Subject:
Medication During School Day
311.02
Issued by:
Lyonel B. Tracy
Date Issued:
February 4, 2009
Supersedes
issues dated:
August 28, 2008
September 4, 2008
Page
1 of 5
This technical advisory is intended to help clarify issues related to delegation of
medications during the school day.
Actual Text - Ed 311.02 Medication During School Day
(a) For the purpose of this rule “school day” means any time during the day, afternoon, or
evening when a child is attending school or other school related activity.
(b) Any pupil, who is required to take during the school day a medication prescribed by a
licensed physician, advanced registered nurse practitioner, licensed physician's assistant or
dentist, shall have a school nurse either assist the student to take the medication or
administer the medication.
(c) This duty may also be undertaken by a RN or LPN under the direction of the school nurse.
(d) The school nurse may delegate the administration of medications, if appropriate to others
pursuant to RSA 326-B Nurse Practice Act and Nur 404.
(e) Asthma inhalers and epinephrine auto injectors may be possessed by a student and self
administered in accordance with RSA 200:42 through RSA 200:47.
(f) If the school nurse is not available the building principal or designee is permitted to assist
students in taking required medications by:
(1) Making such medications available to the student as needed; and
(2) Observing the student as he/she takes or does not take his/her medication; and
(3) Recording whether the student did or did not take his/her medication.
(g) Upon receiving a request from the parent, guardian, or physician relative to a particular
student's need for medication during school hours, the school nurse may contact the parent,
or guardian to discuss whether the student should remain at home, or whether the
medication should be taken before, during, and/or after school. The nurse may also inquire
about any other medical conditions requiring medications and any special side effects,
contraindications and adverse reactions to be observed.
(h) Each local school board, with the advice of the school nurse(s) and school physician if
available shall establish specific policy and procedures to give protection and controls to the
matter of medications in schools.
Subject:
Medication During School Day
311.02
Issued by:
Lyonel B. Tracy
Date Issued:
February 4, 2009
Supersedes
issues dated:
August 28, 2008
September 4, 2008
Page
2 of 5
(i) In order for prescription medications to be given at the school, the following shall occur:
(1) The school nurse shall ensure that a written statement from the licensed prescriber
containing the following be in the student's health record:
a. The student's name;
b. The name and signature of the licensed prescriber and contact numbers;
c. The name, route and dosage of medication;
d. The frequency and time of medication administration or assistance;
e. The date of the order; and
f. A diagnosis, if not a violation of confidentiality;
(2) The school nurse shall ensure that there is written authorization by the parent and/or
guardian which contains:
a. The parent and/or guardian's printed name and signature;
b. A list of all medications the student is currently receiving, if not a violation of
confidentiality or contrary to the request of the parent, guardian or student that such
medication be documented; and
c. Approval to have the school nurse or designee administer the medication, the student
to possess and self-administer and/or the principal or his designee assist the student
with taking the medication; and
(3) The school nurse shall ensure the authorization or other accessible documentation
contains:
a. The parent and/or guardian's home and emergency phone number(s); and
b. The names of persons to be notified in case of a medication emergency in addition to
the parent or guardian and licensed prescriber.
(j) The school nurse shall develop a system of documenting and communicating significant
observations relating to prescriptions, medication's adverse reactions, and other harmful
effects, to the child's parent or guardian and/or licensed prescriber.
(k) The school nurse shall develop and implement procedures regarding receipt and safe
storage of prescription medications.
(l) A parent, guardian or a parent/guardian-designated, responsible adult shall deliver all
medication to be administered by school personnel to the school nurse or other responsible
person designated by the school nurse as follows:
Subject:
Medication During School Day
311.02
Issued by:
Lyonel B. Tracy
Date Issued:
February 4, 2009
Supersedes
issues dated:
August 28, 2008
September 4, 2008
Page
3 of 5
(1) The prescription medication shall be in a pharmacy or manufacturer labeled container;
(2) The school nurse or other responsible person receiving the prescription medication shall
document the quantity of the prescription medication delivered; and
(3) The medication may be delivered by other adult(s), provided, that the nurse is notified in
advance by the parent or guardian of the delivery and the quantity of prescription
medication being delivered to school is specified.
(m) All medications shall be stored in their original pharmacy or manufacturer labeled containers
and in such manner as to render them safe and prevent loss of efficacy. A single dose of
medication may be transferred from this container to a newly labeled container for the
purposes of field trips or school sponsored activities.
(n) All medication to be administered by the school nurse shall be kept in a securely-locked
cabinet which is kept locked except when opened to obtain medications. Medications
requiring refrigeration shall be stored in a locked box in a refrigerator maintained at
temperatures of 38 degrees to 42 degrees. Emergency medications may be secured in other
locations readily accessible only to those with authorization.
(o) No more than a 30-school day supply of the prescription for a student shall be stored at the
school.
(p) Non-prescription medication shall be given only with the written authorization of the parent
and/or guardian and if this is in accordance with school policy.
Related Laws and Rules for Consideration
RSA 326-B:29 prohibits anyone from coercing an RN or LPN into delegating any task if the
nurse determines the delegation to be inappropriate. Additionally, this law protects nurses who
appropriately delegate tasks according to the nurse practice act from disciplinary action because
of the performance of the delegatee:
http://www.gencourt.state.nh.us/rsa/html/XXX/326-B/326-B-29.htm
Nur 404 outlines the circumstances, obligations, and limitations of delegating a nursing task:
http://gencourt.state.nh.us/rules/nur.html
Nur 101 provides definitions of Competency, Delegation, Stable Client, and Unlicensed
Assistive Personnel: http://gencourt.state.nh.us/rules/nur.html
Subject:
Medication During School Day
311.02
Issued by:
Lyonel B. Tracy
Date Issued:
February 4, 2009
Supersedes
issues dated:
August 28, 2008
September 4, 2008
Page
4 of 5
RSA 318:42 allows for the possession and administration of epinephrine for the emergency
treatment of anaphylaxis by licensed practical nurses or registered nurses employed or
contracted by public school systems without the need for explicit written parental authorization:
http://www.gencourt.state.nh.us/rsa/html/XXX/318/318-42.htm
RSA 200:42 – RSA 200:47 describe what needs to be in place to allow students to carry and
self-administer inhalers and epinephrine:
http://www.gencourt.state.nh.us/rsa/html/NHTOC/NHTOC-XV-200.htm
RSA 200:40 – RSA 200:41 allow a school nurse to administer oxygen to a pupil in a medical
emergency as needed: http://www.gencourt.state.nh.us/rsa/html/NHTOC/NHTOC-XV-200.htm
Department Discussion
Any prescription medication to be taken by a public school student during the school day
requires the involvement of a school nurse regardless of the route of administration. The school
nurse must verify the prescription, parental authorization, and accuracy of emergency contact
information. The school nurse must also have in place a system to document adverse reactions
to the medication and to safely store the medication.
After the above requirements are met, the principal or designee may assist students with their
prescriptions if the nurse is unavailable. This assistance consists of providing the medication to
the student then observing and documenting that the student took the medication. However, if
the medication requires administration, that is, the student cannot take the medication by
themselves with the assistance described; only the school nurse or an appropriate delegate may
administer the prescription.
A school nurse alone has the authority to delegate medication administration and may delegate
only if appropriate under the Nurse Practice Act. Parents may not delegate medication
administration directly in the public school setting. Ideally, the school nurse will work with the
parent and/or guardian to identify appropriate delegatees since parental approval and
authorization is required.
If, in conjunction with medication administration, the student requires a comprehensive nursing
assessment and/or evaluation, this must be done by an RN and cannot be delegated.
Supervision will be provided on a continual or intermittent basis as per the Board of Nursing
Administrative Rules. The nurse shall develop a system to ensure the delegatee will follow a
care plan or an emergency care plan, especially if the school nurse will not be available for
Subject:
Medication During School Day
311.02
Issued by:
Lyonel B. Tracy
Date Issued:
February 4, 2009
Supersedes
issues dated:
August 28, 2008
September 4, 2008
Page
5 of 5
consultation or assistance at the time the medication will be administered. The established plan
must take into consideration the individual student needs and the context when the medication
may be needed (e.g., location, activities, availability of EMS, availability of parent or guardian).
It may include instructions for calling 911 and/or the parent as appropriate as well as ensuring
immediate and adequate first aid if needed.
The NH Board of Nursing has a Frequently Asked Question document related to the role of the
School Nurse. This document is under review and will be updated in the near future at
www.state.nh.us/nursing under the FAQ section.
Here are some additional recommended resources to consult before delegating:
1) NH Nurses Association Online Delegation program:
http://www.nhnurses.org/pdf/doc/Delegation_course.doc
2) National Association of School Nurses Position Statements Regarding Using Assistive
Personnel and Delegation: http://www.nasn.org/Default.aspx?tabid=201 (Please note that this
position statement will soon be revised) and http://www.nasn.org/Default.aspx?tabid=349
3) National Council of State Boards of Nursing position paper emphasizes that supervision,
monitoring, evaluation and follow-up by the nurse are crucial components of delegation:
https://www.ncsbn.org/323.htm
RSA 200:42 – RSA 200:47 allows students to carry and self-administer prescription epi pens
and inhalers provided that all conditions described in the statute have been satisfied. For other
prescription drugs students normally self-administer, the school nurse may delegate
administration to the student themselves if the prescriber and parent/guardian provides written
authorization and if school policy supports the practice. Ideally, students should self-administer
their medications in a comfortable and clean location either in class or in a nearby location to
minimize disruption to their academic day. The school nurse should provide supervision as
needed.
School nurses have the authority to possess and administer oxygen and epinephrine as per the
legislation above but schools are not required to stock these drugs. This decision is best left up
to the individual districts with the advice of the school nurse and MD, if available.
For more information on this technical advisory, contact:
Katherine Rannie, RN MSc, [email protected], 271-3891
School Health Services Consultant, Division of Instruction
