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5141.21 Administering Medication

NORTHFIELD BOARD OF EDUCATION FILE CODE: 5141.21

Northfield, New Jersey X Monitored

X Mandated

Policy X Other Reasons

ADMINISTERING MEDICATION

The Northfield Board of Education shall not be responsible for the diagnosis and treatment of student illness. The administration of medication to a student during school hours will be permitted only when failure to take such medicine would jeopardize the health of the student, or the student would not be able to attend school if the medicine were not made available to him/her during school hours.

For purposes of this policy, “medication” shall include all medicines prescribed by a physician for the particular student or medications prescribed by the school physician on standing orders. Medications shall include emergency medication in the event of bee stings, medication for asthma, diabetes, adrenal insufficiency or other medical diagnosis requiring medication during the school day, opioid antidote, and all non-prescription “over the counter” medication (see policy 5141).

Before any medication may be administered to any student either by the school nurse or designated school staff or by the student themselves during school hours, the board shall require the written consent of the parent/guardian which shall give permission for such administration and relieve the board and its employees of liability for administration of medication. In addition, the board requires the written order of the prescribing physician which shall include:

  1. The purpose of the medication;
  2. The dosage;
  3. The time at which or the special circumstances under which medication shall be administered;
  4. The length of time for which medication is prescribed;
  5. The possible side effects of the medication.

Both documents shall be kept on file in the office of the school nurse. A copy of both shall be kept in the office of the school principal.

The district school physician shall develop procedures for the administration of medication which provide that:

  1. All medications, whether prescribed or “over the counter”, shall be administered by the school physician, school nurse or substitute school nurse, the parent/guardian or the student himself/herself where the parent/guardian so permits and with the school nurse present;
  2. Medications shall be securely stored and kept in the original labeled container;
  3. The school nurse shall maintain a record of the name of the student to whom medication may be administered, the prescribing physician, the dosage and timing of medication and a notation of each instance of administration;
  4. All medications shall be brought to school by the parent/guardian or adult student and shall be picked up at the end of the school year or the end of the period of medication, whichever is earlier;
  5. A student may self-administer medication without supervision of the school nurse for asthma or other life-threatening illnesses, a life-threatening allergic reaction or adrenal insufficiency, provided that the applicable requirements of this policy for such self-administration, as described below, are met. “Life-threatening illness” has been defined as an illness or condition that requires an immediate response to specific symptoms or sequelae that if left untreated may lead to potential loss of life such as, but not limited to, the use of an inhaler to treat an asthma attack or the use of an adrenalin injection to treat a potential anaphylactic reaction.

Nebulizers

Each school in the district shall have and maintain at least one nebulizer in the office of the school nurse or at a similar accessible location. The Superintendent shall prepare and the board shall adopt regulations on the administration of asthma medication through the use of a nebulizer by the school nurse or his/her designee(s). Regulations shall be in accord with New Jersey statute and administrative code and shall include, but not be limited to the following:

  1. Requirement that each school nurse shall be authorized to administer asthma medication through use of a nebulizer;
  2. Requirement that each school nurse receive training in airway management and in the use of nebulizers and inhalers consistent with nationally recognized standards;
  3. Requirement that each student authorized to use asthma medication or a nebulizer have an asthma treatment plan prepared by the student’s physician that identifies, at a minimum, asthma triggers and an individualized health care plan for meeting the medical needs of the student while attending school or a school-sponsored event.

Student Self-Administration of Medication

The board shall permit self-administration of medication for asthma, diabetes or other potentially life-threatening illnesses, a life-threatening allergic reaction or adrenal insufficiency by students who have the capability for self-administration of medication, both on school premises during regular school hours and off-site or after regular school hours when a student is participating in field trips or extracurricular activities. Parents/guardians of the student must meet the following conditions:

A. Provide the board with written authorization for the student’s self-administration of medication;

B. Provide written certification from the student’s physician that the student has asthma, diabetes, another potentially life-threatening illness, is subject to a life-threatening allergic reaction, or has adrenal insufficiency and is capable of and has been instructed in the proper method of self-administration of medication; and

C. Sign a statement acknowledging that the district shall incur no liability as a result of any injury arising from the self-administration of medication by the student and that the parents/guardians shall indemnify and hold harmless the district and its employees or agents against any claims arising out of the self-administration of medication by the student.

A student who is permitted to self-administer medication shall be permitted to carry an inhaler or prescribed medication for allergic reactions, including a pre-filled auto-injector mechanism, or prescribed medication for adrenal insufficiency at all times, provided that the student does not endanger himself or other persons through misuse.

The board shall:

  1. Inform the student and his/her parents/guardians that permission is effective for the school year for which it is granted and must be renewed for each subsequent school year upon fulfillment of requirements listed above;
  2. Inform parents/guardians in writing that the district and its employees or agents shall incur no liability as a result of any injury arising from the self-administration of medication by the student; and
  3. Maintain the right to revoke a student’s permission to self-medicate if he/she has failed to comply with all conditions of this policy and/or has violated in any way the tenets of the agreement to self-medicate. The Superintendent shall confer with the school physician and school nurse prior to recommending termination of a student’s permission to self-medicate and shall also consult with the student, the student’s parents/guardians and the student’s physician.

Upon written request of the parent or guardian and as provided in the individualized health care plan, the student shall be allowed to attend to the management and care of his/her diabetes in the classroom or on school grounds, if evaluated and determined to be capable of doing so consistent with the plan, and N.J.S.A. 18A:40-12.15 and board policy 5141 Health for specific rules regarding diabetes management.

Emergency Administration of Epinephrine

The board shall permit the school nurse or school physician to administer epinephrine via epi-pen or other pre-filled auto-injector mechanism in emergency situations. In their absence, a designee or designees who are employees of the board may do so.

The designees must be properly trained by the school nurse in the administration of the epi-pen or other pre-filled auto-injector mechanism using the standardized training protocol designated by the State Department of Education. Each designee shall receive individual training for each student for whom he/she is designated.

The board shall inform the student’s parents/guardians in writing that if the specified procedures are followed, the district, its employees and agents shall have no liability as a result of any injury arising from the administration of the epi-pen or other pre-filled auto-injector mechanism to the student.

Parents/guardians shall provide the board with the following:

  1. Written orders from the physician that the student requires the administration of epinephrine for anaphylaxis and does not have the capability for self-administration of the medication;
  2. Written permission for the administration of epinephrine via epi-pen or other pre-filled auto-injector mechanism by the school nurse and designee(s); and
  3. A signed statement acknowledging their understanding that if the specified procedures are followed, the district shall have no liability as a result of any injury arising from the administration of the epi-pen or other pre-filled auto-injector mechanism by the school nurse or designee(s) to the student and that the district, its employees, and agents shall be indemnified and held harmless against any claims arising out of the administration of the epi-pen or other pre-filled auto-injector mechanism to the student.

Permission for the administration of epinephrine via epi-pen or other pre-filled auto-injector mechanism shall be granted annually and must be renewed each school year upon the fulfillment of the above requirements.

Placement and Availability of Epinephrine, and Transportation to Hospital Emergency Room

Pursuant to N.J.S.A. 18A:40-12.6, school policy requires:

  1. The placement of a student’s prescribed epinephrine in a secure but unlocked location easily accessible by the school nurse and designees to ensure prompt availability in the event of an allergic emergency at school or at a school-sponsored function.  The location of the epinephrine shall be indicated on the student’s emergency care plan.  Back-up epinephrine shall also be available at the school if needed;
  2. The school nurse or designee to be promptly available on site at the school and school-sponsored functions in the event of an allergic reaction; and  
  3. The transportation of the student to a hospital emergency room by emergency services personnel after the administration of epinephrine, even if the student’s symptoms appear to have resolved.

Emergency Administration of Epinephrine for First Time Allergic Reactions at School

The school nurse or trained designee shall be permitted to administer epinephrine via a pre-filled auto-injector mechanism to any student without a known history of anaphylaxis. This includes students whose parents/guardians have not submitted prior written permission or obtained prescribed medication as indicated in the rules above. Epinephrine may be administer to any student without a known history of anaphylaxis when the nurse or trained designee in good faith believes that the student is having an anaphylactic reaction

The district shall maintain a supply of epinephrine auto-injectors that is prescribed under a standing protocol from a licensed physician or an advanced practice nurse in a secure but unlocked and easily accessible location. The supply of epinephrine auto-injectors shall be accessible to the school nurse and trained designees for administration to a student having an anaphylactic reaction.

Liability

No school employee, including a school nurse, or any other officer or agent of a board, or a physician or an advanced practice nurse providing a prescription under a standing protocol for school epinephrine shall be held liable for any good faith act or omission consistent with the provisions of law for the administration of epinephrine (N.J.S.A. 18A:40-12.5 et seq.). No action shall be taken before the New Jersey State Board of Nursing against a school nurse for any such action taken by a person designated in good faith by the school nurse to administer epinephrine according to law (N.J.S.A. 18A:40-12.6). Good faith shall not include willful misconduct, gross negligence or recklessness.

Emergency Administration of Hydrocortisone Sodium Succinate for Adrenal Insufficiency

In the event of an emergency, hydrocortisone sodium succinate shall be administered through an appropriate delivery device and equipment to a student for adrenal insufficiency provided that:

  1. The parents/guardians of the student provide to the board written authorization for the administration of hydrocortisone sodium succinate;
  2. The parents/guardians of the student provide to the board written orders from the physician or advanced practice nurse that the student requires the administration of hydrocortisone sodium succinate for adrenal insufficiency;
  3. The board informs the parents/guardians of the student in writing that the district and its employees or agents shall have no liability as a result of any injury arising from the administration of hydrocortisone sodium succinate; and
  4. The parents/guardians sign a statement acknowledging that the district shall incur no liability as a result of any injury arising from the administration of hydrocortisone sodium succinate to the student and that the parents/guardians shall indemnify and hold harmless the district and its employees or agents against any claims arising out of the administration of hydrocortisone sodium succinate.

The permission is effective for the school year for which it is granted and is renewed for each subsequent school year.

Placement and Availability of Hydrocortisone Sodium Succinate, and Transportation to Hospital

The school nurse shall oversee the following school policy requirements for compliance with law (N.J.S.A. 18A:40-12.3):

  1. The placement of a student’s prescribed hydrocortisone sodium succinate in a secure but unlocked location easily accessible by the school nurse and designees to ensure prompt availability in the event of emergency situations at school or at a school-sponsored function.  The location of the hydrocortisone sodium succinate shall be indicated on the student’s emergency care plan.  Back-up hydrocortisone sodium succinate, provided by the parent/guardian, shall also be available at the school if needed;
  2. The school nurse or designee shall be promptly available on site at the school and school-sponsored functions in the event of an emergency; and
  3. The transportation of the student to a hospital emergency room by emergency services personnel after the administration of hydrocortisone sodium succinate, even if the student’s symptoms appear to have resolved.

Nothing in this policy shall be construed to prohibit the emergency administration of hydrocortisone sodium succinate to a student for adrenal insufficiency by the school nurse or other employees designated when the student is authorized to self-administer hydrocortisone sodium succinate.

Designee Training to Administer Hydrocortisone Sodium Succinate

The school nurse shall have the primary responsibility for the emergency administration of hydrocortisone sodium succinate. The school nurse shall designate, in consultation with the board, additional employees or volunteers to administer hydrocortisone sodium succinate to a student for adrenal insufficiency when the nurse is not physically present at the scene. The school nurse shall recruit and train, in consultation with the board of education, volunteer designees who are determined acceptable candidates by the school nurse within each school building, as deemed necessary by the nursing service plan.

The school nurse shall determine that:

  1. The designees have been properly trained in the administration of hydrocortisone sodium succinate using standardized training protocols established by the Department of Education in consultation with the Department of Health;
  2. The parents/guardians of the student consent in writing to the administration of hydrocortisone sodium succinate by the designees (in addition to the school nurse); and
  3. The parents/guardians of the student have received a written statement that the district and its employees or agents shall have no liability as a result of any injury arising from the administration of hydrocortisone sodium succinate to the student, and that the parents/guardians have signed a statement acknowledging that the district shall incur no liability as a result of any injury arising from the self-administration of medication by the student and that the parents/guardians shall indemnify and hold harmless the district and its employees or agents against any claims arising out of the self-administration of medication by the student.

The permission is effective for the school year for which it is granted and is renewed for each subsequent school year upon fulfillment of the above-listed requirements in this section.

Emergency Administration of Opioid Antidote

“Opioid antidote” means any drug, regardless of dosage amount or method of administration, which has been approved by the United States Food and Drug Administration (FDA) for the treatment of an opioid overdose. Opioid antidote includes, but is not limited to, naloxone hydrochloride, in any dosage amount, which is administered through nasal spray or any other FDA-approved means or methods.

“Opioid overdose” means an acute condition including, but not limited to, extreme physical illness, decreased level of consciousness, respiratory depression, coma, or death resulting from the consumption or use of an opioid drug or another substance with which an opioid drug was combined, and that a layperson would reasonably believe to require medical assistance.

The opioid antidote may be administered to any student, school personnel or other person reasonably believed to be experiencing an opioid overdose. The opioid antidotes shall be accessible in the school during regular school hours and during school-sponsored functions that take place in the school or on school grounds adjacent to the school building.

The opioid antidote shall be stored in a secure but unlocked and easily accessible location, and according to the manufacturer’s directions. To the extent that is safe and practical, the opioid antidote shall be stored at a reasonable proximity of an automated external defibrillator (AED). The school nurse shall be responsible for monitoring the on-site inventory of the opioid antidote, arranging for the replacement of the opioid antidote supply and ensuring the appropriate and safe disposal of administered and expired opioid antidote applicators.

Any student suspected of being under the influence of drugs or alcohol including students suspected of an opioid overdose shall be subject to board policy 5131.6 Drugs, Alcohol, Steroids and Tobacco and applicable law (including but not limited to N.J.A.C. 6A:16-3) regarding prevention, identification, examination, treatment, intervention and referral for substance abuse.

The school nurse shall be primarily responsible for the assessment of any student suspected of being under the influence of drugs or alcohol including, but not limited to, any student suspected of an opioid or other drug overdose. The board shall designate additional district employees (“designated employees”) who volunteer to administer an opioid antidote in the event a person experiences an opioid overdose when the nurse is not physically present at the scene. Such designated employees shall receive training in administration of the opioid antidote in accordance with applicable law. The school nurse or designated employee who believes in good faith that a person is experiencing an opioid overdose, may administer the opioid antidote.

The school nurse or his or her designee or a designated employee shall immediately call 911 upon suspecting an overdose, and notify the parents/guardians as soon as practicable. The school nurse or designee and any designated employee responding to a suspected overdose shall notify the building principal of any suspected overdose and all actions taken including the administration of opioid antidote and the notification of emergency medical services.

If the school nurse or a designated employee are not immediately available and a district employee observes a person overdosing, the employee may contact emergency services. The employee who has contacted emergency services regarding a person suspected to have overdosed shall notify the building principal of any suspected overdose and all actions taken including the administration of opioid antidote and the notification of emergency medical services.

An overdose victim shall be transported by emergency services personnel to the nearest hospital emergency room, including where the victim’s symptoms appear to have resolved. The principal shall designate a member of the school staff to accompany the student to the hospital. The principal shall notify the Superintendent whenever an opioid antidote is administered.

The school nurse shall document the incident including but not limited to:

  1. Date, time and location of the incident;
  2. Names of any staff members or students reporting the incident;
  3. A description of the incident;
  4. Description of the evaluation conducted;
  5. The administration of opioid antidote including the form and dosage;
  6. All actions taken, including, when 911 was called, when emergency services arrived, staff assigned to accompany the student.

The documentation shall be in the same manner as the documentation of administration of other medications under a non-patient specific order.

A school may enter into a shared services agreement for the provision of opioid antidotes pursuant to applicable law if the arrangement will result in cost savings.

Training

The school nurse shall have the primary responsibility for the emergency administration of an opioid antidote. As described above, the board shall designate additional employees (“designated employees”) to administer the opioid antidote who shall be authorized to administer the antidote only after receiving training in accordance with applicable law. The school nurse shall not be solely responsible to train designated employees.

Parent Notification

Written notification of the board opioid overdose policy shall be distributed annually to parents/guardians and adult students. The notification shall inform parents/guardians and adult students that the board authorizes the certified school nurse and/or other appropriately licensed school health professionals as well as designated employeesto administer the opioid antidote.

The school nurse, in consultation with the Superintendent, shall be responsible for the development and regular review of policies and procedures regarding administration of opioid antidotes. The policies and procedures for the use of opioid antidote shall be included in district emergency response procedures.

Liability for the Administration of Opioid Antidote

No school employee, including a school nurse, or any other officer or agent of a board of education, charter school, or nonpublic school, or a prescriber of opioid antidotes for a school through a standing order, shall be held liable for any good faith act or omission consistent with the provisions of applicable law. Good faith shall not include willful misconduct, gross negligence, or recklessness.

Implementation

The board may adopt additional regulations on all aspects of the administration of medication. When implementing school policy and N.J.S.A. 18A:40-12.6, staff will consult these New Jersey Department of Education guidance documents:

  1. Training Protocols for the Emergency Administration of Epinephrine (9/08);
  2. Guidelines for the Management of Life-Threatening Food Allergies in Schools (9/08).

Any person who acts in good faith in accordance with law and board policy shall be immune from any civil or criminal liability arising from actions performed pursuant to law and this board policy.

Adopted: July 22, 2019

NJSBA Review/Update:

Readopted:

Key Words

Administering Medication, Medication in School, Nebulizer, Epinephrine, Anaphylaxis, Asthma

Legal References: N.J.S.A. 18A:11‑1 General mandatory powers and duties

N.J.S.A. 18A:40‑1 Employment of school physicians, optometrists and nurses; salaries; terms; rules

N.J.S.A. 18A:40-3.2 et seq. Medical and Nursing Personnel

N.J.S.A. 18A:40‑4 Examination for physical defects and screening of hearing of students

N.J.S.A. 18A:40-12.3 Self-administration of medication by student; conditions

through -12.4

N.J.S.A. 18A:40-12.5 Policy for emergency administration of epinephrine to public school students

N.J.S.A. 18A:40-12.6 Administration of epinephrine; primary responsibility; through -12.6d parental consent

N.J.S.A. 18A:40-12.7 Nebulizer

N.J.S.A. 18A:40-12.8 Administration of asthma medication by school nurse through nebulizer; training; student asthma treatment plan

N.J.S.A. 18A:40-12.11 Children with diabetes

N.J.S.A. 18A:40-12.12 Definitions

N.J.S.A. 18A:40-12.13 Health care plans for children with diabetes

N.J.S.A. 18A:40-12.14 Employees authorized to administer glucagon

N.J.S.A. 18A:40-12.15 Management by student permitted

N.J.S.A. 18A:40-12.16 Notice to bus driver

N.J.S.A, 18A;40-12.17 Posting of reference sheet

N.J.S.A. 18A:40-12.18 Medical information release

N.J.S.A. 18A:40-12.19 Immunity

N.J.S.A. 18A:40-12.20 Authorized possession of syringe

N.J.S.A. 18A:40-12.21 School choice not restricted

N.J.S.A’ 18A:40-12.22 Administration of medical marijuana

N.J.S.A. 18A:40-12.23 Emergency administration of opioid antidotes

through N.J.S.A. 18A:40-12.28

N.J.S.A. 18A:40-21.1 Required Hepatitis B vaccination

N.J.S.A. 18A:40-21.2 Distribution of fact sheet on meningitis

N.J.S.A. 18A:40-23 Findings and Declarations

N.J.A.C. 18A:40-24 Definitions

N.J.A.C. 18A:40-25 Nursing services to students in non-public schools

N.J.S.A. 18A:40-26 Medical services to non-public school students

N.J.S.A. 18A:40-27.1 Nursing services to non-public preschool students

N.J.S.A. 18A:54‑20 Powers of board (county vocational schools)

N.J.S.A. 45:11‑23 Definitions

N.J.A.C. 6A:16-1.1et seq. Programs to Support Student Development

See particularly:

N.J.A.C. 6A:16-1.3 Definitions

N.J.A.C. 6A:16-2.1 Health services policy and procedural requirements

N.J.A.C. 6A:16-2.2 Required health services

N.J.A.C. 6A:16-2.3 Health services personnel

N.J.A.C. 6A:16-2.4 Required student health records

N.J.A.C. 6A:16-2.5 School health services to nonpublic schools

N.J.A.C. 6A:16-4.1 Policies and procedures for the prevention of drug and alcohol abuse

N.J.A.C. 6A:23A-5.3(e) Failure to maximize SEMI Aid

N.J.A.C. 6A:32-6.3 Requirements of physical examinations

P.L. 2018. C.106 (A542, S1830), an act concerning the emergency administration of opioid 1 antidotes in schools, supplementing chapter 40 of Title 18A of 2 the New Jersey Statutes, and amending P.L.2013, c.46

P.L. 2019, c. 118, an act concerning the self-administration and emergency administration of hydrocortisone sodium succinate for adrenal insufficiency

Overdose Prevention Act, P.L. 2013, c. 46

Bernards Township Education Association v. Bernards Township Board of Education, 1981 S.L.D. (9/29/81), aff’d State Board, 1982 S.L.D. 4/7/82, aff’d App. Div., unpublished opinion (A‑4211‑81T3, 5/18/83)

Communications Workers of America, Local 1033, On behalf of Karen Norton, Barbara Woolston, Mary Ellen Schoen et al. v. New Jersey State Department of Education, Marie H. Katzenbach School for the Deaf, State Board Docket #52‑91

Protocol and Implementation Plan for the Emergency Administration of Epinephrine by a Delegate Trained by the School Nurse, New Jersey State Department of Education, October, 1998

For training for the administration of naloxone see: http://www.state.nj.us/humanservices/dmhas/initiatives/naloxone.html

Possible

Cross References: *5131.6 Drugs, alcohol, tobacco (substance abuse)

*5141 Health

*5141.1 Accidents

*5141.2 Illness

*5141.3 Health examinations and immunizations

*5141.8 Sports related concussion and head injury

*6153 Field trips

*Indicates policy is included in the Critical Policy Reference Manual.

njsba policy services file code: 5141.21

Form

Emergency administration of Opioid antidote FOR DRUG OVERDOSE

Dear ________________________________________,

Parent/Guardian

Time is of the essence when a drug overdose is occurring, or is believed to be occurring. Administering an opioid antidote (defined as naloxone hydrochloride or any other similarly acting drug approved by the United States Food and Drug Administration) blocks effects of opioids and can reverse a potentially life threatening overdose.

In accordance with the New Jersey Law (P.L. 2013, c. 46), the “Overdose Prevention Act” the school physician annually prescribes naloxone as part of the district’s physician standing order. Naloxone shall be administered in an emergency to any student, school personnel or other person during school hours or during on-site school-sponsored activities believed to be experiencing a opioid overdose. The board authorizes that the drug may be administered by the school doctor, the school nurse, other appropriately licensed health professionals deemed capable of administering naloxone by a health care profession, or volunteer trained through a Department of Human Services (DHS) endorsed program to administer naloxone.

The _______________ Board of Education hereby informs you that if board-approved policy and procedures are followed, the district and its employees shall incur no liability whatsoever for any and all claims, damages, losses and expenses of any kind, including reasonable attorney’s fees as a result of any injury arising from the emergency administration of naloxone.

  • I consent to allowing the administration of naloxone to my child if it is believed that he/she may be experiencing a drug overdose.
  • I do not consent to allowing the administration of naloxone to my child if it is believed that he/she may be experiencing a drug overdose.
     

Parent/Guardian

  

Date

Attach board policy and regulation: 5141.21 Administration of Epinephrine

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