5141.1

Students

 

Accidents

 

First Aid

 

First aid kits will be located in shops, laboratories and other designated areas where warranted by the Principal.

 

Any teacher rendering first‑aid to a child shall report it to the nurse and building principal. Teachers will refer cases of first‑aid which s/he judges to be beyond his/her ability to the nurse or Principal.

 

The nurse, Principal and teacher shall advise one another of accidents, situations requiring medical attention, and medical situations which may require the exclusion from school.

 

Immediate Medical Treatment

 

If a child's condition requires immediate medical treatment, the Communications Center will be called.

 

If a child's condition is such that it requires a physician's examination, the family should be notified and asked to call a physician. This action is the responsibility of the nurse, if present, or the Principal or teacher.

 

Legal Reference:         Connecticut General Statutes

 

52‑557b, Emergency medical assistance, no liability for ordinary negligence.

 

10‑205 Appointment of school medical advisors.

 

10‑207 Duties of medical advisors.

 

Regulation approved:     June 15, 1992                                CLINTON PUBLIC SCHOOLS

Regulation revised:        August 16, 1999                              Clinton, Connecticut

5141.2

 

Students

 

Illness

 

Exclusion

 

Any student or school personnel showing symptoms of an infectious disease may be excluded from the playground, school or office during the illness. A suspected illness of a student should be noted by the teacher and reported to the nurse. The decision to exclude a child for illness shall be made by the Principal after consultation with the school nurse.

 

True exclusion begins with the education of the parent to keep the ill child home to assure a speedy, uncomplicated recovery and to protect other students. Children may be excluded from school according to the guidelines in the Board of Education approved Student Handbook or Student Planner issued by the school medical advisor to school personnel.

 

Readmission

 

When a student returns to school after five or more days of illness, s/he should be seen by the school nurse for readmission. A teacher can refer a student, who has been out less than five days, to the school nurse for readmission.

 

(cf. 5141.22 ‑ Communicable/Infectious Diseases)

 

Regulation approved:  August 17, 1992                          CLINTON PUBLIC SCHOOLS

Regulation revised:    August 16, 1999                                  Clinton, Connecticut

5141.21(a)

Students

 

Administration of Medicine

 

Personnel Allowed to Administer Medication

 

The school nurse may administer prescribed oral, topical, inhalant and injectable medication.

 

In the absence of the school nurse, the properly trained and approved Principal (with second person present) may give medications. A teacher who is properly trained and approved will also be designated at each school to administer medication (with second person present) in the absence of Principal and nurse.  A current list of those authorized to administer medication shall be maintained at each school.

 

Self‑administration will be allowed for a self‑reliant student to administer medication for wheezing or anaphylaxis .

 

Any school staff member observing a student carrying or using medication must report it to the school nurse for appropriate follow‑up.

 

TRAINING

 

1. The Principal or teacher shall have received training in the safe administration of medication from the school nurse or a physician licensed to practice medicine.

 

A.        Training shall include but not be limited to the procedural aspects of medication administration, the safe handling and storage of medications and recording, the medication needs of specific students, medication idiosyncrasies, desired effects, potential side effects or untoward reactions.

 

B.        Documentation that such training has been provided and successfully completed shall be maintained and annually updated by the Board of Education. In addition the Board of Education shall maintain and annually update a list of Principals and teachers who have been trained in the administration of medication, they shall provide for a review and informational update for Principals and teachers to be done at least annually.

 

5141.21(b)

Students

 

Administration of Medication

 

TRAINING (continued)

 

2.  Designated personnel shall have completed a course in first aid offered by the American Red Cross, the American Heart Association or developed by the school medical advisor and the local director of health and certified by the director of health which will include instruction in the administration of medication by injection given by the school medical advisor or by another licensed physician.

 

Self‑Administration of Medicines

 

A self‑reliant student in grades 6 through 12 may carry medication for wheezing or anaphylactic reaction on his/her person in the event s/he would need it immediately to avoid a life‑threatening situation. However, there are certain guidelines to be met:

 

1.         That there be written authorization from the parent (or guardian) stating s/he wishes the child to administer his/her own medication and that the parent (or guardian) assumes responsibility for granting this permission.

 

2.         That there be a written authorization from the child's physician or dentist indicating that in his/her judgment the child is capable of self‑administration. Such statement should also include date of diagnosis, drug dosage, and frequency to be taken.

 

3.         The nurse and appropriate personnel be informed of diagnosis and medication and back-up medication be supplied for the nurse's office.

 

4.         The physician's and parent’s (or guardian’s) authorization statements be kept on file in the student's cumulative health record.

 

5.         The nurse counsel and assess the student relative to his/her understanding of his/her diagnosis, medication and importance of taking medication as prescribed and the student then sign the permission sheet.

 

6.         The administration reserves the right to revoke this privilege in the event that the above proper guidelines are not adhered to or if the medicine is not being taken properly.

 

7.         On a field trip, a parent (or guardian) or designee or a trained person must accompany the student, grades PK-12, as a back-up.  In accordance with Section 504, school trips may be cancelled if back-up person is unavailable to accompany the student.

 

 

5141.21(c)

Students

 

Administration of Medication

 

Storage

 

1.          Only currently prescribed medication shall be kept in a designated medication storage area

            maintained by the school nurse.

 

2.         Controlled drugs (as identified by pharmacist, physician, dentist, or State Drug Control Division) shall be kept separate from other drugs in a secure, double-locked metal or wood cabinet with nurse and/or Principal responsible for key.

 

3.         Medication requiring refrigeration shall be stored at temperatures no less than 36° and no more than 46°F.

 

4.         The location of medication for anaphylactic reactions shall be known to involved persons including student.

 

Procedure for Administration of Medication

1.  Diagnosed Conditions

A.  The prescribing medical physician, dentist, advanced practice registered nurse or physician assistant licensed to practice in the United States, must submit a written order for each medication. No verbal orders will be accepted. Forms for these orders are available from the school's health office. All medication orders shall be renewed each school year.

 

B.  The parent  (or guardian) must also sign the above written authorization for medication.

 

C.  The parent (or guardian) must deliver the medication directly to the nurse or Principal.

 

D.  The medicine must be in an original container labeled with the name of patient, the name and strength of medication, the name of prescribing physician, the date of the original prescription, duration of order, and directions for administering. No more than a one‑month supply of prescribed medication shall be kept at school. The nurse should record medication and quantity received.

 

E.   If a student refuses to take medication, if it is not given as prescribed, or if it is lost or spoiled, this should be recorded and the parent (or guardian) notified.

 

F.   Drugs for a student participating in a research protocol under the direction of his/her physician may only be administered by the school nurse or the parent (or guardian).

 

2.  Undiagnosed Conditions

Designated personnel, as cited in section “TRAINING,” section 2, shall follow the Emergency Health Care Plan issued by the School Medical Advisor.

 

5141.21(d)

Students

 

Administration of Medication

 

Procedure for Recording the Administration of Medication

 

1.         Medication administration records shall be maintained for each student receiving medication

during school hours. All entries shall be made in black ink and include student's name, name of medication, dosage of medication, route of administration, frequency of administration, name of prescribing physician, name of parent (or guardian) requesting medication in case of administration of aspirin or aspirin substitute, date medication was ordered, quantity received, date medication is to be reordered, student allergies to food and/or medicine, date and time of administration or omission including reason for omission, full legal signature of the nurse, Principal, or teacher administering the medication.

 

2.         A completed medication administration record should be filed yearly in cumulative health record for each child on medication.

 

3.         When administering a controlled drug on a long-term basis, i.e. longer than one month, a monthly contact by the nurse with the prescribing physician/dentist is suggested. Any change of dosage or duration is to be confirmed in writing by the physician/dentist.

 

4.         The written order of the medical physician, dentist, APRN/PA, Physician Assistant or Treatment Facility and written authorization of the parent (or guardian) shall be filed with student's cumulative health record and kept at least three years.

 

5.     Medication errors will be reported immediately to the parent (or guardian), school nurse,   the prescribing physician, and the school medical advisor.  Medical treatment, when           required as a result of such an error, will be under the direction of the physician and in consultation with the school medical advisor.

 

6.           Medication errors will also be recorded on an accident/incident report form and

            Documented in the student's cumulative health record.

 

7.         In the event of a medication emergency, the following information will be readily available and posted:

 

A.        The local poison information center telephone number;

 

B.        The medical physician, dentist, APRN/PA, Physician Assistant or Treatment Facility to contact in the event of a medication emergency;

 

C.        The name of the person responsible for decision making in the absence of the school nurse.

 

5141.21(e)

Students

 

Administration of Medication

 

Procedure for Recording the Administration of Medication

 

8.           The school nurse will review monthly all medication administration documentation

            Pertaining to the administration of medication by students.

 

9.         The school nurse will also perform periodic worksite observations of medication administration by teachers and Principals who have been trained.

 

 

Administration of Medication on Field Trips

 

1.         The school nurse shall prepare a single dose of medication, place it in an appropriately

labeled envelope and give it to the person trained to administer it during a field trip.

 

2.         The documentation of administration shall be made on an individual medication record

which shall be affixed to the individual medication administration record upon returning to

school.

 

3.         Multiple doses of medication must be transported in a limited quantity (travel pack)

prescription obtained from a pharmacist.  Each limited quantity prescription must have its

own proof of use record for controlled substances.

 

4.         Medication must be stored on the person of the individual designated to administer it or in

a locked box placed in a safe location.

 

 

Disposal of Medication

 

1.         Unused non‑controlled substances shall be picked up by the parent (or guardian) or responsible adult within one week after the parent (or guardian) has been notified or substance disposed of by school nurse  in presence of witness and disposition recorded.

 

2.         Discontinued or surplus controlled substances will be disposed of by the school nurse in the presence of a representative from the Department of Consumer Protection, Drug Control Division

.

5141.21f

Emergency Health Care Plan

 

Standing Order for Allergic Reaction – Anaphylaxis*

*Severe allergic reaction which may occur from insect bite, drug allergy, or food allergy.  Exposure may be by ingestion, inhalation or injection.

 

PROCEDURE

 

I.       Known Reactor:    Always check for individual physician’s orders and give the prescribed

drug and dosage.  DO NOT wait for symptoms to appear, particularly in cases of peanut

allergy, in known sensitive person.  Notify physician.  Follow procedures IV and V below.

 

II.    Unknown Reactor:            Call child’s physician or the school medical advisor immediately. 

Assess patient – some or all of the following symptoms may be present:

 

A.    Exhibiting respiratory difficulties:  Cough, wheezing, painful breathing, tightness

in chest, may cease to breath.

 

1.      Administer EpiPen according to dosage below.

2.      Administer Benadryl according to dosage below.

 

B.     No Respiratory Difficulties:

 

1.      Administer Benadryl according to dosage below.

2.      If respiratory difficulty develops, administer EpiPen according to dosage below.

 

C.     Other Symptoms:

 

1.      Skin:                      Cold and moist to touch, itching, hives, may be present over

body.

2.      Color:                    Flushed or pale at first, then mottled or bluish.

3.      Pulse:                     Rapid at first, may be faint.

4.      Blood Pressure:     Low or unattainable.

5.      Also:                      Restlessness, severe headache, severe nausea, vomiting and

diarrhea, abdominal cramping, fainting, unconsciousness.

 

III. Dosages:

 

A.    EPINEPHRINE:  From Anakit, EpiPen or EpiPen, Jr., per following instructions if

patient is wheezing or having difficulty breathing and no other MD order is available.

 

1.      First Dose:

 

a)      Person over 45 lbs. (grade 3 or above):     Give 0.3cc (0.3 mg) epinephrine         (EpiPen or Anakit) U.S.P. 1:1000 subcutaneously.

 

 

5141.21g

Emergency Health Care Plan (continued)

Standing Order for Allergic Reaction – Anaphylaxis*

*Severe allergic reaction which may occur from insect bite, drug allergy, or food allergy.  Exposure may be by ingestion, inhalation or injection.

 

b)      Person under 45 lbs. (or for all K-2 graders if weight is unknown):        Give 0.3cc (0.15mg) epinephrine (EpiPen Jr.) U.S.P. 1:2000 subcutaneously.

 

2.      Second Dose:        Repeat the injection as above in 10 minutes if no improvement, if deterioration, and if ambulance has not arrived.

 

B.     BENADRYL:

 

Person over 45 lbs.:     4 tsp. (50 mg) elixir or two 25 mg capsules

Person under 45 lbs.:   2 tsp. (50 mg) elixir or one 25 mg capsule

 

IV. Monitor Patient:

 

A.    If indicated, administer epinephrine according to above dosages.

 

B.     Call 911 after administering EpiPen.  Monitor airway.  Be prepared to do CPR.

 

C.     Call parent/guardian.

 

V.    Other Measures:

 

A.    Lay patient down flat, elevate feet 8 – 10” above heart level unless foot is site of insect bite.

 

B.     If insect bite:

 

1.      If bee sting, look for stinger and carefully scrape out.  Do not push, pull, or squeeze with tweezers or imbed stinger.

 

2.      Keep affected part down below level of victim’s heart.

 

3.      Cover patient and keep from losing body heat.  Do not add extra heat.

 

C.     Notify school medical advisor and nursing supervisor if anaphylaxis occurs.

 

Per order of:                ___________________________________________________

                                    Martin W. Sklaire, MD                                               Date

                                    School Medical Advisor

 

5141.21h

PHYSICIAN ORDERS

 

Ingestion of Poisonous Substances

 

Call child’s physician or School Medical Advisor immediately.  If not available, call one of the Poison Centers.

 

State of Connecticut:               860-674-3456  OR  1-800-343-2722

 

Yale New Haven Hospital:      (emergency room)

                                                Adult - 1-203-688-2222

                                                          Child – 1-203-688-3333

 

ORDER:    On direction from physician or poison center, give 1 tablespoon of Ipecac followed by 3 glasses of water.  If vomiting has not occurred within 20 minutes, repeat dosage.

 

BACITRACIN OINTMENT – Apply sparingly to any possibly contaminated wound. Application to be at discretion of school nurse after wound is cleaned.

 

CALAMINE LOTION OR CREAM – Apply topically as needed by school nurse.

 

ACETAMINOPHEN (Tylenol) - With a standing order from the school medical advisor and parent permission, school nurses may administer acetaminophen in the following doses to the middle and high school students in grades 4-12 P.R.N. for headaches, mild discomfort five times during a school year, without written authorization of a physician, dentist, advanced practice registered nurse (APRN), or physician’s assistant.

 

For students who may require acetaminophen more than five times per school year, a written authorization of a physician, dentist, advanced practice registered nurse (APRN),or physician’s assistant and the written authorization of the parent are required.

 

Grades 4 & 5	Acetaminophen:	2 ½ Tsp. or 5 chewable P.O. every 4 hours
Middle Schools	Acetaminophen:	3 Tsp. Or 2 tablets P.O. every 4 hours
High Schools	Acetaminophen:	4 Tsp. Or 2 tablets P.O. every 4 hours

 

Per order of:                ___________________________________________________

                                    Martin W. Sklaire, MD                                               Date

                                    School Medical Advisor

 

5141.21(i)

Students

 

Administration of Medication

 

Review of Procedures

 

These procedures shall be reviewed and/or revised by the school medical advisor, the school nurse and the Board of Education and then submitted to the Department of Health Services biennially as stipulated in Connecticut Regulations for State Agencies 10‑212a‑1 to 10‑212‑7.

 

Legal References:       Connecticut General Statutes

10‑212‑a‑4 Administration of medicines by school personnel.

52‑557b Immunity from liability for emergency medical assistance, first aid or medication by injection. School administer not required to administer or render.

Connecticut Regulations for State Agencies

10‑212a‑1 to 10‑212‑7

Public Act 94-213

 

 

 

Regulation approved:              June 15, 1992                                      CLINTON PUBLIC SCHOOLS

Regulation revised:                 November 2, 1992                                   Clinton, Connecticut

Regulation revised:                 November 7, 1994

Regulation revised:     September 21, 1998

Regulation revised:     August 16, 1999

Regulation reviewed and affirmed:  February 3, 2003

 

 

5141.211(a)

 

 

Students

 

Administering Medications

 

 

Glucose Self-Monitoring in School

 

 

Introduction

 

Diabetes mellitus is a chronic disease that interferes with the body’s ability to produce or use insulin, impairing the ability to metabolize food. Diabetes management balances careful control of diet, exercise and medication. Frequent monitoring or checking of blood glucose levels is critical to diabetes management. Timely blood sugar monitoring and prompt intervention are necessary to prevent life threatening hypoglycemic episodes. Equally important, close monitoring to maintain blood glucose levels within a specified range is essential to prevent long-term complications such as heart disease, kidney failure, blindness, and serious impairment of circulation that may require amputations.

 

The benefits of allowing blood glucose self-monitoring are significant. Students learn better when their blood glucose levels are within the proper range. It is important for schools to address the issue of location(s) of self-monitoring. Students who self-monitor in the classroom or in other locations outside the school health office can more readily adjust their blood sugar levels. They spend less time out of class and thus lose out on fewer learning opportunities provided to children without diabetes. They also gain independence and self-confidence, and experience fewer stigmas when monitoring is treated as a regular occurrence.

 

Guidelines

 

Students with diabetes need an individualized plan to address their health and safety needs in school settings, including settings such as field trips and athletic events. This plan may be a Section 504 Accommodation Plan and/or an Individualized Health Care Plan (IHCP) with an Emergency Care Plan (ECP). (See Appendix A) The State Board of Education recommends that district policies regarding self-monitoring of blood glucose levels in school settings address the following issues:

 

1.     Determine a process for developing and implementing an individualized plan for the student.

 

§         Identify a core team to create the plan. This team should include, at a minimum, the school nurse; appropriate teacher(s); the student (if appropriate); and parent(s), guardian(s) or other family members. Other possible members include the student’s health care provider, an administrator and other school staff.

§         Obtain current health information from the family and the student’s health care provider(s), including how often the child should monitor his or her blood glucose level.

§         Based on the student’s health status, determine the minimum frequency with which health information will be reviewed and updated.

5141.211(b)

 

 

 

Students

 

Administering Medications

 

 

Glucose Self-Monitoring in School (continued)

 

§         Clarify the roles and responsibilities of each member of the core team. (See Appendix B)

 

2.     Define expectations for communication between relevant school staff, family and the student’s health care provider that includes:

 

§         Documentation by the student’s health care provider of health needs, which may be included in appropriate authorizations for medications and procedures to be performed at school.

§         Written permission for school health staff to communicate with the child’s health care provider regarding diabetes management.

§         Clear expectations for minimum frequency of communication.

 

3.     Determine appropriate location(s) for self-monitoring that take into account the individual student’s needs, level of competence, health status, and independence. Location determination should be a team decision. Such a determination should also consider the safety of the child with diabetes, other students, and staff. Factors which may impact determination of self-monitoring location(s) include:

 

§         If self-monitoring locations are outside the health room, completion of a self-monitoring checklist and documentation of such assessment by the school nurse. (Use Form H-027A)

§         Team discussion of the self-monitoring checklist.

§         Completion of a student agreement. (Use Form H-027B)

§         The determination of the location(s) of self-monitoring should address accommodations during field trips, athletics, and unusual circumstances such as lockdowns or building closures.

 

4.     Address safety concerns, including:

§         Specific procedures for disposal of lancets and any material exposed to blood, which meet OSHA Universal Precaution standards.

§         Procedures for transportation of monitoring equipment; storage, security and access to monitoring supplies; identification of signs and symptoms of excessively high or low blood sugar levels and appropriate responses; access to food and drink; and replacement of equipment, and supplies.

 

5141.211(c)

 

Students

 

Administering Medications

 

 

Glucose Self-Monitoring in School (continued)

 

5.      Establish procedures ensuring that the appropriate people (including staff members such as teachers, physical education teacher, custodian, bus driver and substitute staff) are familiar with the 504 plan and/or IHCP and ECP, and are properly “educated” regarding diabetes and the importance of timely treatment. This education should include:

 

§         An understanding of diabetes; the signs and symptoms of high or low levels of blood glucose; familiarity with blood glucose equipment; appropriate location(s) for self-monitoring; possible adverse effects of high or low blood glucose levels on learning; and OSHA Universal Precaution standards.

§         Raising awareness of diabetes and the importance of blood glucose monitoring throughout the school, especially if monitoring is to occur in the classroom. However, individual student and family privacy needs and preferences should be considered.

 

6.     Ensure periodic assessments of the effectiveness of the individual plan, location of self-monitoring and student agreement (Use Form H-027B), including review of the student’s competency level and changes in the school environment. Assessments should occur:

§         At least annually with the school team, including the parents or guardians and when appropriate the student.

§         More frequently if there are changes in the student’s diabetes management plan, changes in the self-monitoring abilities of the student, or whenever an adjustment to the plan is appropriate. If the IHCP is separate from the Section 504 Accommodation Plan, then the team may make modifications to the IHCP without formal review of the 504 plan.

 

Regulation adopted:         March 7, 2005                      CLINTON PUBLIC SCHOOLS

                                                                                                          Clinton, Connecticut