The Texas Board of Nursing (BON) in Austin issued a statement on August 19, 2024:
The Nursing Practice Act (NPA) establishes clear boundaries for nursing practice, explicitly stating that it does not
encompass medical diagnosis or the prescription of therapeutic or corrective measures.
Consequently, administering over-the-counter (OTC) medication without a valid order falls outside the
scope of vocational and professional nursing practice. This regulation is consistent across all
practice settings, including educational environments. The NPA is silent on the universal and
standard use of safe over-the-counter medications when the parent or guardian appropriately
authorizes the treatment option to be administered by a school nurse...
The BON acknowledges that while some districts have standing delegation orders, others require the
parent to secure orders from the student’s provider for all medications, including over-the-counter
options. Orders for medication can be specific to an individual patient or generalized through
standing delegation orders for particular patient populations under certain conditions. In instances
where standing delegation orders are utilized, nurses must assess whether such orders apply to a
given patient’s situation. The Board recognizes that requiring a parent to provide an order from a
student’s provider for seemingly innocuous over-the-counter medications can be burdensome.
The list of OTC medications covered by the school's standard doctor order is as follows:
- Benadryl (age 6 or older only)
- Antimicrobial Cleanser
- Calamine/Caladryl Lotion
- Glucose Gel/Tablets
- Hydrocortisone Cream 1%
- Lip Ointment
- Normal Saline/Solution
- Petroleum Jelly
- Oragel/Anbesol
- Solarcaine/Dermaplast/Aloe Gel
- Sting Kill Swabs
- Antibiotic Ointment
- Tylenol (pain 4 or greater as indicated on The Pain Management Scale) [will only be given up to 3x per school year and not more than two consecutive days]
All other OTC medications must come labeled with the student's name and be accompanied by a doctor's order in order to be given. A medication authorization form (found in the packets passed out at the beginning of the school year) must also be filled out and returned to the school before any medication can be given.
