Health Care Procedures In A School Setting

(1) Pursuant to T.C.A. § 49-50-1602, any health care procedure a student is not capable or competent to perform must be performed by a licensed health care professional in accordance with applicable guidelines of their respective regulatory boards. A physician’s orders and parental authorization are required for any health care procedures performed by a licensed health care professional in the school setting. The written parental authorization shall be kept in the student's school records. (2) All health care procedures, including the administration of medication, shall be conducted in accordance with the Guidelines for Use of Health Care Professionals and Health Care Procedures in a School Setting produced by the Department of Education and the Department of Health. (3) Any child with acute or chronic health issues should have a health assessment completed by a registered nurse. SCHOOL AND STUDENT HEALTH SERVICES CHAPTER 0520-01-13 (a) As warranted by the child’s condition or diagnosis, an Individual Health Plan (IHP) will be completed by the registered nurse. (b) The IHP shall include: 1. Emergency care procedures; 2. A nursing assessment; 3. Physician’s orders; and 4. Parental authorization. (c) A school nurse employed or contracted by the LEA shall be responsible for updating and maintaining each IHP. (4) School nursing staff and any other school personnel, including transportation personnel, who perform or assist with health care procedures which may involve blood borne pathogens must receive annual training on blood borne pathogens, be offered the Hepatitis B vaccine, have appropriate cleaning supplies, and be supplied with gloves. (5) Administration of Medication. (a) Each LEA shall adopt procedures for the safe, effective, and efficient administration of medications at school consistent with the requirements of this rule. (b) Medications administered at school should be limited to those required during school hours which are necessary to maintain the student’s health and those needed in the event of an emergency. (c) For all prescription and non-prescription drugs, a written request shall be obtained from the parent or guardian requesting that medication be given during school hours. The request must include the parent’s or guardian’s name and phone number in case of emergency. It is the parent’s or guardian’s responsibility to ensure that the written request and medication are brought to the school. Local school board policies related to “Zero Tolerance” may require all medications, prescription and non-prescription, be brought to school and delivered to appropriate or designated school personnel by a responsible adult. (d) In the event a dosage is not administered as ordered or any other medication error occurs, a Medication Error Form must be filled out and submitted to the appropriate administrative person in the local school district or routed per the protocol of a contracted agency. The school nurse and parent or legal guardian must be notified in the event of a medication error. Each school shall establish a procedure for providing communication with the parent or guardian regarding any problems with administration of the medication. (6) Self-Administration of Medication. (a) If a student has been taught to perform his or her own health care procedure, including administration of medication, and does not need assistance, space must be made available for the student to perform this task. If a student is performing an invasive procedure, that student should have at minimum a bi-annual nursing assessment of competency and proficiency as well as an IHP. Every attempt should be made on an individual basis to allow a child who is independent to continue self-management. SCHOOL AND STUDENT HEALTH SERVICES CHAPTER 0520-01-13 1. In accordance with T.C.A. § 49-50-1601, a student diagnosed with pancreatic insufficiency or cystic fibrosis may be permitted to self-manage prescribed pancreatic enzyme therapy in the manner directed by the licensed healthcare provider without additional assistance or direction. With written authorization from the healthcare provider and parent, a student with pancreatic insufficiency or cystic fibrosis shall be allowed to carry and self-administer prescribed pancreatic enzymes. 2. Each LEA shall permit possession and self-administration of a prescribed, metered dosage asthma-reliever inhaler by any student with asthma if the student's parent or guardian: (i) Provides to the school written authorization for student possession and self-administration of the inhaler; and (ii) Provides a written statement from the prescribing health care practitioner that the student suffers from asthma and has been instructed in self- administration of the prescribed, metered dosage asthma-reliever inhaler and provides the name and purpose of the medication, the prescribed dosage, the time or times the prescribed inhaler is to be regularly administered, as well as any additional special circumstances under which the inhaler is to be administered, and the length of time for which the inhaler is prescribed. The statements shall be kept on file in the office of the school nurse or school administrator. (iii) The permission for self-administration of the prescribed, metered dosage asthma-reliever inhaler shall be effective for the school year in which it is granted and must be renewed each following school year. The LEA may suspend or revoke the student's possession and self-administration privileges if the student misuses the inhaler or makes the inhaler available for usage by any other person. (iv) A student granted permission to possess and use a metered dosage asthma-reliever inhaler may possess and use the prescribed, metered dose asthma-reliever inhaler when at school, at a school-sponsored activity, or before or after normal school activities while on school properties, including school-sponsored child care or after-school programs. 3. A student with anaphylaxis is entitled to possess and self-administer prescription anaphylaxis medication while on school property or at a school-related event or activity in compliance with the requirements of T.C.A. § 49-50-1602. 4. Upon written request of the parent or guardian, and if included in the student's medical management plan and in the IHP, a student with diabetes shall be permitted to perform blood glucose checks, administer insulin, treat hypoglycemia and hyperglycemia, and otherwise attend to the care and management of the student's diabetes in any area of the school or school grounds and at any school-related activity, and shall be permitted to possess on the student's person at all times all necessary diabetes monitoring and treatment supplies, including sharps. (7) Assistance with Self-Administration of Medication. (a) A local board of education may permit an employee or a person under contract with the board to assist in self-administration of medications, under the following conditions: SCHOOL AND STUDENT HEALTH SERVICES CHAPTER 0520-01-13 1. The student is competent to self-administer nonprescription or prescription medication with assistance; 2. The student's condition, for which the medication is authorized or prescribed, is stable; 3. The self-administration of each dose of the medication is properly documented and the documentation easily retrievable. Documentation shall include date, time, dosage, route, and the signature of the person assisting the student in self- administration; 4. School personnel assisting in self-administration of medications are properly trained by a registered nurse. 5. The Guidelines for Use of Health Care Professionals and Health Care Procedures in a School Setting produced by the Department of Education and the Department of Health are followed; and 6. The student's parent or guardian has provided permission in writing for school personnel to assist with self-administration of medications. (b) The individual assisting with medication self-administration must visually observe the student self-administer the medication or, in the case of a cognitively competent but physically challenged student, perform that portion of self-administration for which the student is physically incapable. (c) Nursing supervision shall be provided to school personnel assisting with the self- administration of medication to ensure local school board policies and state guidelines are being followed. (d) School personnel who volunteer under no duress or pressure and who have been properly trained may administer glucagon in emergency situations and may administer insulin to a student based on the student's IHP. However, if a public school nurse is available and on site, the nurse shall provide this service to the student. 1. Training provided to school personnel on the administration of glucagon and insulin shall be repeated annually and competencies shall be documented at least twice a year in the employee's personnel file. (e) School personnel who volunteer under no duress or pressure and who have been properly trained may administer epinephrine auto-injector to respond to any student believed to be having a life-threatening allergic or anaphylactic reaction, even if a student does not have an epinephrine auto-injector or a prescription on file. If a public school nurse is available and on site, the nurse shall provide this service to the student. The LEA’s supply of epinephrine auto-injectors shall be under a standing protocol from a physician licensed to practice medicine in all its branches. (8) Storage of Medication. (a) School personnel who volunteer under no duress or pressure and who have been properly trained may administer anti-seizure medications, including diazepam gel, to a student in an emergency situation based on that student's IHP. SCHOOL AND STUDENT HEALTH SERVICES CHAPTER 0520-01-13 1. If a school nurse is available, on site, and able to reach the student within the time limit for administration specified in the IHP, then the nurse shall provide this service to the student. 2. All volunteers trained to administer anti-seizure medications shall also be trained in cardiopulmonary resuscitation (CPR). 3. At least one (1) school employee shall serve as a witness on any occasion a volunteer administers anti-seizure medication during an emergency situation, unless a witness is not available within the time limit for administration specified in the IHP.