Administration of Medication and/or Assisting with Self-Administration of Medications: As required by state law (TCA 49-5-415) all medications, with the exception of asthma inhalers and anaphylaxis medication, shall be stored in a secure, separate, locked drawer or cabinet or in a secure locked box. School nurses will provide required annual medication assistance training for all staff assigned by the principal to assist students in self-medication. Only school personnel can assist with the self-administration of medications. Parents or other volunteers including licensed health providers who are not employed by the school system cannot assist students in self-medication.
A student must meet the following conditions in order to self-administer medication:
The student must be competent to self-administer medication with assistance.
The student’s condition, for which the medication is authorized and prescribed, must be stable.
The self-administration of medication must be properly documented.
Guidelines for self-administration of medication are as follows:
Medication should be limited to those required during school hours and necessary to maintain the student’s enrollment and attendance at school.
Medications given once a day should be administered at home.
All prescription drugs given at school shall be prescribed by a licensed prescriber on an individual basis as determined by the child’s health status.
Prescription medication must be brought to school in the original, pharmacy labeled container. The container shall display:
Medication name and dosage
Administration route or other directions
Date prescription filled and expiration date
Licensed prescriber’s name
Pharmacy name, address, and phone number
All non-prescription drugs in school shall be brought to school in the original container listing the ingredients, dose schedule, and child’s name affixed to the container.
Prescription or non-prescription medication administration requires a written parent/guardian request that shall include:
Name and contact information of parent/guardian
Name of medication, dose, time of administration and route of administration
Reason medication is needed
The student’s parent/guardian must complete a “Health Management Authorization Form” except in the rare case where a student has been legally emancipated by a court and is no longer under a parent/guardian’s care. In that case, the student may consent. The returned forms shall be maintained in a secure manner as determine by the principal or school nurse and available only to appropriate staff. New forms must be submitted each school year. At the end of the school year, those medications not picked up shall be destroyed. Instructions on how to destroy medication are available from School Health.
Medication errors include:
Failure to administer medication
Administering the wrong medication dosage
Administering the wrong medication
Administering medication to the wrong student
Administering medication at the wrong time
Administering medication by the wrong route
Should a medication error occur, the principal’s or school nurse’s responsibilities are:
Contact School Health and the parent as soon as possible
Complete a Medication Error Report (available from School Health) Allergies
For students with severe allergies, parents/guardians shall provide documentation from the student’s health care provider supporting:
A diagnosis of a severe allergy and/or anaphylaxis
The identification of the allergen to which the student is allergic
Describes, if appropriate, any prior history of anaphylaxis
Detailed emergency treatment procedure in the event of a reaction
Signs and symptoms of a reaction
List of substitute meals that may be offered by school food service personnel
Listing of any medication prescribed for the child for the treatment of anaphylaxis
Assessment of the student’s readiness for self-administration of prescription medication
When a student enters school and is identified with a severe allergy, the school nurse should be notified. Students with severe allergies must have an Individual Health Plan (IHP)/ Health Management Plan developed by a school nurse. The IHP serves as the action plan in the event of severe allergic reaction. A student with a diagnosis of anaphylaxis is entitled to possess and self-administer medication on school property or during a school event if:
The prescription anaphylaxis medication has been prescribed for that student as indicated by the prescription label
The self-administration is done in compliance with the prescription or written instruction from the student’s physician or other licensed health care provider, and the parent/guardian provides the school with the following information:
Written authorization is given by the parent for the student to self-administer prescribed anaphylaxis medication at school
The student’s parent or guardian must complete a “Health Management Authorization Form” (available from School Health.) The returned forms shall be maintained in a secure manner as determined appropriate by the principal or school nurse and available only to appropriate staff.
The student’s physician or other health care provider signs a written statement that outlines:
The student’s capability of self-administering the prescribed anaphylaxis medication
The circumstances in which the student shall self-administer as well as the name and purpose of the drug 3 „X The prescribed dosage
The period of time for which the medication is prescribed. The physician’s statement shall be kept on file at school by the school nurse or administrator.
The school may suspend or revoke the student’s possession and self-administration privileges if the student misuses the medication.
The student may be subject to disciplinary action. Additional guidelines applicable to managing food allergies: „h Provide food allergy management training for all staff that may come in contact with a child who has a food allergy
Designate school personnel to receive training in the administering of medications, including anaphylaxis medication
Provide accessibility to anaphylaxis medication by trained school personnel when nurse in not immediately available and student does not carry the medication with them
Provide increased student education on the dangers of food allergies
Review policies/prevention plan with involved staff, parent/guardian, student (where age-appropriate) and physician after a reaction has occurred
Discuss field trips with the family of food-allergic child to decide appropriate strategies for managing the food allergy while on a field trip
A plan for substitute teachers should be included in the student’s IHP
Have parent complete the “Eating and Feeding Evaluation Form” provided by Nutrition.
Tennessee Code Annotated 49-5-415 was amended in 2009 to allow non-medical voluntary school personnel to administer Diastat, an emergency medication given rectally for seizures, when a school nurse is not present. Personnel who volunteer are required to attend training conducted by a registered school nurse annually and maintain current CPR training (every two years.) Volunteers who comply with these requirements shall not be liable in any court of law for injury resulting from the reasonable and prudent assistance in the administration of such medications, if performed pursuant to the policies and guidelines. The student’s parent or guardian must provide written permission for school personnel to volunteer to participate in the care of the student with diabetes, and written permission must be kept in the student’s school records. A “Health Management Authorization Form” which serves as the IHP and authorizes medication administration.
TCA 49-5-415 addresses Assistance in self-administration of medications. It notes that any person assisting in self-administration for medication or performing health care procedures including administration of medication shall not be liable in any court of law for injury resulting from the reasonable and prudent assistance in the self-administration of medications if performed pursuant to the policies and guidelines. A “Health Management Authorization Form” (available from School Health) must be completed. Schools must permit possession and self-administration of a prescribed asthma inhaler by any student with asthma if the student’s parent or guardian: Provides to the school written authorization for student possession and self-administration
4 Provides a written statement from the prescribing health care practitioner indicating the need for an inhaler at school. The health care practitioner must also provide:
Name and purpose of medication „h Prescribed dose „h Time or times when the inhaler is to be/may be used Health care practitioner orders must be renewed each school year. The school has the right to suspend or revoke the student’s privilege to carry the inhaler if misuse or sharing of inhaler occurs. Cardiopulmonary Resuscitation (CPR) and First Aid Training At least one and preferably more school staff should be trained in CPR and first aid. A First Aid/ CPR resource chart is provided to each school by School Health. Field Trips Requests for School Nurses The “Field Trip/School-Sponsored Trip Medical Assistance Request Form” (available from School Health) must be completed and returned to School Health at least one week prior to any field trip where nursing services are desired. While every attempt to support field trips will be made, staffing may not allow a nurse on every field trip while still providing nursing services at school. If nursing services are not available, training can be provided to a staff member who volunteers to assist the student medically as allowed by law. Diabetes Students with diabetes must have an Individual Health Plan (IHP) which provides parental consent and the health care practitioner’s specific orders of what must be done at school. Student must be allowed time to manage their diabetes and must have access to their diabetic supplies. Public Chapter 737 amended TCA title 49, Chapter 5 allows the training of volunteer school personnel to assist with student diabetes care in the absence of a school nurse. Students cannot be assigned to a school other than the school for which the student is zoned or would otherwise regularly attend because the student has diabetes. Actions for volunteer school personnel include: „h Understand the student’s medical management and education plan, including the emergency plan, and attending planning/evaluation meetings „h Participate in diabetes management training by the School Nurse which must be conducted annually and documented „h Learn about diabetes „h Assist with student care, excluding insulin administration which requires a school nurse, but may include blood glucose monitoring, urine ketone testing, and emergency Glucagon administration if additional training is provided (testing and proficiency demonstration are mandated by state law in order to administer Glucagon) „h Practice universal precautions and infection control procedures „h Documentation of diabetes management actions and testing „h Observation and documentation of student health and behavior, noting and reporting changes to school nurse and parents „h Respect the student’s confidentiality and right to privacy „h Accompany student on field trips or other school-sponsored events and activities „h Provide support and encouragement to the student 5 Glucagon Administration The student’s parent or guardian must provide written permission for school personnel to volunteer to participate in the care of the student with diabetes, and written permission must be kept in the student’s school records. A “Health Management Authorization Form” (available from School Health) must be completed. Head Lice If a student is positive for head lice, the student is to be given an information letter for the parents regarding treatment and control measures; the student does not have to be sent home early. The student must return to school with either a 1) receipt of purchase of lice medication, or 2) a box top, or 3) an empty bottle as proof of treatment. Health-Related Emergencies/Concerns When a health-related emergency occurs and a nurse is not present, 911 should be called immediately. The child’s parent and School Health shall be notified. Health Screenings Various screenings allow for the early identification of health problems which may interfere with the physical well-being and academic success. Schools should provide a quiet location so that health screening results will be valid. Screeners will complete the screenings with as minimal classroom interruption as possible. Parents/Guardians who do not want their children screened have the right not to have their child screened. Every student will be screened, unless parents/guardians refuse by signing and returning a form that will be sent home in advance. Parents will be notified of any abnormality identified for which follow-up is recommended. Notification can be written or verbal. A minimum of three attempts will be made, if needed, to achieve appropriate notification. Protecting the confidentiality of student health information is mandatory. A confidentiality agreement form must be signed by anyone outside of the school system who performs school health screenings. Vision and Hearing Screenings are conducted annually on all children in Grades Pre-K, K, 2, 4, 6, and 8, as well as on those new to the system or those referred by teachers. Screenings are conducted by a dedicated staff who report to the Director of School Health Other Possible Screenings: Blood Pressure Body Mass Index (BMI) (Height and Weight) Scoliosis Dental Immunizations and Health Examinations All students attending Hamilton County Schools are required to provide a certified copy of birth certificate, student’s social security card, and proof of residency. In addition a Tennessee school immunization certificate, which contains both immunization and physical exam information, is required. If student is entering Hamilton County Schools for the first time, the physical exam must have been completed in the last 12 months. 6 Vaccine Requirements: Vaccine ___________Number of required doses for school attendance _______Grades DPT-DtaP-DT-DTP/Hib-TD 4 doses Kindergarten through 12th; one dose must be given after the 4th birthday Tdap or Tetanus-Diphtheria-Pertussis booster 1 dose 7th grade only Polio (OPV/IPV) 4 doses Kindergarten through 12th; one dose must be given after the 4th birthday MMR (Measles, Mumps, Rubella) 2 doses Kindergarten through 12th Hepatitis-B 3 doses Kindergarten through 12th Hepatitis-A 2 doses Pre-K; Kindergarten *Varicella (Chickenpox) 2 doses Kindergarten through 7th (Or if student has had the chickenpox disease, a date of when the disease was present will be accepted. The student’s Health Care Provider or nurse must write in the date on the student’s immunization record.) Hib 2 doses Only students under 5 years of age Medical Waste Disposal Each school is provided a Sharps container and medical waste container. Medical waste containers are to be used for the disposal of items that have been exposed to blood or other infectious materials/agents (e.g. gloves, bandages) when providing medical treatment to any persons at school. When containers are full, they should be securely sealed. For disposal: 1. Call the mailroom at Central Office (209-8502) to request contaminated waste pick-up. 2. When courier driver arrives at school, assist driver in locating contaminated waste containers in the school. 3. Once container located and red bag or sharps container is removed, replace with new red bag or new sharps container. 4. To order supplies, please complete warehouse requisition and send it to School Health Program office at The Staff Development Center or phone 209-5458. School Health Program School nurses are assigned to schools where the students’ medical needs necessitate a nurse on-site. The School Health Director is responsible for determining where nurses are needed and for making those assignments. The principal’s responsibilities are: „h Contact School Health (209-5458) when a student with health-related concerns enrolls in your school. „h Call School Health if a nurse does not arrive as scheduled, so that a substitute may be made (School Nurses are required to contact School Health if unable to come to work.) „h Provide adequate clinic space. Access to a sink, cot, a locked space for medication, small refrigerator for medication storage (if needed), data line access and printer, and a phone are the minimal necessities. Individual Health Plans (IHP) for Students – School nurses are required to complete an IHP for student with acute or chronic health issues. 7 Health-Related Records – School Health documents are part of the educational record and Family Educational Rights and Privacy Act (FERPA) guidelines shall be followed for ay disclosure of information. Transfer of Other Health-Related Information – Most student health information is stored in the Health section of Power School. Paper copies of physician orders, IHP’s, medication administration and medical procedure logs, etc, are stored in a notebook in the nurse’s office. At the conclusion of the school year, paper copies are labeled and stored by School Health. When a student transfers within the school system, paper documents are sent to the new school. For students transferring out of the system, the paper documents remain at the school. August 2011; updated August 2013