566 - Administration of Medication to Students

STUDENT PERSONNEL

Series 500

Policy Title: Administration of Medication to Students Code No.: 566

The board is committed to the inclusion of all students in the education program and recognizes that some students may need prescription and nonprescription medication to participate in their educational program.

Medication shall be administered when the student's parent or guardian (hereafter "parent") provides a signed and dated written statement requesting medication administration and the medication is in the original, labeled container, either as dispensed or in the manufacturer's container.

When administration of the medication requires ongoing professional health judgment, an individual health plan shall be developed by an authorized practitioner with the student and the student's parent. Students who have demonstrated competence in administering their own medications may self-administer their medication. A written statement by the student's parent shall be on file requesting co-administration of medication, when competence has been demonstrated. By law, students with asthma, airway constricting diseases, respiratory distress or students at risk of anaphylaxis who use epinephrine auto-injectors may self-administer their medication upon the written approval of the student’s parents and prescribing licensed health care professional regardless of competency.

Persons administering medication shall include authorized practitioners, such as licensed registered nurses and physician, and persons to who authorized practitioners have delegated the administration of medication (who have successfully completed a medication administration course). A medication administration course and periodic update shall be conducted by a registered nurse or licensed pharmacist, and a record of course completion shall be maintained by the school.

A written medication administration record shall be on file including:

date;

student's name;

prescriber or person authorizing administration;

medication;

medication dosage;

administration time;

administration method;

signature and title of the person administering medication; and

any unusual circumstances, actions, or omissions

Medication shall be stored in a secured area unless an alternate provision is documented. Emergency protocols for medication-related reactions shall be posted. Medication information shall be confidential information as provided by law

Disposal of unused, discontinued/recalled, or expired medication shall be in compliance with federal and state law. Prior to disposal school personnel shall make a reasonable attempt to return medication by providing written notification that expired, discontinued, or unused medications needs to be picked up. If medication is not picked up by the date specified, disposal shall be in accordance with the disposal procedures for the specific category of medication.

Date of Adoption/Review/Revision:

September 1990

July 1991

August 1994

August 1997

August 2000

July 2003

July 2006

July 2010

September 2012

August 2015

September 2022

January 2024

dawn@iowaschoo… Wed, 02/26/2020 - 21:58

566E1 - Controlled Substance Log

STUDENT PERSONNEL

Series 500

Policy Title: Controlled Substance Log

Code No.: 566E1

CONTROLLED SUBSTANCE LOG

Parent/Guardian is responsible for picking up remaining medication. Medication not picked up by parent/guardian will be turned over to local law enforcement for disposal.

Medication (name and amount)	RN Initials	Witness signature	Date	RN Signature

Medication turned over to Law Enforcement (Name and amount)	RN initials	Law Enforcement Signature	Date	RN signature

Date of Adoption/Revision:

October 2022

dawn@iowaschoo… Wed, 02/26/2020 - 22:02

566E2 - Administering Medication in School

STUDENT PERSONNEL

Series 500

Policy Title: Administering Medication in School

Code No.: 566E2

Dear Parents,

The Department of Education has asked all school districts to have a policy regarding the administration of medicines in school. If your child needs to bring medication to school, please follow these instructions to insure that the medication will be safely given.

A. No over-the-counter medication will be administered at school, unless we have the parent’s

written permission, and prescription medication will be dispensed to students during a school

day only if the following requirements are met:

1) Medication must be in the original container from the pharmacy with the directions

clearly stated. (This serves two purposes: Permission from the doctor and direction

from the pharmacist.) If you ask your pharmacist, he will give you another labeled

container for school. NO BAGGIES OR ENVELOPES WILL BE ACCEPTED AT

SCHOOL.

2) Parents must give written authorization for the administration of the medication.

B. Students are to bring all medications to the school office immediately upon their arrival at

school. Students are not to carry medications with them during the class day.

C. Parents are responsible for picking up any unused medication (that is a controlled substance) at the end of the school year or when the student is no longer taking medication at CCSD. Failure to do so will result in medication being picked up by local law enforcement personnel.

THANK YOU FOR YOUR HELP IN MAKING CERTAIN YOUR CHILD RECEIVES

NEEDED MEDICATION IN A SAFE MANNER

REQUEST FOR GIVING MEDICINE AT SCHOOL

(MUST BE FILLED OUT COMPLETELY)

Student’s Name:___________________________ Grade:___________

Teacher:_________________________________ School:___________

Medication:_______________________________ Time Given:________

Date (From):______________________________ (To):______________

This medicine is furnished by the parent or guardian with the regular label, the name of the pharmacist, and the name and strength of the medicine. This request must be signed by the parent or guardian to authorize giving medication during school hours. The parent signature below gives Carroll Community Schools Health Staff permission to contact the prescribing physician as deemed

necessary with regard to the above listed student.

Parent Signature ____________________________________________________

Significant Information ________________________________________________

dawn@iowaschoo… Wed, 02/26/2020 - 22:04

566E3 - Parental Authorization and Release Form for the Administration of Medications to Students

STUDENT PERSONNEL

Series 500

PARENTAL AUTHORIZATION AND RELEASE FORM FOR THE ADMINISTRATION OF MEDICATION TO STUDENTS

Code No.: 566E3

______________________________________ ___/___/___ _______________________ ___/___/___

Student's Name (Last), (First), (Middle) Birthday School Date

School medications and health services are administered following these guidelines:

• Parent has provided a signed, dated authorization to administer medication and/or provide the health service.

• The medication is in the original, labeled container as dispensed or the manufacturer's labeled container.

• The medication label contains the student’s name, name of the medication, directions for use, and date.

• Authorization is renewed annually and as soon as practical when the parent notifies the school that changes are necessary.

_________________________ _____________ ___________ _____________________

Medication/Health Care Dosage Route Time at School

______________________________________________________________________________

Administration instructions

______________________________________________________________________________

Special Directives, Signs to Observe and Side Effects

______ /_____ /______

Discontinue/Re-Evaluate/Follow-up Date

____________________________________ __________/________/__________

Prescriber’s Signature Date

_____________________________________ _______________________________________

Prescriber's Address Emergency Phone

I request the above named student carry medication at school and school activities, according to the prescription, or other medication administration instructions, and a written record kept. Special considerations are noted above. The information is confidential except as provided by the Family Educational Rights and Privacy Act (FERPA) and any other applicable law. I agree to coordinate and work with school personnel and prescriber (if any) when questions arise. I agree to provide safe delivery of medication and equipment to and from school and to pick up remaining medication and equipment. Procedures for medication disposal shall be in accordance with federal and state law.

(Parent's signature) ____

Parent's address _________________________________________________________

Date _______________Home Phone __________________ Work Phone ________________

Additional information

Authorized Form _____________________________________________________________

________________________________________________________________________________________________________________________________________________________

dawn@iowaschoo… Wed, 02/26/2020 - 22:06

566E4 - Authorization-Asthma, Airway Constricting, or Respiratory Distress Medication Self-Administration Consent Form

STUDENT PERSONNEL

Series 500

Policy Title: Authorization-Asthma, Airway Constricting, or Respiratory Distress Medication Self-Administration Consent Form

No.: 566E4

___________________________________ ____________ ______________________ _________________

Student's Name (Last), (First) (Middle) Date of Birth School Date

The following must occur for a student to self-administer asthma medication, bronchodilator canisters or spacers, or other airway constricting disease medication or for a student with a risk of anaphylaxis to self-administer an epinephrine auto-injector:

• Parent/guardian provides signed, dated authorization for student medication self-administration.

• Parent/guardian provides a written statement from the student’s licensed health care professional (A person licensed under chapter 148 to practice medicine and surgery or osteopathic medicine and surgery, an advanced registered nurse practitioner licensed under chapter 152 or 152E and registered with the board of nursing, or a physician assistant licensed to practice under the supervision of a physician as authorized in chapters 147 and 148C) containing the following:

o Name and purpose of the medication, o Prescribed dosage, and

o Times or special circumstances under which the medication or epinephrine auto-injector is to be administered.

• The medication is in the original, labeled container as dispensed or the manufacturer's labeled container containing the student name, name of the medication, directions for use, and date.

• Authorization shall be renewed annually. In addition, if any changes occur in the medication, dosage or time of administration, the parent is to notify school officials immediately. The authorization shall be reviewed as soon as practical.

Provided the above requirements are fulfilled, the school shall permit the self-administration of medication by a student with asthma, respiratory distress, or other airway constricting disease or the use of an epinephrine auto-injector by a student with a risk of anaphylaxis while in school, at school-sponsored activities, under the supervision of school personnel, and before or after normal school activities, such as while in before-school or after-school care on school-operated property. If the student abuses the self-administration policy, the ability to self-administer may be withdrawn by the school or discipline may be imposed, after notification is provided to the student’s parent.

Pursuant to state law, the school district or and its employees are to incur no liability, except for gross negligence, as a result of any injury arising from self-administration of medication or use of an epinephrine auto-injector by the student. The parent or guardian of the student shall sign a statement acknowledging that the school district is to incur no liability, except for gross negligence, as a result of self-administration of medication or an epinephrine auto-injector by the student as provided by law.

Authorization-Asthma, Airway Constricting, or Respiratory Distress Medication Self-Administration Consent Form

__________________________ __________________________ _____________ __________________

Medication Dosage Route Time

_________________________________________________________________________________

Purpose of Medication & Administration /Instructions

____________________________________

Special Circumstances

___________________________________

Prescriber’s Signature

___________________________________

Prescriber’s Address

/ / ________________

Discontinue/Re-Evaluate/ Follow-up Date

/ / _______________________

Date

_________________________________

Emergency Phone

• I request the above-named student possess and self-administer asthma medication, bronchodilators canisters or spacers, or other airway constricting disease medication(s) and/or an epinephrine auto-injector at school and in school activities according to the authorization and instructions.

• I understand the school district and its employees acting reasonably and in good faith shall incur no liability for any improper use of medication or an epinephrine auto-injector or for supervising, monitoring, or interfering with a student's self-administration of medication or use of an epinephrine auto-injector. I acknowledge that the school district is to incur no liability, except for gross negligence, as a result of self-administration of medication or use of an epinephrine auto-injector by the student.

• I agree to coordinate and work with school personnel and notify them when questions arise or relevant conditions change.

• I agree to provide safe delivery of medication and equipment to and from school and to pick up remaining medication and equipment.

• I agree the information is shared with school personnel in accordance with the Family Education Rights and Privacy Act (FERPA) and any other applicable laws.

• I agree to provide the school with back-up medication approved in this form.

______________________________________

Parent/Guardian Signature (agreed to above statement)

______________________________________

Parent/Guardian Address

Date / /

Home Phone_______________________ _____________

Business Phone _______________________

Self-Administration Authorization Additional Information:________________________________________

________________________________________________________________________________________

dawn@iowaschoo… Wed, 02/26/2020 - 22:07

566R1 - Administration of Medication to Students Regulation

STUDENT PERSONNEL

Series 500

Policy Title: Administration of Medication to Students Regulation Code No.: 566R1

No over-the-counter medication shall be administered at school, unless the school has the parent’s/guardian’s written permission. Prescription medication will be dispersed to students during a school day only if the following requirements are met:

Medication must be in the original container, from the pharmacy with the directions clearly stated. This serves two purposes: signifies permission from the doctor and includes directions from the pharmacist. Pharmacists will supply another labeled container for school upon request when the prescription is filled. NO BAGGIES OR ENVELOPES WILL BE ACCEPTED AT SCHOOL.
Parent/guardian must give written authorization for the administration of the medication.

Students are to bring all medications to the school office immediately upon their arrival at school. Students are not to carry over-the-counter medications with them during the school day unless approved by the school nurse. Students are not to carry prescription medication with them during the school day unless ordered by the physician and cleared by the school nurse.

A written (stored digitally on the district’s Student Information System) medication administration record shall be on file, including:

date;
student's name;
prescriber or person authorizing administration;
medication;
medication dosage;
administration time;
administration method;
signature and title of the person administering medication; and
any unusual circumstances, actions, or omissions.

Medication on school premises shall be kept in a locked container in a limited access storage space. Only appropriate personnel shall have access to the locked container. Each school or facility shall designate in writing the specific locked and limited access space within each building to store pupil medication.

In each building in which a full-time registered nurse is assigned, access to medication locked in a designated space shall be under the authority of the nurse.

In each building in which a less than full-time registered nurse is assigned, access to the medication shall be under the authority of the principal/designee.
All controlled substances will be counted and recorded by two CCSD employees when brought to school by a parent.
Any controlled substance left at the school at the end of the school year will be picked up by local law enforcement for disposal.

Emergency protocols for medication-related reactions shall be posted.

Medication information shall be confidential information and shall be available to school personnel with parental/guardian authorization.

The superintendent/designee shall be responsible, in conjunction with the school nurse, to develop rules and regulations governing the administration of medication, prescription and non-prescription, to students. Students and parents/guardians shall be provided with the requirements for medication procedures by the school annually.

Date of Adoption/Review/Revision:

September 17, 1990

July 22, 1991

August 1994 August 1997

August 2000

July 2003

July 2006

July 2010

September 2012

August 2015

August 2022

dawn@iowaschoo… Wed, 02/26/2020 - 22:00