Code of Massachusetts Regulations › 105 CMR - DEPARTMENT OF PUBLIC HEALTH › Title 105 CMR 210.000 - The Administration Of Prescription Medications In Public And Private Schools › Section 210.100 - Administration of Epinephrine

Current through Register 1525, July 5, 2024
(A) A public school
			 district or non-public school, as defined by the Massachusetts Department of
			 Education, may register with the Department for the limited purpose of
			 permitting properly trained school personnel to administer epinephrine by auto
			 injector in a life-threatening situation during the school day when a school
			 nurse is not immediately available, including field trips, provided that the
			 following conditions are met:
(1) the school
			 committee or, in the case of a non-public school, the chief administrative
			 officer, approves policies developed by the designated school nurse leader or,
			 in the absence of a school nurse leader, a school nurse with designated
			 responsibility for management of the program ("responsible school nurse")
			 governing administration of epinephrine by auto injector. This approval must be
			 renewed every two years;
(2) the
			 school committee or chief administrative officer provides an assurance to the
			 Department that the requirements of
			 105 CMR 210.000 will be
			 met;
(3) in consultation with the
			 school physician, the designated school nurse leader or responsible school
			 nurse manages and has final decision making authority about the program. This
			 person, or school nurses designated by this person, shall select the
			 individuals authorized to administer epinephrine by auto injector. Persons
			 authorized to administer epinephrine shall meet the requirements of
			 105
			 CMR 210.004(B)(2);
(4) the school personnel authorized to
			 administer epinephrine by auto injector are trained and tested for competency
			 by the designated school nurse leader or responsible school nurse, or school
			 nurses designated by this person, in accordance with standards and a curriculum
			 established by the Department.
(a) The
			 designated school nurse leader or responsible school nurse, or school nurses
			 designated by this person, shall document the training and testing of
			 competency.
(b) The designated
			 school nurse leader or responsible school nurse, or a designee, shall provide a
			 training review and informational update at least twice a year.
(c) The training, at a minimum, shall
			 include:
1. procedures for risk
			 reduction.
2. recognition of the
			 symptoms of a severe allergic reaction;
3. the importance of following the medication
			 administration plan;
4. proper use
			 of the auto-injector; and
5.
			 requirements for proper storage and security, notification of appropriate
			 persons following administration, and record keeping.
(d) The school shall maintain and make
			 available upon request by parents or staff a list of those school personnel
			 authorized and trained to administer epinephrine by auto injector in an
			 emergency, when the school nurse is not immediately available;
(5) epinephrine shall be
			 administered only in accordance with an individualized medication
			 administration plan satisfying the applicable requirements of
			 105
			 CMR 210.005(E)  and
			 210.009(A)(6),
			 updated every year, which includes the following:
(a) a diagnosis by a physician that the child
			 is at risk of a life threatening allergic reaction and a medication order
			 containing proper dosage and indications for administration of
			 epinephrine;
(b) written
			 authorization by a parent or legal guardian;
(c) home and emergency number for the
			 parent(s) or legal guardian(s), as well as the names(s) and phone number(s) of
			 any other person(s) to be notified if the parent(s) or guardian(s) are
			 unavailable;
(d) identification of
			 places where the epinephrine is to be stored, following consideration of the
			 need for storage:
1. at one or more places
			 where the student may be most at risk;
2. in such a manner as to allow rapid access
			 by authorized persons, including possession by the student when appropriate;
			 and
3. in a place accessible only
			 to authorized persons. The storage location(s) should be secure, but not locked
			 during those times when epinephrine is most likely to be administered, as
			 determined by the school nurse;
(e) a list of the schoolpersonnelwho would
			 administer the epinephrine to the student in a life threatening situation when
			 a school nurse is not immediately available;
(f) a plan for comprehensive risk reduction
			 for the student, including preventing exposure to specific allergens;
			 and
(g) an assessment of the
			 student's readiness for self-administration and training, as
			 appropriate.
(6) when
			 epinephrine is administered, there shall be immediate notification of the local
			 emergency medical services system (generally 911), followed by notification of
			 the student's parent(s) or guardian(s) or, if the parent(s)or guardian(s) are
			 not available, any other designated person(s), the school nurse, the student's
			 physician, and the school physician, to the extent possible;
(7) there shall be procedures, in accordance
			 with any standards established by the Department, for:
(a) developing the medication administration
			 plan;
(b) developing general
			 policies for the proper storage of medication, including limiting access to
			 persons authorized to administer the medication and returning unused or
			 outdated medication to a parent or guardian whenever possible;
(c) recording receipt and return of
			 medication by the school nurse;
(d)
			 documenting the date and time of administration;
(e) notifying appropriate parties of
			 administration and documenting such notification;
(f) reporting medication errors in accordance
			 with
			 105
			 CMR 210.005(F)(5);
(g) reviewing any incident involving
			 administration of epinephrine to determine the adequacy of the response and to
			 consider ways of reducing risks for the particular student and the student body
			 in general;
(h) planning and
			 working with the emergency medical system to ensure the fastest possible
			 response;
(i) disposing properly of
			 used epinephrine injector;
(j)
			 submitting a written report to the Department of Public Health each time
			 epinephrine is administered to a student or staff, on a form obtained from the
			 Department;
(k) permitting the
			 Department of Public Health to inspect any record related to the administration
			 of epinephrine without prior notice, to ensure compliance with 105 CMR
			 210.100.