FAQs for Nasal Spray and PDA Medication Law
1. What does it mean that a nasal spray is a legend drug or a controlled
substance?
“Legend drugs" means any drugs which are required by state law or regulation of the
pharmacy quality assurance commission to be dispensed on prescription only or are
restricted to use by practitioners only. (RCW 69.41.010 (12))
The term "controlled substance" means a drug or other substance, or immediate
precursor, included in schedule I, II, III, IV, or V of part B of this subchapter (this is
actually the federal controlled substances act).
See 21 U.S.C. §802(32)(A) for the definition of a controlled substance analogue and
21 U.S.C. §813 for the schedule:

Definitions: http://www.deadiversion.usdoj.gov/21cfr/21usc/802.htm

Schedule of Controlled Substances:
http://www.deadiversion.usdoj.gov/21cfr/21usc/812.htm
2. Who can administer a nasal spray to students in a school setting?
If on the premises, a school nurse must administer the medication. If the nurse is
not on the premises, the medication may be administered by a trained school
employee or a parent designated adult (PDA). RCW 28A.210.260.
3. Does the revised law now require epilepsy training for school staff?
Yes. The revised law states, “The board of directors shall designate a professional
person licensed under chapter 18.71, 18.57 or 18.79 RCW as it applies to registered
nurses and advanced registered nurse practitioners, to consult and coordinate with
the student’s parent and health care provider, and train and supervise the
appropriate school district personnel in proper procedures for care for students with
epilepsy to ensure a safe, therapeutic learning environment. Training may also be
provided by an epilepsy educator who is nationally certified.”
4. I am a school nurse and have reviewed the available online training videos for
administration of controlled substances via nasal spray. Does this qualify me
to train and delegate this medication administration to unlicensed school
staff?
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School nurses must act within the scope of their professional practice, and a
delegated nursing task needs to be within the scope of the delegating nurse. A
nurse must possess the depth and breadth of knowledge, and the current clinical
skills, to perform the task safely and effectively. In the process of determining the
appropriateness of nurse delegation in schools, a school nurse uses his or her
judgment to determine the competency of the individual accepting the training to
complete the delegated task. Videos are generally used as complements to update
skill sets and are not used exclusively for developing the mastery necessary to
delegate a nursing task. In every instance, the nurse retains responsibility for the
quality of nursing care provided by the delegatee.
Additional guidance on delegation in schools is available from the Nursing Care
Quality Assurance Commission (NCQAC) Scope of Practice Decision Tree
(Department of Health); and the Office of Superintendent of Public Instruction’s Staff
Model for the Delivery of School Health Services (pages 4 and 5). These documents
are both available on the OSPI Health Services website at
http://www.k12.wa.us/HealthServices/Resources.aspx
The NCQAC Practice Advisory Group for the School Setting is currently working on
delegation guidance for registered nurses in a school setting in an effort to assist the
commission with the development of an advisory opinion on registered nursing
delegation in schools. The American Nurses Association and the National Council of
State Boards of Nursing have produced a joint statement on delegation that can be
consulted for additional guidance at
https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf.
5. Intranasal administration of midazolam is being prescribed for school aged
children with epilepsy. The literature that accompanies midazolam
recommends having respiratory support equipment available when
administering this medication. What does that mean in a school setting where
this medication can be delegated to unlicensed school staff?
The literature accompanying midazolam is present because oversedation is a risk of
the medication. The nurse needs to use her/his clinical judgment when considering
the delegation of a nursing task. Before delegating a nursing task the nurse shall
assess the stability of the student’s health condition and verify the competency of the
unlicensed staff person to perform the delegated task. A part of the assessment
piece is the importance of communicating with the healthcare provider about
delegation of the nursing task to unlicensed school staff for an individual student.
See question 4 for guidance on delegation of nursing tasks to unlicensed school
staff.
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