Guidelines for Medication Administration in Schools
Guideline #1: Legal Considerations
The Minnesota Guidelines relate to the system that needs to be established to manage safe medication administration and to the day-to-day logistics of receiving a medication administration request from parents, have staff trained and ready to provide the medication, document and store the medicine, and communicate with the family and health care provider. Both the system and the individual levels are interwoven in the 10 sections of the Minnesota Guidelines for Medication Administration in Schools, 2005.
1.1 Relevant Laws
The legal basis for the Minnesota Guidelines for Medication Administration in Schools is a set of federal and state laws. Short descriptions of them and web sites are available in the appendices.
Medication administration in schools is a complex issue in part because it intersects health laws and education laws. The laws give guidance and set a foundation for the process that local school districts use to develop, staff, and maintain a safe system for medication administration.
Federal laws emphasize (1) the rights of students with special needs, medical or otherwise, to have access to and to be educated in public schools, and (2) the sensitive topic of records, including family access to education and health records in schools.
- Americans with Disabilities Act (ADA) (42 U.S.C. § 12101 et seq.) and regulations promulgated by the Department of Justice
- Drug and Alcohol Treatment Records (D&A) (42 USCS § 290dd, 42 CFR 2.1 et seq.)
- Family Educational Right to Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 C.F.R. Part 99)
- Health Insurance Portability and Accountability Act (HIPAA), and regulations adopted under it (45 C.F.R. chapters 160 and 164)
- Individuals with Disabilities Education Improvement Act (IDEA), (Public Law 108-446) previously IDEIA
- Prohibition of Mandatory Medication [Child Medication Safety Act (25; Public Law 108-446; Dec. 2004)]
- Individuals with Disabilities Education Act (IDEA) (20 U.S.C. § 1400 et seq.)
- OSHA Blood-borne Pathogen Standard 29 of C.F.R. 1930.1030
- Proposed New Drug, Antibiotic, and Biological Drug Product Regulations (21 C.F.R. 312.3 (b))
- Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794)
State laws pertain to school systems, health care practice, records, and individual rights. In particular, they focus on access to education and data; the provision of school health services; the establishment of local school district medication policies; the rights of students; regulation of health care providers, such as nurses, physicians, and pharmacists; access to care by students; emergency care; and protection of children.
- Administration of Drugs and Medicine (Minnesota Statutes §§ 121A.22, 121A.221, 121A.2205 and 121A.222)
- Children with a Disability (Minnesota Rules, chapter 3525)
- Children with a Disability (Minnesota Statutes, chapter 125A)
- Emergency Treatment of Minors Act (Minnesota Statutes § 144.344)
- Hazardous Substances, Employee Right-to-Know (Minnesota Rules, chapter 5206)
- Health Standards; immunizations; school children (Minnesota Statute § 121A.15, subd. 7.) File on Immunization Records
- Maltreatment of Minors Act (Minnesota Statutes §§ 626.556 to 626.5563)
- Minnesota Board of Teaching Personnel Licensing (Minnesota Rules, chapter 8710.6100, School Nurse)
- Minnesota Children’s Mental Health Act (Minnesota Statutes § 245.4876, subd. 5)
- Minnesota Medical Practice Act (Minnesota Statutes, chapter 147)
- Minnesota Medical Records Act (MMRA) (Minnesota Statutes § 144.335; Access to Health Records)
- Minnesota Mental Health Act (MMHA) (Minnesota Statutes 245.467)
- Minnesota Nurse Practice Act (Minnesota Statutes §§ 148.171 to 148.285) and Minnesota Rules, chapters 6301 through 6340
- Minnesota Pharmacy Act (Minnesota Statutes, chapter 151, and Minnesota Rules chapter 6800)
- Minnesota Government Data Practices Act (Minnesota Statutes, chapter 13; see § 13.32, subd. 2)
- School Health Services (Minnesota Statutes § 121A.21)
- Vulnerable Adult Act (Minnesota Statutes §§ 626.557 to 626.5573)
1.2 School District Policies
Within the framework of existing federal and state laws and these Minnesota Guidelines for Medication Administration in Schools, school districts’ medication administration policies are to reflect recommended practice and be developed in collaboration with the licensed school nurse/registered nurse (LSN/RN), physician, and others, as listed in Minnesota Guideline 7.2.
Local policies and procedures can be individualized based on the evaluation of the student population (e.g., individualized student health needs, speakers of English as a second language, free and reduced lunch numbers, and student mobility) and based on school district personnel and resources.
The various pertinent laws and the Minnesota Guidelines offer a foundation upon which to develop and maintain individual local district policies.
The role of the school board is outlined in Minnesota Statutes § 121A.22, subd. 4:
Drugs and medicine subject to this section must be administered in a manner consistent with instructions on the label. Drugs and medicine subject to this section must be administered, to the extent possible, according to school board procedures that must be developed in consultation:
(1) with a school nurse, in a district that employs a school nurse;
(2) with a licensed school nurse, in a district that employs a licensed school nurse;
(3) with a public or private health or health-related organization, in a district that contracts with a public or private health or health-related organization, according to section 121A.21; or
(4) with the appropriate party, in a district that has an arrangement approved by the commissioner of education, according to section 121A.21.
The authors of this document would like to acknowledge that the ideal system for health and safety in Minnesota schools is to have an LSN to manage the health services program that includes aiding school administration in developing the system for medication administration and directing specific procedures. An LSN with a bachelor’s degree in nursing and a certificate in public health is an expert in nursing assessments and plans based on knowledge of the student, school, home, and community (see National Association of School Nurses, 2002). Using the nursing process, school nurses develop individual health plans for students. Delegation of nursing tasks can be a safe and effective way to perform some of the nursing interventions identified in the individual health plan (see National Association of Schools Nurses, 2004).
In school districts without LSNs/RNs on staff, educational administrators working with school boards are responsible to set up a system through which medication administration policies are developed, acceptable LSN/RN/physician coverage for medication administration oversight via contract or other arrangements is found, people are assigned and trained, the procedures are done safely and consistently, and all necessary documentation is completed. Educational administrators are also responsible to find appropriate resources and medical expertise to address their students’ medication administration needs. School administrators cannot legally fulfill the role of LSNs/RNs.
Those districts with LSNs/RNs on staff or on contract will be able to call on staff to take the lead on these responsibilities.
1.3 Data Privacy
State and federal requirements ensure privacy of student education, health, and medication records, and restrict the sharing of that information. These laws specify how information about medication is handled, including procedures for health records and the documentation of health information, administration of medication, and medication errors. The state laws influencing data privacy are the Minnesota Government Data Practices Act, the Minnesota Medical Practice Act, the Minnesota Medical Records Act, and the Minnesota Mental Health Act, and on the federal level, Drug and Alcohol Treatment Records, FERPA, HIPAA, and IDEA.
Once a parent/legal guardian disclose health information to the school, it becomes private educational data; it is the district’s responsibility to protect the data, make sure that school employees who need the information have it, and guarantee that staff are trained in and follow appropriate data privacy practices.
School personnel should be cautious about easily overheard verbal communications. There need to be firewalls for personal student health information stored on computers.
Educators should have access to health information on a “need to know” basis for “legitimate educational interests” as defined in FERPA (see 34 C.F.R. § 99.31 and Health in Schools, 2003). Schools should rely on the privacy requirements of FERPA to meet the need to protect student privacy and the need to provide school staff with relevant information about students (e.g., when students have medical conditions that affect their learning and safety, such as students who have hearing or vision problems, are subject to seizures, or have asthma or allergies). For school staff to remain current on this topic and use student data appropriately, training must be provided, per FERPA, HIPAA, and IDEA.
1.4 Licensed Medication Prescribers
All states, including Minnesota, have professional practice laws that govern who is authorized to prescribe medications.
Who is a licensed authorized prescribing practitioner in Minnesota?
- Advanced practice registered nurse with prescriptive authority (includes clinical nurse specialist practice, nurse-midwife practice, nurse practitioner practice, or registered nurse anesthetist practice)
- Physician’s assistant who has direction from a physician or written protocol
Who is not a licensed authorized prescribing practitioner in Minnesota?
- Licensed school nurse
- Registered nurse
- Licensed practical nurse
- Medical assistant
- Naturopathic provider
In addition, laws address who can delegate medication administration. Delegation allows flexible planning to meet individual student needs and best utilize staff available in the schools. Delegation of medication administration by LSNs/RNs is allowed in Minnesota schools. For schools, this is a balance between safety standards and reasonableness, given limited resources in schools, rights and needs of students and parents/legal guardians, and the assumption that students constitute a healthy population. Whether or not an LSN/RN is on school staff or contracted by the school, Minnesota law requires that school boards be responsible for policy and procedure development leading to safe medication management.