WHT Law

Administration of Medication in Schools

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Two provisions of the Illinois School Code (hereinafter “School Code”) discuss the administration of medication in public school districts. The first is Section 10-22.21b, which states,

It shall be the policy of the State of Illinois that the administration of medication to students during regular school hours and during school-related activities should be discouraged unless absolutely necessary for the critical health and well-being of the student. Under no circumstances shall teachers or other non-administrative school employees, except certified school nurses and non-certificated registered professional nurses, be required to administer medication to students. This Section shall not prohibit a school district from adopting guidelines for self-administration of medication by students. This Section shall not prohibit any school employee from providing emergency assistance to students.

105 ILCS 5/10-22.21b (Emphasis added.) This section makes clear that with regard to the administration of any medication, neither a teacher nor a non-administrative school employee, but for a certified school nurse or non-certificated registered professional nurse, shall be required to administer medication to students. The September 2000 guidance document entitled Recommended Guidelines for Medication Administration in Schools co-authored by the Illinois Department of Human Services (IDHS) and the Illinois State Board of Education (ISBE) (hereinafter referred to as “IDHS/ISBE Guidance Document”), provides that while the above-mentioned non-administrative personnel and teachers cannot be required to administer medication, they may volunteer to do so. See IDHS/ISBE Guidance Document, Section III.5.C. Further, in an emergency situation, the statute does not prohibit any school employee from providing emergency assistance. The IDHS/ISBE Guidance Document provides that a school district should determine who is responsible for administering medication in the “absence of” a certified school nurse or non-certificated registered nurse (e.g., superintendent, principal). Id.

Please note, while personnel other than the school nurse may administer medication in the absence of the nurse, this is a fallback position, i.e., only when the nurse is not available. ISBE recommends that when one nurse is responsible for multiple buildings, the school utilize “staggered station times” to meet each building’s needs. See IDHS/ISBE Guidance Document, P. 7, Section IV. Accordingly, it is suggested that the administration of medication be limited to administrative staff, in the absence of a nurse. Again, teachers and non-administrative personnel cannot be required to administer medication to students.

Self-Administration of Medication

The second relevant provision, Section 22-30 of the School Code, provides guidance on self-administration of medication and the administration of epinephrine auto injectors, or “epi pens”, in the school setting. The definition of “self-administration” of medication under this Section is limited to “a pupil’s discretionary use of and ability to carry his or her prescribed asthma medication” 105 ILCS 5/22-30(a) (Emphasis added.) Subparagraph (b) further requires that both public and non-public schools “permit the self-administration of medication by a pupil with asthma or the use of epinephrine auto-injector by a pupil,” provided that certain requirements are met regarding written authorization and medication labeling. 105 ILCS 5/22-30(b) (Emphasis added.) The requirements for self-administration of medication, i.e., prescribed asthma medication, are different than the requirements for the use of an epi-pen by a student. The chart below describes the requirements of both:

Requirements Self-Administration of Prescribed Asthma Medication Self-Administration of Epinephrine Auto Injectors
Written Authorization From Parents/Guardians From Student’s Physician, Physician’s Assistant, or Advanced Practice Registered Nurse
Required to be Provided to the School Prescription label, containing:

  • Name of Medication
  • Prescribed Dosage
  • Time/Circumstances under which Medication is to be administered
A written statement from above-listed provider, containing:

  • Name and Purpose of Epi-pen
  • Prescribed Dosage
  • Time(s)/Circumstances under which Epi-Pen is to be administered

 

The above-named documents and related information must be kept on file in the school nurse’s office, or if there is no school nurse, then by the school’s administrator. 105 ILCS 5/22-30(b). Provided that the above requirements are met, the authorization for self-administration of medication and/or use of an epi-pen is effective for the school year for which it was granted, and must be renewed each subsequent school year upon fulfillment of the above requirements. 105 ILCS 5/22-30(d). By receiving proper authorization, a student with prescribed asthma medication or epi-pen, may possess and use it while in school, at a school-sponsored activity, under the supervision of school personnel, or before or after normal school activities, such as a after-school care program operated on school property. 105 ILCS 5/22-30(e).

Further, Public Act 97-0361, which went into effect on August 15, 2011, added the following provisions to Section 22-30:

(b-5) A school district or nonpublic school may authorize the provision of an epinephrine auto-injector to a student or any personnel authorized under a student’s Individual Health Care Action Plan, Illinois Food Allergy Emergency Action Plan and Treatment Authorization Form, or plan pursuant to Section 504 of the federal Rehabilitation Act of 1973 to administer an epinephrine auto-injector to the student, that meets the prescription on file.
(b-10) The school district or nonpublic school may authorize a school nurse do the following: (i) provide an epinephrine auto-injector to a student or any personnel authorized under a student’s Individual Health Care Action Plan, Illinois Food Allergy Emergency Action Plan and Treatment Authorization Form, or plan pursuant to Section 504 of the federal Rehabilitation Act of 1973 to administer an epinephrine auto-injector to the student, that meets the prescription on file; (ii) administer an epinephrine auto-injector that meets the prescription on file to any student who has an Individual Health Care Action Plan, Illinois Food Allergy Emergency Action Plan and Treatment Authorization Form, or plan pursuant to Section 504 of the federal Rehabilitation Act of 1973 that authorizes the use of an Epinephrine auto-injector; and (iii) administer an epinephrine auto-injector to any student that the school nurse in good faith professionally believes is having an anaphylactic reaction.

105 ILCS 5/22-30(b-5)-(b-10) (Emphasis added.) The foregoing statute allows for either a student or any school personnel to administer an epi-pen to the student, which meets the prescription on file, so long as the administration is authorized under the student’s Individual Health Care Action Plan, Illinois Food Allergy Emergency Action Plan and Treatment Authorization Form, or Section 504 Plan. In contrast to Section 10-22.21b discussed above, which limited administration of medication to the school nurse or designated school administrator, Section 22-30(b-5) and subparagraph (b-10) allow “any personnel” to administer an epi-pen to a student, so long as they are authorized to do so under a student’s plan. However, we recommend, in line with Section 10-22.21b, that a non-school administrator, i.e., a teacher, not be required to administer medication against his/her choice, except in emergency situations. It should also be noted that, subparagraph (b-10) provides that a “school nurse”, notably not specified to be a certified school nurse and/or non-certificated registered nurse, may administer an epi pen to a student who the “school nurse” in good faith “professionally believes” is having an anaphylactic reaction. 105 ILCS 5/22-30(b-10).

In sum, the forgoing provisions do not call for the epi pen to be administered by anyone other than the student himself/herself, school personnel designated on the student’s plan, or a “school nurse”. However, Section 10-22.21b states that the statute is not intended to prohibit any school employees from providing emergency assistance to a student. Accordingly, in an emergency situation, it would be reasonable for a school employee to act and administer an epi-pen. The IDHS/ISBE Guidance Document states that a school employee who does not hold a valid Illinois Department of Financial and Professional Regulation (IDFPR) license must receive training in the correct procedure to be used to administer medication or provide specific treatment. See IDHS/ISBE Guidance Document, Appendix C. This may be most relevant to those non-licensed school personnel designated to administer an epi pen, or other medication, on a student’s Individual Health Care Action Plan, or other plan.

Please also note, the school district must inform parents of a student, in writing, that the school (district), including its employees and agents, are not to be held liable except for willful and wanton conduct, as a result of any injury arising from the self-administration of medication or use of an epi-pen regardless of whether authorization was given by the parents or the student’s physician, physician’s assistant, or advanced practice registered nurse. 105 ILCS 5/22-30(c). A statement must further be signed by the parents releasing the school (district) from any such liability and holding them harmless against any claims, except for those based on willful and wanton conduct, arising out of the self-administration of medication or use of an epi-pen. Public Act 97-0361, further added the following language to subparagraph (c) of this Section:

When a school nurse administers an epinephrine auto-injector to a student whom the school nurse in good faith professionally believes is having an anaphylactic reaction, notwithstanding the lack of notice to the parents or guardians of the pupil or the absence of the parents or guardians signed statement acknowledging no liability, except for willful and wanton conduct, the school district or nonpublic school and its employees and agents, including a physician providing standing protocol or prescription for school epinephrine auto-injectors , are to incur no liability, except for willful and wanton conduct, as a result of any injury arising from the use of an epinephrine auto-injector regardless of whether authorization was given by the pupil’s parents or guardians or by the pupil’s physician, physician’s assistant, or advanced practice registered nurse.

105 ILCS 5/22-30(c) (Emphasis added.)

SUMMARY

The following briefly summarizes our recommendations for the administration of medication in the school setting:

1. The school district/school should maintain a policy for the administration of medications to students to be utilized by relevant school administrators and the school nurse. Likewise, the school should furnish a parallel policy to parents, with relevant information regarding requirements for administration of medication by the school nurse, administrator, or their son/daughter in school, including the required forms, releases and requirements of medication labeling.

2. A student may self-administer medication as authorized by written statement from parent(s). Further, a student may self-administer an epi-pen as authorized by written statement from the student’s physician, physician’s assistant, or advanced practice registered nurse. These authorizations shall be renewed annually.

3. Medication received from parents/guardians of a student for administration in school by either the school nurse, school administrator, and/or the student, should be in the original container, and include: the name and purpose of the medication, prescribed dosage, time(s) and/or circumstances under which it should be administered, and contact information of the prescribing physician, physician’s assistant, or advanced practice registered nurse, and information of the pharmacy.

4. The following school personnel may administer medication: a school nurse, which means either a certified school nurse or a non-certificated registered nurse, or a school administrator in the instance that there is no school nurse. Neither a non-administrative school employee nor teacher may administer medications or an epi pen, unless specifically authorized by a student’s Individual Health Care Plan, Illinois Food Allergy Emergency Action Plan and Treatment Authorization Form, or Section 504 Plan. Proper training should be provided to unlicensed administrators of medication.

5. In an emergency, any school personnel may provide emergency assistance to the student.

6. Only a school nurse may administer an epi pen to a student without an epi pen prescription, who the school nurse in good faith professionally believes is having an anaphylactic reaction.