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Medication Policy
 

Medication Administration Forms
2013-2014 Medication Form - English (PDF)

2013-2014 Medication Form - Spanish (PDF)

Parent Request for Self Administration - English (PDF)

Parent Request for Self Administration - Spanish (PDF)

Medication Administration Guideline
Reference: RISD Board Policy – FFAC (LEGAL); FFAC (LOCAL); Texas Education Code § 22.052; Texas Health and Safety Code, chapter 168

I. Introduction
Prescription or non-prescription medication required by a student should be administered at home by a parent or by the student’s medical provider whenever possible. Parents should use every effort to have medication administration set for time periods other than school hours to avoid disruption of the student's school day. RISD recognizes, however, that it may be necessary for a student to receive medication during school hours in some instances. When home administration is not possible, authorized RISD staff may assist in the administration of medications to students during school hours in accordance with these guidelines and Board policy. School nurses will act in compliance with the Nurse Practice Act (“NPA”) at all times and will not administer medication in a manner that conflicts with their professional duties and expectations under the NPA or RISD policies.

II. Administration of Medications

A. RISD staff will only administer those medications that must be given during the school day. If the therapeutic use of the medication can be accomplished by dosage outside of the school day, the medication should not be administered at school.

B. Except as otherwise provided herein, only the school nurse, nurse substitute, health aide, or school employee designated by the Principal (See RISD Health Services Form-Med-10) may administer medications to students. Clinic volunteers may not administer medications.

C. The school shall accept no more than a 30-day supply of a student’s medication.

D. The school shall not administer expired medications.
E. School personnel shall not administer medication in a dosage that exceeds the recommended maximum dosage stated in the most current Physicians Desk Reference (PDR).

F. A registered nurse must administer the first dose of a new medication that has not been previously administered to the student to observe for any adverse reaction to the medication. If a parent brings in a new medication and the nurse cannot be present to administer the first dose, the parent must administer the first dose and remain to observe the student for at least 20 minutes. An exception to these guidelines (F) would be if the medication was an emergency medication such as glucagon, epinephrine, or rectal diazepam.

G. A parent or guardian must pick up all medication immediately after it is discontinued. Medication will be destroyed if not picked up within 2 weeks after the last prescribed dose has been administered.

H. Medications prescribed by out-of-state physicians(1) who are registered and licensed to practice medicine in the USA may be administered up to 90 days. After 90 days, the parent must provide a prescription issued by a physician licensed to practice medicine in the State of Texas.

I. A request to administer experimental or off-label medications will be evaluated on a case-by-case basis by the school nurse, the Director of Health Services, and the prescribing physician. Off-label medications are those FDA approved legal medications that are prescribed for non-approved indications in children (medications prescribed in doses or routes outside the FDA guidelines, medications known to be safe in adults and prescribed without long-term studies demonstrating safety in the pediatric population, or medications approved to treat one type of medical condition, but being prescribed for a different medical condition). Experimental drugs are those medications involved in clinical trials that do not have FDA approval but are designed to protect participant safety and rights. The protocol, information, and documentation required for each case-by-case evaluation is listed on RISD form Evaluation of Research Medications in the School Setting.
III. Refusal of Medication
If a student refuses to take a medication prescribed by the student’s physician or an over the counter medicine, and for which the parent has requested that be administered at school, school personnel will:

A. attempt to discover why student is refusing medication and will encourage the student to accept the medication;

B. not employ extraordinary means or physically force the student to take the medication;

C. contact the student’s parent/legal guardian to apprise him/her of the student’s refusal to take the medication and offer the parent/legal guardian the opportunity to come to the school to administer the medication; and

D. contact the prescribing physician, if appropriate.

IV. Location/Storage for Medications

A. Except as provided below, all medication brought to school, including over-the-counter medications, shall be kept in the school clinic in a locked container.

A student whose physician has diagnosed him or her with asthma or anaphylaxis will be allowed to carry and self-administer medication prescribed for asthma or anaphylaxis when school authorities receive a written request from the prescribing physician that it is medically necessary for the student to have the medicine prescribed for asthma or anaphylaxis available for immediate administration. The student’s parent must provide written authorization for his/her child to carry and administer the medication and the physician must provide a statement to confirm that the student has demonstrated the ability to self-administer the medication via a device as prescribed for asthma or anaphylaxis.

a. The parent’s and physician’s written request is valid for one school year and must be renewed at the beginning of each school year.

b. The student must demonstrate the ability to properly self-administer the medication and express understanding of safety factors and responsibility related to carrying medication. If the student does not comply with the physician’s instructions, RISD will review of the permission to carry the medication.

c. The student must carry the inhaler or emergency medication in the properly labeled original container.

RISD reserves the right to require any medication be kept in the clinic if, in the nurse’s judgment, the student cannot or will not carry the medication in a safe manner and properly self-administer the medication.

V. Written Request

A. A Parent/Physician Request for Administration of Medication by School Personnel Form (Form 314890) must be completed by the parent/guardian for all medication to be administered at school.

1. A separate request form must be completed for each medication.

2. All information requested on the form must be provided before any medication may be administered. This information includes:

a. Student's name,
b. Name of medication,
c. Dosage of medication,
d. Time and dates of administration,
e. Date request made,
f. Reason for the medication,
g. Possible side effects,
h. Student's medication allergies (if any), and
i. Parent/Guardian signature

3. A new written request must be completed for any changes to the original request.

4. A doctor’s permission must be obtained for any student to take a non-prescription medication longer than 10 school days after the initial medication form was filled out.5. A request is valid for the current school year and must be renewed at the beginning of each school year.

6. The school nurse is responsible for maintaining the request form in the Campus Medication Administration Book.

VI. Medication Container

A. Medication (prescription and non-prescription) that is brought to school must be in the original, properly labeled container.

1. A properly labeled prescription medication is one with a pharmacy label that includes the student’s name, name of medication, dosage that matches the parent/doctor request Form, physician’s name, times and methods of administration, and date prescription was filled. The parents should request the pharmacist to dispense two labeled bottles of medication if the medication must be administered at school – one for home and one for school.

2. A new pharmacy label is required for any permanent medication dosage changes. (A doctor’s written order will be accepted for a temporary change and until a new label can be obtained.)

3. Any prescription labels that state “use as directed” must include written clarification from the doctor explaining the dosage and frequency of administration.

4. The original bottle should be provided to the school with only the number of doses that are to be administered during school hours.

5. Non-prescription medication must be labeled with the student’s name. The original container must indicate a dosage guideline and expiration date for the medication.

6. Medication in plastic bags or other non-original containers will not be accepted or administered.

7. All sample medications (including inhalers) dispensed by doctors must be accompanied by the doctor’s written authorization/prescription for the administration of the medication.

VII. Transportation and Check-In Process

A. Controlled Medications

1. All medications that are categorized as controlled substances including, without limitation, Ritalin, Adderral, methylphenidate, Tylenol 3 (contains Codeine), must be transported to and from school by the parent or guardian.

2. The school nurse or designated assistive personnel will record the number of doses delivered to the school. The parent/guardian or another school employee should witness the count.

B. Non-Controlled Medications

1. For student safety, parents/guardians are encouraged to transport all medication (controlled and non-controlled) to and from school.

VIII. Medication Administration

A. The routes of medications (manner of administration) that can be administered in the school setting include oral, topical (e.g., eye drops, ear drops, nose sprays, and ointments), inhaled (e.g., metered-dose inhalers, nebulizer treatments), specific injectable medication, specific rectal medication, and via feeding tube.

B. Who may administer each type of medication:
 
Registered Nurse Authorized Unlicensed Assistive Personnel (2) Authorized Unlicensed Diabetic Care Assistant
Oral Oral Oral
Topical
(e.g. eye drops, ear drops, nose sprays and ointments)
Topical
(e.g. eye drops, ear drops, nose sprays and ointments)
- - - - - - - - - - - - -
Metered Dose Inhalers Metered Dose Inhalers - - - - - - - - - - - - -
Nebulizer Treatment Nebulizer Treatment - - - - - - - - - - - - -
Injectable Medications
(See Note #3)
Injectable Medications
(See Note #3)
Injectable Medications
(See Note #3)
Injectable Insulin
(See Note #4)
- - - - - - - - - - - - - Injectable Insulin
Feeding Tube - - - - - - - - - - - - - - - - - - - - - - - - - -
Rectal Diazepam Rectal Diazepam - - - - - - - - - - - - -
 

1. As used in these guidelines, a reference to "Doctor" or "Physician" includes MDs, DOs, and Dentists licensed to practice in U.S.A., as well as also includes physicians’ assistants and licensed nurse practitioners who are authorized to issue prescriptions and who practice under the authority and supervision of a licensed physician.

2. Authorized Unlicensed Assistive Personnel (UAP): This category includes all personnel (except Registered Nurses) who (i) have been designated by the Principal to administer medication in the school setting, and (ii) have successfully completed medication administration training.

3. Injectable Medication: An Annual Health Services Prescription: Physician/Parent Authorization for Special Health Care form and a Parent/Physician Request for Administration of Medication by School Personnel form must be completed by a physician providing specific instructions for administration of injectable medications at school. The school nurse will be responsible for administering injectable medications. Only in extreme emergency situations will an UAP be asked to administer injectable medications such as Epipen or glucagon. If such medications are administered, 911 must be called for continued care in the emergency situation. Appropriate training of all UAP is required. Unlicensed Diabetic Care Assistants (UDCA) may administer injectable insulin and/or glucagon, or any prescribed oral medication according with the diabetic student’s Individual Health Plan if a Registered Nurse is not available.

4. Insulin: A student may self-administer insulin with supervision provided a Annual Health Services Prescription: Physician/Parent Authorization for Diabetic Care form and a Parent/Physician Request for Administration of Medication by School Personnel form has been completed, and the student has demonstrated competence in self-administration.

Note: A student may be allowed to carry and self-administer medication prescribed for asthma or anaphylaxis under the conditions provided herein.

 
IX. Documentation

A. The school nurse shall maintain a separate medication administration record for each student on the Parent/Physician Request for Administration of Medication by School Personnel (Form # 314890). School personnel shall record each dosage of medication administered on the student’s individual medication record. The date, time, and initials of the person administering the medication are required.

B. All persons administering medication in the school setting must sign the Medication Signature Sheet (See RISD Health Services Form # HS-Med-12) located in the front of the medication administration book.

C. An Incident Report must be completed for any medication error (e.g., missed doses, incorrect medication, incorrect dosage, etc.). A copy is sent to the Director of Health Services who will review the report with an RISD Health Services Medication Peer Review Committee.

D. The Director of Student Health Services shall conduct a periodic review of medication administration procedures and documentation

X. Gastrostomy Tube Feedings

Many gastrostomy tube feedings in the school setting include the physician's order for standard formulas (e.g. Pediasure, Jevity) which come pre-packaged by the manufacturer and list the ingredients contained. However, the physician may prescribe a "homemade" formula, prepared by the parent/guardian, to help meet the child's nutritional needs. When a "homemade" formula is ordered by the physician, the physician's orders must include the specific expected ingredients and indicate the prescribed ratios/volumes of the ingredients.

XI. Herbal Medication

RISD will not administer home remedies, plants, herbs, vitamins, and other non-traditional forms of medicine at school. This decision not to administer unregulated substances is based, among other reasons, on the following rationale:

A. All medication administered in the school setting must be approved by the Food and Drug Administration (FDA). The 1999 Dietary Supplement and Health Education Act created a “supplement” category of pharmaceuticals that includes vitamins, minerals and herbs, which do not require proof of efficacy or safety and do not provide standards for purity and equivalence to similar products from other manufacturers. The FDA has not evaluated these products.

1. The “Texas Standards of Professional Nursing Practice” require the nurse to know the rationale for and the effects of medications to correctly administer the same.

2. The purity and consistency of herbal preparations cannot be verified from batch to batch or manufacturer to manufacturer.

3. Dosage guidelines do not exist for the administration of herbals to school age children.

XII. Medication on Field Trips

A. Any medication that must be sent on a field trip must be in the properly labeled original container or in a properly labeled unit dosage container. The unit dosage container should contain only the required number of pills to be administered on the field trip. A registered nurse or another qualified district employee must fill the properly labeled unit dosage container from the original properly labeled container.

B. A copy of the Parent/Physician Request for Administration of Medication by School Personnel (Form # 3314890) must accompany each medication to be administered on the field trip.

C. The parent/guardian may submit written permission for the school to waive a dose of medicine for the field trip if the medication can be safely rescheduled or omitted.

D. The Principal or designated UAP who will administer medications on a field trip will follow RISD District Policies and Guidelines in the administration of medication

XIII. Training

A. The school nurse will train all school personnel whom the Principal has designated to administer medication prior to their administration of any medication. The school nurse and/or Director of Student Health Services will periodically re-evaluate the skills of the Principal designee to administer medication. Additional training will be provided, as needed, or as otherwise required by law.

B. The Checklist for Medication Administration Training Form (See RISD Health Services Form # HS-Med-11) will be filled out for each Principal designee every year.

(1) As used in these guidelines, a reference to "Doctor" or "Physician" includes MDs, DOs, and Dentists licensed to practice in U.S.A., as well as also includes physicians’ assistants and licensed nurse practitioners who are authorized to issue prescriptions and who practice under the authority and supervision of a licensed physician.

     
 
 
 
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