CODE OF PRACTICE NO. 5
THE VOLUNTARY ADMINISTRATION OF MEDICINES IN SCHOOLS
Reissued January 2005
CODE OF PRACTICE NO. 5
THE VOLUNTARY ADMINISTRATION OF MEDICINES IN SCHOOLS
INTRODUCTION
Legal Position
A.
Any staff who agree to administer medicines to pupils in school do so on an entirely
voluntary basis. There is no obligation on staff to volunteer to administer medicines.
B.
The County Council acknowledges that staff who do agree to administer medicines
are acting within the scope of their employment.
C.
Negligence
(i)
"A headteacher and teachers have a duty to take such care of pupils in their
charge as a careful parent would have in like circumstances, including a duty
to take positive steps to protect their wellbeing”. (Gower -v- London Borough
of Bromley 1999).
(ii)
Parents who allege that a member of staff has acted negligently in the
administration of medicines may bring a civil action against the Local
Education Authority which is vicariously liable for a breach of duty by
headteachers, teachers , other educational professionals and support staff
they employ. In the event of a civil claim for negligence being issued against
a member of staff as well as against the LEA, then the County Council will
indemnify such a member of staff against any claim or action for negligence,
provided that that member of staff has acted responsibly and to the best of
his or her ability and in accordance with the training that he or she received.
2
D.
Criminal Liability
In very rare cases, criminal liability may arise if a member of staff were grossly
negligent and as a result of such gross negligence the pupil dies. This situation
would only arise if the member of staff were reckless or indifferent to an obvious risk
of serious injury or harm.
E.
Disability Discrimination
The Disability Discrimination Act provides that the Governing Body of a school is
subject to an anticipatory duty to make reasonable adjustments outside of the need
to make physical adaptions to buildings and the provision of aids and equipment
which fall to be met by the LEA, to meet the needs of disabled children in general
and to ensure that appropriate policies and practices are in place in order to avoid
discrimination against disabled children. Having in place a policy dealing with the
voluntary administration of medicines is likely to be a reasonable adjustment under
the Act. Claims alleging disability discrimination from a parent are generally made
against the Governing Body of the school in question or, in some circumstances,
against the LEA, and are heard by a SENDIST. Such claims do not give rise to
liability in respect of individual teachers, headteachers or other educational support
staff.
F.
This Code of Practice has been updated and agreed by the Education Safety
Committee.
Reissued January 2005
3
CODE OF PRACTICE NO. 5
THE VOLUNTARY ADMINISTRATION OF MEDICINES
1.
GENERAL
1.1
Children who are acutely ill and who require a short course of
medication e.g. antibiotics, will normally remain at home until the
course is finished. If it is felt by a medical practitioner that the child is fit
enough to return to school, the dosage can usually be adjusted so that
none is required at lunchtime. If, however, this is not possible a
parent/guardian may administer the lunchtime dose by arrangement
with the Head/staff.
1.2
No medicine should be administered by staff unless clear written
instructions to do so have been obtained from the parents or legal
guardians and the school has indicated that it is able to do so (see
sample pro forma – Appendix A). Schools may need to offer
support in the completion of this form where parents have literacy
problems or where English is not their first language.
IT MUST BE UNDERSTOOD THAT ALL STAFF ARE ACTING
VOLUNTARILY IN ADMINISTERING MEDICINES.
1.3
The parents or legal guardians must take responsibility to update the
school of any changes in administration for routine or emergency
medication and maintain an in-date supply of the medication.
1.4
All medicines must be clearly labelled with the child’s name, route i.e.
mode of administering oral/aural etc., dose, frequency and name of the
medication being given.
1.5
Emergency medication and reliever inhalers must follow the child
at all times. Inhalers and emergency treatment medication must follow
the child to the sports field, swimming pool, etc. Children may carry
their own emergency treatment, but if this is not appropriate, the
medication should be kept by the teacher in charge in a box on the
touchline or at the side of the pool. The school may hold spare
emergency medication if it is provided by the parents or guardians, in
the event that the child loses their medication. In these circumstances
the spare medication should be kept securely in accordance with the
instructions below. It is the parents’ responsibility to ensure that
medicines are in-date and replaced as appropriate.
PLEASE ENSURE THAT EACH SECTION IS READ IN CONJUNCTION WITH
THE WHOLE DOCUMENT
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1.6
Where it is agreed by the parents and teachers some medications
or related products e.g., inhalers or Creon will be carried by the
child for self administration. These may be carried in “bum bags” or
swimming pouches. Inhalers should be labelled with the child’s name
and dose: e.g., two puffs.
1.7
All other medicines except emergency medication and inhalers, should
be kept securely. Oral medication should be in a child-proof container.
Some medication needs to be stored in a refrigerator in order to
preserve its effectiveness – this will be indicated on the label. In order
to meet the requirement for security, it is suggested that medication is
stored in a locked cash box within a refrigerator. If a refrigerator is not
available, medication may be kept for a short period in a cool box or
bag with ice packs, provided by the parent/guardian. If kept in a cool
box with ice packs do not store medicine in direct contact with ice
packs as efficacy may be affected. All medication should be kept out of
direct sunlight and away from all other heat sources. Any unused or
time expired medication must be handed back to the parents or legal
guardians of the child for disposal.
1.8
Medicines should be administered by a named individual member of
school staff with specific responsibility for the task in order to prevent
any errors occurring. All children who require medication to be given
during school hours should have clear instructions where and to whom
they report.
1.9
Advice for school staff on the management of conditions in individual
children (including emergency care) will be provided through the
School Nurse or School Doctor on request at the outset of the school’s
consideration of the need for medication. Similarly any difficulties in
understanding about medication usage should be referred to the
School Nurse or School Doctor for further advice.
PLEASE ENSURE THAT EACH SECTION IS READ IN CONJUNCTION WITH
THE WHOLE DOCUMENT
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2.
LONG TERM MEDICATION
2.1
The medicines in this category are largely preventative in nature and it
is essential that they are given in accordance with instructions, see
Section 1 above, otherwise the management of the medical condition is
hindered. (NB specific requirements e.g., it is important that reliever
inhalers are immediately accessible for use when a child experiences
breathing difficulties or when specifically required prior to exercise and
outings.)
2.2
In addition, the parents/guardians must be informed that they must use
the attached pro forma (Appendix A) to report any changes in
medication to the school.
2.3
It is sometimes necessary to explain the use of medication to a number
of pupils in the class in addition to the affected child so that peer group
support can be given.
3.
INJECTIONS
3.1
There are certain conditions e.g. Diabetes Mellitus, bleeding disorders,
or hormonal disorders, which are controlled by regular injections.
Children with these conditions are usually taught to give their own
injections, and where this is not possible, they should be given by their
parents or a qualified nurse (currently employed in a nursing
capacity). It is not envisaged that it will be necessary to give injections
in school unless the child is away on a school visit (see Section 5
below).
PLEASE ENSURE THAT EACH SECTION IS READ IN CONJUNCTION WITH
THE WHOLE DOCUMENT
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4.
EMERGENCY TREATMENT
4.1
i)
No emergency medication should be kept in the school except
those specified for use in an emergency for an individual child.
(see 1 above).
ii)
Advice for school staff about individual children will be provided
through the School Nurse or School Doctor on request at the
outset of planning to meet the child’s needs.
iii)
In the event of the absence of trained staff, it is essential that
emergency back-up procedures are agreed in advance between
the parents and school.
iv)
Storage must be in accordance with Section 1 (above). These
medications must be clearly labelled with the child’s name, the
action to be taken with the route, dosage and frequency (as in
Section 1 above) and the expiry date.
v)
If it is necessary to give emergency treatment, a clear written
account of the incident must be given to the parents or guardians
of the child and a copy must be retained in the school.
4.2
In accordance with 4.1 above
i)
When specifically prescribed, a supply of antihistamines or
adrenaline injection(s) should be made available by parents or
legal guardians if it is known that an individual child is
hypersensitive to a specific allergen e.g. wasp stings, peanuts
etc. Immediate treatment needs to be given before going to the
nearest emergency hospital/or calling an ambulance. Notes
regarding the protocol for establishing the administration of
adrenaline injections and a parental consent form are included
in Appendix B.
ii)
A supply of ‘Factor Replacement’ for injection should be kept in
school where it is required for children suffering from bleeding
disorders. If injection is necessary, it is usual for the child to be
able to give their own injections. If this is not the case, the
parents should be contacted immediately. If contact cannot be
made emergency advice can be obtained between 0900 and
1700 by telephoning the Bleeding Disorders Clinic, Leicester
Royal Infirmary on 0116 2586500.
PLEASE ENSURE THAT EACH SECTION IS READ IN CONJUNCTION WITH
THE WHOLE DOCUMENT
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iii)
A small supply of rectal diazepam may be kept in school for
administration to specifically identified children suffering from
repeated or prolonged fits. Rectal diazepam where prescribed,
should be readily available for use by a qualified nurse
(currently employed in a nursing capacity) or medical staff in
an emergency. Where specific training has been undertaken,
members of school staff may administer rectal diazepam in
accordance with this Code of Practice and with the prior
knowledge and the prior agreement of the child’s medical
advisers and parents. Where this emergency treatment has
been administered by staff, arrangements must be made for the
child to go to the nearest hospital receiving emergencies
immediately after treatment has been given.
Appendix C gives detailed guidance about the administration of
rectal diazepam including Agreement Form procedures, flow
chart, an Agreement Form for completion by the doctor, parent
and school, and a report form.
iv)
At the time of production of this document, Health Service staff
are being trained so that they will be able to offer training to
volunteers in schools in the administration of buccal midazolam
to specifically identified children suffering from repeated or
prolonged fits. Consultants in the Health Service are being
advised about the new procedures. Once the procedures and
training are in place a small supply of buccal midazolam may be
kept in school for administration to specifically identified children
suffering from repeated or prolonged fits.
Appendix D gives detailed guidance about the administration of
buccal midazolam including agreement form procedures, an
agreement form for completion by the Consultant, parent and
school, flow chart and a report form.
v)
A supply of glucose (gel, tablets, drink, food and hypostop etc)
for the treatment of hypoglycaemic attacks, should be provided
by parents/guardians and kept in schools where any pupil
suffers from Diabetes Mellitus. If a second attack occurs within
close temporal proximity (e.g. three hours) the child must go to
the nearest hospital receiving emergencies.
vi)
It is important for children with asthma that reliever inhalers are
immediately accessible for use when a child experiences
breathing difficulties.
PLEASE ENSURE THAT EACH SECTION IS READ IN CONJUNCTION WITH
THE WHOLE DOCUMENT
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5.
SCHOOL VISITS
5.1
Detailed advice and guidance regarding school visits is given in Code
of Practice No. 11, Guidance for the Conduct of Educational Visits and
Adventurous Activities.
5.2
As required by Code of Practice 11, a form must be completed and
returned to the LEA PRIOR to the commencement of any school visit
outside of the County boundary of Leicestershire for a period of more
than 24 hours (see Code of Practice 11).
5.3
A school consent form from the child’s parent or guardian must be
received PRIOR to participation in any school trip. Any medical
problems must be highlighted by the parents or guardians (see Code of
Practice 11 for details).
5.4
Where insurance cover is obtained, medical conditions must be
disclosed, otherwise insurance cover may be refused.
5.5
A named person must be identified to supervise the storage and
administration of medication (see 1 above).
5.6
Wherever possible, children should carry their own reliever inhalers or
emergency treatment (see 1.6 above), but it is important that the
named person (see 5.5 above) is aware of this.
6.
IMPLEMENTATION & REVIEW
6.1
This document constitutes the Approved Code of Practice of
Leicestershire Education Authority. It was agreed by the Education
Safety Committee in September 2004 and supersedes guidance
previously given in earlier versions of Code of Practice 5 and
Administrative Memorandum No. 53.
PLEASE ENSURE THAT EACH SECTION IS READ IN CONJUNCTION WITH
THE WHOLE DOCUMENT
9
7.
DOCUMENTATION
7.1
Appendix A
Request for Administration of medicines (Pink)
7.2
Appendix B
Administration of Adrenaline Injections in response to
severe allergic reactions, advice protocol and parental
consent form. (Yellow)
7.3
Appendix C
Administration of Rectal Diazepam – advice, agreement
form for completion by doctor, parent and school and
rectal diazepam administration report form. (Green)
7.4
Appendix D
Administration of Buccal Midazolam – advice,
agreement form for completion by Consultant, parent
and school and buccal midazolam administration report
form. (Blue)
8.
ADVICE ON MEDICAL CONDITIONS
The School Doctor or Nurse on request will give advice regarding
medical conditions to the school. Parents or guardians of children
suffering from these conditions seeking general information should be
advised to seek advice from their G.P., the school health professionals
(give parents the name and contact number) or from the bodies
detailed below. The following bodies can also supply leaflets regarding
the conditions listed.
Asthma at school – a guide for
teachers
National Asthma Campaign Providence
House
Providence Place
London N1 0NT
Asthma Helpline
Tel: 0845 701 0203
Guidance for teachers concerning
Children who suffer from fits
The British Epilepsy Association
The New Anstey House
Gateway Drive
Yeadon
Leeds LS19 7XY
Tel: 0113 2108800
Guidelines for HIV and AIDS
Department for Education and Skills
Sanctuary Buildings
Great Smith Street
Westminster
London SW1P 3BT
Tel: 0207 9255555
10
Haemophilia
Haemophilia Society
Chesterfield House
Euston Road
London NW1 3AU
Tel:
Allergy to Peanuts and other Nuts
0207 3800600
Asthma & Allergy Research Unit
Leicester General Hospital
Gwendolen Road
Leicester LE5 4PW
Tel: 0116 258 4618
Thalassaemia
UK Thalassaemia Society
107 Nightingale Lane
London N8 7QY
Tel: 0181 348 0437
Fax: 0181 348 2553
Sickle Cell Disease
The Sickle Cell Society
54 Station Road
Harlesden
London NW10 4UA
Tel: 0181 961 7795
Fax: 0181 961 8346
Cystic Fibrosis and School
(A guide for teachers and parents)
Children with diabetes
(Guidance for teachers and school
staff)
Diabetes Careline
Cystic Fibrosis Trust
11 London Road
Bromley
Kent BR1 1BY
Tel: 020 84647211
Diabetes UK
10 Parkway
London
NW1 7AA
Tel: 0207 4241000
Tel: 0207 4241030
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APPENDIX A
REQUEST FOR ADMINISTRATION OF MEDICINES
TO:
Headteacher of
FROM:
Parent/Guardian of
School
Full Name of Child
DATE:
My child has been diagnosed as suffering from
(name of illness).
He/She is considered fit for school but requires the following prescribed
medicine to be administered during school hours
(name of medicine).
Could you please therefore administer
(time) with effect from
(dosage) at
(date) to*
(date)*
The medicine should be administered by mouth** / in the ear ** / nasally ** /
other ** (Please specify)
* Delete if long term medication
** Delete as appropriate
I understand that all staff are acting voluntarily in administering medicines and
have the right to refuse to administer medication. I understand that the school
cannot undertake to monitor the use of inhalers carried by children, and that
the school is not responsible for loss or damage to any medication.
I undertake to update the school with any changes in administration for
routine or emergency medication and to maintain an indate supply of the
medication.
Signed
Name of Parent/Guardian
(please print)
Name of Child
Contact Details: Telephone No. Home
Work
12
APPENDIX B (1/5)
PROTOCOL FOR ESTABLISHING THE ADMINISTRATION OF
ADRENALINE INJECTIONS IN RESPONSE TO SEVERE ALLERGIC
REACTIONS
Sources of Information
There is an anaphylaxis training/resource pack available for school nurses.
Training of School Volunteers
A minimum of 2 volunteers should be trained.
It is envisaged that the school nurse will generally undertake the training of
school volunteers. Updating of school volunteers needs to be undertaken.
Parental Involvement/Counselling
Useful information from the parent might include the nature of allergic
reactions and the provoking allergens. It may be helpful to involve parents in
the educational setting to give a first-hand description of events and to show
the volunteers the injector device to be used.
As it cannot be guaranteed that food provided in school is free of all traces of
allergens, it is advisable for children with food allergies to bring packed
lunches and parents should be made aware of this.
Training of Other Groups
Wherever possible peers should be made aware of the child’s condition and
how they should respond (alerting school staff speedily in the event of an
anaphylactic reaction occurring). All school staff should be similarly aware.
13
APPENDIX B (2/5)
Administration of Pre-Prepared Epinephrine (Adrenaline) Injection(s) in
Response to Anaphylaxis
Protocol for Health Staff to Support Non-medical and Non-nursing Staff
Pre-prepared Epinephrine injections(s)
is/are prescribed by doctor
Administration Agreement Form is signed
by doctor and parent
Parent informs and discusses with head of agency in non-health setting that
emergency pre-prepared epinephrine injection(s) has/have been prescribed
If child unable to self administer, head of agency identifies volunteers to administer
epinephrine
Consider
alternative
management
No volunteer identified
Head of agency contacts related health
professional
Volunteer(s) read(s) service policy/guidelines
on administration of medicines
Parent informed
Parent informs
prescribing Doctor
If volunteer(s)
available, volunteer(s)
receive(s) training from
health professional.
Sign Agreement Form
Volunteer(s) (authorised
person(s)) sign(s)
training form
Head of agency confirms to parents that
procedure will be implemented
Agency keeps original form with all
signatures completed and copies
appropriately
14
APPENDIX B (3/5)
AGREEMENT FOR THE ADMINISTRATION OF PRE-PREPARED
EPINEPHRINE (ADRENALINE) INJECTION(S) AS TREATMENT FOR
ANAPHYLAXIS BY NON-MEDICAL AND NON-NURSING STAFF
TO BE COMPLETED BY A PRESCRIBING DOCTOR, PARENT, THE HEAD OF HE
ADMINISTERING AGENCY AND THE AUTHORISED PERSON.
THE INSTRUCTIONS ON THIS FORM EXPIRE 1 YEAR FROM THE DATE OF
SIGNATURE OF THE HEAD OF THE ADMINISTERING AGENCY.
NAME OF CHILD: ………………………………………..
DOB: …………………..
The above child has been identified as having a severe allergic reaction to:-
Previous symptoms shown that require injection are:-
The device(s) used should be
*Epipen / *Epipen Junior
*0.3 / *0.15 mgs
*Anapen / *Anapen Junior
*0.3 / *0.15 mgs
GIVE DOSE OF PRE-PREPARED EPINEPHRINE INJECTION THEN PHONE 999
FOR AN AMBULANCE
* A second dose using a second prescribed device detailed above should be
administered when:
Remember to tell the
ambulance or EPINEPHRINE
hospital staff the exact
time and name of pre-prepared
PRE-PARED
INJECTION(S)
epinephrine (ADRENALINE)
injection(s) given (seeADMINISTRATION
the Report Form)
REPORT FORM
* delete as appropriate
15
APPENDIX B (4/5)
Complete Report Form giving a clear account of the incident. Copies should go to the
parent, nurse and ambulance staff if possible. The original should be kept by the
administering agency.
The parents will be responsible for informing doctors and anyone else who needs to
know if pre-prepared epinephrine injection(s) has/have been given, for the renewal of
the agreement on expiry and for maintaining an in-date supply of medication.
This plan has been agreed by the following: (Block Capitals)
PARENT/GUARDIAN
NAME
Tel No:
Signature
Date
Emergency telephone contact number
PRESCRIBING DOCTOR
NAME:
Signature
Date
HEAD OF ADMINISTERING AGENCY
NAME:
Signature
Date
AUTHORISED PERSON(S) TO ADMINISTER PRE-PREPARED EPINEPHRINE
INJECTION
NAME (Block Capitals)
Signature
Date
NAME (Block Capitals)
Signature
Date
NAME (Block Capitals)
Signature
Date
NAME (Block Capitals)
Signature
Date
NAME (Block Capitals)
Signature
Date
COPIES OF THIS FORM SHOULD BE HELD BY THE DOCTOR, THE PARENTS
AND THE ADMINISTERING AGENCY
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APPENDIX B (5/5)
PRE-PREPARED EPINEPHRINE INJECTION(S)
(ADRENALINE) ADMINISTRATION REPORT FORM
NAME OF CHILD:
DOB:
DATE OF ALLERGIC REACTION:
TIME REACTION STARTED:
TRIGGER:
DESCRIPTION OF SYMPTOMS OF REACTION:
TIME EPINEPHRINE
INJECTION GIVEN 1st
*2nd
GIVEN BY 1ST
*2ND
DEVICE USED: * Epipen / *Epipen Junior
* Anapen / * Anapen Junior
SITE OF INJECTION 1ST
*2ND
ANY DIFFICULTIES IN ADMINISTRATION?
TIME AMBULANCE CALLED:
ARRIVED:
ANY OTHER NOTES ABOUT INCIDENT (eg child eating anything, other injuries to child):-
WITNESSES:
FORM COMPLETED BY:
NAME (print):
SIGNATURE:
JOB TITLE:
CONTACT TEL. NO:
DATE:
Original to Child’s Agency Record
CC. Hospital with child (where possible)
Parent
* delete as appropriate
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APPENDIX C (1/5)
ADMINISTRATION OF RECTAL DIAZEPAM
School Nurses are able to undertake the training of volunteers identified by schools
to administer Rectal Diazepam to identified children in accordance with the
emergency treatment section of the above Code of Practice.
The issue of the potential for the administration of Rectal Diazepam to be
administered in the school setting will initially be raised with the parents by the
supervising doctor. If the parents are agreeable to this, the doctor will complete the
appropriate parts of the Agreement Form, sign it and obtain the parents’
signature(s). The parents will then be in a position to bring the Agreement Form to
the Headteacher, such that s/he may identify a volunteer. The Headteacher would
then be in a position to contact the School Nurse to arrange appropriate training for
the volunteer if they had previously not received training.
On completion of the training, the Agreement Form would then be signed by both the
person authorised and trained to administer Rectal Diazepam and the Head of the
school.
Also enclosed is a flow diagram to assist schools in understanding the procedures
that should be followed in the completion and development of the Agreement Form.
If emergency treatment is given, a clear written account of the incident should be
given to the parents and a copy retained in school. To this end a specific Report
Form has been developed. Also attached is a flow diagram for the use of the Report
Form.
18
APPENDIX C (2/5)
ADMINISTRATION OF RECTAL DIAZEPAM IN RESPONSE TO EPILEPTIC
SEIZURES/FITS/CONVULSIONS
Protocol for Health Staff to Support Non-medical and Non-nursing Staff
Child with seizures meets criteria for
prescription of rectal diazepam
GP/Consultant Paediatrician prescribes
Discusses with parents indicating this is dependant on volunteer from agency
agreeing to administer rectal diazepam
Agreement form completed and signed by GP/Consultant Paediatrician and parents (and
older child if appropriate). Copies for GP/Consultant Paediatrician and parent
Reconsider
later
Parent takes original copy to non-health setting and discusses with
head of agency, e.g., headteacher, senior social worker (if rectal
diazepam is required in more than one non-health setting an in date
copy of the agreement form may be used with the agreement of the
head of that agency)
Head of agency identifies volunteers to administer rectal diazepam
No volunteer identified
Parent informed
Parent informs
GP/Consultant
Paediatrician
Parent to inform
GP/Consultant
Paediatrician of
expiry of and
need for
reconsideration
of prescription
Volunteer(s) identified
Volunteer(s) read(s) agency
policy/guidelines on
administration of medicines
Volunteer(s) receives training from health
professional which includes discussion of
agreement form for a specific child
Volunteer(s) (authorised person(s)) sign(s) form
Head of agency signs form
(headteacher/senior social worker)
Head of agency (headteacher/senior
social worker) confirms to parents that
procedure will be implemented
Agency keeps original form
with all signatures completed
and copies appropriately
Parent informs
GP/Consultant
Paediatrician
19
APPENDIX C (3/5)
AGREEMENT FOR THE ADMINISTRATION OF RECTAL DIAZEPAM AS TREATMENT
FOR EPILEPTIC SEIZURES/FITS/CONVULSIONS BY NON-HEALTH STAFF
TO BE COMPLETED BY A CONSULTANT or GP, PARENT, THE HEAD OF THE
ADMINISTERING AGENCY AND THE AUTHORISED PERSON
THE INSTRUCTIONS ON THIS FORM EXPIRE 1 YEAR FROM THE DATE OF
SIGNATURE OF THE PRESCRIBING DOCTOR
NAME OF CHILD:
DOB:
Description of type of fit/convulsions/seizure which requires rectal diazepam:tick
tonic and/or clonic seizure (stiff and/or jerking), *lasting
or
*repetitive over
without regaining consciousness
minutes
minutes
IF THE CHILD’S GENERAL CONDITION IS A CAUSE FOR CONCERN AT ANY STAGE
PHONE 999 FOR AN AMBULANCE
The dose of rectal diazepam should be ………. tube containing ………. mgs.
This should be administered by a named individual (see over) in accordance with the
protocol advised by the Leicester, Leicestershire & Rutland Specialist Community
Child Health Services (LLRSCCHS).
The normal reaction to this dose is
and should occur in 5 to 10 minutes
Particular things to note are:-
Action to take (i.e. 2nd dose):After rectal diazepam has been given the child must be escorted to the nearest
hospital receiving emergencies. Unless someone can escort the child to hospital it
will be necessary to ‘phone 999 for an ambulance. Remember to tell the ambulance or
hospital staff the exact time and dose of rectal diazepam given (see the Report Form).
If the parent/carer or a doctor or a nurse is present, the decision about the need for
transfer to the hospital will rest with them.
20
APPENDIX C (4/5)
After rectal diazepam is given, please complete a Report Form giving a clear account
of the incident. Copies should go to the parent and the nurse. The original should be
kept by the administering agency.
The parents will be responsible for informing doctors and anyone else who needs to
know if rectal diazepam has been given, and for maintaining an in-date supply of
medication for ensuring medical consideration of need on expiry of the agreement.
This has been agreed by the following:
GP/CONSULTANT (Block Capitals)
Signature
Date
PARENT/GUARDIAN (Block Capitals)
Signature
Date
OLDER CHILD/YOUNG PERSON (Block Capitals)
Signature
Date
HEAD OF ADMINISTERING AGENCY (Block Capitals)
(HEAD/SENIOR SOCIAL WORKER)
Signature
Date
AUTHORISED PERSON(S) TO ADMINISTER RECTAL DIAZEPAM
NAME (Block Capitals)
Signature
Date
NAME (Block Capitals)
Signature
Date
NAME (Block Capitals)
Signature
Date
COPIES OF THIS FORM SHOULD BE HELD BY THE PARENTS, THE
GP/CONSULTANT AND THE ADMINISTERING AGENCY.
21
APPENDIX C (5/5)
RECTAL DIAZEPAM ADMINISTRATION
REPORT FORM
NAME OF CHILD:
DOB:
DATE OF SEIZURE / FIT / CONVULSION:
TIME SEIZURE / FIT / CONVULSTION STARTED:
ACTIVITY WHEN SEIZURE / FIT / CONVULSION BEGAN:
DESCRIPTION OF SEIZURE / FIT / CONVULSTION:
TIME RECTAL DIAZEPAM GIVEN: DOSE GIVEN:
MG
GIVEN BY:
ANY DIFFICULTIES IN ADMINISTRATION?
TIME SEIZURE / FIT / CONVULSION STOPPED:
TIME CHILD TAKEN TO HOSPITAL:
ANY OTHER NOTES ABOUT INCIDENT (e.g., injuries to child or other parties,
child sleepy):
SIGNED (authorised person):
NAME (print):
DATE:
DESIGNATION:
Original to Child’s Agency Record
cc:
Hospital with child (where possible)
Parent
Other e.g., Health and Safety Adviser for Education
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APPENDIX D (1/5)
ADMINISTRATION OF BUCCAL MIDAZOLAM
When a child would benefit from receiving buccal midazolam in a non-health setting e.g.,
school, nursery, respite facility, then the Consultant Paediatrician will discuss this with the
parent.
If the parent is in agreement the Consultant Paediatrician will complete an agreement form
for the administration of buccal midazolam by non-medical and non-nursing staff in
conjunction with the parent, indicating that administration in a non-health setting e.g.,
school respite centre, is dependent on volunteers being available from that agencies’ staff.
Both the Consultant Paediatrician and parent should sign the agreement form – along with
the child if appropriate.
It is the parent’s responsibility to then raise the issue with, and take the agreement form to,
the head of the administering agency e.g., headteacher, senior social worker. The head
can then identify (a) volunteer(s) to undertake training in the administration of buccal
midazolam.
If no volunteers are identified the parent should be informed and it is the parent who
should inform the Consultant Paediatrician. The Consultant Paediatrician and parent may
wish to reconsider the need for buccal midazolam to be administered in non-home settings
at a later date and restart the process.
If (a) volunteer(s) is/are identified they should read their service policy/guidelines on the
administration of medicines. The head of the administering agency should then liaise with
the health professional eg., School Health Nurse, to arrange a mutually convenient date
for training.
The health professional will carry out a training programme incorporating epilepsy
awareness, first aid for seizures, the administration of buccal midazolam and
documentation to the volunteers. The health professional will discuss with the volunteers
the agreement form for the administration of buccal midazolam for non-medical and nonnursing staff for a specific child.
Following the training the volunteer(s) sign(s) the training agreement form and the
administration agreement form. The administration agreement form then becomes a
contract between the Consultant, the parent and the administering agency e.g., school,
respite agency. The health professional is responsible only for providing the training of the
volunteers – not for the administration of buccal midazolam and not for identifying
volunteers.
The administering agency therefore holds the original copy of the administration
agreement form complete with the signatures of parent, Consultant Paediatrician,
volunteers and administering agency head. The parents are responsible for informing the
Consultant Paediatrician and GP that volunteers have been trained to administer buccal
midazolam.
Parents are responsible for highlighting the expiry date on the agreement form to the
Consultant Paediatrician to review and renew the agreement form when necessary.
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APPENDIX D (2/5)
ADMINISTRATION OF BUCCAL MIDAZOLAM IN RESPONSE TO
EPILEPTIC SEIZURES/FITS/CONVULSIONS
Protocol for Health Staff to Support Non-medical and Non-nursing Staff
Child with seizures meets criteria for
prescription of buccal midazolam
Consultant Paediatrician prescribes
Discusses with parents indicating this is dependant on volunteer from nonnursing and non-medical staff agreeing to administer buccal midazolam
Agreement form completed and signed by Consultant and parents (and older child if
appropriate). Copies for Consultant and parent
Reconsider
later
Parent takes original copy to non-health setting and discusses with
head of agency, e.g., headteacher, senior social worker (if buccal
midazolam is required in more than one non-health setting a copy of
the agreement form may be used with the agreement of the head of
that agency)
Head of agency identifies volunteers to administer buccal
midazolam
No volunteer identified
Parent informed
Volunteer(s) identified
Parent to
inform
Consultant
Paediatrician
of need for
review and
renewal of
agreement
form
Volunteer(s) read(s) service
policy/guidelines on
administration of medicines
Parent informs
Consultant
Volunteer(s) receives training from health
professional which includes discussion of
agreement form for a specific child
Volunteer(s) (authorised person(s)) sign(s) form
Head of agency signs form
Head of agency confirms to parents that
procedure will be implemented
Agency keeps original form
with all signatures completed
and copies appropriately
Parent informs
Consultant
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APPENDIX D (3/5)
AGREEMENT FOR THE ADMINISTRATION OF BUCCAL
MIDAZOLAM AS TREATMENT FOR EPILEPTIC
SEIZURES/FITS/CONVULSIONS BY NON-MEDICAL AND NONNURSING STAFF
TO BE COMPLETED BY A CONSULTANT, PARENT, THE HEAD OF THE
ADMINISTERING AGENCY AND THE AUTHORISED PERSON.
THE INSTRUCTIONS ON THIS FORM EXPIRE 1 YEAR FROM THE DATE
OF SIGNATURE OF THE HEAD OF THE ADMINISTERING AGENCY.
NAME OF CHILD: …………………………….. DOB: …………………..
Description of type of fit/convulsions/seizure which requires buccal midazolam:tick
tonic and/or clonic fits (stiff and/or jerking), * lasting
minutes
or
* repetitive over
minutes
without regaining consciousness
IF THE CHILD’S GENERAL CONDITION IS A CAUSE FOR CONCERN AT
ANY STAGE PHONE 999 FOR AN AMBULANCE.
The dose of buccal midazolam should be ml(s) in volume of 10mg in ml(s)
preparation
This should be prepared and administered by a named individual (see over) in
accordance with the protocol provided by the Leicester, Leicestershire
& Rutland Specialist Community Child Health Service’s (LLRSCCHS).
The normal reaction to this dose is
and should occur in 5 to 10 minutes.
Particular things to note are:-
Action to take:-
After buccal midazolam has been given the child must be escorted to the nearest
hospital receiving emergencies. Unless someone can escort the child to hospital
it will be necessary to ‘phone 999 for an ambulance. Remember to tell the
ambulance or hospital staff the exact time and dose of buccal midazolam given
(see the Report Form). If the parent/carer or a doctor or a nurse is present, the
decision about the need for transfer to the hospital will rest with them.
25
APPENDIX D (4/5)
After buccal midazolam is given, please complete a Report Form giving a
clear account of the incident. Copies should go to the parent and the nurse.
The original should be kept by the administering agency.
The parents will be responsible for informing doctors and anyone else who
needs to know if buccal midazolam has been given, for the renewal of the
agreement on expiry and for maintaining an in-date supply of medication.
This plan has been agreed by the following:
CONSULTANT (Block Capitals) …………………………………………………………
Signature ……………………………………………
Date ………………………
PARENT/GUARDIAN (Block Capitals) ……………………………. Tel No. …………….
Signature …………………………………………….
Date ………………………
OLDER CHILD/YOUNG PERSON (Block Capitals) ………………………………………
Signature …………………………………………….. Date ………………………
HEAD OF ADMINISTERING AGENCY (Block Capitals) ……...…………………………
Signature …………………………………………….. Date ………………………
AUTHORISED PERSON(S) TO ADMINISTER BUCCAL MIDAZOLAM
NAME (Block Capitals) ……………………………………………………………………….
Signature …………………………………………….
Date ………………………
NAME (Block Capitals) ……………………………………………………………………….
Signature …………………………………………….
Date ………………………
NAME (Block Capitals) ……………………………………………………………………….
Signature …………………………………………….
Date ………………………
COPIES OF THIS FORM SHOULD BE HELD BY THE PARENTS, THE
CONSULTANT AND THE ADMINISTERING AGENCY.
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APPENDIX D (5/5)
BUCCAL MIDAZOLAM ADMINISTRATION
REPORT FORM
NAME OF CHILD:
DOB:
DATE OF SEIZURE / FIT / CONVULSION:
TIME SEIZURE / FIT / CONVULSTION STARTED:
ACTIVITY WHEN SEIZURE / FIT / CONVULSION BEGAN:
DESCRIPTION OF SEIZURE / FIT / CONVULSION:
TIME BUCCAL MIDAZOLAM GIVEN:
DOSE GIVEN:
preparation
ML(S) of
GIVEN BY:
ANY DIFFICULTIES IN ADMINISTRATION?
TIME SEIZURE / FIT / CONVULSION STOPPED:
TIME CHILD TAKEN TO HOSPITAL:
ANY OTHER NOTES ABOUT INCIDENT (e.g., injuries to child or other parties, child sleepy):
SIGNED (authorised person):
NAME (print):
DATE:
DESIGNATION:
Original to Child’s Agency Record
cc:
Hospital with child (where possible)
Parent
Nurse
27