• j. Completing written documentation of the incident, detailing who administered the injection, the rationale for administering the injection, the approximate time of the injection(s), and notifications made to school administration, emergency responders, the student's parents/guardians, and the doctor or chief medical officer who issued the standing order.
  • k. Ordering replacement dose(s) of auto-injectable epinephrine.
  • l. Reviewing any incident involving emergency administration of epinephrine to determine the adequacy of response.

G. All school districts and charter schools shall report to the Arizona Department of Health Services all incidents of use of auto-injectable epinephrine pursuant to this rule in the format prescribed by the Arizona Department of Health Services.

C. Annual training in the administration of auto-injectable epinephrine.

• 1. Each school district and charter school shall designate at least two school personnel, in addition to any school nurse or athletic trainer, for each school site who shall be required to receive annual training in the proper administration of auto-injectable epinephrine in cases of anaphylactic shock pursuant to standing order.
• 2. Training in the administration of auto-injectable epinephrine shall be conducted in accordance with minimum Standard and curriculum developed by the Arizona Department of Health Services in consultation with the Arizona Department of Education.
• 3. At a minimum, training shall include procedures to follow when responding to anaphylactic shock, including direction regarding summoning appropriate emergency care, and documenting, tracking and reporting of the event.
• 4. Training shall also include Standard and procedures for acquiring a supply of at least two juvenile doses and two adult doses of auto-injectable epinephrine, restocking auto-injectable epinephrine upon use or expiration, and storing all auto-injectable epinephrine at room temperature and in secure, easily accessible locations on school sites.
• 5. Training shall be conducted by a regulated health care professional, whose competencies include the administration of auto-injectable epinephrine, including but not limited to a licensed school nurse, certified emergency medical technician or licensed athletic trainer.

F. Procedures for the administration of auto-injectable epinephrine in emergency situations.

• 1. All school districts and charters schools shall adopt procedures for the emergency administration of auto-injectable epinephrine by designated trained personnel.
• 2. Procedures shall address, at a minimum, the following requirements:
• a. Determining if symptoms indicate possible anaphylactic shock.
• b. Selecting the appropriate dosage of auto-injectable epinephrine to administer pursuant to a standing order.
• c. Injecting epinephrine via auto-injector pursuant to a standing order, noting the time and dose given.
• d. Calling 911 to advise that anaphylactic shock is suspected and epinephrine was administered. e. Keeping the person stable until emergency responders arrive.
• f. Advising school medical personnel and administration of the incident.
• g. Repeating dose pursuant to a standing order when symptoms persist and emergency responders have not arrived.
• h. Providing emergency responders with used epinephrine auto-injector labeled with name, date and time administered.
• i. Assuring that parents/guardians have been notified and advised to promptly alert student's primary care physician of the incident.

D. Procedures for annually requesting a standing order and the prescription for the inhaler and holding chamber

• 1. Each participating school district or charter school shall obtain a standing order and prescription for inhalers and spacers or holding chambers pursuant to A.R.S. § 15-158 from the chief medical officer of a county health department, a physician licensed pursuant to Title 32, Chapter 13 or 17, or a nurse practitioner pursuant to Title 32, Chapter 15.
• 2. Standing orders and prescriptions shall be requested and renewed annually.

39. In consultation with the department of health services, the department of education, medical professionals, school health professionals, school administrators and an organization that represents school nurses in this state, adopt rules that prescribe the following for school districts and charter schools:

    • (a) Annual training in the administration of auto-injectable epinephrine for designated medical and nonmedical school personnel. The annual training prescribed in this subdivision is optional during any fiscal year in which a school does not stock epinephrine auto-injectors at the school during that fiscal year.

    • (b) Annual training for all school site personnel on the recognition of anaphylactic shock symptoms and the procedures to follow when anaphylactic shock occurs, following the national guidelines of the American academy of pediatrics. The annual training prescribed in this subdivision is optional during any fiscal year in which a school does not stock epinephrine auto-injectors at the school during that fiscal year.

    • (c) Procedures for the administration of epinephrine auto-injectors in emergency situations.

    • (d) Procedures for annually requesting a standing order for epinephrine auto-injectors pursuant to § 15-157 from the chief medical officer of the department of health services, the chief medical officer of a county health department, a doctor of medicine licensed pursuant to title 32, chapter 13 or a doctor of osteopathic medicine licensed pursuant to title 32, chapter 17.

    • (e) Procedures for reporting the use of epinephrine auto-injectors to the department of health services.

40. In consultation with the department of education, medical professionals, school health professionals, school administrators and an organization that represents school nurses in this state, adopt rules that prescribe the following for school districts and charter schools that elect to administer inhalers:
    • (a) Annual training in the recognition of respiratory distress symptoms and the procedures to follow when respiratory distress occurs, in accordance with good clinical practice, and the administration of inhalers, as directed on the prescription protocol, by designated medical and nonmedical school personnel.
    • (b) Requirements for school districts and charter schools that elect to administer inhalers to designate at least two employees at each school to be trained in the recognition of respiratory distress symptoms and the procedures to follow when respiratory distress occurs, in accordance with good clinical practice, and at least two employees at each school to be trained in the administration of inhalers, as directed on the prescription protocol.
    • (c) Procedures for the administration of inhalers in emergency situations, as directed on the prescription protocol.
    • (d) Procedures for annually requesting a standing order for inhalers and spacers or holding chambers pursuant to § 15-158 from the chief medical officer of a county health department, a physician licensed pursuant to title 32, chapter 13 or 17 or a nurse practitioner licensed pursuant to title 32, chapter 15.
    • (e) Procedures for notifying a parent once an inhaler has been administered.

34. Prescribe and enforce policies and procedures:

    • (a) Allowing pupils who have been diagnosed with anaphylaxis by a health care provider licensed pursuant to title 32, chapter 13, 14, 17 or 25 or by a registered nurse practitioner licensed and certified pursuant to title 32, chapter 15 to carry and self-administer emergency medications, including epinephrine, auto-injectors while at school and at school-sponsored activities. The pupil’s name on the prescription label on the medication container or on the medication device and annual written documentation from the pupil’s parent or guardian to the school that authorizes possession and self-administration is sufficient proof that the pupil is entitled to the possession and self-administration of the medication. The policies shall require a pupil who uses an epinephrine auto-injector while at school and at school-sponsored activities to notify the nurse or the designated school staff person of the use of the medication as soon as practicable. A school district and its employees are immune from civil liability with respect to all decisions made and actions taken that are based on good faith implementation of the requirements of this subdivision, except in cases of wanton or wilful neglect.

35. Allow the possession and self-administration of prescription medication for breathing disorders in handheld inhaler devices by pupils who have been prescribed that medication by a health care professional licensed pursuant to title 32. The pupil’s name on the prescription label on the medication container or on the handheld inhaler device and annual written documentation from the pupil’s parent or guardian to the school that authorizes possession and self-administration shall be sufficient proof that the pupil is entitled to the possession and self-administration of the medication. A school district and its employees are immune from civil liability with respect to all decisions made and actions taken that are based on a good faith implementation of the requirements of this paragraph.

3. Procedures that enable a school district or charter school to withdraw a pupil’s authorization to monitor blood glucose and self-administer diabetes medication pursuant to this subsection if the pupil does not practice proper safety precautions as provided in paragraph 2 of this subsection.

4. A requirement that any medication administration services specified in the child’s diabetes medical management plan shall be provided.

A. The school district governing board and the charter school governing body may adopt policies and procedures for pupils who have been diagnosed with diabetes by a health professional who is licensed pursuant to title 32, chapter 13, 14, 17 or 25 or a nurse practitioner who is licensed pursuant to title 32, chapter 15 to manage their diabetes in the classroom, on school grounds and at school sponsored activities as authorized by their primary health professional who is licensed pursuant to title 32, chapter 13, 14, 17 or 25, nurse practitioner who is licensed pursuant to title 32, chapter 15 or pharmacist who is licensed pursuant to title 32, chapter 18 and who is practicing pursuant to § 32-1970. If a school district or charter school follows the policies and procedures adopted pursuant to this section, the employees of the school district or charter school and members of the school district governing board or charter school governing body are immune from civil liability with respect to the actions taken to adopt policies and procedures pursuant to this section and all decisions made and actions taken that are based on good faith compliance with policies and procedures adopted pursuant to this section.

B. If a school district governing board or charter school governing body adopts policies and procedures pursuant to subsection A of this section, the policies and procedures shall include the following components:

• 1. The parent or guardian shall annually submit a diabetes medical management plan to the pupil’s school that authorizes the pupil to carry appropriate medications and monitoring equipment and that acknowledges that the pupil is capable of self-administration of those medications and equipment. The diabetes medical management plan provided by the parent or guardian shall be signed by a health professional who is licensed pursuant to title 32, chapter 13, 14, 17 or 25, a nurse practitioner who is licensed pursuant to title 32, chapter 15 or a pharmacist who is licensed pursuant to title 32, chapter 18 and who is practicing pursuant to § 32-1970, and shall state that the pupil is capable of self-monitoring blood glucose and shall list the medications, monitoring equipment and nutritional needs that are medically appropriate for the pupil to self-administer and that have been prescribed or authorized for that pupil.
• 2. A requirement that the pupil be able to practice proper safety precautions for the handling and disposal of the equipment and medications that the pupil is authorized to use pursuant to this subsection. The pupil’s diabetes medical management plan shall specify a method to dispose of equipment and medications in a manner agreed on by the parent or guardian and the school.
• 3. Procedures that enable the school district or charter school to withdraw a pupil's authorization to monitor blood glucose and self-administer diabetes medication pursuant to this subsection if the pupil does not practice proper safety precautions as provided in paragraph 2 of this subsection.

A. The governing board shall adopt policies and procedures concerning pupils with chronic health problems in consultation with parents, teachers and at least one health professional. The policies and procedures shall be designed to provide continuing learning for pupils with chronic health problems while they are absent from school and to provide for the integration of pupils with chronic health problems into the regular education program as much as possible. The policies and procedures shall include provisions for:

• 1. Homework availability to ensure that pupils with chronic health problems have the opportunity to keep up with assignments and avoid losing credit because of their absence from school.
• 2. Flexibility in physical education activity requirements so that pupils with chronic health problems may participate in the regular physical education program to the extent that their health permits.