THE ROLES AND
RESPONSIBILITIES OF
THE SCHOOL HEALTH
NURSE SERVICE IN
THE MANAGEMENT
OF MEDICINES IN
MAINSTREAM AND
SPECIAL SCHOOLS
Dr Darshana Bhattacharjee, Registrar in Paediatrics.
Karen Evans, Deputy Head of Nursing.
Dr Jo Williams, Consultant in Child Public Health.
November 2014
Contents
Key point
Page
Abbreviations
Purpose of this document
Introduction
Aims of the school nursing service
Roles and responsibilities
Staff training and support
Record keeping and risk assessment
Managing medicines on school premises
Provision for special schools
Summary of key points
Recommendations
References
Appendices
2
3
4
5
6
7
8
9-10
11
12
13
14
15-16
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Management of medicines in schools| November 2014
Abbreviations
CCHP
DfE
DoH
EHC
IHC
KPI
LA
NBT
NMC
SEN
Community Children’s Health Partnership
Department for Education
Department of Health
Education, Health and Care plan
Individual Healthcare Plan
Key Performance Indicator
Local Authority
North Bristol NHS Trust
Nursing and Midwifery Council
Special Educational Needs
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Management of medicines in schools| November 2014
Purpose of this document
This document has been prepared to replace the CCHP “Protocol, Information and Training
Pack for the Administration of Medicines in Schools” document produced in May 2010,
developed within the School Health Nursing Service in North Bristol NHS Trust. The original
policy is now 4 years out of date and in need of revising. Additionally, there is currently a
lack of clarity regarding the exact roles of school nurses in the school, which requires
addressing.
This document gives recommendations aimed at the School Nursing Service in order to
clarify their roles and responsibilities. We have looked at the recent national DfE guidance
“Supporting pupils at school with medical conditions” (April 2014), which provides greater
clarity on the roles of school nurses. We have drawn out the key points from this new
national guidance to enable the CCHP to now update their policy in order to provide clarity
to their staff and communicate this with schools. These recommendations will inform
current service provision and the upcoming procurement of school nurse services from
2015.
This document has been prepared in conjunction with the Department of Public Health in
Bristol City Council and is applicable to Public Health teams in South Gloucestershire, given
that the school nurse service is commissioned by the Local Authority in both areas.
This document can also be shared with the following groups for information:

Schools, academies and pupil referral units (PRUs)
Education and health support staff
Parents/carers and pupils
Health service providers, e.g. GPs



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Management of medicines in schools| November 2014
Introduction
Many children in mainstream and special schools need medicines during the school day.
These may include:


Short term medicines -such as finishing a course of antibiotics.
Long term medicines to keep them well – for example, for epilepsy, cystic fibrosis,
diabetes.
Emergency medicines – for example, for severe allergies or asthma.
Controlled drugs- for example, methylphenidate for ADHD.


The Department for Education advises that governing bodies should ensure that the
school’s policy is clear about the procedures to be followed for managing medicines, and
should develop their own policies to manage these medicines safely (Supporting pupils at
school with medical conditions. DfE, April 2014).
It is statutory that the school should have a clear policy regarding the provision of suitable
training for any member of school staff providing support to a pupil with medical needs, as
identified during the development or review of individual healthcare plans.
Parents (and carers with parental responsibility) have the primary responsibility for their
child’s health. If they are requesting that a school will administer medicines to their child
during the school day they must provide the necessary information and the medicines to
the school.
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Management of medicines in schools| November 2014
Aims of the School Nursing Service in relation to medications
The recently updated DfE guidance states that “every school has access to school nursing
services”. However, national guidance about responsibilities for commissioning school
nursing only ensures that the Local Authority commissions school health nursing for statemaintained schools. Schools which are (or used to be) independent schools, or free schools,
must make their own arrangements.
This document refers to the school nurse service commissioned by the LA and provided by
CCHP (a partnership between NBT and CCHP). The use of the DfE guidance alongside this
update aims to make practices more consistent and to ensure equity of school nurse
provision.
School nurses have specific responsibilities relating to children with special educational or
health needs, as per the Children & Families Act 2014 (section 3). They have a duty to bring
such children to the attention of the local authority, and to inform the child’s parent of their
opinion regarding the child’s needs. However, parents may be the first to inform the school
that their child has a medical condition, and consequently the school can contact the School
Health Nurse service.
School nurses must notify the school when a child has been identified to them as having a
medical condition which will require support in school. They may support staff in writing
and implementing a child’s Individual Healthcare Plan (see Appendices A and B), and
provide specific training.
With regards to managing medicines, the school nursing service should aim:
1. To provide information that will enable all staff to understand the importance of
correct storage, administration, and recording of medicine given in school.
2. To ensure that practice is consistent and standardised across all mainstream and
Special Schools served by CCHP.
3. To inform all health and education staff involved in administering medicines of the
potential of all drugs to cause harm, and of the dangerous or addictive drugs which
are strictly controlled by legislation, during training delivered by school nurses.
It is not the role of the School Nurse to administer all the medicines to children in school.
The role of the School Nurse in mainstream and special schools is to support the safe
administration of medicines by offering training, advice and support to education and health
support staff, and through the development of Individual Health Care Plans where
appropriate.
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Management of medicines in schools| November 2014
Roles and responsibilities
It is not the role of the School Nurse to administer all the medicines to children in school.
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 the pupils with medical conditions that they teach.
Education establishments cannot refuse to take responsibility for the administration of
medication under the Children & Families Act 2014.
Schools are advised to have clear policies about who is responsible for giving medicines. In
mainstream schools it may be most appropriate for a first aider or support worker to
administer all the medicines. In special schools, it may be most appropriate for the child’s
1:1 support worker to administer their medicines as part of their general care.
Pupils with medical conditions will often be best placed to provide information about how
their condition affects them. They should be fully involved in discussions about their medical
support needs and contribute as much as possible to the development of, and comply with,
their individual healthcare plan.
Parents should provide the school with sufficient and up-to-date information about their
child’s medical needs. They may in some cases be the first to notify the school that their
child has a medical condition. Parents are key partners and should be involved in the
development and review of their child’s individual healthcare plan, and may be involved in
its drafting. They should carry out any action they have agreed to as part of its
implementation, e.g. provide medicines and equipment and ensure they or another
nominated adult are contactable at all times.
Ofsted inspection frameworks place a clear emphasis on meeting the needs of disabled
children and pupils with special educational needs (SEN). Schools are expected to have a
policy dealing with medical needs and to be able to demonstrate that this is implemented
effectively.
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Management of medicines in schools| November 2014
Staff training and support
The 2014 DfE guidance recommends that “the school’s policy should be clear that any
member of school staff providing support to a pupil with medical needs should have
received suitable training”. Within Bristol and South Gloucestershire, the Local Authority
gives generic training to school staff, for which schools have to submit an application. It is
crucial that schools arranging training themselves ensure that this remains up-to-date.
The school nursing service in Bristol is able to provide specific training depending on the
individual healthcare needs of the child, which again should be identified from their
healthcare plan. Schools can access this by making a direct referral to the School Nursing
Service. Community Nursing Teams and local specialist nursing teams, for example, for
diabetes and epilepsy, are valuable potential resources for schools seeking advice and
support in relation to children with certain medical conditions. School nurses may be able to
liaise with these teams, in addition to liaising with lead clinicians locally.
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. Training should be sufficient to ensure that staff have confidence in their ability
to support pupils with medical conditions, and to fulfil the requirements as set out in
individual healthcare plans. They will need an understanding of the specific medical
conditions they are being asked to deal with, their implications and preventative measures.
Annual update of training is recommended, and it is the responsibility of the school to
ensure that this is done. The School Nurse service can provide blocks of specific training at
the beginning of the academic year which is updated annually.
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Record keeping and risk assessment
Governing bodies should ensure that written records are kept of all medicines
administered to children. Records offer protection to staff and children and provide
evidence that agreed procedures have been followed. Additionally, any reactions or adverse
events regarding medicines must be documented and fed back to the parents and relevant
healthcare professional.
Annually updated records of training and assessment should be maintained by the school.
However, at present this information is not routinely sent to the relevant school nurse,
therefore it is difficult to ascertain how complete and up-to-date school staff training is at
present. The School Nurse service should consider whether they can advise schools to keep
up-to-date records.
If the School Health Nursing Service is providing the training then the School Health Nursing
Service must also keep details of training and assessment. One of the Key Performance
Indicators (KPI) for school nurse data (for 2014 to 2015) clearly states that the school nurse
service should provide an annual report on the number of training sessions coordinated
with the Local Authority Educational Teams.
Parents should be informed if their child has been unwell at school. Ultimately it is the
responsibility of the parent to ensure the medicines for their child are up to date.
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Managing medicines on school premises
The governing body should ensure that the school’s policy is clear about the procedures to
be followed for managing medicines. The DfE national guidance includes the following
recommendations, which the school nurse service could use to advise certain schools to
incorporate into their existing policies:

Medicines should only be administered at school when it would be detrimental to a
child’s health or school attendance not to do so.

No child under 16 should be given prescription or non-prescription medicines
without their parent’s written consent - except in exceptional circumstances where
the medicine has been prescribed to the child without the knowledge of the parents.
In such cases, every effort should be made to encourage the child or young person to
involve their parents while respecting their right to confidentiality. Schools should
set out the circumstances in which non-prescription medicines may be administered.

A child under 16 should never be given medicine containing aspirin unless prescribed
by a doctor. Medication, e.g. for pain relief, should never be administered without
first checking maximum dosages and when the previous dose was taken. Parents
should be informed.

Where clinically possible, medicines should be prescribed in dose frequencies which
enable them to be taken outside school hours.

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. The exception to this is insulin which must still
be in date, but will generally be available to schools inside an insulin pen or a pump,
rather than in its original container.

All medicines should be stored safely. 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. This is particularly
important to consider when outside of school premises e.g. on school trips.
*Please see the recent document “Guidance on the use of emergency salbutamol inhalers in
schools” produced by the DfE, September 2014, for further information on this.
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Management of medicines in schools| November 2014

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 nonportable 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.

School staff may administer a controlled drug to the child for whom it has been
prescribed. Staff administering medicines should do so in accordance with the
prescriber’s instructions. Schools should keep a record of all medicines administered
to individual children, stating what, how and how much was administered, when and
by whom. Any side effects of the medication to be administered at school should be
noted.

When no longer required, medicines should be returned to the parent to arrange for
safe disposal. Sharps boxes should always be used for the disposal of needles and
other sharps.
It is generally not acceptable practice to prevent children from easily accessing their inhalers
and medication, and administering their medication when and where necessary. Wherever
possible, children should be allowed to carry their own medicines and relevant devices, or
should be able to access their medicines for self-medication quickly and easily.
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Management of medicines in schools| November 2014
Provision for special schools
Pupils with long-term and complex medical conditions may require on-going support,
medicines or care while at school to keep them well. Some children with medical conditions
may also be disabled, and may need to attend schools with additional support and facilities.
Certain children may have special educational needs (SEN) and may have an Education,
Health and Care (EHC) plan in place (this replaces the Statement of Special Educational
Needs from 1st September 2014). These children may have certain staff allocated to them in
order to manage their individual needs as outlined by their IHC. Alternatively, a Health Care
Assistant may be available to deliver the on-going health needs of children with long-term
disabilities. Please note that Health Care Assistants are not provided by the School Nursing
Service; they are specifically trained and funded by separate organisations, for example the
Jessie May Trust or Lifetime.
Again, the role of the school nurse in these circumstances is to support school staff in
planning and implementing a child’s IHC, and to provide advice and liaison in training. It is
not the role of the School Nurse to administer all the medicines to children in special
schools. Training for more complex medical conditions and disabilities may require the
involvement of local specialist nursing teams.
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Summary of key points

It is not the role of the School Nurse to administer all the medicines to children in
school. The role of the School Nurse in mainstream and special schools is to support
the safe administration of medicines by offering training, advice and support to
education and health support staff, and through the development of Individual
Health Care Plans where appropriate.

School nurses must notify the school when a child has been identified to them as
having a medical condition which will require support in school.

It is statutory that the school should have a clear policy regarding the provision of
suitable training for any member of school staff providing support to a pupil with
medical needs, as identified during the development or review of individual
healthcare plans.

Training of school staff should be sufficient to ensure that staff can demonstrate
understanding and have confidence in their ability to support pupils with medical
conditions, and to fulfil the requirements as set out in individual healthcare plans.
School nurses can deliver specific training for managing certain medical conditions.
The Local Authority provides broad training that the school should access.

Any training provided by school nurses should be recorded, with reports produced
annually for commissioners.

Annual update of training is recommended, and it is the responsibility of the school
to ensure that this is done.

Governing bodies should ensure that written records are kept of all medicines
administered to children.
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Management of medicines in schools| November 2014
Recommendations for the School Nurse service
As mentioned at the start of this paper, the aim of this document is to clarify the roles and
expectations of the school nurse service in Bristol and South Gloucestershire in accordance
with the national guidance produced by the DfE, which has recently been updated.
In light of the aforementioned key points, we recommend the following steps that need to
be taken by the school health nurse service should include:
1. Re-writing the CCHP policy for the administration of medicines in schools.
2. Ensuring any training delivered is recorded and reported annually, as per the School
Nurse KPI.
3. Deciding whether to provide a protocol for the administration of medicines in
schools, for the use of certain schools after delivery of training.
4. Offering advice and support to schools in carrying out certain actions, e.g. keeping
written records of all medicines administered to children, as detailed in the updated
CCHP policy (see 1 above).
These recommendations are suggested with the view that the school nurse service in Bristol
and South Gloucestershire will take ownership of the local protocols and policies regarding
the management of medicines in schools. Additionally, by ensuring any recommendations
are in line with national guidance, we hope this will support the school nurse service to give
consistent and unambiguous advice regarding the management of medicines in schools in
Bristol and South Gloucestershire.
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References

Supporting pupils at school with medical conditions: Statutory guidance for
governing bodies of maintained schools and proprietors of academies in England.
Department of Education, April 2014.

Children & Families Act 2014 (Section 3)

Guidance on the use of emergency salbutamol inhalers in schools, Department for
Education, September 2014.

Managing medicines in schools and early years settings, Department for Education
and Skills/Department of Health, March 2005.

NMC (2007) Standards for Medicine Management. Nursing and Midwifery Council:
London

NMC (2008) The Code. Standards of conduct, performance and ethics for nurses and
midwives. Nursing and Midwifery Council: London.

NMC (2008) Advice on delegation for registered nurses and midwives. Nursing and
Midwifery Council: London.

Policy for School Health Nurses to assist schools in supporting children who have
long term and, or complex medical conditions. CCHP (North Bristol NHS Trust),
October 2014.
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Management of medicines in schools| November 2014
Appendix A: Model for developing individual healthcare plans for
children in mainstream schools.
Source: Supporting pupils at school with medical conditions, DfE April 2014.
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Appendix B: Process for formulating a Health Care Plan for children
with long-term and/or complex medical conditions (CCHP)
SHN aware of identified health need for
child/young person but no referral received.
No further action required unless other
identified needs
NO
OR
Referral received for a HCP.
YES
Is HCP required?
Are there Specialist Nurses or other HCPs
involved?
Is HCP required?
NO
YES
Is there pre-existing HCP available?
Contact parent to ascertain child/young
person’s on-going health needs
NO
YES
Assessment or telephone consultation
Formulate HCP with parent/carer &
child or young person
(use generic template if appropriate)
Discuss any pre-existing HCP with relevant school staff & ensure
that school have a copy of the most current HCP or
Liaise/discuss & share with relevant
health professionals
Send completed new HCP to School/GP/Parent/Other relevant
professionals & keep copy for SHN file
(e.g. paediatricians /GP/Specialist Nurses)
Address any training needs in conjunction with Specialist Nurse if
appropriate
16
Source: Policy for School Health Nurses to assist
schools in supporting children who have long term
and, or complex medical conditions, Oct 2014.
Management of medicines in schools| November 2014