Policy Considerations
Section 504, the IDEA, and/or the ADA can require education officials to dispense or supervise the self-administration of medications for qualified students daily as required health services, a process typically involving school nurses and/or other trained personnel. However, while appropriately trained personnel can legally dispense medication or supervise students who self-administer, they typically cannot distribute such nonprescription items as aspirin and vitamins without parental permission.
Policies should include statements explicitly indemnifying school personnel who are properly educated in the dispensation or supervision of self-administrations.
Because some students need medications at school, boards must have policies in place to ensure their safety. Of course, while sound policies cannot ensure that boards will be free from all threats of litigation to the extent that they are followed, they can limit, perhaps even avoid, liability. As such, districts might consider the following recommendations:
1. Policy writing and revising teams should include at least one school board member, the SBO, central office, and building-level administrators, teachers, a staff member, a school nurse, a medical doctor, a representative of a local hospital or healthcare facility, a faculty member from a local college or university, the board attorney, and perhaps an upper-level high school student who receives or self-dispenses medications at school.
2. Districts that do now have registered school nurses on staff should consider hiring one to help ensure safety. Interestingly, national data reveal regional “variances in school nurse staffing, with 88.2% of schools in the Northeast employing a full-time school nurse, followed by 78.9% in the South, 59.9% in the Midwest, and 33.3% in the West.”
3. Policies should ensure that more than one person in a building is prepared to dispense medications or supervise self-administration if the primary staff member is unavailable.
4. Students should not be permitted to carry their medications to and from school daily. Rather, students should deliver their medications, with appropriate prescriptions, to designated personnel in their original, unopened packages with their labels intact. Labels should include the student’s name, the expiration dates of medications, directions for dosage when they should be consumed, and what, if anything, should be eaten or drunk with medications.
Medications should be accompanied by a list of probable reactions or side effects plus explanations of appropriate emergency responses; much of this information is now commonly available from pharmacies.
5. Those dispensing or supervising self-administration should have access to home and/or emergency phone numbers of students’ parents plus the relevant information about all medications; the names and phone numbers of the physician(s) and pharmacist(s) involved; and storage instructions such as avoiding sunlight and having to be kept at specified temperatures.
6. School officials should keep written permissions and authorizations, including prescriptions, for students on file, regardless of whether medications are supervised or self-dispensed.
Parents and older students, such as those in high school, should be required to sign a form annually acknowledging that they have read and agree to abide by the school board’s medication policy. Notes from parents and/or medical professionals should be updated annually as well as when medications are modified or changed.
7. Students who receive or self-administer medications should be allowed to do so only in the presence of trained personnel. Moreover, to protect student privacy, medications should be dispensed and/or self-administered away from peers.
8. Staff members should document the time, date, and location when and where medications were dispensed or self-administered.
9. Personnel dispensing medication or supervising self-administrations should ensure that students have consumed all of their medications in their presence before leaving. After consuming their medications, students should remain in place for a short time to ensure they do not suffer side effects.
10. Those dispensing or supervising self-medications should record their observations of what are or maybe, considered unforeseen medication-related side effects or changes in student behavior.
11. To ensure safety, all medication should be kept in locked cabinets or storage areas. Files should include notations of the receipt, use, return, and disposal of drugs as well as used syringes and needles.
12. To protect students’ Health Insurance Portability and Accountability Act and Family Education Privacy Act rights, files, including prescription and other information, should be kept confidential, with access limited to personnel with legitimate needs to know.
13. School board medication policies should be included in student handbooks, materials sent home to parents, and on district websites. Policies should include statements explicitly indemnifying school personnel who are properly educated in the dispensation or supervision of self-administrations. Also, school boards should carry liability insurance or establish self-insurance plans to safeguard themselves and their employees.
14. Those dispensing or supervising self-administrations must document that they completed regular professional development on issues such as the effects of specific drugs, dealing with adverse reactions, and proper techniques when handling potentially dangerous items such as needles and syringes.
Leadership teams should review their medication policies annually to ensure that they meet best medical practices and follow relevant state laws.