The Tipton Community School District seeks to provide a safe environment for students, staff, and visitors who are at risk of potentially life-threatening incidents that include severe allergic reactions and opioid overdose. Therefore, it is the policy of the district to annually obtain a prescription for epinephrine auto-injectors and opioid antagonists from a licensed healthcare professional, in the name of the school district, for administration by a school nurse or personnel trained and authorized to administer to a student or individual who may be experiencing an anaphylactic reaction or acute opioid overdose.
Procurement and maintenance of supply: The district shall stock a minimum of the following for each attendance center:
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One pediatric doses and one adult doses epinephrine auto-injector
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One dose of naloxone or other opioid antagonist.
The supply of such medication shall be maintained in a secure, easily accessible area for an emergency within the school building, or in addition to other locations as determined by the school district.
School nurses shall routinely check stock of medication and note the following:
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The expiration date
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Any visualized particles or color change for epinephrine auto-injectors
The school nurses shall be responsible for ensuring the district replaces, as soon as reasonably possible, any logged epinephrine auto-injector or opioid antagonists that are empty after use, damaged or close to expiration. The district shall dispose of stock medications and delivery devices in accordance with state laws and regulations.
Training: A school nurse or personnel trained and authorized may provide or administer any of the medication listed in this policy from a school supply to a student or individual if the authorized personnel or school nurse reasonably and in good faith believes the student or individual is having an anaphylactic reaction or opioid overdose. Training to obtain a signed certificate to become personnel authorized to administer an epinephrine auto-injector or opioid antagonist shall consist of the requirements of medication administration established by law and an annual anaphylaxis and opioid overdose training program approved by the Department of Education.
Authorized personnel will be required to retake the medication administration course, training program and provide a procedural skills demonstration to the school nurse demonstrating competency in the administration of stock epinephrine autoinjectors or opioid antagonists to retain authorization to administer these medications if the following occur:
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Failure to administer an epinephrine auto or opioid antagonist according to generally accepted standards of practice (“medication error”); or
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Accidental injection injury to school personnel related to administering the medication (“medication incident”).
Information: Opioid overdose occurs when the amount of opioid in the body is so great the individual becomes unresponsive to stimuli and breathing becomes inadequate. Lack of oxygen affects vital organs, including the heart and brain, leading to unconsciousness, coma, and eventually death. Naloxone is indicated for the reversal of opioid overdose in the presence of respiratory depression or unresponsiveness.
The following may be signs and symptoms of an individual experiencing an opioid-related overdose:
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A history of current narcotic or opioid use or fentanyl patches on skin or needle in the body
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Unresponsive or unconscious individuals
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Not breathing or slow/shallow respirations
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Snoring or gurgling sounds (due to partial upper airway obstruction)
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Blue lips and/or nail beds
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Pinpoint pupils
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Clammy skin
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Vomiting
Note that individuals in cardiac arrest from all causes share many symptoms with someone with a narcotic overdose (unresponsiveness, not breathing, snoring/gurgling sounds, and blue skin/nail beds). If there is no pulse, these individuals are in cardiac arrest and require CPR.
Procedure
- Attempt to rouse and stimulate the student/ patient (rub your knuckles firmly up and down the breastbone).
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Call 911, get an AED. Have someone call the school nurse and parent(s).
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If possible, monitor and record respirations, heart rate and blood pressure. Note suspected opiate overdose (as evidenced by pinpoint pupils, depressed mental status, etc.).
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If available, administer naloxone/ NARCAN® NALOXONE
- Remove yellow cap from needleless syringe. Attach the nasal atomizer (applicator) onto the top of the needleless syringe. Remove purple cap from prefilled vial of naloxone. Thread vial into needleless syringe by gently twisting naloxone until you feel it “catch”. DO NOT PUSH VIAL INTO SYRINGE. Expel air.
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Tilt the person’s head back and spray half of naloxone up one nostril and the other half of naloxone up the other nostril. IMPORTANT: In an emergency, if you do not have the atomizer, you can squirt the naloxone into the person’s nose as directed without the atomizer. NARCAN
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Peel back the package to remove the device. Hold the device with your thumb on the bottom of the plunger and two fingers on the nozzle. Place and hold the tip of the nozzle in either nostril until your fingers touch the bottom of the patient’s nose. Tilt head back. Press the plunger firmly to release the dose into the patient’s nose.
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Continue to perform rescue breathing/CPR as necessary.
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Start rescue breathing if not breathing or CPR if there is no pulse.
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Allow 1-3 minutes for medication to work. If no change to the person’s condition after 2-3 minutes, give another dose of naloxone/NARCAN® as in Step 4 above and continue rescue breathing as necessary.
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Administer CPR if indicated.
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Stay with the person until medical help arrives. Notify EMS of naloxone administration.
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Reported administration should be sent to the State Opioid Response (SOR2) help desk at sor@idph.iowa.gov as an email and only include the date of administration and the outcome (was the individual able to be revived).
Reporting: The district will contact emergency medical services (911) immediately after a stock epinephrine auto-injector or stock opioid antagonist is administered to a student or individual. The school nurse or authorized personnel will remain with the student or individual until emergency medical services arrive.
Within 48 hours, the district will report to the Iowa Department of Education:
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Each medication incident with the administration of stock epinephrine or opioid antagonist.
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Each medication error with the administration of stock epinephrine or opioid antagonist.; or
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The administration of a stock epinephrine auto-injector or opioid antagonist.
As provided by law, the district, board, authorized personnel or school nurse, and the prescriber shall not be liable for any injury arising from the provision, administration, failure to administer, or assistance in the administration of an epinephrine auto-injector or opioid antagonist provided they acted reasonably and in good faith.
The superintendent may develop an administrative process to implement this policy.
NOTE: Districts are not required by law to stock and maintain a supply of epinephrine auto-injectors, bronchodilator canister or spacer, or opioid antagonist. However, if a district decides to stock and maintain a supply of these medications, the board is required to establish a policy.
NOTE: For additional information, training resources and reporting forms regarding voluntary stock medication , please visit the Department of Education’s page titled “School Nurse Resources” and scroll down to “Stock Medications,” located at https://educateiowa.gov/pk-12/learner-supports/school-nurse/school-nurse- resources.
Legal Reference:
Iowa Code §§ 135.185; 190; 279.8.
281 I.A.C. 14.3.
Cross References:
507.02 Administration of Medication to Students
507.02E1 TCSD Authorization Asthma or Airway Constricting Medication Self-Administration Consent Form(s)
507.02E2 TCSD Parental Authorization and Release Form for the Administration of Prescription Medication To Students
507.02E3 TCSD Administration of Medication to Students - Parental Authorization and Release Form for Independent Self Carry and Administration of Prescribed Medication or Independent Delivery of Health service by the Student
507.02E4 TCSD Administration of Medication to Students - Parental Authorization and Release Form for the Administration of Voluntary School Stock of Over-the-Counter medication to Students
Approved: 9/12/2022 Reviewed: 05/13/2024 Revised: 05/13/2024