Policy 5.321

Administration of Student Medication/Treatment

1. Duties and Authority of District School Personnel Regarding Student Medication

   1. Pursuant to Fla. Stat. § 1006.062(1), "Notwithstanding the provisions of the Nurse Practice Act, part I of Chapter 464, school district personnel may assist students in the administration of prescription medication," if the following conditions have been met:

      1. As required by Fla. Stat. § 1006.062(1)(b)1, for each prescribed medication, the student's parent or guardian shall provide to the school principal a signed Physician's Authorization for Student Medication/Treatment form ("Authorization form") prepared by the Health Department) which shall grant to the principal or the principal's designee permission to assist in the administration of such medication and which explains the necessity for the medication to be provided during the school day, including any occasion when the student is away from school property on official school business;

      2. "The school principal or the principal's trained designee shall assist the student in the administration of such medication" pursuant to Fla. Stat. § 1006.062(1)(b)(1);

      3. District personnel shall be trained by a registered nurse, licensed practical nurse, physician's assistant, or physician according to a procedure which the School Board shall include in its approved school health services plan as required by Fla. Stat. § 1006.062(1)(a);

      4. "Each prescribed medication to be administered by District School Board personnel shall be received, counted, and stored in its original container. When the medication is not in use, it shall be stored in its original container in a secure fashion under lock and key in a location designated by the principal," pursuant to Fla. Stat. § 1006.062 (1)(b)2;

      5. A properly executed Physician's Authorization for Student Medication/Treatment form ("Authorization form" prepared by the Health Department) must be on file for the student and the particular medication; and

      6. Other conditions have been fulfilled, and procedures have been followed, as are set forth in this Policy, Sections 1(b) through 8(f) (ii).

   2. A minimum of two (2) District personnel shall be designated by the principal of each school to assist in the administration of medication. These designees will be trained at the beginning of each school year.

   3. District personnel will be designated by the principal to administer medication, as necessary, during a field trip. The designee will be trained by a school nurse.

   4. The Authorization form provided by the custodial parent/guardian shall be a confidential medical record. The Authorization form is to be made available for review only to District personnel designated by the principal to administer medication.

   5. By signing the Authorization form, the custodial parent/guardian provides permission for District personnel designated by the principal to:

      1. administer medication/treatment;

      2. share relevant information with appropriate staff; and/or

      3. contact the student's health care provider concerning the medication ordered.

   6. Pursuant to Fla. Stat. § 1006.062(2), "there shall be no liability for civil damages as a result of the administration of such medication, when the person administering such medication acts as an ordinarily reasonably prudent person would have acted under the same or similar circumstances."

   7. Schools do not have the authority in the absence of the Authorization form or consent of the custodial parent/guardian to administer, or require students to take, medication.

   8. Medications are to be kept in a double-locked cabinet or locked refrigerator.

   9. Medications shall be administered in compliance with the requirements in Section (7) of this Policy.

   10. Medication/treatment orders and Medication Administration Records (MAR) shall be filed in the student's confidential health record (located in the school health room).

2. Authority and Responsibility of the School Nurse

   1. In schools where a school nurse is assigned full-time, the school nurse will manage the medication administration program.

   2. In schools where a part-time school nurse is assigned, or when the school nurse is absent, the administration of medication comes under the authority of the school principal.

   3. Medication/treatment shall be administered in compliance with Section (7) of this Policy.

3. Custodial Parent/Guardian's Request for Student Medication/Treatment

   1. Requests from a custodial parent/guardian for their child to receive any medication/treatment during school hours must be made by submitting a properly executed Authorization form to the school nurse or principals. Further, it is the responsibility of the parent(s)/guardian to notify school administration if the student needs to use a blood glucose monitoring device and/or insulin delivery system at school.

   2. A separate Authorization form must be submitted for:

      1. each medication;

      2. each treatment;

      3. each dosage change; and/or

      4. each new school year.

   3. The custodial parent/guardian may retrieve the medication/treatment from the school at any time before the end of the school year.

   4. Medication that is not retrieved by the custodial parent/guardian after one (1) week following the termination of the physician's order will be destroyed.

   5. Medication that is not retrieved by the custodial parent/guardian within two (2) days after the close of the school year will be destroyed.

   6. When medication is destroyed, this action shall be taken consistent with Fla. Stat. § 499.0121, in such a manner as to ensure total destruction of the substance so that no one could make use of the medication or be harmed by it.

   7. The Authorization form is to be obtained from the office of the student's physician.

4. Medication/Treatment Prescribed by a Physician

   1. Prescribed medication by a physician should be brought to school by the custodial parent/guardian in the original container.

   2. The medication should be given to the school nurse and/or principal's designee.

   3. The container must be appropriately labeled by a pharmacy or by the physician showing:

      1. student's name;

      2. physician's name;

      3. medication name, dose, and administration information;

      4. prescription number (if applicable);

      5. prescription date; and

      6. expiration date.

   4. If the prescription medication is in pill or capsule form, the pills/capsules are to be counted by the school nurse and/or principal's designee in the presence of the parent/guardian and both shall sign the student's Medication Administration Record noting the date, the amount of medication received, and their signatures.

   5. If the prescription medication is in liquid form, the amount of liquid in the container is to be documented by the school nurse and/or principal's designee in the presence of the parent/guardian and both shall sign the student's Medication Administration Record noting the date, the amount of medication received and their signatures.

5. Over-the-Counter Medication

   1. Over-the-counter medication must be:

      1. authorized by a physician;

      2. in the new sealed original container; and

      3. labeled with the student's name by the custodial parent/guardian.

   2. If the over-the-counter medication is in pill or capsule form, the number of pills/capsules is to be documented by the school nurse and/or principal's designee in the presence of the parent/guardian and both shall sign the student's Medication Administration Record noting the date, the amount of medication received, and their signatures.

   3. If the over-the-counter medication is in liquid form, the amount of liquid in the container is to be documented by the school nurse and/or principal's designee in the presence of the parent/guardian and both shall sign the student's Medication Administration Record noting the date, the amount of medication received, and their signatures.

6. Students' Rights and Responsibilities

   1. While on District property, asthmatic students shall be allowed to retain a metered dose inhaler when they have written approval from the custodial parent/guardian and physician (on an "Authorization form") pursuant to Fla. Stat. § 1002.20(3)(h). The school nurse and/or principal's designee shall maintain a copy of these approvals in the medication administration record.

   2. Diabetes management. Pursuant to Fla. Stat. § 1002.20(3) (per HB 747 (2010)), school assignments for students with diabetes will not be restricted on the basis that the student has diabetes, due the absence of a full-time school nurse or due to the absence of school district employees trained in the management of diabetes.

      1. Students with diabetes whose parents/guardians and physician provide written authorization to the school principal may carry diabetic supplies and equipment on their person and attend to the management and care of their diabetes while in school, participating in school-sponsored activities, or in transit to or from school or school-sponsored activities to the extent authorized by the parent and physician and within the parameters set forth by State Board of Education rule. The written authorization shall identify the diabetic supplies and equipment that the student is authorized to carry and shall describe the activities the child is capable of performing without assistance, such as performing blood-glucose level checks and urine ketone testing, administering insulin through the insulin- delivery system used by the student, and treating hypoglycemia and hyperglycemia.

      2. As provided in Board Policy 5.3212, students who need to monitor their blood glucose levels during the school day, as ordered by their physician, have the responsibility of showing the monitoring device and/or insulin delivery system to their teachers and administrators and school nurse at the beginning of the school year or at such later date as corresponds with their starting to use such medical devices at school. The device(s) must be labeled consistent with Sections (4) or (5) above.

   3. While in school, participating in school sponsored activities, or in transit to or from school or school-sponsored activities, students who have experienced or are at risk for experiencing life-threatening allergic reactions shall be allowed to retain an epinephrine auto-injector (not including a two-dose delivery system) and self-administer epinephrine by auto-injector when they have provided the school with written approval from the custodial parent/guardian and physician (on an "Authorization form") pursuant to Fla. Stat § 1002.20(3)(i). The school nurse and/or principal's designee shall maintain a copy of these approvals in the medication administration record.

   4. Pursuant to Fla. Stat. § 1002.20(3) (per SB 166 (2010)), a student who has experienced or is at risk for pancreatic insufficiency or who has been diagnosed as having cystic fibrosis may carry and self-administer a physician prescribed pancreatic enzyme supplement while in school, participating in school-sponsored activities, or in transit to or from school for school-sponsored activities with authorization from the student's parent.

   5. To facilitate correct identification and maintain the health and safety of the student during the administration of the medication/treatment by the school nurse and/or school district staff, the parent/guardian must provide each school year a recent photograph of the student to the principal's designee.

7. Administration of Medication

   1. A reasonable attempt shall be made to administer medicine in a manner which shall not interfere with the educational process.

   2. If the information required in the Authorization form as required in Section (3) (b) (i-vi) above is not available, or the container is not labeled properly pursuant to Section (4) (d) (i-vi), the medication/treatment will not be administered to the student by the school nurse and/or principal's designee.

   3. Further, the medication/treatment will not be administered, and the custodial parent/guardian and the principal/designee must be notified, if:

      1. there is a conflict between the physician's order and the medication label directions (e. g., conflicts regarding the name of the medication, the student's name, the time the medication is to be given, or the dosage);

      2. there is a possible contamination of the medication;

      3. if the medication is to be taken orally, and the student is unable to swallow oral medication;

      4. there has been a change in the medication's color or composition;

      5. there is a question of the student's identity;

      6. the medication has expired; or

      7. the student refuses to take the medication.

   4. Medication "rights" are to be observed before medication is administered to a student. These include but are not limited to:

      1. right student: the student is to be identified before medication is administered.

      2. right medication: the orders must match the medication label.

      3. right dosage: the orders must match the medication label.

      4. right time: the orders must match the medication label and the medication is to be given within thirty (30) minutes before or after the prescribed time.

      5. right route: the medication must be properly administered. Examples of administration are inhalation, oral or injection.

      6. right documentation: following the medication administration or provision of a treatment, documentation must be completed on the student's Medication Administration Record.

   5. The school nurse/principal's designee must observe the student while the student is taking the medication.

   6. Oral medication should be taken with water, unless otherwise specified by the ordering physician.

   7. Any deviation from Section (7) of this Policy must be noted in the student's medication administration record and reported immediately by telephone to the custodial parent/guardian and to the principal/designee.

8. Individual Medication Record

   1. The medication administration record is a legal document.

   2. The person who administers the medication shall note the following information on the student's medication administration record each time a medication/treatment is administered, and all such information shall be recorded in ink :

      1. the initials of the person administering the medication/treatment;

      2. the name and dosage of the medication/treatment; and

      3. the date and time the medication/treatment was given; or

      4. a notation if the medication/treatment should have been administered, but was not.

   3. Any medication/treatment that is administered on an "as needed" basis shall be recorded each time it is given.

   4. Errors made in signing out medications must be crossed out, initialed, and correctly entered; and

   5. Correction fluid, erasures, correction tape or similar items are not permitted on the medication administration record.

   6. The custodial parent/guardian and the principal/designee must be notified, and the medication/treatment will not be administered, if:

      1. there is no written and/or signed physician order in the medication administration record; or

      2. the medication administration record does not contain a signed permission from the custodial parent/guardian.