California Department of Education
SBE-002 (REV 05/17/04)
/Info-cib-lspd-feb05item01
State of California
/Department of Education
Information memorandum
Date: / January 14, 2005TO: /
Members, STATE BOARD of EDucation
FROM: / Sue Stickel, Deputy SuperintendentCurrriculum and Instruction Branch
SUBJECT: / Program Advisory on Medication Administration pursuant to California Code of Regulations (CCR) Title 5, Article 4.1: Administering Medication to Students or Otherwise Assisting Students in the Administration of Medication During the Regular School Day.
At its September 2003 meeting, pursuant to Education Code (EC) Section 49423.6, the State Board of Education adopted additions to the CCR, Title 5, related to “Administering Medication to Students or Otherwise Assisting Students in the Administration of Medication During the Regular School Day.” The Secretary of State formally enrolled the regulations in the CCR in November 2003.
When EC Section 49423.6 was chaptered, a statewide committee of health professionals and educators convened to give guidance to the California Department of Education (CDE) on the development of the medication administration regulations. The committee’s work provided the outline of the chaptered regulations. However, much of the committee’s work went beyond the scope of the regulatory process, such as the identification of best practices and practical hints, and now forms the basis of the non-binding guidance provided in this program advisory that is authorized by Section 611 of the regulations. Section 611 specifically authorizes CDE, with the approval of the State Board of Education, to issue and periodically update a program advisory on medication administration. The State Board of Education will be asked to approve the Program Advisory at their March meeting.
Each year, a growing number of children in California schools must take medication during the school day. School nurses administer some of this medication; however, due to the shortage of nurses in the schools, thousands of doses of medication are administered everyday by school secretaries, clerks, teachers, administrators, and classroom assistants who have little or no health care background. The Program Advisory on Medication Administration provides useful advice and non-binding guidance to district staff on medication administration in the schools. The intent is for the Program Advisory on Medication Administration to be placed on the CDE Web site for use by local education agencies and individuals who have responsibility for medication administration. The program advisory is intended as a guidance document; therefore its use is not required. The program advisory has been reviewed and approved by the CDE Legal Division and by CDE Press.
Attachment 1: Program Advisory on Medication Administration (32 Pages)
Revised: 1/14/2009 7:06 AM
info-cib-lspd-feb05item01
Attachment 1
Page 32 of 32
PROGRAM ADVISORY ON MEDICATION ADMINISTRATION
Related to California Code of Regulations (CCR), Title 5, Article 4.1:
Administering Medication to Students or Otherwise Assisting Students in the Administration of Medication During the Regular School Day
Contents:
Purpose
Introduction
Laws, Regulations and Recommendations
Appendices
Appendix A – Education Code
Appendix B – California Code of Regulations
Appendix C – Glossary
Appendix D – References
Purpose
This is a program advisory issued pursuant to Education Code Section 33308.5, which provides nonbinding recommendations on administering medication to students and otherwise assisting students in the administration of medication. It is intended to provide recommendations to local educational agencies (LEAs) on pertinent issues that have been determined to be important but are outside the scope of regulations. Local education agencies are encouraged to use this information to develop and adopt local policies and procedures to enable students to receive medications safely while attending school. The content of this advisory was prepared from information provided by a medication committee that was convened by the California Department of Education to assist with the development of the Title 5 regulations pertaining to medication administration in schools. Recommendations for policy and procedures on the administration of medication are included in the body of this advisory. Relevant sections of the Education Code (EC) and the California Code of Regulations (CCR) are included in the appendixes.
Introduction
Large numbers of students with chronic and acute illnesses, the huge array of available medications, new treatment regimens, and advanced technologies for administering medication have significantly affected our schools. Many students with special needs are able to participate in the educational system because of the effectiveness of the medication they take. Some students who need medication at school require close observation or other health interventions following the administration of medication to achieve positive outcomes and improved health status. The new treatment methods and new medication delivery technology may also require extensive training and supervision of designated school personnel performing those services.
In a highly publicized report, To Err Is Human, the Institute of Medicine describes causes of medication errors by licensed health care providers in clinical settings. These causes include lack of sufficient staffing; lack of correct patient identification; and misinterpretation of medication abbreviations, acronyms, and symbols on medication orders. In an informal survey of California school nurses in 2001, the nurses reported that common causes of medication errors by unlicensed designated school personnel included the increased number of medications being administered during the school day; the lack of correct student identification; the misinterpretation of medication dose; the lack of sufficient time to accurately log medication administration resulting in overdosing; and the lack of adequate training and supervision for properly administering medication.
The right of students to receive medication at school exists in the following federal laws:
· Public Law 93-112; 87 Stat. 394; 29 U.S.C. Section 794; (H.R. 8070). "Rehabilitation Act of 1973."
· Public Law 101-336; 104 Stat. 327; 42 U.S.C. sections 12101-12213; (S. 933). "Americans with Disabilities Act of 1990."
· Public Law 105-17; 111 Stat. 37; 20 U.S.C. sections 1400-1485; (H.R. 5). "Individuals with Disabilities Education Act Amendments of 1997."
Education Code Section 49423 provides statutory authority for providing assistance in administering medication in California schools. Education Code Section 49423 states:
Notwithstanding the provisions of Section 49422, any student who is required to take, during the regular school day, medication prescribed for him by a physician, may be assisted by the school nurse or other designated school personnel if the school district receives (1) a written statement from such physician detailing the method, amount, and time schedules by which such medication is to be taken and (2) a written statement from the parent or guardian of the student indicating the desire that the school district assist the student in the matters set forth in the physician's statement. (Emphasis supplied.)
California Code of Regulations, Title 5, Article 4.1, provides clarification for implementing Education Code Section 49423. Specifically, the regulations clarify who may administer medications to students requiring medication during the regular school day, under what conditions such administration of medication may occur, and the requirements for the delivery, administration, documentation, and disposal of medication.
The following section, “Laws, Regulations, and Recommendations,” provides nonbinding guidance to LEAs on the administration of medication in California public schools.
Laws, Regulations, and Recommendations
This section provides legal and regulatory text, citations, and recommendations for the Education Code and California Code of Regulations sections cited here in an outline format to help the reader more easily find needed legal references and topic-specific, nonbinding guidance. The full legal citations may be found in the appendices.
I. Authorization From Authorized Health Care Providers
A. Relevant laws and regulations: Education Code (EC) sections 49400 and 49423; Business and Professions Code (BPC) sections 1625, 2051, 2052, 2472, 2746.51, 2836.1, 3041, and 3502.1; California Code of Regulations (CCR), Title 5, sections 600, 601(a), and 602
1. The required written statement authorizing a medication to be administered in California schools shall be provided by an authorized health care provider who is licensed by the State of California to prescribe medication (CCR, Title 5, Section 601[a]). Authorized health care providers include the following persons:
a. California-licensed physicians and surgeons (BPC Section 2051)
b. California-licensed dentists (BPC Section 1625), optometrists (BPC Section 3041), and podiatrists (BPC Section 2472)
c. California-licensed nurse practitioners (BPC 2836.1) and California-certified nurse midwives (BPC Section 2746.51)
d. California-licensed physician assistants (BPC Section 3502.1)
2. Authorization for medications to be administered in California schools that are written by health care providers not licensed in the State of California shall be authorized by a physician and surgeon licensed in the State of California (BPC Section 2052).
B. On the basis of these laws and regulations, it is recommended that:
1. LEAs require the furnishing numbers of nurse practitioners and nurse midwives, and the name, address, and telephone number of the supervising physician.
2. LEAs require the name, address, and telephone number of the supervising physician for all written statements from physician assistants.
3. LEAs that have students attending California schools and who live in another bordering state consult with their local public health physician or school physician for guidance and assistance in administering medications in school that are authorized by out-of-state health care providers.
4. A faxed written statement is an acceptable form of the authorized health care provider’s written statement as long as the details of the authorization are clear and legible.
5. LEAs not accept telephone authorization for the administration of medication to students.
6. LEAs develop policies for handling emergency situations related to obtaining the authorized health care provider’s written statement.
7. All written statements for medication administration at school contain the following information:
a. Student’s name and date of birth
b. Name of the medication to be administered and reason for administration
c. Amount or dose of the medication (EC Section 49423)
d. If authorized changes in medication dosage require pill splitting, the only pills that may be split are those that are scored. Scored pills may be split in half only. Pill splitting may be done with a commercial pill-splitting device.
e. Method of administration (EC Section 49423)
f. Time the medication is to be administered at school (EC Section 49423)
g. Possible side effects
h. For medication prescribed on an as needed basis (PRN), the specific symptoms that necessitate administration of medications, the allowable frequency for administration, and indications for referral for medical evaluation
i. For medication that is to be self-administered by the student, a statement that, in the authorized health care provider’s opinion, the student is competent to safely self-administer the medication according to the conditions in the provider’s written statement
j. Name, address, telephone number, and signature of the California authorized health care provider
8. The parent or guardian obtain and provide the school with the signed authorized health care provider’s written statement for medication administration in school.
9. Written statements authorizing medications to be administered at school be renewed yearly or whenever changes in medication or authorized health care provider occur.
10. Changes in medication authorization that generate a new written statement include the following circumstances:
a. Changes in medication dose, time, and method of administration
b. Change in medication
c. Change in California authorized health care provider
d. Discontinuance of medication administration
II. Written Statement from the Parent or Guardian
A. Relevant laws and regulations: EC sections 44871, 44873, 44874, 44875, 44876, 44877, 44878, 49400, 49422(a), 49423, and 49480; Government Code (GC) Section 815.2(a); CCR, Title 5, sections 600, 601(f), 602, and 603
The parent or guardian shall provide the school with a written statement indicating their desire that the school assist the student with medication administration as set forth in the written statement from the authorized health care provider (EC Section 49423).
B. On the basis of these laws and regulations, it is recommended that:
1. The written statement from the parent or guardian also include:
a. Consent for the school nurse, other duly qualified supervisor of health, or site administrator to communicate with the authorized health care provider and the pharmacist with regard to the provider’s written statement for administration of medication at school.
b. Agreement that the parent or guardian will provide the necessary medication, supplies, and equipment.
c. Agreement that the parent or guardian will notify the school nurse, other duly qualified supervisor of health, or site administrator, if there is a change in the student’s medication, health status, or authorized health care provider.
d. Agreement that the parent or guardian will notify the school nurse, other duly qualified supervisor of health, or site administrator immediately and provide new consent for any changes in authorized health care provider’s authorizations.
2. A new written statement from the parent or guardian be provided annually or whenever there is a new written statement from the authorized health care provider.
3. LEAs not require the parent or guardian to waive any rights, hold the LEA harmless, or agree to any particular placement or related services as a condition of assisting a student in the administration of medication at school.
4. LEAs allow the parent or guardian to submit to the school a written statement rescinding their consent for administration of medication at school at any time.
5. LEAs not accept or act on parent or guardian generated changes or modifications to the medication administration directions in the authorized health care provider’s statement unless the LEA receives such changes in writing from the authorized health care provider.
III. Review of Authorized Health Care Provider’s and the Parent or Guardian’s Written Statements by a School Nurse or Other Duly Qualified Supervisor of Health
A. Relevant laws and regulations: EC sections 44871, 44873, 44874, 44875, 44876, 44877, 44878, 49400, 49422(a), 49423, and 49480; CCR, Title 5, Section 600, and Title 16, Section 1443.5(6)
B. On the basis of these laws and regulations, it is recommended that:
1. A school nurse, other duly qualified supervisor of health, or site administrator review all written statements from authorized health care providers and the parent or guardian regarding the administration of medication at school to ensure that the written statements are complete and that the medication may safely be administered in accordance with the written statements.