The authors walk readers through a process to assure student safety and compliance with state laws while addressing parents’ desire that high school nurses administer nonprescription medications with their signature only.  The outcome was nursing standardized protocols for headache and for dysmenorrhea to permit the registered or certified school nurses to legally administer one of two nonprescription analgesic products to high school students who had written parent consent. The protocol development process included review of problems, e.g., disciplinary incidents of students sharing self-carried over-the-counter medications, and the state education code that was interpreted to require physician order for any medication.  Student health room visit reports indicated the numbers of visits for minor, non-injury headache and menstrual pain. Legal input was sought from the district’s counsel and the state board of registered nurses. Protocols were approved by the district health advisory committee.  All protocols are reviewed yearly.

The protocol requires a standardized and documented assessment for every instance to ensure adequate consideration of injuries, symptom duration, and other conditions or medication use. The protocol cannot be delegated to unlicensed staff. A local organization donates these two medications (acetaminophen or ibuprofen) to the district. 

Implementation of the protocol was tracked one year and indicated increased interactions with students, increased attendance/return to class and positive community support. The nurses concluded that high school students can give accurate histories and should be involved in self-care decisions.

(Awbrey L and Juarez S. J Sch Nurs. 2003;19(1):12-15) 

Comment: I did not name the state so readers can consider the problem statement and the processes by which the district addressed a concern and developed what it regarded as safe and appropriate protocols with safeguards, e.g., consent and no delegation. --J.O.