Medication Consent Form for Physician Ordered Medication
Policy for Administering Medications to Students
in the School District of Janesville
Medications should be administered to school children by parents at home whenever possible. The school nurse and other persons designated in writing, by the building principal, may administer medications to students under established conditions. Before any prescription medication may be administered to a student in the School District of Janesville, school personnel must receive written parental consent and written instructions from the students’ physician or dentist. Non-prescription medications may be administered with written parental/guardian consent only. All written instructions and consent forms shall be filed in the school office. The school nurse assigned to each school building shall be responsible for reviewing the written medication instructions. The building principal shall be responsible for maintaining complete and accurate medication records, and storing all prescription and nonprescription medications in a safe and secure place. School personnel authorized to administer medications to students shall be provided appropriate instruction.
Procedure for Administering Medication to Students
- Administer – Medications which are in the possession of the school and given to the student by designated school personnel.
- Medication Error – Medication errors include: administering the wrong medication or dose of medication, administering the medication at the wrong time, administering a medication by the wrong methods or route (i.e. orally instead of injection) or failing to administer the medication.
- Pupil – Any person who is enrolled in the School District of Janesville as a student, on a full or part-time basis in an approved instructional or co-curricular activity.
- School – A pupil is in school when in attendance at an approved instructional or cocurricular activity, whether held on or off school premises.
- Prescription Medications
- Prescription medications shall not be administered to a student until the following
steps are completed.
(1) The parent provides the school with a completed parent consent form.
(2) The school receives a completed physician order form for administering
- Prescription medications to be administered to students must be in the original container from the pharmacy. Information printed on the container must include:
¨ student’s full name
¨ name of medication and dosage
¨ time medication is to be given
¨ physician name
- Prescription medication will be stored according to manufacturer’s guidelines.
- Prescription medications will be kept in a locked cabinet or drawer that is not accessible to students or where food is stored. Only a limited quantity of the prescription medication is to be kept at school.
- Only school district employees, who are designated by the principal of each school; will be able to administer prescription medications. Except in an emergency, the only other people who may administer prescription medications to a student include:
¨ student’s parent
¨ contracted school nurse
¨ emergency response worker
- The length of time for which a prescription medication is to be administered will be specified in the written instructions from the prescribing physician. The maximum length of any written instruction will be until the end of the current school year. Any time there is a change in dosage, number of doses, or time of administration a new written statement from the prescribing physician is necessary.
- When a prescription medication needs to be refilled, school staff will send a letter home to the parent when five (5) days worth of medications remain, reminding the parent of the need for medication. The current medication container will not be sent home for the parent to refill.
- With medications that are to be given at a specific time during the day, there is a leeway of 60 minutes before to 60 minutes after this specific time within which the medication can be given. If the medication is not taken by the student during this time frame, school personnel need to contact the Rock County Health Department to determine if it is still appropriate to give the medication.
- There are certain situations that require further investigation. If school personnel notice any of the following situations with medications, the following action will be taken:
¨ The color or shape of a refill medication is different from the last prescription. Call the school nurse at 743-5070.
¨ Label on front of medication container requires a tablet to be cut. Refuse mediations, the school district will not cut or break pills.
¨ Information on the medication permission form from the doctor is different from the information on the label of the medication container. Call the school nurse at 743-5070.
¨ Split pills are brought in the correct medication container. Call the school nurse at 743-5070.
¨ A parent/legal guardian gives permission for school personnel to give a medication at a time other than the scheduled time. Do not give the medication and have the parent call the school nurse at 743-5070.
¨ Parent calls the school or sends a permission slip to school, requesting the dose of a medication be changed. Do not change the current order and call the school nurse at 743-5070.
(1) It is the responsibility of the school to insure that prescription and nonprescription medications, which are administered by school personnel, be provided to the correct student, at the designated time. The only exceptions would be if the student refuses the medication, or is absent from school. A student’s refusal to take medication should be documented and the parents/guardians informed.
(2) It is the responsibility of the school employee administering medications to witness the student take the medications in their presence.
- Missing Medications
When a school staff person identifies that medication the school is administering is missing, the school building principal and school nurse will be notified. The school staff person will document on the medication log the date, time, amount, and medication name that is missing. The principal, or their designee, will contact the student’s parent to inform them of the missing medications. If the
medication is a controlled substance (i.e. Ritalin, Methylphenidate, Adderall etc.) a report must be filed with the Director of Student Services and the Janesville City Police.
- Medication Errors
When a medication error is noted by school staff or the school nurse, it must be documented with the school building principal and school nurse.
- Non-prescription Medications and Herbal Treatments
- Designated personnel will administer non-prescription (over-the-counter) medication and herbal treatments only with parental approval as indicated by written consent on the Parental Consent Form for Medication. Non-prescription medication or herbal treatments must be in an original treatment container and labeled with the child’s name, why the medication is needed, when to use the medication/treatment and amount of medication/treatment to give.
- If the dosage for non-prescription medications or herbal treatments is higher than the recommended dose for the student’s age/size, the school nurse will contact the parent/guardian and request a statement from the health care provider to support the need for the higher dosage.
- Adverse Side Effects
- Any School Staff Person who observes adverse side effects to a medication or has concerns with behavioral or physical changes of a student should report these concerns to the school nurse. If a student is exhibiting side effects to a medication, the school nurse will contact the doctor, parent, and school principal regarding this concern. If a change in medication is made by the doctor, verbal orders can be taken by the nurse and followed up with written orders to both the doctor and parent. If the parent requests changes in the medication, the only change the school can make
is to stop administering the medication. If this is the case, send medication form to parent for signature and inform child’s doctor.
- District Records Required
- Accurate and confidential written records shall be established and maintained for each pupil receiving medication.
a. The principal shall identify a person to maintain a daily and up-to-date record of pupils in his/her school requiring medication during school hours and the time the medications are given. The record shall include the pupil’s name, grade level, type of medication, dosage, time to be given, the date and time the medication was administered and the initials of the person administering each dose.
b. At the end of each year all medication logs will be placed in each student’s cumulative record. These medication logs will be maintained in the cumulative record for one year after the student leaves the district.
c. School staff, who administer medications, will notify the parents, of a student who fails to receive requested medications, when the medications and student, are present in the school. A notice will also be given to the school nurse.
- Students may self-administer prescription or non-prescription medication in the school if this is acceptable to the parents and school building principal. If the school determines the student is not responsible to self administer medications in the school, the school may remove the privilege and supervise the dispensing of the medication. Current State law allows a student to carry an inhaler if the school receives a written request from the parent and doctor. In these instances the parent will be informed that this privilege may be suspended or removed by the principal if the student is not responsible in the handling of the inhaler. Parents will be notified if the privilege to carry an inhaler and self medicate is suspended or removed.
- Disposing of Medication
- Before the end of each school year, school staff will send a letter home to parents indicating they are responsible for coming and picking up remaining medications at school. Outside of emergency medications (i.e. epi pens, glucagon, inhalers) and cough drops, all other medications cannot be sent home with the student. Medications that are not picked up by parents will be collected by nursing staff. Each medication (both prescription and nonprescription) will be listed on a manifest along with the student’s name. For prescription medications, the number of pills will also be added to the manifest. A manifest will be completed for each school. Two persons must sign off on the completed manifest. Nonprescription medications will be collected, placed in a box/container, sealed and discarded with regular garbage. Prescription medications will be placed in a sharps container and taken to Kealy Pharmacy to be incinerated.