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I.ÌýÌý ÌýGeneral Statement. ÌýPrescribed 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. Ìý

II.ÌýÌý ÌýRules for all Medications.

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

1.ÌýÌý ÌýNon-Prescribed Medication. ÌýA written authorization must be signed by the student's parents or guardian and filed with the school healthcare provider or principal permitting the use of non-prescribed medication.Ìý

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

3.ÌýÌý ÌýTaking of Non-Prescribed and Prescribed Medication. The ingestion, taking, or application of non-prescribed and prescribed medications, including Ìýnebulized albuterol, shall be performed under the direct supervision and observation of the school healthcare provider, 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. ÌýThe school healthcare provider 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. ÌýIf 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.ÌýÌý ÌýHomeopathic Substances, Herbs, and Vitamins. ÌýHomeopathic 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. ÌýHomeopathic substances, herbs and vitamins, whether prescribed or non-prescribed, shall be subject to the same restrictions and requirements as prescribed medications.

5.ÌýÌý ÌýTransporting Medications to and from School. Ìý

a.ÌýÌý ÌýPreschool and Elementary Schools. ÌýIn 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 items deemed medically necessary and approved within their Diabetic Medical Management plan, Seizure Action plan, and/or their Asthma/Anaphylaxis plan. ÌýElementary school students may possess and use inhalers according to the provisions of Section II(F)(1) of this Rule. ÌýNon-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, healthcare provider, principal, or the principal’s designee.

b.ÌýÌý ÌýMiddle School. ÌýMiddle school students shall not be allowed to transport prescribed medications to and from school with the exception of items deemed medically necessary and approved within their Diabetic Medical Management plan, Seizure Action plan, and/or their Asthma/Anaphylaxis plan. ÌýMiddle school students may possess and use inhalers according to the provisions of Section II(F)(1) of this Rule. ÌýPrescribed medications must be transported by the student’s parents or guardian or by an adult designated in writing by the parents or guardian. ÌýNon-prescribed medications may be transported by middle school students to and from school but must be delivered to the school healthcare provider, principal, or the principal’s designee.

B.ÌýÌý ÌýHigh School. ÌýThe following rules shall apply to the use and application of medications at the high school level.

1.ÌýÌý ÌýNon-Prescribed Medication. ÌýNo written authorization shall be required for non-prescribed medication. ÌýHowever, if a teacher, principal or school healthcare provider observes frequent or inappropriate use by a student of non-prescribed medication, the school may require the following:Ìý

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

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

2.ÌýÌý ÌýPrescribed Medication. ÌýIf prescribed medication is to be ingested, taken, or applied, the following shall be required:

a.ÌýÌý ÌýThe medication shall be delivered to the school healthcare provider, principal, or principal's designee;

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

c.ÌýÌý ÌýThe school healthcare provider 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; andÌý

d.ÌýÌý ÌýThe ingestion, taking or application of prescribed medication, including nebulized albuterol, shall be performed under the direct supervision and observation of the school healthcare provider, 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. ÌýIf the student’s parents or guardian have given written authorization, students will be allowed to possess and/or ingest items deemed medically necessary and approved within their Diabetic Medical Management plan, Seizure Action plan, and/or their Asthma/Anaphylaxis plan 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.ÌýÌý ÌýHomeopathic Substances, Herbs, and Vitamins. ÌýHomeopathic 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. ÌýHomeopathic substances, herbs and vitamins, whether prescribed or non-prescribed, shall be subject to the same restrictions and requirements as prescribed medications.

C.ÌýÌý ÌýAdministration of Injections. ÌýOnly school healthcare providers and school personnel who have been trained to administer the epinephrine auto injector or injectable glucose and are giving injections in emergency life-saving situations may administer injections at school.

1.ÌýÌý ÌýInjectable glucose. ÌýIf a student requires administration of injectable glucose in an emergency diabetic attack, school personnel will call 911. ÌýThe injectable glucose will be provided by the student’s parents or guardian. School personnel other than the school healthcare provider may administer injectable glucose only in emergency situations if they are trained by qualified personnel.

2.ÌýÌý ÌýEpinephrine auto injector Injections. ÌýStudents may use/carry epinephrine auto injector without supervision or monitoring by the school healthcare provider or principal. ÌýThe epinephrine auto injector must be a prescribed medication and the school healthcare provider 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. ÌýAll other injections that are given in response to an emergency should be given by a school healthcare provider if available. ÌýAn emergency medical unit and the student's parents or guardian shall be called.

3.ÌýÌý ÌýOther Injections. ÌýIf a student requires any injections during the school day, students may administer injections in the health office, or an area designated by the principal or the principal’s designee. ÌýParents may request that a school healthcare provider administer injections if the student is incapable of self-administration. ÌýParents shall submit requests to the Executive Director of Student Services.

D.ÌýÌý ÌýRecord Keeping. Ìý

1.ÌýÌý ÌýAuthorization and Medical Directions File. ÌýThe school healthcare provider, principal, or principal's designee for each school shall keep a file which shall contain the following:

a.ÌýÌý ÌýAll authorizations required under this Rule;Ìý

b.ÌýÌý ÌýAll orders or instructions from a physician, physician assistant, or advanced practice registered nurse;Ìý

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

d.ÌýÌý ÌýThe date that medication is delivered to the healthcare provider, principal, or principal's designee.

2.ÌýÌý ÌýDaily Medication Documentation. ÌýIn each school, a daily medication log shall be kept which shall contain the following:

a.ÌýÌý ÌýThe student's name;Ìý

b.ÌýÌý ÌýThe type of medication the student is authorized to have;Ìý

c.ÌýÌý ÌýThe dosage or directions for ingestion, taking, or application of the medication;Ìý

d.ÌýÌý ÌýThe name of the person supervising the student who is taking the medication;

e.ÌýÌý ÌýThe time the medication is administered; and

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

E.ÌýÌý ÌýMedical Information to be Provided to the District. Ìý

1.ÌýÌý ÌýMedical Allergies, Seizures, and Susceptibility to Illness. ÌýIf 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.ÌýÌý ÌýThe name of the medications to which the student is allergic;Ìý

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

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

2.ÌýÌý ÌýInjections for Medical Emergencies. ÌýIf 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.ÌýÌý ÌýThe name of the medication and its dosage; andÌý

b.ÌýÌý ÌýThe method of administration (subcutaneous or intramuscular).

F.ÌýÌý ÌýMiscellaneous Provisions.

1.ÌýÌý ÌýInhalers. ÌýStudents may use/carry inhalers without supervision or monitoring by the school healthcare provider or principal. ÌýThe inhaler must be a prescribed medication and the school healthcare provider or principal shall have received written permission from the student's parents, guardian, as well as a written order from a physician, physician assistant, or advanced practice registered nurse. ÌýThis statement shall also include directions of appropriate inhaler usage. ÌýIf 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 healthcare provider or principal in which case the student's use of the inhaler shall be supervised by the school healthcare provider or principal.

2.ÌýÌý ÌýNasal Inhalation. ÌýStudents may use/carry nasal inhalation medications without supervision or monitoring by the school healthcare provider or principal. The nasal inhalation medication must be a prescribed medication and the school healthcare provider or principal shall have received written permission from the student’s parents, guardian, as well as a written order from a physician, physician assistant, or advance practice registered nurse. This statement shall also include directions of appropriate nasal inhalation medication 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 healthcare provider or principal in which case the student’s use the of nasal inhalation medication shall be supervised by the school healthcare provider or principal.Ìý

3.ÌýÌý ÌýContainers. ÌýAll 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. ÌýThe label must be legible and be written in English, or provide English translations.

4.ÌýÌý ÌýCustody and Storage. ÌýAll medication delivered to the school healthcare provider or principal shall be stored in a container or refrigerator in the health office, principal's office, or other area designated by the school principal. ÌýThe storage area shall either be locked or under the control of a designated school employee.Ìý

5.ÌýÌý ÌýQuantity. ÌýNo 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.ÌýÌý ÌýTransfer to Other Students. ÌýStudents are prohibited from transferring, delivering, or receiving any medication to or from other students. ÌýViolation of this subsection will authorize the confiscation of the medication by the District and subject the students to discipline. Ìý

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

III.ÌýÌý ÌýStudent Discipline. ÌýIf a student violates a provision of this Rule, the student shall be subject to discipline. Ìý

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

1.ÌýÌý ÌýThe school healthcare provider, principal, or principal's designee;Ìý

2.ÌýÌý ÌýThe student's parents or guardian; andÌý

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

B.ÌýÌý ÌýWhile notifications are being given, the student shall remain in the custody of the school healthcare provider, 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.ÌýÌý ÌýIf 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. ÌýUnless otherwise directed by the physician, physician assistant, or advanced practice registered nurse, the school healthcare provider and principal or principal’s designee shall determine what action if any shall be followed to insure the student(s)’ safety. Ìý

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

IV.ÌýÌý ÌýDefinitions.
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A.ÌýÌý ÌýEmergency medical personnel. ÌýEmergency medical personnel shall mean medical personnel who can respond to a medical emergency.Ìý

B.ÌýÌý ÌýMedication. ÌýMedication shall be broadly defined and shall include:

1.ÌýÌý ÌýAll 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.ÌýÌý ÌýAny device, instrument, apparatus, implement, machine, 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.ÌýÌý ÌýPhysician. ÌýPhysician shall mean individuals who are licensed by the Department of Health and Human Services Regulations and Licensure as:
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1.ÌýÌý ÌýMedical Doctors (M.D.) who practice medicine and/or surgery; or

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

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

E.ÌýÌý ÌýPhysician assistant. ÌýPhysician 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.ÌýÌý ÌýQualified personnel. ÌýQualified personnel shall mean individuals who have met an educational or legal requirement necessary to administer emergency injections.

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