Administrative Guideline: Administration of Medication

5.2 At the beginning of the school year, each school shall notify parents/guardians and/or, where appropriate, students that medication may be confiscated if the procedures outlined in the manual have not been complied with. (See Sample Notification Letter to Parents/Guardians - Appendix G)

6.0 Refusal of Medication or Authorization

6.1 If a student fails or refuses to take self-administered or administered medication, school personnel shall advise the student’s parent(s)/guardian(s) as soon as possible.

6.2 If a student refuses to accept emergency medication, school personnel shall attempt to administer it provided there is no risk of injury to himself or herself or to the student. School personnel shall immediately call for emergency medical treatment and notify the student’s parent(s)/guardian(s) or emergency contact.

6.3 School personnel who have reasonable grounds to suspect that a minor student under the age of 16 is in need of medication during school hours and that the parent(s)/guardian(s) have neglected or refused to arrange the administration of medication should refer to Child Abuse/Child Protection Protocol Administrative Guideline to determine the required action to be taken.

6.4 If a minor student between the ages of 16 and 18 provides the school with a duly signed Medical Information Form or Medical Emergency Information Form duly signed by the student’s physician, but the parent(s)/guardian(s) are not prepared to provide authorization, the Principal/Vice-Principal shall refuse attendance of the child until authorization is completed. He/she shall consult with the Supervisory Officer to decide whether the authorization of the parent(s)/guardian(s) is required in the circumstances and what course of action needs to be pursued.

7.0 Self-Administered Medication

7.1 Where students are to self-administer medication which is not required to respond to an emergency during regular school hours:

7.1.1 Parent(s)/guardian(s) and/or where appropriate students shall submit an Authorization Form for Self-Administered Medication (see Appendix “A”) to the Principal/Vice-Principal. The Medical Information Form should be completed by the parent(s)/guardian(s) and/or, where appropriate, the student, and need not be signed by the student’s physician. (These forms shall be filed in the student’s OSR)

7.1.2 The Principal/Vice-Principal, in cases of short term administration of medication, may make exceptions to

7.1.1 by requiring the following information:

7.1.2.1 The name of the medication.

7.1.2.2 Dosage of the medication to be taken.

7.1.2.3 Storage requirements for the medication, including whether it is recommended that the student retain possession of the medication.

7.1.2.4 Time(s) or circumstances in which the medication is to be taken during school hours.

7.1.2.5 The date of final administration of the medication (e.g. How long will the medication be taken?).

7.1.2.6 A signature of the parent regarding the above.

7.1.2.7 Medication supplied in the original container as dispensed and labelled by the pharmacy.

7.1.3 The parent(s)/guardian(s) and/or, where appropriate, the student, shall be responsible for supplying the medication in the original container as it is supplied and labelled by the pharmacy. If necessary, additional labelling shall be added by the parent(s)/guardian(s) and/or the student to ensure the container is labelled at minimum with the student’s name, the name of the medication, the times at which it is to be taken, the dosage (e.g. “one tablet at 11:00 o’clock”), the date the medication expires and instructions for ingestion (e.g. with water).

7.1.4 The Principal/Vice-Principal shall request any additional information he or she feels necessary or relevant.

7.1.5 No records of self-administration will be kept.

7.1.6 Medication shall be stored by the school if:

7.1.6.1 The medication requires special storage (e.g. refrigeration); and/or,

7.1.6.2 Requested by parent.

7.1.8 The parent(s)/guardian(s) and/or, where appropriate, the student, shall be responsible for submitting immediately new forms if the information supplied to the school changes or the Authorization Form expires and, if required, shall submit new forms after June 30 annually.

7.2 If the school is to store the medication, the Principal/Vice-Principal in conjunction with the parent(s) and/or guardian(s) shall arrange the following:

7.2.1 A secure location for the storage of the medication in accordance with its storage requirements (e.g. refrigeration);

7.2.2 Appointed times and informed designated school personnel with alternate designated school personnel to make the medication available to the student.

7.2.3 A date for discontinuation of medication. All information arrangements expire no later than June 30 and must be renewed for each school year.

7.2.4 The return of unused medication to parents/guardians or, where appropriate, the student.

7.2.5 Where the student’s medical condition is of a long-term or continuous nature, the Principal/Vice-Principal shall request the parent(s)/guardian(s) to provide suitable identification, such as a Medic Alert bracelet, of the condition and the procedure to be followed in an emergency.

7.2.6 A copy of the forms and any related arrangement notes shall be kept by the Principal/Vice-Principal and made available as required to the designated school personnel, the parent(s)/guardian(s) and/or, where appropriate, the student. The Principal/Vice-Principal shall advise school personnel to retain all copies of the forms and notes in a manner which protects the student’s privacy and to return the copies to the Principal/Vice-Principal when the medication is no longer required or at the end of the school year.

7.2.7 The disposal of all copies of the forms and notes in possession of school personnel when the medication is no longer required or shortly after June 30 annually. The original forms and notes shall be retained in the OSR.

8.0 Administered Medication

8.1 Oral medication not required to respond to an emergency will likely fall into one of three categories:

8.1.1 Long Term medication which is necessary on an on-going basis, e.g. medication which controls hyperactivity or seizures. 8.1.2 Short Term medication which is necessary for a specific period of time, e.g. antibiotics.

8.1.3 Infrequent medication which is necessary to treat a specific condition, e.g. antihistamine for an allergy which is not life threatening.

8.2 Where oral medication is to be administered by school personnel to a student:

8.2.1 Parent(s)/guardian(s) and/or, where appropriate, students shall submit an appropriately signed Authorization Form for Administered Medication (NonEmergency) (see Appendix "B") to the Principal/Vice-Principal. The Medical Information Form must be completed by the student's physician, if required by the principal, or by the parent(s)/guardian(s) for the administration of non-prescription medication to elementary or exceptional students. These forms shall be filed in the OSR.

8.2.2 The Principal/Vice-Principal, in cases of short term administration of medication, may make exceptions to 8.2.1 by requiring the following information: 8.2.2.1 The name of the medication.

8.2.2.2 Dosage of the medication to be taken.

8.2.2.3 Storage requirements for the medication, including whether it is recommended that the student retain possession of the medication.

8.2.2.4 Time(s) or circumstances in which the medication is to be taken during school hours.

8.2.2.5 The date of final administration of the medication (e.g. how long will the medication be taken?).

8.2.2.6 A signature of the parent regarding the above.

8.2.2.7 Medication supplied in the original container as dispensed and labeled by the pharmacy.

8.2.3 The parent(s)/guardian(s) and/or, where appropriate, the student, shall be responsible for supplying the medication in the original container as it is supplied and labeled by the pharmacy. If necessary, additional labeling shall be added by the parent(s)/guardian(s) and/or the student to ensure the container is labeled at minimum with the student’s name, the name of the medication, the times at which it is to be taken, the dosage (e.g., “one tablet at 11:00 o’clock”), the date the medication expires and instructions for ingestion (e.g. with water).

8.2.4 In situations of uncertainty the Principal/Vice-Principal shall advise the Supervisory Officer of the request for Administered Medication.

8.2.5 The Principal/Vice-Principal shall request any additional information he or she feels necessary or relevant.

8.2.6 All medication to be administered by school personnel shall be stored by the school in a locked cabinet inaccessible to students or the general public.

8.2.7 The Principal/Vice-Principal shall in conjunction with the parent(s)/guardian(s) and/or, where appropriate, the student, arrange for the following:

8.2.7.1 Compliance with the physician’s requirements and the frequency of administration.

8.2.7.2 Secure storage of the medication in accordance with its storage requirements (e.g. refrigeration).

8.2.7.3 Designated school support staff personnel and alternates to administer the medication with appropriate training.

8.2.7.4 Record keeping of the administration of medication.

8.2.7.5 A place to administer the medication.

8.2.7.6 A date for discontinuation of medication is required. All arrangements expire no later than June 30th and must be renewed for each school year.

8.2.7.7 The return of any unused medication to the parent(s)/guardian(s) or, where appropriate, the student when it is no longer required or at the end of the school year, or it will be otherwise safely disposed.

8.2.7.8 A copy of the forms and any arrangement notes shall be kept by the Principal/Vice-Principal and made available to the designated school support staff personnel, the Principal/Vice-Principal, the parent(s)/ guardian(s) and, the student where appropriate. A copy of the forms and the arrangement notes shall also be attached or kept with the Record of Administration of Oral Medication (Appendix E) or Record of Medication for Specified situations (Appendix F).

8.2.8 If there is a situation of uncertainty the Principal/Vice-Principal may choose to notify his or her Supervisory Officer of the request for Administered Medication. The Principal/Vice-Principal shall provide a copy of the Forms and arrangements to the Supervisory Officer. The Supervisory Officer shall review the documentation to ensure that it adheres to the procedures of the guideline.

8.2.9 The Principal/Vice-Principal shall advise school personnel to retain all copies of the forms and arrangement notes in a manner which protects the student’s privacy, and to return the copies to the Principal/Vice-Principal when the medication is no longer required or at the end of the school year.

8.2.10 The Principal/Vice-Principal shall destroy all copies of the forms and written arrangements in the possession of school personnel when the medication is no longer required or shortly after June 30. The original forms and arrangement notes shall be retained in the OSR.

8.3 Principal/Vice-Principal shall ensure that designated school personnel are familiar with and maintain a Record of Administration of Prescribed Oral Medication (attached as (Appendix “E”) or Record of medication for Specified Situations (Appendix F). The choice of forms shall be in accordance with the prescribed administration. A separate record will be kept for each medication to be administered to the student.

8.3.1 The record shall show the student’s name, the medication’s label information, the telephone numbers of the student’s physician, parent(s)/guardian(s) and/or emergency contact(s), the names of the designated school personnel and the dates or circumstances in which the medication is to be administered. The record shall be secured with the medication or near where the medication is stored.

8.3.2 The person administering the medication shall record the date, time, dosage, his or her own name or initials, any side effects and any response to side effects.

8.3.3 The Principal/Vice-Principal shall periodically review the record to ensure that it is being kept appropriately and take steps to address any identified problems.

8.3.4 When the medication is no longer required or at the end of the school year, the record shall be placed in the OSR.

8.3.5 Where the student’s medical condition is of a long-term or continuous nature, the Principal/Vice-Principal shall request the parent(s)/guardian(s) to provide suitable identification, such as a Medic Alert bracelet, of the condition and the procedure to be followed in an emergency.

9.0 Emergency Medication

9.1 Some students may have medical conditions which can often with no or little warning, cause serious or life-threatening episodes, which require an immediate response. Examples are grand mal seizures and life-threatening allergic reactions (e.g. anaphylactic shock caused by exposure to peanuts, bee stings). Some students may be able to self-administer emergency medication. However, there is always a possibility that a student will become incapacitated in an emergency. Where medication or appropriate intervention is required to respond to an emergency which may take place during regular school hours:

9.1.1 Parent(s)/guardian(s) and/or where appropriate students shall submit the appropriately signed Authorization Form for Emergency Medication (attached as Appendix “C”).

9.1.2 If necessary, the Principal/Vice-Principal shall request any additional information he/she determines is necessary. In particular, detailed information from the student’s physician about the student’s medical needs during an emergency is required.

9.2 Where the student is attending school and the procedures set out in this part are not yet in place, the Principal/Vice-Principal shall consult with the Supervisory Officer to determine whether the student will be allowed to attend school until the procedures are in place.

9.3 In situations of uncertainty, the Principal/Vice-Principal shall consult with the Supervisory Officer to determine whether it is within the duties of Board personnel to administer the emergency medication, or whether it is the responsibility of health care professionals provided by the Ministry of Health. If it is determined that administration of the emergency medication is within the duties of Board personnel, this section applies. Otherwise, Section 11.0 applies.

9.4 There may be situations where, given the nature of the medical condition and the life threatening nature of the emergency episode, a student will not be allowed to attend the regular day school program unless and until the services of health care professionals are in place. In these circumstances it may be appropriate for the Principal/Vice-Principal to schedule an IPRC meeting to discuss the student's potential exceptionality.

9.5 Where it is determined that the administration of emergency medication is within the duties of Board personnel the Principal/Vice-Principal, in consultation with the parent(s)/guardian(s) and/or, where appropriate, the student, will inquire into the emergency services available. The following information is required:

9.5.1 What is the expected response time for the ambulance?

9.5.2 Which hospital will the ambulance take the student to? If there is a choice, the parent(s)/guardian(s) and/or the student may specify a preference.

9.5.3 Will the ambulance attendants or paramedics be qualified to administer the medication?

9.5.4 Will the ambulance be equipped with the required medication?

9.5.5 Are there alternative sources of emergency assistance available? (i.e. fire department, medical clinic)

9.5.6 Will the student’s own physician or another qualified person from his or her office agree to and be in a position to attend in the event of an emergency?

9.6 Some medication may require training in order to administer. Primary and detailed training will be given to school support staff personnel and the student’s bus driver designated as individuals responsible for administration of medication. Teachers will not be assigned such designated duties but will receive necessary training. The Public Health Nurse and the Principal/Vice-Principal shall consult with the parent(s)/guardian(s) and/or, where appropriate, the student to arrange for designated school support staff personnel to receive the appropriate training. The Principal/Vice-Principal shall keep a record of all such training in the student’s OSR. In addition, the Principal/Vice-Principal shall, where possible, obtain written confirmation from the person conducting the training that the school support staff personnel were trained and are competent to administer the medication Qualified medical personnel may include, depending on the circumstances:

9.6.1 A physician.

9.6.2 The Victoria Order of Nurses.

9.6.3 Personnel provided by the Ministry of Health or recommended by the Ministry of Health.

9.6.4 In the event that none of the above are willing or available within reasonable financial expectations to provide the service, documentation to that effect will be made and the student’s parent who has been trained, will be requested to provide the training.

9.7 The training should be reviewed and offered annually to new staff and those requiring an update.

9.8 The Principal/Vice-Principal shall develop, in conjunction with the parent(s)/ guardian(s) and/or where appropriate, the student: a written Emergency Protocol setting out step-by-step the procedures to be taken in response to an emergency situation.

9.9 The parents/guardians and/or where appropriate the student, has the responsibility to review the protocol with the physician and have it signed by the doctor before the protocol can be well implemented.. (See letter of request Appendix H). Following that the parent(s)/guardians and/or where appropriate the student, and the Principal/Vice-Principal will sign the same protocol.

9.10 The Emergency Protocol will vary depending on the particular medical circumstances but will at minimum: (Appendix I provides a form that would be a minimally acceptable standard for an Emergency Protocol. Specific cases may require more detailed documentation)

9.10.1 Have the student’s name, picture and the words “Emergency Protocol” displayed prominently on the front.

9.10.2 Comply with any requirements communicated in writing by the student’s physician. 9.10.3 Briefly describe the medical condition and the potential emergency situation (e.g. seizure, potentially fatal, medication must be administered in 5 minutes).

9.10.4 Describe the circumstances in which the medicine is to be administered to the student (e.g. what symptoms will be observed?)

9.10.5 Designate sufficient number of specific school support staff personnel and school support staff alternates to administer and assist with the administration of the medication, including removing and caring for other students, and notification of parents. Be sure all times of the day are covered including bus travel.

9.10.6 Ensure that the parent(s) or guardian(s) and/or where appropriate, the student shall be responsible for supplying, at minimum, two sets of emergency medication in the original container as it is supplied and labeled by the pharmacy. and enough to last until the child can be transported to hospital in the original container as it is supplied and labeled by the pharmacy. If necessary, additional labeling shall be added by the parent(s)/ guardians(s) and/or the student to ensure the container is labeled at minimum with the student’s name, the name of the medication and the dosage, the date the medication expires and instructions for use.

9.10.7 Specify the telephone numbers for emergency medical services and parent(s)/guardian(s)/ emergency contact(s) to be called and the information to be provided by designated school personnel.

9.10.8 Provide instructions as to what to do or not to do in response to the emergency episode.

9.10.9 Provide step-by-step instructions as to how the medication is to be administered, including any necessary health precautions for school personnel (e.g. rubber gloves).

9.10.10 Provide instructions in the event there is a repeat of the emergency episode or the symptoms do not subside.

9.10.11 Provide for the student to be taken to the hospital by ambulance unless a parent/guardian/emergency contact is available to take the student into his or her care.

9.10.12 Provide for the safe disposal of emergency medication and its apparatus after it has been used (e.g. needles).

9.10.13 When the ambulance is ready and the parent(s)/guardian(s)/emergency contact(s) have not arrived, provide for notification to them as to where the ambulance is taking the student and, where necessary, provide for school personnel to accompany the student to the hospital.

9.10.14 Establish additional procedures necessary for situations in which the emergency episode might take place (e.g. gym, playground).

9.10.15 Provide for special circumstances (i.e. parent(s)/guardian(s) must attend on field trips otherwise the student many not attend).

9.10.16 Provide that, if possible, any unused medication will be returned to the parent(s)/guardians(s) or, where appropriate, the student when it is no longer required or at the end of the school year, or will be otherwise safely disposed .

9.10.17 Provide for in accordance with:

• The storage requirements for the medication.
• The need to access the medication quickly.
• The safety of the student requiring the medication, and,
• The safety of other students and school personnel.
• Provide for the display of the Emergency Protocol in appropriate places (i.e. classroom of student, office, staff room, teacher’s daybook).
• Arrange an alternative procedure for the parent(s) / guardians(s) and/or the student too follow when school personnel are unable to provide emergency medication on a given day or days.
• Ensure that the Emergency Protocol will be reviewed regularly by one trained employee and all newly appointed designates.
• Require the parent(s)/guardian(s) and/or, where appropriate, the student to submit immediately new Forms if there is a change in the information provided to the school.
• Inform them that the Emergency Protocol expires on June 30 and that new Forms must be submitted after June 30 annually

9.11 The Principal/Vice-Principal shall review the Emergency Protocol with the designated school personnel and substitutes and ensure they understand and are familiar with the required procedures.

9.12 The Principal/Vice-Principal shall require the parent(s)/guardian(s) and/or, where appropriate, the student, to provide suitable identification, such as a Medic Alert bracelet, to be worn by the student identifying the nature of the condition and the procedure to be followed in an emergency.

9.13 The Protocol shall be attached to the Forms and placed in the OSR.

9.14 A copy of the Protocol will be kept by the Principal/Vice-Principal and provided to the designated school support staff personnel, the parent(s)/guardian(s) and, where appropriate, the student.

9.15 When required, the Supervisory Officer shall review the Emergency Protocol to ensure that it adheres to this Administrative Procedure.

9.16 The Principal/Vice-Principal shall advise school staff support personnel to retain all copies of the Emergency Protocol in a manner which protects the student’s privacy, and to return the copies to the Principal/Vice-Principal when the medication is no longer required or, in any event, at the end of the school year.

9.17 The Principal/Vice-Principal shall ensure that all copies of the Emergency Protocol in possession of school support staff personnel are destroyed when the medication is no longer required or, in any event, on or shortly after June 30. The original Emergency Protocol and Forms shall be retained in the OSR.

10.0 Administration of Medication by Parents/Guardians and Responsible Designates

10.1 Parents/guardians wishing to administer medication to students during school hours or parents/guardians and adult students wishing to appoint a responsible designate to do so shall submit an authorization for Administration of Medication to Students by Parents/Guardians and Responsible Designates (see Appendix “D”).

10.2 School personnel may not allow the administration of medication to a student if the Forms have not been received by the school. School personnel who have not been notified in advance of a parent/guardian or responsible designate’s attendance to administer medication should immediately notify the Principal/Vice-Principal.

10.3 The Principal/Vice-Principal shall ensure that the appropriate individual has signed the Authorization Forms (Appendix D) and shall request any additional information he or she feels is necessary.

10.4 The Principal/Vice-Principal shall consult with the parent(s)/guardian(s), student’s teacher, the responsible designate (where applicable), and/or, where appropriate, the student, to develop a schedule for administration of the medication which is the least disruptive to the student and other students and school personnel.

10.5 Prior to administering medication to a student, all persons administering medication to a student and any person appointing a responsible designate must meet with the Principal/Vice-Principal and appropriate school personnel to be determined by the Principal/Vice-Principal to ensure that the individual who will be administering the medication is known by school personnel.

10.6 The schedule arranged in 10.4 will specify that new arrangements must be made and new Forms submitted after the expiry date specified or after June 30.

10.7 A copy of the schedule shall be made available to the Principal/Vice-Principal, the teacher(s), the parent(s)/guardian(s), the Designate (where applicable) and/or, where appropriate, the student. The Forms and the Schedule shall be placed in the OSR.

10.8 The Principal/Vice-Principal shall monitor the Schedule to ensure that it is working and will take appropriate steps to address any problems, which arise. However, the responsibility for administration of the medication remains solely that of the parent(s)/guardian(s), responsible designate(s) or adult student. No records will be kept by school personnel of the administration of medication.

10.9 Where the student's medical condition is of a long-term or continuous nature, the Principal/Vice-Principal shall request the parent(s)/guardian(s) to provide suitable identification, such as a Medic Alert bracelet, of the condition and the procedure to be followed in an emergency.

10.10 The Principal/Vice-Principal shall destroy all copies of the Schedule in the possession of school support staff personnel when the medication is no longer required or shortly after June 30 annually. The original Forms and Schedule will be retained in the OSR.

11.0 Professional Health Care Services

11.1 When it is determined that it is not within the duties of Board personnel to administer emergency medication, and a student requires professional health care services to provide the administration of medication during regular school hours, the Principal/Vice-Principal shall assist the parent(s)/guardian(s) and/or, where appropriate, the student, to obtain such services.

11.2 For further information with respect to obtaining assistance from the Ministry of Health, please contact:

Medical Officer of Health North Bay Parry Sound District Health
Unit 681 Commercial Street, North Bay, ON P1B 4E7
(Tel) (705) 474-1400 (Fax) (705) 474-8252

Medical Officer of Health Simcoe Muskoka District Health Unit
15 Sperling Drive, Barrie, Ontario L4M 6K9
(Tel) (705) 721-7330 FAX (705) 721-1495