OAR 581-021-0037: Administration of Medication

(1) As used in this rule, definitions of terms shall be as follows: (a) “Adrenal crisis” means adrenal crisis as defined in ORS 433.800. (b) “Adrenal insufficiency” means adrenal insufficiency as defined in ORS 433.800. (c) "Asthma," as defined in ORS 339.866. (d) “Delegation” means a formal delegation of a nursing procedure by a registered nurse to district personnel in accordance with the Oregon Nurse Practice Act (OAR Chapter 851). (e) "Designated personnel" means the school personnel designated and trained to administer medication pursuant to district policy and procedure. (f) “District” means public school district, education service district, or charter school. (g) “Drug” means drug as defined in ORS 689.005. (h) “Medication” means medication as defined in ORS 339.867. (i) “Nonprescription medication” means nonprescription drugs as defined in ORS 689.005. (j) “Notice of a diagnosis of adrenal insufficiency” means written notice to the district from the parent or guardian of a student who has been diagnosed as adrenal insufficient with a copy of an order from the student’s primary care provider that includes the student’s diagnosis, description of symptoms indicating the student is in crisis, prescription for medication to treat adrenal insufficiency crisis, and instructions for follow-up care after medication to treat adrenal insufficiency crisis has been administered. (k) “Prescriber” means a “Practitioner” as defined in ORS 689.005. (l) “Prescription medication” means a “Prescription Drug” as defined in ORS 689.005. (m) "Severe allergy" means a severe allergy as defined in ORS 339.866. (m) “Short-acting opioid antagonist,” means short-acting opioid antagonist as defined by ORS 689.800. (2) Districts shall adopt policies and procedures that provide for: (a) The administration of medication to students by designated personnel; (b) Medications, including injectable medications, may be administered by district personnel as part of a formal delegation by a Registered Nurse. (c) The administration of medication by a student to themselves without assistance from designated personnel. (3) Policies or procedures for the administration of medication to students by designated personnel shall: (a) Include a process to designate and supervise appropriate district personnel that takes into account when a student is in school, at a district-sponsored activity, under the supervision of district personnel, or in transit to or from school or district-sponsored activities; (b) Ensure designated staff have received medication administration training and have access to a school nurse as per OAR 581-022-2220; (c) Require designated personnel to successfully complete annual training on the administration of medication in accordance with the following requirements; (A) Training for designated personnel must be provided by a person who is familiar with the delivery of health services in a school setting and who is: (i) A Registered Nurse licensed by the Oregon State Board of Nursing; or (ii) A prescriber. (B) District shall use training developed by the Oregon Health Authority (OHA) for district personnel to administer epinephrine, glucagon, and medication to treat adrenal insufficiency as required in ORS 333.055, 433.810, 433.815, and 433.830; (C) Training for designated personnel to administer medications to students must align with the ODE Medication Administration Training and at a minimum include a discussion of applicable district policy, procedures and materials, and include the following elements: (i) Safe storage, administration, handling, and disposing of medications; (ii) Accessibility of the medication during an emergency; (iii) Record keeping; (iv) Whether response to medication should be monitored by designated personnel and the role of designated personnel in such monitoring; (v) Emergency medical response procedures following administration of the medication; (vi) Confidentiality of health information; and (vii) Assessment of gained knowledge. (D) The first training for designated district personnel and every third training thereafter must be provided in-person. During subsequent years, designated district personnel may complete an online training so long as a trainer is available following the training to answer questions and provide clarification. (E) An online training may qualify as “in-person” when these measures are met: (i) Content is provided via synchronous, interactive online sessions with the trainer and learners visible on screen. (ii) Trainers must be licensed and work within their scope of practice. (iii) Include in-person, skills demonstration for training developed by the Oregon Health Authority for epinephrine, glucagon, and for medication to treat adrenal insufficiency. (F) District shall maintain documentation of district personnel’s completion of training as required by OAR 166-400-0010; and (G) In alignment with district board policy, any district personnel may be allowed to administer a non-injectable, short-acting opioid antagonist to any student or other individual on district premises who the personnel believe in good faith is experiencing an overdose of an opioid drug without receiving medication administration training. (d) Permit designated personnel to administer prescription medication where: (A) Because of its prescribed frequency or schedule, the medication must be given while in school, at a district-sponsored activity, while under the supervision of school personnel, and in transit to or from school or district-sponsored activities; (B) The student’s parent or guardian has provided written permission. The district with written instruction for the administration of the medication from the prescriber that includes the name of the student, name of the medication, dosage, method of administration, frequency of administration, any other special instructions, and the signature of the prescriber. A prescription medication label prepared by a pharmacist at the direction of a prescriber shall be sufficient if all of the information required by this definition except for the prescriber’s signature is included. (e) Permit designated personnel to administer nonprescription medication where: (A) The nonprescription medication is necessary for the student to remain in school; (B) The nonprescription medication is: (i) Provided in the original manufacturer’s container by the student’s parent or guardian; or (ii) Is part of a district’s stock medication program in compliance with the Oregon Board of Pharmacy rules including OAR 855-035-0005. (C) The student’s parent or guardian has provided written instruction for the administration of the nonprescription medication that includes the name of the student, name of the medication, dosage, method of administration, frequency of administration, any other special instructions, and signature of the student’s parent or guardian. If the written instruction is not consistent with the manufacturer’s guidelines for the nonprescription medication, the written instruction must also include a written order allowing the inconsistent administration signed by a prescriber; and (D) For nonprescription medication that is not approved by the Federal Drug Administration, a written order from the student’s prescriber that includes the name of the student, name of the medication, dosage, method of administration, frequency of administration, a statement that the medication must be administered while the student is in school, any other special instructions, and the signature of the prescriber. (f) Include procedures for the administration of premeasured doses of epinephrine by the trained district personnel to any student or other individual on district premises who the personnel believe in good faith is experiencing a severe allergic reaction, regardless of whether the student or individual has a prescription for epinephrine as provided by ORS 433.815; (g) Include procedures for the administration of medication by district personnel to treat a student who the personnel believe in good faith is experiencing symptoms of adrenal crisis. The procedures must provide that: (A) Per ORS 339.869, only upon notice of a diagnosis of adrenal insufficiency as defined in this rule, the building administrator of the school the student attends will designate one or more district personnel to be responsible for administering medication to treat adrenal insufficiency in the event the student exhibits symptoms that district personnel believe in good faith indicate the student is experiencing symptoms of adrenal crisis; (B) The designated personnel will successfully complete training to administer medication to treat a student who has adrenal insufficiency and is experiencing symptoms of adrenal crisis in accordance with rules adopted by the Oregon Health Authority; (C) The student’s parent or guardian must provide adequate supply of the student’s prescribed medication to the district; and (D) In the event that a student experiences symptoms of adrenal crisis and the designated personnel determines the medication to treat adrenal insufficiency should be administered, any available district personnel will immediately call 911 and the student’s parent or guardian. ( h ) Address the following f or the administration of medications including medications that are self-administered by students : (A) Safe storage, accessibility of medications during an emergency, methods for administration, handling, and disposing of medications; (B) Record keeping; (C) Whether student response to medication should be monitored by designated personnel and the role of designated personnel in such monitoring; (D) Emergency medical response for life threatening side effects and allergic reactions, including the administration of premeasured doses of epinephrine; (E) Initiating emergency medical response when epinephrine or a short-acting opioid antagonist is administered to any student or other individual on district premises is administered; and (F) Confidentiality of student health information contained within the education record. (4) Policies and procedures for the administration of medication by a student to themselves without assistance from designated personnel shall: (a) Permit a student to administer prescription or nonprescription medication to themselves where the student can demonstrate the ability, developmentally and behaviorally, to self- administer medication and has permission to self-administer medication from a school building administrator, and a prescriber or registered nurse practicing in a district setting; (b) Require parental or guardian consent; (c) For nonprescription medication that is not approved by the Federal Drug Administration, require a written order from the student’s prescriber that includes the name of the student, name of the medication, dosage, method of administration, frequency of administration, a statement that the medication must be administered while the student is in school, at a district-sponsored activity, under the supervision of district personnel, or in transit to or from school or district-sponsored activities, any other special instructions, and the signature of the prescriber; (d) Require that backup medication, if provided by a student’s parent or guardian, be kept at the student’s school in a location to which the student has immediate access in the event the student has an asthma or severe allergy emergency per ORS 339.866; (e) Include process for a district to revoke its permission for a student to self-administer medication if the student does not responsibly self-administer the medication or abuses the use of the medication; and (f) Include a process for determining if or when a student may self-carry prescription medication when the student has not been approved to self-administer medication. (5)(a) A district may adopt policies and procedures to allow school district personnel to administer a short-acting opioid antagonist medication to any student or other individual who the district personnel believe in good faith is experiencing an overdose of an opioid drug. (b) A district shall provide to the parent or legal guardian of each minor student enrolled in a school in the district information regarding short-acting opioid antagonists. The information described in this subsection must include at least: (A) A description of short-acting opioid antagonists and their purpose; (B) A statement regarding, in an emergency situation, the risks of administering to an individual a short-acting opioid antagonist and the risks of not administering to an individual a short-acting opioid antagonist; (C) A statement identifying which schools in the district, if any, will have short-acting opioid antagonists, and the necessary medical supplies to administer short-acting opioid antagonists, on site and available for emergency situations; and (D) A statement that a representative of a district may administer to a student a short –acting opioid antagonist in an emergency if the student appears to be unconscious and experiencing an opioid overdose. (c) A school district board shall ensure that the parent or legal guardian of a minor student enrolled in a school within the school district is immediately notified when a short-acting opioid antagonist is administered to the student if the short-acting opioid antagonist is administered while the student is at school, on school property under the jurisdiction of the school district or at any activity under the jurisdiction of the school district. (6) District personnel shall not recommend to a parent or legal guardian of a student that the student seek a prescription for a medication that is prescribed with the intent of affecting or altering the thought processes, mood or behavior of the student. (7) District personnel shall not require a child to obtain a prescription for a substance covered by the Controlled Substances Act, 21 U.S.C. 801 et seq., as a condition of attending school, receiving an evaluation to determine eligibility for Section 504 of the Rehabilitation Act of 1973, early childhood special education or special education under ORS chapter 343 or receiving early childhood special education or special education services. (8) District shall allow the application of and use by students of nonprescription sunscreen, including sunscreen that contains para-aminobenzoic acid, without any required documentation from a licensed health care professional per ORS 339.874. (9) A registered nurse who is employed by a district or a local public health authority as defined in ORS 431.003 to provide nursing services at a district may accept an order from a physician licensed to practice medicine or osteopathy in another state or territory of the United States if the order is related to the care or treatment of a student who has been enrolled at the district for not more than 90 days.