Who makes medication policies in school districts?

[Jory, MSN, APRN, CNM]

I have been on this site for a long time and I know that my question will vary by school district, but I am curious:

Who makes the medication decisions in your school district as to what forms are needed, who administers the medication, authorization, over-the-counter, etc?

I am concerned that the school district where I am is going to kill a child if their strict policies followed much longer.

My daughter's friend collapsed on the playground after school. She has asthma and they had to call 911. They had an inhaler in the office locked up (she self manages at home but wasn't allowed to keep her rescue inhaler with her due to school policies). Her mother said that this has never happened, but when she first told the after-school teacher she was having trouble breathing, she just told her to sit down and drink water. She asked for her inhaler and was told, "It's locked in the office, I don't have access."

Earlier this year another child was stung by a bee that had a known reaction. 911 had to be called, epipen was brought after the child was down a LONG time because the teacher wasn't allowed to have it, the child wasn't allowed to carry it, and once again, someone had to race across campus and access it in the locked office, keys had to be found, etc. That child could have died.

I just wonder who sits around and makes these policies that are clearly more dangerous than having it in the classroom where a licensed teacher has instant access.

[nurseprnRN, BSN, RN]

The person who should take the lead in this effort is the RN in charge of the school nurses in the district. If s/he is unaware of the limited scopes and extensive risks of such policies, the RNs out in the field must make them known. It's not reasonable to expect non-nurses to understand or act proactively on such matters. We are the ones whose prime directive is safety, and we are the ones who understand medications and their administration. We bear this responsibility, in my opinion, pursuant to the ANA Scope and Standards. Its recently updated definition of nursing should give you all the backing you need:

Nursing is the protection, promotion, and optimization of health and abilities,

prevention of illness and injury,

facilitation of healing,

and alleviation of suffering

through

diagnosis, treatment of human response, and advocacy

in the care of individuals, families, groups, communities, and populations.

[Flare, ASN, BSN]

our medication policies are mostly directed by state law. In the case of the inhaler and epipen the children would have been allowed to self carry if signed off by their doctors and parents - we don't have a hard and fast policy on this but my experience with this is around 5th grade or so this starts happening.

[OldDude]

Darn...those policies sound like something from that Billy Bob Thornton movie, Mr. Woodcock. Where he's a coach and tries to "run" the asthma out of a kid...........yikes. Sounds like you're the one to spearhead this one. Good on you and good luck.

[ohiobobcat]

Our policy is adapted from the DOE/Maine School Health Manual in our state. And we allow students to self carry with parental, medical provider and school nurse sign off. That definitely depends on the age and maturity level of the student.

[JenTheSchoolRN, BSN, RN]

Our policy is adapted from the DOE/Maine School Health Manual in our state. And we allow students to self carry with parental, medical provider and school nurse sign off. That definitely depends on the age and maturity level of the student.

Pretty much the same thing in Massachusetts. I work with Grades 7-12 and if they don't self carry, I try my best to transition to that. But any Epi-pen or inhaler is not locked up, it is behind a coded door in a well labeled shoe rack that all administration in the building has easy access to regardless of whether I am there or not.

Sounds like you may need to be the voice of change in your district. My school used to lock up Epi-pens and inhalers; I advocated for the change, citing evidence and they listened. Yours may listen as well.

[LMTCBnurse]

I work with very young students (3-6 year olds), but I did have a student with severe allergies that kept her epi pen with her at all times. The problem was who could give it to her, if she needed it. Only the nurse or principal could administer it. Luckily nothing ever happened.

[morte, LPN, LVN]

In the absence of a state or local law or policy allowing public school students to possess inhalers and selfmedicate to treat asthma, 3 federal statutes may require public schools to permit the carrying of such medications by students: the Individuals With Disabilities Education Act, Section 504 of the Rehabilitation Act of 1973, and Title II of the Americans with Disabilities Act. Local policies and procedures can be based on these federal laws to ensure that students with asthma can take their medicines as needed.

Citizen Rights and State Responses: Asthma Inhalers in Schools: Rights of Students with Asthma to a Free Appropriate Education this is the article the above was quoted from....

[Jory, MSN, APRN, CNM]

I sincerely thank everyone for their suggestions. I am determined that I am going to tget this changed in my school district because this is a dangerous policy.

If they teach the school secretary how to administer sliding scale insulin (our school district does not have a full-time nurse at each school), I think we can manage an epipen or inhaler.

If teachers can be taught CPR and put in charge of watching these kids several hours a day, in my opinion, they should be permitted to administer medication.

I would like to see their evidence where there is a black market for epipens, inhalers, and Tylenol. (Yes, I'm being sarcastic).

I know that for me, this contributes to my children's absences. If I know she needs over the counter medication and don't have time to get to a store and still get to work on time, fill out the paperwork, etc. I just elect to keep her home. Oh, and you cannot send the paperwork nor the medications with the child nor send them home. So if a parent has to show up every day and fill out new paperwork for any over-the-counter or prescription medication that is needed every single day it is given.

It's ridiculous.

[enkwanta]

Not in my school district. At the beginning of each school year all staff are trained on life threatening conditions and the administration of emergency drugs. All persons that need to know are given a simple action plan about the the student's condition and if he/she takes medications at school the location of the medication and when the student should come to the clinic for treatment. These conditions are asthma, seizure disorder, diabetes, and food allergy and insect bites that require Epi-pens. Epi-pens are kept in an unlocked cabinet that is highly visible to all that need to know.

[100kids, BSN, RN]

I make most of the medication policies in my school guided by state law. I work in a PK-6 building. once kids hit around 4th/5th grade I start working on getting them to self-carry status as soon as they are ready. This requires physician, parental and my sign-off but I think it is imperative to get them ready and started with this BEFORE they go to the much bigger High School. At the beginning of the year I train staff in epi-pen administration for students with known allergies and they all know epi-pens are kept unlocked in my office in bins with the child's name on it. We are a small school so it's easier to get to my office faster. I had a sub nurse once who wanted to lock my office door when she went to lunch but I do not allow this because emergency meds (inhalers and epi-pens right now) need to be available whenever kids are in the building. Work towards the change. We are the best advocates for our students.