Administration Of Medication For Adrenal Insufficiency

(1) Each local board of education shall adopt policies and procedures that provide for the administration of medications that treat adrenal insufficiency in compliance with these rules. (2) For purposes of this rule the following definitions are applicable: (a) “Adrenal crisis” means a sudden, severe worsening of symptoms associated with adrenal insufficiency, such as: severe pain in the lower back, abdomen, or legs; vomiting; diarrhea; dehydration; low blood pressure; or loss of consciousness. (b) “Adrenal insufficiency” means a hormonal disorder that occurs when the adrenal glands do not produce enough adrenal hormones. (c) “IHP” means Individualized Healthcare Plan. (d) “LEA” means Local Education Agency. (e) “Nurse practitioner” means a nurse practitioner licensed under T.C.A. title 63, chapter 7. (f) “Physician” means a physician licensed under T.C.A. title 63, chapter 6 or 9. (g) “School personnel” means any person employed by a Local Education Agency (LEA). (3) Training. (a) If an LEA has been informed by a parent or guardian that a student in a school of the LEA has adrenal insufficiency, the LEA shall train school personnel at the school who will be responsible for administering the medication for the treatment of adrenal crisis. (b) Trained personnel shall be available to each student identified as having adrenal insufficiency whose parent or guardian has provided the medication for treatment of adrenal crisis. (c) An LEA shall provide training to any school personnel who volunteer to receive the training and to be responsible for the administration of the medication for the treatment of adrenal crisis. (d) Training on the treatment of adrenal insufficiency shall be coordinated by the LEA and shall be conducted under the supervision of a physician or nurse practitioner or by any SCHOOL AND STUDENT HEALTH SERVICES CHAPTER 0520-01-13 other health care professional licensed under T.C.A. title 63 as delegated by a supervising physician or nurse practitioner. (e) The training shall include, at a minimum, the following: 1. General information about adrenal insufficiency and the dangers associated with adrenal insufficiency; 2. Recognition of the symptoms of a person who is experiencing an adrenal crisis; 3. The types of medications that are available for treating adrenal insufficiency; 4. Proper administration of medications that treat adrenal insufficiency; and 5. LEAs shall maintain a written record of all school personnel who have completed such training. (f) A person who has successfully completed training in the treatment of adrenal insufficiency may possess the medication and necessary paraphernalia for administration of medication. Trained school personnel may administer the medication to the student for whom the medication is prescribed if the student is suffering an adrenal crisis when a school nurse or other licensed health care professional is not immediately available. (g) Trained school personnel shall: 1. Be familiar with the IHP for each student with adrenal insufficiency in the school and become familiar with: (i) The student’s baseline activity level, attitude, and behavior; (ii) The conditions that place additional stress on the body (such as illness or injury) that may trigger an adrenal crisis; (iii) The student’s past history with adrenal crisis; and (iv) The medication and administration route that is prescribed to the student from his or her physician to use during an adrenal crisis. 2. Understand the symptoms of adrenal crisis including unconsciousness, extreme lethargy, or nausea and vomiting. 3. Understand the student’s 504 Plan, Individualized Education Program, or other education plan, if applicable. 4. Practice universal precautions and infection control procedures. 5. Comply with all state and federal privacy laws. (h) An LEA shall not require school personnel who have not received appropriate training to administer medication. (4) If it is determined a student is suffering from an adrenal crisis and the school nurse or other licensed health care professional is not available, the trained school personnel shall: (a) Instruct someone to call 911 and the student’s parent or guardian. SCHOOL AND STUDENT HEALTH SERVICES CHAPTER 0520-01-13 (b) Administer the medication and wait with the student until help arrives. Do not leave the student unattended. (c) Turn the student on his or her side and monitor the student’s breathing. (d) Give the empty vial to the Emergency Medical Responders when they arrive. (5) Medication shall be stored safely and in a location that is readily available and in close proximity of the student. (6) School transportation and activities such as field trips or other out-of-school functions shall be taken into account in the LEA policy regarding treatment of adrenal crisis. (7) The student’s IHP team may consider allowing a student to carry his/her own medication in certain circumstances. The IHP team shall take into account the student’s age and maturity when making this determination.