2018-2019 Pflugerville ISD Medication Administration Policy and Guidelines:
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 make every effort to have medication administration set for time periods other than during school hours to avoid disruption of the student’s school day. However, PfISD recognizes that it may be necessary, in some instances, for a student to receive medication during school hours. When home administration is not possible, authorized PfISD staff may assist in the administration of medications to students during school hours in accordance with the following 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 PfISD policies.
II. Administration of medications
A. PfISD 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. Medication with orders to be given three times daily or less should be administered at home, unless the prescribing physician orders the medication to be given at a specific time during school hours.
B. Except as otherwise provided herein, only the school nurse, nurse substitute, health aide, or school employee designated by the Principal, may administer medication to students. In addition, senior nursing students with authorization from the clinical instructor may administer medications under the direct supervision of the campus RN. Clinic volunteers may not administer medications.
C. The school nurse shall accept no more than a 30-day supply of a student’s medication.
D. The school shall not administer expired medication.
E. School personnel shall not administer medication in a dosage that exceeds the recommended maximum dosage stated in the most current Physician’s Desk Reference (PDR).
F. The school shall not give the first dose of any medication. All first doses of medication must be given at home so the parent can monitor for side effects or adverse reactions.
G. Medications prescribed by out-of-state physicians who are registered and licensed to practice medicine in the USA may be administered for no longer than 2 weeks. After 2 weeks, the parent must provide a prescription issued by a physician licensed to practice medicine in the State of Texas.
H. Best practice indicates that medication can be given up to 30 minutes prior to or past the scheduled time. Therefore, if Pflugerville ISD has a delayed start or early release that is greater than 30 minutes prior to, or past the scheduled time of routine medication administration, the medication will not be administered at school.
I. The campus nurse retains the right to refuse to dispense the medication during school hours, if in his/her opinion it is in conflict with the Texas Board of Nurse Examiners Rules and Regulations, or the medication is not labeled by the FDA for the age group or purpose for which it is requested to be given. This may include narcotic pain medications that are dispensed during the school day.
J. A request for a physician to clarify orders or have ongoing communication to address health issues may occur.
III. Refusal of medication
If a student refuses to take a medication prescribed by the student’s physician or an over-the-counter medicine for which the parent has requested to 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 of medication
A. Except as provided below (V, VI), all medication brought to school, including over-the-counter medications, shall be kept in the school clinic in a locked container.
V. Self-Carry of medication
A student with asthma or anaphylaxis may possess and self-administer prescription asthma or anaphylaxis medication while on school property or at a school-related event or activity if:
A. The medication has been prescribed for that student as indicated by the prescription label on the medicine;
B. The student has demonstrated to the student’s physician or other licensed health-care provider and the school nurse, if available, the skill level necessary to self-administer the prescription medication; including the use of any device required to administer the medication;
C. The self-administration is done in compliance with the prescription or written instructions from the student’s physician or other licensed health-care provider; and
D. A parent of the student provides to the school:
1. Written authorization, signed by the parent, for the student to self-administer the prescription medication while on school property or at a school-related event or activity; and
2. A written statement, signed by the student’s physician or other licensed health-care provider, that states:
a) that the student has asthma or anaphylaxis and is capable of self-administering the medicine;
b) the name and purpose of the medicine;
c) the prescribed dosage for the medicine;
d) the times at which, or circumstances under which, the medicine may be administered; and
e) the period for which the medicine is prescribed.
The physician’s statement must be kept on file in the school nurse’s office.
**PfISD reserves the right to require any medication to be kept in the clinic if, in the nurse’s judgement, the student cannot or will not carry the medication in a safe manner and properly self-administer the medication.
VI. Students with diabetes
A. Students with diabetes shall be allowed to carry diabetic supplies and perform care in the school setting in accordance with doctor’s orders and the student’s Individualized Health Plan (IHP).
B. According to HB 984, each school is required to seek school employees who are not health care professionals to serve as Unlicensed Diabetes Care Assistants (UDCAs) to assist with care of students with diabetes. This position is assigned by the campus principal and requires parent authorization. HB 984 requires that schools assign at least one UDCA if a nurse is assigned to the school full-time.
C. Unlicensed Diabetic Care Assistants (UDCA) may administer injectable insulin and/or glucagon, or any prescribed oral medication according with the diabetic student’s IHP if a Registered Nurse is not available.
D. Proper training for all UDCA’s shall occur annually.
VII. Emergency medication
A. PfISD does not routinely carry stock medication. However, a limited supply of medication such as Benadryl, will be available on an emergency basis only to be given by the campus nurse with parent permission. EG: A student with an unknown allergen who is experiencing signs or symptoms of anaphylaxis.
VIII. Herbal, experimental or off-label medications
Experimental drugs are those medications involved in clinical trials that have not been approved by the FDA, but are designed to protect participant safety and rights. 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).
A. PfISD will not administer any herbal medications or products, medications from another country or in a language other than English, approved off-label or experimental medications, trial or study medications. The only exceptions are supplements or medications that are prescribed by the physician and required by the student’s Individualized Education Plan or Section 504 Plan. In this case, additional forms are required to be completed by the physician for these medications or supplements to be administered during school hours.
IX. Written request
A. A Parent/Physician Request for Administration of Medication by School Personnel form 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 order/signature must be obtained for any student that requires over-the-counter medication for more than 10 doses OR for a requested dosage that is higher than the recommended package directions.
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.
X. 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.
XI. Transportation and check-in process
A. Controlled medications
1. All medications that are categorized as controlled substances including, without limitation, Ritalin, Adderall, 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.
3. Controlled substances and Epi-pens must be picked up by a parent or designated adult. The nurse will not send these medications home with students.
B. Non-controlled medications
1. For student safety, parents/guardians are encouraged to transport all medication (controlled and non-controlled) to and from school.
2. Inhalers and over-the-counter medications may be sent home with the student per the campus RN’s discretion, based on student age and other factors.
PfISD staff will not be responsible for the exchange of student medications between a student’s parents/guardians unless the medication is for medical emergencies such as diazepam, epinephrine, or glucagon. Should the student require medication at multiple households, it is the responsibility of the parent/guardian to facilitate the provision of medication to necessary caregivers outside of the school setting.
In addition, the nurse has the right to refuse any such medication that is brought in by a student or in a student’s backpack and the district is not responsible for lost or misappropriated medication that is sent to the school with the student.
XII. 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:
1. No intravenous, intramuscular or subcutaneous medications, with the exception of diabetes medications, Solu Cortef or Epinephrine, will be considered for administration at school.
2. Unlicensed Diabetic Care Assistants (UDCA) may administer injectable insulin and/or glucagon according with the diabetic student’s Individualized Health Plan if a Registered Nurse is not available.
3. 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.
XIII. 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 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 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 of a field trip will follow PfISD District Policies and Guidelines in the administration of medication.
A. The school RN 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 Health Services Coordinator 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.
**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 Physician’s Assistants and licensed Nurse Practitioners who are authorized to issue prescriptions and who practice under the authority and supervision of a licensed physician.