1/12 Checklist: Administering Medications in K-12 Schools EduRiskSolutions.org

Checklist

Administering Medications in K-12 Schools

Medications administered at school can be necessary for a student’s health and success but can also pose risks. Consider the following UE claims:

❚ A student with a heart condition died suddenly after he was issued an incorrect dosage of asthma medication at school. The student’s parents sued the institution, claiming the medication error caused their child’s death.

❚ After missing several medication doses at school, a student’s ADHD symptoms worsened. The student’s parents sued the institution claiming its medication administration practices violated disability laws.

❚ On a field trip, a student attempted suicide by overdosing on his prescription medication that was left unsecured on a school bus seat. The student’s parents sued claiming the school’s failure to secure the medication caused their child’s injuries.

Minimize these risks by using this checklist to develop proper policies and procedures. For each item, check the appropriate “yes” or “no” box. If the answer is “no,” consider whether further action is necessary. Legal counsel should review all policies and procedures, paying particular attention to state law. For a summary of state laws see:

❚ National Association of State Boards of Education Health Policies

❚ State Policies on Administration of Medication in Schools

u Authorization

❚ Does your institution ask students to provide written authorization by a state licensed prescriber, such as a physician or a physician’s assistant, before administering at school:

à Prescribed medications? � Yes � No

à Herbal and dietary supplements? � Yes � No

à Off-label or research medications? � Yes � No

❚ Does your institution have guidelines addressing how long it will administer over-the-counter (OTC) medications to a student without medical authorization? If your institution requires medical authorization for OTC drugs, please skip this question.

� Yes � No

Actions Needed

2/12 Checklist: Administering Medications in K-12 Schools EduRiskSolutions.org

Actions NeededA. Standard Medical Authorization

❚ Does your institution’s standard medical authorization form request:

à Student’s name? � Yes � No

à Licensed prescriber’s name, telephone number, and signature? � Yes � No

à Date of prescription? � Yes � No

à Name of medication? � Yes � No

à Dosage amount? � Yes � No

à Means by which medication is to be administered, such as orally, via injection, or other?

� Yes � No

à Time of day to be given? � Yes � No

à Anticipated length of treatment? � Yes � No

à Diagnosis or reason for medication (unless the reason should remain confidential)?

� Yes � No

à Serious reactions the student might experience from taking the medication?

� Yes � No

à Serious reactions the student might experience from missing or not administering the medication?

� Yes � No

à Special handling instructions for the medication, such as “avoid sunlight” or “keep refrigerated”?

� Yes � No

à Reason why the medication cannot be administered at home? � Yes � No

B. Parent Authorization

❚ Does your institution require parents or guardians to complete a written consent form before the school administers medication to a student?

� Yes � No

❚ Does your institution’s parental consent form request:

à Student’s name? � Yes � No

à Parent or guardian’s name? � Yes � No

à Parent or guardian’s emergency and daytime phone numbers? � Yes � No

à A statement of consent? � Yes � No

à Date of consent? � Yes � No

3/12 Checklist: Administering Medications in K-12 Schools EduRiskSolutions.org

Actions Needed B. Parent Authorization (continued)

à Allergies? � Yes � No

à Other medications the student is taking, including OTC, herbal, and dietary supplements?

� Yes � No

à Other student health problems or illnesses? � Yes � No

à Student reactions to the initial dose? � Yes � No

à Name of the medication, reason given, and treatment duration (which should match the medical authorization form)?

� Yes � No

❚ If a medication is administered for more than six months, does your institution require parents to complete a new consent form annually or more frequently?

� Yes � No

See the Resources section for sample parental and medical authorization forms.

C. Authorization of Medication Changes

❚ If there are any changes in the original medical authorization, such as a new dosage or a new time of day to administer the medication, does your school:

à Request written authorization for the change by the student’s licensed prescriber, and a parent or guardian?

� Yes � No

à Require a corresponding change in the prescription label (if applicable)?

� Yes � No

à Permit changes in medication via the telephone or other means only:

• Under extreme or urgent circumstances in which it is impossible to get a new written medical authorization?

� Yes � No

• When the licensed prescriber speaks directly with a school nurse or other school official who is authorized to handle medical issues?

� Yes � No

• When the school nurse or other designated school official speaks directly with the student’s parent or guardian?

� Yes � No

• When the changes are documented on the student’s record? � Yes � No

• When the changes are followed by a written order from the licensed prescriber within a few days?

� Yes � No

• When the changes are followed by a new parental consent form within a few days?

� Yes � No

4/12 Checklist: Administering Medications in K-12 Schools EduRiskSolutions.org

Actions Neededv Administration of Medication

A. Medication Labeling

❚ Before administering, does your institution require that medications are in their original container labeled with:

à Student’s name? � Yes � No

à Name of medication? � Yes � No

à Instructions for dosage? � Yes � No

à Frequency of dosage? � Yes � No

❚ For prescription drugs, is the original container labeled with:

à Prescriber’s name? � Yes � No

à Date prescription was filled? � Yes � No

à Pharmacy name and address of the pharmacy? � Yes � No

à Expiration date of the medication? � Yes � No

B. Parental Involvement (Some of these steps may not apply to boarding schools)

❚ Does your institution require that parents:

à Sign a waiver or release identifying the risks and the party responsible for injuries arising out of the school’s administration of medication?

� Yes � No

à Sign a release allowing the institution to consult with the student’s licensed health provider if necessary?

� Yes � No

à Administer the first dose of any new medication at home, unless the medication is solely an “in school” medication?

� Yes � No

à Transport medication so that the student is not responsible for bringing it to school?

� Yes � No

à Pick up unused medication within one week of its expiration date? � Yes � No

❚ Does your institution create regular opportunities to discuss a student’s plan of care with a parent or guardian?

� Yes � No

❚ Does your institution require parents to sign a new authorization and/or release with each new medication prescribed or when a dosage changes?

� Yes � No

❚ Does your institution require a parent to update the school regarding changes in the student’s health status?

� Yes � No

5/12 Checklist: Administering Medications in K-12 Schools EduRiskSolutions.org

Actions NeededActions Needed C. Storage and Disposal of Medications

❚ Does your institution:

à Store medication in a lockable room and storage container? � Yes � No

à Limit access to the room and storage container to authorized staff? � Yes � No

à Refrigerate medication if required? � Yes � No

à Restrict the amount of medication, such as a one-month supply, a student can store on school premises?

� Yes � No

à Make medications such as asthma inhalers, epinephrine auto-injectors, and glucagon easily accessible?

� Yes � No

à Periodically account for “controlled substances” or drugs with abuse potential that are stored at your institution?

� Yes � No

à Notify parents in writing of the date by which unused medication should be picked up or it will be destroyed?

� Yes � No

à Require that disposal of uncollected medication be done in the presence of the school nurse and witnessed by another school employee?

� Yes � No

à Document the name of the medication and the amount disposed along with the student’s name, and have the document signed by both employees present for the disposal?

� Yes � No

à Have a plan for medication transport in the event of emergency evacuation during the school day?

� Yes � No

à Periodically count remaining medication on hand and reconcile that amount with the administration log (discussed below)?

� Yes � No

D. Training for Administering Medication

❚ All individuals who administer medications to students must meet minimum qualifications specified by state law. Do these individuals receive proper training on:

à State and federal laws affecting the administration of medication in schools, including confidentiality issues?

� Yes � No

à School policies and procedures relating to the administration of medication, including those related to self-administration?

� Yes � No

à Forms related to the administration of medication in schools? � Yes � No

à The safe storage, handling, and disposal of medications in schools, and on field trips or other off-site activities?

� Yes � No

à Identifying and dispensing medication to students? � Yes � No

6/12 Checklist: Administering Medications in K-12 Schools EduRiskSolutions.org

Actions Needed D. Training for Administering Medication (continued)

à Documenting the administration of medications? � Yes � No

à The procedures for handling administration errors or missed doses? � Yes � No

E. Refusing to Administer Medication

❚ When refusing to administer medication to a student, does your institution:

à Review its decision with legal counsel to ensure it does not violate disability laws?

� Yes � No

à Discuss its decision with the student’s parent or guardian? � Yes � No

à Issue a letter that has been reviewed by legal counsel to the student’s parent or guardian explaining the reason for the refusal? See the Resources section for a sample “Refusal to Administer” letter.

� Yes � No

F. Self-Administration of Medication

❚ Does your institution’s state law and policy permit students to self-administer? If no, please skip this section.

� Yes � No

à Does your institution place any limits on which medications may be self-administered even if allowed under your state law?

� Yes � No

❚ Before allowing a student to self-administer medications, does your institution:

à Comply with the authorization requirements for administering medication outlined in Section 1 of this checklist?

� Yes � No

à Comply with state laws affecting self-administration at K-12 schools, including any minimum age requirements?

� Yes � No

à Require the student and a parent or guardian to verify in writing the student’s:

• Ability for self-administration? � Yes � No

• Understanding that medication is not to be shared? � Yes � No

à Require the licensed prescriber to state in writing that the student is qualified and able to self-administer medication?

� Yes � No

à Assess and declare, in writing, that the student is physically and emotionally capable of self-administering medication?

� Yes � No

à Determine whether the medication requires special accommodations, such as refrigeration or security, that make it inappropriate for self-administration?

� Yes � No

à Notify and prepare appropriate staff members, such as teachers, principals, and others about the student’s self-administration of medication?

� Yes � No

7/12 Checklist: Administering Medications in K-12 Schools EduRiskSolutions.org

Actions Needed F. Self-Administration of Medication (continued)

à Annually or more frequently require students to renew their permission to self-administer medications?

� Yes � No

❚ Has your institution considered a “medication pass” system in which students who self-administer carry a pass at all times that states the student’s name, the medication, date issued, who issued the pass, when the pass expires, and when the medication should be taken?

� Yes � No

G. Record Keeping

❚ Does your institution keep a medication log documenting:

à Student’s name? � Yes � No

à Name of the medication? � Yes � No

à Schedule for medication administration? � Yes � No

à Dosage? � Yes � No

à Date and time of administration? � Yes � No

à Route of administration (oral, injection, etc.)? � Yes � No

à Signature or initials of the person administering the medication? � Yes � No

❚ Does your institution require the medication log be completed at the time of medication administration?

� Yes � No

❚ In the event of recording errors, does your institution have a process for correcting the log?

� Yes � No

❚ Does your institution retain the following records for students receiving medication: See the Resources section for sample medication logs.

à Medical authorization? � Yes � No

à Parental consent? � Yes � No

à Self-administration form (if applicable)? � Yes � No

à Pertinent information about the medication? � Yes � No

à Release or waiver signed by a student’s parent or guardian to administer medication?

� Yes � No

à Any written communication between the school and parent? � Yes � No

8/12 Checklist: Administering Medications in K-12 Schools EduRiskSolutions.org

Actions Neededw Medication Doses

A. Timing

❚ Does your institution strive to administer all medications within one hour before or after the prescribed time?

� Yes � No

❚ Does your institution communicate this time frame to parents and licensed prescribers so they can express any concerns?

� Yes � No

B. Missed Doses

❚ If a student misses (or refuses) a dose, does your institution:

à Review the student’s medical authorization form to understand the potential medical consequences?

� Yes � No

à Send for a student who fails to appear for a scheduled dose? � Yes � No

à Check on the student and respond to any medical consequences? � Yes � No

à Promptly report the missed dose to the:

• Student? � Yes � No

• Parent or guardian? � Yes � No

• Student’s licensed prescriber? � Yes � No

• Appropriate school administrator? � Yes � No

à Discuss with the student and a parent why the medication was missed and strategies to prevent missed doses?

� Yes � No

à Document the missed dose in the medication log? � Yes � No

à Complete an accident or incident reporting form? See the Resources section for sample incident forms.

� Yes � No

C. Incorrect Doses

❚ If an incorrect dose is given, does your institution:

à Review the student’s medical authorization form to understand the potential medical consequences?

� Yes � No

à Check on the student and respond to any medical consequences? � Yes � No

à Promptly report the incorrect dose to the:

• Student? � Yes � No

• Parent or guardian? � Yes � No

9/12 Checklist: Administering Medications in K-12 Schools EduRiskSolutions.org

Actions Needed C. Incorrect Doses (continued)

• Licensed prescriber? � Yes � No

• Appropriate school administrator? � Yes � No

• Require consultation with the local Poison Control Center in the event of a higher dose?

� Yes � No

à Document the error in the medication log? � Yes � No

à Complete an accident or incident reporting form? See the Resources section for sample incident forms.

� Yes � No

x Emergency Medication

❚ To manage students suffering from conditions that may require the administration of emergency medications, such as a life-threatening allergy, asthma, diabetes, or opioid overdose, does your institution:

à Comply with all of the best practices for administering medication discussed in Section 2?

� Yes � No

à Have a school nurse or other trained school representative supervise the management and treatment of students with emergency conditions?

� Yes � No

à Allow students to self-administer their emergency medications only if your institution complies with the practices described in Section 2(F), “Self-Administration”?

� Yes � No

à Have an emergency plan in place for field trips and other events off school grounds (see Section 5)?

� Yes � No

A. Emergency Epinephrine

❚ Does your school administer emergency epinephrine to students without documentation of a previous allergy risk? If “no,” please skip this section.

� Yes � No

❚ To ensure proper administration of emergency epinephrine, does your school:

à Consult with legal counsel and a physician about its procedures for administering epinephrine?

� Yes � No

à Have available emergency epinephrine kits on:

• School grounds? � Yes � No

• School field trips or other off-site activities, such as athletic competitions?

� Yes � No

à Train relevant school personnel on the location and use of emergency epinephrine, including its use on field trips?

� Yes � No

10/12 Checklist: Administering Medications in K-12 Schools EduRiskSolutions.org

Actions Needed A. Emergency Epinephrine (continued)

à Identify students at high risk for anaphylaxis and allergic reaction, such as those with a history of allergic reaction or a chronic respiratory illness?

� Yes � No

à Identify areas or situations in which allergic reactions are more likely, such as situations involving potential exposure to insect bites, food, or latex?

� Yes � No

à Train personnel, such as teachers, working in areas where students are exposed to insect bites, latex, or food about the use of emergency epinephrine, such as where it is stored and how to use it?

� Yes � No

à Regularly check the institution’s emergency epinephrine kits to ensure they are not expired or damaged?

� Yes � No

B. Emergency Response

❚ When a student is administered an emergency medication, does your institution:

à Immediately contact the following:

• 911 or emergency services? � Yes � No

• Student’s primary health care provider? � Yes � No

• Student’s parent or guardian? � Yes � No

à Ensure that a school staff member remains with the student until a parent, guardian, or emergency contact arrives?

� Yes � No

à Complete an incident report in instances when emergency response measures are activated or other emergency health issues occur?

� Yes � No

y Field Trips, Off-Campus Activities, and Study Abroad

A. Short-Term Field Trips and Off-Campus Activities

❚ For field trips and off-campus activities that are one day or shorter, does your institution require that:

à The person in charge of administering medications is given at least one day of advance notice?

� Yes � No

à The amount of medication needed for the field trip is placed in an original, properly labeled container?

� Yes � No

à The student’s parental consent and medical authorization forms are accessible during the trip?

� Yes � No

à A school nurse or other properly trained employee attends the field trip, stores the medication, and administers it?

� Yes � No

11/12 Checklist: Administering Medications in K-12 Schools EduRiskSolutions.org

Actions Needed A. Short-Term Field Trips and Off-Campus Activities (continued)

❚ If a nurse or other trained employee cannot administer the medication on a field trip, does your institution permit other accommodations, such as allowing the student’s:

à Parent or guardian to attend the activity and administer the medication?

� Yes � No

à Health care provider to authorize in writing eliminating the dose or adjusting the medication’s administration time for the day of the field trip?

� Yes � No

B. Longer-Term Field Trips or Study Abroad Trips

❚ For school trips longer than one day, has your institution addressed:

à How medication will be:

• Stored? � Yes � No

• Administered, including whether emergency and self-administration are feasible and appropriate?

� Yes � No

• Supplied or refilled (some medications used in the U.S. are not available in other countries)?

� Yes � No

à Proper training of school officials in charge of administering medication on the trip?

� Yes � No

• Monitoring the student’s health? � Yes � No

• How to handle a missed or incorrect dosage? � Yes � No

• Documenting the administration of medication? � Yes � No

• Preventing and addressing the unauthorized use of student medication?

� Yes � No

• Emergency administration of medication? � Yes � No

❚ Prior to approving a student’s participation in a trip, are consultations encouraged between the student, a parent or guardian, the school official in charge of the trip, and the student’s health care provider regarding:

à Storing, administering, and supplying medication on the trip? � Yes � No

à Monitoring the student’s health on the trip? � Yes � No

à Addressing missed or incorrect dosages? � Yes � No

à Additional health risks posed by the trip? � Yes � No

12/12 Checklist: Administering Medications in K-12 Schools EduRiskSolutions.org

Actions Needed

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To learn more, please visit www.UE.org.

The material appearing in this publication is presented for informational purposes and should not be considered legal advice or used as such.

Copyright © 2019 by United Educators Insurance, a Reciprocal Risk Retention Group. All rights reserved. Permission to post this document electronically or to reprint must be obtained from United Educators. UE-13351R1 03/19

ResourcesSample FormsMedical & Parental Authorization Virginia General Guidelines for Administering Medication in School (page 261)

Student Agreement for Medication Self-Administration North Carolina School Health Program Manual (page 231)

Medication Logs North Carolina School Health Program Manual (page 245)

Texas School Health Guidelines. Chapter 5: Medication Administration.2017. Texas Department of State Health Services (page 260)

Incident ReportsNorth Carolina School Health Program Manual (page 241)

Texas School Health Guidelines. Chapter 5: Medication Administration. 2017. Texas Department of State Health Services (page 262)

Refusal to Administer LetterTexas School Health Guidelines. Chapter 5: Medication Administration. 2017. Texas Department of State Health Services (page 255)

Recommended Practices and PoliciesAmerican Academy of Pediatrics. Policy Statement—Guidance for the Administration of Medication in School. September, 2009

National Association of School Nurses. Position Statement: Medication Administration in the School Setting

Texas School Health Guidelines. Chapter 5: Medication Administration. 2017. Texas Department of State Health Services

Utah Department of Health. Guidelines for Administration of Medication in Schools. 2017