3416 - Medication at School

General Statement 

Under normal circumstances, all student medications, both prescription and over the counter (OTC) medications should be administered before and/or after school hours under supervision of the parent or guardian. When it is necessary for a student to receive prescribed or OTC oral or topical medication, eye drops, ear drops, or nasal spray at school or school-sponsored events, the parent/guardian must submit a written parental/guardian request and a written authorization form from a licensed healthcare practitioner (LHP) prescribing within the scope of their prescriptive authority. If the medication will be administered for more than fifteen consecutive days, the LHP must also provide written, current, and unexpired instructions for the administration of the medication. 

The superintendent will establish procedures for required and proper: 

1. Designating staff members who may administer medication to students; 
2. Training, delegation, and supervision of staff members in the administration of medication to students by registered nurse (RN), including oral medication, topical medication, eye drops, ear drops, and/or nasal spray; 
3. Obtaining signed and dated parent/guardian and LHP request and authorization for the administration of medications, including instructions from the LHP if the medication is to be given for more than fifteen (15) days; 
4. Transporting medications to and from school; 
5. Storing medication in a secure or limited access area; 
6. Labeling medication; 
7. Administering of medication, including identification of student and medication; 
8. Documenting administration of medication, including errors, reactions, or side effects; 
9. Disposing of medications; 
10. Maintaining records pertaining to the administration of medication; 
11. Maintaining student confidentiality; 
12. Permitting, as appropriate, possession and self-administration of medications necessary for student school attendance; 
13. Permitting possession and self-administration of OTC topical sunscreen products (see Sunscreen Section below); and 
14. Reviewing and evaluating of medication practices and documentation. 

School District Policy and Procedure 3419-Self-Administration of Asthma and Anaphylaxis Medication and School District Policy and Procedure 3420-Anaphylaxis Prevention and Response govern the use of injectable medication for the treatment of anaphylaxis. 

Except for limited situation, no school staff other than a RN or licensed practical nurse (LPN) may administer suppositories, rectal gels, or injections (except for emergency injections for students with anaphylaxis, as stated in School District policy and Procedure 3419-Self-Administration of Asthma and Anaphylaxis Medication and School District Policy and Procedure 3420-Anaphylaxis Prevention and Response). In some situations, a parent designated adult (PDA) may administer certain injections. 

If the school decides to discontinue administering a student’s medication, the superintendent or designee must provide notice to the student’s parent or guardian orally and in writing prior to the discontinuance. There must be a valid reason for the discontinuance that does not compromise the health of the student or violate legal protections for the disabled. 

Sunscreen 

OTC topical sunscreen products may be possessed and used by students, parents/guardians, and school staff without a written prescription or note from a LHP if the following conditions are met: 

Medical Marijuana 

Washington State law (RCW 69.51A.060) permits the use of medical marijuana, however, federal law (Title IV-Part A-Safe and Drug Free Schools and Communities and the Controlled Substances Act (CSA) (21 U.S.C. § 811)) prohibits the possession and use of marijuana on the premises of recipients of federal funds including educational institutions. School nurses may not administer medical marijuana. See 3423-Administration of Marijuana for Medical Purposes, regarding parental administration of medical marijuana on school grounds, school bus, and school-sponsored activities. 

Each school principal, in consultation with the school Registered Nurse will authorize two (2) staff members to administer all medications including over the counter (OTC) medications. These designated staff members will receive RN delegation and training prior to school opening each year and more frequently as necessary. 

For the purpose of this procedure, “medication” means oral medication, topical medication, eye drops, ear drops, and nasal spray. This definition DOES NOT include OTC topical sunscreen products regulated by the US Food and Drug Administration (see Sunscreen section below). Oral medications are administered by mouth either by swallowing or by inhaling and may include administration by mask if the mask covers the mouth or mouth and nose. 

Required Notification of Emergency Medical Services (EMS) 

After every administration of any legend (prescribed) drug or controlled substance by nasal spray to a student, EMS (911) will be summoned as soon as practicable. 

Medications may be dispensed to students on a scheduled basis upon written authorization from a parent/guardian with a written request by a licensed health professional prescribing within the scope of their prescriptive authority. If the medication is to be administered for more than fifteen consecutive days, the written request must be accompanied by written instructions from a licensed health professional. Requests will be valid for not more than the current school year. All new orders for medication or medication changes must be approved by the supervising RN prior to school staff administering the first dose. 

The medication must be properly labeled and be contained in the original container. Individuals administering medication will: 

1. Collect the medication directly from the parent/guardian (students should not transport medication to and from school except for medications needed for the treatment of medical emergencies). Collect a medication request and authorization form properly signed by the parent/guardian and by the LHP including instructions from the LHP if the medication is to be administered for more than fifteen consecutive days. 
2. Count the medication and record the number of pills or amount of liquid medication received, with initials and date received, on the medication log. It is preferable to have two people count and initial; 
3. Counting of controlled substances at least weekly as recommended by the Board of Pharmacy. On weekly medication counts, the nurse must have assistance and a witness to the actual count of the medications. 
4. Store the prescription or OTC medication (not more than a twenty (20) day supply) in a locked, substantially constructed cabinet or limited access area (for emergency medications); 
5. Maintain a current record which indicates that the medication was administered. If a dose is missed, note the reason, e.g. “absent” this record must be kept for 8 years; 
6. Medications may not be given after the date specified on the authorization form or expiration date on the label; and 
7. Report medication errors to the school nurse immediately. 

Provide for supervision by a physician or registered nurse. A copy of the medication policy will be provided to the parent/guardian upon request. 

Oral or topical medications, eye drops, ear drops, or nasal spray may be administered by a registered nurse, a licensed practical nurse, or designated staff who are delegated to, trained, and supervised by the RN. 

Nasal sprays containing controlled substances may only be administered by a school nurse in the building. If a school nurse is not in the building, the task may be delegated to an authorized school employee. A parent-designated adult with training as required by RCW 28A.210.260[AH1] may also administer the medication when a nurse is not in the building. After a school employee (not a school nurse) administers a nasal spray that is a controlled substance, the employee must summon emergency medical assistance as soon as practicable except in instances when the administration of the nasal spray occurs routinely as documented in emergency care plan signed by parent/guardian and LHP. 

No medication will be administered by injection by unlicensed school staff except when a student is susceptible to a life-threatening anaphylactic condition consistent with Policy and Procedure 3419-Self-Administration of Asthma and Anaphylaxis Medications and Policy and Procedure 3420-Anaphylaxis Prevention and Response when acting as a parent designated adult for students with diabetes, or when acting as a designated trained responder for opioid overdose reversal medication administration consistent with Policy and Procedure 3424- Opioid Related Overdose Reversal. 

The parent will submit a written authorization to act according to the specific written orders and supporting directions provided by licensed health professional prescribing within their prescriptive authority (e.g., medication administered to counteract a reaction to a bee sting). Such medication will be administered by staff trained by the supervising registered nurse to administer such an injection. 

Written orders for emergency medication, signed and dated, from the licensed health professional prescribing within their prescriptive authority will: 

1. State that the student suffers from an allergy which may result in an emergency; 
2. Identify the drug, the mode of administration, and the dose; 
3. Indicate when the medication will be administered based on anticipated or actual symptoms; 
4. Recommend follow-up after administration, administration of additional medications, transport to hospital; and 
5. Specify how to report to the health professional prescribing within their prescriptive authority and any record keeping recommendations. 

If a health professional and a student’s parent/guardian request that a student be permitted to carry their own medication and/or be permitted to self-administer the medication, the principal may grant permission after consulting with the school nurse. The process for requesting and providing instructions will be the same as established for oral medications. The principal and nurse will consider the age, maturity and capability of the student; the nature of the medication; the circumstances under which the student will or may have to self-administer the medication and other issues relevant to the specific case before authorizing a student to carry and/or self-administer medication at school. Except in the case of multi-dose devises (like asthma inhalers), students will only carry one day’s supply of medication at a time. Violations of any conditions placed on the student permitted to carry and/or self-administer their own medication may result in termination of that permission, as well as the imposition of discipline when appropriate. 

Sunscreen 

OTC topical sunscreen products may be possessed and used by students, parents, and school staff, without a written prescription or note from an LHP, if the following conditions are met: 

1. The product is regulated by the US Food and Drug Administration as an OTC sunscreen product; and 
2. If possessed by a student, the product is provided to the student by their parent/guardian. 

Students who possess OTC topical sunscreen products that meet the above criteria may carry up to 8 ounces at a time, preferably with the container in a plastic bag. 

Violations of any conditions placed on the student permitted to carry and/or self-administer their own sunscreen products may result in confiscation and termination of that permission, as well as the imposition of discipline when appropriate. 

School staff may assist students in the application of sunscreen products in certain circumstances and in the presence of another staff member. The appropriate staff member will consider the age, maturity, and capability of the student the need for the application of sunscreen, and other issues relevant in the specific case, before assisting students in the application of sunscreen products at school or during school-sponsored events. However, staff members are not required to assist students in applying sunscreen. 

Parent-Designated Adult Care of Students with Epilepsy or Diabetes 

The policy and procedure for parent designated adults caring for students with epilepsy or students with diabetes are: 

• 3411 – Accommodating Students with Seizure Disorders or Epilepsy 
• 3415 – Accommodating Students with Diabetes

Parent-designated adults who are not school employees are required to show evidence of comparable training and meet school district requirements for volunteers. Parent-designated adults will receive additional training from a parent-selected health care professional or expert in epileptic care to provide the care requested by the parent. School staff are not responsible for the supervision of the procedures authorized by the parents and carried out by the parent-designated adult.