West Fargo Public Schools has established a program for providing medication to students during the school day and when students are otherwise under the district's direct supervision (e.g., participating in a school activity, on a school-sponsored trip). This program is only available to students when the applicable requirements under this policy have been satisfied.

QUALIFICATIONS FOR ELIGIBLE SCHOOL MEDICATION PROVIDERS

In order to be eligible to provide medication under this policy, an individual must meet the following criteria and receive approval from the building principal.

1. Received education and training in medication administration, including the following topics:
   1. Individual's authority and role in providing medication
   2. Proper medication storage, inventory, and disposal
   3. Proper techniques for providing medication including, but not limited to, understanding pharmacy labels, standard precautions for infection control (e.g., hand washing), six rights of medication administration, and measuring and dispensing protocols
   4. Appropriate documentation of all medication provided and confidentiality requirements
   5. Basic medical terminology related to providing medication
   6. Appropriate action if unusual circumstances occur (e.g., medication error, adverse reactions, student refusal) and how and when to seek medical consultation or assistance
2. Provided the building principal with verification that the above training and education is complete
3. Undergone a criminal history record check through the district and received satisfactory adjudication
4. Agreed to perform the duty of providing medication for at least the duration of the school year
5. Received written consent of the student's parent/guardian
6. Agreed to comply with this policy and any additional district rules on providing medication
7. The school medication provider must complete ACBD-E1: School Medication Provider Opt-Out or Opt-In & Verification of Eligibility each year and file it with the building principal.

The district shall pay the cost of all district-authorized education and training for school medication providers.

REQUIREMENTS & PROHIBITIONS FOR ALL SCHOOL PERSONNEL

All school employees shall comply with the district's Drug and Alcohol Free Workplace policy, which prohibits illegal activities associated with prescription and over-the-counter medication. In addition, eligible school medication providers and all other school employees with knowledge of a student's health condition and/or medication regimen shall comply with district policies and law on confidentiality of student education records that include student health information.

All school employees are required, as soon as possible, to report to building administration or their designee any observed or reported sign or symptom that a student may be having an adverse medication reaction or allergic reaction.

Only a licensed nurse can take a verbal order from a licensed prescriber in the school setting. Except as provided in this policy for certain emergency medications: Epinephrine, Glucagon, Diastat, only a licensed nurse shall administer other injectable medications in the school setting. School staff cannot provide any parenteral medication unless they have had individualized delegation from a nurse and are on the North Dakota Board of Nursing registry. Emergency Epinephrine can be administered by a staff member that has been trained for those student who require emergency epinephrine treatment in accordance with North Dakota Administrative Code Ch. 33-37-01 and/or students who require emergency medication under NDCC 15.1-19-16. This policy shall not supersede NDCC 15.1-19-16, which contains criteria for a school to authorize student self-administration of emergency medication. In addition, refer to Nurse Practice Act exemption found in NDCC 43-12.1-04(1).

In no case should a staff member provide, recommend, prescribe, or require medication. The building administrator of each school shall ensure that the procedural safeguards and records contained in this policy are followed prior to administration of any medication or treatment. The building administrator of each school shall designate who shall be given the responsibility to check in and administer the medication.

All personnel having responsibility for supervising students shall have access to information on the health portions of the student's school records, including related medical problems, and shall be informed of anticipated circumstances for which school personnel may need to be in touch with emergency or medical personnel.

A list of designated personnel within the school building who are responsible for administering the medication should be kept on file with the building administrator. Any violation of this policy or other district rules governing medication may result in disciplinary action, including, but not limited to, discharge (in accordance with applicable law) and/or removal of medication provider duties, if applicable.

TYPES OF MEDICATION PROVIDED

The district may provide both prescription and over-the-counter medication to students covered by this policy so long as the medications are legal under state law and are authorized to be provided to the student by their parent/guardian and, when applicable, healthcare provider in accordance with this policy. The medications should be FDA approved or, if necessary, the nurse can consult with the health care provider to determine if medication is necessary for the current care of student. Eligible school medication providers may provide oral and non-oral, noninvasive medication (i.e., medication provided by non-parenteral routes) to students covered by this policy.

Prescription and non-prescription ("over-the-counter") medications required by a student shall be administered by a parent at home or by the student's medical provider if possible. Parents shall use every effort to have medication administration times set for time periods other than school hours. When this is not possible, within the limitations set by this policy, West Fargo Public School's trained staff or school nursing staff may assist in the administration of medication during school hours. West Fargo Public Schools retains the right to refuse to administer medications or provide other medical treatments. No prescription or nonprescription medication should be carried by a student or kept in his or her locker unless the authorization for self-administration has been completed.

School personnel will administer no prescription medication unless prescribed by a licensed prescriber and have the authorization forms signed by both the parent or legal guardian and the licensed provider.

Except for students covered by an Individual Education Program (IEP) or 504 Plan, if a student's medication requires administration through the parenteral route, the district may deny a parent's/guardian's request to provide such medication or may require the parents/guardians to reimburse the district for the expense of hiring a healthcare provider who has authority under state law to administer such medication, if the district does not have a medically qualified and eligible school medication provider on staff who is willing to administer the medication. Eligible school medication providers shall not provide medication through parenteral routes unless they have the proper authority under state law, including certification or licensure, to perform such functions. The district shall retain verification of such authorization, certification, or licensure.

If a medically qualified and eligible school medication provider is requested to perform any invasive medication administration, the district first should contact its insurer to determine if additional liability coverage is necessary if the district has not previously made this inquiry.

Prior to the administration of medication, verify the health care provider’s orders with the current pharmacy labeled container for:

1. Right name of student
2. Right medication
3. Right dosage
4. Right time
5. Right route (oral, topical)
6. Right documentation after giving the medication

DOCUMENTATION

A separate record for each student shall be kept of the administration of medication on a "Medication Administration Record" that includes: student name, medication, dosage, time, and signature of person administering the medication, and a place for other information to be recorded, such as any observed reaction to the medication or possible side effects. All such records shall be deemed a permanent part of the student's health records and shall be confidential. Medication and treatment forms will be given to the school nurse at the end of each school year to be filed. These original forms will be placed in the student's cumulative education file in the health folder (red in color) section in the back of the file.

STUDENTS ELIGIBLE FOR PARTICIPATION

The following students are eligible for participation in the medication program established by this policy:

• Students who qualify for this service under their IEP or 504 Plan. The district shall pay the cost of these services.
• Students who are not covered by the Individuals with Disabilities Education Act (IDEA) or 504 but who require medication when under the direct supervision of the school and whose parents/guardians are unable to make arrangements to provide medication themselves. An exception to such a student's participation in the medication program may apply if the student requires medication through a parenteral route (see section on types of medication provided).

REQUIREMENTS FOR PARENTS/GUARDIANS PRIOR TO DISTRICT PROVIDING MEDICATION

Whenever possible, the first dose of medication should be given to a student at home. A parent/guardian must sign a written form authorizing their student to receive medication from an eligible school medication provider prior to carrying out this service. A new authorization form is required anytime the student has a change in their medication regimen, when a new medication is to be provided and at the beginning of each school year.

For prescription drugs: Any prescription medication to be administered must be accompanied by a completed ACBD-E2: Prescription or Over-the-Counter Authorization for Medication Administration, which must be signed by the student's parent or legal guardian and the student's dentist, physician, and/or other licensed prescriber. It is also acceptable to have a current computerized medication list from the health care provider. This form requires instructions from an appropriate healthcare provider on how, when, and how long to provide medication. Prescription medications must be supplied in the original pharmacy-labeled container and include the name and phone number of the pharmacy.

The following information must be included on ACBD-E2: Prescription or Over-the-Counter Authorization for Medication Administration:

• Student's name
• Name and strength of medication and route (i.e., oral, topical, drops)
• Dosage amount
• Time of administration
• Length of time student will be on medication
• Storage instructions, such as refrigeration
• Instructions for administration
• Major side effects or adverse reactions
• Amount of medication received by school and expiration date
• Allergies

For Over-the-Counter Medication

Any over-the-counter medication to be administered must be accompanied by a completed ACBD-E2: Prescription or Over-the-Counter Authorization for Medication Administration, including instructions from the parent/guardian on how, when, and how long to provide medication. Over-the-counter medication must be supplied in the original manufacturer’s container, and the container must list the ingredients, and storage instructions. The container must be labeled with the student’s name and if unsealed the number or amount of medication in the container. If the parent/guardian requests a dosage different than the manufacturer’s recommendation for a non-prescription medication; a signed authorization will be necessary from both the parent/guardian and the licensed prescriber prior to giving the medication.

Dispensing Equipment

If dispensing equipment is required (e.g., measuring cups, droppers), it must be provided by the parent/guardian. The equipment must be clean, operable, and labeled with the student's name and date of birth. Any special medical equipment storage instructions must be provided to the school by the parent/guardian or student's healthcare provider.

Stock Medication

If providing from the stock supply the manufacturer recommended dosage must be followed and the parent/guardian must have signed the yearly permission form to give acetaminophen 325 mg, available only in tablet form. If no signed form than the parent/guardian must be verbally contacted before the administration of the stock acetaminophen. The school district may provide stock acetaminophen 325 mg for students in grades 1 – 12. For grades 6 – 12, stock ibuprofen 200mg and antacids 500mg are available and given as directed.

For all requests for the school to provide medication the following applies:

• Contact numbers for the student's parents/guardians and healthcare provider(s)
• Waiver of confidentiality allowing administration or the eligible school medication provider to contact the student's healthcare provider(s) with questions or concerns and allowing the district to share information about the student's health condition and/or medication regimen with any school employee/volunteer with a legitimate need to know.
• Information on possible adverse reactions and side effects associated with each medication that the parent/guardian is requesting the school to provide and certification that students have been educated in possible side effects.

All medication preferably should be hand delivered by a parent/guardian to the school medication provider. Do NOT send any medication with the student on the bus. The medication provider shall ensure that the appropriate authorization form(s) is/are complete, that the medication has not expired, that the medication is appropriately labeled in accordance with above requirements, and that parents/guardians have complied with all other applicable provisions of this policy before accepting the medication from the parent/guardian.

MEDICATION CHECK-IN REQUIREMENTS WHEN DISTRICT IS ADMINISTERING MEDICATION

The building administrator of the school shall designate who within the school will be given the responsibility to check in and administer the medication.

The authorized school designee will complete ACBD-E3: Medication Check-In and file the form with ACBD-E2: Prescription or Over-the-Counter Authorization for Medication Administration.

The administrator shall establish a medication check-in procedure to be done by the designated personnel or the school nurse, to include the following:

• record the date medication was deposited;
• ensure the required authorization is on file;
• notify the person designated to administer medication;
• count and record the number or amount of medication if possible in the presence of the person who deposited the medication.

Schools shall accept no more than one month’s supply of any prescription medication at one time. It is the parent or guardian's responsibility to replenish the medication supply if necessary.

All medication preferably should be hand delivered by a parent/guardian to the designated district official. This official shall ensure that the appropriate authorization form(s) is/are complete, that the medication has not expired, that the medication is appropriately labeled in accordance with above requirements, and that parents/guardians have complied with all other applicable provisions of this policy before accepting the medication from the parent/guardian.

MEDICATION STORAGE & DISPOSAL

Medication will be stored in the following manner:

• All medications will be kept in a secure, locked, clean container or cabinet
  • Inaccessible to students
  • Separate from staff medication
  • Protected from sources of contamination
• Away from heat, light, and sources of moisture (e.g., not in the kitchen or bathroom)
  • At temperature specified on the label (refrigerated if required)
  • Separate from food
    • In a sanitary and orderly manner
  • Controlled substances susceptible to theft (e.g., Ritalin) will be stored in a locked container, which shall be stored in accordance with label storage instructions. Administration may consult a pharmacist for a list of such substances.

Medications that are out-of-date or for which parental/medical authorization has expired must be picked up by the parent/legal guardian. A designated school medication provider or school nurse is responsible for sending such notice to parents/guardians. The notice should contain a reasonable deadline for the parent/guardian to pick up the medication and notification that failure to pick up medication by the deadline or failure to make arrangements to pick up the medication on an alternate date after the deadline will result in the school destroying the medication. Under no circumstances will medication be released to students except medication that a student is authorized to carry or upon case review. This is to ensure safety for all students. When medications are not picked up by the parent/guardian, they must be destroyed in accordance with government recommendations and that process should be witnessed and documented on ACBD-E4: Medication Record Administration by the building principal or designee who is not the school medication provider. The main medication disposal method will be to drop off at the West Fargo Police Department medication drop off container. Prescription medications that are disposed should be documented on the medication calendar that they were destroyed.

Needles and syringes must be disposed of in a manner consistent with appropriate Occupational Safety and Health Administration guidelines.

Failure of a school medication provider to comply with the above storage and disposal requirements may result in the district revoking medication responsibilities and/or disciplinary action.

STUDENT SELF-ADMINISTRATION REQUIREMENTS

When the student can demonstrate proper administration of the medication (prescription or over the counter), and if the student, their parent/guardian, health care provider and principal agree it is appropriate for the student to self-administer the medication, the student will be allowed to carry and self-administer the medication. ACBD-E5: Request & Authorization for Student Self-Administration of Medication must be completed and signed by parent/guardian, student and the health care provider for prescription medication. If the medication is over the counter, it requires a parent/guardian and student signature. Questions regarding any student observed by school personnel self-administering medication should be referred to the school nurse/or building principal.

A new authorization form is required anytime the student has a change in their medication regimen, when a new medication is to be provided, and at the beginning of each school year.

Requirements for Self-Administration of Prescription Medication

1. Authorization to self-administer medication from the student's healthcare provider. This authorization must indicate whether the student is authorized only to self-administer the medication or is authorized to carry and self-administer the medication.
2. Instructions from an appropriate healthcare provider on how, when, and how long the student will need to self-administer medication.
3. Certification from the healthcare provider that the student has received instruction in and is capable of self-administering the medication in a responsible and secure manner.
4. For controlled substances only two or three pills can be with the student at one time.
5. A parent/guardian and student signature are also required on the form.

Requirements for Self-Administration of Over-the-Counter Medication

1. Instructions from the parent/guardian on how, when, and how long the student will self-administer medication. If the student will take a dosage other than as recommended by the manufacturer, the district requires approval from an appropriate healthcare provider prior to authorizing the student to self-administer.
2. Certification from the parent/guardian that the student has received instruction in and is capable of self-administering the medication in a responsible and secure manner. This certification must indicate whether the student has parental consent to self-administer the medication or has parental consent to carry and self-administer the medication.
3. A parent/guardian and student signature is required on the form.

Requirements of All Student Self-Administration Medication Requests

1. Contact numbers for the student's parents/guardians and healthcare provider(s)
2. Waiver of confidentiality allowing administration or an eligible school medication provider to contact the student's healthcare provider(s) with questions or concerns and allowing the district to share information about the student's health condition and/or medication regimen with any school employee/volunteer with a legitimate need to know.
3. Information on possible adverse reactions and side effects associated with each medication that student will self-administer and certification that the student has received education on these reactions and side effects.

Students will be prohibited from carrying medication that has special storage requirements such as, but not limited to, medication that requires refrigeration. The district may require the student to comply with additional medication storage requirements for safety reasons. These requirements will be developed on a case-by-case basis.

Requirements for Administrative Check-Ins

Before a student self-administers medication in schools, the following check-in procedures are required:

1. The building administrator of the school shall designate who within the school will be given the responsibility to check in and possibly administer the medication if the student does not self-administer.
2. The school medication provider will complete ACBD-E3: Medication Check-In and file the form with ACBD-E5: Request & Authorization for Student Self-Administration of Medication.
3. The administrator shall establish a medication check-in procedure to be done by the       designated personnel or the school nurse to include the following:
   1. record the date medication was deposited;
   2. ensure the required authorization is on file;
   3. notify the person designated to administer medication;
   4. count and record the number or amount of medication if possible in the presence of the person who deposited the medication.
4. School shall accept no more than one month’s supply of any prescription medication at one time. It is the parent or guardian's responsibility to replenish the medication supply if necessary.
5. If dispensing or other medical equipment is required for a student to self-administer medication (e.g., measuring cups, droppers), it must be provided by the parent/guardian. The equipment must be clean, operable, and labeled with the student's name and date of birth. Any special medical equipment storage instructions must be provided to the school.
6. Prior to a student self-administering medication, the medication preferably should be hand delivered by a parent/guardian to the designated district official. This official shall ensure that the appropriate authorization form(s) is/are complete, that the medication has not expired, that the medication is appropriately labeled in accordance with above requirements, and that the parent/guardian and student has complied with all other applicable provisions of this policy before authorizing a student to self-administer the medication.

MEDICATION OFF-CAMPUS WHEN STUDENT IS UNDER DISTRICT SUPERVISION

Parents/guardians must make arrangements with the building principal for students who will require medication off-campus while under the district's supervision prior to the activity or event (e.g., students who participate in field trips). At a minimum, parents/guardians making such a request shall be required to comply with the applicable authorization requirements contained in this policy. The district shall develop, on a case-by case basis, check-in and storage requirements for all medication provided or self-administered in this context. The district may consult the student's healthcare provider(s) when developing these rules.

• The administration of medication on field trips shall be as follows:
• If the student is to self-administer medication the same procedure shall be in effect as for the regular school day.
• Any medication to be administered to a student while on a field trip will be kept in the possession of an adult assigned to administer the medication and accompanying the student on the trip.
• All medication must be clearly marked in a sealed envelope with the student's name, the medication name, and directions as to the dosage, time and method of administration. The trained school medication provider will be the person responsible for placing the medication in the sealed, labeled envelope. The assigned adult on the field trip is responsible for recording the medication administration upon the return to school. This needs to be recorded on the individual student's medication record administration form.
• When on a field trip the parent/guardian is aware the trained school medication provider has placed the medication in an envelope but the assigned adult on the fieldtrip is the person who will dispense the medications.                                    

ADDITIONAL PROHIBITIONS, RESTRICTIONS, & REQUIREMENTS FOR STUDENTS

All students are required to comply with the district's policy on drug and alcohol-free schools, which contains prohibitions on illegal activities associated with prescription and over-the-counter medication. Students who violate administrative policy FFA-AP: Student Alcohol and Other Use or Abuse by engaging in a prohibited activity with medication originally authorized by this policy may be subject to disciplinary action. In addition, the district may refuse to provide medication to the violating student and/or may prohibit the violating student from self-administering medication as long as:

• The student is not covered by an IEP or 504 Plan.
• The medication is not covered by an emergency provision in law or needed on an emergency basis as determined by administration in consultation with the student’s healthcare provider (i.e. inhaler, Epi pen or insulin). Parents/guardians of violating students not subject to an exception above will be required to make arrangements to provide medication to their children during the school day.

SPECIAL TREATMENTS/OBSERVATIONS

Special treatments (i.e. catheterization, chest percussion therapy, and gastrostomy feedings) are delegated medical functions; they require a licensed prescriber's written order and written parent/guardian permission and should be included in the student's Individual Education/Health Plan. When students require extensive medical health related observations while in school or if medical-health related equipment or appliances must be monitored while the student is in school, additional procedures will need to be established (see ACBD-E8: Authorization for Administration of Specialized Health Care Procedures and ACBD-E9: Documentation of Procedure Administration). In addition, school nurses may document the procedure in the health section of power school or if appropriate on the monthly individual calendar in their health binder.

If medication is administered while a treatment is being given, the requirements of the medication administration policy need to be met.

EMERGENCY CARE PLAN FOR DIABETES

Due to the complexity of diabetes and the different levels of assistance needed to manage diabetes, ACBD-E10: Diabetic Management Care Plan can be formulated by the parent, student, teacher/principal and school nurse. The plan shall include the written signed order of the student’s licensed health care prescriber and parent/guardian signature. This plan includes management related to meals and snacks, exercise and sports, blood sugar testing, low or high blood sugar readings, carbohydrate counting, and insulin administration. The documentation of blood sugars or carbohydrate counting would be recorded in the health section of power school or on the student’s monthly individual calendar in their health binder. The documentation of insulin administration would be recorded on ACBD-E3: Medication Record Administration or, if appropriate, on the student’s monthly individual calendar in their health binder.

Emergency Medications

All personnel must be informed of proper procedures in emergencies and of circumstances in which they are expected to directly call the emergency medical assistance number. THE EMERGENCY NUMBER FOR WEST FARGO IS 911.

If medication is for emergency use only, such as an Epi-Pen for severe allergy, Diastat for seizures, or Glucagon for very low blood sugar then it may be administered by the school nurse, or a person trained by the licensed school nurse or licensed health care prescriber upon written consent from a parent or legal guardian. In emergency cases the school personnel shall promptly notify emergency medical personnel (DIAL 911) and the parent(s) or legal guardian.

Refer to medication off campus section, when the student is under district supervision related to a field trip.

For each student whose health condition requires a prescribed emergency medication, a written emergency care plan will be formulated by the parent, student, teacher and school nurse. The plan shall include the written signed order of the student's licensed health care prescriber, parent /guardian signature. Currently North Dakota Century Code allows emergency medications of Epinephrine, Glucagon and Diastat to be given by staff that have been trained by the school nurse or licensed health care provider.  

In addition, a stock Epi Pen may be used on a person with an undiagnosed health condition for an emergency if they are exhibiting symptoms of anaphylactic reaction.

Training of staff on Epi Pens

In accordance with Chapter 33-37-01 the school nurse will yearly train a minimum of two school staff on the use of the Epi Pen. The lead school nurse will receive a scanned copy of the school staff that attended the training, per building, from the assigned nurse. The list of attendees will include the following: staff name, date of training, who did the training, and school location. The training can include face to face interaction, DVD video on anaphylaxis with compliance thru survey monkey. The results of the survey monkey would be sent to the lead school nurse. The Epi Pens will be stored in the designated locked medication area as determined by each school location.

LIABILITY DISCLAIMER

It is not the intent of the district to expand or modify the district's potential liability exposure through the development of this medication program. The district's voluntary creation of this program shall not be construed to create or assume any potential liability under any local, state, or federal law or regulation. State law provides liability protection for establishing and providing medication under a school medication program. This protection extends to all eligible school medication providers, the school district, and the Board so long as each party is acting in good faith.

The district is not responsible for determining the qualifications of healthcare providers whose signatures appear on prescriptions and other medical documentation submitted to the district by parents/guardians. The district assumes that by signing such documentation, the healthcare provider is attesting to the validity of their qualifications and credentials. The district will comply with healthcare providers' orders but assumes no liability for their content.

SCHOOL MEDICATION PROGRAM REGULATIONS AUTHORIZING PARTICIPATION

The district shall designate at least one eligible school medication provider to receive all requests to participate in the school medication program. This individual(s) shall be responsible for ensuring that parents/guardians and students are in compliance with all applicable components of the district's policy and law on the school medication program before authorizing participation. This includes, but is not limited to:

• Completion by the parent/guardian, healthcare provider (if applicable), and student of the Authorization/Parental Consent for School to Provide Medication or Student to Self-Administer Medication form.
• Verification that parent/guardian has satisfied all check-in requirements.
• Compliance with NDCC 15.1-19-16, if the student will self-administer emergency medication covered by this law.

The authorizing school medication provider(s) may defer any request to provide medication should such request be incomplete or otherwise noncompliant with district policy or law. The authorizing school medication provider(s) may deny a request to provide medication prohibited by district policy. The authorizing school medication provider(s) may also deny a request to provide medication through a parenteral route except when:

• The student is required to receive the medication under an IEP or 504 Plan.
• The school has a medically qualified and eligible medication provider who has agreed to provide the medication.

The authorizing school medication provider(s) shall consult with administration prior to acting on any request to provide medication through a parenteral route.

REQUIREMENTS FOR PROVIDING MEDICATION

All school medication providers are required to provide medication in good faith consistent with medication training and education received, including compliance with all training and education in medication safety, handling and dispensing, student identification, documentation, and sanitation protocols. All school medication providers are required to document all medication provided on the medication record administration form. Failure to complete this documentation may result in the district revoking medication responsibilities.

MEDICATION INCIDENTS OR ERRORS

Medication providers are required to complete ACBD-E6: Medication Incident Report for any medication incident or error, including but not limited to:

• Forgot to document the medication by the end of school day on which the medication was provided
• Forgot to give a dose of medication
• Gave the medication at the wrong time
• Gave the medication by the wrong route
• Gave the wrong dose of the medication
• Gave the wrong medication
• Gave the medication to the wrong child

The form is to be completed as soon as possible after the incident occurred and appropriate response actions/interventions were taken. It must be filed with the building principal. Failure to complete this documentation may result in the district revoking medication responsibilities.

PROGRAM REVIEW

The district may require medication providers to undergo additional training as needed and may hire a qualified consultant to audit the school medication program periodically.

Adopted: 08/09/93

Reviewed:

Revised: 04/24/95, 08/13/07

01/09/12, 04/01/15

02/27/18, 01/29/20