HOUSTON – A school nursing organization that sends recommendations to Texas schools is now proposing the requirement of a doctor’s note for over-the-counter medications.
The Texas School Nursing Organization (TSNO) proposed this requirement in early August.
KPRC 2′s Rilwan Balogun reached out to the organization about the proposal on Wednesday, August 14, but was directed to the Texas Board of Nursing (BON).
The BON will consider the proposal next week, according to the TSNO.
Some of the items, the TSNO proposes for doctor’s notes include are: Benadryl, Tylenol, salt, petroleum jelly, sting-kill swabs, rash cream, glucose gel (administered for insulin), and more.
“A parent’s request is not sufficient by itself for nurses to administer medication. This is true for all nurses in every setting,” according to the TSNO’s website. “Texas School Nurses Organization does not have the authority to require school districts or school nurses to update their procedures. TSNO supports school nurses utilizing their professional judgment to practice nursing safely within their scope of practice.”
After KPRC 2 reached out to the organization, the group removed its resource toolkit PDF explaining in-depth the proposal. However, Balogun had already downloaded the 32-page packet.
The Texas Board of Nursing sent the following statement regarding the recommendation:
The mission of the Texas Board of Nursing (BON or Board) is to protect and promote the welfare of the people of Texas by ensuring that each person holding a license as a nurse in this state is competent to practice safely. The Board fulfills its mission through the regulation of the practice of nursing and the approval of nursing educational programs. This mission, derived from the Nursing Practice Act (NPA), supersedes the interest of any individual, the nursing profession, or any special interest group.
The professional scope of nursing practice arises from the NPA and Board rules and regulations which have the force of law in Texas. Other state laws may restrict nursing scope of practice when practicing in specific settings, but other state laws cannot expand the scope of nursing practice to include aspects of care exceeding the boundaries set by the NPA and Board rules.
It is the position of the Board that each licensed nurse upholds their duty to maintain client safety by practicing within the parameters of the NPA and Board Rules as they apply to each licensee [Position Statement 15.14.] The NPA describes a defined limit to nursing practice, as nursing practice “does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures” [NPA 301.002(2)&(5)].
Acts performed by nurses must be within the scope of nursing practice and appropriate orders must be in place for acts that go beyond the practice of nursing. Nurses administer medication or treatments as ordered by a physician, podiatrist, or dentist [NPA 301.002(2)(C).] The Board has position statements addressing orders from practitioners functioning under the delegated authority of a physician: advanced practice registered nurses, physician assistants, and pharmacists.
Nurses cannot accept orders for medication administration from patients, family members, unlicensed personnel, or other unidentified licensed health professionals. Without a valid order, a request by a patient or their family does not provide authorization for a nurse to administer medication. This applies to Texas nurses across all practice settings.
Texas school districts respond
Aldine ISD - Aldine ISD prioritizes the health and safety of our students and is dedicated to providing our students with the appropriate care necessary during school hours. The district is aware of the Texas School Nursing Association’s recently updated guidelines for over-the-counter (OTC) medications.
At this time, Aldine ISD will continue to follow existing district policies and procedures concerning the administration of OTC medications which is limited to basic first aid for students and staff. District nurses provide care in alignment with the standards set forth by the National Association of School Nurses, the Texas School Nurse Organization, and the Texas Board of Nursing (BON). The BON is expected to release a public resource that will provide a more comprehensive explanation of the framework and formal decision regarding the administration of OTC medications.
Aldine ISD remains committed to the well-being of our students and will continue to monitor the guidelines closely in order to make decisions in the best interest of our students’ health.
Alief ISD - “With the new communication from TSNO and the Texas Board of Nursing, we’ve had to review our district policies and practices. In the past, districts were able to administer certain OTC medications solely based on parent/guardian authorization. Moving forward, districts will require both a physician’s authorization and the parent/guardian’s authorization to administer OTC medications.
While this updated guidance does not affect most medications we give students, it does affect certain things like how we administer anti-inflammatories after injuries and fever-reducing agents.
As guidance changes, Alief ISD will continue to review policy and ensure safe medication administration practices across the district.”
Texas City ISD - Basically, our nurses do not distribute any medication (prescription or over the counter) without the proper documented orders from the doctor. The health handbook has the form that they need to get filled out and returned. Once we have that, then we can give out the medication. Nurses have this information in their student medical files. They would refer to it before dispensing.
Cy-Fair ISD - Due to a recently issued Texas Board of Nursing (BON) opinion, prescription and over-the-counter (OTC) medications administered by registered nurses in public school clinics now require parental consent and an order from a healthcare provider with prescriptive authority.
Cypress-Fairbanks ISD (CFISD) has always required an appropriate healthcare provider’s order for prescription medications. However, as a result of the BON opinion, the district must also require parents and legal guardians to provide an appropriate healthcare provider’s order to administer OTC medications.
To eliminate the requirement for parents or guardians to provide an order for five commonly administered OTC medications, CFISD has obtained a standing physician’s order that will meet the BON requirement. School nurses may administer the following OTC medications if parents provide the medication in an original, unopened container and sign their consent on a medication authorization form:
· Acetaminophen (e.g. Tylenol)
· Ibuprofen (e.g. Advil, Motrin)
· Naproxen (e.g. Aleve)
· Diphenhydramine (e.g. Benadryl)
· Calcium carbonate (antacids)
All other requests from parents or guardians for the administration of an OTC medication must also include a complete healthcare provider’s order.
We understand this is a change from our previous practice, but CFISD remains committed to supporting our students’ health and learning needs while complying with the updated requirements set forth by the BON. Please reach out to the school nurse at your student’s school if you have any questions