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I. General Statement.ĚýPrescribed medication shall not be brought to school unless the written directions of a physician, physician assistant, or advanced practice registered nurse state that the prescribed medication must be taken during school hours or during school activities.

II. Rules for all Medications.

A. Preschool, Elementary and Middle School Levels. The following rules shall apply to the use, application, and transportation of all medications at the preschool, elementary school, and middle school levels.

1. Non-Prescribed Medication. A written authorization must be signed by the student's parents or guardian and filed with the school nurse or principal permitting the use of non-prescribed medication.

2. Prescribed Medication. The student or the student's parents or guardian must provide the school nurse or principal with a written order of a physician, physician assistant, or advanced practice registered nurse that prescribes the type and amount of medication. A current prescription label will satisfy the requirements of this paragraph. In addition, a written authorization permitting the use of medication must be signed by the student's parents or guardian and filed with the school nurse or principal.

3. Taking of Non-Prescribed and Prescribed Medication. The ingestion, taking, or application of non-prescribed and prescribed medications, including nebulizers, shall be performed under the direct supervision and observation of the school nurse, principal, or principal's designee, who shall have successfully completed a District competency assessment pursuant to the Medication Aide Act and applicable state rules and regulations, will be administered as directed on the manufacturer’s label, as directed by the student's physician, physician assistant, or advanced practice registered nurse. The school nurse or health room paraprofessional may assist a student with eye drops or eardrops if the school nurse or health room paraprofessional deems it appropriate or the student is unable to effectively administer such. If the student’s parents or guardian have given written authorization, students will be allowed to possess and/or ingest glucose tablets as needed anywhere on school grounds.

4. Homeopathic Substances, Herbs, and Vitamins. Homeopathic substances, herbs, and vitamins shall not be administered by school staff unless prescribed by a physician, physician assistant, or advanced practice registered nurse and dispensed by a pharmacist or other person authorized by law. Homeopathic substances, herbs and vitamins, whether prescribed or non- prescribed, shall be subject to the same restrictions and requirements as prescribed medications.

5. Transporting Medications to and from School.

a. Preschool and Elementary Schools. In the preschool and elementary schools, students shall not be allowed to transport non-prescribed or prescribed medications to and from school with the exception of glucose tablets. Elementary school students may possess and use inhalers according to the provisions of Section II(F)(1) of this Rule. Non-prescribed or prescribed medications must be transported by the student’s parents or guardian or by an adult designated in writing by the parents or guardian, and must be delivered to the school nurse, principal, or the principal’s designee.

b. Middle School. Middle school students shall not be allowed to transport prescribed medications to and from school with the exception of glucose tablets. Middle school students may possess and use inhalers according to the provisions of Section II(F)(1) of this Rule. Prescribed medications must be transported by the student’s parents or guardian or by an adult designated in writing by the parents or guardian. Non- prescribed medications may be transported by middle school students to and from school but must be delivered to the school nurse, principal, or the principal’s designee.

B. High School. The following rules shall apply to the use and application of medications at the high school level.

1. Non-Prescribed Medication. No written authorization shall be required for non-prescribed medication. However, if a teacher, principal or school nurse observes frequent or inappropriate use by a student of non-prescribed medication, the school may require the following:

a. Written authorization by the student's parents or guardian permitting the possession and use of the non-prescribed medication; and/or

b. A written statement signed by a physician, physician assistant, or advanced practice registered nurse permitting the use of the non-prescribed medication.

2. Prescribed Medication. If prescribed medication is to be ingested, taken or applied, the following shall be required:

a. The medication shall be delivered to the school nurse, principal, or principal's designee;

b. A written authorization signed by the student's parents or guardian permitting the possession and use of the medication shall be filed with the school nurse or principal;

c. The school nurse or principal shall be provided with the written order of a physician, physician assistant, or advanced practice registered nurse prescribing the medication, and its dosage; and

d. The ingestion, taking or application of prescribed medication, including nebulizers, shall be performed under the direct supervision and observation of the school nurse, principal, or principal's designee, who shall have successfully completed a District competency assessment pursuant to the Medication Aide Act and applicable state rules and regulations, and as directed by the physician, physician assistant, or advanced practice registered nurse. If the student’s parents or guardian have given written authorization, students will be allowed to possess and/or ingest glucose tablets as needed anywhere on school grounds and to possess and administer inhalers according to the provisions of Section II(F)(1) of this Rule.

3. Homeopathic Substances, Herbs, and Vitamins. Homeopathic substances, herbs, and vitamins shall not be administered by school staff unless prescribed by a physician, physician assistant, or advanced practice registered nurse and dispensed by a pharmacist or other person authorized by law. Homeopathic substances, herbs and vitamins, whether prescribed or non- prescribed, shall be subject to the same restrictions and requirements as prescribed medications.

C. Administration of Injections. Only school nurses and school personnel who have been trained to administer the Epi-Pen or Glucagon and are giving injections in emergency life-saving situations may administer injections at school.

1. Glucagon Injections. If a student requires administration of Glucagon in an emergency diabetic attack, school personnel will call 911. The Glucagon will be provided by the student’s parents or guardian. School personnel other than the school nurse may administer Glucagon injections only in emergency situations if they are trained by qualified personnel.

2. Epi-pen Injections. Students may use/carry Epi-Pens without supervision or monitoring by the school nurse or principal. The Epi- Pen must be a prescribed medication and the school nurse or principal shall have received written permission from the student’s parents or guardian as well as a written order from a physician, physician assistant, or advance practice registered nurse. All other injections that are given in response to an emergency should be given by a school nurse if available. An emergency medical unit and the student's parents or guardian shall be called.

3. Other Injections. If a student requires any injections during the school day, students may administer injections in the nurse’s office or an area designated by the principal or the principal’s designee. Parents may request that a school nurse administer injections if the student is incapable of self-administration. Parents shall submit requests to the Director of Student Services.

D. Record Keeping.

1. Authorization and Medical Directions File. The school nurse, principal, or principal's designee for each school shall keep a file which shall contain the following:

a. All authorizations required under this Rule;

b. All orders or instructions from a physician, physician assistant, or advanced practice registered nurse;

c. The dates that authorizations and/or orders of a physician, physician assistant, or advanced practice registered nurse are received; and

d. The date that medication is delivered to the nurse, principal, or principal's designee.

2. Daily Medication Documentation. In each school, a daily medication log shall be kept which shall contain the following:

a. The student's name;

b. The type of medication the student is authorized to have;

c. The dosage or directions for ingestion, taking, or application of the medication;

d. The name of the person supervising the student who is taking the medications

e. The time the medication is administered; and

f. Any refusal by the student to take and/or receive the medication.

E. Medical Information to be Provided to the District.

1. Medical Allergies, Seizures, and Susceptibility to Illness. If a student is either allergic to a certain medication or is prone to seizure or other illness, the student's parents, guardian, physician, physician assistant, or advanced practice registered nurse shall provide the District, in writing, with the following information on or by the first day of school:

a. The name of the medications to which the student is allergic;

b. The serious illnesses to which the student is susceptible; and

c. If the student is susceptible to an illness, what steps are to be taken by school personnel in the event the illness occurs.

2. Injections for Medical Emergencies. If a student is required to receive an injection for a medical emergency, the student's parents, guardian, physician, physician assistant, or advanced practice registered nurse shall notify the school, in writing, and provide the following information on or by the first day of school:

a. The name of the medication and its dosage; and

b. The method of administration (subcutaneous, intramuscular, intravenous, etc.).

F. Miscellaneous Provisions.

1. Inhalers. Students may use/carry inhalers without supervision or monitoring by the school nurse or principal. The inhaler must be a prescribed medication and the school nurse or principal shall have received written permission from the student's parents, guardian, as well as aĚýwritten order from aĚýphysician, physician assistant, or advanced practice registered nurse. This statement shall also include directions of appropriate inhaler usage. If school personnel observe a student using an inhaler in excess of the directions on the inhaler or with a frequency which would be considered unreasonable, it shall be reported to the school nurse or principal in which case the student's use of the inhaler shall be supervised by the school nurse or principal.

2. Containers. All medication shall be kept in its original container with its original label which describes the ingredients of the contents, recommends dosages, and provides appropriate warnings. The label must be legible and be written in English, or provide English translations.

3. Custody and Storage. All medication delivered to the school nurse or principal shall be stored in a container or refrigerator in the nurse's office, principal's office, or other area designated by the school principal. The storage area shall either be locked or under the control of a designated school employee.

4. Quantity. No more than a thirty (30) day supply of prescribed medication shall be provided and delivered to the school by the student, student's parents or guardian, unless there is a written order by a physician, physician assistant, or advanced practice registered nurse requiring a greater supply.

5. Transfer to Other Students. Students are prohibited from transferring, delivering, or receiving any medication to or from other students. Violation of this subsection will authorize the confiscation of the medication by the District, and subject the students to discipline.

6. Finger Stick Blood Test. Students who have been taught finger stick blood tests shall follow those procedures that they have been taught. Parents of students who have diabetes, and/or students who have diabetes, should notify the school nurse or principal at the beginning of the school year that the student is diabetic, and should provide the school nurse or principal with all information required under this Rule. Students may administer the finger stick blood test in the nurse’s office or in another area designated by the principal or the principal’s designee.

III. Student Discipline. If a student violates a provision of this Rule, the student shall be subject to discipline.

A. In addition, where appropriate, the following people shall be immediately notified of a violation of this Rule:

1. The school nurse, principal, or principal's designee;

2. The student's parents or guardian; and

3. The physician, physician assistant, or advanced practice registered nurse prescribing the medication if deemed necessary.

B. While notifications are being given, the student shall remain in the custody of the school nurse, principal, or principal's designee until necessary notifications have been made and until actions have been taken to eliminate any possible threat to the student or other students.

1. If medications have been improperly dispensed or ingested by the student or other students, the student’s physician, physician assistant, or advanced practice registered nurse shall be requested to give the proper medical directions to be followed by the school staff. Unless otherwise directed by the physician, physician assistant, or advanced practice registered nurse, the school nurse, and principal or principal’s designee shall determine what action if any shall be followed to insure the student(s)’ safety.

2. If the physician, physician assistant, or advanced practice registered nurse cannot be reached and the school nurse or principal determines that an emergency exists, emergency medical personnel shall be immediately called. The parents or guardian shall be notified of any action being taken.

IV. Definitions.

A. Emergency medical personnel. Emergency medical personnel shall mean medical personnel who can respond to a medical emergency.

B. Medication. Medication shall be broadly defined and shall include:

1. All prescribed medications, over the counter and other non- prescribed medications, and all chemical substances, compounds, homeopathic substances, herbs, vitamins, and/or devices, which purport to aid in a person’s health or well-being or are intended for use in the diagnoses, cure, mitigation, treatment, or prevention of diseases, or are intended to affect the structure or any function of the body; and

2. Any device, instrument, apparatus, implement, machine,Ěý
contrivance, implant, or other similar or related article, including any component part or accessory, which is prescribed by a physician, physician assistant, or advanced practice registered nurse and dispensed by a pharmacist or other person authorized by law.

C. Physician. Physician shall mean individuals who are licensed by the Department of Health and Human Services Regulations and Licensure as:

1. Medical Doctors (M.D.) who practice medicine and/or surgery; or

2. Osteopathic Physicians (D.O.) who are also authorized to prescribe medications.

D. Advanced practice registered nurse. Advanced practice registered nurse shall mean individuals who are licensed and practicing under and in accordance with the Advanced Practice Registered Nurse Act.

E. Physician assistant. Physician assistant shall mean individuals who are licensed under Neb. Rev. Stat. §§ 38-2046 through 38-2055 to perform medical services under the supervision of a licensed physician.

F. Qualified personnel.ĚýQualified personnel shall mean individuals who have met an educational or legal requirement necessary to administer emergency injections.
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