This toolkit provides guidance on addressing chronic health conditions of students.

The department of health, in consultation with the department of education and the bureau of TennCare, shall develop a comprehensive state plan to reduce the burden of asthma on school children in this state. The comprehensive plan shall, at a minimum:

• (1) Promote the development of school asthma action plans between LEAs and local health agencies. School asthma action plans shall include emergency protocols for medical emergencies due to asthma complications;

• (2) Encourage schools to have individual asthma action plans for students with asthma;

• (3) Encourage in-service training for teachers, and encourage athletic coaches and athletes to participate in the American Lung Association's asthma treatment training;

• (4) Encourage the development of education for local boards of education and the public concerning self-administration of asthma medications; and

• (5) Promote procedures to reduce exposure to smoke, allergens and other irritants in school buildings, on school grounds and at school events

(b) In addition to assistance with self-administration of medications provided for in subsection (a), school personnel who volunteer under no duress or pressure and who have been properly trained by a registered nurse employed or contracted by the LEA may administer glucagon in emergency situations and may administer daily insulin to a student based on that student's individual health plan (IHP). However, if a public school nurse is available and on site, the nurse shall provide this service to the student. The public school nurse may train as many school personnel as volunteer and are willing to assist with the care of students with diabetes but should seek to ensure at least two (2) volunteers are available. The nurse shall be under no duress to qualify any volunteer unless such volunteer is trained and deemed by the nurse to be competent. In addition, in order to reduce the number of syringes present in schools, the nurse may encourage the use of an insulin pen, when available and deemed medically appropriate by the student's treating physician. The public school nurse employed or contracted by the LEA shall be responsible for updating and maintaining each IHP. The department of health and the department of education shall jointly amend current Guidelines for Use of Health Care Professionals and Health Procedures in a School Setting to reflect the appropriate procedures for use by registered nurses in training volunteer school personnel to administer glucagon and insulin. The board of nursing shall be afforded the opportunity to review and comment on the guidelines before they take effect and any training begins. The guidelines developed shall be used uniformly by all LEAs that choose to allow volunteer school personnel to administer glucagon and insulin. Training pursuant to subdivision (d)(3) to administer glucagon and insulin shall be repeated annually and competencies shall be documented at least twice a year in the employee's personnel file. The provisions of subdivision (a)(3) regarding protection from liability shall apply also to the volunteers who provide services pursuant to this subsection (b) and the registered nurses who provide their training.

(c) Notwithstanding any provision of this title or any other law or rule to the contrary:

• (1) An LEA must permit possession and self-administration of a prescribed, metered dosage asthma-reliever inhaler by any asthmatic student if the student's parent or guardian:

• (A) Provides to the school written authorization for student possession and self-administration of the inhaler; and

• (B) Provides a written statement from the prescribing health care practitioner that the student suffers from asthma and has been instructed in self-administration of the prescribed, metered dosage asthma-reliever inhaler. The statement must also contain the following information:

• (i) The name and purpose of the medication;

• (ii)The prescribed dosage;

• (iii) The time or times the prescribed inhaler is to be regularly administered, as well as any additional special circumstances under which the inhaler is to be administered; and

• (iv) The length of time for which the inhaler is prescribed;

• (2) The statements required in subdivision (c)(1) shall be kept on file in the office of the school nurse or school administrator;

(d) (1) Notwithstanding any law, policy, or guideline to the contrary, a local board of education or a governing board for a nonpublic school may permit school personnel to volunteer to assist with the care of students with diabetes under the following conditions:

• (A) The student's parent or guardian and the student's personal health care team must have developed a medical management plan that lists the health services needed by the student at school and is signed by the student's physician, nurse practitioner or physician assistant;

• (B) The student's parent or guardian shall have given permission for the school's trained volunteer or school nurse to participate in the care of the student with diabetes. The written permission shall be kept in the student's school records.

• (C) Assistance in the care of students with diabetes must be documented in accordance with this subsection (d); and

• (D) The department of education and the department of health shall, after considering recommendations from national organizations involved with diabetes care, jointly amend current "Guidelines for Use of Health Care Professionals and Health Care Procedures in a School Setting" to reflect the appropriate procedures for use by the school registered nurse (RN) in training school personnel who volunteer to assist with the care of students with diabetes. The guidelines may not take effect and no training under the guidelines may take place until the board of nursing has been afforded an opportunity to review and comment on the guidelines. The guidelines must be used uniformly by all LEAs that choose to allow school personnel to volunteer to assist with the care of students with diabetes.

  (2) The guidelines for assistance with the care of students with diabetes must include the following:

• (A) Guidelines for recognition, management and treatment of hypoglycemia and hyperglycemia;

• (B) Guidelines for understanding the individual health plan (IHP) for a student with diabetes with regard to blood glucose level target ranges, schedules for meals and snacks and actions to be taken in the case of schedule disruption; and

• (C) Guidelines for performing blood glucose monitoring, ketone checking and recording the results and also for performing insulin and glucagon administration.

  (3) All school nurses must be educated in diabetes care and must have knowledge of the guidelines. School personnel, who volunteer under no duress to assist with the care of students with diabetes, must receive training pursuant to the guidelines from a school RN. The school RN may use certified diabetes educators and licensed nutritionists to assist with the training. All training must be renewed on an annual basis and competency must be noted in the personnel file. No school personnel shall be required to volunteer for the training. School personnel may not be reprimanded, subject to any adverse employment action or punished in any manner for refusing to volunteer.

(e) (1) A student with anaphylaxis is entitled to possess and self-administer prescription anaphylaxis medication while on school property or at a school-related event or activity if:

• (A) The prescription anaphylaxis medication has been prescribed for that student as indicated by the prescription label on the medication;

• (B) The self-administration is done in compliance with the prescription or written instructions from the student's physician or other licensed health care provider; and

• (C) A parent of the student provides to the school:

• (i) Written authorization, signed by the parent, for the student to self-administer prescription anaphylaxis medication while on school property or at a school-related event or activity;

• (ii) A written statement, signed by the parent, in which the parent releases the school district and its employees and agents from liability for an injury arising from the student's self-administration of prescription anaphylaxis medication while on school property or at a school-related event or activity, except in cases of wanton or willful misconduct; and

• (iii) A written statement from the student's physician or other licensed health care provider, signed by the physician or provider, that:

• (a) Supports a diagnosis of anaphylaxis;

• (b) Identifies any food or other substances to which the student is allergic;

• (c) Describes any prior history of anaphylaxis, if appropriate;

• (d) Lists any medication prescribed for the child for the treatment of anaphylaxis;

• (e) Details emergency treatment procedures in the event of a reaction;

• (f) Lists the signs and symptoms of a reaction;

• (g) Assesses the student's readiness for self-administration of prescription medication; and

• (h) Provides a list of substitute meals that may be offered by school food service personnel.

• (2) The physician's statement must be kept on file in the office of the school nurse of the school the student attends or, if there is not a school nurse, in the office of the principal of the school the student attends.

• (3) If a student uses the medication in a manner other than prescribed, the student may be subject to disciplinary action under the school codes.

(f) (1) The department of education, in conjunction with the department of health, shall develop and make available guidelines for the management of students with life-threatening food allergies to each LEA. The guidelines shall include, but need not be limited to:

• (A) Education and training for school personnel on the management of students with life-threatening food allergies, including training related to the administration of medication with a cartridge injector;

• (B) Procedures for responding to life-threatening allergic reactions to food;

• (C) Procedures for the maintenance of a file by the school nurse or principal for each student at risk for anaphylaxis;

• (D) Development of communication strategies between individual schools and local providers of emergency medical services, including appropriate instructions for emergency medical response;

• (E) Development of strategies to reduce the risk of exposure to anaphylactic causative agents in classrooms and common school areas such as the cafeteria;

• (F) Procedures for the dissemination of information on life threatening food allergies to school staff, parents and students, if appropriate by law;

• (G) Procedures for authorizing school personnel to administer epinephrine when the school nurse is not immediately available;

• (H) Procedures for the timely accessibility of epinephrine by school personnel when the nurse is not immediately available;

• (I) Development of extracurricular programs related to anaphylaxis, such as nonacademic outings and field trips, before and after school programs and school-sponsored programs held on weekends;

• (J) Creation of an individual health care plan tailored to the needs of each individual child at risk for anaphylaxis, including any procedures for the self-administration of medication by the children in instances where the children are capable of self-administering medication and where such self-administration is otherwise in accordance with this title; and

• **(K) Collection and publication of data for each administration of epinephrine to a student at risk for anaphylaxis.