DIASTAT IN SCHOOLS STATE LAW SUMMARY (revd. 8/07)

Transcription

1 in Alabama See ALA. BD. OF NURSING ADMIN. CODE 610 X Yes, ALA. BD. OF NURSING ADMIN. CODE 610 X 6.06 (2) and (4): specific types of prescription s to a student may be delegated to a UAP. Alaska No state policy. Yes, ALASKA ADMIN. CODE, tit. 12, (b): may be delegated only to a (1) home and communitybased services provider or (2) residential supported living services provider RNs cannot delegate specific tasks to UAPs that require independent nursing judgment or intervention this includes the rectal or vaginal s ALA. BD. OF NURSING ADMIN. CODE 610 X X 6.06 (2) and (4)(C). Routine nursing duties may be delegated to another person under the standards set out in ALASKA ADMIN. CODE, tit. 12, ALASKA ADMIN. CODE, tit. 12, (a). Nursing duties that require the exercise of professional nursing knowledge or judgment or complex nursing skills may not be delegated, e.g., management for unstable medical conditions requiring ongoing assessment and adjustment of dosage or timing of administration. ALASKA ADMIN. CODE, tit (a) * In the school context, UAPs typically include health aides, teachers, and teachers aides. ** Signifies a possible model approach that might be adopted by other states.

2 in Arizona Varies by school district. But, in the case of a minor student, shall only occur on the written request or authorization of a parent or legal guardian. ARIZ. REV. STAT Yes, ARIZ. REV. STAT also requires that minor students need written request or authorization from parent or guardian before can be administered. But, see also each individual School District s policies and procedures for specifics. ARIZ. REV. STAT (2002) gives school districts the responsibility of establishing policies and procedures the prescription to students by school employees. See each district for specific policies and procedures. Arkansas California No state policy that specifically addresses the in schools per se. See CAL. CODE REGS., tit. 5, 604 No, ARK. ST. BD. OF NURSING RULES, ch. 5 (E)(5): any s shall not be delegated. Yes, CAL. EDUC. CODE and Dept of Education has issued contradictory guidance on authority of UAPs to administer; the Education Code itself suggests that UAPs may do so. Nurse cannot delegate s. They may only delegate certain tasks. The Nursing Practice Act (NPA) does not authorize RNs to delegate to non licensed persons nursing tasks and functions which require substantial knowledge and skill CAL. BUS. & PROF. CODE 2725(b) and (a)(1). 2

3 in Colorado Colorado NPA allows RN to delegate duties to a UAP. However, the nurse s employer can establish policies, procedures, and standards that limit or prohibit delegation of certain tasks. COLO. REV. STAT Yes, 3 COLO. CODE REGS (7.1, 7.2, 7.4) a nurse can delegate administration of certain types of s without prior training, such as oral, topical, and inhaled. In order to delegate administration of certain emergency s, the delegatee must have sufficient training and specific written protocol to determine if the needs to be administered. A nurse may delegate any task that does not require nursing judgment. COLO. REV. STAT (2). A nurse can delegate certain s. 3 COLO. CODE REGS (7.1, 7.2, 7.4) Connecticut s is not required in schools. CONN. AGENCIES REGS a 2 (a). If the local or regional board allows the, no may be administered by licensed personnel or designated staff without the written consent of an authorized prescriber and a parent or guardian. CONN. AGENCIES REGS a 2 (b) (c). CONN. AGENCIES REGS a 2 (b) and CONN. GEN. STAT. ANN a (a)(2), (c)(2) give school districts the responsibility of establishing policies and procedures the prescription to students by school employees. See each district for specific policies and procedures CONN. AGENCIES REGS a 2 and CONN. GEN. STAT. ANN a only reference a nurse s ability to delegate administration of s in schools. Nothing is stated about the authority to delegate other nursing tasks. 3

4 in Delaware District of Columbia DEL. ADMIN. CODE, tit. 14, 817 (2003) allows the prescription by a school nurse if certain conditions are met. No state policy that specifically addresses the by nurses in schools. No, DEL. ADMIN. CODE, tit. 24, (2003) states that a RN cannot delegate s to a UAP. Yes, D.C. CODE (1993) any employee who has been properly trained may administer in compliance with the signed, written instructions of a licensed practitioner if parent/guardian handdelivers s to school, gives consent in writing, and employee is under the supervision of an RN or licensed practitioner. A nurse can delegate any task that is within the scope of sound professional nursing judgment to delegate and that does not involve nursing knowledge, judgment, and skill. DEL. ADMIN. CODE, tit. 24, , D.C. Board of Education and the D.C. Department of Human Services jointly issue rules and regulations that establish criteria for the selection, in consultation with the school based licensed nurse, of employees at each public school who shall administer. D.C. CODE (a)(9) (1993). 4

5 in Florida See FLA. ADMIN. CODE r. 64 B FLA. STAT (1)(b) allows each district school board to adopt policies and procedures governing the prescription by district school board personnel. ** FLA. STAT (4) allows UAPs to perform health related services upon successful completion of childspecific training, including (d) administering emergency injectable. However, under FLA. STAT (5), for all other invasive medical services not listed in (4), a licensed medical professional shall determine if UAPs shall be allowed to perform such service. School board policies and procedures designate non medical school personnel who will administer in school. FLA. STAT (1)(b). Nurses must use their nursing judgment to consider the suitability of the task or activity to be delegated. FLA. ADMIN. CODE r. 64 B FLA. ADMIN. CODE r. 64 B does not specifically include as a task that a nurse is prohibited from delegating. 5

6 in Georgia GA. STATE EDUC. RULE (2000) requires each school system to develop a Student Services Plan that provides guidelines for its various components including school health services. falls under the Georgia Code s definition of the practice of nursing. GA. CODE (6), (8)(I) (J). Each public school in this state shall permit the self asthma by a student who has asthma. GA. CODE (2002). The Georgia NPA does not provide for delegation of licensed activities to unlicensed individuals. See GA. CODE and Hawaii HAW. ADMIN. RULE (a) is a part of the practice of nursing as a RN. As such, the RN retains full responsibility for administration. The Georgia School Health Resource Manual (2004) states that if emergency (EpiPen, Glucagon, Diastat) is ordered by the physician and is provided by the family, school administration and staff should be prepared to comply with the plan, per local policy. Yes, exceptions apply that allow for the oral and topical and in emergency situations, other premeasured, by school health aides, as provided in section HAW. REV. STAT (6), An RN is the only one who can delegate medical tasks to UAPs. HAW. REV. STAT and HAW. ADMIN. RULE HAW. ADMIN. RULE allows a RN to delegate nursing tasks that do not require the UAP to exercise nursing judgment or intervention, 6

7 in but only in settings where a RN is not regularly scheduled and not available to provide direct supervision see HAW. ADMIN. RULE

8 in Idaho Illinois Indiana The board of trustees of each school district shall adopt a policy permitting the selfadministration of administered by way of a metered dose inhaler by a pupil for asthma or other potentially lifethreatening respiratory illness. IDAHO CODE (2004). Certified school nurses and non certificated registered professional nurses are required to administer to students. 105 ILL. COMP. STAT. 5/ b (2000); see also 225 ILL. COMP. STAT. 65/5 10 (l)(4). cannot be administered without the written and dated consent of the parent and must be administered in accordance with the physician s prescription. IND. ADMIN. CODE tit. 511 r (2000). No, UAPs may not be delegated procedures involving acts that require nursing assessment or diagnosis, establishment of a plan of care or teaching, the exercise of nursing judgment, or procedures requiring specialized nursing knowledge, skills or techniques. Idaho Administrative Procedures Act s. 490 Yes, UAPs are allowed to administer, but cannot be required to do so. Additionally, no UAP is prohibited from providing emergency assistance to students. 105 ILL. COMP. STAT. 5/ b (2000). Yes, but a school or school board may not require a teacher or other school employee who is not employed as a school nurse or physician to administer. IND. CODE ANN (1). A school administrator, teacher, or other school employee designated by the school Nurses can delegate duties other than certain s. Idaho Administrative Procedures Act s. 400 RNs delegate and supervise UAPs who assist them with implementing the plan of care. 225 ILL. COMP. STAT. 65/5 10 (l)(6). Registered nursing means teaching, administering, supervising, delegating, and evaluating nursing practice and delegating tasks which assist in implementing the nursing or medical. IND. CODE ANN

9 in administrator, after consultation with the school nurse, who in good faith administers s (following written order of a practitioner and written permission of the pupil's parent or guardian, except in the case of a life threatening emergency) is not liable for civil damages. IND. CODE ANN (2) and (4). Before the school employee provides the service, the school must have on file a written statement from the practitioner or registered nurse that indicates the school employee has received the training required under this section. IND. CODE ANN (c). 9

10 in Iowa IA ADC requires that individuals who need special health services to participate in their education receive these services concomitantly with their education. IA ADC (11) says that persons administering shall include licensed registered nurses. In order to administer at school, the individual's parent provide a signed and dated written statement requesting administration at school; the shall be in the original labeled container either as dispensed or in the manufacturer's container; and there must be a written administration record. Kansas There is no law addressing; however, it is suggested that the school board and superintendent in conjunction with school nurses and other school personnel should Generally yes (with specified training), but not Diastat. The student may selfadminister in school if they have been shown to be competent. Otherwise, must be administered by licensed registered nurses, physicians and persons who have successfully completed a administration course reviewed by the board of pharmacy examiners (IA ADC (11)). IA ADC , says that as part of an individual health plan, which the school is required to do for children with special needs, any qualified designated personnel can administer the health plan; there is no requirement that this person be a nurse or other medical professional. Yes, as long as the administration complied with the requirements of K. A. R According to the Concept Paper on Declaration, which the Iowa Board of Nurses has signed on to, the functions of assessment, evaluation, and nursing judgment should not be delegated. Furthermore, a decision by the Iowa state board of nursing found that delegation of the duty of administering antiseizure was not allowed because each child has his/her own unique pattern of seizure activity. (In Re: Petition for Declaratory Ruling Filed By: Barbara J. Allen, R.N., Iowa Board of Nursing, Declaratory Ruling No. 69 (1994) (available at government /nursing/pdf_files/ ruling_69.pdf). K. A. R a school nurse may delegate the if the following requirements are met: 1) The initial dose has previously 10

11 in Kentucky collaborate with a physician consultant and the health advisory committee for each school to develop a policy for the. The guidelines go on to say that the policy must comply with the nursing board s regulations given in the second two columns of this chart. (Guidelines are available at kdheks.gov/cf/downloads/guidelines_ for_.pdf). As a school employee that meets the requirements of KY. REV. STAT. ANN (a designated provider of health services), school nurses may be asked to administer Diastat to students under KY. REV. STAT. ANN Yes. KY. REV. STAT. ANN (2)(c) states that, under certain circumstances, health services may be provided by school employees who have had the responsibility delegated to them by a medical professional. been administered to the student, 2) the does not require dosage calculation, and 3) The nursing care plan requires administration by accepted methods of administration other than by intravenous route, intramuscular route, through intermittent positive pressure breathing machines, through any tube inserted into the body. Under KY. REV. STAT. ANN (2)(c), the nurse may delegate performance of a health service to a UAP. **KY. REV. STAT. ANN (2005) mandates that each school board or district have at least one qualified school employee at each school who is on duty during the entire school day to administer Diazepam rectal gel. The UAP is not required to consent to administer the unless consenting to provide 11

12 in health services under state law. 12

13 in Louisiana LA. REV. STAT. ANN. 17:436.1 (B) (1) (a) (c) (1997) requires a written order from a physician, provided to the school, and clear instructions detailed in a letter from the guardian and listed on the container. Yes. LA. REV. STAT. ANN. 17:436.1 (B) allows non medical school board employees to administer s under certain conditions. The nurse may delegate administration to trained UAPs once s/he has determined that this administration can be safely performed by and delegated to that UAP. LA. REV. STAT. ANN. 17:436.1 (B) (1) (a) (c) ** Regarding Diastat, the nurse must base his/her judgment on: 1) a clinical protocol that clearly describes the responsibility and accountability of the certified school nurse delegating rectal Diastat administration to trained UAPs or LPNs; 2) a signed agreement from the student s parents authorizing the Diastat to their child by a nurse or trained UAP; 3) the RN s assessment that the trained UAP is competent to administer the rectal Diastat. Louisiana Board of Nursing, Declaratory ment Regarding the Registered School Nurse Delegating to Trained Unlicensed 13

14 in School Employees the Rectal Diastat in Certain Emergency Situations, March 15,

15 in Maine Maryland Any public or approved private school shall have a written local policy and procedure for administering, which allows UAPs to administer after having received training. ME. REV. STAT. ANN. tit. 20 A 254(5)(B) (2003). Under CODE ME. R , ch. 40, the Dept. of Education promulgated rules for administration that stated the school nurse will provide direction and oversight for the in the school. MD. CODE ANN., 13A mandates local boards of education in conjunction with local health departments to develop policies ensuring school health services to be provided to all students with special health needs. The designated school ME. REV. STAT. ANN. tit. 20 A 254(5)(A C) provides direction for training of unlicensed school personnel in the, and requires that students be allowed to carry and self administer prescribed emergency s; specifically, asthma inhalers or epinephrine auto injectors with health care provider approval and school nurse assessment demonstrating competency. MD. CODE ANN., states that administration is a nursing task that may be delegated to an unlicensed individual in the school setting in accordance with the rest of this provision (which is given in the third column of this chart). Based upon the documentation of training and competency of unlicensed personnel to administer, the school nurse shall make a recommendation to the Superintendent concerning the authorization of such persons to administer to students. CODE ME. R , ch. 40 (3)(D). MD. CODE ANN., (2007) may delegate administration of medicine if 1) the licensed nursing staff has identified the function as being performed routinely, 2) the specific treatment is performed at a high frequency necessary to retain competency, and 3) the treatment is inherently low risk to the 15

16 in health services professional can serve on the pupil services team and participate in the health services component of an Individualized Education Plan, the Individualized Family Service Plan, or the Transitional Plan committees. Lastly, the regulation requires the board and the health department to formulate policies the storage and during school hours and during schoolsponsored activities. client (there is a set of factors used to determine this). 16

17 in Massachusetts MASS. GEN. LAWS ch. 112, 80B, para. 1 &2 (2005): Nursing practice requires substantial specialized knowledge of nursing theory and related scientific, behavioral and humanistic disciplines. Nursing practice involves the, therapeutics and treatment prescribed by duly authorized nurses in advanced roles. Michigan MASS. GEN. LAWS ch. 71, 54B (2005) states that the department of public health promulgates regulations governing the s, and that the department will consult with the board of registration in nursing and the board of registration in medicine. Michigan does not have an official Scope of Practice for nurses. However, Michigan Public Health Code provides a general definition of No, under MASS. REGS. CODE tit. 244, 3.05(5) (2005), nurses cannot delegate the to UAPs. Yes, MICH. COMP. LAWS ANN (West 2006) allows UAPs to administer, as long as it is in the presence of another adult or in an Under MASS. REGS. CODE tit. 244, 3.05(4) (2005) provides that certain nursing activities can be delegated: (a) activities that do not require nursing assessment and judgment during implementation; (b) collecting, reporting, and documentation of simple data; (c) activities that meet or assist the patient/client in meeting basic human needs, including, but not limited to: nutrition, hydration, mobility, comfort, elimination, socialization, rest and hygiene. A school administrator can designate a UAP to administer. MICH. COMP. LAWS ANN MICH. COMP. LAWS ANN. 17

18 in Minnesota the practice of nursing Mich. Pub. Acts 368. emergency, and with the written permission of the pupil s guardian, and in compliance with the doctor s instructions. Yes, if a pupil s parent submits a written or oral request that school personnel administer or it is allowed by the pupil s IEP. MINN. STAT. ANN. 121A.22, subd.1 (West 2006). There are also exceptions for emergency, e.g., asthma inhaler and epinephrine. Id. at subd. 2 (4), (9), (10) (West 2006) states that an RN may delegate to a qualified UAP the performance of selected acts, tasks, or functions if it falls within the RN s scope of practice and will be performed under the RN s supervision. However, an RN may not delegate any task that requires the level of education, skill, and judgment required of the RN. MINN. STAT. ANN. 121A.22, subd. 4 states that drugs and medicine must be administered according to school board procedures. 18

19 in Mississippi MS. CODE ANN., requires all school to have a school nurse who will offer services including coordination of services for children with disabilities to ensure that they receive appropriate medical assistance and are able to remain in public school, and will provide emergency treatment of injury and illness to include controlling bleeding, managing fractures, bruises or contusions and cardiopulmonary resuscitation (CPR). MS. CODE ANN., allows for the selfadministration of by students if they meet certain requirements. Otherwise, no. Chapter III of the Mississippi Board of Nursing Rules and Regulations says that a nurse may only delegate the to other licensed nurses. Missouri MO. REV. STAT (2006) allows school nurses to keep on hand and administer prefilled syringes of epinephrine to any student who the nurse believes is having an anaphylactic reaction. MO. REV. STAT (2006) states that [n]o employee of any school district may be required to administer or medical services for which the employee is not qualified according to standard medical practices. MO. REV. STAT (2006) provides for self for students with asthma or The Missouri Nurse Practice Act (MO. REV. STAT to ) allows for delegation of administration when the procedure is under the control and supervision of a registered professional nurse. 19

20 in Montana There is nothing in the Montana Code that deals with nurses administering s. However, there are sections in the Code that: 1) allow UAPs (selected by the parent) to administer glucagon (MONT. CODE ANN ) and 2) allow self asthma (MONT. CODE ANN ). anaphylaxis. Yes, but only in certain circumstances. may only be delegated by the nurse in schools, and is limited to certain s and routes, to include suppository taken from: a prefilled, labeled holder; a labeled unit dose container; or an original marked and labeled pharmacy container. MONT. ADMIN. R (2005) Nurse delegates certain types of in schools. MONT. ADMIN. R (2005). Glucagon administration: A parent/guardian of a diabetic student may designate an adult (i.e., a school district employee, who is trained and voluntarily agrees to administer glucagon to the student) to administer glucagon to diabetic students. The parent designated adult may administer glucagon in an emergency situation. (MONT. CODE ANN (2004)). 20

21 in Nebraska Nevada RNs delegate, direct, and assign nursing interventions that may be performed by others. Neb. Admin. Code tit. 172, NEV. REV. STAT requires school nurses to design and carry out a plan of nursing care for a pupil with special needs which incorporates any plan specified by the pupil's physician or provider of health care, and which is approved by the pupil's parent or guardian. The nursing services provided pursuant to a plan of nursing care must be performed in compliance with chapter 632 of NRS. NAC states that a school nurse shall develop safe and effective procedures for the to pupils that comply with Under NEB. REV. STAT , a UAP can provide routine s by oral, inhalation, topical, and instillation into the eyes, ears, and nose, or via other routes, if certain conditions are followed. NEB. REV. STAT (1)(a) (d) and (2). NAC states that a school nurse can delegate any duty of nursing care in the list provided by the Board of Nursing to a qualified person. According to an advisory opinion by the Board of Nursing, the definition of a qualified person includes a family member/friend, designated or identified by the student's parent or legal guardian, who is exempt from the regulations of the Nurse Practice Act and, without delegation, training or supervision by the school nurse, may perform required care for the student unless employed by the school district. RN can delegate noncomplex nursing interventions to a UAP. Neb. Admin. Code tit. 172, NAC states that a school nurse may delegate only those duties of nursing care that the Board has approved. The Board will maintain a list of the duties it has approved for delegation and provide a copy of the list to a school nurse or member of the general public upon request. If the nurse does delegate the duty of administering, it must be to a qualified person as defined by (ac). The Board of Nursing confirmed this definition in an advisory opinion available in the appendix to this chart. 21

22 nationally recognized standards and the laws of this. This means that the nurse can administer only if the is labeled, there is written authorization from the parent or guardian, and there is verifification that the has been prescribed and dispensed by a person authorized to do so. in 22

23 in New Hampshire N.H. CODE ADMIN R. ED states that any pupil, who is required to take during the school day a prescribed by a licensed physician, advanced registered nurse practitioner, licensed physician's assistant or dentist, shall be supervised in taking by the school nurse, who shall administer the. There are several requirements the nurse must ensure are met before prescription can be administered at school, which can be found in (e) and are listed in the appendix to this chart. N.H. CODE ADMIN R. ED states that If the school nurse is not available, the building principal or designee is permitted to assist students in taking required s by: (1) Making such s available to the student as needed; and (2) Observing the student as he/she takes or does not take his/her ; or (3) Recording the student did not take his/her. In addition, Nur states that unlicensed assistive personnel who have competency to perform the specific task to be delegated can administer. All prescribed injectable shall be administered by a registered nurse or others who are qualified under RSA 326 B, Nurse Practice Act. Asthma inhalers and epinephrine auto injectors may be possessed and selfadministered by a student (N.H. Code Admin R. Ed ). Otherwise, the nurse may delegate the administration to any licensed nurse or any unlicensed individual that is competent to administer the (Nur ). New Jersey N.J. ADMIN. CODE tit. 6a states that it is a duty of the school nurse to carry out written orders and standing orders of the school physician (one can assume this includes ). In Yes, the individual s parent or guardian is allowed to administer, or someone designated by the school nurse in the case of an epinephrine emergency (N.J. ADMIN. CODE tit. 6A ) The law does not specifically address the. In delegating selected nursing tasks to licensed practical nurses or ancillary nursing personnel, the registered professional nurse shall be 23

24 in New Mexico New York addition, N.J. ADMIN. CODE tit. 6a authorizes nurses to administer. There is nothing about the specific duty of a nurse to administer ; however, N.M. CODE ANN states that districts must make provisions for school health programs that address the needs of students and staff. No (see N.M. STAT. ANN A 3). Yes, but only in emergency situations. N.Y. EDUC. LAW 6908 (a) (iv) (McKinney 2003) allows UAPs to furnish nursing assistance in case of an emergency. responsible for exercising that degree of judgment and knowledge reasonably expected to assure that a proper delegation has been made. A registered professional nurse may not delegate the performance of a nursing task to persons who have not been adequately prepared by verifiable training and education. (N.J. ADMIN. CODE tit ) For the criteria that should be considered in delegating a duty, see the appendix to this chart. There is no specific law about this, but the New Mexico Board of Nursing Rules say a nurse can be disciplined if a nurse delegates the duty of administering. (N.M. CODE ANN (1978)) NY Education Department, Rules of the Board of Regents, 29.1(b)(10) (2006) prohibits delegation of professional responsibility by licensed persons to an 24

25 in North Carolina The Office of Elementary, Middle, Secondary and Continuing Education (EMSC) and the Office of Higher Education and Office of the Professions (NY Education Dept, SED) have released memoranda specifically allowing UAPs to administer epinephrine and glucagon in emergency situations. Yes, under N.C. GEN. STAT. ANN. 115C (West 2005), it is within the scope of duty of public school employees to administer any prescribed by a doctor upon written request of the parents, to give emergency health care, and to perform any other first aid or lifesaving techniques in which the employee has been trained in a program approved by the Board of Education. However, no employee is required to administer or attend lifesaving techniques programs. Id. individual who the licensee knows or has reason to know, lacks the education, experience or licensure to perform those tasks. The principal of each school determines which persons will participate in the medical care program (i.e., administration and lifesaving technique training programs). under N.C. GEN. STAT. ANN. 115C (West 2005). 25

26 in North Dakota Ohio See OHIO ADMIN. CODE ANN Yes, as long as a registered nurse follows the delegation procedures in N.D. ADMIN. CODE Must be specific for a specific person. Yes, OHIO REV. CODE ANN Can delegate to any licensed person, but only to UAP as provides. See N.D. ADMIN. CODE Yes, OHIO ADMIN. CODE ANN (A)(2) provides that nurse may delegate administration of in accordance with OHIO REV. CODE ANN ; see OHIO ADMIN. CODE ANN for requirements for delegating tasks. Oklahoma A school nurse can administer prescription and nonprescription at school with written Yes, pursuant to written authorization by parent or guardian of student. (OKLA. STAT. ANN. tit ) A state court ruled that the NPA does not prohibit UAPs from administering Diastat. Lancaster School District Support Association v. Board of Education, Lancaster City School District, No. 03 CVH (Ohio Ct. of Common Pleas March 6, 2006), appeal dismissed based on mootness. may not be delegated to unlicensed persons unless a specific state law (like Oklahoma statute 70, 26

27 in Oregon authorization from the student s parent or guardian. (OKLA. STAT. ANN. tit ) Yes, the school district boards adopt policies and procedures that provide for the prescription to students by trained UAPs. However, a school district board shall not require UAPs who have not received appropriate training to administer. OR. REV. STAT (2) (2005). section ) allows for it. (See Oklahoma Board of Nursing s Guidelines for Delegation of Nursing Tasks to Unlicensed Persons). Under OR. REV. STAT (1) (2005), the Board of Education adopts rules (including training requirements for UAPs) for the prescription to students by trained school personnel. 27

28 in 28

29 in Pennsylvania 55 PA. CODE Rhode Island In a public school, a certified school nurse teacher must administer s; a private school can use either a certified nurseteacher or a registered nurse. (Section of Rhode Island Rules and Regulations for School Health Programs) This must be administered in accordance with the restrictions of sections of the Regulations. South Carolina The South Carolina Board of Education Regulations states the duties and responsibilities of a school nurse are to be prescribed by the Staff members who have gone through training specified by 55 PA. CODE can administer oral, topical and eye and ear drop prescription s and epinephrine injections for insect bites. No lay person can administer in the school setting, though there are certain exceptions in the case of epinephrine. (Section 18.3 of Rhode Island Rules and Regulations for School Health Programs) Yes, if they are trained by a nurse in the case of an emergency or in the case of a student who needs in order to attend school. (See South Carolina Board of Nursing Advisory Opinions Available at /nursing/index.asp?file=advisoryop.htm) Cannot delegate to UAPs unless otherwise provided by law. However, this authority is allowed for some emergencies under a Bd of Nursing Opin, No. 50: /pol/nursing/advisoryop/ AO50.pdf. 29

30 principal in accordance with the laws and regulations governing nursing in South Carolina. (43 205) in 30

31 in South Dakota Tennessee S.D. CODE ANN. REGS (2)(b): Duties of school nurse are to be prescribed by the principal. TENN. CODE ANN (2006) states that is a practice of professional nursing that requires substantial specialized judgment and skill based on knowledge of the natural, behavioral and nursing sciences. S.D. CODE ANN. REGS. 91 1A(7).: Unlicensed nursing personnel shall not administer s. s to students during the school day must be performed by appropriately licensed health care professionals. TENN. CODE ANN (2006). As of August 2007, there was a bill (Sen. Bill 0461) pending in the TN legislature that would amend the above provisions to allow schools to designate volunteers to administer Diastat, and that would require assignment of RNs to administer until a volunteer is identified (in the case where a child with a Diastat prescription is enrolled only). See Tennessee Board of Education guidelines include seizures under common emergencies that may require first aid and/or immediate emergency care provided by a school staff person. Guidelines for the Use of Healthcare Professionals and Health Procedures in a School Setting 11 (2003). This may mean that Diastat is an emergency exception. It is considered unprofessional conduct, unfitness, or incompetency by reasons of negligence, habits or other causes to [a]ssign[] unqualified persons to perform functions of licensed persons or delegating nursing care functions and tasks and/or responsibilities to others contrary to the Nurse Practice Act or rules and regulations to the detriment of patient safety. TENN. BD. OF NURSING RULES (1)(l) (2006). 31

32 in 32

33 in Texas The responsibility of administering s to students is considered an administrative task assigned by the principal, rather than a health related service delivered or delegated by a health care professional. TX School Health Guidelines, Ch. 5: Administration 208 (2005). Under TEX. EDUC. CODE ANN (a), the task of administering may be assigned to a school employee by the principal as an administrative function. ***Texas Board of Nurse Examiners Position ment states that emergency Epipens, Glucagon, and Diastat may be administered by an unlicensed person under [22 TEX. ADMIN. CODE] 224.6(4) in order to stabilize the child and prevent complications from delaying treatment. The RN may delegate tasks in the school setting in compliance with 22 TEX. ADMIN. CODE 224 and 225. The responsibility of administering s to students is considered an administrative task assigned by the principal, rather than a health related service delivered or delegated by a health care professional. TX School Health Guidelines, Ch. 5: Administration 208 (2005). Legal permission to administer is granted to employees of the school district, when authorized by school principals or superintendents. The law grants immunity to all school district employees. TX School Health Guidelines, Ch. 5: Administration 208 (2005). The decision to delegate a specific task is always at the discretion of the RN in accordance with 22 TEX. ADMIN. CODE 224.8(b)(1)(C) or 225.9(c). Students can selfadminister for asthma or anaphylaxis. TEX. EDUC. CODE ANN. 33

34 in (2006). 34

35 in Utah Vermont Virginia Says nothing about who should administer the, but gives standard procedure in Board of Education Rule School Health Services for Virginia has its own web page, where they have Yes, as long as the school board has adopted policies for the designation of employees who may administer and training for those employees, the student s parent has provided written request that be administered during the regular school hours, and the student s doctor has provided a statement of detailed instructions that by UAPs at school is medically necessary. UTAH CODE ANN. 53A (1) (2006). Yes, see next column. The School Health Services web page says any school personnel who has been trained in the The local school board determines whether a UAP can administer. UTAH CODE ANN. 53A (1) (a) (2006). Nurses may delegate any task to another nurse or an unlicensed person if the patient is stable, has controlled symptoms and predictable care outcomes. Assessment, evaluation and nursing judgment can never be delegated. (see Advisory Opinion 5 from the Vermont Board of Nursing in the Appendix) Cannot delegate. (18VAC Nursing tasks that shall 35

36 in Washington published procedures for several medical situations, including the use of rectally administered diazepam in the event of a seizure. These procedures say a school nurse can administer diazepam. Under WASH. REV. CODE ANN. 28A (2002), public and private schools may provide for the oral, but are not required to do so. Diastat (in potential problems and techniques) may administer it. This report is available at: VDOE/Instruction/Health/ SHCP6neurological.pdf If the school allows for oral s, the board of directors shall designate a professional person licensed to train and supervise the designated school district personnel in proper procedures. WASH. REV. CODE ANN. 28A (7). UAPs are allowed to administer for diabetes related emergencies, if they are trained and there is prior written approval. 28A (1)(x). not be delegated). A registered nurse may delegate tasks of nursing care to other individuals where the registered nurse determines that it is in the best interest of the patient, except for the s. A registered nurse may not delegate acts requiring substantial skill. Acts that require nursing judgment shall not be delegated. WASH. REV. CODE ANN (3) (2003). Students are allowed to self administer for diabetes, or asthma or anaphylaxis, when there is prior written parental approval. WASH. REV. CODE ANN. 28A

37 in W. Virginia W. VA. CODE R RNs duty to decide if tasks should be delegated. and 28A (3) (2005), respectively. Yes, West Virginia Code of Rules states that may be administered by school personnel who are designated, qualified, trained and authorized to administer s to students. W. VA. CODE R RN determines if the prescribed may be safely delegated to designated qualified personnel. W. VA. CODE R

38 in Wisconsin Yes, any school employee may administer a prescription drug to a pupil in compliance with the written instructions of a practitioner if the pupil's parent or guardian consents in writing. WIS. STAT. ANN (2)(a)(2) (West 2005). However, no employee, except a health care professional, may be required to administer a drug or prescription drug to a pupil under this section by any means other than ingestion. WIS. STAT. ANN (5). Under WIS. STAT. ANN (4), any school board whose employees are authorized to administer prescription drugs to pupils must adopt a written policy governing the such drugs to pupils. In developing the policy, the school board shall seek the assistance of one or more appropriate health care professionals who are employees of the school board or are providing services or consultation. Id. Wyoming Wyoming Public School Board Police 5330 says will be administered in school only when failure to do so would jeopardize the student s health. The nurse is one person who can administer. Yes, but they must do it in the presence of another adult. (Wyoming Public School Board Policy 5330). is not listed as one of the tasks that may be delegated by a nurse in the Wyoming Board of Nursing s Rules and Regulations 7 8. ** For information about general state policies the in schools, please refer to ** 38

39 in W:\WPGROUPS\LEGADV\DIASTAT\Schools\ Law Chart\Diastat in Schools 507.doc 39