Maine Public School Do Pain Patients Get Same Access?
Photography By © Michael John Coleman 2007
WASHINGTON, DC November 1st, 2007— Access to medication to small children without the parent’s knowledge. This is one of the national stories that has the capacity to create excellent public health dialog in almost any social group you might come across in your day.
Now, if you are a parent living in Portland Maine our hearts go out to you! We Virginians feel somewhat safe regarding our school systems and what controlled substances the school board gives out. So what are we really talking about? Access to medication comes to mind. So many pain patients lack fair access to appropriate pain management these days. But yet an 11-year child can have access to a Federally controlled substance without her mother or father’s knowledge. The is all a bit disconcerting to many.
Over the years MAGNUM has gone to bat for students at the request of the parents so their children can have access to their Migraine medication, which so many school systems across the nation will not allow. They always cite the same reason why young student Migraineurs cannot have access to the Migraine medication: because it is a Federally controlled substance!
Well, you could imagine our surprise when we heard the Portland Pupil Pill story break! It was OK to give out a Federally controlled drug to a student for sex, but not allow the same little girl access to another Federally controlled drug to abort pain of a Migraine?
The good news is MAGNUM had an opportunity to debrief the Director of Human Resources for the Portland, Maine School system! Michael John interviewed Joline Hart for about a half hour, and we can tell you that regardless of all the hoopla in the national media, the children in that school system are under good leadership when it comes to patient care. As for policy, well we will let the nation continue to debate with the Portland school Board. Even though they do not allow ‘self-care’ they do keep the student medication in the nurse’s office and the student can have access any time they need it. Which made us feel much better.
It really made us stop and wonder what was happening if an 11-year old could walk in and obtain the pill, but may not be able to afford, via the family health insurance, a good Migraine aborting pill from the same school system?
If you are interested, the Rules for Medication Administration in Maine Schools are below. Now you really will know more than your friends about what is allowed or not! Great fun at parties. But really access to the best medications is no laughing matter.
05-071 DEPARTMENT OF EDUCATION (COMMISSIONER)
Chapter 40: RULE FOR MEDICATION ADMINISTRATION IN MAINE SCHOOLS
SUMMARY: This rule provides directions to public and private schools approved pursuant to 20-A MRSA 2902 in the administration of medication to students during the students’ attendance in school programs. It is to assist school administrative units in implementing the provision of the medication statute [20-MRSA § 254 (5) (A - C)] that provides direction for training of unlicensed school personnel in the administration of medication, and requires that students be allowed to carry and self-administer prescribed emergency medications; specifically, asthma inhalers or epinephrine auto-injectors with health care provider approval and school nurse assessment demonstrating competency.
1. Definitions
Administration: Administration means the provision of prescribed medication to a student according to the orders of a health care provider.
Asthma inhaler: An asthma inhaler is a device for the delivery of prescribed asthma medication which is inhaled. It includes metered dose inhalers, dry powder inhalers and nebulizers.
Epinephrine auto injector: An epinephrine auto injector is a device to deliver the correct epinephrine dose parenterally and is used as a treatment for symptoms of an allergic reaction.
Health Care Provider: A health care provider is a medical/health practitioner who has a current license in the State of Maine with a scope of practice that includes prescribing medication.
Indirect Supervision: Indirect supervision means the supervision of an unlicensed school staff member when the school nurse or other health provider is not physically available on site but immediately available by telephone.
Medication: Medication means prescribed drugs and medical devices that are controlled by the U.S. Food and Drug Administration and are ordered by a health care provider. It includes over-the-counter medications prescribed through a standing order by the school physician or prescribed by the student’s health care provider.
Medication Error: A medication error occurs when a medication is not administered as prescribed. This includes when the medication prescribed is not given to the correct student, at the correct time, in the dosage prescribed, by the correct route, or when the medication administered is not the correct medication.
Parent: Parent means a natural or adoptive parent, a guardian, or a person acting as a parent of a child with legal responsibility for the child’s welfare.
School Nurse: School nurse means a registered professional nurse with Maine Department of Education certification for school nursing.
Self-Administration: Self-administration is when the student administers medication independently to him or her self under indirect supervision of the school nurse.
Training for Unlicensed School Personnel: Training for unlicensed school personnel means the organized and systematic education of unlicensed school personnel who will administer medications to students.
Unlicensed School Personnel: Unlicensed school personnel are persons who do not have a professional license that allows them, within the scope of that license, to administer medication.
2. ADMINISTERING MEDICATIONS IN A SCHOOL SETTING.
A. The school nurse will provide direction and oversight for the administration of medication in the school.
B. School nurses are responsible for their own actions in the administration of medication. It is the school nurse’s responsibility to clarify any medication order which he or she believes to be inappropriate or ambiguous. The school nurse has the right and responsibility to decline to administer a medication if he/she believes it jeopardizes student safety. In this case, the nurse must notify the parent, the student’s health care provider and the school administrator.
C. Any public or private school approved pursuant to 20-A MRSA 2902 shall have a written, local policy for administering medication. The policy must include the following:
i. All unlicensed school personnel who administer medication must be trained before receiving authorization to do so.
ii. Before medication is administered to a student there must be:
1. A current written request from the parent for any medication administered to a student.
2. A current written order from the prescribing health care provider for any medication administered at school. The order must include the student’s name, the name of the medication, the dose, the route of administration, time intervals to be given, any special instructions, and the name of the prescribing licensed health care provider. A medication label that provides sufficient information may be used in lieu of a written order unless the medication is to be administered for more than 15 consecutive days.
3. Written parental permission forms and physician orders must be renewed at least annually. Physician orders must be renewed if there are changes in the order.
iii. It is recommended that the first dose of a newly prescribed medication be given at home.
iv. The medication must be delivered to school in its original container, properly labeled.
v. Students may possess and self-administer emergency medication of an inhaled asthma medication or an epinephrine auto-injector under the following conditions:
1. Written approval is received from the student’s health care provider stating that the student has the knowledge and skills to safely possess and use an inhaled asthma medication or an epinephrine auto-injector. The Maine School Asthma Plan is preferred for students who have been prescribed an asthma inhaler.
2. Written approval is received from the parent indicating that his/her child may carry and self-administer the medication.
3. The student demonstrates to the school nurse their ability to properly and responsibly carry and use the inhaled asthma medication or epinephrine auto-injector.
D. Procedures/protocols for medication administration (when not included in the school’s policy) must be developed for:
i. How medications are to be safely transported to and from school.
ii. Medication administered on field trips and other off campus activities that is in compliance with the Department of Education’s Procedure for Medication Administration on Field Trips.
iii. Accountability of medications, particularly those regulated by the Federal Narcotics Act.
iv. The proper storage of medication at school.
v. The training of appropriate staff on administration of emergency medications.
vi. The procedure to use should a medication reaction occur.
vii. Access to medications in case of a disaster.
viii. The process for documenting medications given and medication errors.
ix. The proper disposal of medications not retrieved by the parents.
3. REQUIRED TRAINING OF UNLICENSED SCHOOL PERSONNEL TO ADMINSTER MEDICATION.
A. Any unlicensed school personnel who administers medication to a student in a school setting must be trained in the administration of medication before being authorized to carry out this responsibility. Following the initial training, a training review and information update must be held at least annually for those staff members authorized to administer medications.
B. The training must be provided by a registered professional nurse or physician.
C. The training on administration of medication must include the following components:
i. Current laws and school policies related to medication administration,
ii. Resources available to staff regarding medication administration,
iii. Basic anatomy of routes of medication (ex. gastro-intestinal route, lung, ear, eye, and nose),
iv. Basic classification of medications,
v. Common medications with side effects,
vi. How to read a medication label,
vii. How to document medications administered and medication errors,
viii. The five rights of medication administration (right student, right medication, right dose, right time, and right route),
ix. Procedure/protocols for administering medication(s),
x. Signs and symptoms of adverse effects,
xi. Responding to emergencies,
xii. Working with parents, and
xiii. Protecting the confidentiality of student health information.
D. The trainer shall document the training and the competency of school personnel trained. Based upon the documentation of training and competency of unlicensed personnel to administer medication, the school nurse shall make a recommendation to the Superintendent concerning the authorization of such persons to administer medication to students.
E. School personnel trained in the administration of fluoride as part of the Oral Health Program in the Bureau of Health, are exempt from this rule for the administration of fluoride.
STATUTORY AUTHORITY:
20-A M.R.S.A. §254(5)(A-C), Resolve 2005 c. 11
EFFECTIVE DATE:
June 24, 2005 – filing 2005-186 (major substantive)
NON-SUBSTANTIVE CORRECTIONS:
February 1, 2007
Accessed from internet @ http://www.maine.gov/sos/cec/rules/05/071/071c040.doc
