ADMINISTRATIVE PROCEDURES

Batch #4, Redline Edits SHELTON SCHOOL DISTRICT ADMINISTRATIVE PROCEDURES Policy No. 3416P Series 3000 (Students) Page 1 of 8 PROCEDURE - MEDICATION AT SCHOOL Under normal circumstances prescribed or oral medication and oral over-the-counter medications should be dispensed before and/or after school hours under the supervision of the parent or legal guardian. Prescribed or over-the-counter oral medication may be dispensed to students on a scheduled or as needed basis upon written authorization signed from a licensed health professional (LHP) prescribing within the scope of his or her authority. Medications must be properly labeled with name of medication, students name, date, quantity, strength per dosage unit, licensed health professional name, and how often the medication is to be given; and the LHP request are required. Authorization forms are valid for only one school year. 1. It is the parent s responsibility to keep school staff informed of changes in the child s condition or changes in the LHP orders. 2. It is the parent s responsibility to also keep emergency contact information current. Oral medications are administered by mouth either by swallowing, inhaling (may include administration by mask if the mask covers the mouth or nose), and gastric tubes. Medications given by routes other than oral routes are regulated by the law relating to nursing care, 18.79 RCW. Medications such as ointments, eye or ear drops, suppositories, or injections that are ordered by a LHP can only be administered by student family members, registered nurse (RN), licensed practical nurse, or self-administered by the student. The administration of medications by routes other than by mouth cannot be delegated to unlicensed school staff except in an emergency situation. There are instances in which a LHP and a parent may request that a student be permitted to carry his/her own medication and/or to self-administer the medication. (See District Wide Procedures, Section F.) The administration of oral medications may be discontinued by the school upon recommendation of the school nurse, provided that oral and written notice is given to the parent or legal guardian in advance of the dates of discontinuance, the remaining dosages shall be sent

Page 2 of 8 home immediately. There shall be a valid reason for discontinuance that does not compromise the health of the student or violate legal protections for the disabled. DISTRICT WIDE PROCEDURES A. Each school principal, in conjunction with the school nurse, shall will authorize two staff members who mayto administer prescribed or non-prescribed or over-the-counter medications at school and ensure that they are trained by a RN to administer prescribed or over-the-counter oral medication. The medication. These designated staff members will: receive RN delegation prior to the opening of school each year. 1. Maintain a daily log indicating which prescribed or over-the-counter oral medication was dispensed. 2. Maintain an accurate count of medication doses delivered to the school, administered to the parent, destroyed and/or returned to the parent. 3. For purposes of this procedure, "medication" means oral medication, topical medication, eye or ear drops and nasal spray. This definition DOES NOT include over-the-counter topical sunscreen products regulated by the US Food and Drug Administration (see Sunscreen section below). Oral medications are administered by mouth either by swallowing or by inhaling and may include administration by mask if the mask covers the mouth or mouth and nose. Medication may be dispensed to students on a scheduled basis upon written authorization from a parent with a written request by a licensed health professional prescribing within the scope of their prescriptive authority. If the medication is to be administered more than fifteen consecutive days the written request must be accompanied by written instructions from a licensed health professional. Requests will be valid for not more than the current school year. The prescribed or non-prescribed medication must be properly labeled and be contained in the original container. The dispenser of prescribed or non-prescribed oral medication will: Collect the medication directly from the parent (students should not transport medication to school), collect an authorization form properly signed by the parent and by the prescribing health professional and collect instructions from the prescribing health professional if the oral medication is to be administered for more than fifteen consecutive days; Store the prescription or over-the-counternon-prescribed oral medication (not more than a twenty (20) day supply) in a locked, substantially constructed cabinet.; Maintain a daily record which indicates that the prescribed or non-prescribed medication was dispensed; Provide for supervision by a physician or registered nurse; and

Page 3 of 8 A copy of this policy will be provided to the parent upon request for administration of medication in the schools. Prescribed and over-the-counter oral or topical medications, eye drops or ear drops may be administered by a registered nurse, a licensed practical nurse or an authorized staff member. Nasal sprays containing legend (prescription) drugs or controlled substances may only be administered by a school nurse or, if a school nurse is not present on school premises, an authorized school employee; or a parent-designated adult with training as required by RCW 28A.210.260. No prescribed medication will be administered by injection by staff except when a student is susceptible to a predetermined, life-endangering situation. The parent will submit a written statement which grants a staff member the authority to act according to the specific written orders and supporting directions provided by licensed health professional prescribing within his or her prescriptive authority (e.g., medication administered to counteract a reaction to an insect sting). Such medication will be administered by staff trained by the supervising registered nurse to administer such an injection. Written orders for emergency medication, signed and dated, from the licensed health professional prescribing within his or her prescriptive authority will: State that the student suffers from an allergy which may result in an anaphylactic reaction; Identify the drug, the mode of administration, and the dose. Epinephrine administered by inhalation, rather than injection, may be a treatment option. B. Medications and permission forms are valid for only one school year. All medications including inhalers, bee sting allergy kits, over-the-counter medications and prescriptions must be taken home at the end of the school year. Prior to the end of the school year, parents of students with leftover medication should be notified in writing and provided the opportunity to pick up the medication. If they do not pick up the medication in time, the medication should be counted by two school district staff, disposed of, and a statement verifying the counting and disposal should be dated and signed by the staff members. C. Students are given the primary responsibility to go to the medication assistant for their medications. As a minimum, if a student fails to go to the office for any particular dose, school staff should make one attempt per dose missed to contact the student and administer the medication. Attempts need to be documented. Disciplinary action may be taken if a student repeatedly misses doses. D. Only a licensed nurse may administer nasal tube feedings. E. These medical authorizations are kept until five (5) years after a student has graduated from high school or for three (3) years after a student has left a school within the district.

Page 4 of 8 This decision must be made by the licensed health professional prescribing within his or her prescriptive authority; Indicate when the injection will be administered based on anticipated symptoms or time lapse from exposure to the allergen; Recommend follow-up after administration, which may include care of the stinger, need for a tourniquet, administration of additional medications, transport to hospital; and Specify how to report to the health professional prescribing within his or her prescriptive authority and any record keeping recommendations. F. If a health professional and a student s parent request that a student be permitted to carry his/or her own medication and/or be permitted to self-administer the medication at school, on field trips or at extra-curricular activities, the school nurseprincipal may grant permission after consulting with the principal. 1. school nurse. The process for requesting and providing instructions will be the same as established for oral medications. The principal and nurse shallwill take into account the age, maturity and capability of the student; the nature of the medication; the circumstances under which the student will or may have to selfadminister the medication and other issues relevant in the specific case before authorizing a student to carry and/or self -administer medication at school. 2. Except in the case of multi-dose devices (like asthma inhalers), students shallwill only carry one day s supply of medication at a time. Violations of any conditions placed on the student permitted to carry and/or self-administer his or her own medication may result in termination of that permission, as well as the imposition of discipline when appropriate. SCHOOL PROCEDURES A. Ideally, no more than a 20-day dosage of prescribed or over-the-counter medication may be sent to school at one time. The medication must be properly labeled and be in the original container. Empty containers will be returned to the parent or destroyed. B. Medication sent to school should be collected directly from the parent/guardian and a receipt will be given. Students should not transport medication to school. The District will not be responsible for lost or stolen medications carried by the student. C. Only the health care provider can authorize medication modifications; changes must be submitted on a new medication form. A parent/guardian request cannot be honored. The medication container must also match the new changed prescription. However, the school nurse can accept a fax or a telephone medication change order. Parents will need to sign

Page 5 of 8 the medication change order before the modifications will be acted upon. The prescription bottle with the old order can be used up to ten school days to give parents time to get a bottle with the new order as long as the nurse has a current order and directs the medication assistant to use the available bottle. D. If pills are to be split in half, this must be done before giving them to the school. The proper measuring device should accompany liquid medications. E. Non-prescription medication requires a health provider s approval and signature. Specific instructions ( give Tylenol if student feels sick is not acceptable) regarding when to give medications and the frequency needs to be provided. The health care provider may fax or telephone the order to the school nurse, however the parent must also sign the permission form before any medication can be given. F. Because of the schedule and other responsibilities it is possible for a dose or doses to be delayed or missed. If a dose is missed the parent/guardian will be notified. FIELD TRIPS AND EXTRA-CURRICULAR ACTIVITIES MEDICATION ADMINISTRATION A. As a part of the enrollment process, parents will be asked to sign a blanket permission form to allow their children to attend field trips and other extra curricular activities throughout the school year. Parents may also approve that medications normally dispensed at school may also be given on the field trip or extra-curricular activity. Parents must be notified in advance of a field trip or extra curricular activity. B. Students normally taking medication at home may need to take medication while on a field trip or extra-curricular activity extending beyond the normal schools hours. If parents indicate that medication not routinely given at school will need to be given on the field trip or extra-curricular activity, then the authorization to administer medication must be completed and signed by parent and LHP prior to the field trip or extra-curricular activity. The medication will have to be supplied by the parent in the original pharmacy bottle. C. All of the requirements of the oral medication statute must be met on the field trip or extracurricular activity, e.g. staff must be trained by an RN as is required when giving medication at school. D. The medication will be carried on the field trip or extra-curricular activity by the designated trained staff person(s) in a fanny pack or locked box with access limited to those giving the medication. 1. Medication should be in the original pharmacy-labeled container or as supplied by the school nurse.

Page 6 of 8 2. Prior to the field trip or extra-curricular activity, the medication assistant and designated trained staff person record and sign a Field Trip Medication Log form with the name of the student, the name of the medication, the strength per dosage unit, the quantity, the time to be given and the date. 3. Upon returning to school from the field trip or extra-curricular activity, the signed log sheet and any leftover medication is returned to the medication assistant, who will transfer the information to the regular school medication log for the student. The medication assistant should sign and date a log sheet that documents the return of the medication and any problems that might have occurred with the medication on the field trip or extra-curricular activity. E. There may be issues associated with disabled or 504 students that the district staff must address before they assume the responsibility for administering oral medications on field trips or extra-curricular activities. If an accommodation plan requires the district to administer oral medications at school, this plan would apply to the field trip as well unless there were medical reasons not to take the student with a disability on the field trip or extracurricular activity. The district must investigate whether or not staff can safely accept responsibility for the student who has the right to the field trip and who may require medication on the field trip or extra-curricular activity. There may be instances when the student should not go on the field trip or extra-curricular activity because of the unstable/fragile nature of his/her condition and or the nature and or the distance from the emergency care that might be required. There may be other solutions to permit the student to attend such as: 1. Request the parent to accompany the student and attend to the student s medical needs. 2. Assign an appropriately trained and licensed school staff person to care for the child on the trip. 3. The student carries his/her medication and self-administers with parent, LHP and school nurse permission unless the student s plan specifically states the district staff will administer the medication. 4. If none of these are possible, the school provides a comparable learning experience at school or in a safe location. MEDICATION BY INJECTION PROCEURES Rarely, a staff member may be called upon to give an injection. Such is the case if an emergency epinephrine injection is required for severe allergic reaction when there is swelling of mouth, tongue, or throat, such that breathing may become impaired. This injection is taught in standard first aid courses.

Page 7 of 8 A. No prescribed medication shall be administered by injection by staff except when a student is susceptible to a predetermined, life-threatening situation. B. The parent shall sign the medication form which grants a staff member(s) the authority to act according to the specific written orders and supporting directions provided by a licensed health professional prescribing within his or her prescriptive authority (e.g., medication administered to counteract a reaction to a bee sting). A. Such medication shall be administered by staff trained by a licensed or registered nurse to administer such an injection, 911 should also be called. B. Written orders for emergency medication, signed and dated, from the LHP shall: 1. State that the student suffers from an allergy which may result in an anaphylactic reaction. Identify the precipitating allergens, if known. Identify the drug, the mode of administration and the dose. Sunscreen Over-the-counter topical sunscreen products may be possessed and used by students, parents, and school staff, without a written prescription or note from a licensed health care provider, if the following conditions are met: The product is regulated by the US Food and Drug Administration as an over-the-counter sunscreen product; and If possessed by a student, the product is provided to the student by their parent or guardian. Students who possess over-the-counter topical sunscreen products that meet the above criteria may carry up to 8 ounces at a time, preferably with the container in a plastic bag. Violations of any conditions placed on the student permitted to carry and/or self-administer his or her own sunscreen products may result in confiscation and termination of that permission, as well as the imposition of discipline when appropriate. School staff may assist students in application of sunscreen products in certain circumstances and in the presence of another staff member. The appropriate staff member will take into account the age, maturity, and capability of the student, the need for the application of the sunscreen, and other issues relevant in the specific case, before assisting students in application of sunscreen products at school or during school-sponsored events. However, staff members are not required to assist students in applying sunscreen. (The following procedures are specific to parent-designated adult care of students with epilepsy): Parent-Designated Adult Care of Students with Epilepsy Parents of students with epilepsy may designate an adult to provide care for their student consistent with the student's individual health care plan. At parent request, school district

Page 8 of 8 employees may volunteer to be a parent-designated adult under this policy, but they will not be required to participate. Parent-designated adults who are school employees will file a voluntary, written, current and unexpired letter of intent stating their willingness to be a parent-designated adult. Parent-designated adults who are school employees are required to receive training in caring for students with epilepsy from the school nurse. Parent-designated adults will receive additional training from a parent-selected health care professional or expert in epileptic care to provide the care (including medication administration) requested by the parent. Parent-designated adults who are not school employees are required to show evidence of comparable training, and meet school district requirements for volunteers. Parent-designated adults will receive additional training from a parent-selected health care professional or expert in epileptic care to provide the care requested by the parent. The (insert appropriate staff member) is not responsible for the supervision of procedures authorized by the parents and carried out by the parent-designated adult. 2. Indicate when the injection shall be administered based on anticipated symptoms or time lapse from exposure to the allergen. 3. Recommend follow-up after administration, which may include care of the stinger, administration of additional medications, and transport to the hospital. Specify how to report to the LHP and any record keeping recommendations. 1/22/02 11/23/10 Revised: