MEDICATION ADMINISTRATION IN SCHOOLS: WHAT YOU NEED TO KNOW



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MEDICATION ADMINISTRATION IN SCHOOLS: WHAT YOU NEED TO KNOW Renae Sisk, RN, BSN, NCSN S t a te S c h o o l N u r se C o n sultant E m a il: r sisk@nd.gov P h o n e: 7 01. 328.4526

KEY POINTS: ND State Statute 15.1-19-23 http://www.legis.nd.gov/ ND Board of Nursing FAQ https://www.ndbon.org/regulationspractice/practice/schoolnsgmedadmin.asp Key points to remember: Paperwork medical provider orders, consent form, log form, etc. Policies Storage locked, dry, organized Controlled substance tight control 6 Rights To avoid medication errors Emergency Situations (Epinephrine, Glucagon, Diastat) Is medication part of IEP or 504 Plan? Do or Die What are liabilities if you DON T administer the life-saving medication? There is a significant difference between daily medications and emergency medications. Although you can opt out of medication administration, certain situations do not allow this.

TRAINING Nurse, diabetic educator, physician, other medical provider School Nurse, Public Health Nurse, Clinic Nurse Curriculum posted online at http://www.ndhealth.gov/school-nursing/ Law isn t specific on who trains or how often the training is done. Once a year Change of staff New student/condition Thinking outside the box Telehealth Sharing school nurses

NORTH DAKOTA STATE STATUTES ND state statute 15.1-19-23 reads as follows 15.1-19-23. Medication program - Establishment - Opt-out - Liability - Immunity from liability. 1. The board of a school district or the governing body of a nonpublic school may establish a program for providing medication to students that includes authorizing individuals to provide medication to a student if the individual has received education and training in medication administration and has received written consent of the student's parent or guardian. 2. A teacher or classified staff member, who is not employed as a licensed health care provider to provide medication, may choose to not provide medication under the program established under subsection 1. 3. An individual authorized to provide medication under subsection 1, or a school district, the board of a school district, or the governing body of a nonpublic school that establishes a program for providing medication to students is not civilly or criminally liable for any act or omission of that individual when acting in good faith while providing medication to a student, except when the conduct amounts to gross negligence.

STUDENT SELF-CARRY LEGISLATION 15.1-19-16. Asthma - Anaphylaxis - Self-administration of medication by student - Liability. 1. A student who has been diagnosed with asthma or anaphylaxis may possess and self-administer emergency medication for the treatment of such conditions provided the student's parent files with the school a document that is signed by the student's health care provider and which: a. Indicates that the student has been instructed in the self - administration of emergency medication for the treatment of asthma or anaphylaxis; b. Lists the name, dosage, and frequency of all medication prescribed to the student for use in the treatment of the student's asthma or anaphylaxis; and c. Includes guidelines for the treatment of the student in the case of an asthmatic episode or anaphylaxis. 2. Neither a private school or a school district nor any employee of the private school or district is liable for civil damages incurred by: a. A student who administers emergency medication to himself or herself in accordance with subsection 1. Page No. 4 b. An individual because a student was permitted to possess emergency medication in accordance with subsection 1. 3. For purposes of this section, "emergency medication" includes a prescription drug delivered by inhalation to alleviate asthmatic symptoms and an epinephrine auto injectable pen. http://www.legis.nd.gov/cencode/t15-1c19.p df? 201506161 25501

NDBON FAQ S/SCHOOL NURSING MEDICATION ADMINISTRATION S C H O O L N U R S I N G M E D I C A T I O N A D M I N I S T R ATION B e l o w a r e e x a m p l e s o f q u e s t i o n s / s c e n a r i o s t h a t s c h o o l n u r s e s a r e f a c e d w i t h e v e r y d a y. T h e q u e s ti o n s a n d r e s p o ns e s w e r e p r e p a r e d i n c o n s u l t a t i o n w i t h t h e N o r t h D a k o t a B o a r d o f N u r s i n g, t h e N o r t h D a k o t a S c h o o l N u r s e O r g a nization ( N D S N O ), N o r t h D a k o t a D e p a r t m e nt o f H e a l t h, a n d N o r t h D a k o t a S c h o o l B o a r d A s s o c i a t i o n. W h o i s r e s p o n s i b l e f o r a s s i g n i n g t h e t a s k o f m e d i c a t i o n a d m i n i s t r a t i o n a n d / o r i n d i v i d u a l h e a l t h c a r e s e r v i c e s i n t h e s c h o o l s e t t i n g? The school administrator is responsible for assignments within the school setting. A student s parent or legal guardian must provide written consent to the school for any individual to provide requested medication administration and/or individual health care services to the student. See NDCC 43-12.1-04(9)(g), 23-44-03, and 15.1-19-23. W h a t i s t h e n u r s e s r e s p o n s i b i l i t y a n d l i a b i l i t y i n r e g a r ds t o t h e i m p l e m e n t a t i o n o f N D C C 2 3-44- 03 a n d N D C C 4 3-1 2. 1-0 4 ( 9 ) ( g )? The licensed registered nurse needs to be familiar with the provision added to the existing section of law, NDCC 43-12.1-04, which identifies persons who are exempt from the provisions of the North Dakota Nurse Practices Act. The new provision, set forth in subsection 9 (g) of NDCC 43-12-04, exempts a person that provides medications, other than by the parenteral route, within a primary or secondary school under a program established under section 15.1-19-23 if the individual has received education and training in medication administration and has received written consent of the student s parent or guardian. These laws must be read together to fully understand the scope of school authority to provide medications to students. W h o s u p e r v i s e s m e d i c a t i o n a d m i n i s tration i n s c h o o l a n d a s s e s s e s i n d i v i d u a l c o m p e t e n c y? The authority for school staff to administ e r medicat ions is a relationshi p between the school and the authorizing parent or legal guardian. The accountability for safe and effective medication administration is with the school administrator. Nurses administering medication in a school are accountable under the North Dakota Nurse Practices Act (NDCC Chapter 43-12.1).

NDBON FAQ S CONT. I f a s c h o o l n u r s e i s p r e s e n t i n a s c h o o l b u i l d i n g w h e r e m e d i c a t i o n a d m i n i s t r a t i o n o r i n d i v i d u a l h e a l t h c a r e s e r v i c e s h a v e b e e n a s s i g n e d t o s o m e o n e o t h e r t h a n t h e n u r s e, c a n t h e n u r s e p r o v i d e t r a i n i n g / e d u c a t i o n t o t h e s c h o o l s t a f f o n s a f e p r a c t i c e s? Yes. If medication administration has not been assigned to the nurse, the nurse may provide training/education to an individual who will provide medications and/or individual health care services within a primary or secondary school according to NDCC 43-12.1-04((9)(g). The registered nurse, who verifies a competency, is accountable for verifying and documenting that individual s competency on that given date, but not for the quality of the service provided by that individual over a specified period of time. This is not considered delegation according to the North Dakota Nurse Practices Act and the school nurse would not be liable for errors occurring in the actual administration of medication by another individual. However, accountability for the training of safe medication administration lies with both school administrator and the licensed registered nurse who provide s training/ educa t ion. W h a t l i a b i l i t y e x i s t s f o r t h e s c h o o l n u r s e i f a h e a l t h p r o b l e m w i t h a s t u d e n t a r i s e s a n d t h e n u r s e h a s n o t b e e n i n v o l v e d i n t h e p l a n o f c a r e? The school nurse is required to follow standard emergency procedures. The student s parent or legal guardian is ultimately responsible for notifying the school of a health concern (i.e. medication administration and/or individual health care services.) The school nurse is not liable for relying or acting upon any incorrect or incomplete information provided by the school, parent or legal guardian. W h o c a n d o i n j e c t i o n s a n d o t h e r i n v a s i v e p r o c e d u r e s i n t h e s c h o o l s e t t i n g? License d nurses and others as authorized by law. W h a t k i n d o f t r a i n i n g i s r e q u i r e d f o r n o n - n u r s i n g s t a f f t o d o i n j e c t i o n s a n d o t h e r i n v a s i v e p r o c e d u r e s i n t h e s c h o o l s e t t i n g? A register e d nurse may delegate nursing intervent ions in accordance with the Nurse Practices Act ( NDCC Chapter 43-12.1). Sections 43-12.1-16 and 43-12.1-16.1 allow nurses to delegate and supervise nursing interventions to a person exempt under the Nurse Practice Act; however, parenteral (injections or intravenous) routes are not authorized pursuant to the exemption set forth in NDCC 43-12.1-04-09(g) of the Nurse Practices Act. Licensed nurses are accountable to identify acceptable nursing interventions on a specific client by an unlicensed assistive person on an individual basis. The individual to whom the nurse delegates must be registered on the Unlicensed Assistive Person registry or another registry recognized by the board.

NDBON FAQ S CONT. C a n s c h o o l s t a f f a d m i n i s t e r a n i n s u l i n i n j e c t i o n? If a diabetic student is stable and has specific parameters, an insulin injection may be delegated by the licensed nurse usi n g the rules for specifi c delegati on. NDAC 54-07- 08, Specific Delegati o n of Medicati on Admini st r at io n, outlines the process for th e nurse to follow. W h a t c a n p a r a m e d i c s a n d E M T s d o? The Division of Emergency Medical Services and Trauma (DEMST) serves as North Dakota s lead emergency medical services (EMS) agency and is responsible for certification and licensure of EMS personnel. I s t h e n u r s e l e g a l l y a b l e t o e x c h a n g e v e r b a l i n f o r m a t i o n w i t h a c h i l d s d o c t o r w i t h o u t a w r i t t e n r e l e a s e o f a u t h o r i z a t i o n f r o m a p a r e n t a n d d o e s t h e n u r s e p r a c t i c e a c t o r H I P A A a d d r e s s t h i s i s s u e? It is recommended that each public health unit should have their own designated Health Insurance Portability and Accountability Act (HIPAA) Officer (it is required under 45 CFR 164.530(a) of HIPAA) if they are handling Protected Health I nformation ( PHI) and they should be responding accordingly to their own HI PAA related duties. C a n t h e s c h o o l m e d i c a t i o n p r o v i de r a d m i n i s t e r t h e f o l l o w i n g E m e r g e n c y M e d i c a t i o n s : Glucagon for Hypoglycemia Ep i nephrine for Anap hylaxis Diastat Rectal Gel for Seizures Unless provided for specifically in federal or state law, these medications are generally not used in stable, predictable situations, so emergency care procedures must be in place and implemented. In an emergency, school personnel could administ er a Glucagon injection and Diastat gel according to Nurse Practices Act exempt ion found in NDCC 43-12. 1-04( 1). The administrat ion by school personnel of Epinephr in e for Anaphylaxis is authorized as provide d by NDCC 23-01- 05. 2. Nurses may provide training to indivi d ua l s that may administ er medicat ion during an emergenc y. In addition to the scenarios described above, individuals who are not licensed or registered with the North Dakota Board of Nursing may also be authorized to administer medications in other circumstances, including cases of emergency or disaster. The applicable exemptions are described in NDCC 43-12.1-04.

FOR MORE INFORMATION Renae Sisk, RN, BSN, NCSH Maternal Child Health & School Nurse Consultant North Dakota Department of Health Division of Family Health 600 East Blvd Ave Bismarck, ND 58505-0200 phone: 701.328.4526 email: rsisk@nd.gov website: http://www.ndhealth.gov/school-nursing/

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