Committee reviews bill to let schools stock and use intranasal epinephrine and clarify nurse authority

The committee considered a bill to expand school stock-supply authority for epinephrine by adding intranasal epinephrine (a nasal spray formulation) alongside autoinjectors and by clarifying that school nurses — not school administrators — should direct medical delegation and training.

Representative Leslie Goldman, sponsor of the bill as introduced in the House, said the measure arose from a school nurse’s request to update statute so the new intranasal formulation can be used in emergencies. A state health office witness summarized the bill’s two principal changes: allow stock intranasal epinephrine in schools and adjust delegation language so school nurses, rather than administrators, designate and supervise personnel who may administer epinephrine.

Why it matters: The change would let schools maintain a stock supply of intranasal epinephrine or autoinjectors (or both) for emergency use, clarify who may be authorized to administer the medication, and require training and written individualized plans for students with life-threatening allergies.

Key points of the proposed language

- Definitions and standing orders: The draft adds a definition for intranasal epinephrine, allows a health care professional to prescribe epinephrine in a school’s name, and requires the prescriber to consult with the school nurse to issue a standing order that includes assessment, administration, post-administration care (including contacting emergency services), and disposal procedures.

- Stock supply and procurement: A school may maintain a stock supply of autoinjectors and/or intranasal epinephrine and may enter arrangements with manufacturers or suppliers to obtain products for free or at reduced prices.

- Delegation and authority: The bill clarifies that a school administrator may authorize the school nurse to act, and the school nurse may then designate personnel (employees, agents, volunteers, including LPNs where applicable) to administer or maintain the stock supply under the nurse’s supervision. Counsel said nurses sought that change because school administrators giving medical direction to nurses was not appropriate.

- Training, protocols and plans: The bill directs the State Board (in consultation with the Department of Health) to adopt policies for schools, establishes protocol requirements, and requires schools to prepare written individualized plans of action for students with known life-threatening allergies. Training must cover storage (including temperature concerns), administration, recognition of anaphylaxis, and post-event procedures.

Questions and clarifications from committee members

Members asked whether families can supply a child’s epinephrine or whether the school must stock it; witnesses said the bill does not mandate one approach and that plans are generally handled case by case in agreement between family and school nurse. The health witness noted practical issues such as storage temperature (autoinjectors have recommended storage ranges) and recommended the committee seek school-nurse input on logistics and training needs.

Liability and regulation

The draft preserves immunity for schools and prescribers for administration or self-administration of epinephrine under the statute, except for intentional misconduct. The bill states that providing or administering the products under the section does not constitute the practice of medicine.

Next steps

The bill was introduced in the House, passed House Education and the floor unanimously, and the committee discussed drafting clarifying language to ensure protocols are coherent and do not produce unintended results. Witnesses and committee staff suggested bringing school nurses and other operators in for implementation-level questions. No formal vote on the bill was recorded in the transcript; the session served to explain the draft and surface implementation issues.