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JLCD-R, Medication Management



Information:  The Department of Public Health, in conjunction with the Department of Education, has created guidelines and mandated licensing to insure the safe and proper administration of medications in the school setting.  Regulations for administration of medications in school are important in order to:


  1. Encourage school attendance of students who require medications during school hours,
  2. Set uniform standards for safe and proper administration of medication,
  3. Recognize the professional role of school nurses and their ability to safely manage the medication administration program,
  4. Set standards for self-administration of medication, improving access for students.


Regulations for the state of Massachusetts include requirements for management of the program by licensed professionals, including School Nurses and Physicians.  They also provide a means to register and obtain licensing to allow unlicensed personnel to administer medications in a limited role.  The Gardner Public Schools currently maintain state registration for delegation of medication for field trips and other short-term, special school events.  To insure safe and accurate medication, a copy of a current (published within 2 years) Nursing Drug Reference book and The comprehensive School Health Manual will be kept in each health room.


Management:  The School Nurse Leader shall review medication policies and procedures as needed, and at least every two (2) years, in conjunction with the School Physician and the School Committee.  The Nurse Leader will monitor and document any medication errors in the course of the school year.


Orders:  The School Nurse shall maintain proper medication orders from a licensed prescriber and shall renew orders at the beginning of each academic year.  All medications administered in school must be prescribed, even over the counter medication.  Each change or review of medications by the prescriber should be documented appropriately in the medication record.  The School Nurse may accept telephone orders from a prescriber only if faxed or written documentation is to follow.  A signed medication order must be placed in the medication record within three (3) school days of the initial order.  Whenever possible, the medication order shall be obtained, and the medication administration plan (MAP) in place before the student enters, or re-enters, school.


In accordance with standards of practice, each order shall contain:


  1. Student’s name.
  2. Name AND signature of the prescriber, with business phone number.
  3. Generic name of the medication, and brand name if applicable.
  4. Route and dose of medication prescribed.
  5. Frequency and time of medication prescribed.
  6. Reason for giving medication, if an “as needed” drug.
  7. Specific directions for administration, if needed.


The MAP must contain:


  1. Any special side effects, contraindications or adverse reactions that may occur.
  2. Any other medications taken by the student, with potential interactions.
  3. The date of next scheduled visit to the prescriber should appear on the medication order form.
  4. A parental consent form must be completed and filed with the MAP.


Short-term medications, including antibiotics, or other medications prescribed for ten (10) days or less, may be accepted with the current label utilized as the prescription.  If the nurse has any questions, she may request a written prescription from the physician. 


Documentation:  A medication administration record must be maintained for each student that receives medication during the school day.  Confidentiality of this record must be insured.  The Medication Administration Daily Log (MADL) must contain the following:


  1. Student’s name, DOB, sex, grade and homeroom,
  2. The school name and year,
  3. Medication, dosage, route, frequency and times of administration,
  4. Full signature and initials of each nurse administering medication,
  5. A calendar to allow initials to denote the giving of the medication,
  6. A section for narrative notes and significant information.


A MAP for the current medications should be filed near the MADL.  Consent and order forms, with parental consent forms, should also be filed near the MADL.


The school nurse shall document on the MADL, including:


  1. Initials in appropriate boxes for date, time, medication administered.
  2. The patient’s response to prn (as needed) medications.
  3. The appropriate code for the medication, and a narrative, if needed.
  4. Codes to be documented are:

i.    A-Absent

ii.   E-Early Dismissal

iii.  N-No Medication Available

iv.  O-No Show

v.      X-No School

vi.     F-Field Trip

vii.   W-Dosage Withheld

  1. All documentation must be completed in ink, to prevent erasure or confusion.
  2. Narrative notes are to be completed on the back of the MADL form, in ink, and in clear writing that explains:

i.    Why a medication is withheld

ii.   Why/when a medication is destroyed or returned to family

iii.  When and number of medications received


The school nurse may elect to withhold any medication if she is unsure of directions, feels the student’s current condition merits withholding the medication or if the medication has potential for harmful or dangerous repercussions.


(See attachments for forms)




School:  ___________________________________________________________


Name: __________________________________     DOB: _______________        Grade: ______


Parent/Guardian: ________________________________     Home Phone: __________________

                                                                                          Work Phone: __________________


Emergency Contact: ______________________________     Phone: _______________________


Licensed Prescriber ______________________________      Phone: _______________________


Food/Drug Allergies: ____________________________        Diagnosis: ___________________

                                                                                                            (If not in violation of confidentiality)




1.  Medication: ______________________________     Dosage: __________________________


Frequency: _______________________________


Route: ____________ Order Date: _______________           D/C Date: ________________

Quantity of Med Received: _____________   Date Received: _______________

Exp. Date of Med Received: ________________    

Specific Directions (e.g., times given): _______________________________________________


2.  Possible Side Effects:


     Adverse Reactions:


3.  Required Storage Conditions:  Store at Room Temperature/Original Container/Locked Cabinet


4.  Plan for Field Trips: If applicable, designated person will be authorized in writing by the parent and care plan and med administration discussed/reviewed

      Delegate for Field Trips: 1.  _________________________        2.  _______________________


5.  May self-administer? ____Yes  ____ No (need doctor/parent permission, nurse determines if it is safe and appropriate)


6.  Other persons to be notified of medication administration (with parental permission): ___________________________________________________________________________


7.  Other meds being taken by student (if not in violation of confidentiality): _________________


8.  Location where medication administration will occur:  ____ Health Room  ____ Other (specify)  ____ Field Trips, if applicable and _______________________________________


9.  Plan for monitoring medication, if needed: continually assess for side effects and adverse reactions as well as intended effect of medicine.


10.  Other: Contraindications:




School Nurse Signature: ______________________________________      Date: ______________


Parent/Guardian Signature: ____________________________________     Date: ______________


Student Signature, if appropriate: _______________________________      Date: ______________







(to be completed by a licensed prescriber)


Name of Student: __________________________________ Date of Birth: _________________

            Address:   _____________________________________________Grade: ____________


(Print) Licensed Prescriber: _______________________________Title: ____________________

            Telephone #: __________________________           Fax #: ___________________________


Medication: _____________________________(Generic): ______________________________

            Dose: _________________________________________

Route: _________________________________________

            Frequency: _____________________________________

Time given: ____________________________________

            (Medications should be scheduled at hours other that school-time, when possible)

            Date of Order: __________________________________

Discontinuation/Expiration Date: ___________________


Specific Directions/information for administration: _____________________________________


Diagnosis/Purpose of Med*: _______________________________________________________


Any other medical conditions*: ____________________________________________________

* If not in violation of confidentiality


Optional Information


Any side effects, contraindications or adverse reactions to observe for: _____________________



Other medication taken by student __________________________________________________


Consent for self-administration (in safe and appropriate situations): yes____     no____


Date of next scheduled visit : ______________________________________________________


Date: ______________________




Signature of Licensed Prescriber



School Nurse Protocols




General Information


Student’s name: _________________________________________            Date of Birth: ________


School: _____________________     Grade: _________________   Sex: _______


Parent/Guardian Printed Name: ____________________________________________________

Address: ______________________________________________

Home Phone: ___________________________                    Work: ___________________________


Emergency Contact Name: _________________________________           Relationship: ________

Home Phone: ___________________________                    Work: ___________________________


My son/daughter is currently receiving the following medications, either at home or in school:



(to be completed if not in violation of confidentiality)





1.  I give permission to have the school nurse (or school personnel designated by the school nurse) administer the following medication: ______________________________, prescribed by: ______________________________ to ____________________________________________.

(Licensed Prescriber)                                                               (Name of Student)


2.  I give permission for my son/daughter to self-administer medication if the school nurse determines it is safe and appropriate.  _____Yes                _____No


3.  I give permission for the school nurse to share with appropriate school personnel information relative to the prescribed medication administration (i.e., adverse side effects) as she/he determines necessary for my son/daughter’s health and safety.  _____Yes              _____No

Any restrictions on release? _______________________________________________________


(Please note: I understand that I may retrieve the medicine from the school at any time and that the medicine will be destroyed if it is not picked up within one week following the termination of the order or one week beyond the close of school.)


___________________________________________                      __________________________

Signature of Parent/Guardian                                                   Date



Relationship to Student



Self-Administration of Medications in the Gardner Public Schools


Information:  The Gardner Public Schools require all medication to be stored in the school’s health room, and monitored by the school nurse.  If an individual student is capable of utilizing prescribed medication independently, the school nurse may assess the following requirements and determine whether an independent medication program is appropriate.




1.       Student, school nurse, and parent/guardian agree to conditions under which self-administration may occur.


2.       School nurse develops MAP for safe self-administration.


3.       School nurse deems the student capable, and observes responsible use of med.


4.       Student identifies the medication, frequency, and time of day for the medication that is ordered.


5.       There is written authorization from the parent/guardian for self-administration.


6.       The licensed prescriber provides written orders for self-administration, if the school nurse feels it is needed.


7.       Student follows procedure for documentation of self-administration.


8.       The school nurse, in conjunction with student, teachers, and parent/guardian, determines a safe place for the student to store medications, and maintains a back-up supply in the health room.


9.       School nurse monitors self-administration, including some or all of the prompts listed below:


a.       Instructing student in self-administration,

b.       Reminding the student to take meds,

c.       Visual observation to monitor compliance,

d.       Recording meds taken,

e.       Notifying parent/guardian, or prescriber of side effects, changes in MAP, or refusal/failure to take meds.


The school nurse may inform teachers/administrators that the student is self-administering, with permission of the parent/guardian.



Delegation of Medications for Field Trips and Short Term School Events




In accordance with Department of Public Health Regulations, and with our medication policies, each student must have a delegation permission form signed yearly.  This form must be signed by the student’s parent/guardian and filed in the student’s health files.  Unlicensed school personnel may give medications while attending field trips or short-term events if they have been trained in specific medication administration, as well as in the use of an Epi-Pen.




The teacher/staff who are planning to leave the schools for field trips or short-term events must inform the school nurse at least two (2) weeks in advance in order to allow time for the nurse to obtain labeled prescription bottles, lists of students and medication concerns lists.  The teacher/staff who will be attending such events must have training in medication delegation, administration and Epi-Pen use.  This training must occur within 6 months of the field trip and the designated medication administrator must verbalize medication names, doses, times and special considerations for each student who will receive medications during the field trip or short-term event.





School Nurse Documentation of Parental Permission for Delegation of Medications for Short Term Events or Field Trips


The Gardner Public Schools are registered with the Department of public Health for delegation of medications for field trips or short-term events.  This delegation may occur only for staff that have completed instructions regarding medications, doses, times given and use of the Epi-Pen.  In order for faculty/staff to provide medication for your child during a field trip or event, parental permission must be given.  Each student must provide a labeled, empty, prescription bottle to use during the trip.  Parental permission given on this form will allow the student to participate in field trips without concern for appropriate medication dosage.  Please review and sign the form below and return it to the health office for filing.  This form will provide sufficient permission for the entire school year, unless medication changes are dramatic.



I, _______________________________________, parent/guardian for ________________________________________ hereby give consent to allow delegation of medication administration for short-term events or field trips.  I understand that the staff/faculty who will give this medication are trained in medication administration, as well as possible side effects or emergency issues.



_____________________________________________                  __________________________

Signature of Parent/Guardian                                                   Date



_____________________________________________                  __________________________

Signature of School Nurse                                                       Date





Medication Delegation Training Record


The following unlicensed school personnel have been authorized by the Gardner School Nurse Leader and selected by the school nurse at: _________________________________________ to administer medications in the event of an emergency or during a field trip/special event when the school nurse is not available.  Individuals have been trained by the school nurse in the administration of the medication listed beside their name.  Training includes administration, special considerations, possible adverse reactions and any necessary emergency procedures to be followed.  Authorization to administer medications is contingent upon the staff’s ability to verbalize understanding and competency regarding a specific medication.


Name of Unlicensed Personnel                       Medication      Training Date   Review       Instr. Init.


______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________             _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______

______________________________            _________      ____________              _________    ______




Reporting and Documentation of Medication Errors



A medication error may include any failure to administer medication as prescribed, within the school setting.  Any individual designated to provide medications for a student may be required to report and document an error.  Therefore, all school nurses, as well as faculty and staff delegated for field trips or short-term events must be aware of this procedure.  A medication error includes any failure of the “5 R’s” as well as failure to administer the drug.


The “5R’s” include:


            Right Name

            Right Time

            Right Does

            Right Med

            Right Route


In order to prevent medication errors, all individuals who give medications shall be encouraged to review the “5R’s” prior to giving a medication.



If a medication error occurs, reporting of the error to appropriate persons, monitoring of the person giving the medication and documentation of all that occurs, is most import.  These measures will provide for communication of the problem, safety of the patient and prevention of future occurrences.



Prompt notification of the error can be very important.  As soon as the error is identified, the person who give the medication must notify:


1.         The Primary Care Physician

2.         The School Nurse Leader

3.         The Parent/Guardian of the Student


The physician may determine any need for follow up treatment or monitoring and order such activities through the school nurse, if available, or the School Nurse Leader.  The School Nurse Leader will assist the person in error to fill out an accident/occurrence report form following the procedures in the health manual.


All medication errors resulting in any illness or medical care will be reported to the Department of Public Health, Bureau of Family and Community Health; 1-617-624-5493.


Any suspected diversion or tampering with medications shall be reported to the Department of Public Health, Division of Food and Drugs; 1-617-983-6700, or 617-522-3700.


The School Nurse Leader shall review the event with the involved persons provide necessary teaching and safety steps to prevent further errors and to ensure proper administration of medications in the future.

File: JLCD-R


[Adopted: December 2003]

[Revised: October 2015)


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