Your responsibilities for administering medicines (part two)

Special needs consultant Patti Turner details the actions you need to take to ensure your school is fully meeting the medicinal needs of all children

See also part one in this series

Prescribed medicines
It is best practice only to give medicines at school if it is absolutely necessary and non-administration would adversely affect the child’s health and/or education. For example, if a child has been prescribed antibiotics, they may well be fit to return to school before their course is complete. Not to complete the course can be detrimental so it is necessary to give the medicine while they are at school.

Controlled drugs
Controlled drugs can be highly dangerous, addictive or have value on the black market and as such need to be treated with particular caution. Methylphenidate, of which Ritalin is one form, is a controlled drug. Ideally this should be stored in a non-portable locked container within a locked cupboard. Only named staff should have access to this. Anyone can administer the medicine, but should ask a second person to witness their actions. Tablets, or if the medication is in injection form, vials, should be checked and counted both before and after administration and a record kept.

Non-prescription drugs
Non-prescription medicines must never be given to children without specific prior written permission from parents. A very clear policy statement should be made on the circumstances in which such medicines will be administered. It is in everyone’s best interests that this is kept to a minimum. For example it is common practice to administer travel sickness tablets to children going on trips: as long as the procedures are clear there is no reason not to do this. However, you should be reluctant to consider giving non-prescription analgesics, particularly those containing paracetamol to children. If a child is in need of regular medication because of pain, you should ask the parents to take them to a doctor.

Record keeping
It is imperative to keep accurate and up-to-date records of all medicines administered to children. There should be a record for each individual child. It should list the medicine to be administered, the time, date and the dose, the name of the person administering and their signature. If there are any problems, such as refusal or dropped tablets this too should be recorded. In the case of controlled drugs, the number of tablets or vials both before and after administration should also be recorded as should the name and signature of the witness.

Educational visits and sporting activities
Children who have medical needs cannot be excluded from any school activity unjustifiably. You will need to consider how their needs including medication are dealt with in these circumstances. You will need to make arrangements for staff to give any medication, to record that it has been given and to ensure its security.

Children who self-administer medication
It is good practice to encourage children to take responsibility for administering their own medicine, albeit under supervision from staff. This is particularly the case where children are on medication long term (for example diabetics) and need to develop the independence and discipline to cope with this.

Health care plans
Children with complex or long-term medical needs may require a health care plan. This should be drawn up jointly by the school, health care professionals (school nurse, GP paediatrician), parents and if possible the child themselves. Your policy needs to be flexible enough to allow for different needs to be addressed.

This plan should outline the various responsibilities of the people involved. It may highlight areas where particular staff who have agreed to administer certain medications will need further information and training in order to do so. It is the head’s responsibility to see that they get this. Your school nurse should be able to advise you and may be able to give appropriate training.

Roles and responsibilities
Parents, or those with parental responsibility, need to be given the opportunity to provide the head with all relevant information on their child’s health needs. For all children this should be regularly updated as needs do change. Parents should work with you to help you meet their child’s needs.

As a headteacher you are responsible for putting policy into action and developing procedures. You need to consider systems for information sharing. Even if a class teacher, for example is not responsible for administering medication, they will need to know that a child is taking medication so they can look out for side effects. You are likely to delegate the responsibility for administration of medicines to others and will need to ensure cover in their absence.

All teachers and other staff will need to be aware of emergency procedures and their general duties under the policy. They should also have sufficient information provided by parents or health professionals to allow them to deal with the needs of individual children.

Common conditions
There are a number of common conditions which at some time or other we will all encounter.

Asthma: The most common and still on the increase. Blue reliever inhalers are a common sight in schools. The brown, red or orange preventative inhalers are unlikely to be necessary during school hours. Children should always have access to inhalers and in many schools carry them individually. In others each class has a particular place where they are stored. It is not good practice for children to use each other’s inhalers because of infection risks. Each inhaler should be labelled with the child’s name. Many schools have a separate policy for the use of inhalers.

Epilepsy: One in every 200 children suffers from epilepsy. It can be controlled by anti-epileptic drugs and these should not need to be administered during the school day.

Most epileptic seizures last from a few seconds to a few minutes depending on the child and the severity or type of epilepsy. Occasionally when a child has longer seizures they will be prescribed diazepam as an emergency procedure to help bring them out of the seizure.

Diabetes: About one in 500 children are diabetic. Diabetes is normally controlled through injections of insulin. It is unusual for these to be needed at school, but where they are and younger children are involved, staff may need to be trained to do this.

Anaphylaxis: This is a severe allergic reaction to certain foods and substances. Common culprits are peanuts, wasp stings, eggs and cow’s milk. Symptoms can occur very quickly after exposure and include sweating, shortage of breath and swelling of the tongue, lips and throat. Some children experience a tingling sensation in the mouth and lips, heightened colour and skin rashes. Adrenaline pens are the standard emergency treatment. These are ready loaded injection devices. They are simple to administer, but staff who may need to administer them should be trained in their use. Whenever a child suffers an anaphylactic shock an ambulance must be called, even if adrenaline has been administered.

Medical information forms
Medical information forms should ask for the following information:

Child details: name, class, date of birth, medical condition or illness.
Medicine details: name of medicine as described on container, date dispensed, expiry date, dosage and method or route of administration, timing of doses, special precautions and possible side effects.
Where the medicine is for a limited period only, the first and last dates it should be administered.
Where the medicine is long term, a date when the administration will be reviewed and who is responsible for initiating the review.
Will the child self administer or not?
Emergency information; initial action, such as any emergency treatment, also who to contact, their relationship to the child, phone number and address.
Clarification of parents’ role: medicine to be delivered by them to a named person, medicines will only be accepted if in original containers, an understanding that the school is not obliged to administer the medicine and that they will inform school of changes in writing.

Medicine receipt and administration records
All medicines on school premises should be recorded and accounted for. You must keep a record of what medicines you receive from parents. This should include:

name of child
date medicine received
name, strength and quantity of medicine
expiry date
signature of the parent and member of staff receiving the medicine.

A clear record must also be kept of medicines administered to children. This is also the case where staff witness and support children to self administer. Whether you keep individual records or a record for all children depends on circumstances. Where a child requires several different medications at various times during the day an individual record is probably necessary. As a minimum such records must include:

child’s name
date and time
name of medicine and dose administered
space to note any reactions
staff name and signature (and witness name and signature in the case of controlled drugs.)

Encourage parents to work with medical professionals and the
pharmacist by:

Asking the doctor, dentist or nurse to prescribe in dose frequencies which enable medication to be taken outside school hours. Twice daily is ideal. Three times daily can be taken morning, after school and at bedtime.
Requesting that medication is dispensed in two parts: one for home and one for school.
Requesting the use of a monitored dose system from the pharmacist when a child is taking several medications at different times during the day. In this system tablets and capsules are dispensed in colour coded blister packs that make it easier to ensure that the right medication is being taken at the right time.

Further information
The DFES and Department of Health have jointly produced Managing Medicines in Schools and Early Years Settings, which can be downloaded from: www.teachernet.gov.uk/wholeschool/healthandsafety

Former SENCO Patti Turner is now a director of CC Training Ltd, a consultancy firm that delivers training to care and education workers.

This article first appeared in Primary Headship – May 2007

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