Ala. Admin. Code r. 610-X-7-.14

Current through Register Vol. 43, No. 1, October 31, 2024

Section 610-X-7-.14 - Delegation of Injectable Medication Administration for Adrenal Insufficiency in the School Setting

(1)Definitions

(a) Adrenal Insufficiency. Adrenal Insufficiency is a hormonal disorder that occurs when the adrenal glands do not produce enough hormones. Adrenal Insufficiency is a chronic condition requiring the student to take daily medications.

(b) Adrenal Crisis: Adrenal Crisis is an acute condition that is an exacerbation of the student's adrenal insufficiency caused by illness, injury, stress, or missing daily medications.

(c) Stress Dose. A stress dose is an extra dose of medication given in addition to the student's daily prescribed dose when the student's body experiences physical or emotional stress. Depending on the severity or nature of the event, the stress dose may be given orally or via an injection.

(d) School setting: preschool through 12^th grade in a public or private school or school bus or any school activity sponsored by such a school in which the student is a direct participant, including but not limited to before school and after school programs, field trips, extended off-site excursions, and extracurricular activities.

(e) Trained, Unlicensed Medication Assistant: a school employee who volunteers to receive delegation of administration of medications (including injectable medications) specific to the adrenal insufficiency of a student in the school setting and receives the approved training.

(2) General Principles

(a) The injection of injectable medications specific to the adrenal insufficiency of the student is a nursing task that may be delegated to a Trained, Unlicensed Medication Assistant in accordance with the requirement of Act 2023-75 and the student's Individual Health Plan (IHP). The selection of the type of medication and dosage levels shall not be delegated.

(b) An Individual Health Plan (IHP) shall be developed for any student diagnosed with adrenal insufficiency who is in the school setting.

(c) Delegation of tasks for students with adrenal insufficiency shall be confined to procedures that do not require nursing assessment, judgment, evaluation, or complex skills.

(d) Factors the school nurse shall consider and may include in the IHP are:

1. Age of onset and current age of student with adrenal insufficiency.

2. Recent hospitalizations.

3. Recent incidents requiring stress dosing.

4. Recent incidents of adrenal crisis.

5. Comorbidities or other chronic illnesses.

6. Participation in sports or other school-sponsored activities.

7. Orders from a legally authorized prescriber, which shall include instructions for oral stress dosing for minor illness or injury and instructions for injectable stress dosing for serious illness or injury.

8. Student's comprehension and adherence to treatment.

9. Parent's comprehension and adherence to treatment.

10. School Instructions provided by the student's health care provider related to adrenal insufficiency.

(e) Teaching school personnel about adrenal insufficiency does not constitute delegation.

(f) The injection of injectable medications specific to the adrenal insufficiency of the student is limited to:

1. The student's Individual Health Plan.

2. Trained, Unlicensed Medication Assistants who have received training and competency validation for each student assigned to them.

3. Specific students.

4. Specific identified time frame.

(g) The delegation shall include documentation of the administration of medications and appropriate reporting to the school nurse.

(3) Procedure

(a) The school nurse shall validate the competency of the trained, unlicensed medication assistant to whom delegation of administration of medication (including injectable medications) specific to adrenal insufficiency is given.

(b) Administration of injectable medications specific to adrenal insufficiency by the Trained, Unlicensed Medication Assistant receiving the delegation shall only occur when consistent with the IHP. The delegation includes authorization for the Trained, Unlicensed Medication Assistant to reconstitute the injectable medication, draw up the ordered dose of the injectable medication, and administer the dose to the patient.

(c) In the event that a Trained, Unlicensed Medication Assistant administers a stress does of an injectable medication specific to adrenal insufficiency, the Trained, Unlicensed Medication Assistant shall thereafter immediately summon emergency medical services for the student and notify the school nurse.

(d) Training of the Trained, Unlicensed Medication Assistants shall occur prior to any delegation of administration of medications (including injectable medications) specific to the student's adrenal insufficiency.

(e) The school nurse shall follow the training guidelines developed by the State Department of Education in consultation with the Alabama Board of Nursing.

(f) The local education agency, in consultation with the school principal, shall identify any volunteer in each school to the school nurse for possible training.

(g) An annual report of the number of Trained, Unlicensed Medication Assistants in each school and the delegation of administration of administration of medications (including injectable medications) specific to adrenal insufficiency to Trained, Unlicensed Medication Assistants shall be provided to the Board of Nursing by the Lead Nurse of each school system.

Ala. Admin. Code r. 610-X-7-.14

Adopted by Alabama Administrative Monthly Volume XLII, Issue No. 10, July 31, 2024, eff. 9/14/2024.

Author: Alabama Board of Nursing

Statutory Authority:Code of Ala. 1975, § 34-21-6, 34-21-2(j), Alabama Act No. 2023-75.