www.halton.gov.uk
Supporting pupils at school
with medical conditions
Ann McIntyre
Operational Director
Children’s Organisation and Provision
This morning we aim to:
• Summarise the requirements of the
Children and Families Act 2014
• Clarify roles and responsibilities
• Provide advice that will enable you to
administer basic medication; and
• Identify where further support and
training can be obtained
AGENDA
Time
Subject
Speaker
9.00am
ARRIVAL - Tea/coffee
9.15am
Introduction
Ann McIntyre
9.45am
Basic Medication Awareness
10.00am
Medicines Records Management
Libby Evans
Lucy Reid
Cre Dyas
Tony Dean
10.15am
BREAK - Tea/Coffee
10.30am
Practical Sessions (30 minutes each session)
1.
Medicines Management
2.
Infection Control
Libby Evans
Lucy Reid
Michelle Prescott
3.
Asthma Salbutamol Inhalers
Margaret Gorst
12.00pm
Health Care Plans
12.15pm
Question and Answer Session
Denise Hogg
Annette Dunning
Panel
12.30pm
EVENT CLOSE
Supporting pupils at school
with medical conditions
•
From 1st September 2014, governing bodies will have a new statutory duty under the Children and Families Act 2014 - to ensure schools make arrangements
to support pupils with medical conditions.
•
A medical conditions policy will be required, ensuring pupils with medical
conditions have full access to education, including physical education and school
trips.
•
Children and young people with medical conditions are entitled to a full education
and have the same rights of admission to school as other children. This means
that no child with a medical condition should be denied admission or prevented
from taking up a place in school because arrangements for their medical
condition have not been made.
•
Statutory duty applies to schools, academies and Pupil Referral Units
What has stayed the same?
• Children and young people with medical conditions are entitled to a
full education and have the same rights of admission to school as
other children. This means that no child with a medical condition
should be denied admission or prevented from taking up a place in
school because arrangements for their medical condition have not
been made.
• Medicines should only be administered at school when it would be
detrimental to a child’s health or school attendance not to do so.
Where clinically possible, medicines should be prescribed in dose
frequencies which enable them to be taken outside school hours
What has stayed the same?
• Any member of school staff may be asked to provide support to
pupils with medical conditions, including the administering of
medicines, although they cannot be required to do so. Although
administering medicines is not part of teachers’ professional duties,
they should take into account the needs of pupils with medical
conditions that they teach.
• Head teachers should make sure that school staff are appropriately
insured and are aware that they are insured to support pupils in this
way.
• Schools should only accept prescribed medicines that are in-date,
labelled, provided in the original container as dispensed by a
pharmacist and include instructions for administration, dosage and
storage
What has stayed the same?
•
•
•
Children should know where their medicines are at all times and be able to
access them immediately. Where relevant, they should know who holds the
key to the storage facility.
Medicines and devices such as asthma inhalers, blood glucose testing meters
and adrenaline pens should be always readily available to children and not
locked away.
A child who has been prescribed a controlled drug may legally have it in their
possession if they are competent to do so, but passing it to another child for
use is an offence. Monitoring arrangements may be necessary. Schools
should otherwise keep controlled drugs that have been prescribed for a pupil
securely stored in a non-portable container and only named staff should have
access. Controlled drugs should be easily accessible in an emergency. A
record should be kept of any doses used and the amount of the controlled
drug held in school
What has stayed the same?
• Governing bodies should ensure that written records are
kept of all medicines administered to children.
• School Nurses - every school has access to school nursing
services. They are responsible for notifying the school
when a child has been identified as having a medical
condition which will require support in school. They may
support staff on implementing a child’s individual
healthcare plan and provide advice and liaison, for
example on training.
Key Changes
• Governing bodies should ensure that their school develop a
policy for supporting pupils with medical conditions that is
reviewed regularly and is readily accessible to parents and
school staff.
• A medical conditions policy and arrangements must be in place,
so that pupils with medical conditions have full access to
education, including school trips and physical education
• Governing bodies should ensure that school leaders consult
health and social care professionals, pupils and parents to
ensure that the needs of children with medical conditions are
effectively supported.
Key Changes
• Governing bodies should ensure that the arrangements they set up
include details on how the school’s policy will be implemented
effectively, including a named person who has overall responsibility for
policy implementation.
• School staff should receive sufficient and suitable training and achieve
the necessary level of competency before they take on responsibility to
support children with medical conditions. Head teachers should ensure
that sufficient trained numbers of staff are available to implement the
policy and deliver against all individual healthcare plans, including in
contingency and emergency situations. This may involve recruiting a
member of staff for this purpose.
• Governing bodies should ensure that sufficient staff have received
suitable training and are competent before they take on responsibility to
support children with medical conditions.
Supporting pupils at school with
medical conditions
In order to support schools to fulfil their statutory duties, a range of
resources and support has been developed in conjunction with:
• Consultant, Public Health
• Health Co-ordinator for Children of School Age
• Clinical Manager School Health, Bridgewater
• Lead Pharmacist - Halton Locality Medicines Management Team
• Commissioning Manager Health, Public Health
• Acting Divisional Manager, Inclusion 0-25
• Principal Health and Safety Advisor
• Operational Director, children’s Organisation and Provision
• Principal Policy Officer
Supporting pupils at school with
medical conditions
These resources will include:
• A revised ‘Supporting pupils at school with medical conditions’ policy,
which schools can adopt if they wish to do so;
• Where to go for training and further guidance;
• Information bulletins will be circulated to schools advising them of
the changes through the schools e-bulletin, Chairs of Governors
Briefings etc.
• Information will be made available through Halton’s Local offer and
the Children’s Trust websites.
The role of Governing Bodies
The governing body:• must ensure that arrangements are in place to support pupils with
medical conditions.
• should ensure that the focus is on the needs of each individual child
and how their medical condition impacts on their school life.
• should ensure that their arrangements give parents and pupils
confidence in the school’s ability to provide effective support for
medical conditions in school.
• must ensure that the arrangements they put in place are sufficient to
meet their statutory responsibilities and should ensure that policies,
plans, procedures and systems are properly and effectively
implemented.
The role of Governing Bodies
The governing body should ensure that:• all schools develop a policy for supporting pupils with medical
conditions that is reviewed regularly and is readily accessible to
parents and school staff.
• the arrangements they set up include details on how the school’s
policy will be implemented effectively, including a named person who
has overall responsibility for policy implementation.
• the school’s policy sets out the procedures to be followed whenever a
school is notified that a pupil has a medical condition.
• the school’s policy covers the role of individual healthcare plans, and
who is responsible for their development, in supporting pupils at
school with medical conditions.
The role of Governing Bodies
Governing bodies should ensure that:• written records are kept of all medicines administered to
children.
• the school’s policy sets out what should happen in an
emergency situation.
• the appropriate level of insurance is in place and
appropriately reflects the level of risk.
• the school’s policy sets out how complaints may be made
and will be handled concerning the support provided to
pupils with medical conditions.
Staff Training
•
Governing bodies should ensure that sufficient staff have received suitable
training and are competent before they take on responsibility to support
children with medical conditions.
•
Staff must not give prescription medicines or undertake health care
procedures without appropriate training (updated to reflect any individual
healthcare plans). A first-aid certificate does not constitute appropriate
training in supporting children with medical conditions.
•
Governing bodies should ensure that the school’s policy covers arrangements
for children who are competent to manage their own health needs and
medicines.
The role of Headteachers
Headteachers are responsible for implementing this policy and the
developing individual healthcare plans and are to ensure that relevant
staff have sufficient resources, including training and personal protective
equipment, to support pupils with medical conditions. In order to do so
they should identify a named person who has overall responsibility for:
• ensuring that sufficient staff are suitably trained;
• that all relevant staff will be made aware of the child’s condition
including any requirement for the child to participate in outside the
classroom activities where appropriate;
• cover arrangements are in place at all times in case of staff absence
or staff turnover to ensure someone is always available
The role of Headteachers
• supply teachers are briefed;
• risk assessments have been carried out for school visits, holidays, and
other school activities outside of the normal timetable;
• procedures are in place to cover any transitional arrangements
between schools for any medical issues;
• for children starting at the school, necessary arrangements are in
place in time for the start of the relevant school term so that they
start at the same time as their peers;
• Individual Healthcare plans are monitored including identifying pupils
who are competent to take their own medication.
The role of Headteachers
• The management of accepting, storing and administering
any medication. Note: if the school chooses to hold an
emergency Salbutamol Inhaler it should be cross
referenced in the Asthma policy;
• That appropriate protective equipment is made available
to staff supporting pupils at school with medical
conditions.
• Ensure that there is effective coordination and
communications with relevant partners, professionals,
parents and the pupils.
The role of Headteachers
Headteachers should ensure that:• written records are kept of all medicines administered to children.
• the school’s policy sets out what should happen in an emergency
situation.
• the appropriate level of insurance is in place and appropriately
reflects the level of risk.
• the school’s policy sets out how complaints may be made and will be
handled concerning the support provided to pupils with medical
conditions.
The role of the named person
The named person has overall responsibility for policy implementation,
including responsibility:
• for ensuring that sufficient staff are suitably trained,
• to ensure that all relevant staff are made aware of the child’s condition,
• to put in place cover arrangements in case of staff absence or staff
turnover to ensure someone is always available,
• briefing for supply teachers,
• to undertake risk assessments for school visits, holidays, and other school
activities outside of the normal timetable, and
• for monitoring of individual healthcare plans.
The role of school staff
• Any member of school staff may be asked to provide support to
pupils with medical conditions, including the administering of
medicines, although they cannot be required to do so.
• Although administering medicines is not part of teachers’
professional duties, they should take into account the needs of pupils
with medical conditions that they teach.
• School staff should receive sufficient and suitable training and
achieve the necessary level of competency before they take on
responsibility to support children with medical conditions.
• Any member of school staff should know what to do and respond
accordingly when they become aware that a pupil with a medical
condition needs help.
The role of parents
Parents should:• provide the school with sufficient and up-to-date
information about their child’s medical needs.
• be involved in the development and review of their child’s
individual healthcare plan, and may be involved in its
drafting.
• carry out any action they have agreed to as part of their
child’s individual healthcare plan implementation, eg
provide medicines and equipment and ensure they or
another nominated adult are contactable at all times.
The role of local authorities
Local authorities:
• are commissioners of school nurses for maintained schools and academies.
• have a duty to promote co-operation between relevant partners such as
governing bodies of maintained schools, proprietors of academies, clinical
commissioning groups and NHS England,
• provide support, advice and guidance, including suitable training for school
staff, to ensure that the support specified within individual healthcare plans
can be delivered effectively.
• should work with schools to support pupils with medical conditions to attend
full time. Where pupils would not receive a suitable education in a
mainstream school because of their health needs, the local authority has a
duty to make other arrangements.
Practice not acceptable
• Prevent children from easily accessing their inhalers and medication
and administering their medication when and where necessary
• Send children with medical conditions home frequently or prevent
them from staying for normal school activities, including lunch, unless
this is specified in their individual healthcare plans;
• If the child becomes ill, send them to the school office or medical
room unaccompanied or with someone unsuitable;
• Require parents, or otherwise make them feel obliged, to attend
school to administer medication or provide medical support to their
child, including with toileting issues.
• Prevent children from participating, or create unnecessary barriers to
children participating in any aspect of school life, including school
trips, eg by requiring parents to accompany the child.
Flu vaccinations
• HBC employees can present to the ASDA Pharmacy in Runcorn or
Widnes and show their ID badge to get a free flu vaccination.
• This runs till November 30th . Staff are advised to call the store first
just to make sure the pharmacist is in. But these are drop in sessions.
• Everyone who goes will be asked to fill a consent forms so that we
know they have had the vaccination and we can arrange payments to
ASDA
• Additionally anyone who has a long term condition, is a carer or
pregnant can also go to the pharmacy to get a free vaccination
ASDA Runcorn number 01928 703210
ASDA Widnes number 0151 422 5912
Basic Medication Awareness
17th October 2014
Libby Evans - School Health Nursing Service
Lucy Reid - Locality Lead Pharmacist
Do you have any specific
questions or issues you’d
like to be covered?
Aims
• Scope of this awareness session
• Responsibilities
• Why might medication need to be
administered within the school setting?
• Safe storage and disposal (including controlled
drugs)
• Safe administration of medicines
• Record Keeping
Scope of the Session
What will be covered
What’s not covered
• Basic awareness
• Overview
• Reassurance
• Specialist techniques
• Specific therapeutic areas
• Emergency medication
Why medication might need to be
administered within the school setting?
• Children with medical needs have the same rights of
admission to school.
• Most children will at some time have short term medical
needs.
• Some children however have longer term medical needs
and may require medicines on a long term basis to help
them keep well.
• The administration of medication at school will minimise
the time pupils will need to be absent
• Some children require emergency medication e.g.
adrenaline auto-injector
Responsibilities
General
• Medication must be given at home where
possible
• The health and welfare of the pupil is
paramount in all decisions regarding the
administration of medication. Therefore if
school staff have any concerns regarding
medication or dosage for a pupil then advice
MUST be sought before any medicine is given.
Responsibilities
•
•
•
•
•
Parent/Carers
MUST provide all relevant information to the school
and any changes MUST be in writing
Routinely all medicines MUST be handed to a
responsible adult – exception self-management
Prescribed medicines MUST always be provided in
the original container dispensed by a pharmacist.
Non-prescribed medication MUST only be
administered in line with the policy and MUST have
full written instructions provided by the parent/carer
MUST sign the appropriate consent form.
Responsibilities
•
•
•
•
•
Staff
Never accept medicines out of their original
container.
Always follow instructions on pharmacy label
and/or parental consent form.
Record all medicines given in the appropriate
manner
Adhere to policy and procedures at all times
Report any incidents or errors immediately in
line with policy and procedures
Safe Storage
• Always store medicines in a secure place with
restricted access.
• Some medicines need to be stored in a fridge
according to manufacturers instructions. These can
be stored alongside food but must be kept in an air
tight container and clearly labelled.
• Large volumes of medicines should not be stored.
• Medicines that may be required in an emergency
must always be readily available e.g. Inhalers,
adrenaline auto-injector
• Controlled drugs must be stored securely within a
locked cupboard (fixed to a wall)
Safe Disposal
• The medication is the property of the patient
• Do not dispose of any medication in general waste or
down the drain
• Medication no longer required or out of date must be
handed back to the parent/carer for disposal via a
community pharmacy
• Only medication in use and in date should be stored –
follow policy regarding end of term procedures
• Ensure records are kept of any medication returned to a
parent/carer even if it is no longer needed or out of date.
Safe Administration of Medication
Always follow the five ‘Rights’
• Right Patient
• Right Medicine
• Right Dose
• Right Route
• Right Time
ALWAYS check against the label AND consent form
If there are any discrepancies DO NOT proceed without further advice
Always check the medicine is in date
Example of pharmacy label
100ml Phenoxymethlypenicillin Oral Solution 250mg/5ml
Take ONE 5ml spoonful FOUR times a day for FIVE days
Space the doses evenly throughout the day. Keep taking this
medicine until the course is finished, unless you are told to
stop
Take this medicine when your stomach is empty. This means
an hour before food or 2 hours after food
Shake well before use
Master A Patient
15thOctober 2014
A PHARMACY 123 Pharmacy Street, Anytown AB1 C34
Tel: 01234 567890
Keep out of the sight and reach of children
Example of pharmacy label
Name and
quantity of
the
medicine
100ml Phenoxymethlypenicillin Oral Solution 250mg/5ml
Take ONE 5ml spoonful FOUR times a day for FIVE days
Space the doses evenly throughout the day. Keep taking this
medicine until the course is finished, unless you are told to
stop
Take this medicine when your stomach is empty. This means
an hour before food or 2 hours after food
Shake well before use
Master A Patient
15thOctober 2014
A PHARMACY 123 Pharmacy Street, Anytown AB1 C34
Tel: 01234 567890
Keep out of the sight and reach of children
Example of pharmacy label
100ml Phenoxymethlypenicillin Oral Solution 250mg/5ml
Take ONE 5ml spoonful FOUR times a day for FIVE days
The NAME
of the child
Space the doses evenly throughout the day. Keep taking this
medicine until the course is finished, unless you are told to
stop
Take this medicine when your stomach is empty. This means
an hour before food or 2 hours after food
Shake well before use
Master A Patient
15thOctober 2014
A PHARMACY 123 Pharmacy Street, Anytown AB1 C34
Tel: 01234 567890
Keep out of the sight and reach of children
Example of pharmacy label
100ml Phenoxymethlypenicillin Oral Solution 250mg/5ml
Take ONE 5ml spoonful FOUR times a day for FIVE days
The dose and
directions for use
Space the doses evenly throughout the day. Keep taking this
medicine until the course is finished, unless you are told to
stop
Take this medicine when your stomach is empty. This means
an hour before food or 2 hours after food
Shake well before use
Master A Patient
15thOctober 2014
A PHARMACY 123 Pharmacy Street, Anytown AB1 C34
Tel: 01234 567890
Keep out of the sight and reach of children
Example of pharmacy label
100ml Phenoxymethlypenicillin Oral Solution 250mg/5ml
Take ONE 5ml spoonful FOUR times a day for FIVE days
Space the doses evenly throughout the day. Keep taking this
medicine until the course is finished, unless you are told to
stop
Take this medicine when your stomach is empty. This means
an hour before food or 2 hours after food
Shake well before use
Master A Patient
15thOctober 2014
A PHARMACY 123 Pharmacy Street, Anytown AB1 C34
Precautions
relating to
the use of
the product
Tel: 01234 567890
Keep out of the sight and reach of children
Example of pharmacy label
100ml Phenoxymethlypenicillin Oral Solution 250mg/5ml
Take ONE 5ml spoonful FOUR times a day for FIVE days
Space the doses evenly throughout the day. Keep taking this
medicine until the course is finished, unless you are told to
stop
Take this medicine when your stomach is empty. This means
an hour before food or 2 hours after food
Shake well before use
Master A Patient
15thOctober 2014
A PHARMACY 123 Pharmacy Street, Anytown AB1 C34
Date of
dispensing
Tel: 01234 567890
Keep out of the sight and reach of children
Example of pharmacy label
100ml Phenoxymethlypenicillin Oral Solution 250mg/5ml
Take ONE 5ml spoonful FOUR times a day for FIVE days
Space the doses evenly throughout the day. Keep taking this
medicine until the course is finished, unless you are told to
stop
Take this medicine when your stomach is empty. This means
an hour before food or 2 hours after food
Shake well before use
Master A Patient
15thOctober 2014
A PHARMACY 123 Pharmacy Street, Anytown AB1 C34
Tel: 01234 567890
Keep out of the sight and reach of children
Name and address of dispensing
pharmacy
Self-Management
• Where a pupil is competent to do so they should
take responsibility to manage their own
medicines – discussion between school and
parents/carers should take place to agree this
decision and this should be documented.
• There is still the need to ensure the medicine is
kept safe and is not accessible to other pupils.
• Need to consider actions if child encounters any
problems and what they do
Non Prescribed Medication
• Only after parental advice should schools administer
paracetamol or other pain relief – this must be in writing
with full instructions
• Parental consent must be obtained before administration
and on every occasion
• Schools must not keep it’s own stock of medication; it
should be provided by parents for use solely by their child.
• Before administering staff should check that the
medication has been given in the past without adverse
effect – schools need a record of this.
• Record any medicines given.
• Must be in original manufacturers packaging
Record Keeping
• Parental consent forms
• Health Care Plan where appropriate – not in all cases
• Recording sheets should cover:
– Supply
– Administration
– Disposal
• Details of any medication given should be recorded
and signed for by the person administering it.
Hygiene
• Always wash hands before and after
administering any medication.
• Do not touch medicine with hands
Issues that may occur
• Record if medicine is refused, late, or missed –
inform parent/carer and senior staff member
• If an error occurs inform senior staff member
and parent/carer immediately
• Written information maintained by the school
or school staff regarding a pupil including
information about medical needs is
confidential
Days Trips and Residential
• Children who have medical needs cannot be excluded
• It is recommended medication is stored in a locked box
when off school premises and held by a designated
member of staff
• Consider how their needs including medication are
dealt with in these circumstances
• Extra training maybe required
• Medication should be in original containers
• Full written information required
• Record keeping
ANY QUESTIONS
Medicine Records
Management
Tony Dean
Cre Dyas
When should schools use
medicine records?
EVERYTIME a child/young person needs to take
medication
Medicine Records
•
•
•
•
•
•
•
Parental Agreement for School to Administer Medicine
Head Teacher Agreement to Administer Medicine
Request for Child to Carry his/her Medicine
Record of Medicine Administered to Individual Child
Staff Training Record- Administration of Medicines
Use of Emergency Salbutamol Inhaler
Specimen letter to Inform Parents of emergency
Salbutamol Inhaler use
• Authorisation for the administration of rectal diazepam
Maladministration of Medication
• What is maladministration of medication?
• What to do in the case of maladministration?
Call First Aider
Call ambulance if appropriate/ retain
container
Inform Parents
Report incident on Accident Reporting System
Insurance
• Schools should ensure they have suitable
insurance in place to ensure that staff
supporting pupils with medical conditions are
indemnified
• Schools not buying into the council’s insurance
scheme should contact to their insurers to
ensure appropriate level of cover
Where to Find the Information?
School Medicine Management Policy
www.halton.gov.uk/localoffer
Accident reporting system
http://hbc/teams/HANDS/Pages/Health-andSafety-and-Risk-Management-Portal.aspx
Tea/Coffee BREAK
Practical Sessions
1. Medicines Management
Libby Evans
Lucy Reid
2. Infection Control
Michelle Prescott
3. Asthma Salbutamol Inhalers
Margaret Gorst
Individual Health Care Plans
(HCP)
Denise Hogg - Service Lead Children’s
Community Nursing
Annette Dunning - Specialist Practitioner in
Children’s Community Nursing
Why do we need an individual
healthcare plan ?
‘’ The aim is to ensure that all children with
medical conditions, in terms of both physical and
mental health, are properly supported in school
so that they can play a full and active role in
school life, remain healthy and achieve their
academic potential.’’[DfE,2014]
Developing a health care plan
• Medical need or healthcare issue identified that could
impact on pupil’s wellbeing or safety.
• IHCP’s can be initiated by a member of the school
staff or a healthcare professional involved in providing
care to the child.
• The plan will be drawn up in partnership with pupil,
family, school and health.
• Partners agree who will take the lead writing the plan.
Who should be involved in the process?
•
•
•
•
Key school staff
Child or young person
Parent or legal guardian
Relevant healthcare professional e.g School
Nurse; Children’s Community Nurse; Specialist
Nurse; Allied Healthcare professional; Hospital
Consultant; GP.
What information needs to be in a plan?
• The medical condition.
• The pupil’s needs.
• Specific support for the pupil’s educational,
social and emotional needs.
• The level of support needed.
• Who will provide this support.
• What to do in an emergency.
View Assessment Form
Example of a completed plan.
• Child A is a young person in main stream secondary school with
a diagnosis of Juvenile Arthritis. Suppressed immunity.
• Contact Details.
• Description of medical needs and symptoms.
• Daily care requirements.
• Description of what constitutes an emergency .
• Follow up care for child A.
• Who is responsible in an emergency?
• Agreement and sign off by pupil, parents author of the plan.
View School plan for child A
Implementation and review of the IHCP
• Responsibility for ensuring the plan is
finalised and implemented rests with the
school. [DfE 2014]
• IHCP should be reviewed annually or when
condition changes.
Need assistance?
Who to contact?
• Follow your local policy for guidelines on supporting pupils at
school with medical conditions.[HBC,2014]
• Contact your school nurse.
• Is the child under a specialist nurse? Contact them directly.
• Is there a consultant involved? Contact their secretary.
• Is the pupil known to Statutory services? Contact Social care.
• Children’s Community Nurse Team? Tel 0151 495 5400.
References :• Supporting pupils at school with medical conditions.
Statutory guidance for governing bodies of
maintained schools and proprietors of academies in
England. April 2014. DfE.
• Supporting pupils at school with medical conditions
policy.
August 2014. Halton Borough Council.
Q & A Session
Over to you!
Event close
• Please complete evaluation forms.
• Any remaining questions please add
to sticky wall, along with your email
address and we will get back to you.
Many thanks