by Maureen Anichini Lemon and JaneAnn Monson (Fall 2018)
In June 2018, the Illinois State Board of Education (ISBE) issued the first updated Guidance Document on the Administration of Medication in Illinois Schools (Guidance) in 18 years. Unlike its predecessor, the new Guidance provides a Question and Answer Format (summarized below) to the four principles found in the School Code (105 ILCS 5/10-22.21b).
(1) Administration of medications at school and school-related activities should be discouraged unless necessary for the critical health of the student.
The use of the word “medication” in a school district’s policy on the administration of medication to students is broader than the common term may suggest. The word includes any product that contains ‘drugs,’ as that term is defined in the Illinois Pharmacy Act. This includes herbal medicines, aromatherapy, and essential oils. Although a dietary supplement is not, by definition, a ‘drug,’ the Guidance indicates that a dietary supplement may be treated as medication if the school is being asked to give the dietary supplement to a student. Additionally, according to the Guidance, insect repellants and sunscreen should also be treated as medication, requiring a medical order and parent request before being administered to students, because they contain ingredients regulated by the FDA and may result in adverse consequences when in contact with children. The Guidance offers restrictions that school nurses and school administrators are advised to follow regarding what medications should not be administered by school staff, including drugs that carry an FDA-issued “black box warning”.
The term ‘administration of medication’ does not solely mean physically giving the medication to a student; it also means directing a student to swallow or otherwise absorb a medication, and selecting medication for the student. The law covers all school-related activities including field trips and school-sanctioned sports, club events, competitions and other activities for which a school or district sponsors, chaperones or otherwise bears some responsibility. The law does not include child care or other activities for which a school may lease or provide space for an entity for which the school does not maintain any school sponsorship.
Satisfying the “absolutely necessary” requirement means there is no suitable non-medication treatment and the student would not be able to function during the school day without it. According to the Guidance, the occasional minor pain or discomfort (headache, menstrual cramps, constipation, stomachache, etc.) can be treated with non-medical measures, such as increased fluids, health snack, short-term rest, use of heating pad or cold pack, relaxation exercises or bathroom break. From this statement, it is fair to deduce that the Guidance was written by an individual who has never experienced menstrual cramps.
(2) Teachers and other non-administrative school employees, except certified school nurses and non-certificated registered professional nurses, may not be required to administer medications to students.
Pursuant to recent revisions to the Illinois Nurse Practice Act, 225 ILCS 65, a Registered Nurse may, but is not required to, delegate medication administration to a willing non-nurse staff member with the approval of the non-nurse staff member’s supervisor. Such delegation can occur only if the medication is taken by mouth, or applied to the skin whether topically, transdermally, or subcutaneously. The administration of medication given to a student through any other portal (nasal, rectal, injection into a muscle or vein or other access) may not be delegated to a non-nurse. While an administrator may administer medication, the Guidance notes that administrators may not delegate this authority to any other staff member. The Guidance recognizes, however, that non-nurses and non-administrators may voluntarily assist a student with medications pursuant to the Care of Students with Diabetes Act or in the case of an emergency.
(3) A school district may choose to adopt guidelines for student self-administration of medication.
State law requires schools to allow students to self-carry and self-administer certain drugs used to treat diabetes, asthma, and severe allergies. Besides these specific medications, a school district may choose which, if any, other medications students are allowed to self-carry and self-administer.
(4) Any school employee may provide emergency assistance to students.
Emergency assistance by any staff member may be used to address a student’s bona fide emergency need for medication. However, a school district should not rely on this principle as cover simply because an RN or administrator is unavailable to administer routine medications. A licensed health care provider (the Guidance recommends the school’s Registered Nurse) may educate any staff member on procedures to follow in the event of an emergency. This training may be general (CPR/AED training) or related to a student’s specific health condition that may require medication to save the student’s life.
Medical Cannabis Infused Products
Since the June Guidance, two new laws have been enacted by the Illinois General Assembly that address the administration of medication to students. First, Governor Rauner signed Ashley’s Law on August 1, 2018, requiring school districts to permit the administration of cannabis infused products. The law went into effect immediately.
Prior to Ashley’s Law, individuals who were otherwise permitted access to cannabis products under the Compassionate Use of Medical Cannabis Pilot Program Act (Act) were prohibited from possessing cannabis on school property or in a school bus. Under Ashley’s Law, a school district shall authorize a parent/guardian to administer a medical cannabis infused product to a student at school or on the child’s school bus if both the student and the parent/guardian have registry identification cards under the Act. After administering the product, the parent/guardian must remove the product from the school premises or school bus. Ashley’s Law does not allow a student to smoke cannabis on school grounds.
Ashley’s Law requires school districts to implement a policy regarding the administration of cannabis infused products (such as foods, oils or ointments) and includes the following restrictions: (1) administration of the product may not cause a disruption to the school’s educational environment or cause exposure to other students; (2) no member of the school staff is required to administer the product; (3) a student may not be disciplined or denied access to school because of their receipt of the product; and (4) a school may not authorize the use of the product if the school district or school would lose federal funding as a result of the authorization.
Undesignated Asthma Medication
Second, effective January 1, 2019, Illinois school districts will be authorized to maintain a prescription of undesignated asthma medication. Currently, Section 22-30 of the Illinois School Code (105 ILCS 5/22-30) authorizes school districts to maintain a standing protocol for undesignated epinephrine auto-injectors (EpiPens) and opioid antagonists. Public Act 100-726 has added undesignated asthma medication to the types of medications that may be housed.
“Asthma medication” is defined as quick-relief asthma medication, including albuterol or other short-acting bronchodilators, approved by the FDA for the treatment of respiratory distress. It includes medication delivered through a device, including a metered dose inhaler with a reusable or disposable spacer or a nebulizer with a mouthpiece or mask. The school district may maintain a supply of asthma medication in any secure location that is accessible before, during or after school where a person is most at risk, including but not limited to a classroom or the nurse’s office. As with undesignated EpiPens and opioid antagonists, a school nurse or trained personnel may carry undesignated asthma medication and may administer the medication to anybody (not only students) who the school nurse or trained personnel in good faith believes is experiencing respiratory distress.
The District’s policy on the administration of medication in schools and its implementing procedures should be reviewed and updated to reflect the updated Guidance, the requirements of Ashley’s Law, and the ability to maintain and use undesignated asthma medication. If you have any questions regarding your policy or its implementation, please call one of the Ottosen Britz attorneys for assistance.