N.Y. Comp. Codes R. & Regs. tit. 8 § 136.7

Current through Register Vol. 46, No. 45, November 2, 2024

Section 136.7 - Self-administration of Certain Medications by Students

(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.

N.Y. Comp. Codes R. & Regs. Tit. 8 § 136.7

Adopted New York State Register October 7, 2015/Volume XXXVII, Issue 40, eff.10/7/2015

Amended New York State Register April 27, 2022/Volume XLIV, Issue 17, eff. 4/27/2022