Setting School Medication Policies

This article describes the process by which Massachusetts developed medication administration guidelines for schools. Development and implementation of the regulations included:

1) a broad-based advisory committee (professional associations, school administrators, parent groups and regulatory bodies);
2) wide distribution of the regulations and sample local policies and forms through regional orientation meetings;
3) a standardized training program with competency testing to assure consistency among schools who register to delegate medication administration tasks to unlicensed personnel; and
4) periodic updates for school nurses.

In setting minimum standards for safe and proper prescription medication administration, the committee offered schools two choices:

1) use of only licensed persons to administer medications, consistent with existing state statutes; or
2) delegation to unlicensed personnel in a manner consistent with state nursing regulations.

Both strategies were based on a school nurse (RN) managed model. To delegate to unlicensed staff, three requirements were set:

1) a district-level plan prepared by the school nurse with input of a school physician;
2) identified categories of staff, e.g., health aides, secretary, to administer medications; and
3) registration with the State including an assurance of a sufficient number of RNs to supervise.

The regulations require:

1) written parental consent,
2) an order by a licensed prescriber (MD, NP, PA, DDS, Midwife),
3) an individual medication plan completed by the school nurse, and
4) documentation on an individual student log which becomes part of the school health record, and
5) a medication error report form.

Rules allow for self-administration of medications such as asthma inhalers. The nurse and parent determine the plan for self-administration including storage, e.g., backpack, and a method for monitoring the self-administration.

Non-prescription medicines are outside the jurisdiction of the Massachusetts state health department, but state nursing practice regulations allow the school to require either an individual student medical order or to authorize the school nurse and a "school-employed licensed prescriber" to develop a protocol for specific over-the-counter products.

Results of the process included training over 800 nurses, administrators, lawyers, and parents in five regional orientations, and application of the regulations to the 600 private schools with their participation on the advisory body. School nurses who feared that the delegation option would risk student safety and nursing jobs found that school administrators developed a better appreciation for the seriousness of student health services. Some schools are employing more RNs rather than registering for the delegation option.

(Sheetz A, Blum M. Medication administration in schools: The Massachusetts experience. J Sch Health. 1998;68(3):94-98)

COMMENT: This process demonstrated the value of bringing all views to the planning table and examining all pertinent laws and safety issues involved in developing policy and regulations for one aspect of school nursing. This could be replicated at the local level through a school health advisory council.