Medication Administration for Students in Schools Procedure
Cache County School District (CCSD) Medication Authorization Forms
A. Cache County School District Medication Authorization Form: This form must be used when parents/guardians request school personnel to administer medication (except for asthma, allergy, or diabetes medication). It must be signed by both a parent/guardian and a licensed healthcare provider. This form should be updated annually or when there are changes in medication administration.
B. Cache County School District Medication Storage Form: This form is for parents/guardians who want the school to store medication for their child to be administered by parent/guardian or possibly Emergency Medical Services (EMS). School employees will not administer this medication. The form should be updated annually or when there are changes in medication storage.
C. Allergy Action Plan Form: This form is required for students with allergies and must be signed by both a parent/guardian and a licensed healthcare provider. It reflects a plan of care and allows designated trained school personnel to administer emergency allergy medications, including epinephrine, and authorizing students to carry and self-administer emergency allergy medications when ordered by the healthcare provider. Annual updates are required, or as modifications occur in the prescribed allergy medication.
D. Asthma Action Plan Form: This form is required for students with asthma and must be signed by both a parent/guardian and a licensed healthcare provider. It reflects a plan of care and allows designated trained school personnel to administer asthma medication and authorizing students to carry and self-administer asthma medication when ordered by the healthcare provider. Annual updates are required, or as modifications occur in the prescribed asthma medication.
E. Diabetes Medication Management Order Form: This form is for students with diabetes and must be signed by a licensed healthcare provider. It provides orders for diabetes medication and is used to develop a diabetes school health plan. It allows designated trained school personnel to administer diabetes medications and it allows students to possess and self-administer diabetes medication when ordered by the healthcare provider. Annual updates are required, or as modifications occur in the prescribed diabetes medication.
F. Diabetes School Health Plan Form: This form must be signed by a parent/guardian. It outlines the student's diabetic needs and care at school and should be updated annually or when there are changes in the student's care.
G. Seizure Medication Management Form: This form is for students with specified emergency seizure medications and must be signed by both a parent/guardian and a licensed healthcare provider. Annual updates are required, or as modifications occur in the prescribed emergency seizure medication.
Administration of Medication at School
A. The student’s parent/guardian must provide a completed, current, signed, and dated “CCSD Authorization of School Personnel to Administer Medication” form for each school year or when there are changes in medication administration.
B. The student’s licensed medical provider must sign and date the medication authorization form describing the method, amount, and time schedule for medication administration and the side effects that may be seen.
C. The medication must be delivered to the school by the parent/guardian or an authorized adult. Expired medication cannot be administered.
D. Prescription medication must be properly labeled by a pharmacy.
E. Non-prescription medication must be in the original container, labeled with the child's name and dose, as per doctor’s orders.
F. Parents or guardians, along with school personnel responsible for receiving and administering medication, should collectively count and document the pills or doses. This process should be recorded on the relevant CCSD medication forms.
G. The district nurse must annually delegate and provide training to the designated employee for administering medication deemed appropriate for school settings. This training will include:
- How to properly administer medication(s);
- Indications for the medication(s);
- Dosage and time of medication(s);
- Adverse reactions and side effects of medication(s);
- Proper maintenance of records;
- CCSD online training, in-person training and written CCSD Medication Training Manual.
H. Designated staff, including teachers in charge of field trips, will receive medication administration training.
I. Medication and all associated forms and records will be securely stored in a designated location. Access to this location will be authorized and monitored by the school principal or their designee. If refrigeration is necessary, medication will be stored in a designated refrigerator.
J. A “Medication Administration Record” (MAR) will be maintained for each student receiving medication. Each administered dose will be documented, including the date, time, and the signature or initials of the administering person.
K. The school nurse will provide a complete annual medication audit and will record the findings upon the CCSD “Medication Audit Form”. Any controlled substance medications will be audited with the school nurse and one other employee.
L. Any adverse reactions will be reported promptly to the school nurse and parent/guardian and documented on the “Utah Medication Error Report Form” reporting form.
Legal References:
Approved by District Administration: March 21, 2024