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Over-the-Counter Overview

Accessibility and administration of over-the-counter (OTC) medications to students in the school setting can potentially provide symptomatic relief, leading to better learning and fewer classroom disruptions. The use of OTC medications and rules for administration can vary depending on state or school district-specific standards. Schools need to have clear guidelines and policies on OTCs that comply with state regulations and nurse practice acts to ensure the safety and well-being of students. 

OTC Associated Risks

While helpful in many circumstances for alleviating symptoms of common school-day complaints, including minor aches and pains, OTC administration in the school setting is not without risk and liability.

  • Frequent treatment with OTC medication may establish unhealthy habits of reliance on and misuse of medication. Students should be provided education on nonpharmaceutical measures for symptom relief and treatment for underlying causes of common ailments like dehydration leading to headaches or the need to use the bathroom presenting as abdominal pain.


  • Side effects, adverse reactions, and interactions with other medications and foods can occur from OTCs, just as with any other medication.


  • OTCs can, at times, pose a risk of masking signs or symptoms of a more serious health condition or infectious disease.


OTC Policies & Protocols

When deciding whether to administer OTC medications in schools, weighing the potential benefits against the potential risks is crucial. Schools, in consultation with their school nurses, should follow state and district-specific guidelines for administering OTCs. In general, NASN recommends "all policies for prescribed medications should also apply to OTCs.

  • A written order from a licensed prescriber should be required. One of the biggest challenges associated with OTC medication administration in school is obtaining prescriber permission or orders for short-term use. For this reason, many schools collaborate with a school physician or other willing licensed provider in the community to provide standing orders and protocols for stock medications.


  • Signed parental authorization is necessary to administer OTCs and should be updated annually for stock medications.


  • Frequent education for parents and students is essential. This includes details about the school's medication policies, self-administration allowances, stock medications, and proper and safe use of OTCs.


Safe and effective medication administration is one of the primary responsibilities of school nurses and is a critical component of keeping kids healthy and ready to learn. While outside the school setting, OTCs aren't subject to the same prescribing and dispensing regulations as Rx medications, school nurses administering OTC medications at school must do so within the scope of their practice while adhering to all state regulations to ensure the health and safety of students.

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