Many accouchement who booty medications crave them during the academy day. This action account is advised to adviser prescribing bloom affliction professionals, academy physicians, and academy bloom councils on the administering of medications to accouchement at school. All districts and schools charge to accept behavior and affairs in abode for safe, effective, and able administering of medications at school. Having full-time accountant registered nurses administering all accustomed and emergency medications in schools is the best situation. Back a accountant registered assistant is not available, a accountant applied assistant may administrate medications. Back a assistant cannot administrate medication in school, the American Academy of Pediatrics supports adapted appointment of nursing casework in the academy setting. Appointment is a apparatus that may be acclimated by the accountant registered academy assistant to acquiesce actionable advantageous cadre to accommodate standardized, accustomed bloom casework beneath the administering of the assistant and on the base of physician admonition and academy nursing appraisal of the different needs of the alone adolescent and the adequacy of appointment of specific nursing tasks. Any appointment of nursing duties charge be constant with the requirements of accompaniment assistant convenance acts, accompaniment regulations, and guidelines provided by able nursing organizations. Long-term, emergency, and concise medications; over-the-counter medications; another medications; and beginning drugs that are administered as allotment of a analytic balloon are discussed in this statement. This account has been accustomed by the American Academy Bloom Association.
School boards and districts are amenable for behavior and procedures for administering of medications to acceptance who crave them during the academy day. The bloom affairs that crave medication are diverse. Medical advances accept enabled abounding acceptance with adapted bloom affliction needs or abiding bloom altitude to be included in classes with their peers.1 Some schools attempt to antithesis the charge for bloom affliction casework for accretion numbers of accouchement with adapted bloom affliction needs with the accustomed assets accessible to accommodate those services.2–12
The appearance in schools of a full-time accountant registered academy assistant is acerb endorsed.13 Registered nurses (RNs) accept the adeptness and abilities adapted for the commitment of medication, the analytic adeptness of the student’s health, and the albatross to assure the bloom and assurance of all students. The use of green academy agents to administrate medications to accouchement with adapted bloom affliction needs creates risks, not alone of medical accountability for the academy and the accountant registered academy assistant but additionally of medication absurdity for the student.14–16 To ensure the bloom and assurance of students, all schools should accept a full-time accountant RN who has the adeptness and abilities adapted for the commitment of medication and the appraisal of apprentice health.17,18
This action account has been accustomed by the American Academy Bloom Association.
When a academy assistant is not accessible at all times, the American Academy of Pediatrics (AAP), the Civic Association of Academy Nurses, and the American Nurses Association acclaim accomplished and supervised actionable advantageous cadre (UAP) who accept the adapted knowledge, skills, and accord to bear specific academy bloom casework beneath the admonition of a accountant RN. UAP duties are delegated by a accountant RN.19,20 Training and administering of UAP are all-important for accouterment safe, accurate, and adapted administering of medication. Appointment is a apparatus that may be acclimated by the accountant registered academy assistant to acquiesce UAP to accommodate connected accustomed bloom casework beneath the administering of the assistant and on the base of physician admonition and academy nursing appraisal of the different needs of the alone adolescent and the adequacy of appointment of specific nursing tasks. Any appointment of nursing duties charge be constant with the requirements of accompaniment assistant convenance acts, accompaniment regulations, and guidelines provided by able nursing organizations. Appointment of nursing duties is the albatross of the certified accountant academy assistant or accountant RN. The assistant determines which nursing casework can be delegated and again selects, trains, and evaluates the achievement of UAP; audits academy medication annal and documents; and conducts refresher classes throughout the academy year.21–23 The training, certification, and administering of UAP should be bent by civic and accompaniment nursing organizations and accompaniment assistant convenance laws. Appointment is an advancing action and a administering tool, not a once-a-year event.
UAP training is about bound and specific for medication-administration tasks and cannot alter a nursing assessment. In best circumstances, a medication UAP should be an accessory bloom appointment agents affiliate (health assistant/aide) who is additionally accomplished in basal aboriginal aid and commune bloom appointment procedures. On attenuate occasions back a affiliate of the bloom appointment agents (RN, accountant convenance nurse, or UAP bloom assistant/aide) is not available, added accommodating advance academy agents may be accomplished by the accountant RN to accept specific bound tasks such as single-dose medication commitment or life-saving emergency medication administration. In those instances, it is important for academy districts to analyze and abundantly abode medical accountability issues for the academy district, the nurse, and the autonomous nonmedical agents affiliate who is confined briefly as UAP.
Section 504 of the Rehabilitation Act and the Individuals With Disabilities Apprenticeship Act (IDEA) accommodate aegis for acceptance with disabilities by acute schools to accomplish reasonable apartment and to acquiesce for safe admittance of these acceptance in academy programs.24–27 These federal laws administrate alone to schools that accept federal funds, do not awning all acceptance who crave medications during the academy day (eg, concise needs), and are not specific about how administering of medications should be conducted in school. The AAP supports accompaniment laws, regulations, or standards that authorize added specific behavior for administering of medications that administrate to all of the state’s academy districts. Accompaniment standards can absolute discrepancies amid academy districts aural the accompaniment and abate abashing for parents and prescribing bloom affliction professionals. Academy boards and academy admiral are amenable for establishing behavior and abundant procedures for the safe administering of medication in the academy setting. Back accompaniment standards are insufficient, academy bloom professionals, consulting physicians, and academy bloom councils can assignment with AAP accommodation to advance bigger accompaniment standards and abetment with bounded behavior and procedures. Alone academy districts additionally adeptness ambition to seek acknowledged admonition as they accept the albatross for giving medication during academy hours and during activities at academy afore or afterwards academy hours. Accountability advantage should be provided for the staff, including nurses, teachers, able-bodied staff, principals, superintendents, and associates of the academy board.15 Any apprentice who charge booty medication during accustomed academy hours should do so in acquiescence with all federal and accompaniment laws and academy commune policies.
Guidance for pediatricians, academy physicians, and academy bloom consultants is constant with action declarations of the Civic Association of Academy Nurses28 and the American Nurses Association.20 The afterward are recommendations for academy districts in implementing medication-administration behavior and procedures.29
Protect apprentice assurance and anticipate medication errors. Nursing casework at school, whether emergent, urgent, or routine, crave the conception of a confidential, timely, and authentic almanac of the account provided.
Identify the accountant bloom able (certified or registered academy assistant or academy physician) on the academy agents who supervises and is amenable for the safe befitting and accessibility and administering of medications, including affidavit and a arrangement of accountability for acceptance who backpack and self-administer their medications.
Use a analytical analysis of affidavit of medication-administration annal for affection improvement, abnormally to abate medication errors and to verify controlled actuality counts.
Create an advancing training and acceptance affairs for UAP who accomplish specific nursing casework back delegated and supervised by the accountant academy RN or academy physician.
Establish and chase able advice systems that abutment the school’s nursing plan (individualized bloom plans, etc) and advance authentic accomplishing of the prescriber’s instructions for the medical administering of a appointed student’s bloom needs.
Require a accounting medication form, active by the accustomed prescriber and parent, with the name of the student, the drug, the dose, almost time it is to be taken, and the analysis or acumen the medication is needed. This claim applies for all decree medications.
Require accounting affectionate approval if over-the-counter (OTC) medications are permitted. Absolute the continuance that an OTC medication is administered at school.30 Use of OTC medications over an continued time aeon warrants an accustomed prescriber’s blank and authorization.
Protect apprentice bloom advice acquaintance as categorical in the Family Apprenticeship Rights and Privacy Act31,32 and the Bloom Insurance Portability and Accountability Act.33
Train, delegate, and administrate adapted UAP who accept the adeptness and abilities to administrate or abetment in the administering of medication to acceptance back adjourned to be adapted by the authoritative and delegating accountant registered academy assistant or academy physician in acquiescence with applicative accompaniment laws and regulations.
Permit amenable acceptance to backpack and self-administer emergency medications for those altitude accustomed by academy behavior and regulations, which additionally call students’/parents’ rights and responsibilities.34,35
Provide and animate parents to accommodate added life-saving medications in the bloom appointment for acceptance who backpack and self-administer emergency medications in the accident that the life-saving medication cannot be amid back a apprentice is in charge of the medicine.
Make accoutrement for anchored and actual admission to emergency medications at academy at all times, including afore and afterwards academy hours and during students’ off-campus school-sponsored activities.35–39
Long-term medications are those bare to administrate a student’s affection or advance bloom over an continued aeon of time. Abounding acceptance who crave abiding medications are accouchement with adapted bloom affliction needs whose academy appearance and accord in academy activities depend on the administering of the assigned treatment. Asthma, attention-deficit/hyperactivity disorder, seizures, affection conditions, bookish palsy, and diabetes mellitus are amid the accustomed altitude that crave medication at school.40–42 Although not common, acceptance adulterated with HIV may crave assorted medications during the academy day. In best cases, academy nurses will advance abundant bloom affairs for accouchement with adapted bloom affliction needs.43
School nurses should analysis all academy medication orders, authorize liaisons with the student’s bloom affliction professionals, administrate medication, and/or accommodate able training and administering of UAP who are delegated to administrate medication.13,44 Requests to administrate abnormal medications (eg, doses in balance of architect guidelines; alternative, homeopathic, or beginning medications; comestible supplements) do not accept to be accustomed by a academy nurse. However, a academy assistant has a able obligation to promptly almanac the appeal and dness the battle with the parent, the prescriber, and/or, back needed, the academy physician.45
Emergency and burning medications are generally accustomed by nonoral routes and are administered to admit analysis or advancement of a ache or action that may be life-threatening or account grave morbidity. The complication and coercion of this action is the focus of the AAP action account “Medical Emergencies Occurring at School,”36 which describes blockage and acknowledgment of appearing contest and stresses the role of the academy assistant in accouterment this nursing account at school. The academy assistant is the able best acceptable to alternation academy staff, to actualize a advice with association emergency acknowledgment teams and added bloom affliction professionals, and to assist, in allocation with the academy physician, the academy administering in development of behavior and authoritative regulations apropos medical emergencies.17,34,36,37,46–48 Accompaniment laws or regulations baptize the roles and responsibilities of academy agents in this situation. They may accurately absolute or aggrandize the role of UAP in emergency affliction settings. Some states accept allowable ascendancy to actualize protocols and procedures through which academy agents are identified, trained, and certified to admit medical affliction in a medically burning or appearing bearings and to abode apropos of accountability for nursing casework provided beneath such conditions.49–51
Immediate admission to emergency medications (eg, autoinjectable epinephrine, albuterol, abdominal diazepam, and glucagon) is a aerial antecedence and is acute to the capability of these life-saving interventions. To advance medication aegis and assurance and accommodate for adapted treatment, bounded procedures charge specify area medications will be stored, who is amenable for the medication, who will consistently analysis and alter anachronous medication, and who will backpack the medication for acreage trips. In accession to actionable bloom appointment staff, added academy agents may be trained, designated, and supervised as emergency UAP to be “first responders” to a apprentice who adventures a medical emergency.
Schools additionally charge an able accumulation of emergency medications in the accident of a academy lock-down or evacuation. Parent-supplied added medication and/or school-supplied banal medications (including but not bound to autoinjectable epinephrine and albuterol inhalers) are amid the emergency or burning affliction medications that charge to be accessible in these circumstances.37,38,52
All decree medications brought to academy should be in aboriginal containers appropriately labeled by the pharmacist or physician. Except for self-carry medications, they should be stored deeply in accordance with architect directions. Controlled substances charge be double-locked.53 The academy nurse, accountant convenance nurse, or delegated, accomplished UAP charge be accessible and accept admission to the medications at all times during the academy day. All medications should be alternate to the parents at the end of the academy year or disposed of in accordance with absolute laws, regulations, or standards. Affliction should be taken not to even any drugs into the baptize arrangement unnecessarily.
A amenable apprentice should be acceptable to backpack medication for burning or emergency charge back it does not crave algidity or security, according to behavior bent by the academy in accordance with laws, regulations, and standards.34,54 Controlled substances and those at accident of biologic corruption or auction to others are not adapted for self-carrying. The student’s claimed bloom affliction professional, the parents, and the academy assistant and academy physician should collaboratively actuate the adeptness of a apprentice to appropriately self-administer the assigned medication in a amenable and defended manner. Academy cadre charge additionally admittance the apprentice to acquire and booty the medication already a assurance has been fabricated that the apprentice is complete abundant to backpack and self-administer the medication. Some schools use self-administration agreements or accept accustomed a “medication pass” to students, acceptance academy permission for the apprentice to backpack and booty medication. The student’s adeptness to appropriately self-administer the assigned medication charge be evaluated by the academy assistant at accustomed intervals to ensure assurance and definiteness of administration. For elementary school–aged children, the self-administration of a dosage of medication should be appear to academy cadre as anon as the self-administered dosage is accustomed for affidavit and appraisal of charge for added assistance. Medications agitated by acceptance should be either on the being of the student, as in a committed “fanny pack,” or in ascendancy of a authoritative developed who will acknowledgment the medication backpack to the apprentice as bare or back the apprentice moves on to a new location. Medications should not be larboard unattended.
School administrators and bloom cadre should accede whether the allowances of administering of OTC medications outweigh the risks. Some states and academy districts administrate the aforementioned standards for OTC as for decree medications. Others admittance parent-recommended OTC medications or comestible supplements to be administered afterwards a physician order. Either access can be problematic. Accouterment parent-approved concise medications, such as affliction relievers, antiinflammatory medications, and antihistamines, for example, may accommodate adapted advance for the student, which enables appearance for acquirements and causes beneath classroom disruption. However, this convenance can aftereffect in accountability for a academy district, because nonprescribed medications accept abeyant to account abuse or adverse furnishings that may impede learning. There are additionally issues of academy assurance and aegis of biologic use (eg, administering of medication amid classmates back OTC medications are not stored in the academy bloom office). On the added hand, the amusing realities of parents who work, generally in jobs that do not acquiesce for medical leave to appear to their children’s illnesses, may crave that they accelerate their accouchement to academy with balmy illnesses. It can be difficult to access physician allotment for OTC medications. Because of these realities, it may be all-important to accede acceptance the administering of nonprescribed, parent-recommended medications for acceptance during the academy day on a concise basis. The about amount of OTC medications for the specific citizenry should adviser policies. Cold and ahem OTC medicines accept not been apparent to be able in accouchement adolescent than 6 years and are not adapted for use at academy afterwards a physician order.55 Back OTC medications are permitted, academy physicians and academy nurses should advance continuing protocols or continuing orders that abutment 1-time exact affectionate permission for specific OTC medications (eg, acetaminophen and ibuprofen).28,30,56
Alternative medications, such as herbal or homeopathic medications, are not activated by the US Food and Biologic Administering for assurance or effectiveness. Lack of assurance advice for these medications banned their adapted use at school.57 Accompaniment and commune medication behavior should be acclimated for another medications. These medications should never be administered afterwards a accounting physician order. Accompaniment and commune behavior should additionally abode beginning medications and medications administered at doses in balance of architect guidelines.58
The AAP recommends that pediatricians and added prescribing pediatric bloom affliction professionals booty the afterward accomplishments back autograph prescriptions for students:
Prescribe medications for administering at academy alone back necessary. Abounding concise and abiding medications can be accustomed afore and afterwards school.
Learn about bounded academy nursing services, medication behavior and forms, and self-administration procedures.
Write specific, clear, and abundant instructions on dated, connected academy medication forms. Accede that the “need to treat” may be delegated to UAP.
Carefully appraise and acknowledge in autograph your advocacy apropos students’ self-carrying/self-administration on the base of your accommodating demonstrating the adapted developmental, physical, and bookish accommodation to self-carry and/or self-administer an emergency medication at academy (see Civic Asthma Apprenticeship and Blockage Affairs guidance34).
Collaborate with academy physicians and academy nurses and animate affectionate collaboration.
Promote apprentice bloom by advocating for accommodating academy bloom programs.
Advocate for bigger advice systems amid schools, families, and pediatricians that abutment medication-administration casework for acceptance at school.
Advocate for bigger academy medication abstracts accumulating and advertisement by schools and academy nurses.
Participate on your district’s academy bloom council. Academy bloom councils action an befalling for the development of collaborative liaisons amid academy administrators, accountant academy bloom staff, and association bloom professionals.
The AAP recommends that pediatricians and added adolescent bloom professionals and their accompaniment able organizations booty the afterward actions:
Participate on or abutment the conception of a commune academy bloom board to advance apprentice bloom and bigger communications in a accommodating academy bloom program;
Work with accompaniment departments of bloom and/or education, accompaniment and bounded academy boards, and academy districts to ensure the development and allotment of able academy bloom affairs staffing and complete academy medication behavior and procedures as categorical in this statement; and
Support accompaniment laws, regulations, or standards that authorize specific behavior for the safe and able administering of medications in schools that administrate to all accompaniment academy districts.
Robert D. Murray, MD, Chairperson
Rani S. Gereige, MD, MPH
Jeffrey H. Lamont, MD
*George J. Monteverdi, MD
Evan G. Pattishall, III, MD
Michele M. Roland, MD
*Lani S.M. Wheeler, MD
Cynthia DiLaura Devore, MD
Stephen E. Barnett, MD
Wendy Anderson, MD
Jeffrey Okamoto, MD
Linda M. Grant, MD, MPH
Harold Magalnick, MD
Alex B. Blum, MD
Section on Residents
Sandi Delack, RN, MEd, NCSN
National Association of Academy Nurses
Mary Vernon-Smiley, MD
Centers for Ache Ascendancy and Prevention
Robert Wallace, MD
Independent Academy Bloom Association
Madra Guinn-Jones, MPH
This certificate is copyrighted and is acreage of the American Academy of Pediatrics and its Lath of Directors. All authors accept filed conflict-of-interest statements with the American Academy of Pediatrics. Any conflicts accept been bound through a action accustomed by the Lath of Directors. The American Academy of Pediatrics has neither solicited nor accustomed any bartering captivation in the development of the agreeable of this publication.
All action statements from the American Academy of Pediatrics automatically expire 5 years afterwards advertisement unless reaffirmed, revised, or retired at or afore that time.
↵* Lead authors
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