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Definitions
A. Prescription Medication: those medications, which are obtainable only with the written consent of a licensed
physician or other healthcare practitioner.
B. Non-prescription medications: Those medications, which can be obtained over the counter, without a
prescription.
C. Prescribing Health Care Practitioner - Licensed physician, dentist, podiatrist, ophthalmologist, nurse
practitioner, optometrist, and/or physician's assistant with prescriptive power in the State of Wisconsin.
D. Controlled Substance
E. Parent or legal guardian of a student.
Prescription Medications
A. The designated school personnel shall administer prescription medications only when written direction and a
signature is obtained from the prescribing health care practitioner, as well as written parental consent for this
service has been received. The parent is responsible for having the Authorization for Administration of
Prescription Medication form completed and filed in the school office. If this form is not used then the
following information must be provided:
1. Student name
2. Date of birth
3. Name of medication
4. Reason for action of medication
5. Dosage
6. How is the medication given?
7. Time(s) to be administered or frequency if it is an "as needed" medication
8. Indications for when an "as needed" medication should be given
9. Duration (how long the medication should be given)
10. Possible side effects or adverse effects of the drug and actions to be taken if this occurs
11. Parental consent, signature and date
12. Name of prescribing health care practitioner and phone number
B. The parent shall supply the medication in an original pharmacy (labeled) container. The instructions on the
label MUST match the written instructions from the prescribing health care practitioner. The following
information must be on the bottle:
1. Student name
2. Name of medication
3. Dosage
4. Time or frequency drug is to be given
5. Name of prescribing health care practitioner
6. Name and phone number of pharmacy
C. If written instructions from a physician are not immediately available, the school nurse (R.N.) may take a
verbal order from a prescribing health care practitioner for a specific medication as long as the prescribing
health care practitioner signs this order within ten (10) days and provided written consent from the parent for
administration of this medication is on file.
D. The prescribing health care practitioner must verify in writing the discontinuance or change in dosage of any
prescription medication.
E. Epinephrine auto injectors or other auto injector systems are the only acceptable delivery systems of
intramuscular injections of Epinephrine that can be used to treat severe allergic reactions in school. An
Allergy Action Plan must be completed and signed by the prescribing health care practitioner and parent in
order for the student to receive medication in school. Parents should be instructed that it is highly
recommended that a back up epinephrine auto injector be kept in the school office. If an epinephrine auto
injector is used by a student or staff member 911 must be called.
School staff should be instructed in safe and appropriate use of Epi Pen.
F. Students may carry asthma inhalers so that they have immediate access to these medications. Parents are
asked to file an Asthma Medication Self Administration Authorization Form. This form acknowledges that the
student knows how to use the inhaler, when to use it and when to seek assistance from staff if the
medication is not working. Asthma inhalers are prescription medications and parent/guardian consent must
be on file as well as the signature and instructions of a prescribing health care practitioner. Students who
carry and self-administer this prescription medication must have the medication correctly (prescription)
labeled with their name, the name of the drug, and directions for its use. School staff will not document self-
administration of this medication. Parents can place a back up inhaler in the school office if they so desire.
G. Self-Administration: Reliable 9-12 grade students may carry and self-administer their own prescription and
nonprescription medication as long as the medication is not a controlled substance. A physician's signature
is required if the medication is a prescription medication.
H. Designated school personnel must store and administer all medications to students in grades K-8 with the
exception of asthma medications delivered by inhaler. The prescribing health care practitioner, and the parent
must sign appropriate forms and provide written instructions and authorization for the student to carry and
self-administer this medication. This authorization may be indicated on the appropriate School District forms.
I. Students who carry and self-administer prescription medications (grades 9-12 only) must have these
medications correctly labeled with their name, the name of the drug, and directions for its use. All appropriate
signatures and consents must be obtained from parents and the health care provider and be on file in the
school office.
J. School personnel are not required to document medication that the student self-administers.
K. Any student who shares medication with another student will no longer be allowed to carry and self-
administer their own medication.
Non-Prescription Medications
A. Designated school personnel shall administer non-prescription medications to students only when the parent
has provided written instructions and consent for administration of these medications. The form "Authorization
for Administration of Medication" should be used. If this form is not used the following information must be
provided:
1. Student named
2. Name of medication
3. Reason for, or action of medication
4. Dosage
5. Route
6. Frequency (time to be given) or conditions it is to be given for (i.e. a regularly scheduled med. or "as
needed")
7. Duration (how long med. is to be given)
8. Parent consent, signature and date
B. NO medication will be administered at school without the necessary information and signed consent on file.
C. Under no circumstances will the School District supply any over the counter medications to a student. It is
the parent's responsibility to provide all medications to be taken at school.
D. All non-prescription medication, provided for administration at school, must be in the original
manufacturer's labeled container or packaging. The manufacturer's label, including directions for
administration cannot be obscured. School staff will not exceed recommended dosages or alter the
recommended duration of time in which subsequent dosages of medication may be given.
E. Self-Administration: If a parent wishes a reliable student, in grades 9-12 may carry and self-administer a non-
prescription medication (such as Tylenol or non-aspirin, acetaminophen, Ibuprofen, Midol, etc.) at school.
General Considerations
A. Students may not carry or self-administer any controlled substance medications at any level or building. The
administration maintains the authority to determine if any particular drug, beyond this definition, is not
appropriate in terms of safety, for a student to carry in school. (This includes pain medications and attention
deficit medications.)
B. All medications shall be supplied by the parent/guardian. Parents are responsible for restocking the
medications at school. Only small amounts of medication should be kept at school. Controlled substance
medications must be brought in to the school by the parent.
C. An accurate, individual, Student Medication Record, shall be maintained on each student. This record will
include:
1. Name, birth date, grade, school year
2. Medication name, dose, date/time given
3. Signature and initials of person administering medication
This record shall be maintained in the Pupil Physical Health Record of each student receiving
medication.
D. Written authorization for medications expire at the end of each school year if not discontinued during the
course of the school year.
New orders need to be obtained for all medications at the beginning of each school year.
E. Except as otherwise noted, all medications that are to be administered by school personnel shall be stored
in a secure location that maintains the quality (i.e. refrigeration) of the medication. In most incidences this
will be a locked cabinet in the school office. Medications, administered by teachers or other teaching staff
members will be kept in a locked cabinet in the classroom. Medication that must be accessible to the
student must be stored in an appropriate and safe location per student need (i.e. emergency medications).
F. School personnel will encourage students to independently come to the school office to receive medication.
Students who cannot or will not independently come to the school office at the specified time each day will
be called to the office. If a student refuses to take a medication s/he will be counseled on the necessity of
taking the medication as directed and if s/he still refuses the parent will be contacted.
G. Parents/guardians are asked to notify the school principal, teacher, classroom aide or other staff member if
the student is taking medication that may affect his/her behavior.
H. The building administrator will designate a staff member who will be responsible for administering medication
to students who require medication on a field trip or at a time when the student is engaged in a school
activity outside of the building. This employee will receive instruction in the administration and documentation
of the medication. The staff member should carry the medication. Medication will be in a single dose
envelope or container labeled with the student's name, medication, dose and time to be given. Epinephrine
auto injectors, glucagon and diastat should also accompany students on all field trips.
I. Parents will be notified, prior to end of the school year, of any remaining medication that is still at school.
They will be asked to pick up this medication by the last student day of school. Medication that remains after
this time will be destroyed. Two (2) staff members will document (see Medication Disposal Form) and
destroy all medications left at school. No medication will be retained at school over the summer.
J. In the event of a medication error or omission the building administrator, parent, school nurse and, if
necessary, prescribing health care practitioner will be notified. The person who has made the error shall
complete a Medication Incident Form, explaining the error. It will be filed in the student's health record.
Approved/Adopted: July 13, 2009 |
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