New York Codes, Rules and Regulations
Title 8 - EDUCATION DEPARTMENT
Chapter II - Regulations of the Commissioner
Subchapter G - Health And Physical Education
Part 136 - HEALTH SERVICE
Section 136.7 - Self-administration of Certain Medications by Students
Universal Citation: 8 NY Comp Codes Rules and Regs ยง 136.7
Current through Register Vol. 46, No. 12, March 20, 2024
(a) Definitions. As used in this section:
(1) Inhaled rescue
medications means a solution of a drug or a combination of drugs administered
to the respiratory passages via inhalation for immediate alleviation of
respiratory distress for persons with asthma or other respiratory diseases.
Such medication(s) are delivered by devices approved by the United States Food
and Drug Administration and include metered dose inhalers, nebulizers, and
other similar devices for the delivery of respiratory medications to the
respiratory passage.
(2)
Epinephrine auto-injector means an automated injection delivery device,
approved by the United States Food and Drug Administration, for injecting a
measured dose of the drug epinephrine.
(3) Ketone test means a blood test utilizing
a drop of blood on a blood ketone test strip and a blood glucose meter or urine
dipstick test utilizing a urine ketone test strip placed into the urine to
determine the number of ketones present in either the blood or urine.
(4) Blood glucose test means a blood test
utilizing a drop of blood on a blood glucose test strip, and a blood glucose
meter to determine the blood glucose level.
(5) Insulin means insulin hormone and similar
proteins used as a medication to treat diabetes.
(6) Glucagon means a hormone medication that
raises the level of glucose in the blood.
(7) Duly authorized health care provider
means a licensed health professional who is authorized to diagnose medical
conditions and prescribe medications and treatments in accordance with his/her
respective scope of practice under Title VIII of the Education Law, including,
but not limited to, a physician, physician assistant, and nurse
practitioner.
(8) Cumulative health
record means the record of health information maintained by the school or board
of cooperative educational services for each student, which shall be kept
confidential consistent with the Federal Family Education Rights and Privacy
Act (FERPA) and any other applicable Federal and State laws.
(9) Emergency action plan means a care plan
written by a duly authorized health care provider, or the director of school
health services or a school nurse which specifies a student's health care needs
along with direction for staff to take in the event of an emergency where a
licensed health professional is not present.
(10) Diabetes Management Plan means a care
plan developed by a duly authorized health care provider, school health
personnel, and the parent or person in parental relation that specifies in
detail how the student is to manage diabetes at school including, but not
limited to, detailed information for treatment of hypoglycemia and
hyperglycemia by school personnel if the student becomes unable to do so
independently, blood glucose range, and insulin coverage scale or correction
factor orders for use by a licensed health professional if one is
available.
(11) School day means
any day, including a partial day, that students are in attendance at school or
at a facility maintained by a board of cooperative educational services for
instructional purposes.
(12)
School property means in or within any building, structure, athletic playing
field, playground, parking lot, or land contained within the real property
boundary line of a public elementary or secondary school or a facility
maintained by a board of cooperative educational services for instructional
purposes, or in or on a school bus, as defined in Vehicle and Traffic Law
section 142.
(13) School function
means a school district or board of cooperative educational services sponsored
extra-curricular event or activity regardless of where such event or activity
takes place, including, but not limited to, an event or activity that may take
place in another state.
(b) Students Affected with Asthma or Another Respiratory Disease.
(1) Each board of
education or trustees of each school district and each board of cooperative
educational services shall allow a student to carry and self-administer their
prescribed inhaled rescue medication during the school day, on school property
and at any school function, if the student provides the school district and/or
board of cooperative educational services, as applicable, with:
(i) written consent from the parent or person
in parental relation; and
(ii)
written permission (also referred to as an order) and an attestation from a
duly authorized health care provider confirming:
(a) that the student has a diagnosis of
asthma or other respiratory disease for which inhaled rescue medications are
prescribed to alleviate respiratory symptoms or to prevent the onset of
exercise induced asthma;
(b) the
student has demonstrated that he or she can self-administer the prescribed
inhaled rescue medication effectively; and
(c) the expiration date of the order, the
name of the prescribed rescue medication, the dose the student is to
self-administer, times when medication is to be self-administered by the
student, and the circumstances which may warrant the use of the
medication.
(2) A record of such written consents shall
be maintained in the student's cumulative health record.
(3) Upon written request of a parent or
person in parental relation, the school district or board of cooperative
educational services, as applicable, shall allow the student to maintain an
extra inhaled rescue medication in the care and custody of a licensed nurse,
nurse practitioner, physician assistant, or physician employed by such district
or board of cooperative educational services.
(i) Nothing in this section shall require a
school district or board of cooperative educational services to retain a
licensed nurse, nurse practitioner, physician assistant, or physician solely
for the purpose of taking custody of such extra inhaled rescue medication; or
require that such licensed health professionals be available at all times in a
school building for the purpose of taking custody of the inhaled rescue
medication.
(ii) Such inhaled
rescue medication provided by the parent or person in parental relation shall
be made available to the student as needed in accordance with school policy and
the written permission provided by the duly authorized health care provider.
(4) Each student with
asthma or another respiratory disease who is permitted, under this section to
self-administer his or her prescribed inhaled rescue medication should have an
emergency action plan on file with the school district or board of cooperative
educational services.
(c) Students with Allergies.
(1) Each board of education or trustees of
each school district and each board of cooperative educational services shall
allow a student to carry and self-administer their prescribed epinephrine auto
injector during the school day, on school property and at any school function,
if the student provides the school with:
(i)
written consent from the parent or person in parental relation; and
(ii) written permission (also referred to as
an order) and an attestation from a duly authorized health care provider
confirming:
(a) that the student has a
diagnosis of an allergy for which an epinephrine auto injector is needed for
the emergency treatment of allergic reactions;
(b) the student has demonstrated that he or
she can self-administer the prescribed epinephrine auto injector effectively;
and
(c) the expiration date of the
order, the name of the prescribed medicine, the dose the student is to
self-administer and the circumstances which may warrant the use of the
medication.
(2) A record of such written consents shall
be maintained in the student's cumulative health record.
(3) Upon written request of a parent or
person in parental relation the school district or board of cooperative
educational services, as applicable, shall allow the student to maintain an
extra epinephrine auto injector in the care and custody of a licensed nurse,
nurse practitioner, physician assistant, or physician employed by such district
or board of cooperative educational services.
(i) Nothing in this section shall require a
school district or board of cooperative educational services to retain a
licensed nurse, nurse practitioner, physician assistant, or physician solely
for the purpose of taking custody of such extra epinephrine auto injector; or
require that such licensed health professionals be available at all times in a
school building for the purpose of taking custody of the epinephrine auto
injector.
(ii) Such epinephrine
auto injector provided by the parent or person in parental relation shall be
made available to the student as needed in accordance with school policy and
the orders prescribed by the duly authorized health care provider.
(4) Each student with allergies
who is permitted under this section to self-administer his or her prescribed
epinephrine auto injector should have an emergency action plan on file with the
school district or board of cooperative educational services.
(5) Licensed nurses, nurse practitioners,
physician assistants, or physicians employed by schools or boards of
cooperative educational services are authorized to administer prescribed
epinephrine pursuant to the scope of practice of the licensed individual under
Title VIII of the Education Law, to students diagnosed with an allergy by a
physician or other duly authorized health care provider and who are permitted
under this section to self-administer their prescribed epinephrine auto
injector.
(6) Separate from the
authority provided by section
136.6
of this Part, for students authorized to self-administer their prescribed
epinephrine pursuant to this section, the board of education or trustees of
each school district and board of cooperative educational services and
nonpublic schools are authorized, but not required, to have licensed registered
professional nurses, nurse practitioners, physician assistants, and physicians
train unlicensed school personnel to administer prescribed epinephrine
auto-injectors in emergency situations, where an appropriately licensed health
professional is not available, to the students authorized to self-administer
their prescribed epinephrine auto injector pursuant to this section. Training
by the licensed health professional shall be provided in a competent manner and
in accordance with subdivision (f) of this section.
(d) Students with Diabetes.
(1) Each board of education or trustees of
each school district and each board of cooperative educational services shall
allow a student to carry and self-administer their prescribed insulin, carry
glucagon, and carry and use equipment and supplies necessary to check blood
glucose and/or ketone levels during the school day, on school property and at
any school function, if the student provides the school with:
(i) written consent from the parent or person
in parental relation; and
(ii)
written permission (also referred to as an order) and an attestation from a
duly authorized health care provider confirming:
(a) that the student has a diagnosis of
diabetes for which insulin and glucagon through appropriate medication delivery
devices, and the use of equipment and supplies to check blood glucose and/or
ketone levels are necessary;
(b)
the student has demonstrated he or she can self-administer the prescribed
insulin effectively, can self-check glucose or ketone levels independently, and
can independently follow prescribed treatment orders; and
(c) the expiration date of the order, the
name of the prescribed insulin or glucagon, the type of insulin delivery
system, the dose or dose range of insulin the student is to self-administer,
times when the insulin is to be self-administered by the student, the dose of
glucagon that is to be administered, and the circumstances which may warrant
the administration of the insulin by the student or the administration of
glucagon to the student. The written permission must also identify the
prescribed blood glucose and/or ketone test, the times testing is to be done,
and any circumstances which warrant checking a blood glucose and/or ketone
level.
(2) A
written diabetes management plan shall be provided. A record of such written
consents shall be maintained in the student's cumulative health
record.
(3) Upon written request of
a parent or person in parental relation, the school district or board of
cooperative educational services shall allow the student to maintain extra
insulin, insulin delivery system, glucagon, blood glucose meter and related
supplies to treat such student's diabetes provided by the parent or person in
parental relation in the care and custody of a licensed nurse, nurse
practitioner, physician assistant, or physician employed by such district or
board of cooperative educational services.
(i) Nothing in this section shall require a
school district or board of cooperative educational services to retain a
licensed nurse, nurse practitioner, physician assistant, or physician solely
for the purpose of taking custody of extra insulin, insulin delivery system,
glucagon, blood glucose meter and related supplies to treat such student's
diabetes; or require that such licensed health professionals be available at
all times in a school building for the purpose of taking custody of insulin,
insulin delivery system, glucagon, blood glucose meter and related supplies to
treat such student's diabetes.
(ii) Such insulin, insulin delivery system,
glucagon, blood glucose meter and related supplies to treat such student's
diabetes provided by the parent or person in parental relation, shall be made
available to the student as needed in accordance with school policy and the
orders prescribed by the duly authorized health care provider.
(4) Students with diabetes may
also carry food, oral glucose, or other similar substances necessary to treat
hypoglycemia pursuant to district policy, provided such district policy shall
not unreasonably interfere with a student's ability to treat
hypoglycemia.
(5) Each student with
diabetes who is permitted under this section to self-administer their
prescribed insulin, carry glucagon, and carry and use equipment and supplies
necessary to check blood glucose and/or ketone levels during the school day
should have an emergency action plan on file with the school district or board
of cooperative educational services.
(6) Licensed nurses, nurse practitioners,
physician assistants, or physicians employed by school districts or boards of
cooperative educational services are authorized to calculate prescribed insulin
dosages, administer prescribed insulin, program the prescribed insulin pump,
refill the reservoir in the insulin pump, change the infusion site, inject
prescribed glucagon, teach an unlicensed person to administer glucagon to an
individual, and perform other authorized services pursuant to the scope of
practice of the licensed individual under Title VIII of the Education Law, to
students diagnosed with diabetes by a physician or other duly authorized health
care provider and who are permitted under this section to self-administer their
prescribed insulin and carry glucagon, and carry and use equipment and supplies
necessary to check blood glucose and/or ketone levels during the school day.
Nothing in this section shall authorize unlicensed persons to perform these
services except as otherwise permitted by Education Law section 921.
(7) The board of each school district and
board of cooperative educational services and nonpublic schools are authorized,
but not required to have licensed registered professional nurses, nurse
practitioners, physician assistants, and physicians train unlicensed school
personnel to administer prescribed glucagon in emergency situations where an
appropriately licensed health care professional is not available, to students
who are permitted under this section to self-administer their prescribed
insulin and carry glucagon, and carry and use equipment and supplies necessary
to check blood glucose and/or ketone levels during the school day. Training by
the licensed health professional is to be provided in a competent manner and in
accordance with subdivision (f) of this section.
(e) In accordance with Title VIII of the Education Law, only licensed health professionals whose scope of practice permits may administer medication to a student in a school setting unless otherwise permitted by Education Law sections 6908, 907, 921 (as added by Chapter 423 of the Laws of 2014) and 921 (as added by Chapter 424 of the Laws of 2014).
(f) Training of Unlicensed Personnel to Administer Certain Medications to specific students.
(1) Prescribed Epinephrine Auto-Injectors.
Unlicensed school personnel employed by school districts, boards of cooperative
education services, and non-public schools must complete an annual course of
training regarding the administration of prescribed epinephrine auto-injectors
to a student. Such training must be provided and documented by an authorized
licensed health professional as described in subdivision (c) of this section.
Components of such training shall include, but not be limited to:
(i) Identification of the specific
allergen(s) of the student(s), including review of each student's emergency
action plan, if available;
(ii)
signs and symptoms of a severe allergic reaction warranting administration of
epinephrine;
(iii) how to access
emergency services per school policy;
(iv) the steps for administering the
prescribed epinephrine auto-injector.
(v) observation of the trainee using an
epinephrine auto-injector training device;
(vi) steps for providing ongoing care while
waiting for emergency services;
(vii) notification of appropriate school
personnel ; and
(viii) methods of
safely storing, handling, and disposing of epinephrine auto-injectors.
(2) Training of
Unlicensed Personnel to Administer Prescribed Glucagon. Unlicensed school
personnel employed by school districts, boards of cooperative education
services, and non-public schools must complete an annual course of training
regarding the administration of prescribed glucagon to a student. Such training
must be provided and documented by an authorized licensed health professional
as described in section (d) of this section. Components of such training shall
include, but not be limited to:
(i) overview
of diabetes and hypoglycemia utilizing a department approved course on glucagon
administration;
(ii) review of the
student's emergency care plan, if available, including treatment of mild or
moderate hypoglycemia;
(iii) signs
and symptoms of a severe hypoglycemia warranting administration of
glucagon;
(iv) how to access
emergency services per school policy;
(v) the steps for mixing, if necessary, and
administering the prescribed glucagon;
(vi) observation of the trainee using a
manufacturer's glucagon training device or demonstration device;
(vii) steps for providing ongoing care while
waiting for emergency services;
(viii) notification of appropriate school
personnel; and
(ix) methods of
safely storing, handling, and disposing of glucagon and used needles and
syringes.
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