Administration of Epinephrine

(A) A public school district or non-public school, as defined by the Massachusetts Department of Elementary and Secondary Education, may register with the Department for the limited purpose of permitting properly trained unlicensed school personnel to administer any available, FDA-approved, pre-dosed form of epinephrine (hereafter, any available, FDA-approved, pre-dosed form of epinephrine will be referred to solely as epinephrine for the purposes of 105 CMR 210.010) in a life-threatening situation during regular school activities when a school nurse is not immediately available, including field trips, provided that the following conditions are met: (1) the school committee or governing body approves policies developed by the medication program manager governing administration of epinephrine. This approval must be renewed every year; (2) the school committee or governing body provides an assurance to the Department that the requirements of 105 CMR 210.000 will be met through registration with the Department; (3) in consultation with the school physician, the medication program manager oversees and has final decision-making authority about the epinephrine program; (4) the unlicensed school personnel authorized to administer epinephrine are trained and evaluated by the medication program manager, or school nurses designated by this person, in accordance with standards and a curriculum established by the Department. (a) The medication program manager, or school nurses designated by this person, shall document the training and evaluation of competency. (b) The medication program manager, or a designee, shall provide a training review and informational update at least twice a year. (c) The training, at a minimum, shall include: 1. procedures for risk reduction. 2. recognition of the symptoms of a severe allergic reaction; 3. the importance of following the medication administration plan; 4. proper use of the administration device; and 5. requirements for proper storage and security, notification of appropriate persons following administration, and record keeping. (d) The school shall maintain and make available upon request by caregivers or staff documentation of those unlicensed school personnel authorized and trained to administer epinephrine in an emergency, when the school nurse is not immediately available; epinephrine given by unlicensed school personnel shall be administered only in accordance with an individualized medication administration plan satisfying the applicable requirements of 105 CMR 210.005(E) and 210.009(A)(6), updated every year, which includes the following: (a) a diagnosis by a licensed prescriber that the student is at risk of a life-threatening allergic reaction and a medication order containing proper dosage and indications for administration of epinephrine; (b) written authorization by a caregiver; (c) phone number for the caregiver, as well as the names(s) and phone number(s) of any other person(s) to be notified if the caregiver is unavailable; (d) identification of places where the epinephrine is to be stored, following consideration of the need for storage: 1. at one or more places where the student may be most at risk; 2. in such a manner as to allow rapid access by authorized persons, including possession by the student when appropriate; and 3. in a place accessible only to authorized persons. The storage location(s) should be secure, but not locked during those times when epinephrine is most likely to be administered, as determined by the school nurse; (e) documentation of the unlicensed school personnel who would administer the epinephrine to the student in a life-threatening situation when a school nurse is not immediately available; (f) a plan for comprehensive risk reduction for the student, including preventing exposure to specific allergens; and (g) an assessment of the student’s readiness for self-administration and training, as appropriate. (6) when epinephrine is administered, there shall be immediate notification of the local emergency medical services system (generally911), followed by notification of the student's caregiver. If epinephrine is administered by unlicensed school personnel, the school nurse, and other individuals as warranted and deemed appropriate by the school nurse, must also be notified; there shall be procedures, in accordance with any standards established by the Department, for: (a) developing the medication administration plan; (b) developing general policies for the proper storage of medication, including limiting access to persons authorized to administer the medication and returning unused or outdated medication to a caregiver whenever possible; (c) recording receipt and return of medication by the school nurse; (d) documenting the date and time of administration; (e) notifying appropriate parties of administration and documenting such notification; (f) reporting medication errors in accordance with 105 CMR 210.005(F)(5); (g) reviewing any incident involving administration of epinephrine to determine the adequacyof the response and to consider ways of reducing risks for the particular student and the student body in general; (h) planning and working with the emergency medical system to ensure the fastest possible response; (i) disposing properly of used or expired epinephrine administration devices; (j) submitting the Department of Public Health Epinephrine Administration Report to the Department of Public Health each time epinephrine is administered to a student or staff, in accordance with 105 CMR 210.009(C); and (k) permitting the Department of Public Health to inspect any record related to the administration of epinephrine without prior notice, to ensure compliance with 105 CMR 210.010. (B) Epinephrine may be administered in accordance with 105 CMR 210.000 in before and after school programs offered or provided bya school, such as athletic programs, special school events and school-sponsored programs on weekends, provided that the public school district or non- public school is registered with the Department pursuant to 105 CMR 210.010(A) and meets the requirements set forth in 105 CMR 210.010(B). (1) Epinephrine may be administered in such before and after school programs and special events, to students attending the school where the epinephrine is to be administered, provided that the following requirements in 105 CMR 210.010(B)(1)(a) through (d) are met: (a) school committee or governing body approves, in the policy developed in accordance with 105 CMR 210.010(A)(1), administration of epinephrine in such programs. The policy shall identify the school official(s), along with a school nurse for each school designated by the medication program manager, responsible for determining which before and after school programs and special events are to be covered by the policy; (b) the designated school nurse approves administration of epinephrine in that program and selects the properly trained person(s) to administer the epinephrine; (c) the school complies with the requirements of 105 CMR 210.010(A), including immediate notification of emergency medical services following administration of epinephrine, but need not comply with the requirement of 105 CMR 210.004(A)(3); and (d) the program is not licensed by another state or municipal agency, in which case the regulations promulgated by that agency will apply. (2) Epinephrine may be administered in such before and after school programs and special events to students from another school or school district if approved in the school policy developed pursuant to 105 CMR 210.010(A)(1) and in accordance with the requirements in 105 CMR 210.010(B)(2)(a) through (d). (a) The school complies with the requirements of 105 CMR 210.010(A) and 210.010(B)(1), including immediate notification of emergency medical services following administration of epinephrine, except as provided in 105 CMR 210.010(B)(2)(d). (b) In the event the student is accompanied by unlicensed school personnel from the sending school, such personnel, whenever possible, shall assume responsibility for ensuring that the epinephrine is brought, properly stored and administered as necessary, in accordance with the medication administration plan developed by the sending school in accordance with 105 CMR 210.010(A)(5). (c) In the event the student is not accompanied by unlicensed school personnel from the sending school or such personnel are not trained in the administration of epinephrine, the receiving school may, at its discretion, assume responsibility for administering epinephrine, provided that: 1. the designated school nurse in the receiving school is provided with adequate prior notice of the request, which is at the discretion of the designated school nurse in the receiving school; 2. as appropriate the designated school nurse selects properly trained person(s) to administer the epinephrine; and 3. the student provides the epinephrine to be administered. (d) If the receiving school assumes responsibility for administering epinephrine, whenever possible, the sending school may, with proper consent, provide the designated school nurse in the receiving school with copy of the medication administration plan developed in accordance with 105 CMR 210.005(E). The medication administration plan shall be provided to the receiving school nurse prior to the event, if possible, or on the day of the event. If no medication administration plan is provided, the student at a minimum shall provide to the designated school nurse in the receiving school: 1. written authorization and emergency phone numbers from a caregiver; 2. a copy of a medication order from a licensed provider; and 3. any specific indications or instructions for administration. (C) Administration and storage of epinephrine shall be governed solely by 105 CMR 210.010.