1. New Mexico Emergency Medications in Schools Head 2 Toe 2016 Winona Stoltzfus MD

2. New Mexico Emergency Medication in Schools Act – NMAC 7.30.12.1 Rules promulgated February 27,2015

3. Emergency Medications in Schools  Voluntary program for school districts  Creates way for school to have “stock” medications  available for use in emergency situations  Two medications through the program:  albuterol and/or  epinephrine 3

4. Status of School Epinephrine Legislation and Guidelines 4

5. Key Requirements 1. Only schools with a PED licensed school nurse can implement this program 2. For emergencies only 3. EMS always activated! 5

6. Who may give emergency medications?  Only schools with a PED licensed school nurse can implement this program  Epinephrine  Any trained school staff member who has been trained by the school RN  Albuterol  Only trained PED licensed school nurse  Due to Board of Nursing Regulations 6

7. What does it take to start the program? 1. School district administration opts to use program  School Board reviews Rules and Recommendations to School Districts for Stock Emergency Medications in Schools document  Signs and submits acknowledgment form to School Health Advocate (SHA) / Regional Health Officer (RHO)  Standing Order requested from RHO using above form  School district creates Policies and Procedures for Respiratory Distress and Anaphylaxis 7

8. What does it take to start the program? 2. Pharmacy License (Class C or School Based Emergency Medicine Class D Clinic)  Initial inspection fee & bi-annual license fee  Consultant Pharmacist  Quarterly for Class C, annual for Class D  Medication(s) obtained  Emergency medications and supplies stored safely and accessibly in a tempature controlled environment 3.Staff is trained  Training log form kept 3 years 4. Logs are maintained  Temperature log  Medication log 8

9. Standing Orders /Medications /Supplies  Request from School Board or school’s governing body submitted to Regional Health Officer (RHO)  RHO writes the standing order for emergency medications requested by the school  Medications may be directly obtained from the pharmacy by a school nurse or delivered to the school nurse.  Albuterol:  aerosol canisters, spacers, masks and/or  Epinephrine:  Standard dose and pediatric dose auto-injectors with carrier tubes  Ambient air thermometer 9

10. Procurement & Maintenance of Emergency Medications  School districts may purchase prescribed medications directly from pharmacies after obtaining a standing order from the RHO  School districts may accept gifts, grants, bequests, or donations from any source for albuterol canisters and spacers/masks or epinephrine auto-injectors from a manufacturer or wholesaler of such medication and supplies  However, medications cannot be donated by individuals for whom the medication was prescribed  Schools must maintain a record of purchases, grants, gifts, bequests or donations for 3 years in the school health office and can be inspected upon request  Schools will maintain a supply of emergency medications  When medications are used, the supply must be replenished  Stock medications checked regularly to verify medications have not expired 10

11. The supply of emergency albuterol and/or emergency epinephrine allowed under this law is not intended to replace albuterol or epinephrine prescribed to students with known allergies and/or asthma. Physicians should still prescribe epinephrine and/or albuterol as appropriate and encourage parents whose children are diagnosed with allergies and/or asthma to put in place an Individual Health Care Plan, Emergency Action Plan, or a Section 504 Plan with their child’s school. 11

12. Storage provisions for Albuterol  Store albuterol canisters according to Board of Pharmacy regulations in a temperature controlled environment  Avoid exposure to extreme hot or cold temperatures  59°F to 77°F (Temps above 120°F may cause the canister to burst)  Stored in a secure location that is unlocked and readily accessible to trained personnel  Maintain the Medication Log Sheet & Temperature Log Sheet  Maintain a recordkeeping system so medications and supplies are checked regularly & replaced before the expiration dates  Nurse completes pharmacy audit form annually 12

13. Storage Provisions for Epinephrine  Store epinephrine (standard-dose and pediatric-dose) according to Board of Pharmacy regulations (temp controlled environment)  Store in a secure location that is unlocked and readily accessible to trained personnel  Store in the carrier tube and protect from the light  Avoid exposure to extreme hot or cold temperatures  68°F to 77°F (Do not store in a refrigerator or freezer)  Epinephrine solution should be clear; discard if discolored  Maintain the Medication Log & Temperature Log  Maintain a recordkeeping system so medications and supplies are checked regularly & replaced before the expiration dates  Nurse completes pharmacy audit form annually 13

14. Summer storage  When school is closed for prolonged periods, arrangements must be made to monitor temperature storage conditions of emergency medications to insure temperature stays within the range stated for each medication.  For summer storage and winter break:  some schools have used small portable cooling devices (similar to those used for wine), to keep medications stable.  Or, school districts can elect to store all emergency medications in one location where the temperature is controlled and can be monitored daily. 14

15. Medication Record Keeping for Both C & D Medication Rooms  Record keeping at a minimum will include:  Daily Room Temperature Log  Date medication was received  Product description  Lot Number  Expiration date  Destruction or disposal date  Audit forms will be submitted to the consulting pharmacist every year and submitted to the Board of Pharmacy every other year for renewal.  NM Pharmacy Association(NMPhA) http://nmpharmacy.orghttp://nmpharmacy.org or 1-800-464-8729  Log forms and self-audit forms are included in the Rules and Recommendations document and from the Board of Pharmacy 15

16. Disposal  Expired medications must be kept separate and secure until disposed  School Nurse is responsible for proper disposal of expired medications  Expired medications may be returned to the supplying pharmacy or disposed of according to Board of Pharmacy regulations  The Board of Pharmacy is a resource for direction in proper disposal of expired medications  A record of disposed medications must be kept  A sample medication log sheet is included in the Rules and Recommendations document 16

17. Trainings  School districts that decide to maintain and administer emergency medications will follow the New Mexico Department of Health Rules and Recommendations.  Trainings will be reviewed and approved by NM DOH. Provide SHA with a copy of the training to be presented for approval before presenting it to school staff.  A training log will be kept at each school in the school health office for a minimum of 3 years. Training records may be maintained electronically or in hard copy.  A PED licensed School Nurse will provide oversight of the program in the school, including school staff trainings. 17

18. Training for Emergency Albuterol  PED licensed school nurses will complete approved training on administering albuterol (reviewed and by the NM DOH).  Refer to pages 15 & 17 Rules and Recommendations to School Districts for Stock Emergency Medications in Schools document.  Current school nurses will complete the training a minimum of one time and as determined by the NM DOH; new school nurses will complete the training as part of their orientation process and then as determined by NMDOH.  Refresher trainings on albuterol administration may be recommended by the NM DOH. 18

19. Training for Emergency Epinephrine  School personnel, including non-licensed personnel, will complete training on administering epinephrine that is reviewed and approved by the NM Department of Health.  Refer to pages 16 & 18 Rules and Recommendations to School Districts for Stock Emergency Medications in Schools document.  Current school nurses will complete the training one time and new school nurses will complete the training as part of their orientation process.  Non-licensed personnel will complete the training annually. 19

20. RESOURCES FOR SCHOOL DISTRICTS  Centers for Disease Control and Prevention. Strategies for Addressing Asthma Within a Coordinated School Health Program. Washington, DC: US Department of Health and Human Services; 2013. http://www.cdc.gov/healthyyouth/asthma/strategies/asthmacsh.htm  Centers for Disease Control and Prevention. Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs. Washington, DC: US Department of Health and Human Services; 2013. http://www.cdc.gov/healthyyouth/foodallergies/pdf/13_243135_A_Food_Allergy_Web _508.pdf  Clinical Conversations for the School Nurse: Food Allergy Management in the School Setting. National Association of School Nurses; 2014. https://www.nasn.org/ToolsResources/FoodAllergyandAnaphylaxis/ClinicalConversatio nsfortheSchoolNurse  Safe at School and Ready to Learn: A Comprehensive Policy Guide for Protecting Students with Life-Threatening Food Allergies, Second Edition. National School Boards Association; 2012. http://www.nsba.org/safe-school-and-ready-learn-comprehensive-policy-guide- protecting-students-life-threatening-food 20

21. Resources for School Nurses 21 www.NASN.orgwww.NASN.org NASN Online Food Allergy and Anaphylaxis Toolkit www.EpiPen4Schools.comwww.EpiPen4Schools.com Anaphylaxis: Know It. See It. Treat It. Training Video

22. Most important elements? PREVENTION and PREPAREDNESS 22