Section 210.100 - Administration of Epinephrine(A) A public school district or non-public school, as defined by the Massachusetts Department of Education, may register with the Department for the limited purpose of permitting properly trained school personnel to administer epinephrine by auto injector in a life-threatening situation during the school day when a school nurse is not immediately available, including field trips, provided that the following conditions are met: (1) the school committee or, in the case of a non-public school, the chief administrative officer, approves policies developed by the designated school nurse leader or, in the absence of a school nurse leader, a school nurse with designated responsibility for management of the program ("responsible school nurse") governing administration of epinephrine by auto injector. This approval must be renewed every two years;(2) the school committee or chief administrative officer provides an assurance to the Department that the requirements of 105 CMR 210.000 will be met;(3) in consultation with the school physician, the designated school nurse leader or responsible school nurse manages and has final decision making authority about the program. This person, or school nurses designated by this person, shall select the individuals authorized to administer epinephrine by auto injector. Persons authorized to administer epinephrine shall meet the requirements of 105 CMR 210.004(B)(2);(4) the school personnel authorized to administer epinephrine by auto injector are trained and tested for competency by the designated school nurse leader or responsible school nurse, or school nurses designated by this person, in accordance with standards and a curriculum established by the Department.(a) The designated school nurse leader or responsible school nurse, or school nurses designated by this person, shall document the training and testing of competency.(b) The designated school nurse leader or responsible school nurse, or a designee, shall provide a training review and informational update at least twice a year.(c) The training, at a minimum, shall include: 1. procedures for risk reduction.2. recognition of the symptoms of a severe allergic reaction;3. the importance of following the medication administration plan;4. proper use of the auto-injector; and5. requirements for proper storage and security, notification of appropriate persons following administration, and record keeping.(d) The school shall maintain and make available upon request by parents or staff a list of those school personnel authorized and trained to administer epinephrine by auto injector in an emergency, when the school nurse is not immediately available;(5) epinephrine shall be administered only in accordance with an individualized medication administration plan satisfying the applicable requirements of 105 CMR 210.005(E) and 210.009(A)(6), updated every year, which includes the following: (a) a diagnosis by a physician that the child is at risk of a life threatening allergic reaction and a medication order containing proper dosage and indications for administration of epinephrine;(b) written authorization by a parent or legal guardian;(c) home and emergency number for the parent(s) or legal guardian(s), as well as the names(s) and phone number(s) of any other person(s) to be notified if the parent(s) or guardian(s) are unavailable;(d) identification of places where the epinephrine is to be stored, following consideration of the need for storage:1. at one or more places where the student may be most at risk;2. in such a manner as to allow rapid access by authorized persons, including possession by the student when appropriate; and3. in a place accessible only to authorized persons. The storage location(s) should be secure, but not locked during those times when epinephrine is most likely to be administered, as determined by the school nurse;(e) a list of the schoolpersonnelwho would administer the epinephrine to the student in a life threatening situation when a school nurse is not immediately available;(f) a plan for comprehensive risk reduction for the student, including preventing exposure to specific allergens; and(g) an assessment of the student's readiness for self-administration and training, as appropriate.(6) when epinephrine is administered, there shall be immediate notification of the local emergency medical services system (generally 911), followed by notification of the student's parent(s) or guardian(s) or, if the parent(s)or guardian(s) are not available, any other designated person(s), the school nurse, the student's physician, and the school physician, to the extent possible;(7) there shall be procedures, in accordance with any standards established by the Department, for: (a) developing the medication administration plan;(b) developing general policies for the proper storage of medication, including limiting access to persons authorized to administer the medication and returning unused or outdated medication to a parent or guardian whenever possible;(c) recording receipt and return of medication by the school nurse;(d) documenting the date and time of administration;(e) notifying appropriate parties of administration and documenting such notification;(f) reporting medication errors in accordance with 105 CMR 210.005(F)(5);(g) reviewing any incident involving administration of epinephrine to determine the adequacy of the response and to consider ways of reducing risks for the particular student and the student body in general;(h) planning and working with the emergency medical system to ensure the fastest possible response;(i) disposing properly of used epinephrine injector;(j) submitting a written report to the Department of Public Health each time epinephrine is administered to a student or staff, on a form obtained from the Department;(k) permitting the Department of Public Health to inspect any record related to the administration of epinephrine without prior notice, to ensure compliance with 105 CMR 210.100.(B) Epinephrine may be administered in accordance with 105 CMR 210.000 in before and after school programs offered or provided by a school, such as athletic programs, special school events and school-sponsored programs on week-ends, provided that the public school district or non-public school is registered with the Department pursuant to 105 CMR 210.100(A) and meets the requirements set forth in 105 CMR 210.100(B). (1) Epinephrine may be administered in such before and after school programs and special events, to students attending the school where the epinephrine is to be administered, provided that the following requirements in 105 CMR 210.1000(B)(1)(a) through (d) are met: (a) school committee or chief administrative officer in a non-public school approves, in the policy developed in accordance with 105 CMR 210.100(A)(1), administration of epinephrine in such programs. The policy shall identify the school official(s), along with a school nurse for each school designated by the school nurse leader or responsible nurse, responsible for determining which before and after school programs and special events are to be covered by the policy;(b) the designated school nurse approves administration of epinephrine in that program and selects the properly trained person(s) to administer the epinephrine;(c) the school complies with the requirements of 105 CMR 210.100(A), including immediate notification of emergency medical services following administration of epinephrine, but need not comply with the requirement of 105 CMR 210.004(B)(3); and(d) the program is not licensed by another state agency, in which case the regulations promulgated by that state agency will apply.(2) Epinephrine may be administered in such before and after school programs and special events to students from another school or school district if approved in the school policy developed pursuant to 105 CMR 210.100(A)(1) and in accordance with the requirements in 105 CMR 210.00(B)(2)(a) through (d). (a) The school complies with the requirements of 105 CMR 210.100(A) and 210.100(B)(1), including immediate notification of emergency medical services following administration of epinephrine, except as provided in 105 CMR 210.100(B)(2)(d).(b) In the event the student is accompanied by school personnel from the sending school, such personnel, whenever possible, shall assume responsibility for ensuring that the epinephrine is brought, properly stored and administered as necessary, in accordance with the medication administration plan developed by the sending school in accordance with 105 CMR 210.100(A)(5).(c) In the event the student is not accompanied by school personnel from the sending school or such personnel are not trained in the administration of epinephrine, the receiving school may, in its discretion, assume responsibility for administering epinephrine, provided that:1. the designated school nurse in the receiving school is provided with adequate prior notice of the request, which shall be at least one week in advance unless otherwise specified by the designated school nurse;2. the designated school nurse in the receiving school approves administration of epinephrine for that student;3. the designated school nurse selects properly trained person(s) to administer the epinephrine; and the student provides the designated school nurse or the person(s) selected by the4. designated school nurse to administer epinephrine with the medication to be administered.(d) If the receiving school assumes responsibility for administering epinephrine, whenever possible, the student shall provide the designated school nurse in the receiving school with copy of the medication administration plan developed in accordance with 105 CMR 210.005(E). The plan shall be provided to the designated school nurse in timely fashion in accordance with procedures established by the nurse. If no medication administration plan is provided, the student at a minimum shall provide to the designated school nurse in the receiving school: 1. written authorization and emergency phone numbers from a parent or guardian;2. a copy of a medication order from a licensed provider; and3. any specific indications or instructions for administration.(C) Administration of epinephrine shall be governed solely by 105 CMR 210.100. The provisions of 105 CMR 210.004(B)(5) and 210.005(E)(1)(o) shall not be applicable to the administration of epinephrine.