NWESD Policy Manual & Administrative Procedures

3419-P – Self-Administration of Asthma and Anaphylaxis Medication Procedure

Asthma is an inflammatory disease of the respiratory tract. Anaphylaxis is a life-threatening allergic reaction that may involve systems of the entire body. Anaphylaxis is a medical emergency that requires immediate medical treatment and follow-up care by an allergist/immunologist.

Students with asthma or anaphylaxis are authorized, in consultation with the NWESD 189 or cooperating member district professional registered nurse, to possess and self-administer medication for asthma or anaphylaxis during the NWESD 189 program day, during NWESD 189 sponsored events and while traveling to and from NWESD 189 sponsored activities. The student shall be authorized to possess and self-administer medication if the following conditions are met.

1. The parent/guardian must submit a written request for the student to self-administer medication(s) for asthma or anaphylaxis.
2. A health care practitioner has prescribed the medication for use by the student during educational program hours and the student has received instructions in the correct and responsible way to use the medication(s).
3. The student demonstrates to the health care practitioner and a professional registered nurse at the educational program site the skill necessary to use the medication and to use the device necessary to administer the medication.
4. The health care practitioner provides a written treatment plan for managing the asthma or anaphylaxis episodes of the student and for use of medication during education program hours. The written treatment plan should include name and dosage of the medication, frequency with which it may be administered, possible side effects and the circumstances that warrant its use.
5. The parent/guardian must sign a statement acknowledging that the NWESD 189 shall incur no liability as a result of any injury arising from the self-administration of medication by the student and that the parents/guardians shall indemnify and hold harmless the NWESD 189 and its employees or agents against any claims arising out of the self-administration of medication by the student.

The authorization to self medicate will be valid for the current program year only. The parent/guardian must renew the authorization each year.

In the event of an asthma or anaphylaxis emergency, the NWESD 189 shall have the following easily accessible at educational site:

1. The student’s written treatment plan;
2. The parent/guardian’s written request that the student self medicate; and
3. The parent/guardian’s signed release of liability form.

Backup medication, if provided by the parent/guardian, shall be kept at a location at the educational program site to which the student has immediate access in the event of an asthma or anaphylaxis emergency.

A student’s authorization to possess and self-administer medication for asthma or anaphylaxis may be limited or revoked by the site administrator after consultation with the NWESD 189 or cooperating member district professional registered nurse and the student’s parents/guardian if the student demonstrates an inability to responsibly possess and self-administer such medication.

Asthma or Anaphylaxis Rescue Procedures

In the event of an asthma or anaphylactic episode, the NWESD 189 or cooperating member district nurse shall be immediately contacted. In the absence of a school nurse, the person responsible for school health duties will be contacted. For asthma, NWESD 189 staff will follow the procedures outlined in the most recent edition of the AMES: Asthma Management in Educational Settings manual including:

1. Managing the students’ school environment;
2. Training school personnel in rescue procedures;
3. Accompanying all students exhibiting symptoms;
4. Providing care as designed in the student’s emergency care plan;
5. Calling 911, if appropriate;
6. Notifying the student’s parent/guardian;
7. Documenting interventions; and
8. Reviewing the student’s emergency care plan and making changes, if necessary.

For anaphylaxis, the NWESD 189 will follow the Guidelines for the Care of Students with Anaphylaxis published by the Office of the Superintendent of Public Instruction.

Presented to Board: 09/15/05
Revised: 10/24/12

Date Revised: 10/24/12