Series 5000: Students

5141.21 Administration of Medication

Administering Medication

The purpose of this policy is for the Board of Education (Board) to determine who shall  administer medications in a school and the circumstances under which self-administration of  medication by students shall be permitted. 

The Board of Education allows students to self-administer medication and school personnel to  administer medication to students in accordance with the established procedures, and applicable  state regulations, sections 10-212a-1 through 10-212a-10 inclusive. In order to provide  immunity afforded to school personnel who administer medication, the Board of Education, with  the advice and approval of the School Medical Advisor and the school nurse supervisor, shall  review and/or revise this policy and regulation biennially concerning the administration of  medications to District students by a nurse, or in the absence of a nurse, by qualified personnel  for schools. The District’s School Medical Advisor (or other qualified physician) shall approve  this policy, its regulations and any changes prior to adoption by the Board. 

Definitions 

Administration of medication means any one of the following activities: handling, storing, preparing or pouring of medication; conveying it to the student according to the medication  order; observing the student inhale,apply, swallow, or self-inject the medication, when  applicable; documenting that the medication was administered; and counting remaining doses to  verify proper administration and use of the medication. 

Advanced practice registered nurse means an individual licensed pursuant to C.G.S. 20-94a.

Authorized prescriber means a physician, dentist, optometrist, advanced practice registered nurse or physician assistant, and for interscholastic and intramural athletic events only, a podiatrist. 

Before- and after-school program means any child care program operated and administered by a local or regional Board of Education or municipality exempt from licensure by the Office of  Early Childhood. Such programs shall not include public or private entities licensed by the  Office of Early Childhood or Board of Education enhancement programs and extra-curricular  activities. 

Board of Education means a local or regional Board of Education, a regional educational  service center, a unified school district, the regional vocational-technical school system, an  approved private special education facility, the Gilbert School, the Norwich Free Academy,  Woodstock Academy or a non-public school whose students receive services pursuant to Section  10-217a of the Connecticut General Statutes.

Cartridge injector means an automatic prefilled cartridge injector or similar automatic  injectable equipment used to deliver epinephrine in a standard dose for emergency first aid  response to allergic reaction. 

Controlled drugs means those drugs as defined in Connecticut General Statutes Section 21a-240. 

Cumulative health record means the cumulative health record of a student mandated by  Connecticut General Statutes Section 10-206. 

Director means the person responsible for the operation and administration of any school  readiness program or before- and after-school program. 

Eligible student means a student who has reached the age of eighteen or is an emancipated  minor. 

Error means: 

(1) the failure to do any of the following as ordered: 

(a) administer a medication to a student; 

(b) administer medication within the time designated by the prescribing physician; 

(c) administer the specific medication prescribed for a student; 

(d) administer the correct dosage of medication; 

(e) administer medication by the proper route; and/or 

(f) administer the medication according to generally accepted standards of practice; or 

(2) the administration of medication to a student which is not ordered by an authorized  prescriber, or which is not authorized in writing by the parent or guardian of such  student, except for the administration of epinephrine for the purpose of emergency first  aid pursuant to Connecticut General Statutes 10-212a and Section 10-212a-2 of the  Regulations of Connecticut State Agencies. 

Extracurricular activities means activities sponsored by local or regional Boards of Education  that occur outside of the school day, are not part of the educational program, and do not meet the  definition of before- and after-school programs and school readiness programs.

Guardian means one who has the authority and obligations of guardianship of the person of a  minor, and includes: (1) the obligation of care and control; and (2) the authority to make major  decisions affecting the minor’s welfare, including, but not limited to, consent determinations  regarding marriage, enlistment in the armed forces and major medical, psychiatric or surgical  treatment. 

Intramural athletic events means tryouts, competition, practice, drills, and transportation to and  from events that are within the bounds of a school district for the purpose of providing an  opportunity for students to participate in physical activities and athletic contests that extend  beyond the scope of the physical education program. 

Interscholastic athletic events means events between or among schools for the purpose of  providing an opportunity for students to participate in competitive contests which are highly  organized and extend beyond the scope of intramural programs and includes tryouts,  competition, practice, drills, and transportation to and from such events.

Investigational drug means any medication with an approved investigational new drug (IND)  application on file with the Food and Drug Administration (FDA), which is being scientifically  tested and clinically evaluated to determine its efficacy, safety and side effects and which has not  yet received FDA approval. 

Licensed athletic trainer means a licensed athletic trainer employed by the school district  pursuant to Chapter 375a of the Connecticut General Statutes. 

Medication means any medicinal preparation including over-the-counter, prescription and  controlled drugs, as defined in Connecticut General Statutes Section 21a-240. This definition  includes Aspirin, Ibuprofen or Aspirin substitutes containing Acetaminophen. 

Medication emergency means a life-threatening reaction of a student to a medication. 

Medication plan means a documented plan established by the school nurse in conjunction with  the parent and student regarding the administration of medication in school. Such plan may be a  stand-alone plan, part of an individualized health care plan, an emergency care plan or a  medication administration form.

Medication order means the written direction by an authorized prescriber for the administration  of medication to a student which shall include the name of the student, the name and generic  name of the medication, the dosage of the medication, the route of administration, the time of  administration, the frequency of administration, the indications for medication, any potential side  effects including overdose or missed dose of the medication, the start and termination dates not  to exceed a 12-month period, and the written signature of the prescriber. 

Nurse means an advanced practice registered nurse, a registered nurse or a practical nurse  licensed in Connecticut in accordance with Chapter 378 of the Connecticut General Statutes. 

Occupational therapist means an occupational therapist employed full time by the local or  regional board of education and licensed in Connecticut pursuant to Chapter 376a of the  Connecticut General Statutes. 

Paraprofessional means a health care aide or assistant or an instructional aide or assistant  employed by the local or regional Board of Education who meets the requirements of such Board  for employment as a health care aide or assistant or instructional aide or assistant. 

Physical therapist means a physical therapist employed full time by the local or regional Board  of Education and licensed in Connecticut pursuant to Chapter 376 of the Connecticut General  Statutes. 

Physician means a doctor of medicine or osteopathy licensed to practice medicine in  Connecticut pursuant to Chapters 370 and 371 of the Connecticut General Statutes, or licensed to  practice medicine in another state. 

Physician assistant means an individual licensed to prescribe medications pursuant to Section  20-12d of the Connecticut General Statutes. 

Podiatrist means an individual licensed to practice podiatry in Connecticut pursuant to Chapter  375 of the Connecticut General Statutes. 

Principal means the administrator in the school. 

Qualified medical professional, as defined in C.G.S. 10-212, means a physician licensed under  Chapter 370, an optometrist licensed to practice optometry under Chapter 380, an advanced  practice registered nurse licensed to prescribe in accordance with Section 20-94a or a physician  assistant licensed to prescribe in accordance with Section 20-12d.

Qualified personnel for schools means (a) a qualified school employee who is a full time  employee or is a coach, athletic trainer, or school paraprofessional or for school readiness  programs and before and after school programs, means the director or director’s designee and  any lead teachers and school administrators who have been trained in the administration of  medications. For school readiness programs and before- and after-school programs, Directors or  Director’s designee, lead teachers and school administrators who have been trained in the  administration of medication may administer medications pursuant to Section 10-212a-10 of the  State regulations. 

Qualified school employee, as defined in C.G.S. 10-212, means a principal, teacher, licensed  athletic trainer, licensed physical or occupational therapist employed by a school district, coach  or school paraprofessional. 

Research or study medications means FDA-approved medications being administered  according to an approved study protocol. A copy of the study protocol shall be provided to the  school nurse along with the name of the medication to be administered and the acceptable range  of dose of such medication to be administered. 

School means any educational facility or program which is under the jurisdiction of the Board  excluding extracurricular activities. 

School medical advisor means a physician appointed pursuant to C.G.S. 10-205. 

School nurse means a nurse appointed in accordance with Connecticut General Statutes Section 10-212. 

School nurse supervisor means the nurse designated by the local or regional Board of  Education as the supervisor or, if no designation has been made by the Board, the lead or  coordinating nurse assigned by the Board. 

School readiness program means a program that receives funds from the State Department of  Education for a school readiness program pursuant to subsection (b) of Section 10-16p of the  Connecticut General Statutes and exempt from licensure by the Office of Early Childhood pursuant to subdivision (1) of subsection (b) of Section 19a-77 of the Connecticut General Statutes. 

Self-administration of medication means the control of the medication by the student at all  times and is self-managed by the student according to the individual medication plan.

Supervision means the overseeing of the process of the administration of medication in a school. 

Teacher means a person employed full time by a Board of Education who has met the minimum  standards as established by that Board for performance as a teacher and has been approved by the  School Medical Advisor and school nurse to be designated to administer medications pursuant to  the Regulations of Connecticut State Agencies Sections 10-212a-l through 10-212a-7. 

General Policies on Administration of Medication 

A child with diabetes may test his/her own blood glucose level per the written order of a  physician stating the need and the capacity of such child to conduct self-testing along with  written authorization of the parent/guardian. Such self-testing shall be pursuant to guidelines  promulgated by the Commissioner of Education. The time or place where a student with  diabetes may test his/her blood-glucose level on school grounds shall not be restricted provided  the student has written parental/guardian permission and a written order from a physician  licensed in Connecticut. 

The school nurse or school principal shall select a qualified school employee to, under certain  conditions, give a glucagon injection to a student with diabetes who may require prompt  treatment to protect him/her from serious harm or death. The nurse or principal must have the  written authority from the student’s parent/guardian and a written order from the student’s  Connecticut-licensed physician. The authorization shall be limited to situations when the school  nurse is absent or unavailable. No qualified school employee shall administer this medication  unless he/she has annually completed any training required by the school nurse and school  medical advisor in the administration of medication with injectable equipment used to administer  glucagon, the school nurse and school medical advisor must attest that the qualified school  employee has completed such training and the qualified school employee voluntarily agrees to  serve as a qualified school employee. The injections are to be given through an injector or  injectable equipment used to deliver an appropriate dose of glucagon as emergency first aid  response to diabetes. 

A child diagnosed with asthma or an allergic condition, pursuant to State Board of Education  regulations, may carry an inhaler or an Epipen or similar device in the school at all times if  he/she is under the care of a physician, physician assistant, or advanced practice registered nurse  (APRN) and such practitioner certifies in writing to the Board of Education that the child needs  to keep an asthmatic inhaler or Epipen at all times to ensure prompt treatment of the child’s asthma or allergic condition and protect the child against serious harm or death. A written  authorization of the parent/guardian is also required.

A school nurse may administer medication to any student pursuant to the written order of an  authorized prescriber (physician, dentist, optometrist, an advanced practice registered nurse, or a  physician assistant and for interscholastic and intramural athletic events only, a podiatrist) and  the written authorization of a parent or guardian of such child or eligible student and the written  permission of the parent/guardian for the exchange of information between the prescriber and the  school nurse necessary to ensure the safe administration of such medication. 

In the absence of a school nurse, any other nurse licensed pursuant to the provisions of Chapter  378, including a nurse employed by, or providing services under the direction of the Board of  Education at a school-based clinic, only qualified personnel for schools who have been properly  trained may administer medications to students as delegated by the school nurse upon approval  of the School Medical Advisor and the school nurse may administer medication to any student in  the school following the successful completion of specific training in administration of  medication and satisfactory completion of the required criminal history check. 

Medications with a cartridge injector may be administered by qualified personnel for schools  only to a student with a medically diagnosed allergic condition which may require prompt  treatment to protect the student against serious harm or death. Qualified personnel for schools, as  defined, may administer oral, topical, intranasal, or inhalant medication in the absence of a  licensed nurse. Investigational drugs or research or study medications may not be administered  by qualified personnel for schools. 

Coaches and licensed athletic trainers during intramural and interscholastic events may  administer medications pursuant to Section10-212a-9 of the Regulations of Connecticut State  Agencies and as described in this policy and in the administrative regulations to this policy. 

In compliance with all applicable state statutes and regulations, parents/guardians may  administer medications to their own children on school grounds. 

Administration of Medication by Paraprofessionals 

A specific paraprofessional, through a plan approved by a school nurse supervisor and School  Medical Advisor, may administer medications including medications administered with a  cartridge injector, to a specific student with a medically diagnosed allergic condition that may  require prompt treatment in order to protect the student against serious harm or death pursuant to  Section 10-212a-9 of the Regulations of Connecticut State Agencies and as described in the  administrative regulations. The approved plan also requires the written authorization of the  student’s parent/guardian and pursuant to the written order from the student’s authorized  prescriber licensed to prescribe medication.

Administration of Medications in School Readiness Programs and Before- and After School Programs 

Directors, or their designees, who may include lead teachers or school administrators, who have  been properly trained, may administer medications to students as delegated by the school nurse  or other registered nurse, in school readiness programs and before- and after-school programs  that are child care programs. Such programs must either be District-administered or administered  by a municipality exempt from licensure by the Department of Public Health and are located in a  District public school. Medicine may be administered pursuant to the Regulations of  Connecticut State Agencies, Section 10-212a-10, to children enrolled in these programs. 

Administration of medications shall be provided only when it is medically necessary for program  participants to access the program and maintain their health status while attending the program.  A child attending any before- or after-school program, defined as any child care program  operated and administered by the Board in any building or on the grounds of any district school,  upon the request and with the written authorization of the child’s parent/guardian and pursuant to  the written order from the student’s authorized prescriber, will be supervised by the District staff  member (Director or designee, lead teacher, school administrator) trained to administer  medication including a cartridge injector. Such administration shall be to a particular student  medically diagnosed with an allergy that may require prompt treatment to avoid serious harm or death. 

Investigational drugs or research or study medications may not be administered by Directors or  their designees, lead teachers or school administrators. 

Properly trained Directors, Directors’ designees, lead teachers or school administrators may  administer medications to students as delegated by the school nurse or other registered nurse.  They may administer oral, topical, intranasal, or inhalant medications. No medication shall be  administered without the written order of an authorized prescriber and the written approval of the  parent/guardian. 

The selected staff member shall be trained in the use of a cartridge injector by either a licensed  physician, physician’s assistant, advanced practice registered nurse or registered nurse. The  selected staff member is also required to complete a course in first aid offered by the American  Red Cross, the American Heart Association, the National Ski Patrol, the Department of Public  Health or any Director of Health. 

The administration shall determine, in cooperation with the School Medical Advisor and school  nurse [supervisor] whether additional school nursing services/nurses are required based on the  needs of the program and the participants in the program. This determination shall include  whether a licensed nurse is required on site. The recommendation shall be subject to Board approval.

The Board will allow students in the school readiness and before- and after-school programs to  self-administer medication according to the student’s individual health plan and only with the  written order of an authorized prescriber, written authorization of the child’s parent or guardian,  written approval of the school nurse (The nurse has evaluated the situation and deemed it  appropriate and safe and has developed a plan for general supervision of such self-medication.),  and with the written permission of the parent or guardian for the exchange of information  between the prescriber and the school nurse necessary to ensure the safe administration of such  medication. 

An error in the administration of medication shall be reported immediately to the school nurse,  the parents/guardians and the prescribing physician. In case of an anaphylactic reaction or the  risk of such reaction a school nurse may administer emergency oral and/or injectable medication  to any child in need thereof on school grounds, or in the school building, according to the  standing order of the School Medical Advisor or the child’s private physician. However, in an  emergency any other person trained in CPR and First Aid may administer emergency oral and/or  injectable medication to any child in need on school grounds, or in the school building. In  addition, local poison control center information shall be readily available at the sites of these  programs. The Program Director or his/her designee shall be responsible for decision making in  the absence of the nurse. 

In the event of a medical emergency, the following will be readily available: (1) local poison  information center contact information; (2) the physician, clinic or emergency room to be  contacted in such an emergency; and (3) the name of the person responsible for the decision  making in the absence of a school nurse. 

All medications shall be handled and stored in accordance with the provisions of subsection (a)  to (k) inclusive of the Regulations of Connecticut State Agencies, as outlined in the  accompanying administrative regulation to this policy. 

Where possible, a separate supply of the child’s medication shall be stored at the site of the  before- or after-school program or school readiness program. If this is not possible, a plan should  be in place to ensure the timely transfer of the medication from the school to the program and  back on a daily basis. 

Documentation and record keeping shall be done in compliance with the stipulations outlined in  the administrative regulation accompanying this policy.

Administration of Medication by Coaches and Licensed Athletic Trainers During  Intramural and Interscholastic Events 

During intramural and interscholastic athletic events, a coach or licensed athletic trainer who has  been trained in the general principles of medication administration applicable to receiving,  storing, and assisting with inhalant medications or cartridge injector medications and  documentation, may administer medication for select students for whom self-administration  plans are not viable options as determined by the school nurse. 

The medication which may be administered is limited to: (1) inhalant medications prescribed to  treat respiratory conditions and (2) medication administered with a cartridge injector for students  with a medically diagnosed allergic condition which may require prompt treatment to protect the  student against serious harm or death. 

The school nurse is responsible for the student’s individualized medication plan and shall  provide the coach with a copy of the authorized prescriber’s order and the parental/guardian  permission form. Parents are responsible for providing the medication, such as the inhaler or  cartridge injector, to the coach or licensed athletic trainer, which shall be kept separate from the  medication stored in the school health office during the school day. 

Medications to be used in athletic events shall be stored in containers for the exclusive use of  holding medications; in locations that preserve the integrity of the medication; under the general  supervision of the coach or licensed athletic trainer trained in the administration of medication;  and in a locked secure cabinet when not in use at athletic events. 

The agreement of the coach or licensed athletic trainer is necessary for the administration of  emergency medication and the implementation of the emergency care plan. 

Coaches and athletic trainers are required to fulfill the documentation requirements as outlined in  the administrative regulations accompanying this policy. Errors in the administration of  medication shall be addressed as specified in Section 10-212a-6 of the Regulations of  Connecticut State Agencies, and detailed in the administrative regulation pertaining to this  policy. If the school nurse is not available, a report may be submitted by the coach or licensed  athletic trainer to the school nurse on the next school day.

Storage and Use of Epinephrine Cartridge Injectors (Emergency Administration of  Epinephrine to Students without Prior Written Authorization) 

A school nurse or, in the absence of a school nurse, a “qualified school employee” who has  completed the training required by PA 14-176, shall maintain epinephrine in cartridge injectors  for the purpose of emergency first aid to students who experience allergic reactions, who were  not previously known to have serious allergies and who do not have a prior written authorization  of a parent/guardian or a prior written order of a qualified medical professional for the  administration of epinephrine. 

The school nurse or school principal shall select qualified school employees who voluntarily  agree to be trained to administer such epinephrine as emergency first aid. There shall be at least  one such qualified school employee on the grounds of each District school during regular school  hours in the absence of the school nurse. Each school must maintain a supply of epinephrine in  cartridge injectors (epipens) for such emergency use. 

The school shall fulfill all conditions and procedures promulgated in the regulations established  by the State Board of Education (Section 10-212a-2) for the storage and administration of  epinephrine by school personnel to students for the purpose of emergency first aid to students  who experience allergic reaction and do not have prior written authorization for epinephrine  administration. 

The school nurse or, in the absence or unavailability of such school nurse, such qualified school  employee may administer epinephrine to a student experiencing a life-threatening undiagnosed  allergic reaction as emergency first aid, to students who do not have a prior written authorization  from a parent or guardian or a prior written order from a qualified medical professional for the  administration of epinephrine. A qualified school employee must annually complete the required  training program in order to be permitted to administer epinephrine utilizing an epipen. 

Following the emergency administration of epinephrine by a qualified school employee to a  student who does not have a prior written authorization of a parent/guardian or a prior written  order of a qualified medical professional, such administration must be reported immediately to  the school nurse or medical advisor, the student’s parent/guardian by the school nurse or the  qualified school employee and a medication administration record shall be submitted by the  qualified school employee at the earliest possible time, but not later than the next school day.  Such record must be filed in or summarized on the student’s cumulative health record.

The parent/guardian of a student may submit, in writing, to the school nurse and school medical  advisor, if any, that epinephrine shall not be administered to his/her child permitted by statute. The District shall annually notify parents/guardians of the need to provide such written notice. 

The Board of Education, recognizing this emergency use of epinephrine for previously  undiagnosed students, per the statute, is to take place during “regular school hours” establishes  such hours to be from the arrival of the first students to the school site to the departure of the last  bus serving the school at the conclusion of the day’s instructional programs. 

Administration of Anti-Epileptic Medications to Students 

With the written authorization of a student’s parent/guardian, and pursuant to the written order of  a physician, a school nurse (and a school medical advisor, if any), shall select and provide  general supervision to a qualified school employee, who voluntarily agrees to serve as a qualified  school employee, to administer anti-epileptic medication, including by rectal syringe, to a  specific student with a medically diagnosed epileptic condition that requires prompt treatment in  accordance with the student’s individual seizure action plan. Such authorization is limited to  situations when the school nurse is absent or unavailable. No qualified school employee shall  administer such medication unless he/she annually completes the training program developed by  the State Department of Education, in consultation with the School Nurse Advisory Council. 

In addition, the school nurse (and school medical advisor, if any), shall attest, in writing, that  such qualified school employee has completed the required training. The qualified school  employee shall also receive monthly reviews by the school nurse to confirm his/her competency  to administer anti-epileptic medication. For purposes of the administration of anti-epileptic  medication, a “qualified school employee” means a principal, teacher, licensed athletic trainer,  licensed physical or occupational therapist employed by the District, coach or school  paraprofessional. 

(cf. 4112.5/4212.5 – Security Check/Fingerprinting) 

(cf. 5141 – Student Health Services) 

(cf. 5141.23 – Students with Special Health Care Needs)

Legal Reference: Connecticut General Statutes 

10-206 Health Assessment 

10-212 School nurses and nurse practitioners. Administration of medications by parents or guardians on school grounds. Criminal history;  records check. 

10-212a Administration of medications in schools. (as amended by PA 99- 2, and June Special Session and PA 03-211, PA 04-181, PA 07-241, PA  07-252, PA 09-155, PA 12-198, PA 14-176 and PA 15-215) 

10-220j Blood glucose self-testing by children. Guidelines. (as amended  by PA 12-198) 

19a-900 Use of cartridge injector by staff member of before- or after school program, day camp or day care facility. 

21a-240 Definitions 

29-17a Criminal history checks. Procedure. Fees. 

52-557b Immunity from liability for emergency medical assistance first  aid or medication by injection. School personnel not required to  administer or render. (as amended by PA 05-144, An Act Concerning the  Emergency Use of Cartridge Injectors) 

Connecticut Regulations of State Agencies 10-212a-1 through 10-212a-10,  inclusive, as amended. 

Code of Federal Regulations: Title 21 Part 1307.2 

20-12d Medical functions performed by physician assistants. Prescription  authority. 

20-94a Licensure as advanced practice registered nurse. 

PA 07-241 An Act Concerning Minor Changes to the Education Statutes 

29-17a Criminal history checks. Procedure. Fees. 

Policy adopted: February 12, 2018 THOMASTON PUBLIC SCHOOLS Thomaston, Connecticut