PJ2 Administration of Medications at School

PJ2 Administration of Medications at School

NM PED licenses New Mexico school nurses; however, it is NMDOH who provides the medical over-sight of all school nurses per the New Mexico State Statute 24-1-4(B) of the Public Health Act. The NM Public Health Act, of 2016 states “a regional health officer shall provide medical over-sight to school nurses in the regional health officer’s region. A school nurse shall make reports relating to public health as the regional health officer in the school nurse’s region requires.” Regional School Health Advocates assist the regional health officers and the school districts in their regions in compliance with this statute.

If possible, all medications should be given at home. If medications must be given during school hours they shall be administered in compliance with the New Mexico Administrative Code, New Mexico Nursing Practice Act, New Mexico School Health Manual Standards, and this procedural directive.

For purposes of this procedural directive, a “medication” means any substance that is ingested, injected, inhaled or used topically in the diagnosis, treatment and/or the prevention of disease. This includes prescription drugs, over-the-counter and non-prescription drugs. Health care providers who have prescriptive authority in the United States will authorize prescription medications. Medication authorizations are acceptable, for example, from licensed medical doctors (MDs), nurse practitioners (NPs), osteopathic physicians (DOs), doctors of oriental medicine (DOMs), physician assistants (PAs) and certified diabetes educators affiliated with medical doctor, as well as clinical nurse specialists or psychologists who have completed the pharmacology course requirements to obtain prescriptive privileges. Some prescriptive privileges are limited to a specific area of practice for example; a doctor of oriental medicine is only authorized to write prescriptive orders for oriental medicine herbs.

For purposes of this procedural directive, “controlled substance” means a drug or chemical substance whose possession and use are controlled by law.

The following process shall be followed when it is absolutely necessary for a student to take medication during the instructional day.

Process for Administration of Medications at Schools

The provider and the parent/legal guardian shall submit written authorization for the medication to be given during the instructional day. The licensed school nurse shall make every effort to assist the parent/legal guardian in obtaining written authorization for a student’s needed medication. The information provided in the written authorization must match the label information on the medication container. This will ensure that the medication being taken is consistent with the medication authorized.

The parent/legal guardian and physician/provider may submit written consent for a student to self-administer his/her own medication without supervision. A licensed school nurse or trained designee shall administer medication to those students who do not have consent or who are unable to administer their own medication.

An Albuquerque Public Schools employee shall NOT proceed with medication administration without a completed authorization form that has been transcribed by a licensed school nurse. If a request to administer medication is sent to school without the appropriate written authorization the following steps shall be taken:

• The licensed school nurse shall be notified immediately of the situation.
• If the assigned licensed school nurse is unavailable, a buddy nurse(s) or the Nursing Services Office shall be called.

Initial medication orders must be in written form. If existing orders need to be modified or changed only a licensed school nurse can accept verbal changes in orders from providers. Such verbal authorizations are valid for five (5) working days only and the school nurse shall request that the provider send a written authorization to the school within five (5) working days. Parents must provide written consent for any verbal change in orders prior to the change taking effect at school.

The parent/legal guardian may come to school and administer the medication to his or her child until a written authorization can be secured by the licensed school nurse.

To avoid medication errors and assure optimum safety for students, Albuquerque Public Schools recommends that daily morning medications be given by the parents/legal guardians at home before the school day. If the parent is unable to give the daily morning dose of medication on a consistent basis, the school nurse may assume the daily administration of the morning medication or delegate medication administration to a trained designee. These exceptions must be noted in the written plan on file in the school health office. Albuquerque Public School nurses shall not administer occasional or intermittent morning medications in order to avoid double dosing medication errors.

In life-threatening emergency situations such as anaphylaxis, severe asthma reaction or a diabetic reaction a non-medically licensed school employee may administer certain oral, inhaled, rectal or parenteral (injectable) medication to a student provided that:

• A physician/provider written authorization for emergency medication must be on file with the health office at the school for the current school year, unless otherwise allowed by state law, rule or statute.
• The non-medically licensed school employee is trained by a licensed school registered nurse or a licensed medical provider for the current school year.

Non-medically licensed school employees shall be trained to follow a specific procedure for administration of medication that assures students receive their medication in a safe and timely manner. This training shall be provided annually by the licensed school registered nurse.

Students shall be carefully instructed in how to take their medication at school. The method and plan of administration shall be a coordinated effort between the student, parent/legal guardian, the medical provider, licensed school nurse and other school employees who may assist and supervise administration of medication.

Each student shall have each medication in a pharmacy labeled container or an original labeled container if an over-the-counter, non-prescription or doctor of oriental medicine prepared remedy.
*NOTE: the pharmacy/original label shall NOT serve as a provider’s authorization. The information on the provider’s written authorization or parent’s written authorization for an over-the-counter medication must match the label on the container.

Albuquerque Public Schools recommends that parents/legal guardians transport the medication to school. It shall be the responsibility of the parents/legal guardians to deliver the medication to the health office. Please refer to the school handbook for specific requirements each school may have.

Medication shall be stored in a locked medication cabinet in the health office. Exceptions shall be noted on the medication authorization form or the Individualized Healthcare Plan and shall pertain to medication that must be stored in a refrigerator or those carried by students.

• Emergency rescue medications will be stored unlocked during school hours to facilitate access to them in case of emergency need.

The Nursing Services Office shall determine the requirements for recording the date, time and medication administered as well as for monitoring beneficial and/or adverse effects of medication. These requirements shall be followed at each school as defined in the Albuquerque Public Schools Nursing Manual.

One day’s worth of medication (except for controlled substances) may be carried and self-administered by the student without supervision under certain circumstances, provided that:

• An appropriate written authorization is on file in the health office for the current school year. A “Provider Order and Medication Administration Order” form signed by the physician/provider and the parent/legal guardian shall be required for prescription drugs that may be given more than short-term (1 to 14 days). An over-the-counter or short-term prescription authorization form shall be signed by the parent/legal guardian for all over-the-counter, non-prescription, or short-term (1 to 14 days) prescription medications/remedies, unless otherwise allowed by state law, rule or statute.
• The written authorization shall specify the medication name, dosage and time of administration.
• The student shall be deemed competent to take the medication as ordered on the authorization form.

• When a student is not competent to carry and administer his/her own medication without supervision or when the medication is a controlled substance the administration of the medication shall be given by school nurse or a trained Albuquerque Public Schools employee.
• An Albuquerque Public Schools employee shall NOT send ANY excess medication home with a student with the exception of emergency medications. A parent/legal guardian shall be notified to pick up the excess medication. Any medication left at the end of the day on the last day of the school year shall be destroyed according to the process in the Albuquerque Public Schools Nursing Manual.
• An Individualized Healthcare Plan shall be written, by the licensed school registered nurse if medication is to be given on a daily basis for longer than fourteen (14) school days. A copy shall be filed with the confidential student cumulative health record, in the medication log book and may be given to the parent/legal guardian and appropriate school staff as necessary.
• The principal shall be responsible for provision of the equipment and materials necessary for the safe storage, administration and documentation of medication taken at school.
• All requirements and guidelines shall be followed as stated in the Albuquerque Public Schools Nursing Services Medication Procedures.

Complementary and Alternative Medications/Non-FDA Approved Substances (Herbs, Supplements, etc.)

An APS student may self-administer Complementary and Alternative Medications when the following criteria are met:

1. A Provider Order and Medical Authorization Form must be completed by an approved provider, similarly to approved medications and must include: outlining the indications, manufacturer, ingredients, preparation, frequency, possible side effects, drug interactions and mode of administration
2. The preparation must be provided in the manufacturer’s labeled container or in the original labeled container. Contents must match the written order
3. The product will be stored and self-administered in the Health Office. Students should not carry herbal, dietary products and essential oils on their person
4. The order is effective for one school year. A new order is required at the beginning of each school year or whenever the orders are changed
5. Medical cannabis is excluded from this procedural directive as it is not eligible for student self-administration

APS school nurses, and/or employees shall not administer non-FDA approved herbal and /or dietary supplements and essential oils regardless of delivery: orally, topically, or diffused.  These substances do not have consistent and reliable United States Pharmacopeia (USP) formulation to ensure dose purity and consistency, are not regulated by the FDA, and a predictable dose calculation for herbal products has not been established in pediatrics. 

Administration of any medication shall not contradict the NM Nurse Practice Act and federal law.

The district (including its employees and agents) shall not incur any liability against any and all claims, damages, causes of action or injuries incurred or resulting from the administration of the medication or as a result of any injury arising from the student’s transport, self-administration of medication and staff administration. The parent/guardian shall indemnify and hold harmless Albuquerque Public Schools (including its employees and agents) against any claim arising out of the administration of medication at school. 

Administrative Position:           

• Executive Director of Student, Family and Community Support

Department Director:                

• Director of Nursing Services

References:

Legal Cross Ref.:

• 6.12.2 NMAC
• New Mexico Nursing Practice Act
• New Mexico School Health Manual
• New Mexico Public Health Act (NMSA 24-1-4)

Board Policy Cross Ref.:              

•   JL - Student and Staff Wellness and Welfare

Procedural Directive Cross Ref.:     

• Albuquerque Public Schools Nursing Manual (contact Nursing Services)

Forms:                                         

• Authorization to Administer Medication (contact Nursing Services / Coordinated School Health)
• Student Accident report (contact Risk Management)

NSBA/NEPN Classification:      JLCD

Revised: May 1995
Revised: April 1996
Revised: May 1997
Revised: January 2007
Reviewed: September 24, 2010
Revised: October 15, 2010
Revised: June 12, 2013
Reviewed: November 11, 2014
Revised: November 12, 2014
Reviewed: September 11, 2019
Revised: September 20, 2019

 

This page was last updated on: December 9, 2009.