regulations and any changes prior to submission to the Board of Education for its approval.

The administration of medication includes the activities of handling, storing, preparing or pouring of medication, conveying it to the student according to the medication order, observing the student inhale, apply, swallow, or self-inject the medication, when applicable; documenting that the medication was administered.

A student who is required to receive medication or wants to take any medication, prescription or over the counter, during school hours must provide:

  1. The authorized prescriber's (physician, dentist, optometrist, advanced practice registered nurse, or physician assistant; and in the case of interscholastic or intramural athletic events, a podiatrist orders for medication, prescription or over the counter, on a school district form which specifies the student's name, the name of the medication, indications for the medication, dosage of medication, route of administration, frequency of administration, start and termination dates, side effects to be observed (if any) and management of such effects. Student allergies to food and/or medicine and signature of the provider is also required on the form. This medical order must be renewed yearly if a student is to be administered medication by school personnel.
  2. Written authorization from his or her parent or guardian allowing school personnel to administer said medication. This authorization shall be renewed yearly and shall include parental consent for school personnel to destroy said medication if not repossessed by the parent or guardian within a seven (7) day period of notification by school authorities.
  3. The medication must be in its original container with the correct label from the pharmacy or manufacturer.

Students who are able to self-administer medication may do so provided:

  1. An authorized prescriber provides a written order for self-administration of said medication.
  2. There is written authorization for self-administration of medication from the student's parent or guardian.
  3. The school nurse has evaluated the situation and deemed it to be safe and appropriate; has documented this on the student's cumulative health record, and has developed a plan for general supervision.
  4. The student and school nurse have developed a plan for reporting and supervision of self-administration and notification of teachers.
  5. The principal and appropriate teachers are informed that the student is self-administering prescribed medication.
  6. Such medication is transported to the school and maintained under the student's control within these guidelines.

In addition, the Board permits those students who have a verified chronic medical condition and are deemed capable to self-administer prescribed emergency medication, including rescue asthma inhalers and cartridge injectors for medically-diagnosed allergies, to self-administer such medications and may permit such students to self-administer other medications, excluding controlled drugs, as defined in Connecticut General Statute 21a-240. Such students must provide:

  1. An authorized prescriber's written medication order including the recommendation for self-administration; and
  2. A written authorization for self-administration of medication from the student's parent or guardian.

Further, the school nurse shall assess the student's competency for self-administration in the school setting and deem it to be safe and appropriate, including that a student:

  1. is capable of identifying and selecting the appropriate medication by size, color, amount, or other label identification;
  2. knows the frequency and time of day for which the medication is ordered;
  3. can identify the presenting symptoms that require medication;
  4. administers the medication properly;
  5. maintains safe control of the medication at all times;
  6. seeks adult supervision whenever warranted; and
  7. cooperates with the established medication plan.

In the case of inhalers for asthma and cartridge injectors for medically-diagnosed allergies, the school nurse's review of a student's competency to self-administer inhalers for asthma and cartridge injectors for medically-diagnosed allergies in the school setting shall be used to prevent a student from retaining and self-administering inhalers for asthma and cartridge injectors for medically-diagnosed allergies. Students may self-administer such medications only with the written authorization of an authorized prescriber and written authorization from the student's parent or guardian or eligible student.

The school nurse is responsible for:

  1. Reviewing the medication order and parental authorizations;
  2. Developing an appropriate plan for self-administration;
  3. Documenting the medication plan in the student's or participant's health record; and
  4. Informing qualified personnel for schools and other staff regarding the student's self-administration of prescribed medication.

The medication shall be transported to school by the student and maintained under the student's control in accordance with the District's policy on self-medication by students and the individual student plan.

Self-administration of controlled medication may be considered for extraordinary situations such as international field trips. Such self-administration must be approved by the school nurse supervisor and the School Medical Advisor in advance and an appropriate plan shall be developed.

Medication may be administered by a licensed nurse, or in absence of such licensed personnel, any other nurse licensed pursuant to the provisions of Chapter 378, including a nurse employed by, or providing services under the direction of the Board of Education at a school-based clinic, qualified personnel for schools (principals, teachers, licensed physical or occupational therapists and coaches and licensed athletic trainers during intramural and/or interscholastic athletics) trained in the administration of medication. They shall not be held liable for any personal injuries which may result from acts or omissions constituting ordinary negligence.

A licensed practical nurse may administer medications to students if he/she can demonstrate evidence of one of the following:

  1. Training in administration of medications as part of their basic nursing program;
  2. Successful completion of a pharmacology course and subsequent supervised experience;
  3. Supervised experience in medication administration while employed in a health care facility.

Licensed practical nurses shall not train or delegate the administration of medication to another individual. Such nurses shall only administer medications after the medication plan has been established by the school nurse or registered nurse.

Medication will be administered according to the following procedures:

  1. The school nurse will develop a medication administration plan for each student before medication may be administered by any staff member. The school nurse will also review regularly all documentation pertaining to the administration of medication for students.
  2. The qualified personnel for schools approved by the School Medical Advisor and school nurse will be formally trained by the school nurse or School Medical Advisor prior to administering medication. The school nurse, acting as designee and under the direction of the School Medical Advisor, will annually instruct such staff members in the administration of medication. The training shall include, but not be limited to:

    A.The generic principles of safe administration of medications.
    B.Review of state statute and school regulations regarding administration of medication by school personnel.
    C.Procedural aspects of the administration of medication, including the safe handling and storage of medication, and documentation.
    D. Specific information related to each student's medication and each student's medication plan including the name and generic name of the medication, indications for medication, dosage, routes, time and frequency of administration, therapeutic effects of the medication, potential side effects, overdose or missed dose of the medication, and when to implement emergency interventions.
  3. A list of qualified personnel successfully trained and approved to administer medication along with documentation of the annual update of trainees shall be submitted to the Superintendent by the nursing supervisor on October 31 of each year. All such individuals including school nurses and nurse practitioners must have also satisfactorily passed the completed general and student-specific administration of medication training for the current school year, and names and credentials of the nurse or School Medical Advisor trainer or trainers.
  4. A current list of those authorized to give medication shall be maintained in each school.

Administration of Medications by Paraprofessionals

A specific paraprofessional, in the absence of a school nurse, may only administer medications to a specific student in order to protect that student from harm or death due to a medically diagnosed allergic condition or Type 1 diabetes according to the following:

A.only with the approval of the School Medical Advisor and school nurse, in conjunction with the school nurse supervisor, and under the supervision of the school nurse;

B.with a proper medication authorization from the authorized prescriber in conformity with Connecticut General Statute 10-212a;

C.with parental/guardian permission to administer the medication at school;

D.only medication necessary for prompt treatment of an allergic reaction or hypoglycemic shock, including, but not limited to, a cartridge injector (EpiPen for allergic reactions or glucagon injection for hypoglycemic shock), and

E.the paraprofessional shall have received proper training and supervision from the school nurse as detailed in Section10-212a-3 and Section 10-212a-7 of the Regulations of Connecticut State Agencies.

    Note: The use of a paraprofessional to administer medications, as described above, is not mandated by law or regulation. Such use is subject to Board of Education approval.

Handling and Storage of Medications

All medication, except those approved for keeping by students for self-medication, must be delivered by the parent or other responsible adult and shall be received by the nurse assigned to the school or, in the absence of such nurse, by other qualified personnel for schools trained in the administration of medication and assigned to the school. The school nurse must:

    A.Examine on site any new medication, medication order and parent/guardian authorization to insure that it shall be properly labeled with dates, name of student, medication name, dosage and physician's name, and that the medication order and permission form are complete and appropriate.

    B.Develop an administration of medication a plan for the student before any medication is given by qualified personnel for schools.

    C.Review all medication refills with the medication order and parent/guardian written authorization prior to the administration of medication.

    D.Except as indicated by a student's emergency care plan, emergency medications shall be stored in an unlocked, clearly labeled and readily accessible cabinet or container during school hours under the supervision of the nurse or the principal or principal's designee trained in the administration of medication.

    E.Emergency medications shall be locked beyond the regular school day or program hours except as otherwise determined by a student emergency care plan.

    F.Record on the Student's Individual Medication Record the date the medication is delivered and the amount of medication received.

    G.Store medication requiring refrigeration in a refrigerator at no less than 36 degrees Fahrenheit and no more than 46 degrees Fahrenheit. The refrigerator shall be located in a health office maintained for health service purposes with limited access. Non-controlled medications may be stored directly on the shelf of the refrigerator with no further protection needed. Controlled medications shall be stored in a locked box affixed to the refrigerator shelf.

    H.Store prescribed medicinal preparations in securely locked storage compartment. Controlled substances shall be contained in separate compartments, secured and locked at all times. At least two sets of keys for the medication containers or cabinets shall be maintained for each school building or before- and after-school programs and school readiness programs. The school nurse shall maintain one set of keys. The additional set shall be under the direct control of the Principal and, if necessary, the Program Director or lead teacher trained in the administration of medication shall also have a set of keys.

All medication, except those approved for keeping by students for self-medication, shall be kept in a designated locked container, cabinet or closet used exclusively for the storage of medication.

In the case of controlled substances, they shall be stored separately from other drugs and substances in a separate, secure, substantially constructed, locked metal or wood cabinet.

No more than a three month supply of a medication for a student shall be stored at the school. All medications, prescriptions and non-prescription, shall be delivered and stored in their original containers and in such a manner as to render them safe and effective. No medication for a student shall be stored at a school without a current written order from an authorized prescriber.

Access to all stored medications shall be limited to persons authorized to administer medications. Each school or before-and after-school program and school readiness program shall maintain a current list of those persons authorized to administer medications.

Destruction/Disposal of Medication

At the end of the school year or whenever a student's medication is discontinued by the authorized prescriber, the parent or guardian is to be contacted and requested to repossess the unused medication within a seven (7) school day period. If the parent/guardian does not comply with this request, all medication (non-controlled drugs) is to be destroyed by the school nurse in the presence of at least one witness (school physician, principal, teacher) according to the following procedures:

1.Medication will be destroyed in a non-recoverable fashion. (Procedure below recommended by Connecticut Department of Environmental Protection, Office of Pollution Prevention.)

A.Keep the medication in its original container.

    • To protect privacy and discourage misuse of the prescription, cross out the patient's name with a permanent maker or duct tape or remove the label.
    • (Chemotherapy drugs may require special handling. Work with your healthcare provider on proper disposal options for this type of medication.

B.Modify the medications to discourage consumption.

    • For solid medications: such as pills or capsules: add a small amount of water to at least partially dissolve them.
    • For liquid medications: add enough table salt, flour, charcoal, or nontoxic powdered spice, such as turmeric or mustard to make a pungent, unsightly mixture that discourages anyone from eating it.
    • For blister packs: wrap the blister packages containing pills in multiple layers of duct or other opaque tape.

C.Seal and conceal.

    • Tape the medication container lid shut with packing or duct tape.
    • Place it inside a non-transparent bag or container such as an empty yogurt or margarine tub to ensure that the contents cannot be seen.
    • Do not conceal medicines in food products because animals could inadvertently consume them.

D.Discard the container in your trash can.

Schools that want to dispose of controlled substances should call the Drug Control Division of the CT Department of Consumer Protection for assistance at 860-713-6055.

2.The following information is to be charted on the student's health folder and signed by the school nurse and witness:

A.Date of destruction.
B.Time of destruction.
C.Name, strength, form and quantity of medication destroyed.
D.Manner of destruction of medication.


3.Controlled substances shall not be destroyed by the school nurse. Controlled substances shall be destroyed pursuant to Section 21a-262-3 of the Regulations of the Connecticut State Agencies. In the event that any controlled substance remains unclaimed, the school nurse or Supervisor of Nursing shall contact the Connecticut Commissioner of Consumer Protection to arrange for proper disposition. Destruction may also be conducted by a Connecticut licensed pharmacist in the presence of another pharmacist acting as a witness. Any accidental destruction or loss of controlled drugs must be verified in the presence of a second person, including confirmation of the presence or absence of residue and jointly documented on the student medication administration record and on a medication error form pursuant to Connecticut General Statute 10-212a(b). If no residue is present notification must be made to the Department of Consumer Protection (DEP) pursuant to Section 21a-262-3 of the Regulations of Connecticut State Agencies.

4.The completed medication administration record for non-controlled medications may be destroyed in accordance with Section M8 of the Connecticut Municipality Retention Schedule, provided it is superseded by a summary on the student health record.

5.The completed medication administration record for non-controlled medications may be destroyed in accordance with Section M8 of the Connecticut Municipality Retention Schedule, provided it is superseded by a summary on the student health record.

Protection of Privileged and Private Medical Information

Under Federal law of HIPPA it is the legal responsibility of all institutions and people with access to private or privileged medical information that it is not shared and is protected under Federal law without the express and specific approval by a legal parent or guardian or by the student if he (she) is of legal age or is an emancipated minor. Medication data can be released without permission if the identity of the student is anonymous.

Documentation and Record Keeping

Record keeping of medication administration shall either be in ink and shall not be altered or shall be recorded electronically, in a record that cannot be altered, on the individual student's medication record form which, along with the parental authorization form and the authorized prescriber's order, becomes part of the student's permanent record. Records shall be made available to the

Connecticut State Department of Education upon request, for review until destroyed pursuant to C.G.S. 11-8a and C.G.S. 10-212a(b) for controlled medications.

Each school readiness or before-and after-school program where medications are administered shall maintain an individual medication administration record for each student who receives medication during regular school or program hours. A medication administration record shall include the:

A.Name of the student;
B.Birthdate of the student
C.Name of medication;
D.Dosage of medication;
E.Route of administration;
F.Frequency of administration;
G.Name of the authorized prescriber, dates for initiating and terminating the administration of the medication, including extended year programs;
H.Quantity received which shall be verified by the adult delivering the medication;
I.Student allergies to food and/or medicine;
J.Date and time of administration or omission including reason for omission;
K.Dose or amount of drug administered;
L.Full written or electronic signature of the nurse or qualified personnel for schools administering the medication; and
M.For controlled medications, a medication count which shall be conducted and documented at least once a week and co-signed by the assigned nurse and a witness.

The completed medication administration record for controlled medications shall be maintained in the same manner as the non-controlled medications. In addition, a separate medication administration record needs to be maintained in the school for three years, pursuant to Connecticut General Statute 10-212a(b).

The written order of the authorized prescriber, the written authorization of the parent or guardian to administer the medication and the written parental/guardian permission for the exchange of information by the prescriber and school nurse to ensure the safe administration of such medication shall be filed in the student's cumulative health record or, for before- and after-school programs and school readiness programs, in the child's program record.

Record of the medication administered shall be entered in ink on an individual student medication record form and filed in the student's cumulative health folder. If the student is absent, it shall be so recorded. If an error is made in recording, a single line shall be run through the error and initialed.

An authorized prescriber's verbal order, including a telephone order, for a change in any medication may be received only by a school nurse. Such verbal order must be followed by a written order within three (3) school days.

    1. An error in the administration of medication shall be reported to the school nurse who will initiate appropriate action and documentation in a student incident report and on his/her cumulative record.

    2. Untoward reactions to medication shall be reported to the school nurse, the parent, and the student's physician.

    3. Records of controlled substances shall be entered in the same manner as other medications with the following additions:

    A.The amount of controlled drug shall be counted and recorded on the individual student medication record form after each dose given.

    B. A true copy (carbon or NCR) of the forms shall be retained by the school for 3 years and the original filed in the student's permanent health record.

    C. Loss, theft or destruction of controlled substances shall be immediately, upon discovery, reported to the Supervisor of Nursing Services who will contact the Connecticut Commissioner of Consumer Protection.

In the absence of a licensed nurse, only qualified personnel for schools who have been properly trained may administer medication to student. Qualified personnel for schools may administer oral, topical, or inhalant medications. Medications with a cartridge injector(s) may be administered by qualified personnel only to a student with a medically diagnosed allergic condition which may require prompt treatment to protect the student against serious harm or death.

Investigational drugs may not be administered by qualified personnel for schools.

In the case of the administration of a medication with a cartridge injector in an after-school readiness program or child-care program, such administration shall be reported to the school nurse no later than the next school day.

Medication Errors

Whenever any error in medication administration occurs, the following procedures shall apply:

A.the person making the error in medication administration shall immediately implement the medication emergency procedures in this regulation if necessary, and shall immediately notify the school nurse and the principal (if the Principal was not the person who made the error);

B.the school nurse shall immediately notify the authorized prescriber and the student's parent or guardian.

C.the Principal shall notify the Superintendent or the Superintendent's designee, advising of the nature of the error and all steps taken or being taken to rectify the error, including contact with the authorized prescriber and/or any other medical action(s). (An incident report form is to be sent to the Superintendent or his/her designee.)

A report shall be completed using the authorized accident/incident report form.

Any error in the administration of medication shall be documented in the student's cumulative health record.

Administration of Emergency Medication under Connecticut General Statute 10-212a

In the absence of a school nurse, any other nurse licensed pursuant to provisions of Chapter 378 including a nurse providing services at a school-based health clinic, qualified personnel for schools may give emergency medication orally or by injection to students with a medically diagnosed allergic condition or medically diagnosed Type 1 diabetes which would require such prompt treatment to protect the child from serious harm or death so long as the administrator or teacher has completed training in administration or such medication.

Whenever a student has an untoward reaction to administration of a medication, resolution of the reaction to protect the student's health and safety shall be the foremost priority. The school nurse and the authorized prescriber shall be notified immediately, or as soon as possible in light of any emergency medical care that must be given to the student.

Emergency medical care to resolve a medication emergency includes but is not limited to the following, as appropriate under the circumstances: (or: In the event of a medication emergency, the following will be readily available:)

A.The use of the 911 emergency response system;
B.The contact of a local poison information center;
C.The physician, clinic or emergency room to be contacted in such an emergency;
D.The name of the person responsible for the decision making in the absence of the school nurse;
E.The application by properly trained and/or certified personnel of appropriate emergency medical care techniques, such as cardio pulmonary resuscitation;
F.Administration of emergency medication in accordance with policy #5141.21 and this administrative regulation; and
G.Transporting the student to the nearest available emergency medical care facility that is capable of responding to a medication emergency.

As soon as possible, in light of the circumstances, the principal shall be notified of the medication emergency. The Principal shall immediately thereafter contact the Superintendent or the Superintendent's designee.

The school nurse is responsible for notifying the parent or guardian, advising of the existence and nature of the medication emergency and all steps taken or being taken to resolve the emergency and protect the health and safety of the student, including contact with the authorized prescriber and/or any other medical action(s) that are being or have been taken.

Supervision

The school nurse is responsible for general supervision of administration of medications in the school(s) to which that nurse is assigned. The school nurse's duty of general supervision includes, but is not limited to the following:

1. Availability on a regularly scheduled basis to:

a. review orders or changes in orders, and communicate these to personnel designated to administer medication for appropriate follow-up;
b. set up a plan and schedule to ensure medications are given;
c. provide training to qualified personnel for schools and other licensed nursing in the administration of medications, and assess that the qualified personnel for schools are competent to administer medications;
d. support and assist other licensed nursing personnel and qualified personnel for schools to prepare for and implement their responsibilities related to the administration of specific medications during school hours; and,
e. provide consultation by telephone or other means of telecommunications. (In the absence of the school nurse, an authorized prescriber or other nurse may provide this consultation.)
f. provide appropriate follow up to ensure the administration of medication plan results in desired outcome.

2. In addition, the school nurse shall be responsible for:

a. implementing policies and procedures regarding the receipt, storage, and administration of medications;
b. reviewing, on a monthly basis, all documentation pertaining to the administration of medications for students;
c. observing the competency to administer medication by qualified personnel for schools; and
d. conducting periodic reviews, as needed, with licensed nursing personnel and qualified personnel for schools, regarding the needs of any student receiving medication.

Administration of Medication during Intramural and Interscholastic Athletics

A coach or licensed athletic trainer, trained in the general principles of medication administration applicable to receiving, storing, and assisting with inhalant medications or cartridge injector medications and documentation, may administer medication for select students, according to the student's individualized medication plan, for whom self-administration plans are not viable options as determined by the school nurse.

The medication which may be administered is limited to: (1) inhalant medications prescribed to treat respiratory conditions and (2) medication administered with a cartridge injector for students with a medically diagnosed allergic condition which may require prompt treatment to protect the student against serious harm or death, provided the following requirements have been met.

A coach or licensed athletic trainer shall be trained in (1) the general principles of administration of medication applicable to receiving, storing and assisting with inhalant medications or cartridge injector medications, and documentation; (2) student specific needs for assistance according to the individualized medication plan.

The school nurse, shall provide the coach with a copy of the authorized prescriber's order and the parental/guardian permission form. Parents are responsible for providing the coach or licensed athletic trainer the medication, such as the inhaler or cartridge injector, which shall be kept separate from the medication stored in the school health office during the school day.

Medications to be used in athletic events shall be stored in containers for the exclusive use of holding medications; in locations that preserve the integrity of the medication; under the general supervision of the coach or licensed athletic trainer trained in the administration of medication; and in a locked secure cabinet when not in use at athletic events.

The coach or licensed athletic trainer's agreement is necessary for the administration of emergency medication and the implementation of the student's emergency care plan.

Coaches and licensed athletic trainers are required to fulfill the documentation requirements as outlined in these administrative regulations. A separate medication administration record for each student shall be maintained in the athletic area. Errors in the administration of medication shall be addressed as specified in Section 10-212a-6 of the Regulations of Connecticut State Agencies, and detailed in these administrative regulations. If the school nurse is not available, a report may be submitted by the coach or licensed athletic trainer to the school nurse on the next school day.

An administration of medication record shall be submitted to the school nurse at the end of each sport season and filed in the student's cumulative health record.


Legal Reference: Conn. Gen. Stat. § 10-206 Health assessments.
Conn. Gen. Stat. § 10-212 School nurses and nurse practitioners. Administration of medications by parents or
guardians on school grounds. Criminal history record sheets.
Conn. Gen. Stat. § 10-212a Administration of medications in schools, at athletic events and to children in
school readiness programs. (as amended by P.A. 03-211, PA 04-181 and PA 09-155)
Conn. Gen. Stat. § 19a-900 Use of cartridge injector by staff member of before or after school program, day
camp or day care facility.
Conn. Gen. Stat. § 21a-240 Definitions.
Conn. Gen. Stat. § 29-17a Criminal history records checks. Procedure. Fees.
Conn. Gen. Stat. § 52-557b "Good Samaritan law". Immunity from liability for emergency medical assistance,
first aid or medication by injection. School personnel not required to administer or render. (as amended by
PA 05-144 – An Act Concerning the Emergency Use of Cartridge Injectors)
Connecticut Regulations of State Agencies
Conn. Gen. Stat. §§ 10-212a-1 through 10-212a-10
1307.21 Code of Federal Regulation

Litchfield Board of Education
Regulation Adopted: October 28, 1986
Regulation Revised: December 9, 1986
Regulation Revised: March 22, 1994
Regulation Reviewed: September 24, 1996
Regulation Revised: February 11, 1997 (Copy to Dept. of Public Health)
Regulation Reviewed: October 1, 1998
Regulation Reviewed: February 22, 1999 (Copy to Dept. of Public Health)
Regulation Revised: January 28, 2003 (Copy to Dept. of Public Health)
Regulation Reviewed: November 2005
Regulation Revised: January 18, 2006
Regulation Revised: November 30, 2011
Regulation Revised: April 2, 2014

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