Stock Epinephrine in Schools TOOLKIT
Developing an Undesignated Stock Epinephrine Policy and Procedures

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Undesignated Stock Epinephrine

MN Statute 121A.2207 Life-Threatening Allergies in Schools: Stock Supply of Epinephrine Delivery Systems

Subdivision 1. Districts and schools permitted to maintain supply.

Notwithstanding section 151.37, districts and schools may obtain and possess epinephrine delivery systems to be maintained and administered by school personnel to a student or other individual if, in good faith, it is determined that person is experiencing anaphylaxis regardless of whether the student or other individual has a prescription for an epinephrine delivery systems. The administration of an epinephrine delivery system in accordance with this section is not the practice of medicine.

(b)  Registered nurses may administer epinephrine delivery systems in a school setting according to a condition-specific protocol as authorized under section 148.235, subdivision 8. Notwithstanding any limitation in sections 148.171 to 148.285, licensed practical nurses may administer epinephrine delivery systems in a school setting according to a condition-specific protocol that does not reference a specific patient and that specifies the circumstances under which the epinephrine delivery system is to be administered, when caring for a patient whose condition falls within the protocol.

Subd. 2. Arrangements with manufacturers.

 A district or school may enter into arrangements with manufacturers of epinephrine delivery systems to obtain epinephrine delivery systems at fair-market, free, or reduced prices. A third party, other than a manufacturer or supplier, may pay for a school's supply of epinephrine delivery systems.

Subd. 3. Standing order for distribution and condition specific protocol.

The commissioner of health must provide a district or school with a standing order for distribution of epinephrine delivery systems under sections 148.235, subdivision 8; and 151.37, subdivision 2.

MN Statute 121A.2205 Possession and Use of Epinephrine Delivery Systems Model Policy

Subdivision 1 (2) defines “epinephrine delivery system" means a device that automatically injects a premeasured dose of epinephrine medication product approved by the United States Food and Drug Administration that automatically delivers a single, premeasured dose of epinephrine to prevent or treat a life-threatening allergic reaction.

• Epinephrine delivery systems could include auto injectors or nasal atomizers.  Both types of delivery systems are currently available and approved through the Food and Drug Administration.

These statutes allow for but does not require schools to stock and administer epinephrine delivery system for life-threating allergies.  Implementation of stock epinephrine delivery system program requires several components.

A school may find it very helpful to identify a person who can coordinate the overall development of the school’s policy and emergency response procedures. Most schools will find it helpful to identify key roles and staff to be a part of a team including school administrators, building principals, school nurse, student support staff, teachers, and partner with community agencies, families, and students as appropriate.

Developing an Undesignated Stock Epinephrine Policy

A policy is a guide for decision making within an organization that is a rule for action. Policies are typically developed and adopted by the local school board after being systematically reviewed by a team.

It is recommended that a school or district create a policy for administration of stock epinephrine as part of the emergency response to a possible severe allergic reaction, known as anaphylaxis. A school policy could consider having a purpose statement, the general statement of the policy, definitions to support or clarify the policy, a general overview of policy and responsibilities of the school nurse, other health services staff, and other school staff as needed to respond and provide the administration of an epinephrine delivery system as emergency response to possible anaphylaxis and legal references as needed.

Because epinephrine is a prescription medication and individual students may have emergency care plans that direct staff to administer an individually prescribed epinephrine delivery system, schools may want to address the intended recipient of the school’s stock epinephrine program and if it will include students with an individual prescription for an epinephrine delivery system.  

Emergency Response Procedure for Life-Threatening Allergic Reaction (Anaphylaxis)

A procedure is a sequence of steps that should be followed to implement policies. This procedure may vary slightly by site even within a school district pending the environment and resources.

Schools are encouraged to consider the following questions for the development of the school’s procedure.

• Who is the population of students, staff, and visitors to be served? Will this include students with an individual prescription for an epinephrine delivery system (and if so, under what circumstances will the stock epinephrine be used instead of the individually prescribed epinephrine delivery system)?  
• Where will the emergency response be delivered and where the epinephrine delivery system be secure, accessible, and stored per manufactures direction?
• Which school staff, at the designated location, will be trained to respond and to administer the medication when an emergency response is needed? Who else should be a part of the emergency response team, besides the person trained to the given the medication?
• Consider when the trained staff will be available to provide this emergency response. During the school day only? During other after school hour events?
• How staff will be initially trained and remain competent in the knowledge to identify a possible a life-threatening allergic response, know, and administer the medication appropriately, and initiate?
• What type of communication, notification, and documentation will need to be completed as part of the emergency response and medication administration?