Supporting Pupils with Medication Needs

Supporting Pupils with Medication Needs Courtesy of Cathleen Maguire WELB

Background • Joint Department of Education, Department of Health, Social Services and Public Safety publication • In conjunction with the ELBs, CCMS, a range of education and health professionals and the Teachers’ Unions • Guidance sent by Department Education to all schools on 14 April 2008 with a covering letter and addendum regarding some updated medical terminology

Working party established through the Regional Strategy Group (ELBs) • Function – to organise dissemination of medication needs guidance to all schools – total of 1308 schools, in all sectors in Northern Ireland • Composition of working party – an officer from each Board, a DE rep. and principals of mainstream and special schools • Funding of £248k earmarked by DE for training • WELB holds budget for all Boards

Medication Needs Guidance Training Working Group • Chair • Cathleen Maguire WELB • Members • Paula Jordan Principal, Sperrinview School • David Ryan BELB (Secretary) • Roberta Connolly NEELB • Mary Shalley SELB • Noreen McElroy Principal, Erne School • Peter Dornan BELB • Karen Atchison Principal, Cooley Primary School • John Shivers SEELB • Alison Thompson Special Education Branch, DE

Current situation re tendering • Tenders were invited from more than four companies for submission to WELB by 7 May 2008 • Three were finally submitted and the successful company is The Beeches Management Centre who work in association with Educare on an East/West basis in Northern Ireland • Each major stage was brought to the RSG for approval • Training for Principals of all schools will be completed during the first term of 2008/09 subject to the conditions of the tender

Foreword to Guidance There is no legal duty that requires school staff to administer medication; this is a voluntary role and this guidance does not intend to alter in any way the right of staff not to volunteer.

Important to note • Administration of medication remains the responsibility of parents • Only essential medication should be taken to school, with the Principal’s permission • Parents should be encouraged to request medicines that can be administered outside of school hours • Schools should be aware of the risks of administering common painkillers and should do so only under medical guidance

Roles and Responsibilities • 1.3.1 It is important that responsibility for pupil’s health and safety is clearly defined and that each person involved with pupils who need medication is aware of what is expected of them. A partnership approach with close co–operation among schools, parents, health professionals and other agencies is important in providing a supportive environment for pupils with these needs to enable them to participate fully in school activities.

Roles and responsibilities • Parental responsibility: • ensure their child’s fitness to attend school • make the school aware of the need for medication • agree the school’s role with the principal • provide medical evidence, written instructions and make a written agreement • provide medication details

Roles and responsibilities • Parental responsibility: • provide sufficient, correctly labelled medication • ensure changes are notified • dispose of unused medication • give written permission for their child to carry his / her own medication

Roles and responsibilities • Employer responsibilities: • ensure that the school has a policy • ensure that the insurance arrangements provide staff with full cover • make staff aware of their legal responsibilities • make sure that correct procedures are in place • keep accurate records • ensure that staff have appropriate training

Roles and responsibilities • Board of Governors responsibilities: • safeguard and promote the welfare of pupils on school premises or in the lawful control of a member of school staff • ensure their school has policies • ratify said policies • follow health and safety policies produced by the ELBs and CCMS • take account of the views of the principal, staff and parents when developing the policy

Roles and responsibilities • Principals’ responsibilities: • operation of the policy – including the development of procedures • make parents aware of the policy and dealing sympathetically with requests • make all staff aware of the policy and procedures • delegate the co ordination role • ensure that relevant staff are informed about the child’s condition and how to meet the child’s needs and receive training including any emergency procedures

Roles and responsibilities • Principals’ responsibilities: • safe storage of medicines • arrange cover where needed • ensure that accurate records are kept • ensure that supply teachers and other visitors are informed of medication needs • ensure that work experience placements are suitable and that pupils are encouraged to share information with employers • ask the employer to provide written confirmation of insurance cover for staff

Roles and responsibilities • The voluntary nature of this role must be re-emphasised but where teachers or other staff volunteer their responsibilities are to : • understand the pupil’s condition and when and where s/he may need extra attention • be aware of the possibility of emergencies and how to manage them • take part in appropriate training • be aware of possible side effects and how to manage them • supervise those who self-administer as required

Roles and responsibilities • Role of the School Health Service: • the school nurse is the primary point of contact • co – ordinates the compilation of the Medication Plans – calling on the input/ expertise of others as required • practices may differ slightly from one Health and Social Care Trust to another

Part 1 – Contextual issues • Three categories of medication • Short term/acute such as for a chest infection • Long term such as for asthma or ADHD • Medical emergency – ‘out of the blue’ or an aspect of a known medical condition • Indemnity policy • Confidentiality and need for sensitivity • Need for Health and Education collaboration re children with Statements

Developing policies for supporting pupils with medication needs • Sample policy available on Pages 15 – 17 • Policy needs to be clear to staff, parents and pupils • It must deal with whether the Principal accepts responsibility for administration of medication and the areas covered such as: • prior written agreement of parents • action to be taken if a child refuses to take medication • record keeping • labelling, safe storage and disposal of medication • self administration of medication

The Medicines Act 1968 • Classifies medicines General Sales List (GSL), Pharmacy (P) and Prescription Only Medicines (POM) • ‘No-one may administer a parenteral POM otherwise than to himself, unless he is an appropriate practitioner or is acting in accordance with the directions of an appropriate practitioner.’

The Medicines Act 1968 • Certain medicines are exempt from this restriction when administered for the purpose of saving life in an emergency e.g Anaphylaxis • Adrenaline is one of the exemptions • Epipens are safer because of the pre-measured dose

Controlled Drugs • Methylphenidate (Ritalin®, Equasym®, Concerta®) • Controlled by Misuse of Drugs Act which states specific requirements for storage, administration and recording: • Locked, non-portable container • Only named staff to have access • Records kept for audit and safety purposes

Circumstances when special arrangements are required • Educational trips – the guidance does not give advice on whether or not children should be included in trips but where they are a copy of the Medication Plan should be taken on a school visit as appropriate • Sporting activities – may require modification or precautions such as an inhaler • School transport – training must be supplied to staff re. emergency procedures as appropriate and staff must be aware of their roles, responsibilities and liabilities

Part 11 – Administration of medication • Parent must produce medication in original labelled container with name of medication, pupil’s name, dosage, date and expiry date. Unlabelled containers are unacceptable • Self administration recommended for those deemed old and developmentally mature enough to self medicate • Advice provided on refusal of medication • Record keeping using Form AM4 advised • Photocopiable Forms AM1 to AM6 are included for use as a full Medication Plan

Administration of long term medication • Completion of a full Medication Plan (MP) normally necessary • Medication Plan must involve health professional, parent, principal, class teacher, head of year/form teacher, SENCO, adult assistant if in place, school staff who agree to administer medication, staff trained in emergency procedures and pupil, as appropriate • Need for an MP should only be assessed by a health professional

Administration of long term medication • Forms AM2 or AM3 may be used for pupils with medical needs who do not require a full Medication Plan • MP should include child’s name and contact details, medical condition, special requirements, medication and side effects, what constitutes an emergency, precise steps to be taken in an emergency, emergency phone numbers, role of the school and details of other health and social care professionals involved

Medication Plan: Forms AM1 – AM7 • Full MP will consist of AM1, AM2/3, AM4, AM6. Form AM7 is authorisation for administration of rectal diazepam • Form AM5 is the school’s record of medication administered to all children • Pages 36 and 37 outline function of forms • All forms are downloadable as WORD documents at www.deni.gov.uk • Pages 39 to 51 are the forms to be copied

Part 111 – Emergency Procedures • Emergencies are usually related to four conditions and are reflected in a pupil’s MP: • Acute asthmatic attack • Diabetic hypoglycaemic attack • Anaphylactic reaction • Prolonged epileptic seizures • Emergency procedures outlined (Pages 55, 56) including an Emergency Call Form for display by the office telephone (Page 57) • ‘The consequences of taking no action are likely to be more serious than those of trying to assist in an emergency’

Part 1V – most common conditions and practical advice • Basic information is provided on the five most common medical conditions in schools: • Asthma • Epilepsy • Diabetes • Anaphylaxis • Attention Deficit Hyperactivity Disorder (ADHD) • Symptoms of onset are identified, medicine and control are outlined and advice is provided re. emergency procedures in respect of each condition.

Part V – Contacts • Useful contacts for support organisations in respect of main medical conditions • Internet resources • Additional information on anaphylaxis issued by DHSS&PS available at: Http://www.dhsspsni.gov.uk/hsc_sqsd_20-08.pdf (This information emailed by DE to all schools on C2k and sent by hard copy to those not on C2k )

Supporting Pupils with Medication Needs