Does your school have an effective policy on the administration of medication to children? Special needs consultant Patti Turner looks at some of the problems that can arise and the ways to avoid them
The demands of inclusion and the Disability Discrimination Act mean that all schools will have to seriously consider their policy on administering medicines to children during school hours. In this article I look at the sort of problems that can arise from a flawed policy and consider questions relating to supply, storage, administration and disposal of medicines.
A cautionary tale
Two siblings with ADHD were prescribed methylphenidate (the generic name for drugs such as ritalin). Their school agreed to administer a dose to each child at lunchtime and a teaching assistant agreed to take responsibility for this. The parents signed a form giving permission and agreed to bring in the correct number of tablets for each week on the Monday morning.
So each Monday the children’s mother went to the office with two specially designed boxes with a compartment for each day of the week. Each box was labelled on the bottom with the child’s name. In each compartment was the tablet for that day. At lunchtime the teaching assistant would take the children to the office, where she checked the labels on the base of each box, administered the tablets and recorded this in a book kept with the medication. She would then put the boxes containing the remaining tablets back in the plastic ice cream tub they were kept in and lock them in the stationery cupboard.
One day the teaching assistant was ill and a class teacher decided to administer the tablets instead. She took both children into the office with the tablets in their boxes. She opened a box and gave the younger child a tablet, which he duly swallowed. It was only then that the older child explained that their names were on the boxes and asked if the teacher had checked. She hadn’t and had given the younger child a tablet meant for his sibling. The tablets looked identical and were both methylphenidate, so presumably, she reasoned, no damage done.
Unfortunately, the older child then informed her that his sibling was allergic to the tablet he had just taken. There followed a check through the medication permission forms; was there any indication of what reaction to expect? None could be found. The parents were phoned, but could not be contacted. Whoever answered the phone at the doctor’s surgery was extremely unhelpful. NHS Direct said a trip to A&E was the only option.
At this point the child’s mother miraculously picked up the message left for her and phoned the school. Panic over. The worst to expect was that the child would feel very nauseous. She would come and collect him and keep an eye on him at home.
The mind boggles at the possible repercussions if such a mistake had had serious consequences; so much so that your reaction as a school leader is likely to be a refusal to take responsibility for the administration of medication to children at school. This, however, could land you in difficulty. The Disability Discrimination Act requires schools to make reasonable adjustments to cater for the needs of children with disabilities. This includes children on long-term and even short-term medication.
All schools need to have a policy in place to cover the administration of medication to children. The school in which our cautionary tale is set had a policy, but the procedures were flawed and in some aspects illegal. By the end of this pair of articles you will see why this was the case and should have a better understanding of what needs to be covered by an effective policy and supporting procedures on the administration of medication in schools.
Policy and procedures
Your policy needs to be clear and workable. It should be understood by staff, children and parents and will provide a sound basis for ensuring that children with medical needs are properly cared for and supported while at school.
It is essential that all parents, not just those who have children with medical needs, understand the policy and what you are able to take responsibility for. The main points that need to be covered are:
- Procedures for managing prescription medicines that need to be taken during the school day.
- Procedures for managing prescription medicines on trips and outings.
- Roles and responsibilities of staff managing and supervising the administration of medication.
- Responsibilities of parents in respect of their child’s medical needs.
- The need for prior written agreement from parents before medicines can be administered.
- The circumstances in which non-prescription medicines can be administered.
- Policy on assisting children with long term and complex medical needs.
- Policy on children carrying and administering their own medication.
- Staff training.
- Record keeping.
- Safe storage.
- Access to emergency procedures.
- Risk assessment and management procedures.
Managing medicines in school
Whether you have agreed to administer prescription or non-prescription medication, whether the need is long term or short term, the procedures for managing that medication while it is on school premises and while you have a duty of care for the child will be essentially the same and will need to cover:
- supply (by parents)
Before giving medication to any child you must have written agreement from the parents. This agreement should include the child’s name, the name of the medication, the required dose and agreed time of administration. It should also be clear whether the medication is ongoing or to be taken up until a particular date. Any possible side effects should be listed and/or the information leaflet that is normally supplied by the manufacturer made available.
Parents should bring the medicine into school and hand it to an appropriate person, who should then record that it has been received.
It is absolutely essential that you only accept medication that is in its original labelled container.
It is good practice for the person receiving the medicine to check that the label indicates the name of the child, that the dose parents have stipulated coincides with that detailed on the label and that the medicine is ‘in date’. Where the medicine is in tablet or capsule form, they should if possible check the number provided. It is possible to buy a special device for counting tablets from Boots.
Medicines can be classed as substances hazardous to health and as such must be stored securely. It is also important to note that some need to be stored at particular temperatures or away from light. This information will be on the medicine label and in the manufacturer’s information leaflet. Most medicines should be kept in a locked cupboard. The key should be kept safely, but children should know where their medication is and who can access it.
If medicine needs to be kept cool, then it should be placed in a fridge where children cannot freely access it. Store medicines in a labelled airtight container to keep them separate from food products.
Some emergency medication such as adrenaline pens (for children who suffer from allergies) and asthma inhalers should not be locked away as children need quick access to these. You will need to make arrangements to ensure that only those for whom they are prescribed have access to them.
Your policy and procedures should make it clear who is responsible for administering medicines. It is not part of a teacher’s statutory duties and in most schools is delegated to a teaching or support assistant. It should also be clear who is responsible in the absence of that person. Anyone who has or may at sometime have responsibility for giving children medicines should be very clear about the correct procedures and where appropriate (eg administering adrenaline pens) received training from health professionals working with the school/child.
As a general guideline before administering medication to a child the staff member should:
- wash their hands
- ensure that a drink is available if appropriate (some tablets can irritate and damage the throat and oesophagus if administered without a drink)
- check the label on the medication: name of child, dose, route of administration (eg by mouth, into ear/eye, rubbed on the skin), any special instructions and expiry date.
If there is any doubt about any procedure staff should not administer, but seek advice from parents or health professionals.
It a child refuses the medication, they must not be forced. Staff can try to encourage them or perhaps get someone else to try. Under no circumstances should you attempt to hide the medicine in food or drink, unless you have written permission from parents to do so.
It is normally considered poor practice to give medicines covertly, although in rare cases where the health professionals judge that it is in the child’s interests to do so, this is acceptable. Some children do find tablets difficult to swallow so may be given them, with their full knowledge, in, for example, a spoonful of jam. Even in these circumstances parents must give written instructions. As some medicines can react with certain foods it is advisable that they have sought advice from their pharmacist.
Occasionally mistakes will happen. In most cases, whether it is a missed dose or a medicine given in error there will be no harm done. Parents should be contacted and the mistake explained to them. In the case of a missed dose, you may be able to give it at a later time. Where a dose has been given in error, it is important that the child is monitored for any reactions and medical advice sought if you are in any way concerned.
Tablets and capsules are occasionally dropped on the floor or spat out. In these cases place the tablet in a labelled envelope and return it to the parents. In no circumstances should it be flushed down the toilet or thrown in the bin.
When a child leaves the school, ceases to need medication or if a medicine has passed its expiry date, return any that is unused to the parents. If this is not possible take it to a pharmacist for disposal.
Medicines and the law
There are a number of relevant laws that affect the way you deal with medicines in schools.
Disability Discrimination Act 1995 (as amended by the SEN and Disability Act 2001) makes it a requirement for schools not to unjustifiably discriminate against children with disabilities, including those with medical needs.
Health and Safety at Work Act 1974 and Management of Health and Safety at Work Regulations 1999. School managers have a responsibility to ensure that safety measures are in place to cover the needs of all staff, visitors and children in the school. This may mean conducting risk assessments and making special provision for children with particular health needs.
Control of Substances Hazardous to Health Regulations 2002. COSHH covers the use and storage of hazardous substances. Some medicines fall into this category.
Medicines Act 1968. This covers all aspects of the supply and administration of medicines. It allows any adult to administer a medicine to a third party as long as they have consent and administration is in accordance with the prescriber’s instruction. This includes the administration of some forms of injection (with appropriate training).
Misuse of Drugs Act 1971. This act and its associated regulations cover the supply, administration and storage of controlled drugs. At times schools may have a child who has been prescribed a controlled drug.
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
Click here for part two of this series
Former SENCO Patti Turner is now a director of CC Training Ltd, a consultancy firm that delivers training to care and education workers.