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## Complete Summary

#### GUIDELINE TITLE

Guidelines for the administration of medication in school.

#### BIBLIOGRAPHIC SOURCE(S)

Guidelines for the administration of medication in school. Committee on
School Health. Pediatrics 2003 Sep;112(3 Pt 1):697-9. \[13 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12949307)

#### GUIDELINE STATUS

This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years
by the authoring body, at which time a recommendation is made that the
policy be retired, revised, or reaffirmed without change. Until the
Board of Directors approves a revision or reaffirmation, or retires a
statement, the current policy remains in effect.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Diverse health circumstances requiring administration of medicine at
school

#### GUIDELINE CATEGORY

Management

#### CLINICAL SPECIALTY

Family Practice\
Pediatrics

#### INTENDED USERS

Allied Health Personnel\
Health Care Providers\
Nurses\
Physicians

#### GUIDELINE OBJECTIVE(S)

To appropriately guide prescribing physicians as well as school
administrators and health staff on the administration of medications to
children at school

#### TARGET POPULATION

Medication-dependent school children

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Administering the following medications in school:

    -   Over-the-counter products

    -   Certain prescribed medications

    -   Herbal medications

    -   Experimental drugs that are administered as part of a clinical
        trial

    -   Emergency medications

2.  Establishing school policies for the administration of medication in
    the school setting

3.  Training and education of faculty and parents to ensure student
    safety

#### MAJOR OUTCOMES CONSIDERED

Not stated

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not stated

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

The American Academy of Pediatrics recommends that school districts
consider the following medication issues when writing policy:

1.  Parent-recommended short-term medications

2.  Emergency and urgent medications

3.  Security and storage of medication

4.  Principles of student safety

Refer to the original guideline document for details.

**Guidelines for Pediatricians**

1.  Pediatricians, other child health professionals, and their
    state-level professional organizations should work with state
    departments of health and/or education and with local schools and
    districts to support the development of sound medication policies
    (American Academy of Pediatrics, 1997)

2.  Physicians should be aware that prescribing drugs on an
    \"as-needed\" basis can be problematic in schools where no health
    professional is available at the school site to assess the actual
    need. Any medication that can be given on a regular basis rather
    than \"as needed\" should be prescribed as such to avoid giving
    school staff members and the student responsibility to determine the
    need.

3.  The prescribing pediatrician or other health professional should
    notify the school (usually on school medication forms) of adverse
    effects that may be reasonably expected and contraindications to
    administering the medication.

4.  School districts and their personnel are not obliged to administer
    experimental medications and medication doses that exceed dosages
    approved by the United States Food and Drug Administration.
    Prescribing physicians should inform schools of the nature of each
    drug that is administered in school as well as adverse effects that
    may be expected for each drug that may be part of a blinded
    experimental trial. The prescribing physician should provide this in
    a written format for the school, and the packaging at school should
    include the experimental code.

5.  The physician should state whether a student is qualified and able
    to self-administer a medication, and this input, along with the
    consent of the parent, student, and school staff, should be used to
    determine whether this is advisable.

**Guidelines for Administrators and Health Personnel in Schools and
School Districts**

1.  To administer any prescribed medication, require a written statement
    from the parent and the physician that provides the name of the
    drug, the dose, approximate time it is to be taken, and the
    diagnosis or reason the medication is needed. Administration of
    medications purchased outside the United States is not exempt from
    requiring the written prescription of a US-licensed physician.

2.  School policies and practices for medication administration must
    ensure that student confidentiality is protected, as outlined in the
    Family Education Rights and Privacy Act (Family Educational Rights
    and Privacy Act; National Association of School Nurses, 2000;
    National Task Force on Confidential Student Health
    Information, 2000) and the Health Insurance Portability and
    Accountability Act (Health Insurance Portability and Accountability
    Act, 1996).

3.  In the absence of trained medical staff, the school principal or a
    designee should administer medication to students. It is imperative
    that any person administering medication be educated about the
    method of administration and contraindications to giving the
    medication. Specify how the medication will be administered to
    students when they participate in field trips, school camps, and
    other out-of-school activities.

4.  Older and responsible students should be allowed to self-medicate at
    school with over-the-counter medications and certain prescription
    medications (e.g., albuterol for asthma, insulin for diabetes) when
    this is recommended by the parent and physician and the student is
    deemed responsible to remember prescribed doses. Obtain written
    notification from parents acknowledging that the school bears no
    responsibility for ensuring the medication is taken. Immediately
    confiscate medication shared with classmates and remove the
    student\'s privilege of self-administration.

5.  Herbal medications can have serious and dangerous adverse effects.
    These and over-the-counter medications, when taken on a regular
    basis, should require a physician\'s note that in essence
    \"prescribes\" these nonprescription medications. The school should
    have physician-approved protocols (indications, dose, and
    contraindications) for using over-the-counter medications, should
    never use a drug for children at ages below which the drug is not
    approved (unless it is prescribed), and should reserve the right to
    limit the duration that over-the-counter medications are
    administered solely on the basis of parent recommendation.

6.  Notify parents that it is the parents\' responsibility to supply the
    school with prescribed medications, provide labeled containers, keep
    medications current, supply medical devices (e.g., nebulizers,
    insulin pumps, oxygen), and help to maintain these devices.

7.  Protocols for the documentation of all therapies given at school,
    whether emergency or routine, should be established. Some schools
    use a log, and others use a computer-based student medical record
    system. Any errors in medication administration at school need to be
    reported to at least 1 common supervisor so that patterns of errors
    and corrective action can be taken. Measures taken by school
    administrators after a medication error must be designed so that
    they do not discourage staff self-reporting of errors (Schwab,
    Panettieri, & Bergren, 1998).

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### REFERENCES SUPPORTING THE RECOMMENDATIONS

[References open in a new
window](http://www.guideline.gov/summary/select_ref.aspx?doc_id=4249)

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting each recommendation is not specifically
stated.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

-   Appropriate administration of medications to children at schools

-   Benefits of parent-recommended short-term medications such as pain
    relievers, anti-inflammatory medications, and antihistamines include
    symptomatic improvement for the student that enables learning and
    causes less classroom disruption.

#### POTENTIAL HARMS

Disadvantages of parent-recommended short-term medications include
difficulty in obtaining physician permission for limited use, liability
of the school district in assisting with the administration of an
unprescribed medication that has potential to cause harm, and issues of
school safety and security of drug use (e.g., sharing of medication
between classmates).

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

The guidance in this report does not indicate an exclusive course of
treatment or serve as a standard of medical care. Variations, taking
into account individual circumstances, may be appropriate.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Patient-centeredness\
Safety

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Guidelines for the administration of medication in school. Committee on
School Health. Pediatrics 2003 Sep;112(3 Pt 1):697-9. \[13 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12949307)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2003 Sep

#### GUIDELINE DEVELOPER(S)

American Academy of Pediatrics - Medical Specialty Society

#### SOURCE(S) OF FUNDING

American Academy of Pediatrics

#### GUIDELINE COMMITTEE

Committee on School Health

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Committee on School Health, 2002-2003*: \*Howard L. Taras, MD,
*Chairperson*; Barbara L. Frankowski, MD, MPH; Jane W. McGrath, MD;
Cynthia Mears, DO; Robert D. Murray, MD; Thomas L. Young, MD

*Liaisons*: Janis Hootman, RN, National Association of School Nurses;
Janet Long, American School Health Association; Jerald L. Newberry, Med,
National Education Association Health Information Network; Mary
Vernon-Smiley, MD, MPH, Centers for Disease Control and Prevention

*Consultant*: \*Wayne Yankus, MD

*Staff*: Su Li, MPA

\*Lead authors

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years
by the authoring body, at which time a recommendation is made that the
policy be retired, revised, or reaffirmed without change. Until the
Board of Directors approves a revision or reaffirmation, or retires a
statement, the current policy remains in effect.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [American Academy of Pediatrics
(AAP) Web
site](http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/3/697).

Print copies: Available from American Academy of Pediatrics, 141
Northwest Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927.

#### AVAILABILITY OF COMPANION DOCUMENTS

None available

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on February 19, 2004. The
information was verified by the guideline developer on March 29, 2004.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions. Please contact the
Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest
Point Blvd, Elk Grove Village, IL 60007.

### DISCLAIMER

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Date Modified: 11/3/2008