Proposed Text
8VAC20-671-710. Medication and health.
A. Each student shall have on file evidence of a comprehensive physical examination prescribed by the State Health Commissioner from a qualified licensed (i) physician, (ii) nurse practitioner, or (iii) physician assistant acting under the supervision of a licensed physician. The examination must contain, at a minimum, information required on the Commonwealth of Virginia School Entrance Health Form.
B. Each student shall have an up-to-date certificate of immunization.
C. Any student or staff with a medical condition that is contagious or infectious shall take leave from school while in that condition unless attendance is approved by a qualified health care provider. Conditions meeting this requirement must be provided in the parent/student handbook or other print materials.
D. A first aid kit shall be maintained and readily accessible for minor injuries and medical emergencies in each building used for instruction or other school activity.
E. Each private school for students with disabilities shall develop a written policy related to its procedures to address students with severe allergies who may be at risk of an anaphylactic reaction necessitating the use of an epinephrine auto-injector. The policy shall address, but is not limited to: (1) an overview of anaphylaxis and its symptoms; (2) staff training in the possession and administration of epinephrine auto-injectors; (3) standing orders; (4) responding to anaphylaxis; (5) post administration of epinephrine actions; and (6) storage, access, and maintenance. [ School administrators shall ensure that the school's policy is consistent with the Guidelines for Recognition and Treatment of Anaphylaxis in the School Setting which are published on the Virginia Department of Education's (VDOE) website. ]
F. Each private school for students with disabilities shall
ensure that it has at least two (2) auto-injectable epinephrine units in both
dosage sizes, 0.3 mg (for students weighing more than 66 pounds) and 0.15 mg [
(for students weighing less than 66 pounds) ] [ for
student who weigh 33 to 66 pounds, ] [ on
site during each school day, ] [ on school
premises, ] to be administered by [ a school
nurse, if appropriate within the private school or an employee of the private
school who is authorized and ] [ any
employee of a school for students with disabilities licensed by the Board of
Education who is authorized by a prescriber and ] trained in
the administration of epinephrine to any student believed to be having an
anaphylactic reaction. [ on school premises, during
the academic day. The Code of Virginia (§8.01-225.A.13) provides civil
protection for employees of a private school who are appropriately trained to
administer epinephrine. ] [ Stock epinephrine
is intended for use on school premises and should not be carried offsite.
Additional epinephrine should be made available along with arrangements for
administration during field trips and other official offsite school activities.
]
E. G. Procurement and acceptance of medication.
1. All medications [ , including
epinephrine, ] shall be accepted only in the
original container with written permission signed and dated by the parent to
administer to the child.
2. The use of all prescriptive medication [ ,
to include epinephrine, ] must be authorized in writing by a licensed
prescriber.
3. For students [ enrolled in private
schools for students with disabilities ] with known life threatening
allergies [ and/ ] or anaphylaxis the [
private ] school administrator shall
obtain, through the student's parent or legal guardian, "student specific"
written instructions from the student's health care provider for handling
anaphylaxis and all necessary medications for implementing the student specific
order on an annual basis.
4. The private school [ for students with
disabilities ] administrator shall designate an authorized medical
provider [ (MD, DO, PA, or NP with prescriptive
authority) ] [ with prescriptive authority, such
as a medical doctor, doctor of osteopathy, physician's assistant, or nurse
practitioner ] and obtain a standing order to prescribe
"non-student specific" epinephrine for students within the [ private
] school who do not presently have a health care plan
addressing the administration of epinephrine, to be administered to any student
believed to be having an anaphylactic [ reaction on
school grounds, during the academic day ] .
5. [ Private ] school
administrators shall coordinate with, among other resources as they deem
appropriate, placing school divisions, local health department directors, local
practitioners, and the Virginia Chapter of the American Academy of Pediatrics
to assist them in obtaining the required standing orders for treatment of
anaphylaxis and prescriptions to order auto-injectable epinephrine.
6. Standing orders and prescriptions shall be renewed annually and with any change in prescriber.
H. The expiration date of epinephrine solutions shall be
checked periodically; but not less than monthly. The auto-injector unit should
be replaced if it is approaching its expiration date. The contents should be
inspected through the clear window of the auto-injector. The solution should be
clear; if it is discolored or contains solid particles, discard and replace the
unit. Used, expired, or epinephrine auto-injectors with discolored solution or
solid particles shall not be used and shall be discarded in a sharps container.
The school [ division ] shall
maintain a sufficient number of extra doses of epinephrine for replacement of
used or expired school stock on the day it is used or discarded. Each school
shall maintain documentation that its stock of epinephrine has been checked on
a monthly basis to ensure proper storage, review of expiration dates, medication
stability, and replacement upon use or disposal under the aforementioned
criteria.
FI. All medication and medical paraphernalia,
with the exception of epinephrine auto-injectors shall be properly labeled and
securely locked or stored in accordance with the Virginia School Health
Guidelines. Epinephrine auto-injectors must be stored in a safe, unlocked
and accessible location, in a dark place at room temperature (between 59oF -
86oF). Epinephrine cannot be stored in a refrigerator. Although epinephrine
should not be maintained in a locked cabinet or behind locked doors,
precautions must be in place to ensure that the epinephrine auto-injectors are
not readily available to student access. The location of the epinephrine must
be clearly marked at the storage location and staff must be made aware of the
storage location in each school.
GJ. An individual medication administration
record shall be maintained for each medication a student receives and shall
include student name, date the medication is to begin, drug name, schedule for
administration, strength, route, identification of the individual who
administered the medication, and dates the medication was discontinued or
changed.
K. Once epinephrine is administered, local Emergency
Medical Services (911) shall be activated and the student transported to the
emergency room for follow up care. In some reactions, the symptoms go away,
only to return one to three hours later. This is called a "biphasic reaction."
Often these second-phase symptoms occur in the respiratory tract and may be
more severe than the first-phase symptoms. Therefore, follow up care with a
health care provider is necessary. The student will not be allowed to remain at
school or return to school on the day epinephrine is administered. The
administration of epinephrine shall be treated as a serious incident and shall
be reported to the parent or legal guardian immediately using all means of
contact provided by the parent (i.e. home, cell, or work phone number, e-mail,
or text message), but no later than the end of the school day. The [
private ] school administrator shall ensure that
an appropriate serious incident form is completed by the end of the day on
which the administration of epinephrine occurred. The incident report shall
include, but is not limited to, the following information: (1) the date and
time the incident occurred; (2) the name of the staff who administered the
epinephrine; (3) a record of the attempt(s) made (including date, time, mode of
communication, and [ the private school employee making
the attempt ] [ name of employee making the
attempt ] ) to notify the parent of the use of the epinephrine;
(4) summary of contact with parent; and (5) the name of the person who completed
the incident report. The [ private ] school
administrator shall provide a copy of the incident report, via e-mail or
facsimile, to the Department within 24 hours of completing the report.
H. L. The provider shall develop and implement
written policies and procedures regarding:
1. Managing medication errors to include the following: administering first aid; contacting the poison control center; notifying the prescribing physician; taking action as directed; documenting the incident; reviewing medication errors and staff responses; and reporting errors to the parent and placing agency;
2. Handling adverse drug reactions;
3. Revising procedures as events may warrant;
4. Disposing of medication and medical supplies such as needles, syringes, lancets, etc.;
5. Storing of controlled substances;
6. Distributing medication off campus; and
7. Documenting medication refusal.
I. M. The telephone number of a regional poison
control center and other emergency numbers shall be posted on or near the
phone.
J. N. Medication training.
1. All staff responsible for medication administration shall have successfully completed medication training, including refresher training, in a program approved by the Board of Nursing or be licensed by the Commonwealth of Virginia to administer medication before they can administer medication.
2. The [ private ] school
administrator shall identify an appropriate number of staff, but not less than
two employees, in addition to the school nurse [ (RN or
LPN) ] ; as appropriate, to be trained in the
administration of epinephrine by auto-injector. Only trained personnel shall
administer epinephrine to a student believed to be having an anaphylactic
reaction. Training shall be conducted in accordance with the most current edition
of the Virginia Department of Education's Manual for Training Public School
Employees in the Administration of Medication or other approved training
programs, such as, Medication Administration Training for Youth (MATY) or
Medication Administration Training (MAT). Training shall be conducted as often
as needed to ensure adequate staff are trained, but not less than annually.
2. 3. Training shall be provided to staff in
medication procedures and effects and infection control measures, including the
use of standard precautions.
3. 4. Staff certified in first aid and CPR shall
be available at all times on the school grounds and during any school-sponsored
activity.
4. 5. Documentation of medication training must
be maintained in personnel files.
5. 6. Staff authorized to administer medication
shall be informed of any known side effects of the medication and the symptoms
of the effects.
K. O. Monitoring the supply of medications.
1. Upon receiving any medication, staff members handling medication shall count individual tablets and measure the level of liquid medicine in the presence of the parent(s) or another staff member and record the count on the medication log.
2. The medication log shall include the signature or initials of the staff member who counted the medication and the parent or staff who witnessed the occurrence. When initials are used, the medication administration record must contain the full name of the staff with corresponding initials for identification purposes.
3. Students shall be prohibited from transporting medication unless directed otherwise by the student's health care plan.
P. The requirements outlined above related to the
possession and administration of epinephrine extend to activities off the [
private ] school [ grounds
] [ premises ] [
(including, but not limited to, transportation to and from the private
school for field trips, nonacademic activities, etc.) ] . [ Therefore,
school policies shall include specific protocols for responding to anaphylaxis
in the school setting, both onsite and at offsite school events, such as field
trips. ]
Q. In accordance with [ §8.01-225.A.13 of
] the Code of Virginia [ , at §8.01-225.A.13
] , any person who is an employee of a school for students with
disabilities, as defined in §22.1-319 and licensed by the Board of [
education ] [ Education ] , [
or an employee of a private school that complies with accreditation
requirements set forth in §22.1-19 and is accredited by the Virginia Council
for Private education who is authorized by a prescriber and trained in the
administration of epinephrine and who provides, administers, ]
[ who is authorized by a prescriber and trained in the administration
of epinephrine and who administrators ] or assists in the
administration of epinephrine to a student believed in good faith to be having
an anaphylactic reaction, or is the prescriber of the epinephrine, shall not be
liable for any civil damages for ordinary negligence in acts or omission
resulting from rendering of such treatment. Whenever any employee is covered by
the immunity granted in [ this subsection ]
[ §8.01-225.A.13 of the Code of Virginia ] , the
school shall not be liable for any civil damages for ordinary negligence in
acts or omission resulting from such [ provision,
] administration [ , ] or
assistance.