JLCD: ADMINISTRATION OF MEDICATION TO STUDENTS
Although the School Committee discourages the administration of medication to students during the school day when other options exist, it recognizes that in some instances a student’s chronic or short-term illness, injury, or disabling condition may require the administration of medication during the school day. The school will not deny educational opportunities to students requiring the administration of medication in order to remain in attendance and participate in the educational program.
The intent of this policy is to promote the safe administration of medications to students by school personnel and to provide for authorization of student emergency self-administration of medication from asthma inhalers and epinephrine. Auto-injectors with health care provider approval and school nurse assessment demonstrating competency, and authorizes any student who attends public school to possess and use topical sunscreen product while on school property or at a school-sponsored event without a note or prescription from a health care provider if the product is regulated by the federal Food and Drug Administration for over-the-counter use for the purpose of limiting skin damage from ultraviolet radiation.
The School Committee encourages collaboration between parent/legal guardian and the schools in these efforts.
The School Committee disclaims any and all responsibility for the diagnosis, prescription of treatment, and administration of medication for any student, and for any injury arising from a student’s self-administration of medication.
I. DEFINITIONS
“Administration” means the provision of prescribed medication to a student according to the orders of a health care provider.
“Allergen” is a substance that can cause an allergic reaction.
“Anaphylaxis” is a severe, whole-body allergic reaction to a chemical that has become and allergen.
“Asthma Inhaler” is a device for the delivery of prescribed asthma medication which is inhaled. It includes metered dose inhalers, dry powder inhalers and nebulizers.
“Collaborative practice agreement” A written and signed agreement between a physician licensed in this State or a school health advisor under section 6402-A and a school nurse under section 6403-A that provides for the prescription of certain medications by the physician or school health advisor and administration of these certain medications by the school nurse or designated school personnel to a person in specific situations as described in this rule. [20-A MRSA §6305 and §6307].
“Health care provider” means a medical/health practitioner who has a current license with a scope of practice that includes prescribing medication.
“Indirect supervision” means the supervision of an unlicensed school staff member when the school nurse or other health care provider is not physically available on site but immediately available by telephone.
“Medication” means prescribed drugs and medical devices that are controlled by the U.S. Food and Drug Administration and are ordered by a healthcare provider. It includes over-the-counter medications prescribed through a standing order by the school physician or prescribed by the student’s health care provider.
“Medication Error” is when a medication is not administered as prescribed. This includes when the medication prescribed is not given to the correct student, at the correct time, in the dosage prescribed, by the correct route, or when the medication administered is not the correct medication.
“Parent/legal guardian” means a natural or adoptive parent/legal guardian, or a person acting as a parent/legal guardian of a child with legal responsibility for the child’s welfare.
“School Health Advisor” means a physician or family or pediatric nurse practitioner per [20-A MRSA §6402-A]
“School nurse” means a registered professional nurse with Maine Department of Education certification for school nursing.
“Self-administration” is when the student administers medication independently to him/herself under indirect supervision of the school nurse.
“Sunscreen” means any product regulated by the FDA as an over-the-counter product designed to protect skin from harmful UVA/UVB rays from the sun. For purposes of use in the school setting, allowable products include oils, lotions, creams, gels, butters, pastes, ointments, and sticks.
“Training for Unlicensed School Personnel” means the education of unlicensed school personnel to safely administer a medication for which they have received training. Documentation of the training will be maintained.
“Unlicensed school personnel” are persons acting on behalf of the school who do not have a professional license that allows them, within the scope of that license, to administer medication.
II. ADMINISTRATION OF MEDICATION BY SCHOOL PERSONNEL
The school nurse, under the administrative supervision of the Superintendent, will provide direction and oversight for the administration of medication to students.
A. Parent/Legal Guardian Consent
In the event that no reasonable alternative exists, the parent/legal guardian may consent in writing that medication be administered to the student during the school day. The written consent must include an acknowledgement and agreement that unlicensed personnel may administer the medication as per the health care provider’s instructions. In addition, the consent shall indicate that information regarding the student’s medication may be shared with appropriate school personnel. Parent/legal guardian must provide the reason requiring the administration of medication. Consents shall be valid for the current school year only. Verbal permission may be used if needed due to extenuating circumstances. For this purpose, explicit verbal permission from the parent/legal guardian must include the medication requested, dose, route, and time interval to be given. This is to be documented in the student health record and valid for one day only.
B. Health Care Provider’s Order
A written order from the student’s health care provider substantiating the fact that the administration of a particular medication during the school day is necessary for the student’s health and attendance in school must be obtained prior to the administration of the medication. Such an order must include:
1. The student’s name;
2. The name of the medication;
3. The dose;
4. The route of administration (e.g., tablets, liquid, drops); and
5. Time intervals for administration (e.g., every four hours, before meals);
6. Any special instructions; and
7. The name of the prescribing health care provider.
School nurses are responsible for their own actions in the administration of medication. It is the responsibility of the school nurse to clarify any medication order that they believe to be inappropriate or ambiguous. In accordance with Department of Education Rule Chapter 40 § 2(B), the school nurse has the right and responsibility to decline to administer a medication if they believe such administration would jeopardize student safety. In this case, the school nurse must notify the parent/legal guardian, the student’s health care provider and the school administrator (i.e., building principal or designated administrator).
A medication label that provides sufficient information may be used in lieu of a written order unless the medication is to be administered for more than 15 consecutive days.
C. Renewal of Parent/Legal Guardian Consent/Form and Health Care Provider Order
A written parent/legal guardian consent form and a health care provider orders must be renewed at least annually. Health care provider orders must be renewed whenever there are changes in the medication order.
D. Delivery and Storage of Medication
The student’s parent/legal guardian or another adult shall deliver any medication to be administered by school personnel to the school in its original container with an unaltered pharmacy label. In the event that this is not practical, the parent/legal guardian must contact the school to make alternate arrangements. Students that self-carry medication may bring those medications to school themselves.
If the health care provider’s order/prescription is for a medication regulated by the Federal Narcotics Act, no more than a one-week supply shall be kept at school.
The parent/legal guardian is responsible for notifying the school of any changes in or discontinuation of a prescribed medication that is being administered to the student at school. The parent/legal guardian must remove any medication no longer required or that remains at the end of the school year. If medications are not retrieved by the parent/legal guardian at the end of the school year, the school nurse shall dispose of them properly.
Medications will be counted upon arrival and stored appropriately. Those medications that are Class II substances shall be counted on a Control Count Register and shall be kept double locked unless being administered or counted.
E. Recordkeeping
School personnel and the student’s parent/legal guardian shall account for all medication brought to school. The number of capsules, pills or tablets, and/or the volume of other medications brought to school shall be recorded in either the electronic health record or Control Count Register.
School staff administering medication shall document each instance the medication is administered, including the date, time, and dosage given.
The school nurse shall maintain a record including the parent’s/legal guardian’s consent, physician’s order, details of the specific medications (including dosage and timing of medication), and documentation of each instance the medication is administered.
Records shall be retained according to the current State schedules pertaining to student health records.
F. Confidentiality
To the extent legally permissible, staff members may be provided with such information regarding medication and its administration as may be in the best interest of the student.
G. Administration of Medication
The first dose of a newly prescribed medication should be given at home for close monitoring of its effects. The exception will be the use of an epinephrine auto-injector by the student or nurse for a known allergy or by the school nurse, if one is available, for a student with an unknown anaphylaxis, or emergency medication for diabetes such as, but not limited to glucagon or other life-saving medication.
Medication may be administered during the school day by licensed medical personnel acting within the scope of their licenses.
All unlicensed personnel (principals, teachers, education technicians, school secretaries, coaches, bus drivers, etc.) who administer medication must receive training before being authorized to do so.
The School Nurse will carry rescue medications in a ‘Go-Bag’ in the event of a disaster.
Based upon the documentation of training and competency in the administration of medication, the school nurse will make recommendations to the Superintendent/designee pertaining to authorization of unlicensed persons to administer medication. Training that shall be acceptable for the purpose of authorization of unlicensed personnel is addressed under the section of this policy titled “Required Training of Unlicensed Personnel to Administer Medication.”
H. Administration of Medication During Off-Campus Field Trips and School-Sponsored Events
The school will accommodate students requiring administration of medication during field trips or school-sponsored events as follows: The school nurse, principal, and, as appropriate, the school unit’s Section 504 Coordinator and/or IEP team will determine whether an individual student’s participation is contraindicated due to the unstable/fragile nature of their health condition, the distance from emergency care that may be required, and/or other extraordinary circumstances. The student’s parent/legal guardian and primary care provider, if indicated, will be consulted in making this determination. The decision will be made in compliance with applicable laws, including the IDEA, § 504 and the Americans with Disabilities Act (ADA).
The parent/legal guardian must provide the appropriate number of doses needed for the duration of the field trip or school-sponsored event.
When there are no contraindications to student participation, an appropriately trained staff member will be assigned to administer medication. The parent/legal guardian will be encouraged to accompany the student, if possible, to care for the student and administer medication.
All provisions of this policy shall apply to medications to be administered during off-campus field trips and school-sponsored events and remain in compliance with section 4 of the Rule for Medication Administration in Maine Schools.
I. Student Self-Administration of Asthma Inhalers, Epinephrine Pens, and Insulin Pumps/Pods
Students with allergies, asthma, or diabetes may be authorized by the building principal, in consultation with the school nurse, to possess and self-administer medication from an epinephrine pen (EpiPen), asthma inhaler, or medications related to the care of insulin dependent diabetes during the school day, during field trips, school-sponsored events, or while on a school bus. The student shall be authorized to possess and self-administer medication from an epinephrine pen, asthma inhaler, or medications related to the care of diabetes if the following conditions have been met.
1. The parent/legal guardian (or student, if 18 years of age or older) must consent in writing authorization for their child to self-administer medication from an epinephrine pen, asthma inhaler, or medications related to the care of insulin dependent diabetes. The parent/legal guardian will be informed that the school cannot accurately monitor the frequency and appropriateness of use when the student self-administers medication, and that the school unit will not be responsible for any injury arising from the student’s self-medication.
2. The student must have the prior written approval of their primary health care provider and, if the student is under the age of 18, the prior written approval of their parent/legal guardian for self-administration of inhalers, epinephrine, or medications related to the care of insulin dependent diabetes. The written notice from the student’s primary care provider must specify the name and dosage of the medication, frequency with which it may be administered, and the circumstances that may warrant its use.
a. An Individualized Health Plan and Emergency Plan for anaphylaxis is needed for those with
epinephrine autoinjectors.
b. An Individualized Health Plan and Emergency Plan is needed for those students with asthma requiring treatment and management at school.
c. An Individualized Health Plan and Emergency Plan is needed for those students with diabetes
requiring treatment and management at school.
3. The student’s parent/legal guardian must submit written verification to the school from the student’s primary care provider confirming that the student has the knowledge and the skills to safely possess and use an epinephrine pen, asthma inhaler, or other medications related to the care of their insulin dependent diabetes.
4. The student demonstrates to the school nurse their ability to carry and use the inhaled asthma medication, epinephrine auto-injector, or medication related to the care for their insulin dependent diabetes properly and responsibly. The school nurse should consider the ability of the student to understand their diagnosis, appreciate the importance of taking their medication at the right time and in the right amount and accept the responsibility that comes with self-carry medications.
5. Recognizing that there are many unique medical needs of children. If it is determined within the Individualized Health Plan that self-carrying a specific medication not previously addressed in this rule is necessary, a school nurse may allow it so long as the conditions in 1-4 are met.
6. Authorization granted to a student to possess and self-administer medication from an epinephrine pen, asthma inhaler, or medication related to the care of insulin dependent diabetes shall be valid for the current school year only and must be renewed annually.
7. Students may possess and self-administer topical sunscreen without a signed order from a health care provider under the following conditions:
a. Sunscreen is to be in its original container, labeled with directions of use and warnings.
b. Written permission from a parent/legal guardian as required by Section 2 C (ii)(1).
c. School nurse or other school personnel may inspect sunscreen product for safety and proper FDA labeling.
d. There is no expectation that school staff will apply sunscreen to students.
e. There is no expectation that the school will supply sunscreen to all students.
f. A student who is unable to physically apply sunscreen may be assisted by school personnel when directed to do so by the student, if permitted by a parent/legal guardian or guardian and authorized by the school.
g. It is recommended that aerosol or spray sunscreen not be used in schools because it could adversely affect students with asthma and/or allergies.
A student’s authorization to possess and self-administer medication from an epinephrine pen, asthma inhaler, or medications related to the care of diabetes may be limited or revoked by the building principal after consultation with the school nurse and the student’s parent/legal guardian if the student demonstrates inability to responsibly possess and self-administer such medication.
To the extent legally permissible, staff members may be provided with such information regarding the student’s medication and the student’s self-administration as may be in the best interest of the student.
Sharing, borrowing, or distribution of medication is prohibited. The student’s authorization to self-administer medication may be revoked and the student may be subject to disciplinary consequences for violation of this policy.
J. Required Training of Unlicensed Personnel to Administer Medication
It is understood that the school administration delegates to voluntary unlicensed personnel medication administration following a training conducted by the school nurse.
Staff will be trained annually on administration of emergency medications including the detailed standards for the signs and symptoms of anaphylaxis and the use of epinephrine autoinjector for previously unknown severe allergies.
Unlicensed school personnel who administer medication to students in a school setting (at school, on school transportation to or from school, on field trips, or during school-sponsored events) must be trained in the administration of the medication to be administered before being authorized to carry out this responsibility. Such training must be provided by a registered professional nurse or physician and include the components specified in Department of Education Rules Chapter 40 and other applicable Department of Education standards, recommendations, programs, and/or methodologies.
The trainer shall document the training and competency of unlicensed school personnel to administer medication. Based upon a review of the documentation of training and competency in the administration of medication, the school nurse will make recommendations to the Superintendent/designee pertaining to authorization of such unlicensed personnel pertaining to authorization to administer the medication.
The training on administration of medication must include the following components:
1. Current laws and school policies related to medication administration,
2. Resources available to staff regarding medication administration,
3. Basic anatomy of routes of medication administration,
4. Basic classifications of medication,
5. Common medications with side effects,
6. How to read a medication label,
7. How to document medications administered and medication errors,
8. The five rights of medication administration (student, medication, route, dose, time),
9. Procedures/protocols for administering medication,
10. Signs and symptoms of anaphylaxis,
11. Signs and symptoms of adverse effects,
12. Responding to emergencies,
13. Working with parent/legal guardian, and
14. Protecting the confidentiality of student health information.
Following the initial training, a training review and information update must be held at least annually for those unlicensed school personnel authorized to administer medication.
The training on administration of medication need not include the following components listed in above at the discretion of the school nurse. The training should be sufficient for the safe administration of the needed medication. This training is considered appropriate for the specific field trip/off-campus event.
K. Delegation and Implementation
The Superintendent/designee shall be responsible for developing administrative procedures and/or protocols to implement or supplement this policy.
Such procedures/protocols shall include direction regarding:
1. Safe transport of medication to and from school;
2. Administration of medication during field trips and school-sponsored events;
3. Accountability for medications, particularly those regulated by the Federal Narcotics Act;
4. Proper storage of medication at school;
5. Training of appropriate staff on administration of emergency medications;
6. The procedure to follow in the event of a medication reaction;
7. Access to medications in case of a disaster;
8. The process for documenting medications given and medication errors; and,
9. The proper disposal of medications not retrieved by parent/legal guardian.
L. Medication Administration On School Field Trips
1. Any unlicensed personnel administering medications must have documentation of their training in the administration of medication on file in the school, including personnel administering medication on a field trip.
2. There must be written permission from the parent/legal guardian providing consent to administer the medication in school and a written physician’s order and/or an appropriately labeled, original medication container.
3. Duplicate medication containers shall be obtained from the pharmacy to be used for field trips as this is
considered best practice.
4. The school nurse will provide a review of the medication and its administration to the trained personnel on an as needed basis. All trained personnel administering medication must understand what to do in an emergency.
5. The medication will be transported and stored in compliance with any special directions for the medication and will be secured as safely as possible.
6. The administration of medication on a field trip will duplicate as much as possible, the guidelines found in the “Guidelines for Training of Non-Licensed Personnel in Medication Administration.” This will include consideration of student privacy and cleanliness of the area where medications are administered.
7. Medication will be administered to the student to assure that the right student receives the right medication, with the right dose, at the right time, by the right route. The trained personnel administering the medication will double-check the student with the medication label and will double-check the dose. The medication will be given within 30 minutes either side of the prescribed time. The nurse will review with the Unlicensed staff the name of the physician prescribing the medication, and any special or emergency directions. Staff will call the school nurse with questions regarding medication administration.
8. Trained unlicensed staff that administers the medication will document administration on the Medication Administration Record.
9. Special Considerations
a. Out of State Field Trips. Schools must consider other states’ laws when administering medications. It is advisable that the school nurse contact the Board of Nursing in the state of the school trip regarding questions about unlicensed school personnel administering medications. Some states do not allow unlicensed school personnel to administer medications, for example.
If the school nurse is attending the out of state field trip, they should determine if it is part of the Nurse Licensure Compact, which allows a nurse to have one multistate license with the ability to practice in the home state and other compact states. If the state is not a compact state, then the school nurse should contact that state’s office that regulates nursing practice.
b. Self-administration of medication. School administrative units have the discretion to create procedures to allow for self-administration of medication by students on overnight trips or in unique situations where there may not be authorized adults to hold/administer medication. This procedure must include the consent of both the student’s parent/legal guardian and medical provider in cooperation with the school nurse. The student should be knowledgeable about their condition/medication and sufficiently responsible to possess and capable of self-administration. The arrangements must be done in advance to allow for the communication between medical provider and school nurse.
c. Refer to Policy JLCDA for details regarding the administration of medical marijuana on in-state or out-of-state field trips.
M. Medication Errors and/or Reactions
1. In the event of a medication error or reaction the student’s safety will come first.
2. Once the student is safe, the school nurse will contact the parent/legal guardian and health care provider to report the error or reaction.
3. Any medication error will be recorded on a Student Accident form and will be submitted to Central office to Human Resources.
4. Any medication reaction will be noted in the child’s health chart or electronic record.
5. In the event of an error, a review of medication administration procedures will be performed by the school nurse in conjunction with the Superintendent/designee.
N. Stocking, Possessing, and Use of Naloxone Hydrochloride
The school nurse or other licensed health care professional whose scope of practice includes administration of naloxone hydrochloride is authorized to stock and possess naloxone hydrochloride prescribed by a legally authorized individual and to administer such naloxone hydrochloride to a student, staff member or visitor experiencing an apparent opioid overdose during school, during a school-sponsored activity or on school grounds.
O. Epinephrine Guidelines
1. A Life-threatening Allergy Protocol is available on the nurse’s website and includes steps taken to prevent exposure, training frequency, designated staff, record keeping, and reporting. [20-A MRSA §6305 (9)]
2. Without a Collaborative Practice Agreement in place, a trained unlicensed school staff member can administer epinephrine only to a specific student as part of that student’s individual health plan (IHP) with a prescription specific to that student. A school nurse may administer epinephrine to any person whom they believe to be experiencing anaphylaxis so long as there is a standing order from the school health advisor for this purpose. [20-A MRSA §6305 (5)]
3. Students with a medically documented known allergy and risk of anaphylaxis should have an individualized health plan in place.
4. Training for school staff shall include common allergens, causes and signs of anaphylaxis, prevention, how to recognize anaphylaxis, and how to administer epinephrine auto injector.
P. Medical Marijuana Guidelines
Reasonable accommodations must be made for students who hold written certification for the medical use of non-smokeable marijuana under Title 22, section 2423-B. [20-A MRSA §6306] For the purposes of this rule cannabidiol (CBD) oil is a marijuana product and subject to the same limitations. Medical marijuana may only be possessed and administered under the following conditions:
a. The student requires a dose during the school day.
b. It is possessed by the parent/legal guardian or caregiver only.
c. Only the parent/legal guardian or caregiver may administer medical marijuana – it cannot be done by, or delegated to, a school employee or any other person than the primary caregiver.
Refer to policy JLCDA for more guidelines in the use of Medical Marijuana in schools
Q. Glucagon Rescue Therapy Guidelines
Undesignated ready-to-use glucagon rescue therapy may be administered by a school nurse or unlicensed school personnel (who has completed approved training) to a student with a known diagnosis of diabetes if the student’s prescribed glucagon is not available on site or has expired. The glucagon rescue therapy may be administered on school property (including the school building, playground, school bus, during field trips, and sanctioned excursions away from school property).
The law permits schools to maintain supplies of undesignated ready-to-use glucagon rescue therapy.
R. Reporting
1. Each school administrative unit and approved private school is encouraged to submit to the Department of Education, on a form developed by the Department, a report of each incident in the school administrative unit or the approved private school or at a school event involving a severe allergic reaction or the administration of an epinephrine autoinjector or administration of naloxone for a suspected opioid overdose; and
2. The Department may request reports on medication administration in schools.
Adopted: July 5, 1994
Revised: September 2, 2003: June 15, 2004: June 5, 2012; March 19, 2019; December 21, 2021; May 3, 2022;, November 21, 2023
Reviewed by PC: January 5, 2023
Legal Reference:
20-A M.R.S.A. §§ 254; 4009(4); 4502 (5)(N)Ch. 40; 125 § 10.01(c) (Me. Dept. of Ed. Rule)
28 C.F.R. Part 35 (Americans with Disabilities Act of 1990)
34 C.F.R. Part 104 (Section 504 of the Rehabilitation Act of 1973)34 C.F.R. Part 300 (Individuals with Disabilities Education Act)
20-A M.R.S.A. §254(5) (A-D); Resolve 2005 ch. 11; PL 2013 ch. 526; PL 2019 ch.32