SDE: Clinical Guidelines Ch7M

Clinical Procedure Guidelines for Connecticut School NursesPrintable version | Back to Contents
Specialized Health Care Procedures

M. Injectables: Intramuscular, Subcutaneous Medication or Vaccination Administration


Injecting a medication or immunization into a muscle or subcutaneous (SC) tissue.


To maintain a medication or immunization regime prescribed by an authorized health care provider.


The appropriate size sterile needle, syringe, gloves, and alcohol swab.


  1. Follow “The Six Rights of Medication Administration,” (right medication, right dose, right student, right route, right time, and right approach).
  2. Determine the correct size needle and injection site.
  3. Medication authorizations for injectable medications in school should specify the injection site options and any other detail specific to that medication that is necessary to ensure safe administration in school.
  4. For subcutaneous insulin injections, follow the above procedures and see chapter 3 for specific insulin injection considerations.
  5. For intramuscular (IM) injections of epinephrine using an auto-injection device (such as an EpiPen).

Immunization considerations

  1. The list of current vaccines and administration considerations is found on the CDC's Web site. Access the electronic version to ensure that it reflects the most recent updates.
  2. The National Childhood Vaccine Injury Act (NCVIA), enacted in 1986, set forth three basic requirements for all vaccination providers. These apply to school nurses who directly administer a vaccination. When a local health department administers the vaccine at a school, it is responsible for this criteria:
    1. Providers must give the patient (or parent/legal representative of a minor) a copy of the relevant federal “Vaccine Information Statement” (VIS) for the vaccine they are about to receive.
    2. Providers must record certain information about the vaccines administered in the patient’s medical record or a permanent office log, including:
      1. Name of manufacturer
      2. Lot #
      3. Expiration date
    3. Providers must document any adverse event following the vaccination that the patient experiences and that becomes known to the provider, whether or not it is felt to be caused by the vaccine, and submit the report to the Vaccine Adverse Event Reporting System (VAERS).
    4. As of April 2008, NCVIA requirements apply to diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, hepatitis A, hepatitis B, Haemophilus influenzae type b (Hib), varicella, influenza, pneumococcal conjugate, meningococcal, rotavirus, and human papillomavirus (HPV) vaccine.

Select Nursing Considerations

Administration of injectable medications or vaccinations in the school setting by a school nurse needs to carefully consider individual factors related to each student. Some questions to consider include:

  • Is the administration of this medication part of an IHCP that addresses a chronic disease management or is it a short-term health problem?
  • Is the administration of this medication in school necessary for this student to maintain his or her education?
  • Are there other options for administration times that do not include school hours?
  • Is this the safest option to help manage this particular health issue?

Delegation Considerations

Only a school nurse, RN, or LPN can administer IM or SC medications or immunizations.

Exception: If approved by the local or regional board of education, paraprofessionals, in the absence of a school nurse, may only administer medications to a specific student to protect that student from harm or death due to a medically diagnosed allergic condition, including the administration of medications with a cartridge injector, such as an EpiPen (Connecticut General Statutes, Section 20-212a).


Bowden, V.R., and Greenberg, C.S. (2008). Pediatric Nursing Procedures, 2nd edition. Philadelphia, PA: Lippincott Williams and Wilkins.

The National Childhood Vaccine Injury Act (NCVIA). 1986.

The Regulations of Connecticut State Agencies. Administration of Medications by School Personnel and Administration of Medication During Before- and After-School Programs and School Readiness Programs.


State Department of Public Health. Connecticut Immunization Program.


Content Last Modified on 7/23/2014 1:29:05 PM