1. MEDICATION UPDATE August, 2017
Jamie Smith, State School Nurse Consultant, Oregon Health Authority
Ely Sanders, Sexual Health and School Health Specialist, Oregon Department of Education
Introduce ourselves and our roles and why we are here.
Ely – my name is Ely Sanders and I am the ….
Jamie – my name is Jamie Smith and I am the State School Nurse Consultant within the Public Health Division of the Oregon Health Authority.

2. Learning Objectives
Participants will recognize updated rules for medication administration in Oregon schools.
Participants will gain an understanding of the rationale for current rules/laws.
Participants will have questions answered about medication administration in Oregon schools.
Ely
Our objectives for this webinar include:
Updated rules for medication administration in Oregon Schools
Rationale for the updated rules
Answer your questions about medication administration in Oregon Schools
The Chat box is where we would like you to enter your questions. We will try to answer questions along the way where applicable, but otherwise will answer them at the end.

3. Law/Rule Structure Quick Review Oregon Revised Statutes (ORS)
ORS Chapters
= Education
= Public Health
Oregon Administrative Rules (OAR)
OAR Chapters
333 = Public Health Division
581 = Oregon Department of Education
Jamie
To provide some background, we will quickly review the way laws work in Oregon.
The ORS is the law passed by the Oregon Legislature.
The OARs are the rules that state agencies create to implement the intent of the law. The OARs must be consistent with the applicable ORS’, and the OARs can be updated/changed without Legislative action. Sometimes an ORS will mandate a state agency or agencies to update their rules (OARs).
There is a numbering scheme that correlates with a specific state agency (see within slide)

4. Legal Requirements ORS 339.866-339.873
OAR (ODE)
Oregon Nurse Practice Act (OSBN)
ORS & OAR –
Board of Pharmacy rules
OAR –
Public Health rules
ORS & OAR –
Age of consent
ORS , , &
Jamie
These are the main ORS/OARs that impact Medication Administration in Oregon schools.
(Page 2 of manual) ORS provide the ‘law’ that dictates how medications are given in Oregon schools.
From these ORS’, ODE created OAR (summarized on page 3 of manual) which further explains the intent of the law and provides guidelines on how to administer medications in the school setting in Oregon schools.
In addition to the ODE rules, we have to also keep in mind the Oregon NPA, Board of Pharmacy rules, Public Health rules and Age of Consent laws.

5. ORS
A school district board shall adopt policies and procedures that provide for self-administration for medication by K-12 students with asthma or severe allergies:
In school
At a school-sponsored activity
While under the supervision of school personnel
In before-school or after-school are programs on school-owned property
And in transit to or from school or school-sponsored activities
Medication defined as:
Medication that is no injected
Premeasured doses of epinephrine that are injected
Medication that is available for treating adrenal insufficiency (crisis)
Ely
This is a snapshot of the ‘Law’ under ODE purview.

6. ODE Memo Changes to OAR 581-021-0037
Housekeeping
Recommended changes from the field/SNAG
Food supplements
Training
Minor consent law consistency
Sexual Health, Mental Health, General Health
Legislatively required
Out of State
Multiple stakeholders were engaged in updating/reviewing the OAR
Ely
ODE recently (date?) released a memo outlining the changes to OAR
Stakeholders: SNAG, Board of Pharmacy, OSBA, OSBN, OSNA, OSEA, & OHA-Public Health

7. OAR 581-021-0037 Staff administered vs self administered
Types of medication – prescription vs nonprescription
‘Physician’ vs. ‘Prescriber’
Qualified trainer
Training
Lifesaving Treatment protocols
IHP for life-threatening allergies and AI
Out of state orders
Age of Consent
Jamie
ODE promulgated the rules which addresses this list of items.
We will cover some of the specific updates in later slides.

8. OAR 581-021-0037 Staff administered vs self administered
Types of medication – prescription vs nonprescription
‘Physician’ vs. ‘Prescriber’
Qualified trainer
Training
Lifesaving Treatment protocols
IHP for life-threatening allergies and AI
Out of state orders
Age of Consent
Jamie
Nonprescription vs Prescription definition – Federal law doesn’t require/requires a prescription from a provider
Non-FDA approved nonprescription medications – allowable, but only with prescriber ‘order’ and verification that it is needed during the school day.

9. OAR 581-021-0037 Staff administered vs self administered
Types of medication – prescription vs nonprescription
‘Physician’ vs. ‘Prescriber’
Qualified trainer
Training
Lifesaving Treatment protocols
IHP for life-threatening allergies and AI
Out of state orders
Age of Consent
Jamie
Physician changed to prescriber to be all-encompassing of those that are allowed to prescribe medications in Oregon.

10. OAR 581-021-0037 Staff administered vs self administered
Types of medication – prescription vs nonprescription
‘Physician’ vs. ‘Prescriber’
Qualified trainer
Training
Lifesaving Treatment protocols
IHP for life-threatening allergies and AI
Out of state orders
Age of Consent
Jamie
This was updated to better reflect what is happening in the field. Some districts were doing in-person only, some were doing online only without much direction from the state. This creates a consistent standard across the state.
In addition, Pharmacist was added to list of prescribers because of recent legislative changes and the Out of State order section was updated to reflect the nurses that not only work for a school district but also those that work for an ESD or Health Department.

11. OAR 581-021-0037 Staff administered vs self administered
Types of medication – prescription vs nonprescription
‘Physician’ vs. ‘Prescriber’
Qualified trainer
Training
Lifesaving Treatment protocols
IHP for life-threatening allergies and AI
Out of state orders
Age of Consent
Jamie
Another significant change was the handling of self-administration of prescription medication. This would also apply to self-administration of non-FDA approved medications given with a written prescriber order. The wording now includes the opportunity for either the prescriber or the RN practicing in the school setting to approve of a student self-administering in school.

12. Training Materials/Forms
Training Manual
PowerPoint
Medication Forms
Jamie
The ODE Training Manual has been updated and is available on the School Nurse site at ODE.
Local policies and forms should be referenced during the training.
The trainer should create an assessment tool for participants – quiz, hands-on?
Does not include nebulizers, intranasal Versed, oxygen, and rectal Diastat
If the trainer wants to include one or more of these, they will need to add applicable information.
MAR – Medication Administration Record
Confidentiality/Records Retention
There is a PowerPoint that accompanies the ODE Training Manual. This PowerPoint has been updated to reflect the changes to OAR
- There is a link in the presenter notes to YouTube videos if the instructor wanted to augment the training. The videos are supportive information that should be used to support the information included in the manual and PowerPoint slides.
Engagement strategies added in Presenter Notes for those of us that are not great ‘instructors’
Provide an example – next slide
There are example medication forms on the ODE website that districts can use if they choose to.

13. Engagement Strategies
Jamie
For example, the trainer would direct participants to page 8 of the manual and say:
Medication comes in many forms and is administered in various ways.
One method of administration is oral (by mouth).
ASK – what common forms of medications are administered by mouth?

14. Learning Objectives
Participants will recognize updated rules for medication administration in Oregon schools.
Participants will gain an understanding of the rationale for current rules/laws.
Participants will have questions answered about medication administration in Oregon schools.
Ely
How did we do?

16. Questions? What questions do you have and/or what did we miss?
Please type your question into the chat box and we will answer them in the order that they are received.

17. Thank you! Jamie Smith – jamie.leon.smith@dhsoha.state.or.us
Ely Sanders –
As always, we are here to support you. Please reach out if you need additional help and/or have questions that arise after absorbing the information.