ADMINISTERING MEDICINES TO STUDENTS

(REGULATION 2870)

Prescription Medication

The student's physician shall provide a written request that the student be given medication during school hours. The request shall state the name of the student, name of drug, dosage, frequency of administration, route of administration, and the name of the physician. The diagnosis/indication for use of the medicine shall be provided. When possible, the physician should state adverse effects and applicable emergency instructions. A parent/guardian shall provide a written request that Rockwood School District comply with the physician's request to give medication.

In lieu of the physician's written request, the District will accept a prescription label properly affixed to the medication in question. Said label must contain the name of the student, name of the drug, dosage, frequency of the administration, route of administration, and the name of physician. Along with the labeled medication, a parent/guardian shall provide a written request that Rockwood School District comply with the physician's request to give medication.

When parent/guardian does not provide a written request for the administration of medicine, the registered professional nurse or his/her designee will attempt to contact the parent and obtain the written request.

If it is not possible to contact the parent/guardian, the child's physician shall be contacted. If that is not possible, Rockwood's consulting physician shall be contacted for directions. The District will not administer the initial dose of any medication. The day's first dose of medication should be given at home.

In the absence of the parent/guardian's written request, correct prescription label, manufacturer's label or the physician's request, the parent/guardian may personally administer medication to his/her child at school. Usual precautions regarding proper identification of the parent/guardian shall be exercised. The driver's license may be used as a means of identification.

Over-the-Counter Medication

The student's physician shall provide a written request that the student be given medication during school hours. The request shall state the name of the student, name of drug, dosage, frequency of administration, route of administration, and the name of the physician. The diagnosis/indication for the use of the medicine shall be provided. When possible, the physician should state adverse effects and applicable emergency instructions.

Over-the-counter medications must be brought to school in their original container and kept in the health room in the possession of the nurse.

The prohibition against the possession and use of over-the-counter medication on school property and at school-sponsored activities on or away from school property shall not apply to products containing sunscreen and sun blocking agents, including lotions, creams, lip balm and other similar products, so long as such product (1) contains no other substances prohibited under this or any other Board policy and (2) is in the original, clearly labeled manufacturer's container.

The student will assume the responsibility for requesting the medication each day at the proper time.

The parent/guardian will provide a written request that Rockwood School District comply with the physician's request to give medication.

Emergency Medication

For students who may be in need of emergency medication, written standing orders from the District's consulting physician will be obtained annually for the administration of such medication, i.e., epinephrine, Tylenol.

Procedures for Medication Administration and Control

A parent/guardian or other responsible party designated by the parent/guardian will deliver all medication to be administered at school to the school nurse or designee. All medication, prescription or over-the-counter, must be in a pharmacy or manufacturer labeled container. The District shall provide secure, locked storage for medication to prevent diversion, misuse, or ingestion by another individual.

The administration of medication, including over-the-counter medications, is a nursing activity governed by the State of Missouri Nurse Practice Act. It must be performed by the registered professional school nurse. Said nurse may delegate and supervise the administration of medication by unlicensed personnel who are qualified by education, knowledge and skill to do so. Said registered nurse must provide and document the requisite education, training, and competency verification.

Medication Administration and Control

The transportation of medication to school or from school by students is prohibited with the exceptions provided for self-administration of medication by waiver.

• Upon receipt of medication from parent/guardian, count or measure the initial quantity delivered to school and document on the Daily Medication Record (Form 7146).
• If medication is brought to school by a student, count or measure the initial quantity delivered to school and document on the Daily Medication Record (Form 7146) and document in SOAP notes as "Meds from Student."
• If medication brought to school is needed for administration at home, the parent/guardian must pick up the needed quantity from the School Nurse or designee and the quantity taken will be documented on the Daily Medication Record. Student will not be allowed to transport medication on the bus.
• Controlled medications are to be counted upon receipt at school and again at least weekly by a nurse and a witness (e.g., school nurse and trained staff member). Each count is to be documented and signed by both individuals.
• The latest medication order is to be placed behind each student's Daily Medication Record in the Medication Log. (Replaced orders are to be filed in the student's medical file).
  Medication is not to be left out of the designated storage location at any time (e.g., left on counter, desk, etc.).
• Medications must be left in and dispensed from the pharmacy or manufacturer labeled container.
• The following is to be verified at the time medication is administered:

The RIGHT student, medication, dose, time and route

• Documentation is to be completed promptly for all medications administered, including any errors that occur during the administration process.
• Any medication administration errors are to be documented on Report of Medication Error (Form #7159). Advise the building administrator of the error and notify the parent/guardian. The completed Report of Medication Error (Form #7159) is to be filed in the nurse's office and medication error documented in student SOAP Notes as "Medication Error." If parent/guardian requests a copy of the completed Report of Medication Error (Form #7159), the nurse may provide them a copy.
• Medications remaining from a course of treatment or at the end of the school year is to be picked up from the nurse (or an authorized alternate) by the parent/guardian or an adult designated by the parent/guardian. These medications will not be sent home with the student. Quantity of medication picked up by parent/guardian is to be documented on the Daily Medication Record with signature of nurse and parent/guardian.
• Any medication not picked up will be destroyed according to DEA regulations. The destroying of the medication is to be performed by the nurse and witnessed by another nurse or staff member and documented on the Daily Medication Record with signatures of both persons.
  

Failure of Student to Come For Medication or Refusal to Take Medication

Student Fails to Come for Medication

• If student fails to come to health room at prescribed time, initiate building protocol to administer medication consistent with physician's order.
• If necessary, develop a plan to help student to remember to come for medication (Example: prompts from alarm on wristwatch, reminder from classroom teacher, etc.). Assess and revise the plan until results are consistently within the 30-minute variance.
  

Student Refuses to Take Medication

• If a student refuses to take a medication, physical force and/or restraining devices are not appropriate.
• Upon refusal, document on Daily Medication Record and advise the parent/guardian.

Field Trips and After School

1. Repackaging of medications will be witnessed. The nurse will record as a field trip (F) or after school (AS) med on the front of the student Medication Log and the witness will sign on the backside of student Medication Log.

2. Repackaged medications will be labeled with

• Teacher name
• Student name
• Medication name
• Dosage to be given (# of pills if in pill form)
• Time to be given

 

3. Individual giving medication on field trip or after school will record time given and signature on pill envelope or inhaler/Epi Pen bag label and return envelope and bag to nurse.

4. Nurse will include record of giving in Medication Log Notebook by stapling the envelopes/labels to a blank page of paper or by making a "copier" copy of the envelopes/labels.

Health Room and Medications Accessibility Information

1. Two sets of keys will always be kept for the health room.

• Nurse will have a set.
  
  Transfer of keys will be recorded on Nurse's Health Room Key Log. (For example, while nurse is at lunch and a team member has the keys)
  
• Principal will have a set.
  Each principal will determine building procedure for key control.

2. Emergency medications such as inhalers and Epi Pens are to be accessible at all times when students are present including after school activities.

Exception for Potentially Harmful Administration

It shall be the policy of this District that the District will not knowingly administer any medication to a student if the District's registered professional school nurse believes in his/her professional judgment, that such administration could cause harm to the student, other students, or the District itself. Such cases may include, but are not necessarily limited to, situations in which the District is being asked to administer medication in a dosage that exceeds the highest recommended dosage listed in the current annual volume of the Physician's Desk Reference or other recognized medical or pharmaceutical text.

Self-Administration of Medication

Students in grades nine through twelve may carry their own over-the-counter medication and consume or apply this medication as directed by their physician. This medication must be in its original container and the student must carry with the medication a written statement from the parent/guardian requesting self-administration. A self-administration waiver must be on file in the nurse's office.

When students and/or parents of students in grades nine through twelve prefer that over-the-counter medication be kept in the school nurse's office and administered by the school nurse, the requirements of Over-the-Counter Medication, of this procedure shall apply.

Students with asthma or any potentially life threatening respiratory illness may carry with them for self-administration metered dose inhalers containing "rescue" medication and Epi-Pen. Possession and self-administration of these prescription medications must comply with the Missouri Safe Schools Act, 1996.  The directives of this Act will be given to each parent/guardian who requests permission for his/her child to carry and self-administer such medication, and are enumerated in the guidelines of this administrative procedure, as per Appendix A.

Parent/Guardian Administration

In situations where the above requirements are not met, or any time the parent/guardian chooses, the parent/guardian may come to school to administer medicine to his/her child. The parent should report to the office to have the child summoned to meet the parent in the office.

APPENDIX A

1. Self-administration of metered-dose "rescue" medication inhaler
    
   The parent/guardian shall provide written authorization for the child's self-administration of this medication with a written history of the child's experience with the potentially life-threatening respiratory illness. He/she shall provide a plan of action for addressing any emergency situation, which could reasonably be anticipated as a consequence of self-administering this medication.
2. The parent/guardian shall provide written certification from the child's physician, or the physician shall provide written certification that the child has asthma or another potentially life-threatening respiratory illness. This certification shall further state that the child has been instructed in and is capable of the proper method of self-administration of the specific rescue medication, that he/she has been informed of the dangers of improper use and the danger of permitting other persons to use the prescribed medication.
3. The District shall inform the parent/guardian of the child in writing that the District, its employees or agents shall incur no liability as a result of any injury arising from the self-administration of the medication by the child.
4. The parent/guardian shall sign a statement acknowledging the District shall incur no liability as a result of injury arising from the self-administration of this medication by the child. The parent/guardian 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 child.
5. This authorization is effective for the school year for which it is granted and must be renewed annually, renewal contingent upon completion of the above four steps with each request for renewal.
6. The District may require children to maintain current duplicate metered-dose "rescue" inhalers with the school nurse.
7. The child shall report to the school nurse within a timely manner when he/she has had occasion to use his/her "rescue" medication.
8. The registered professional nurse shall communicate to parent/guardian and/or physician the effect of the medication on the student, and apprise them of frequency of need. Concerns regarding proper use of the medication can be discussed with parent/guardian and the physician.
9. When administration pursuant to the physician's order is perceived to be ineffective or when it is believed that the safety of the child is at risk, the physician shall be contacted immediately. If said physician is unavailable, Rockwood's consulting physician shall be contacted for direction.
   

CONTAGIOUS DISEASES

When a child has had a contagious disease like measles or chicken pox, he/she should bring a doctor's statement to the office stating that he/she is free from contagion and able to return to school. If such a statement is not available, the child is to report to the nurse's office to be checked to see if all symptoms of the disease have disappeared. The nurse will contact the parents/guardians and decide if further information is needed.

EMERGENCY CARDS AND INFORMATION

The school office maintains up-to-date information on all students. Some of this information is very important in case of emergencies. New cards are sent home with every student the first day of school. It is imperative that parents/guardians complete these and return them to school immediately. During the year if any of the information listed on the enrollment form or emergency cards changes, please send this information to the school office. Telephone number(s), addresses, employment, and other communication changes should all be reported. If your telephone number is unlisted, we still need to have it. The school considers all telephone numbers confidential.

HEALTH EXAMINATIONS

A health examination is required of all students, regardless of grade level, upon initial entry into Rockwood School District. New students are given one month from their first day of attendance to provide a physical examination to the school nurse. If parents/ guardians can produce written confirmation from a physician that their child has had a physical within the past year, it will fulfill the requirement. You are to interpret the "past year" as being from the date the child starts school.

The administration may waive the requirement for a health examination upon written objection by a parent or guardian. Health examinations may be performed by a doctor of medicine (MD), or doctor of osteopathy (DO).

HEALTH SCREENINGS

• The following screenings are conducted annual by the school nurse.
• Vision is screened in grades 1, 3, and 5, as well as all new students to the district and all students receiving Special School District services.
• Hearing is screened in grades Kdg., 1, 2 and 4, all new students to the district, and all students receiving Special School District services.
• Fifth-grade girls are screened for Scoliosis.

IMMUNIZATIONS

State law requires that each student have specific immunizations before entering school. All students must be properly immunized. Check with the school nurse or your physician for immunization requirements.

Parents can view the Missouri School Immunization Requirements for 2009-10 on this link School Requirements 09-10 .pdf

No Grace Period - All students are required to have up-to-date immunizations before they can attend school in the fall. Parents/Guardians are responsible for checking with their physician to insure that their child's immunizations are current. If a child is due for a booster over the summer months, it MUST be obtained prior to the first date of attendance. New enrollees MUST provide proof of immunizations at the time of enrollment.

IMMUNIZATION EXEMPTIONS

Students may be exempted from the immunization requirements for religious beliefs or medical contradictions only. Parents/Guardians may obtain the appropriate objection card from the school nurse.

The St. Louis County Health Department operates free walk-in immunization clinics

MEDICAL EMERGENCIES

When a child is injured or becomes ill at school, and in the judgment of the school nurse he or she should be sent home, the parent/guardian is called. If the parent/guardian cannot be reached, the person(s) listed on the emergency card will be called. It is important to keep your child's emergency card up-to-date.

STUDENT ABSENCES

If your child is going to be absent, please call the school before 9:00 a.m.(636-861-7766) and give the information to Mrs. Davis, the school nurse, or the school secretary. If you do not call school, the nurse will call you at home or at work to see why your child is not in attendance. If the nurse cannot reach you, a written excuse is required upon your child's return to school. When calling to report an absence, please state the child's name, his/her teacher's name, and the reason for the absence. Excusable Absences:

• Death in the student's immediate family
• Student illness
• National Religious Holiday
• Family out of town - when a family is leaving town and desires to take the child with them, the student may be excused provided
• The school is notified in advance
• The student procures his/her assignments in advance of absence
• All assigned work is turned in upon student's return to school
• All tests or quizzes are made up