NORWICH FREE ACADEMY
ADMINISTERING OF MEDICATION
The purpose of this policy is for the Norwich Free Academy (NFA) to determine whom and under what circumstances medication may be administered to students in school including the circumstances under which self-administration of medication by students shall be permitted.
NFA allows students to self-administer medication and NFA 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, NFA, with the advice and approval of its school medical advisor and the school nurse supervisor, shall review and/or revise this policy and regulation biennially concerning the administration of medications to NFA students by a nurse, or in the absence of a nurse, by qualified personnel for schools. NFA’s school medical advisor shall approve this policy, its regulations and any changes prior to adoption.
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.
Authorized prescriber means a physician, dentist, optometrist, advanced practice registered nurse or physician assistant and, for interscholastic and intramural athletic events only, a podiatrist.
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.
Carrier means any school district, educational institution, or person, firm or corporation under contract to such district or institution engaged in the business of transporting students. (C.G.S. 14-212 (2)).
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.
Coach means an athletic coach as defined in Connecticut General Statutes Section 10-222e as any person holding a coaching permit issued by the State Board of Education who is hired by a NFA to coach a sport for a sport season as part of intramural or interscholastic athletics.
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.
(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 prescriber;
(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 Section 10-212a-2 of the Connecticut General Statutes and subsection € of Section 10-212a-2 of the Regulations of Connecticut State Agencies.
Extracurricular activities means activities sponsored by NFA 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 or contracting with the Board of Trustees 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 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.
Optometrist means an optometrist licensed to provide optometry pursuant to Chapter 380 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.
House principal means the administrator for each house at NFA.
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 school employee, as defined in C.G.S. 10-212, means a house principal, teacher, licensed athletic trainer, coach, intervention specialist, job coach or campus safety officer.
Qualified personnel for schools means a qualified school employee who is (A) (i) a full time employee, or (ii) a coach, athletic trainer, intervention specialist, job coach or campus safety officer.
Qualified school employee, as defined in C.G.S. 10-212, means a house principal, teacher, licensed athletic trainer, coach, intervention specialist, job coach or campus safety officer.
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 bus driver means any person who holds a commercial driver's license with a public passenger endorsement to operate a school bus pursuant to subsection (a) of C.G.S. 14-44.
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 Board of Trustees as the supervisor or, if no designation has been made by the Board of Trustees, the lead or coordinating nurse
assigned by the Boards of Trustees.
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.
Teacher means a person employed full time by a Board of Trustees 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
Except for the administration of epinephrine as emergency first aid to students who do not have a prior written parent authorization or written medical order as provided in this policy, and for the self-application of an over-the-counter sunscreen product by students six years of age and older with prior written parent authorization, no medication may be administered to any student without (1) the written order of an authorized prescriber, and (2) the written authorization of the student’s parent or guardian or eligible student, and (3) the written permission of the parent for the exchange of information between the prescriber and the school nurse necessary to ensure the safe administration of such medication.
A school nurse, or in the absence of a school nurse, any other nurse licensed pursuant to the provisions of Chapter 378 of the Connecticut General Statutes, including a nurse employed by, or providing services under the direction of NFA at a school based clinic, may administer medication to students in accordance with all state laws and regulations and this policy and its regulations including those specifying required training and criminal background checks.
Absent the availability of a school nurse or other licensed nurse, certain qualified employees including intervention specialists, coaches and licensed athletic trainers, and others as specified in this policy and its regulations who have been properly trained may administer medication to students. Administration shall be in accordance with this policy, its regulations, state and federal law and state regulations for the administration of medication.
Prescribed medication shall be administered to and taken by only the student for whom the prescription has been written.
In compliance with all applicable state statutes and regulations, parents or guardians may administer medications to their own children on school grounds.
Students may be permitted to self-administer medication only in accordance with this policy, its regulations, state law and state regulations governing the administration of medication.
Any student who is six years of age or older may possess and self-apply an over-the-counter sunscreen product while in school prior to engaging in any outdoor activity, provided prior written authorization signed by the student's parent or guardian is submitted to the school nurse. Authorization shall be renewed each school year. A form will be made available to this purpose.
For any 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.
Investigational drugs or research or study medications may not be administered by qualified personnel for schools.
Self-testing of blood glucose level by a child with diabetes
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.
Self-administration by a child diagnosed with asthma or diagnosed with a life threatening allergic condition
A child diagnosed with asthma or a diagnosed life-threatening allergic condition, pursuant to State Board of Education regulations, may possess, self-administer or possess and self- administer medicine administered through the use of an asthmatic inhaler or an EpiPen or similar device in the school at all times or while receiving school transportation services 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 NFA 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.
Administration of Naloxone (Narcan)
Opioid overdoses have become epidemic. NFA’s medical advisor has prescribed standing orders for a suspected overdose as per the Naloxone (Narcan) Policy #5141.21. The order permits the NFA school nurses to administer Naloxone (Narcan) to students believed or suspected to be experiencing an opioid overdose on school ground during school hours.
School Bus Drivers Training
To the extent that NFA provides school transportation services to students, NFA must provide training to all designated NFA employees, including instruction on (1) identifying the signs and symptoms of anaphylaxis, (2) administering epinephrine by a cartridge injector ("EpiPen"), (3) notifying emergency personnel, and (4) reporting an incident involving a student's life- threatening allergic reaction (“cartridge injector training”). Such training can be completed online, provided the online module fulfills legislative requirements. Training must be completed upon hire or upon contracting with a new driver, except that a driver who received the training after the most recent issuance or renewal of his or her school bus operator endorsement is not required to repeat it.
In accordance with state law, bus drivers are granted immunity from civil liability that may arise from the emergency administration of a cartridge injector (Epipen) to a student who experiences a life-threatening allergic reaction on or in the vicinity of a school bus while accessing school transportation services.
The transmission of life-threatening allergy information for each NFA student who may require the use of a cartridge injector while on school transportation shall be shared with transportation carriers in the manner set forth in the regulations accompanying this policy and in accordance with state and federal law.
Administration of Medication by a School Nurse
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.
Administration of Medication in the Absence of a School Nurse
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 NFA at a school-based clinic may administer medication to any student. Qualified school personnel who have received the requisite training in the administration of medication in accordance with state law, received approval of the School Medical Advisor and the school nurse and who have satisfactorily completed a required criminal background check may administer medication to any student in accordance with state law and regulations and this Policy and its regulations 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 Section 10-212a-9 of the Regulations of Connecticut State Agencies and as described in this policy and in the administrative regulations to this policy.
Administration of Medication by Intervention Specialists
A specific intervention specialist, 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 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 annual training required by Section 10-212a, of the Connecticut General Statutes, as amended from time to time, shall maintain epinephrine in cartridge injectors for the purpose of emergency first aid. EpiPens expire yearly. Therefore, NFA is responsible for refilling their prescriptions annually and for maintaining an adequate supply of EpiPens for emergency first aid to students without prior authorization.
The NFA medical center supervisor shall review the expiration dates for epinephrine cartridge injectors maintained by NFA on a monthly basis.
The school shall fulfill all conditions and procedures promulgated in the regulations established by the State Board of Education 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 house 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 NFA during regular school hours in the absence of the school nurse. Each house must maintain a supply of epinephrine in cartridge injectors (EpiPens) for such emergency use.
During regular school hours, when the school nurse is absent or unavailable, qualified school employees who have completed the annual training required by Section 10-212a, of the Connecticut General Statutes, as amended from time to time, may administer epinephrine as emergency first aid to students who experience allergic reactions and who do not have prior written authorization of a parent or guardian or prior written order of a qualified medical professional for the administration of epinephrine.
For the purpose of administration of epinephrine to students without written authorization who are experiencing a life threatening allergic reaction, qualified school employees refers to house principal, teacher, intervention specialist, job coach, or campus safety officer.
The parent or guardian of any student may submit, in writing, to the school nurse or school medical adviser that epinephrine shall not be administered to such student pursuant to this section. The school nurse shall notify selected and trained personnel of the students whose parents or guardians have refused emergency administration of epinephrine. NFA shall annually notify parents or guardians of the need to provide such written notice.
Administration of Glucagon to a Specific Student with Diabetes
Qualified school employees may administer glucagon within injectable equipment used to administer glucagon in an appropriate dose for emergency first aid response to students with diabetes in the event that there is written authorization of a student’s parent or guardian and the school nurse and school medical Advisor have attested in writing that the qualified school employee has completed the annual training and voluntarily agrees to serve in this capacity.
Authorization of injectable glucagon is limited to situations when the school nurse is absent or
unavailable. For purposes of emergency medication administration of glucagon, the term qualified school employee refers to a house principal, teacher, intervention specialist, job coach, or campus safety officer.
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 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 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 house principal, teacher, intervention specialist, job coach, or campus safety officer.
Required Training for School Bus Drivers
By June 30, 2019, school transportation carriers must provide training to all school bus drivers, including instruction on (1) identifying the signs and symptoms of anaphylaxis, (2) administering epinephrine by a cartridge injector ("EpiPen"), (3) notifying emergency personnel, and (4) reporting an incident involving a student's life-threatening allergic reaction. Such training can be completed online, provided the online module fulfills legislative requirements.
Beginning July 1, 2019, each carrier must provide the training to designated NFA employees (1) following the issuance or renewal of a public passenger endorsement to operate a school bus for carrier employees, and (2) upon the hiring of a school bus driver who is not employed by such carrier (e.g., subcontractor), except a driver who received the training after the most recent issuance or renewal of his or her endorsement is not required to repeat it.
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, PA 15-215 and PA 18-185)
10-212c Life-threatening food allergies and glycogen storage disease: Guidelines; district plans (as amended by PA 18-185)
19a-900 Use of cartridge injector by staff member of before- or after- school program, day camp or day care facility
20-12d Medical functions performed by physician assistants. Prescription authority 20-94a Licensure as advanced practice registered nurse
29-17a Criminal history records 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 and PA 18-185)
PA 07-241 An Act Concerning Minor Changes to the Education Statutes
PA-12-198 An Act Concerning the Administration of Medicine to Students with Diabetes, the Duties of School Medical Advisors, the Availability of CPR and AED Training Materials for Boards of Education and Physical Exercise During the School Day
PA 14-176 An Act Concerning the Storage and Administration of Epinephrine at Public Schools
PA 15-215 An Act Concerning Various Revisions and Additions to the Education Statutes
PA-18-185 An Act Concerning the Recommendations of the Task Force on Life- threatening Food Allergies in Schools Connecticut Regulations of State Agencies 10- 212a-1 through 10-212a-10, inclusive
PA 07-241 An Act Concerning Minor Changes to the Education Statutes
Code of Federal Regulations: Title 21 Part 1307.2
Regulation Adopted: 9/15/98
Regulation Revised: 1/5/99, 3/20/01, 1/27/05, 2/1/10, 12/13/10, 9/17/13, 9/15/