UAP Reference Tool and Checklist for School Nurses

Prior to delegation of medications to UAP’s, the school nurse must read and familiarize themselves with the state laws and guidelines related to the roles and responsibilities within the school nurses’ scope of practice.  The following four links are related to the scope of practice and responsibilities in the role of delegation specific to the school nurse and have vital information regarding the important details, which are too numerous to outline on this checklist. This guide is a breakdown of the steps involved once the nurse is familiar with the noted laws and regulations.

  1. 105 CMR 210.000 permits school nurses to delegate responsibility for the administration of prescription medications to trained, nursing-supervised school personnel (see SHIELD resources on Medication and Delegation for more).
  2. Review the BORN guidelines for the delegation of medications and five rights to delegation (opens in a new tab)
  3. Review the ‘Medication Administration in a School Setting: School Nursing Practice in Massachusetts’ ebook (opens in a new tab)
  4. Review and familiarize oneself with  the UAP training (URL to UAP training and quiz)

Steps to UAP Training and Delegation

 1. Decide who can be trained as a UAP for a student. (See requirements for UAP’s in the medication administration handbook). It is the right of the school nurse to refuse someone if there is concern about their ability to safely fulfill the role of the UAP. Proceed to step 2 if you feel they are appropriate for training.

 2. Have the UAP take the BU SHIELD training for Medication Administration for Unlicensed Administration Personnel (Add the URL).

 3. Once the UAP has taken the training and the post-training quiz, have them supply a copy of the completion for student or department records. A passing grade for the quiz is set at 80% (three attempts are allowed for passing). If the UAP cannot pass after three attempts, question if this is the right UAP to safely delegate medication administration.

 4. Review the training with the UAP and answer any questions they may have about the training. Also, review any questions they may have gotten wrong on the post-training quiz.

 5. Review the job aid provided by the training with the UAP to ensure that they understand the scope and responsibility of the role, most importantly, the five rights of administration, the nine steps of safely administering a medication and what to do if there is a medication error or concern.

 6. Once the school nurse feels confident that the UAP understands the process of medication administration, assess their skills:

  • Review the students MAP (Medication Administration Plan) with the UAP and ensure that they understand the content.  The name(s) of the UAP(s) should be documented on the MAP and consent form.
  • Review the signed consent form from the caregivers.  Per 105 CMR 210.005, ‘Written consent from the parent or guardian for the named responsible adult to administer the prescription medication shall be obtained.’
  • Review the medication with the UAP providing them with knowledge about the label and medication content utilizing the ‘five rights’ to medication administration. It is your responsibility, as the school nurse, to ensure that the pharmacy label, medication content, consent form and MAP are aligned correctly.
  • Have the UAP demonstrate the process with you and the student receiving the medication to ensure they are following all of the appropriate steps.  Refer to the ‘nine steps of medication administration’ found on the UAP training job aid. If a UAP misses a step, it is the responsibility of the school nurse to educate them so that they understand the process fully.
  • Educate the UAP on specific medication documentation. Ensure that the UAP understands the documentation process.
  • Review what to do if there are any medication errors or emergencies.

 7. Document the completion the skills training with the UAP. The school or school system must retain this documentation and be able to provide it to caregivers or school nurse delegators upon request.

Key Points:

  • If for any reason, the school nurse has concerns about the UAP’s ability to safely administer medication, they need to make their concerns known to the nursing supervisor or other appropriate school administrators. The school nurse is held accountable for all aspects of the delegation decision-making process, its implementation, supervision, and evaluation.
  • Remember that the school nurse must be available to the UAP at all times should they have any questions or concerns. 
  • The school nurse must have separate skills training for each prescription medication that has been provided for every student.  In other words, the school nurse can’t just show the UAP what to do with one student and assume they are trained for all students. If the school nurse is not completely aware of the specifics, they should take the BU SHIELD UAP training to become familiar with the process as well as review the Medication Administration Handbook, Medication Delegation content.