ADMINISTRATION OF MEDICATION AT SCHOOL

Many children are able to attend school because of the effectiveness of medications in treating many chronic health conditions and long and short-term illnesses. If possible, all medications, including Medical Cannabis, should be given at home. If medications must be given during school hours, they shall be administered in compliance with the New Mexico Administrative Code, New Mexico Nursing Practice Act, New Mexico School Health Manual Standards, and this policy.

This policy applies to prescription medications, non-prescription (i.e., over-the-counter) medications, and Medical Cannabis. It is designed to ensure maximum protection for all students- those who receive medications at school and those who do not. The District reserves the right, in accordance with procedures established by the Superintendent, to circumscribe or disallow the use or administration of any medication on school premises if the threat of abuse or misuse of the medicine may pose a risk of harm to a member or members of the student population.

Medication shall be dispensed and/or administered only according to this policy, and the district shall not be liable for failure to properly dispense medication or allow the administration of same when the parent/guardian and/or student have not complied with this policy.

A. Definitions

For purposes of this policy, the following definitions apply:

1.  “Certifying Practitioner” means a health care practitioner who is licensed in New Mexico to diagnose a Qualified Patient and recommend Medical Cannabis as a course of treatment, for a Qualified Student;

2.  “Diabetes” means type one or type two diabetes mellitus; complications related to diabetes mellitus; or prediabetes;

3.  “Diabetes Care Personnel” means a school employee who volunteers to be trained and is trained in accordance with Section 3 of the Student Diabetes Management Act;

4.  “Diabetes Medical Management Plan” means a document that a student’s personal health care practitioner and parent or guardian develops that sets out the health services that the student needs at school and that is signed by the student’s health care practitioner and parent or guardian;

5.  “Diabetes Supervisory Personnel” means a school employee who is trained to recognize the signs and symptoms of hypoglycemia and hyperglycemia and understands the actions to take in response to diabetes-related emergency situations;

6.  Qualified Student

7.  “Health Care Practitioner” means a person authorized under New Mexico law to prescribe medication for the treatment of associated medical conditions;

8. “Medical Cannabis” means cannabis that is:

a.  recommended for treatment of a student’s debilitating medical condition as defined in the Lynn and Erin Compassionate Use Act, in a written certification by a Certifying Practitioner;

b.  dispensed by a cannabis producer that has received approval from the New Mexico Department of Health to conduct sales of Medical Cannabis;

c.  is in the form of a capsule, extract, or concentrate to be ingested through the mouth that:

i. may be safely divided into measurable doses;

ii. is not an aerosol product consumable through smoking or in particulate form as a vapor or by burning;

iii. is not a food or beverage product;

iv. is not a salve, balm or other topical product;

v. does not require refrigerated storage; and

d.   is authorized to be possessed, stored, and/or administered in the school building by a Qualified Student’s Primary Caregiver and carried to a school in package or container clearly labeled with:

i. the student’s name and date of birth; and

ii. the recommended dosage allotment.

9.  “Medication” means a drug as that term is defined in Section 201 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321) and includes inhaled bronchodilators, inhaled corticosteroids and auto-injectable epinephrine;

10.  “Prescription” means a qualified health care practitioner’s written information, affixed to the dispensing container of a medication and which includes, at a minimum: (a) name of the medication; (b) date of prescription and prescription number; (c) name of the student for whom the medication is prescribed; (d) name of the prescribing health care practitioner; and (e) dosage and time of administration.

11.  “Primary Caregiver” means a parent, guardian or other person designated by a Certifying Practitioner as taking responsibility for managing the well-being of a Qualified Student authorized as a Qualified Patient with respect to the medical use of cannabis pursuant to the provisions of the Lynn and Erin Compassionate Use

12.  “Qualified Patient” means a person who has:

a.  been diagnosed by a Certifying Practitioner;

b.  received written certification from a Certifying Practitioner; and

c.  is currently enrolled in the New Mexico Department of Health’s Medical Cannabis program and has received a current and valid registry identification card pursuant to the Lynn and Erin Compassionate Use Act.

13.  “Qualified Student” means a student who demonstrates evidence to the District that the student is authorized as a Qualified Patient pursuant to the Lynn and Erin Compassionate Use Act to carry and use Medical Cannabis;

14.  “school setting” means any of the following locations during a school day:

a.  a school building;

b.  a school bus used within the state during, in transit to or in transit from a school-sponsored activity;

c.  a public vehicle used within the state during, in transit to or in transit from a school-sponsored activity in the state; or

d. a public site in the state where a school-sponsored activity takes place.

15.  “Self-administration” means a student’s authorized discretionary use of his or her prescribed medication(s), pursuant to a prescription from a health care practitioner and in accordance with District policy and procedures;

16.  “Written Certification” means a statement written by a Qualified Student’s Certifying Practitioner, which is not valid for more than one year from the date of issuance:

a.  in a Qualified Student’s medical records or in the Written Treatment Plan statement;

b.  certifying that the Qualified Student has a debilitating medical condition pursuant to the Lynn and Erin Compassionate Use Act;

c.  certifying that the Certifying Practitioner believes that the potential health benefits of the medical use of cannabis would likely outweigh the health risks for the Qualified Student; and

d.  signed by the Certifying Practitioner.

17.  “Written Treatment Plan” means a document developed by the Primary Caregiver in collaboration with the Certifying Practitioner that:

a.  includes the certifying Practitioner’s diagnosis and description of the Qualified Student’s debilitating medical condition per the Lynn and Erin Compassionate Use Act;

b.  describes the plan for recommended treatment with the Medical Cannabis, including

i. The recommended dosage allotment

ii. The recommended frequency of administration of Medical Cannabis in a school building, and,

iii. Is signed by the Primary Caregiver and Certifying Practitioner.

B. Parent Responsibilities

1.  Prescription and Over-the-Counter Medication Authorization Forms:

The parent/guardian and a licensed health care practitioner with prescriptive rights must annually sign an Authorization to Administer Medication form to administer prescription medications. For over-the-counter medications, the parent/guardian must annually sign the Authorization to Administer Over-the-Counter Medication form. In addition, the parent/guardian must provide a new Authorization to Administer Over- the-Counter Medication form for each medication to be administered at school and each time changes occur in the medication or dosage. When discontinuing a medication, the parent guardian must provide a written request for discontinuation of medication.

The Public Education Department licensed school nurse (“school nurse”) shall review every Authorization to Administer Medication form for compliance with the form’s requirements.

2.  Provision of Medication:

The parent/guardian must provide prescription and over-the counter medications directly to the school nurse. A student is not permitted to transport prescription medications to school unless all requirements for self-carrying and self-administration of medication have been met.

a.  For prescription medications, the parent/guardian must provide the school nurse each medication in its own pharmacy-labeled container with the name of the medication, strength and current dosage, scheduled administration, name of the student and name of the prescribing health care practitioner.

b.  Meant for over-the-counter medications, the parent/guardian must provide the medication in the manufacturer’s original packaging that contains the age/weight/dosage ratios and administering instructions.

3.  Administration of Medical Cannabis:

School personnel may not possess, store, or administer Medical Cannabis. Medical Cannabis cannot be stored in a School Setting.

Medical cannabis may only be possessed and administered by the Primary Caregiver of a Qualified Student in accordance with state law, district policy and this regulation. A Qualified Student is not entitled to the implementation of the provisions of Section 22-33-5 NMSA 1978 and this rule, as well as the Lynn and Erin Compassionate Use Act and applicable department of health rules, outside of this state. Medical cannabis cannot be possessed or administered on a school bus.

Prior to any Primary Caregiver’s possession or administration of Medical Cannabis on Rio Rancho Public Schools (RRPS) property, parents or legal guardians of a Qualified Student must provide the principal with the following for the current school year:

a. a copy of the Qualified Student’s valid, signed written certification for use of Medical Cannabis pursuant to the Lynn and Erin Compassionate Use Act;

b. a copy of the Qualified Student’s New Mexico Department of Health (NMDOH) issued ID card, which includes the name of the Primary Caregiver;

c. a Written Treatment Plan on a form approved by RRPS, prepared by the student’s health care practitioner, and agreed to by the school administration, that affirms the student’s qualifying debilitating medical condition, provides the recommended dosage allotment and frequency of administration (including the amount of THC and/or CBD per dose) , and is signed by the Primary Caregiver and the Certifying Practitioner;

d. from the NMDOH regarding the enrollment status of the Qualified Student in the NMDOH’s Medical Cannabis Program; and,

e. a written release from the Qualified Student’s parent or legal guardian in the form approved by the District that releases from civil liability RRPS, RRPS personnel and volunteers, schools, school personnel and volunteers, RRPS school board, and school board members from any liability and reimbursement claims for costs associated with accidental spillage or waste of medical cannabis;

f. a signed Health Insurance Portability and Accountability Act (HIPAA) authorization from the Primary Caregiver, using the HIPAA authorization form posted on the New Mexico department of health’s website, that permits the school to obtain current information from the department of health regarding the enrollment status of the qualified student in the department of health’s medical cannabis program. The HIPAA authorization form shall be retained as a medical record;

A written certification and a Written Treatment Plan shall be valid for no more than one year from the date of issuance and shall be presented to the school at, or prior to, the beginning of the school year for which the written certification and Written Treatment Plan shall apply, or prior to the date the student begins attendance at RRPS.

All administration of Medical Cannabis to Qualified Students shall be in accordance with the written certification for use of Medical Cannabis and the Written Treatment Plan from the student’s health care practitioner. No student may possess, store, or self-administer medical cannabis, and no Primary Caregiver may possessor administer Medical Cannabis to a Qualified Student in a manner that disrupts the educational environment or causes other students to be exposed to Medical Cannabis.

All Medical Cannabis to be possessed and administered to a Qualified Student, in accordance with this regulation, shall be in a new package or container from an authorized dispensary with clearly labeled identifiers including the Qualified Student’s name, date of birth, dosage allotment, and the amount of THC and/or CBD.

A Qualified Student who uses Medical Cannabis in the morning before school, at school, or during a school event, will not be permitted to drive a motor vehicle on District property. No student may use or be under the influence of a cannabis product in a manner inconsistent with provisions of the Lynn and Erin Compassionate Use Act.

In the event of spillage or waste of Medical Cannabis in the school setting, on that same day, the Primary Caregiver must be notified and must clean up and remove the cannabis completely and document same.

No school employee who refuses to possess, store, or administer Medical Cannabis under this regulation, and related district policy, shall be disciplined by RRPS.

4. Back-Up Medication:

The parent/guardian of a student who is allowed to self-carry and self-administer asthma medication and/or emergency anaphylaxis medication may provide the school with back-up medication that shall be kept in a location to which the student has immediate access in the event of an asthma or anaphylaxis emergency.

B.  Methods of Administering Prescription Medication

Each student who is administered prescription medication at school (including self- administered) shall have a Health Management Plan. The school nurse shall work with the parent/guardian to develop the Health Management Plan based on the students Health Care Practitioner’s medical orders for each student who receives medication at school.

The following medication administration options are available and may be considered when developing a Health Management Plan and obtaining signed Authorization to Administer Medication forms for administering medication at school:

1.  A parent/legal guardian may visit the school to administer the prescribed medication to the student, in a location approved by the Principal or Principal’s designee, and bring the medication to and from school on each visit.

2.  A student who has a medical diagnosis of asthma or an anaphylaxis-associated medical condition and complies with the New Mexico Administrative Code (NMAC 6.12.2.9 and NMAC 11.14.05) to self-assess, carry and self-administer related and prescribed medication(s) under the following conditions:

a. The health care practitioner has prescribed the medication for use by the student during school hours.

b. The health care practitioner has instructed the student in the correct and responsible use of the medication.

c. The student has demonstrated to the health care practitioner and the school nurse the skill level necessary to use the medication and any device that is necessary to administer such medication as prescribed.

d. The health care practitioner has formulated a Written Treatment Plan for managing the asthma or anaphylaxis episodes of the student and for medication use by the student during school hours or school-sponsored activities, including transit to or from school or school-sponsored activities.

e.  The parent/guardian has provided all required documentation to the school nurse, including, but not limited to, a signed Authorization to Administer Medication form and the health care practitioner’s Written Treatment Plan.

f.  The parent/guardian has provided a signed statement acknowledging that, notwithstanding any provision of state law to the contrary, the school (including its employees and agents) is to incur no liability as a result of any injury arising from such self-administration (including self-carrying) of medication and the parent or guardian will indemnify and hold harmless the school (including its employees and agents) against any claim arising out of such self-administration (including self-carrying) of medication.

g.  The authorization is effective only for the school year for which it is granted and shall be renewed by the parent or guardian each subsequent school year.

The parent/guardian of a student who is allowed to self-carry and self-administer asthma medication and emergency anaphylaxis medication may provide the school with back-up medication that shall be kept in a location to which the student has immediate access in the event of an asthma or anaphylaxis emergency. The school nurse shall develop procedures to address the safekeeping of back-up medication in a manner that ensures the medication is easily accessible by the student.

Authorized school personnel who in case of an emergency and in good faith provide a person with back-up asthma medication and/or emergency anaphylaxis medication, equipment, or supplies are to incur no liability as a result of providing the materials and medication to an authorized student or individual.

3.  In accordance with the request of a parent or guardian of a student with diabetes and the student’s Diabetes Medical Management Plan, a school nurse or, in the absence of a school nurse, Diabetes Care Personnel shall perform diabetes care functions that shall include, at a minimum:

a. Checking and recording the student’s blood glucose levels and ketone levels or assisting the student with checking and recording these levels;

b. Responding to blood glucose levels that are outside of the student’s target range;

c. Administering glucagon and other emergency treatments as prescribed;

d. Administering insulin or assisting the student in administering insulin through the insulin delivery system that the student uses;

e. Providing oral diabetes medications; and

f. Following instructions regarding meals, snacks, and physical activity.

A school nurse or at least one Diabetes Care Personnel shall be at each school where a student with diabetes is attending and shall be available to provide care to each student with diabetes during regular school hours and during all school- sponsored activities, trips, extended offsite excursions and extracurricular activities in which the student with diabetes is a participant and on buses where the bus driver has not been trained in diabetes care and a student with diabetes is a passenger.

Students with diabetes shall attend the school they would otherwise attend if they did not have diabetes. A student shall not be restricted from attending any school on the basis that the student has diabetes, that the school does not have a school nurse, or that the school does not have trained diabetes care personnel. A school shall not require or pressure parents or guardians to provide diabetes care for a student with diabetes at a school or school-related activities.

4.  Self-assessment and self-administration of diabetes treatment medications:

Upon the written request of a parent or guardian of a student with diabetes and authorization by the student’s Diabetes Medical Management Plan, a student with diabetes shall be permitted to:

a. Perform blood glucose checks,

b. Administer insulin through the insulin delivery system that the student uses;

c. Treat hypoglycemia and hyperglycemia; and

d. Otherwise attend to the care of the student’s diabetes in the classroom, in any area of the school or school grounds.

A student with diabetes shall be permitted to possess on the student’s person at all times all necessary supplies and equipment to perform these monitoring and treatment functions. If the student’s parent or guardian or the student requests, the student shall have access to a private area for performing diabetes care tasks.

Students are allowed to self-carry and use equipment and supplies, for storage and disposal of sharps, for self-assessment and for self-administration of diabetes treatment medications that have been legally prescribed to the student by a licensed health care practitioner under the following conditions:

a. The Health Care Practitioner has prescribed the medication for use by the student during school hours.

b. The Health Care Practitioner has directed the instruction of the student in the correct and responsible use of the medication, and approved the student's ability to perform self-assessment and medication self-administration.

c. The student has demonstrated to the school nurse the skill level and developmental level necessary to correctly store and use any equipment and supplies required to perform self-assessment and self-administration of such medication as prescribed by the Health Care Practitioner.

d. The school, with input from the parent/guardian and based on the student’s Health Care Practitioner’s medical orders, has formulated a written Health Management Plan for management of diabetes care for the student that includes but is not limited to the correct storage and disposal of sharps by the student, the performance of self-assessment procedures, and the self- administration of medication.

e.  The parent/guardian has provided all required documentation to the school nurse, including, but not limited to, a signed Diabetes Medical Management Plan.

f.  The parent/guardian has provided a signed statement acknowledging that, notwithstanding any provision of state law to the contrary, the school (including its employees and agents) is to incur no liability as a result of any injury arising from the performance of self-assessment procedures and the self-administration of medication nor from any injury arising from the student carrying and disposing of equipment and supplies to perform these procedures, and the parent/guardian will indemnify and hold harmless the school, including its employees and agents, against any claim arising out of the performance of these procedures or storing and disposing of equipment and supplies to perform them.

g.  The authorization is effective only for the school year for which it is granted and shall be renewed by the parent or guardian each subsequent school year; and

h.  The student may lose these rights if, as determined by the school nurse and the school administrator, endangerment to the student's person or other persons occurs through the misuse of equipment, supplies, or medication or if the student's self-administration of medication is inconsistent with the prescribed dosage.

5. Over-the-Counter (OTC) Medication

Students may receive OTC medication, provided that the parent/guardian has submitted a signed Authorization to Administer Over-the-Counter Medication form for the administration (including self-administration) of OTC medication and supplied the school nurse with the medication in the manufacturer’s original packaging. The school nurse may develop procedures by which a school nurse may administer OTC medication without a signed authorization only if:

The school nurse believes in his/her professional judgment that administering the nonprescription medication will alleviate the student’s condition; and The school nurse obtains telephonic permission from the parent/guardian prior to administering the medication. The telephonic permission shall be witnessed by at least one other person, and all witnesses shall document that permission was given and sign the documentation form.

6.  Administration by an adult affiliated with school operations who has been delegated by the school nurse to administer the medication:

The school nurse may transfer to such competent individual, the authority to administer prescription or OTC medication to a student if the following conditions are met:

a. The person is prepared, qualified, licensed, or certified to perform the delegated activity.

b. The nurse is accountable for assessing the situation and is responsible for the decision to delegate or make the assignment.

c. The delegating nurse is accountable for each activity delegated, for supervising the delegated activity, and for assessing the outcome of the delegated activity.

The nurse may not delegate the specific functions of nursing assessment, evaluation and nursing judgment; however, registered nurses engaged in school nursing practice may delegate medication administration, including emergency medication, to adults affiliated with school operations.

7.  Administration by the School Nurse:

A school nurse is licensed to administer prescription or OTC medications according to FDA labels. When administering such medication, the school nurse shall assess the student’s health status and disease process before and after the administration of the medication and to evaluate the student’s response to the drug or biologic agent. If a student is either too young or incapable of administering his or her own medication even with assistance, arrangements shall be made with the school nurse to either administer the medication directly to the student or delegate the administration of medication.

D. Field Trips

1.  If a student must receive medication while on a school-sponsored field trip, the parent/guardian shall notify the school nurse and the student’s teacher that the student will require medication during the field trip. The school nurse should work with the student’s teacher and parent/guardian to develop a Health Management Plan which may include any of the methods of administering medication under this policy, as appropriate. The parent/guardian shall bring to the school a separate single dose field trip supply of medications, in an original pharmacy-labeled container prepared by a pharmacist for the scheduled field trip. These medications should not come from the individual student's supply held at school.

2.  If a Qualified Student’s Written Treatment Plan requires administration of Medical Cannabis on in-state field trips or school sponsored-events, the Qualified Student’s Primary Caregiver must transport and administer such Medical Cannabis. Such transportation and administration may not disrupt the educational environment or causes other students to be exposed to Medical Cannabis. No student or Primary Caregiver may possess, use, distribute, sell or be under the influence of a cannabis product in a manner that is inconsistent with the provisions of state law, district policy and district regulation.

E. Transportation:

1.  The school nurse shall develop procedures to ensure the safe and secure transport of medications when emergency medications are transported to school, from school, and in an emergency evacuation during the school day. These procedures shall include the designated place for transport and the personnel authorized to administer medication during transport when necessary.

2.  When medications must be administered during transport, the school nurse shall work with the student’s teacher and parent/guardian to develop a Health Management Plan which may include any of the methods of administering medication under this policy as appropriate.

F. Medication Storage:

1.  Prescription and OTC medications shall be stored in a central location within a locked cabinet in a secured area; in a cool, dark place, unless otherwise indicated. An exception is self-administered medication that students have permission to keep in their possession (self-carry).

2.  Prescription and OTC medications that require refrigeration are kept in a separate locked box within a refrigerator, a locked refrigerator, or a refrigerator in a locked room.

3.  All prescription and OTC medications should be kept in original pharmacy-labeled containers provided by the dispensing pharmacy/provider or the manufacturer.

4.  Medical cannabis may not be stored in a School Setting. Medical cannabis may only be possessed and administered by the Primary Caregiver of a Qualified Student, in accordance with state law, district policy and this regulation.

5.  At the end of the school year, or at the time of a student’s early withdrawal, transfer, disenrollment or graduation, whichever occurs first,, unused prescription medication shall be returned to the parent/guardian or disposed of in accordance with the School Health Manual Procedures.

6.  The district shall not be responsible for loss or damage of medications due to theft.

G. Documentation and Record Keeping:

1.  Written Treatment Plans, Authorization to Administer Medication forms, and other records related to medication administration including self-carry and self-administration shall be kept on file at the student’s school in a location easily accessible by authorized individuals who have a legitimate need to know and in the event of an emergency including an asthma or anaphylaxis emergency. The school nurse shall develop procedures to address the safekeeping and confidentiality of the required information consistent with board policy relating to student records.

2.  The school nurse shall develop procedures pursuant to which the administration of medication shall be fully documented for each student who receives medication at school. Unless the student is self-carrying and self-administering, such procedures shall include entering in the student’s record the date, time, and dosage, and initials of the staff member administering or assisting with the self-administration of the medication. Documentation shall be made in ink or electronically and signed by each person who administers or supervises the self-administration of medication. Procedures also shall be developed to address the documentation of medication errors, missed doses of medication, and the maintenance and administration of controlled substance, as the term is defined in Schedules I.

3.  The medication log and accompanying documentation shall become a part of the student’s permanent health record for the parent/guardian and health care practitioner and shall be maintained in accordance with the confidentiality requirements of state and federal laws.

H. Students with Health Management Plans, Section 504 Plans and Individualized Education Programs

1.  “Health Management Plan” (HMP) means a written plan that identifies the student’s health care needs and is developed by the school nurse cooperatively with the student and parent or guardian based on the orders provided by the student’s health care practitioner.

2.  An HMP shall be developed for students who require accommodations and health care during the school day. One example is students with diabetes who require care to manage their diabetes during the school day. The student’s HMP shall incorporate his or her Medical Management Plan.

3.  If the student has a Section 504 Plan or an Individualized Education Program (IEP), the HMP shall be reviewed by the Section 504 Committee or IEP Team and included as part of the IEP or Section 504 Plan.

I. Training

RRPS shall provide annual training on the district’s medical administration policy and procedures. Training shall include annual diabetes training pursuant to NMAC 6.12.11 for all school nurses, at least two Diabetes Care Personnel, all Diabetes Supervisory Personnel at each school attended by a student with diabetes, and bus drivers as required by law.

LEGAL REFERENCE:
NMSA 22-33-1 et seq.
NMSA 22-34-1 et seq.
NMAC 6.12.10
NMAC 6.12.11

Rio Rancho Public Schools
Adopted: August 13, 2018

Previous policy adoption history

Adopted: August 8, 1994
Revised: December 13, 1999
Reviewed & Revised: August 27, 2007
Reviewed and Revised: November 18, 2019