Administering Medication to Students
NEPN/NSBA Code: JLCD
The School Committee acknowledges that in certain circumstances it may be necessary for a student to have medication administered while in attendance at school. The school committee discourages administration of medication on school premises when other options exist. Whenever possible, it is recommended that the first dose of a newly-prescribed medication be given at home. The school will not deny educational opportunities to students requiring the administration of medication in order to remain in attendance and participate in the educational program.
The intent of this policy is to promote the safe administration of medications (including emergency/rescue medications) to students by school personnel and to provide for authorization of student emergency self-administration of medication from asthma inhalers and epinephrine autoinjectors.
This policy does not apply to medical marijuana, which is addressed in the School Committee’s policy JLCDA, Medical Marijuana in Schools.
This policy authorizes the adoption of a collaborative practice agreement for the purposes of stocking and administration of epinephrine autoinjectors by the school nurse or designated trained school personnel to any student during school or a school-sponsored activity under emergency circumstances involving anaphylaxis.
This policy also authorizes the adoption of a collaborative practice agreement to provide for the possession and administration of naloxone hydrochloride or other noninjectable opioid overdose-reversing medication by the school nurse or designated trained school personnel to students, staff, or visitors during school or a school-sponsored activity or otherwise on school grounds in emergency circumstances involving an opioid overdose or apparent opioid overdose.
The School Committee encourages collaboration between parents/guardians and the schools in matters involving student medication.
The School Committee disclaims any and all responsibility for the diagnosis, prescription of treatment, and administration of medication for any student, and for any injury arising from a student’s self-administration of medication.
This policy authorizes the school unit and its schools to obtain a standing order for undesignated ready-to-use glucagon rescue therapies and permits the school nurse or designated trained unlicensed school personnel to administer glucagon rescue therapy to a student with a known diagnosis of diabetes if the student’s prescribed glucagon is not available on-site or has expired. The glucagon must be stored in a secure location, immediately accessible to the school nurse and designated trained unlicensed school personnel, and maintained according to the manufacturer’s instructions.
I. DEFINITIONS
“Administration” means the provision of prescribed medication to a student or other persons according to the orders of a health care provider.
“Collaborative practice agreement” means a written and signed agreement between a physician licensed in Maine or a school health advisor, as defined in 20-A MRSA §6402-A, and a school nurse that provides for the prescription of epinephrine autoinjectors by the physician or school health advisor and administration of epinephrine injectors by the school nurse or designated school personnel to students during school or a school-sponsored activity under emergency circumstances involving anaphylaxis; or as defined in 20-A MRSA § 6307 that provides for the prescription of naloxone by the physician or school health advisor and the administration of naloxone by the school nurse or designated school personnel to students, staff, or visitors during school or a school-sponsored activity or otherwise on school grounds under emergency circumstances involving an opioid overdose or apparent opioid overdose.
“Designated school personnel” are unlicensed school personnel who have completed such training in administration of medication as may be required by Maine statutes or DOE rules and who have been authorized by the school nurse to administer medication.
“Diabetes Care plan” means an individual health plan document that specifies the diabetes-related services needed by a student at school and at school-sponsored activities and which may include an emergency action plan.
“Emergency action plan” means a document that provides guidelines to prepare school personnel to respond to a serious life-threatening injury or medical emergency.
“Health care provider” means a medical/health practitioner who has a current license in the State of Maine with a scope of practice that includes prescribing medication.
“Indirect supervision” means the supervision of an unlicensed school staff member when the school nurse or other health care provider is not physically available on site but immediately available by telephone.
“Medication” means prescribed drugs and medical devices that are controlled by the U.S. Food and Drug Administration and are ordered by a health care provider. It includes over-the-counter medications prescribed through a standing order by the school physician or prescribed by the student’s health care provider. For the purpose of this policy, “medication” includes epinephrine, naloxone hydrochloride and other noninjectable opioid overdose-reversing medications, and glucagon, but does not include medical marijuana.
“Parent” means a natural or adoptive parent, a guardian, or a person acting as a parent of a child with legal responsibility for the child’s welfare.
“School nurse” means a registered professional nurse with Maine Department of Education certification for school nursing.
“Self-administration” is when the student administers medication independently to him/herself under indirect supervision of the school nurse.
“Standing order” is an order written by a health care provider (as defined in this policy) for the entire population of students or subset thereof rather than written for a specific named individual.
“Undesignated ready to-use glucagon rescue therapy” means a USDA-approved glucagon rescue therapy that does not require reconstitution for the treatment of severe hypoglycemia, in a dosage form that can be rapidly administered in an emergency, including prefilled injectable or nasally administered glucagon.
“Unlicensed school personnel” are persons who do not have a professional license that allows them, within the scope of that license, to administer medication.
II. ADMINISTRATION OF MEDICATION BY SCHOOL PERSONNEL
A. Parental Request
In the event that no reasonable alternative exists, the parent/guardian may request in writing that medication be administered to the student during the school day. The written request must include an acknowledgment and agreement that unlicensed personnel may administer the medication as per the health care provider’s instructions. In addition, the request shall indicate that information regarding the student’s medication may be shared with appropriate school personnel. Parents may provide the reason (diagnosis) requiring the administration of medication. Requests shall be valid for the current school year only.
B. Health Care Provider’s Order
All parental requests must be accompanied by a written order from the student’s health care provider substantiating the fact that the administration of a particular medication during the school day is necessary for the student’s health and attendance in school. Such order must include:
1. The student’s name;
2. The name of the medication;
3. The dose;
4. The route of administration (e.g., tablets, liquid, drops); and
5. Time intervals for administration (e.g., every four hours, before meals);
6. Any special instructions; and
7. The name of the prescribing health care provider.
It is the responsibility of the school nurse to clarify any medication order that they believe to be inappropriate or ambiguous. In accordance with Department of Education Rule Chapter 40 § 2(B), the school nurse may decline to administer a medication if he/she believes such administration would jeopardize student safety. In this case, the school nurse must notify the parent, the student’s health care provider and the school administrator (i.e., building principal or designated administrator).
C. Renewal of Parent Permission Requests/Forms and Health Care Provider Orders
Written parental permission requests/forms and health care provider orders must be renewed at least annually. Healthcare provider orders must be renewed whenever there are changes in the order.
D. Delivery and Storage of Medication
The student’s parents shall deliver any medication to be administered by school personnel to the school in its original container and properly labeled. In the event that this is not practical, the parent must contact the school to make alternate arrangements.
No more than a 20-day (one-month) supply of medication shall be kept at school, excluding inhalers and epinephrine autoinjectors. The parent is responsible for the replenishment of medication kept at school.
If the health care provider’s order/prescription is for a medication regulated by Schedule II of the Controlled Substances Act (21 USC §812) (e.g., Ritalin and Adderall) no more than a twenty (20) days’ supply shall be kept at school.
The parent is responsible for notifying the school of any changes in or discontinuation of a prescribed medication that is being administered to the student at school. The parent must remove any medication no longer required or that remains at the end of the school year. Remaining medication may be discarded.
The school nurse shall be responsible for developing and implementing procedures for the appropriate and secure storage of medications kept at school, and all medications shall be stored in accordance with this procedure.
E. Recordkeeping
School personnel and the student’s parent shall account for all medication brought to school. The number of capsules, pills or tablets, and/or the volume of other medications brought to school shall be recorded.
School staff administering medication shall document each instance the medication is administered including the date, time, and dosage given.
The school nurse shall maintain a record including the parent’s request, physician’s order, details of the specific medications (including dosage and timing of medication), and documentation of each instance the medication is administered.
Records shall be retained according to the current State schedules pertaining to student health records.
F. Confidentiality
To the extent legally permissible, staff members may be provided with such information regarding medication and its administration as may be in the best interest of the student.
G. Administration of Medication
Medication may be administered during the school day by licensed medical personnel acting within the scope of their licenses.
The school nurse, under the administrative supervision of the Superintendent, will provide direction and oversight for the administration of medication to students.
All unlicensed personnel (principals, teachers, education technicians, school secretaries, coaches, bus drivers, etc.) who administer medication must receive training before being authorized to do so.
Based upon the documentation of training and competency in the administration of medication, the school nurse will make recommendations to the Superintendent/designee pertaining to authorization of unlicensed persons to administer medication. Training that shall be acceptable for the purpose of authorization of unlicensed personnel is addressed under the section of this policy titled “Required Training of Unlicensed Personnel to Administer Medication.”
H. Administration of Medication During Off-Campus Field Trips and School-Sponsored Events
The school will accommodate students requiring administration of medication during field trips or school-sponsored events as follows:
The school nurse, principal, and, as appropriate, the school unit’s Section 504 Coordinator and/or IEP, will determine whether an individual student’s participation is contraindicated due to the unstable/fragile nature of his/her health condition, the distance from emergency care that may be required, and/or other extraordinary circumstances. The student’s parent and primary care provider will be consulted in making this determination. The decision will be made in compliance with applicable laws, including the IDEA, § 504 and the Americans with Disabilities Act (ADA).
The parent must provide the appropriate number of doses needed for the duration of the field trip or school-sponsored event.
When there are no contraindications to student participation, an appropriately trained staff member will be assigned to administer medication. The parent will be encouraged to accompany the student, if possible, to care for the student and administer medication.
All provisions of this policy shall apply to medications to be administered during off-campus field trips and school-sponsored events. As practicable, the administration of medication on a field trip will duplicate as much as possible, the guidelines found in the Medication Administration Handbook for Unlicensed School Personnel.
I. Student Self-Administration of Asthma Inhalers and Epinephrine Auto-injectors, insulin pumps, pens, or needles.
Students with allergies or asthma may be authorized by the building principal, in consultation with the school nurse, to possess and self-administer emergency medication from an epinephrine autoinjector or asthma inhaler during the school day, during field trips, school-sponsored events, or while on a school bus. The student shall be authorized to possess and self-administer medication from an epinephrine autoinjector or asthma inhaler if the following conditions have been met.
1. The parent (or student, if 18 years of age or older) must request in writing authorization for the student to self-administer medication from an epinephrine autoinjector or asthma inhaler.
2. The student must have the prior written approval of his/her primary health care provider and, if the student is under the age of 18, the prior written approval of his/her parent/guardian. The written notice from the student’s primary care provider must specify the name and dosage of the medication, frequency with which it may be administered, and the circumstances that may warrant its use.
3. The student’s parent/guardian must submit written verification to the school from the student’s primary care provider confirming that the student has the knowledge and the skills to safely possess and use an epinephrine autoinjector or asthma inhaler.
4. The school nurse shall evaluate the student’s technique to ensure proper and effective use of an epinephrine autoinjector or asthma inhaler taking into account the maturity and capability of the student and the circumstances under which the student will or may have to self-administer the medication.
5. The parent will be informed that the school cannot accurately monitor the frequency and appropriateness of use when the student self-administers medication, and that the school unit will not be responsible for any injury arising from the student’s self-medication.
A student’s authorization to possess and self-administer medication from an epinephrine autoinjector or asthma inhaler may be limited or revoked by the building principal after consultation with the school nurse and the student’s parents if the student demonstrates inability to responsibly possess and self-administer such medication.
To the extent legally permissible, staff members may be provided with such information regarding the student’s medication and the student’s self-administration as may be in the best interest of the student.
Sharing, borrowing, or distribution of medication is prohibited. The student’s authorization to self-administer medication may be revoked and the student may be subject to disciplinary consequences for violation of this policy.
J. Administration of Glucagon Rescue Therapy
The school nurse or designated trained unlicensed school personnel may administer undesignated ready-to-use glucagon rescue therapy to a student with a known diagnosis of diabetes, as specified in the student’s Individual Health Plan (IHP)/Diabetes Care Plan, if the student’s prescribed glucagon is not available on site or has expired. Glucagon therapy may be administered in school buildings, on school grounds, playground, on school buses as well as on field trips or school-sponsored excursions.
The Plan will include a current school year written request/permission and acknowledgment that glucagon rescue therapy may be administered by unlicensed school personnel.
The school will provide an emergency action plan to a school employee who transports a student for school-sponsored activities. The emergency action plan must identify the student with diabetes, the potential emergencies that may occur as the result of the student’s diabetes and provide the school’s emergency contact information and diabetes care plan.
Immediately after the administration of glucagon rescue therapy to a student, a school employee must call for emergency assistance, notify the school nurse, and follow the emergency action plan.
K. Dispensation of Over-the-Counter Medications
With prior written (or electronic) parent permission, students may receive certain over the counter medications at school, e.g., Tylenol, Ibuprofen, Tums, cough drops, etc. pursuant to a standing order from the school physician/school health advisor.
L. Sunscreen
Students may possess and self-administer topical sunscreen without a signed order from a health care provider under the following conditions:
Sunscreen is to be in its original container, labeled with directions of use and warnings. Because it may adversely affect students with asthma and/or allergies, aerosol and spray sunscreens will not be allowed in schools.
The student must have written permission from their parent.
School nurse or other school personnel may inspect sunscreen product for safety and proper FDA labeling.
There is no expectation that school staff will apply sunscreen to students.
There is no expectation that the school will supply sunscreen to students.
A student who is unable to physically apply sunscreen may be assisted by school
personnel when directed to do so by the student, if permitted by a parent or guardian and authorized by the school.
M. Required Training of Unlicensed Personnel to Administer Medication
Unlicensed school personnel who administer medication to students in a school setting (at school, on school transportation to or from school, on field trips, or during school-sponsored events) must be trained in the administration of medication before being authorized to carry out this responsibility. Such training must be provided by a registered professional nurse or physician and include the components specified in Department of Education Rules Chapter 40 and other applicable Department of Education standards, recommendations, programs, and/or methodologies.
The trainer shall document the training and competency of unlicensed school personnel to administer medication. Based upon a review of the documentation of training and competency in the administration of medication, the school nurse will make recommendations to the Superintendent/designee pertaining to authorization of such unlicensed personnel pertaining to authorization to administer medication.
Following the initial training, a training review and information update must be held at least annually for those unlicensed school personnel authorized to administer medication.
N. Delegation and Implementation
The Superintendent/designee shall be responsible for developing administrative procedures and/or protocols to implement or supplement this policy.
Such procedures/protocols shall include direction regarding:
1. Safe transport of medication to and from school;
2. Administration of medication during field trips and school-
sponsored events;
3. Accountability for medications, particularly those regulated by
Schedule II of the Controlled Substances Act;
4. Proper storage of medication at school;
5. Training of appropriate staff on administration of emergency
medications including the standards for the signs and symptoms of
anaphylaxis and the use of epinephrine autoinjectors for previously
unknown severe allergies;
6. The procedure to follow in the event of a medication reaction;
7. Access to medications in case of a disaster;
8. The process for documenting medications given and medication
errors; and
9. The proper disposal of medications not retrieved by parents.
10. Protocols for the possession and application of sunscreen
Legal Reference: 20-A MRSA §§ 254(5); 4009(4); 4502 (5)(N); 6305; 6308
Me. Dept. of Ed. Rule Ch. 40
21 USC §801 et. seq. (Controlled Substances Act)
28 C.F.R. Part 35 (Americans with Disabilities Act of 1990)
34 C.F.R. Part 104 (Section 504 of the Rehabilitation Act of 1973)
34 C.F.R. Part 300 (Individuals with Disabilities Education Act)
Cross Reference: JLCDA – Medical Marijuana in Schools
Adopted: Prior to 1982
Revised: June 8, 1992; February 1, 2005, February 9, 2006, July 11, 2019,
November 9, 2023, October 10, 2024