Medication Administration and Storage Policy

Need for Medication Administration and Standards

Students with medical conditions may require medication to be administered during school hours.

Prior to the commencement of each school year, and thereafter as circumstances require, the principal shall determine which employees will participate in the medical care program.

The principal shall designate one or more school personnel on each campus to have initial and annual training with the school nurse regarding the storage and emergency use of rescue inhalers, epinephrine auto-injectors, and glucagon administration.

Unlicensed assistive personnel (UAP) may assist students with medication administration. These include any designated and trained school staff. A program of careful instruction, with ongoing technical assistance and supervision from the school nurse, is essential. School personnel should remain knowledgeable of best practices, state laws, local policies, guidelines, and record keeping. On-going communication with parents/guardians is an essential part of safe medication administration.

Parent or Legal Guardian Responsibilities

● Limit medication requests to be given during the school day to those necessary in order to maintain the child at school. Students should not receive the first dose of a newly prescribed routine medication at school due to unknown response.
● Complete a Request for Medication Administration form and / or Allergy/ Asthma Action Plan form for school personnel to administer medication at school. Separate request/permission forms must be completed for each medication to be given at school.
● Students with asthma, diabetes, or at risk for anaphylactic allergic reactions may possess and self-administer medication on school property within certain parameters. Students possessing life-saving medications should complete page 4 of the Allergy/ Asthma Action Plan form.
● Review and adhere to the Student Handbook Medication Policy.

School Nurse Responsibilities

A limited number of staff should be identified to ensure consistency in medication administration and reduce the potential for error.
Responsibilities of the school nurse include:
● Participate in the development and annual evaluation of written school policy and procedures for medication administration.
● Coordinate the medication process according to the adopted policy.
● Provide training for school staff who are assigned the responsibility for administering and safely securing medications at school.
● Regularly audit the completed forms and procedures for quality, accuracy, safety, and compliance with written guidelines. Address audit variances and recommend changes to policy/procedure, if identified.
● Serve as a consultant to principals, school staff, and parents regarding medications.
● Review medication orders for appropriate usage, dose, route of administration, and side effects that may be expected.
● Regularly assess the effectiveness of student medication plans and communicate findings to parents and physicians.
● Assure access to emergency medications for all students and aid for students that need assistance.

Responsibilities related to medication storage at school

● Provide proper storage space to ensure that medications are secure, yet readily accessible to staff and students. Security for medications must be planned on an individual basis. Stock epinephrine auto injectors cannot be locked. Rescue inhalers and individually ordered epinephrine auto injectors should be readily accessible. Controlled substances or other medications at high risk for diversion should be locked with access limited to the school nurse, school staff person designated to administer medication, and the principal or their designee.
● Assure protection of controlled medications from diversion. The Drug Enforcement Agency Title 21 Code of Federal regulations 21 CFR 1301.72 requires storage of Schedule I and Schedule II medications within a locked cabinet within a room that has a door that also locks. They must be stored under a double-locking mechanism.
● Designate staff who will be trained to provide care for students with diabetes including administration of ordered medications.
● Provide refrigerated storage for medications as needed using a lock box if necessary. Medications are to be kept separate from food. Appropriate temperature ranges for the medications, as directed on the label, must be maintained and monitored.
● Designate one or more persons the responsibility of the security and administration of the medications. A back-up person will be needed when the designated person is absent.

Responsibilities related to medication administration at school

All medications administered at school must have a written or electronic request signed by the parent or legal guardian. Consent may be verified for common over the counter medications on FACTS (as completed by the parent/ guardian) or a completed Request for Medication Administration form.

All “rights” of medication administration listed below must be upheld in the school setting when giving medication:
● Right student – Always verify by asking the student’s name.
● Right medication – Always compare the label on the bottle with the medication request/authorization form that is signed by the health care provider.
● Right dosage – Always double-check the dosage on the pharmacy label with the dosage on the medication authorization form.
● Right time – Check the Request for Medication Administration form for the time the dose is to be given. Up to 30 minutes before or after the prescribed time is acceptable.
● Right route – Check the Request for Medication Administration form and pharmacy label to verify the route of administration. For example, by mouth, dropped in the eye or ear. Contact the parent/ legal guardian if any uncertainty is present.
● Right documentation – Immediately document in writing or via FACTS that medication has been given.

Medication Variance or Mistake

Any variance should be documented and reported. UAP should be told that variance reporting will not be used punitively; it will be used to ensure the best outcome for the child. Honesty and prompt reporting are always in the best interest of the student and the employee. Examples of variances include:
● missing a dose of medication
● giving duplicate doses of a medication
● giving a medication to the wrong child
● giving the wrong medication or the wrong dose
● giving the medication at the wrong time
● giving the medication by the wrong route
● failing to correctly document administration

Special Circumstances

Building Evacuation:

Schools may experience the need to evacuate for a variety of reasons. It is important that emergency medications be available to students at all times. In the case of building evacuation, emergency medications should be removed from the building by the school’s designated staff member. Evacuation drills should include the removal of emergency medications for practice and in case they are needed during the drill.

School medication providers should be assigned a known location during a school evacuation that allows staff and students to access emergency medications. It is the responsibility of the medication provider to ensure that the student has access to their emergency medication. Confidentiality and safe storage of medications during an emergency should be maintained.

Each medication given during such emergencies should be documented in accordance with policy. If the medication log is not available during evacuation, document the administration of medication in a temporary manner that can be retained and add that document to the medication administration log upon return to the building.

Field Trips:

● Prior to the field trip: The original medication container used at school or repackaging one day’s worth of medication should be prepared. Parents should be instructed to request an extra pharmacy labeled, child-resistant vial for field trip use. Ensure that the label includes the student’s name, name of medication, time to receive the medication, and any instructions. The school nurse should provide the attending faculty member a list of all students on the field trip that will need medication and the name of the adult that is trained to give the medications for that field trip. The telephone number of the school nurse should be provided.
● On the day of the field trip: the trained medication administrator/ faculty member will pick up all medications, copies of medication authorization/documentation forms for each medication, and allergy/ asthma action plans. All medication and forms should be protected and secured in a locked box or a wearable backpack to ensure medication and forms are never left unattended. The medication administrator will be accountable for all student-labeled medication containers, unused emergency medications, and student information sheets.
● Upon returning to school after the field trip: the designated field trip medication administrator will return all student-labeled medication containers, unused emergency medications, and student information sheets to the school nurse or the daily medication staff member. The field trip administrator will assure documentation of all medications administered and completion of variance forms, if needed. The school nurse or medication staff member should check the field trip list to ensure that all student medications are accounted for and documented.

Last modified: 25 January 2022