CHAPTER 30 FAMILY AND CHILDREN HEALTH CARE SERVICES
PART 12 EMERGENCY
MEDICATIONS IN SCHOOLS
7.30.12.1 ISSUING AGENCY: New Mexico Department of Health.
[7.30.12.1
NMAC - N, 02/27/2015]
7.30.12.2 SCOPE: This rule applies to public, private, or charter
schools in New Mexico unless otherwise expressly limited.
[7.30.12.2
NMAC - N, 02/27/2015]
7.30.12.3 STATUTORY AUTHORITY: These rules are promulgated pursuant to the
following statutory authorities: (1) the Department of Health Act,
Section 9-7-6(E) NMSA 1978, which authorizes the secretary of the department of
health to “...make and adopt such reasonable and procedural rules and
regulations as may be necessary to carry out the duties of the department and
its divisions;” (2) the Public Health Act, Section 24-1-3(G) and (O) NMSA 1978 and
Section 24-31-1 NMSA 1978, which authorize the department to prescribe the
duties of school nurses to maintain and enforce rules to carry out the
provisions of the Public Health Act; and to promulgate rules pursuant to the
Emergency Medication in Schools Act; and (3) the Emergency Medication in
Schools Act, Sections 22-33-1 through 22-33-4 NMSA 1978, which authorizes the
department to adopt regulations to carry out the provisions of the Emergency
Medication in Schools Act.
[7.30.12.3
NMAC - N, 02/27/2015]
7.30.12.4 DURATION: Permanent.
[7.30.12.4
NMAC - N, 02/27/2015]
7.30.12.5 EFFECTIVE DATE: February 27, 2015, unless a later date is
cited at the end of a section.
[7.30.12.5
NMAC - N, 02/27/2015]
7.30.12.6 OBJECTIVE: The purpose of this rule is to allow access to
emergency medications in the school setting for the treatment of respiratory
distress with albuterol and the treatment of anaphylactic reactions with
epinephrine. Stock emergency medications
are intended for students who have not previously been diagnosed with
conditions leading to respiratory distress or anaphylaxis or who have a history
of these conditions and do not have medications on their person or stored at
school.
[7.30.12.6
NMAC - N, 02/27/2015]
7.30.12.7 DEFINITIONS:
A. “Adverse
event form” is a department form used by school nurses to report events
with potential impact on the health of the students or the school, including
administration of stock albuterol or epinephrine.
B. “Albuterol” includes albuterol or
another inhaled bronchodilator, as recommended by the department of health, for
the treatment of respiratory distress.
C. “Albuterol aerosol
canister” means a portable drug delivery device packaged with multiple
premeasured doses of albuterol.
D. “Anaphylaxis” or “anaphylactic
reaction” means a sudden, severe, and potentially life-threatening
whole-body allergic reaction.
E. “BOP” refers
to the board of pharmacy.
F. “Class D Medication
Room” is specific for schools and is used only for emergency medications. The Class D Medication Room criteria
is established by the board of pharmacy.
The criteria includes requirements for
procurement of medications, storage, tracking, and disposal of expired
medications.
G. “Department” means department of health.
H. “Emergency
medication” means albuterol or epinephrine.
I. “Epinephrine” includes epinephrine or
another medication, as recommended by the department of health, used to treat
anaphylaxis until the immediate arrival of emergency medical system responders.
J. “Epinephrine auto-injector” means a
portable, disposable drug delivery device that contains a premeasured single
dose of epinephrine.
K. “Governing body” means a governing body
of a private school.
L. “Health care practitioner” means a
person authorized by the state to prescribe emergency medication.
M. “PED” means the public education
department.
N. “Respiratory distress” includes
impaired oxygenation of the blood or impaired ventilation of the respiratory
system.
O. “School” means a public school, charter
school, or private school.
P. “Spacer” means a
holding chamber that is used to optimize the delivery of albuterol to a
person's lungs.
Q. “Stock supply” means an appropriate
quantity of emergency medication, as recommended by the department of health.
R. “Trained personnel”
means a school employee, agent, or volunteer designated by the school nurse to
administer epinephrine on a voluntary basis outside of the scope of employment
and who has completed department approved epinephrine administration training that
has been documented by the school nurse, school principal, or school leader.
[7.30.12.7 NMAC
- N, 02/27/2015]
7.30.12.8 EMERGENCY MEDICATIONS:
A. Standing Orders.
(1) A
physician employed or authorized by the department, may prescribe a standing
order in the name of the school or school district for a stock supply of
albuterol aerosol canisters and spacers, or a stock supply of standard-dose and
pediatric-dose epinephrine auto-injectors for use in accordance with this rule.
(2) Each
local school board or governing body may request a standing order for and may
provide to schools within its jurisdiction stock supplies of albuterol and
epinephrine. In order to request a
standing order, the school board must review and acknowledge in writing the rules
and recommendations developed by the department for emergency medication use. All requests for standing orders must be in
writing to a department approved physician.
When the standing order is issued by the department approved physician,
it will be sent to the requesting school district or governing body within one
week of the request. A copy of the order
will be kept by the department school health advocate for his or her assigned
region.
(3) A
pharmacist may dispense a stock supply of albuterol aerosol canisters and
spacers or a stock supply of standard-dose and pediatric-dose epinephrine
auto-injectors pursuant to a standing order prescribed in accordance with this
section. Medications may be directly
obtained from the pharmacy by a school nurse or delivered to the school in
accordance with the school’s established procedure.
(4) All
standing orders are renewed annually.
B. Storage provisions: School districts that decide to maintain and
administer emergency medications will establish a Class D Medication Room in each
school that stocks emergency medications in compliance with New Mexico BOP regulations.
School nurses who maintain a Class D Medication
Room license will be required to complete an annual medication room audit and
submit it to the BOP.
(1) Albuterol - Each school that obtains a stock supply of albuterol aerosol
canisters and spacers shall store them:
(a) in a secure location that is unlocked and readily accessible
to a school nurse to administer albuterol;
(b) pursuant to BOP regulations, including requirements for
storage, record maintenance, and medication room audits or consulting
pharmacist’s visits;
(c) within the manufacturer-recommended temperature range; and
(d) albuterol
will be secured in a manner consistent with the procedure employed by the
school nurse for other emergency medications; the medication cabinet, which is kept
in the school nurse’s office, is kept unlocked when the school nurse or school health
assistant are present in the office; if
the school nurse or school health assistant are not present, the school nurse’s
office will be locked.
(2) Epinephrine - Each school that obtains a stock supply of standard-dose and
pediatric-dose epinephrine auto-injectors shall store them:
(a) in a secure location that is unlocked and readily accessible
to trained personnel;
(b) pursuant to BOP regulations including requirements for
storage, record maintenance, and medication room audits or consulting pharmacist’s
visits;
(c) within the manufacturer-recommended temperature range; and
(d) epinephrine
will be stored in a secure, unlocked location determined by the school nurse
and principal; this
location should be easily accessed by trained school personnel in the event of an
emergency situation; a location is
considered secure for the purposes of epinephrine storage if school staff are
present full-time in that location; for example, the secretary’s office or the
main office.
C. Disposal: Albuterol and epinephrine - Each local school
board or governing body shall dispose of expired emergency medication pursuant
to BOP regulations. Expired medications
will be placed in a separate, quarantined section of the medication room and
disposed of per the Class D Medication Room regulations.
(1) The
school nurse will be responsible for proper disposal of expired medications.
(2) The
BOP is a resource for direction in proper disposal of expired medications.
(3) Expired
medications may be disposed of either by using a consultant pharmacist or by
transferring the medications to a pharmacy with an appropriate transfer log.
D. Procurement and
maintenance of emergency medications.
(1) A
local school board or a school within its jurisdiction of a governing body may
accept gifts, grants, bequests, or donations from any source to carry out the provisions
of this rule, including:
(a) albuterol aerosol canisters and spacers or epinephrine
auto-injectors from a manufacturer or wholesaler; or
(b) epinephrine or albuterol, or such other medication as the
department deems appropriate, from a manufacturer or wholesaler of such
medication; and
(c) this type of donation can be accepted if the medications are
not expired and have been maintained properly.
(2) School
districts or governing bodies may buy prescribed medications directly from
pharmacies after obtaining a standing order.
(3) Schools
will keep a record of any grants, gifts, bequests, or donations. The record is to be held at the school in the
school office for three years and can be inspected by BOP, department personnel,
and school administrative personnel upon request. The records will be kept in the school health
office by the school nurse. Records may
be kept electronically or in hard copy.
(4) Schools
will maintain a supply of emergency medications:
(a) the supply will be replenished as medications are used
according to the procedure in 7.30.12.8 NMAC; and
(b) medications in stock will be checked to verify that
medications are not expired.
[7.30.12.8 NMAC
- N, 02/27/2015]
7.30.12.9 TRAINING: School
districts that decide to maintain and administer emergency medications will
follow the department rules and recommendations, according to the following
guidelines:
A. Use of
albuterol:
(1) PED
licensed school nurses will complete training on administering albuterol reviewed
and approved by the department;
(2) current school nurses will complete the training at a
minimum of one time and as determined by the department; new school nurses will
complete the training as part of their orientation process, and then as
determined by the department; and
(3) refresher trainings on albuterol may be recommended by the
department, at a minimum of every five years.
B. Use of
epinephrine:
(1) school personnel, including non-licensed personnel, will
complete training on administering epinephrine that is reviewed and approved by
the department;
(2) current school nurses will complete the training one time
and new school nurses will complete the training as part of their orientation
process;
(3) non-licensed personnel will complete the training annually;
and
(4) refresher trainings on epinephrine for PED licensed school
nurses may be recommended by the department, at a minimum of every five years.
C. Training will be
documented and a training log will be kept at each school in the school health
office for a minimum of five years.
Training records may be maintained electronically or in hard copy.
[7.30.12.9
NMAC - N, 02/27/2015]
7.30.12.10 ADMINISTRATION OF EMERGENCY
MEDICATIONS:
A. Use of
albuterol:
(1) only a PED licensed school nurse, who has completed the
requisite training, will administer inhaled albuterol on an emergency basis;
(2) if no school nurse is available, immediately call 911;
(3) inhaled
stock albuterol will be given for treatment of respiratory distress only when
the student is experiencing respiratory distress, per criteria that will be
covered in training, and does not have medication available; albuterol may be administered to
students who have not previously been diagnosed with conditions leading to
respiratory distress and students who have a history of respiratory disease but
do not have medication at school;
(4) when stock albuterol is used, 911 will be called immediately
to activate the emergency response system;
(5) after administration of albuterol, the student’s condition
will be continuously monitored, and any additional treatment indicated will be
given until an emergency medical system responder arrives;
(6) as
soon as practicable, the parent, guardian, or legal custodian of the student
having respiratory distress will be notified by phone or in accordance with
contact information on file at the school;
(7) a
log will be kept of when albuterol is used and the outcome of the student; these logs will be
kept in the school health office at least five years; logs will be available for review upon
request, per applicable federal and state privacy laws; logs will be maintained by the school nurse; logs may be either electronic or hard copy;
and
(8) an adverse events form will be completed when albuterol is administered
on an emergency basis; the form will be
submitted within three working days to the regional school health advocate or
the regional health officer; adverse
events forms will be maintained by the department for a minimum of five years.
B. Use of
epinephrine:
(1) school personnel, including non-licensed personnel, who have
completed the requisite training, may administer epinephrine on an emergency
basis;
(2) epinephrine
will be given for treatment of severe anaphylactic reactions only when the
student is experiencing signs of anaphylaxis, per criteria that will be covered
in training, and does not have medication available; this includes students who have not
previously been diagnosed with conditions leading to anaphylaxis and students
who have a history of anaphylaxis and who do not have medication at school;
(3) each school that receives a stock supply of standard-dose
and pediatric-dose epinephrine auto-injectors shall:
(a) develop
and implement a plan to have one or more trained personnel on the school
premises during operating hours, which includes class time and after school
activities; and
(b) follow an anaphylactic reaction prevention protocol, as
recommended by the department, to minimize an allergic student's exposure to
food allergies.
(4) when stock epinephrine is used, 911 will be called
immediately to activate the emergency response system;
(5) after administration of epinephrine, the student’s condition
will be continuously monitored and any additional treatment indicated will be
given until an emergency medical system responder arrives;
(6) as soon as practicable, the parent, guardian, or legal
custodian of the student will be notified by phone or in accordance with
contact information on file at the school;
(7) a
log will be kept of when epinephrine is used and the outcome of the student; these logs will be
kept in the school health office at least five years; logs will be available for review upon
request, per applicable federal and state privacy laws; logs will be maintained by the school nurse; logs may be either electronic or hard copy;
(8) an adverse events form will be completed when epinephrine is
administered on an emergency basis; the
form will be submitted within three working days to the regional school health
advocate or the regional health officer;
adverse events form will be maintained by the department for a minimum
of five years.
[7.30.12.10
NMAC - N, 02/27/2015]
7.30.12.11 PREVENTION
A. A vital part of
the emergency medication in schools programs is preventing respiratory distress
and severe allergic reactions.
B. Recommendations
will be developed by the department for school districts to use in the
development of policies and procedures addressing both the use of the
medications and prevention of respiratory distress and severe allergic
reactions. The recommendations document
will be issued upon request to interested school districts and governing
bodies. The document will be available
online through the office of school and adolescent health’s website at http://nmhealth.org/about/phd/hsb/osah/.
C. The following resources
are available for school districts to use in developing prevention strategies,
and can be obtained from the office of school and adolescent health’s website
at http://nmhealth.org/about/phd/hsb/osah/ or by contacting the office at 300
San Mateo Blvd. NE, Suite 902, Albuquerque, NM 87108:
(1) the environmental protection agency’s “indoor air quality: tools for schools;”
(2) the centers for disease control and prevention’s “voluntary
guidelines for managing food allergies in schools and early care and education
programs;” or
(3) the centers for disease control and prevention’s toolkit “initiating change:
creating an asthma-friendly school.”
D. Other resources
are available through the department’s asthma control program as well as the office
of school and adolescent health.
[7.30.12.11
NMAC - N, 02/27/2015]
HISTORY
OF 7.30.12 NMAC: [RESERVED]