Policy and Procedures for Supporting Pupils at School with Medical Conditions and First Aid (formerly known as Administration of Medicines)

** To see the full version of this Policy, including all the Appendices mentioned, please click here: Policy and Procedures for supporting pupils with medical conditions **

Foreword

This document has been prepared to provide guidance on the policy and procedures for Supporting Pupils at School with Medical Conditions, (formerly known as Administration of Medicines) and First Aid. The requirements for statutory provision of Supporting Pupils at Schools with Medical Conditions, First Aid have been taken into account.

Revision

Risk assessments for first aid and the management of medical needs will be reviewed and updated towards the end of each academic year and at the start of the next academic year. This will enable the previous years’ experience to be assimilated and information about new starters, adults and children, to be obtained.

If a sudden change in plans for an activity occurs, an on-the-spot re-assessment can be done. This is sometimes called a dynamic risk assessment.

History of policy changes/review

Author: Briarwood School

Introduction

This Statement of Policy has been approved by the governors of Briarwood School. It should be read in conjunction with the DfE Statutory Guidance “Supporting Pupils at Schools with Medical Conditions’ 2015, “Guidance for First Aid for Schools” 2014 and the “Statutory Framework for the Early Years Foundation Stage” 2014. This DfE document includes a duty to make arrangements to support pupils with medical conditions. These functions can be conferred on a governor, a headteacher, a committee or other member of staff as appropriate. Help and cooperation can also be enlisted from other appropriate persons. However, the governing body, proprietor or management committee remains legally responsible and accountable for fulfilling their statutory duty.

Education Establishments, local authorities, health professionals and other support services should work together to ensure that children with medical conditions receive a full education. In some cases this will require flexibility and involve, for example, programmes of study that rely on part time attendance at school in combination with alternative provision arranged by the local authority. The local authority must ensure that the plan provides for the child or young person to be educated in a maintained nursery school, mainstream school or mainstream post-16 institution, unless that is incompatible with:

1. the wishes of the child’s parent or the young person, or
2. the provision of efficient education for others.

Under Workplace Reform teachers’ conditions of employment do not include giving medication or supervising a pupil taking it. However, education establishments cannot refuse to take responsibility for supporting pupils at schools with medical conditions. It should be an integral part of the establishment’s approach to safeguarding pupils.  They must strive to be an inclusive institution and appeal for volunteers from the staff as a whole to come forward. If not, the establishment must manage change to include appropriate jobs/recruit as necessary.

The Health and Safety (First Aid) Regulations (updated 2013) require employers to provide trained persons, equipment etc. to deal with First Aid emergencies and ill-health occurring at work.

First Aid is provided to:

• Preserve life
• Limit the effects of the condition
• Promote recovery

Policy

This policy applies to all employees, pupils, visitors and service users of Briarwood School. It is explicit about what practice is and is not acceptable. The governing body, leadership and management team will put arrangements in place to support pupils with medical conditions. They will ensure arrangements are in place for children who are competent to do so, to manage their own health needs and medicines.

This policy will be readily accessible for parents/carers and establishment staff.

The governing body delegate the overall responsibility for policy implementation to the Headteacher.

The governing body require that Individual Care Plans are implemented and reviewed appropriately, with a designated person responsible for their collation/acquisition/updating from relevant medical professionals. This is currently the Head of School.

Supporting Pupils at Schools with Medical Conditions is primarily a parent/carer responsibility. Pupils should take medication at home where possible, although provision has been made for medications to remain in school. The vast majority of antibiotics don’t need to be taken at school as they can be taken before and after school and again at bed time.

If the child is acutely unwell, parents/carers should keep them at home for an appropriate period, e.g. sickness and/or diarrhoea for 48 hours (though if over-eating has been known to have taken place, for e.g., flexibility can be applied). More information on exclusion periods following infectious diseases is available from Public Health England.

It is appropriate for over the counter medicines to be administered by a member of staff, or self-administered by the pupil during school hours, following written permission by the parents, as they consider necessary. Parents/Carers are also responsible for informing the school about any major injuries occurring outside of the establishment, for example, if they return with a plaster cast. This is so that the school can prepare for any additional needs this pupil may then have, and if necessary, risk assess. Externally occurring injuries also need to be reported to the Designated Safeguarding Lead (DSL) immediately.

Parents/Carers must provide, in written form, comprehensive and up to-date information on the condition of pupils and changes for better or worse and the medication used. This must be signed, dated and must expressly authorise staff to administer that medication. Parents/Carers must notify staff of all changes in circumstances and/or any other relevant information.

If medication is missed/refused, parents/carers should be alerted and asked to what we need to do to support their child.

There must be a written and signed-off plan for each pupil that is likely to require medication during an off-site visit.

First Aid should be provided where a person will need further medical treatment until such help arrives, and for the treatment of minor injuries. First aiders must do what is appropriate to relieve extreme distress or prevent further and otherwise irreparable harm, e.g. use of an adrenaline pen while keeping themselves safe.

The school may use recruitment as an opportunity to secure a sufficient number of staff with responsibilities for the supporting pupils at schools with medical conditions and first aid. Where no volunteers come forward, it would then be incorporated into the employment contract.

Trained individuals must be available at all times of the school day (e.g. Lunchtimes).

Following any staff reorganisations it is important to check that appropriate numbers of trained individuals are still available.

Only suitably trained individuals can administer medicines to pupils. An Admin of meds course must be completed. Please note that attendance at a first aid course does not constitute ‘supporting pupils at schools with medical conditions’ training.

Senior leaders and managers will take advice from GPs, hospital doctors, occupational health advisors, school nurses, other medical staff and medical charities or other suitable sources as needed.

Arrangements will be in place to make first aid supplies, emergency adrenaline pens, (if held) spare inhalers (if held) and a defibrillator machine (if held) available for any community groups or after school (independent) play schemes, etc. using the facilities, if applicable or ensure the hirers/users have such provision themselves, or achieve the list between them.

The pupils at Briarwood school are also disabled and have severe or profound learning difficulties. For children with SEND this policy must be also read in conjunction with the SEND code of practice.

Responsibility

The Governing body is responsible for selecting the appropriate manager or leader (currently the heads of school) to keep risk assessments/care plans for those with significant medical needs up to date and for ensuring that appropriately detailed arrangements are implemented. The risk assessment/care plans will be supported by the information requested from Parents/Carers at the start of each year. In addition staff and volunteers will be asked for any relevant information they may wish to give on their own health.

The leadership team and Heads of schools must establish the First Aid need by risk assessment and identify suitable employees who are willing to undertake First Aid training and supporting pupils at schools with medical conditions training (see Appendix E). If there are pupils under 5 years old there must be suitable numbers of paediatric first aiders. There must be adequate cover to cater for periods of staff sickness or leave. A register must record the members of staff who have received first aid and / or supporting pupils at schools with medical conditions training. This must be reviewed regularly and always at the start of each academic year. Sufficient numbers of staff must be trained in the use of an Adrenaline pen if there are identified Adrenaline pen users. The school keeps an Automatic External Defibrillator machine (see Appendix P) and that staff are trained in its use.

Employees must be informed of the location of the First Aid personnel and equipment available to them in their working environment. This will be in the form of a standard notice which will be displayed on the Health and Safety notice board at a minimum.

The school maintains a register which records pupils’ medical conditions and allergies e.g. asthma, epilepsy and anaphylaxis. Pupils with severe allergies and requiring adrenaline pens must complete/have an individual healthcare plan. This information must be disseminated amongst all appropriate staff/volunteers involved in the supervision of pupils.

The school must find the appropriate balance between information-sharing and confidentiality. Key information such as ‘severe allergy’ or ‘emergency medicine needed’ must be kept on display in the classroom. Files containing individual healthcare plans must be available in the classroom but not on public display. Similarly, information on food allergies needs to be displayed at the times of the day where food is being prepared/served, and also in classrooms where activities may contain foods (e.g. craft activities with natural materials / tasting in RE etc).

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.

Facilities must be provided to ensure that First Aid is rendered to employees, visitors, service users (including students), volunteers, agency staff etc, if they become ill or are injured at work or under the jurisdiction of the school, on or off site. Headteachers/Managers must put systems in place to ensure that all medicines, medical equipment, first aid rooms/changing areas/tables etc are correctly and safely stored and regularly cleaned after use and maintained.

In administrating medication/treatments and deciding emergency courses of action, staff must have due regard for the following implications and equality issues:

• Diverse cultural values
• Specific medical conditions encountered in particular ethnic groups
• The practices and ethical values of particular faith groups and
• The need for appropriate privacy of pupils while at the same time ensuring issues such as potential accusations of child abuse, especially where intimate procedures are involved or addressed.

Due care should be exercised where English is not the first language of the pupil or parent/carer. Translation services must be sought if parents have difficulty understanding or supporting their child’s medical condition themselves.

The leadership team or Heads of Schools must urgently notify delegated services should there be an outbreak of a notifiable disease such as Norovirus and the postholder will deal with RIDDOR or other reporting requirements. The local Consultant in Communicable Disease Control (CCDC) can advise on the circumstances in which pupils with infectious diseases should be sent home, and the action to be taken following an outbreak of an infectious disease. Or Public Health Services at Bristol City Council at;
PO Box 595, Brunel House, St George’s Road Bristol, BS1 5UY

Tel: 0117 922 2500
Email: health.safety@bristol.gov.uk

The Headteacher must check that the school Public Liability Insurance arrangements will provide an indemnity to employees in respect of claims for personal injury. This indemnity extends to volunteers who have been asked to undertake such duties. The indemnity is subject to the following conditions:

• That training has been received and regularly updated
• That all appropriate Personal Protective Equipment has been issued, maintained, updated and used where necessary and
• That the employee/volunteer has acted within the limitations of their training and has observed all protocols. The employee/volunteer must also be aware of possible side effects of the medication and what to do if they occur.

NB: This indemnity will not apply where claims relate to a criminal offence, a malicious act or an instance of wilful misconduct.

Treatment

Assistance in the administration of prescribed medication can only be made at the request of the pupil’s healthcare practitioner or parent/carer. Where pupils are competent to discern whether they require medication, the role of the staff could well be simply to assist with the administration of that medication e.g. asthma inhalers.

If a child suffers a seizure lasting 5 mins and Buccal Midazolam is advised to be administered according to the Health Care Plan, this must be done, even if it is the first time the child has ever had Buccal. Prior to administering it ring for an ambulance. After administering it, parents must be informed.

Even if all pupils can ‘self administer’ this does not take away the need for staff to attend training.  It is vital that staff understand that a child experiencing an asthma attack or severe difficulty breathing will be unable to administer their own medicines successfully and, therefore, staff will need to have the training to know how to do it. Where the school holds a spare inhaler, all staff must know where it is located and it must not be locked away in a manner that makes it inaccessible to them.

For most pupils at Briarwood, direct administration by staff is permitted where pupils are not competent due to their learning difficulties etc.

Unless the procedure is incredibly basic (see section C of Appendix A), or is emergency treatment such as issuing an inhaler, no member of staff should administer medication unless they have received the appropriate training. Medication directly administered by staff should always be recorded, together with details of the dose, frequency, date, time, name of pupil and main symptom(s) identified, which would prompt a course of action.

Before administering a medication (such as paracetamol), the parent/carer must be contacted and asked if there have been any previous doses that day.

Parents/carers have a responsibility to inform staff members if pupils have brought in medicines and may need to take them in the day. Over-the-counter medication like Calpol can be given by Admin of meds trained staff with written permission from the parent/carer. The bottle must be clearly labelled with the child’s name on it. Staff must fill in a MARs sheet and send a copy home to parents. If not kept as a regular medicine, it will be returned to the parent/carer on conclusion of the school day.

Members of staff should read and comply with the instructions on the container supplied or with the packaging. Expiry dates must be checked.

Where pupils have difficulty in opening containers, or reading labels they or their parent/carers should discuss with their pharmacist the possibility of compliance aids and labels of large print. Staff should note that pupils may still have such difficulties and will require help, including the opening of bottles or the accessing of out-of-reach items.

Failure to obtain relief from the prevailing symptom(s) and any other concerns, following administration of prescribed or non-prescribed medication, must result in the Parents/Carers being informed. The pupil concerned must be referred as necessary to an appropriate medical practitioner. In the event of anaphylactic attack it is important to administer an adrenaline pen as soon as possible and then call 999 for an ambulance, stating your postcode.  The defibrillator machine should be used as soon as possible, although some staff have received training, it is not necessary as the machine talks staff through the process.

For pupils on off site visits and pupils who are being transported, their parents/carers must sign consent forms detailing that medication is appropriate for their child’s use and highlighting any known substances to which that the child has an adverse reaction. Staff carrying out off site visits must carry out risk assessments and must be fully appraised of pupils who may require such medication.

There must always be an individual present who is trained in paediatric first aid if under 5’s are attending the trip.

Sadly, first aid / supporting pupils with medical conditions will not always work and there might be a death in the school. Dial 999, have the postcode ready, and ask for immediate police attendance.  Preserve the scene in case the police wish to investigate. Remove all staff and pupils present to another room and keep them there, with clear instructions to not spread any news via email or social media. The intention is to limit the opportunity for rumours to start and to ensure the parents / close relatives hear from the correct source.

Reporting of accidents and incidents of occupational ill-health

First aid and medical support staff will record incidents on an accident form. All administration of medicine must also be recorded. There should be one incident per page, due to data protection. Any serious incident must be reported to the Headteacher immediately. The school operations committee must also regularly analyse the incident book to spot any patterns and for investigative purposes.

Notification can be made to parents/carers about head bumps and minor injuries through the home school diary at the end of the day with the child. Any significant incident should be discussed with the leadership team or Head of School and will normally be reported to parents/carers by telephone straight away. All injuries, however minor, must be reported to parents/carers in writing at the end of the day.

Notification will be made by the Headteacher to:

• Health and Safety Executive as required under RIDDOR going through Delegated Services
• OFSTED if it is a serious incident and there are safeguarding issues.
• The LA if it is a serious incident and there are safeguarding issues.
• If there is a serious disease the appropriate GP or Public Health England at https://www.gov.uk/phe or through Delegated Services.

Dealing with Medicines Safely

Some medicines may be harmful to anyone for whom they are not prescribed.  Briarwood School agrees to administer this type of medicine, but has a duty to ensure that the risks to the health of others are properly controlled.  In line with COSHH (Control of Substances Hazardous to Health) regulations, there must be a system of checks in place to ensure that all medicines are issued to the correct pupil.

Senior leaders and Heads of Schools should make adequate provision for the safe and appropriate storage of medication. This will normally be a locked cupboard / fridge. Medicines must be supplied, clearly labelled with person name and dose and stored in the original containers. However, certain emergency medicines such as adrenaline pens must not be locked away in a manner that makes them inaccessible to staff. Case-by-case risk assessments will be needed to identify the safest and most appropriate way to store these.

Where a pupil needs two or more prescribed medicines, each should be in a separate container.  Non-healthcare staff should never transfer medicines from their original containers. The only exception to this is certain medications for diabetes. The senior leaders and Heads of Schools are responsible for making sure that medicines are stored safely.  Pupils should know where their own medication is stored and who holds the key.

Some medicines need to be refrigerated.  Medicines can be kept in a refrigerator containing food but should be in an airtight container and clearly labelled.  The establishment must restrict access to a refrigerator holding medicines.

It is wise to have two adrenaline pens for each child at risk of anaphylaxis in the school – one stored with the child, and the other in the school office.  Each adrenaline pen would ideally be stored in a plastic wallet that also contains the name of the child, her/his photograph, and a copy of the child’s individual healthcare plan.

School staff should not dispose of medicines.  Parents/carers should collect medicines, or they should be sent home at the end of each term.  Parents/carers are responsible for disposal of date-expired medicines. If parents/carers do not collect all medicines they should be taken to a local pharmacy for safe disposal.

Sharps boxes should always be used for the disposal of needles. Sharps boxes can be obtained by parents/carers on prescription from the child’s healthcare practitioner. A waste contractor must collect and dispose of the boxes.

All staff should be familiar with normal procedures for avoiding infection and follow basic hygiene procedures. Staff should have access to protective disposable gloves, aprons and masks as necessary and take care when dealing with spillages of blood or other body fluids and disposing of dressings or equipment. This is clinical waste and has to be disposed of by a suitable contractor. If PPE is required for the administration of a medication, all the necessary PPE should be alongside e.g. gloves to encourage use.

As part of general risk management processes there are arrangements in place for dealing with emergency situations. A member of staff should always accompany a pupil taken to hospital by ambulance, and should stay until the parent/carer arrives. Health professionals are responsible for any decisions on medical treatment when the parent/carer is not available. Staff are not usually advised to take a pupil to hospital in their own car. Should they do so, in exceptional circumstances, they must be insured and also accompanied by an additional adult. It is usually safer to call an ambulance.

Individual health care plans should include instructions as to how to manage a pupil in an emergency. All members of staff, including SMSAs, need to be briefed on what to do, or who to contact in the event of an emergency.  There may be pupils who have a “do not resuscitate” instruction, and this information should be sensitively communicated to all staff members involved.

Monitoring and Review

Its implementation is seen as the responsibility of all staff.  Its use and effectiveness will be supported and monitored by the Headteacher and Governors.

This policy is next scheduled for review in September 2021