Discretionary medication administration in schools

This memorandum is in response to queries from the field regarding PRN or discretionary medication administration in schools.

Registered nurses working as school nurses are in a unique place. Although they are school employees working under the rules and regulations of the local school board and State of Maine Department of Education, they are also licensed by the Department of Professional and Financial Regulation, Board of Nursing and therefore must follow the Nurse Practice Act and its rules. The registered nurse coordinates and oversees unlicensed personnel within a school to assign specific health tasks to be done and provides the training. Any unlicensed school staff who will administer medication must be trained by a registered nurse or physician before carrying out this task. It is the position of the Board of Nursing, that any task that requires a nursing assessment or judgment cannot be assigned to unlicensed personnel. When medication is not routine, such as with over-the-counter ibuprofen, for example, and the student’s response to the medication is less predictable, nursing oversight should be carefully considered. When evaluating if medication can be administered by an unlicensed staff, the school nurse should assess the situation and consider the following:

  • The task should not inherently involve ongoing assessment, interpretation, or nursing judgment and decision making
  • The school nurse should have the ability to provide adequate oversight of the unlicensed staff member’s medication administration tasks

It is recommended that schools take time to review their medication policies and procedures to ensure requirements from both the Board of Nursing and the Department of Education are being met. The following are resources that may assist your school in doing this:

Maine Board of Nursing Position Statement for School Nursing http://www.maine.gov/boardofnursing/practice/position-statements/school-nursing.html

Maine State Board of Nursing, Chapter 6 Regulations relating to coordination and oversight of patient care services by unlicensed health care assistive personnel. http://www.maine.gov/boardofnursing/docs/Chapter%206.pdf

Maine Department of Education, Chapter 40 Rule for Medication Administration in Maine schools. http://www.maine.gov/sos/cec/rules/05/chaps05.htm

Maine Department of Education, Decision Tree for Nurse Coordination and Oversight. http://www.maine.gov/doe/schoolhealth/manual/documents/nurse_decision_tree.pdf

Maine Department of Education, School Health Manual. Medication Administration in Schools Introduction http://www.maine.gov/doe/schoolhealth/manual/documents/intro_medication_administration_in_schools.pdf

For further information contact Emily Poland, School Nurse Consultant, Maine Department of Education at emily.poland@maine.gov.

PRIORITY NOTICE: Resources to help schools keep students and school staff safe

Maine schools have long taken security seriously, working with local fire, police, and County Emergency Management Agencies to update emergency operations plans and exercise those plans at the local level.

Maine has worked at the State and local levels to strengthen the safety and security of its schools. Efforts have included free day-long security workshops in partnership with the Maine Principals’ Association and Maine School Management Association in addition to extensive tools to inform local planning, training, and preparation.

A 2014 Legislative report on the preparedness and facility security of Maine schools created by national and local experts praised the positive climates in Maine schools.

However, in light of recent high profile national incidents, the Department is reminding districts of resources available to support schools in their ongoing efforts to keep students and school staff safe.

Available on the Maine Department of Education website are, a free school security guide created for Maine DOE by Safe Havens International entitled Twenty Simple Strategies to Safer and More Effective Schools and a similar resource specific to building safety entitled Seven Important Building Design Features to Enhance School Safety and Security.  These guides are evidence-based strategies.

In addition, the U.S. Department of Homeland Security has available a cyber security awareness campaign called Stop.Think.Connect. which focuses on raising awareness about how to be safer and more secure online.

After a horrific incident like what happened recently in Florida, people want to take action. The safest response is to slow down, have local conversations about security (schools, fire, police, and county emergency management agencies), and take account of what is in place first before taking action.

For more resources, including training and emergency operations planning, from Maine DOE and its emergency planning partners, visit: http://www.maine.gov/doe/security/ or contact Pat Hinckley at 624-6886 or by email at pat.hinckley@maine.gov .

Child Sexual Abuse Prevention Education and Response Model Policy

The Maine Department of Education (DOE), as directed by Maine law Public Law 2015, Ch. 292 (LD 1180), An Act To Require Education in Public Preschool Programs and Elementary Schools Regarding Child Sexual Abuse, has developed a model policy for schools on child sexual abuse prevention education and response. The law (20-A MRSA §254, sub-§18) states that all school administrative units (SAUs) that operate schools with grades public preschool program through grade 5 shall adopt a written local policy for child sexual abuse prevention education and response that is consistent with the Maine DOE model policy located at www.maine.gov/doe/healthed/laws/ under Safety & Accident Prevention. The policy must include the following:

  • Child sexual abuse response and reporting procedures;
  • Child sexual abuse awareness training and prevention education for school personnel;
  • Age-appropriate child sexual abuse prevention education for students;
  • School response and reporting procedures for child sexual abuse; and
  • Resources a victim of child sexual abuse or nonoffending caregivers of a victim of child sexual abuse may access for services and support.

Pursuant to this statute, school administrative units (SAUs) are required to develop a policy beginning in the 2017-18 school year. However, given the late release of the model policy, SAUs are expected to develop the policy on or before the beginning of the 2018-19 school year.

The Maine DOE and the Maine Coalition Against Sexual Assault (MECASA) are available to provide technical assistance in the writing and implementation of this policy that is intended to educate preschool through grade 5 children, as well as school personnel, families and community members in the prevention of and response to child sexual abuse. A web-based resource and trainings to support the implementation of this law are being developed by the MECASA with support from the Maine DOE. The website is expected to be launched this spring.

For more information on the new requirements contact Susan Berry, Maine DOE’s Health Education and Health Promotion Coordinator, at susan.berry@maine.gov.

FEMA opens nominations to recognize youth for their work in Emergency Preparedness

The Federal Emergency Management Agency (FEMA) will be opening up nominations nationwide for youth from grades 8 to 11 to join the National Youth Preparedness Council. Nominations will be opened for six week starting in late January, early February. If you know of youth involved in emergency preparedness work, who are part of Teen CERT, Medical Response Corps, or volunteer locally to help people with local emergencies, please let them know about this upcoming opportunity.

New England’s current youth council representative is from Connecticut and currently is serving her second term on this national council.

For more information about the National Youth Preparedness Council visit this website: https://www.ready.gov/youth-preparedness-council

For additional information please contact Sara Varela, Regional Preparedness Liaison, FEMA Region 1 (703) 713-8819 sara.varela@icf.com


PRIORITY NOTICE: Widespread Influenza in Maine

The following message has been provided by the Maine Center for Disease Control and Prevention.

Influenza activity in Maine is widespread with laboratory confirmed influenza reported in all counties. Influenza A/H3, and influenza B have been confirmed in Maine indicating both strains are circulating.  Maine CDC has followed up on 52 outbreaks of influenza as of Thursday January 25, 2018. Influenza vaccination is still strongly encouraged and is widely available, especially to protect those persons at risk of severe disease.  The vaccine appears to be a good match to three strains (A/H1, B/Yamagata, B/Victoria) this year, and it is not too late to get vaccinated.  Nationally, the majority of the circulating A/H3 strains are not a good match to the vaccine.  Maine specific data is not available at this time, but it is assumed to be similar to the national picture.  Vaccination is still recommended as it will protect against the other three strains, and it may offer cross protection and decrease the severity of illness.

What can Maine schools do to prevent and control influenza?

  • Report outbreaks: Report outbreaks of any illness, defined as student absenteeism rates >15%, immediately to Maine CDC.  Submit > 15% absenteeism reports through the Department of Education NEO Dashboard Absenteeism Reporting application (for more information, see http://maine.gov/education/sh/contents/AbsenteeReportingNEOSHM.3.2017.pdf).  Field epidemiologists are available to provide consultation on infection control.  Reports may also be called to 1-800-821-5821.
  • Promote health among students and staff: Encourage students, parents, teachers and staff to be aware of their health and to identify early if they have influenza-like illness (defined as fever of 100 degrees or greater, plus sore throat and/or cough).  Promote four steps to prevent flu: wash hands, cover cough, stay home if sick, and get vaccinated.   Individuals should stay home until 24 hours after fever resolves without the use of fever reducing medications.
  • Increase environmental cleaning: Frequently clean high touch surfaces, like door knobs, desks, and light switches – this helps break down the presence of the virus in the environment.
  • Review school policy on sickness and health: Review with staff your school policy on illness among students and staff.  Invite the school nurse or physician to speak at a staff meeting or school board meeting to promote prevention of influenza.  Consider steps the school will take in the event of continued elevated absenteeism.

Where can I find more information? 

Reminder of Restraint and Seclusion Overview and Awareness Information Course

As mid-school year approaches, this is a reminder of The Restraint and Seclusion Overview and Awareness Information Course that is provided by the Maine DOE to districts at no cost.

In accordance with Chapter 33, “Annually, each covered entity shall provide overview and awareness information to all staff, including contracted providers, regarding the content of this rule and any local policies or procedures related to the use of physical restraint and seclusion” (Chapter 33, Section 4.2).

SafeSchools and Maine DOE collaborated to create this 25 minute, web based course specifically to address Chapter 33.

To register staff for the Restraint and Seclusion Overview and Awareness Information Course, contact Justin Moore at SafeSchools. He can be reached by calling 1-800-434-0154, ext 7028 or emailing at jmoore@safeschools.com.

School Based Health Center Survey

In an effort to learn more about what health services are available in School Based Health Centers (SBHC) around the State of Maine, the Department of Education requests any school unit that has one to complete a short survey.

The survey consists of 5 questions that ask about partnered agencies, services provided, clientele served, as well as some basic financial information. The purpose is only to gather information that may inform future Department guidance and resources.

Your participation is voluntary, but we hope that you will take a few minutes to help gather data. Please be sure that this request gets passed along to the appropriate person in your school unit so that it can be completed by December 21, 2017.

School Based Health Centers (SBHC) Survey

For more information contact Emily Poland, Maine DOE School Nurse Consultant at 207-624-6688.