The administration of medication in the school setting is a service offered to parents and students to promote wellness and decrease absenteeism.  When there is a need for a student to receive medication in school, safe and proper administration is essential.

 I.    Prescription Medication

        A.    Medication Authorization

All prescription medication to be given in school must be ordered by a person authorized to prescribe medication in Maryland.  Maryland law defines authorized prescriber as physician, nurse practitioner, certified midwife, podiatrist, physician’s assistant or dentist.  (Section 12-101(b) Health Occupations, Annotated Code of Maryland) 

The order must be signed by the authorized prescriber.  In lieu of a written signature, a stamp with the prescriber’s signature or electronic signature is acceptable; however, a printed name stamp is not acceptable. A medication authorization form must accompany each medication order.  An order should be renewed annually even if the order is for a (whenever necessary) medication.  The authorization should be filed in the student’s school health record.  See Appendix A. 

Verbal orders from an authorized prescriber may be taken only by a registered nurse (RN) or a licensed practical nurse (LPN).  This order should be recorded by the nurse in the student’s medication record and must be followed up, within ten days, by a written order from the prescriber.  If unable to obtain the written order, the nurse should attempt to contact both the prescriber and parent/guardian.  If the written order is not received within ten days, administration of the medication must be discontinued in school. 

Faxed orders for the administration of medication may be accepted when submitted on an authorized form and signed by an authorized prescriber.  The parent/guardian should sign the authorization within ten days.  The authorization should be filed in the student’s health record.

        B.    Parental Consent

Written parental consent is required for each medication ordered and for each new order (even if the medication was previously given in school).  See Appendix A.

In the case of verbal orders from an authorized prescriber, verbal consent from the parent should be obtained and documented, to be followed by the written consent within 10 days.

Parental consent forms should be filed in the student’s school health record.

        C.    Labeling, Storage, and Disposal

The original prescription container should accompany all medications to be administered in school.  Parents should request two containers (one for school and one for home) from the pharmacist when getting a prescription filled.  Medications should be brought to the school by the parent or responsible adult, especially for elementary school students.  However, if this is not possible, the parent/guardian should inform the school nurse, principal, or designee by telephone that his/her child is bringing the  non-narcotic medication to school and how much of the medication is in the container.  This alleviates any questions about how much medication should have been in the container when the child reached the school.  The amount of medication received should be checked by the school nurse, principal, or designee and documented as soon as the student delivers the medication, the exception being narcotics.

The original prescription container should be labeled with the following:

• Name of student.

• Name of medication

• Dosage of medication to be given.

• Frequency of administration.

• Route of administration.

• Name of physician/authorized prescriber ordering medication.

• Date of prescription.

• Expiration date. 

In compliance with the School Health Standards (COMAR 13A.05.05.05--.15), all  medication must be stored in a locked cabinet.  Medications that must be refrigerated must be stored in a locked box in the refrigerator.  Access to medication locked in the designated space shall be under the authority of the designated school health professional, the principal, and/or designee. 

All medication must be destroyed one week after the expiration date or at the end of the school year.  If not retrieved by a parent or responsible adult, unused and unclaimed medication should be disposed of by flushing. Empty asthma inhalers may be disposed of in the trash.  Sharps (needles, lancets) should be disposed of in a puncture proof container.  Puncture-resistant biohazard containers will be used for the disposal of all sharps such as needles, syringes, and lancets.  These containers will be ordered by the facility or school nurse or designee through the Maintenance Office and will be stored at each work site with other medical supplies.  Containers will be placed in every room where sharps are used.  All biohazard sharps containers must be under the control of a staff person when in use and/or stored in areas where they are inaccessible to the public.  When the container is three quarters (3/4) full, treat the contents with bleach, turn the top to the locked position and place the container in the regular waste.  Containers will be placed only in buildings where sharps are used.  (Garrett County Exposure Control Plan)

        D.    Administration of Medication

The designated school health professional, in collaboration with the principal, implements the medication policy.  School staff and parents should be informed of the medication policies and procedures annually.

• The parent/guardian should give the first dose of any new prescription or over-the-counter medication, except for emergency medications (e.g. Epi-Pen);

• Prescription medications should be counted when sent to school.  The designated school health professional should record and sign the MAR along with that of a witnessing parent/guardian or a responsible employee.

• A record must be maintained each time a medication is administered.  See Appendix B  Students who self-administer must inform the designated school health professional, principal or their designee of the need for medication, as soon as possible.

• A plan should be developed by the school nurse, parent/guardian, and physician, and should address how to keep records of administration. It must be determined by the nurse whether a student who self administers medication is responsible to self carry their medication. The developmental ability of the student, the need to have ready access to emergency medication and the safe storage of medication must be taken into account when making this decision.

II.    Narcotics

If a narcotic must be administered in school, the guidelines for prescription medications must be followed with the following modifications: 

• The parent/guardian shall bring the medication to school.

• The amount of the drug received should be immediately counted and recorded by the school health professional and/or designee, witnessed by a responsible employee.

• The narcotic should be counted on a scheduled basis by the designated school health professional and witnessed by a responsible employee.  This count should be reconciled with the prior count and medication administration record.

• The school nurse should maintain no more than a 30 day supply of narcotics.

• There must be a new order and parent authorization every 30 days EXCEPT if the narcotic is to be given whenever necessary.  If the narcotic is to be given for more than thirty days, the designated school health professional should contact the parent or prescriber to confirm the continued need for the medication.

III.    Over-the-Counter (OTC) Medications

The administration of over-the-counter drugs will be conducted in accordance with the guidelines for prescription medication.

• Nurses may administer over-the counter drugs only with verbal or written prescriptive order from an authorized prescriber.

• Storing and recording the administration of the over-the-counter medication should follow the same guidelines as prescription medications.

IV.    Homeopathic Medications

• Administration of homeopathic medicines will be conducted in accordance with the guidelines for prescription drugs.

• Storing and recording the administration of the over-the-counter homeopathic medication should follow the same guidelines as prescription medications.

V.    Delegation of Medication Administration to Unlicensed Staff

Plans for the administration of medications in the absence of the nurse should be developed collaboratively  by the school nurse and the principal.  The decision regarding delegation of medication administration should be considered in conjunction with other school duties, such as lunch and recess supervision.  Such comprehensive planning will ensure that the most appropriate person is assigned to each task and that medication administration is completed in a safe manner.

Criteria for Personnel Selected to Administer Medication in the Absence of the School Nurse: In all cases, the person to whom the nurse delegates the administration of medications should meet criteria set forth in COMAR 10.27.11 and COMAR 10.39.01.

In the judgment of the nurse, the task delegated can be properly and safely performed by the unlicensed individual or certified nursing assistant without jeopardizing the client’s welfare.  In the nurses judgment, the person must be competent to perform the task assigned.  Additionally, the person should:

• Be an employee and agree to this responsibility.

• Have good attendance.

• Be familiar with the students in the school.

• Possess good organizational skills.

• Handle stress in a calm manner.

• Have coverage/assistance available for regularly assigned job duties during peak times when medications must be given (usually between 11:00 a.m. - 1:00 p.m.).

• Be in a quiet environment which allows for safe and effective medication administration.

Since the majority of medication doses are scheduled for administration between the hours of 11:00 a.m. and 1:00 p.m., plans must include considerations for the person’s lunch.

COMAR 10.27.11.05G and COMAR 10.39.01 requires that persons administering medications under the direction of a nurse be appropriately trained and supervised.  Persons administering medication must be trained by using the School Health Medication Administration Training Program approved by the Maryland Board of Nursing.  This training provides instruction in the administration of oral medication.  Administration of medication by any other route requires the delegating nurse train the unlicensed person on a one-to-one basis.  Records of the date and nature of the initial training and every two year re-certification must be maintained.

Periodic direct supervision by registered nurses of personnel assigned responsibility for medication administration will occur.  Registered nurses will maintain records of this supervision using the Medication Administration Skills Checklist, which is to be completed every 45 calendar days.  (See Appendix C)

Each person assigned routine responsibility for medication administration should have at least one person designated as an alternate to substitute in the case of absence.  Selection and training of alternates should follow the same process outlined above.

Persons assigned responsibility for medication administration should have regular opportunities to administer medications in order to reinforce training and ensure that best-practice skills are maintained.

Medication administration is not an appropriate assignment for a school volunteer.

VI.    Administration of Medication on School -Sponsored Activities

Medications should be administered to students on school sponsored trips and activities only when absolutely necessary, and when possible, timing of doses should be adjusted to occur outside of the school-sponsored activity period.  Medications may be administered on school-sponsored trips and activities only when previously administered and a parent permission form is on file.  The determination of whether a medication is administered during a school-sponsored trip or activity and by whom should be determined by the designated school health professional in collaboration with the principal and parents.  Options for administration of medications during a school-sponsored  trip or activity may include the following:

• Parent/guardian may accompany student on the school-sponsored activity and administer the medication.

• A single dose of the medication can be placed in a properly labeled envelope or container by the licensed nurse only to be given on the school-sponsored activity by school personnel.

• A parent may send a single dose of medication for the field trip in a properly labeled prescription or over-the counter container to be given by school personnel.

• Following the school-sponsored activity, the single dose medication envelope should be returned to the heath suite with documentation of signature and time medication was given.  A notation should be made on the student’s medication record that the medication was administered.

VII.    Errors in the Administration of Medication

If an error in medication administration occurs (such as missing a dose, giving the incorrect dose, giving incorrect medication to the student, or giving a student another student’s medication even if the medication was same drug and dose), the procedures below should be followed:

• The student should be observed for untoward side effects from incorrect medication administration.

• Appropriate action should be taken based on nursing judgment and/or physician order.

• The parent, school administrator, nursing supervisor and primary care provider of the child getting the wrong medication should be notified.

• The appropriate reporting form should be completed (See Appendix D).

• Submit written incident report within 48 hours to the Supervisor of School Health Services.