Code of Massachusetts Regulations
105 CMR - DEPARTMENT OF PUBLIC HEALTH
Title 105 CMR 210.000 - The Administration Of Prescription Medications In Public And Private Schools
Section 210.100 - Administration of Epinephrine
Universal Citation: 105 MA Code of Regs 105.210
Current through Register 1531, September 27, 2024
(A) A public school district or non-public school, as defined by the Massachusetts Department of Education, may register with the Department for the limited purpose of permitting properly trained school personnel to administer epinephrine by auto injector in a life-threatening situation during the school day when a school nurse is not immediately available, including field trips, provided that the following conditions are met:
(1) the school
committee or, in the case of a non-public school, the chief administrative
officer, approves policies developed by the designated school nurse leader or,
in the absence of a school nurse leader, a school nurse with designated
responsibility for management of the program ("responsible school nurse")
governing administration of epinephrine by auto injector. This approval must be
renewed every two years;
(2) the
school committee or chief administrative officer provides an assurance to the
Department that the requirements of
105 CMR 210.000 will be
met;
(3) in consultation with the
school physician, the designated school nurse leader or responsible school
nurse manages and has final decision making authority about the program. This
person, or school nurses designated by this person, shall select the
individuals authorized to administer epinephrine by auto injector. Persons
authorized to administer epinephrine shall meet the requirements of
105
CMR 210.004(B)(2);
(4) the school personnel authorized to
administer epinephrine by auto injector are trained and tested for competency
by the designated school nurse leader or responsible school nurse, or school
nurses designated by this person, in accordance with standards and a curriculum
established by the Department.
(a) The
designated school nurse leader or responsible school nurse, or school nurses
designated by this person, shall document the training and testing of
competency.
(b) The designated
school nurse leader or responsible school nurse, or a designee, shall provide a
training review and informational update at least twice a year.
(c) The training, at a minimum, shall
include:
1. procedures for risk
reduction.
2. recognition of the
symptoms of a severe allergic reaction;
3. the importance of following the medication
administration plan;
4. proper use
of the auto-injector; and
5.
requirements for proper storage and security, notification of appropriate
persons following administration, and record keeping.
(d) The school shall maintain and make
available upon request by parents or staff a list of those school personnel
authorized and trained to administer epinephrine by auto injector in an
emergency, when the school nurse is not immediately available;
(5) epinephrine shall be
administered only in accordance with an individualized medication
administration plan satisfying the applicable requirements of
105
CMR 210.005(E) and
210.009(A)(6),
updated every year, which includes the following:
(a) a diagnosis by a physician that the child
is at risk of a life threatening allergic reaction and a medication order
containing proper dosage and indications for administration of
epinephrine;
(b) written
authorization by a parent or legal guardian;
(c) home and emergency number for the
parent(s) or legal guardian(s), as well as the names(s) and phone number(s) of
any other person(s) to be notified if the parent(s) or guardian(s) are
unavailable;
(d) identification of
places where the epinephrine is to be stored, following consideration of the
need for storage:
1. at one or more places
where the student may be most at risk;
2. in such a manner as to allow rapid access
by authorized persons, including possession by the student when appropriate;
and
3. in a place accessible only
to authorized persons. The storage location(s) should be secure, but not locked
during those times when epinephrine is most likely to be administered, as
determined by the school nurse;
(e) a list of the schoolpersonnelwho would
administer the epinephrine to the student in a life threatening situation when
a school nurse is not immediately available;
(f) a plan for comprehensive risk reduction
for the student, including preventing exposure to specific allergens;
and
(g) an assessment of the
student's readiness for self-administration and training, as
appropriate.
(6) when
epinephrine is administered, there shall be immediate notification of the local
emergency medical services system (generally 911), followed by notification of
the student's parent(s) or guardian(s) or, if the parent(s)or guardian(s) are
not available, any other designated person(s), the school nurse, the student's
physician, and the school physician, to the extent possible;
(7) there shall be procedures, in accordance
with any standards established by the Department, for:
(a) developing the medication administration
plan;
(b) developing general
policies for the proper storage of medication, including limiting access to
persons authorized to administer the medication and returning unused or
outdated medication to a parent or guardian whenever possible;
(c) recording receipt and return of
medication by the school nurse;
(d)
documenting the date and time of administration;
(e) notifying appropriate parties of
administration and documenting such notification;
(f) reporting medication errors in accordance
with
105
CMR 210.005(F)(5);
(g) reviewing any incident involving
administration of epinephrine to determine the adequacy of the response and to
consider ways of reducing risks for the particular student and the student body
in general;
(h) planning and
working with the emergency medical system to ensure the fastest possible
response;
(i) disposing properly of
used epinephrine injector;
(j)
submitting a written report to the Department of Public Health each time
epinephrine is administered to a student or staff, on a form obtained from the
Department;
(k) permitting the
Department of Public Health to inspect any record related to the administration
of epinephrine without prior notice, to ensure compliance with 105 CMR
210.100.
(B) Epinephrine may be administered in accordance with 105 CMR 210.000 in before and after school programs offered or provided by a school, such as athletic programs, special school events and school-sponsored programs on week-ends, provided that the public school district or non-public school is registered with the Department pursuant to 105 CMR 210.100(A) and meets the requirements set forth in 105 CMR 210.100(B).
(1)
Epinephrine may be administered in such before and after school programs and
special events, to students attending the school where the epinephrine is to be
administered, provided that the following requirements in 105 CMR
210.1000(B)(1)(a) through (d) are met:
(a)
school committee or chief administrative officer in a non-public school
approves, in the policy developed in accordance with 105 CMR 210.100(A)(1),
administration of epinephrine in such programs. The policy shall identify the
school official(s), along with a school nurse for each school designated by the
school nurse leader or responsible nurse, responsible for determining which
before and after school programs and special events are to be covered by the
policy;
(b) the designated school
nurse approves administration of epinephrine in that program and selects the
properly trained person(s) to administer the epinephrine;
(c) the school complies with the requirements
of 105 CMR 210.100(A), including immediate notification of emergency medical
services following administration of epinephrine, but need not comply with the
requirement of
105
CMR 210.004(B)(3);
and
(d) the program is not licensed
by another state agency, in which case the regulations promulgated by that
state agency will apply.
(2) Epinephrine may be administered in such
before and after school programs and special events to students from another
school or school district if approved in the school policy developed pursuant
to 105 CMR 210.100(A)(1) and in accordance with the requirements in 105 CMR
210.00(B)(2)(a) through (d).
(a) The school
complies with the requirements of 105 CMR 210.100(A) and 210.100(B)(1),
including immediate notification of emergency medical services following
administration of epinephrine, except as provided in 105 CMR
210.100(B)(2)(d).
(b) In the event
the student is accompanied by school personnel from the sending school, such
personnel, whenever possible, shall assume responsibility for ensuring that the
epinephrine is brought, properly stored and administered as necessary, in
accordance with the medication administration plan developed by the sending
school in accordance with 105 CMR 210.100(A)(5).
(c) In the event the student is not
accompanied by school personnel from the sending school or such personnel are
not trained in the administration of epinephrine, the receiving school may, in
its discretion, assume responsibility for administering epinephrine, provided
that:
1. the designated school nurse in the
receiving school is provided with adequate prior notice of the request, which
shall be at least one week in advance unless otherwise specified by the
designated school nurse;
2. the
designated school nurse in the receiving school approves administration of
epinephrine for that student;
3.
the designated school nurse selects properly trained person(s) to administer
the epinephrine; and the student provides the designated school nurse or the
person(s) selected by the
4.
designated school nurse to administer epinephrine with the medication to be
administered.
(d) If the
receiving school assumes responsibility for administering epinephrine, whenever
possible, the student shall provide the designated school nurse in the
receiving school with copy of the medication administration plan developed in
accordance with
105
CMR 210.005(E). The plan
shall be provided to the designated school nurse in timely fashion in
accordance with procedures established by the nurse. If no medication
administration plan is provided, the student at a minimum shall provide to the
designated school nurse in the receiving school:
1. written authorization and emergency phone
numbers from a parent or guardian;
2. a copy of a medication order from a
licensed provider; and
3. any
specific indications or instructions for administration.
(C) Administration of epinephrine shall be governed solely by 105 CMR 210.100. The provisions of 105 CMR 210.004(B)(5) and 210.005(E)(1)(o) shall not be applicable to the administration of epinephrine.
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