Administering Medication in Schools

Administering medication can involve and include several tasks.

For the purpose of this article we will look at the following tasks and responsibilities when we discuss administering medication:

• Receiving and storing medication.
• Checking prescription information and expiry dates on medications.
• Ensuring hand hygiene is maintained by all parties handling medications.
• Ensuring appropriate PPE is used.
• Reminding pupils to take medication.
• Supporting pupils to access medication.
• Assisting pupils to dispense their medication, e.g. opening containers/blister packs.
• Supporting pupils to measure the correct dosage of medication.
• Supporting pupils to consume or apply medication.
• Supporting pupils to assemble and use equipment needed to take medications, e.g. nebulisers or space chambers for inhalers.
• Giving pupils emergency medications.
• Monitoring pupils for side effects after taking medications.
• Recording activities involving medication.

Key legislation

There are several different pieces of legislation that set out the legal requirements for the handling and administration of medicines in schools, including:  

• The Children and Families Act (2014).
• Health and Safety at Work etc. Act (1974).
• Misuse of Drugs Act (1971).
• School Premises Regulations (2012).
• Education Act (1996).

The Children and Families Act (2014) places a duty on the governing bodies of schools to ensure that pupils with medical conditions are properly supported and have access to a full education.

As part of this duty schools must have arrangements in place to ensure that pupils who need medication during school hours can be supported to access and take this medication safely.

Staff are not expected to know or remember all the relevant legislation; however, they are expected to know and follow the school’s medication policy. This will ensure that staff have acted within the boundaries of the law.

What are the consequences of not following relevant legislation and guidance?

Failing to follow legislation and guidance can have very serious consequences for everyone involved including: the pupil, the school, the staff member and their colleagues.

Consequences for the pupil

Not complying with legislation can lead to unsafe medication handling and administration practices which can increase the likelihood of a medication error occurring.

Medication errors could mean pupils are given the wrong medication, no medication, or too much medication, all of which could lead to the pupil becoming seriously unwell or in serious cases could lead to death.

Consequences for the school

Failure to follow legislation will lead to poor quality services which would lead to poor Ofsted inspection ratings and a poor reputation. Where there are significant or repeated breaches in following legislation there could also be fines or prosecutions.

Consequences for the staff member

Where an individual staff member has failed to follow legislation or school policies and procedures, they could be in breach of their contract of employment.

As a result, failure to comply could lead to disciplinary action and dismissal. Depending on the nature of the issue it could also lead to the staff member being barred from working with children or vulnerable people in the future.

The roles and responsibilities of administering medication in school

Most pupils at some stage of their school career will need to take prescribed or over-the-counter medications to help treat or manage a medical condition.

Administering and storing medication will always carry a level of risk. Most medications can be given at intervals which can be planned around the school day, e.g. antibiotics which must be taken three times a day could be given at home on a morning before school, after school and before bedtime.

It is therefore reasonable for schools to work with parents/carers and healthcare professionals to see whether the medication can be administered outside of school hours.

Medication should only be administered during school hours when it is necessary, and the medication cannot be given before/after school.

In relation to administering medication there are the following roles and responsibilities outlined within the legislation:

• Parents/legal guardians have the primary responsibility for their child’s health and wellbeing.
• Governing bodies of schools are responsible for ensuring pupils with medical conditions are supported and have access to a full education.
• Headteachers are responsible for ensuring that policies are implemented, and all staff are aware of the policy and their role in relation to supporting pupils with medical needs.
• School staff must ensure pupils are supported to access and take medication safely when it is needed during school hours.
• Teachers do not have a legal or contractual duty to administer or supervise pupils taking medications; however, they can take on this role voluntarily.
• Support staff in schools may be contracted to administer medications.

Any staff member involved in administering medications either as part of their employment contract or voluntarily is responsible for ensuring they follow the school’s policies and procedures when administering medication to pupils.

What is a school medication policy?

Every school must have a detailed policy in place that explains the school’s approach to managing pupils’ medical needs and outlines the procedures in place to safely manage medication needs.

The policy must include:

• Details of parents/carers’ duty to inform the school of medical needs and how to do this.
• A procedure to follow when a parent/carer informs the school of a medical need.
• How individual pupil’s medical needs will be recorded.
• Specific staff roles and responsibilities in relation to managing pupils’ medical needs and medications.
• The school’s policy on administering non-prescription / over-the-counter medications.
• How medication should be delivered to school and stored in school.
• When and how class teachers will be made aware that a pupil has medical needs.
• How pupils and staff access medication.
• Whether children are permitted to keep any medication with them during the school day, e.g. inhalers for asthma.
• What records must be kept relating to medication.
• What medication checks and audits will be completed and by whom.
• What to do in the event of a pupil becoming seriously unwell.
• What to do in the event of a pupil having an adverse reaction to medication.

What are individual Health Care Plans

To ensure that accurate and detailed records are kept, schools are expected to create Individual Health Care Plans (IHCP) for pupils with long-term medical conditions and needs. The government has provided an example IHCP and information on what they should contain in the statutory guidance ‘Supporting pupils at school with medical conditions’ (December 2015).

IHCPs should be completed with the pupil and their parent/carer and should contain the following information:

• The pupil’s information: name, date of birth, class, home address and medical diagnosis.
• Next of kin contact information: name, relationship to child, contact telephone numbers.
• GP: name, address, contact number.
• Contact names and numbers of any consultant, hospital clinic or other named medical professional involved.
• Which staff members will support the pupil.
• Information about the medical condition and how it affects the pupil, e.g. symptoms, side effects, impact on daily life, triggers, daily support needs.
• Information on how the medical condition may impact on the pupil’s learning and development.
• Any medications needed: name of medication, dosage, how and when medication is taken, possible side effects.
• Arrangements needed for school trips/events.
• Any potential emergency situations: warning signs/symptoms, steps to take in the event of an emergency.
• Who was involved in writing and agreeing the plan.
• Date plan was written, when and how often it will be reviewed.

The importance of written consent

As well as having an Individual Health Care Plan (IHCP) schools must also have written consent from the parent/carer to administer medication. The consent form must include specific information about the medication including the name, dose, time, method, and any special instructions.

Schools may wish to use the written consent to also document the agreement for how the medication will be delivered to school, e.g. that the medication will be handed to a specific member of staff.

Schools can only administer medication which is in its original container and is clearly labelled. For prescription medication the label must have been printed by the dispensing pharmacy with the medication’s name, child’s name and details, GP’s name, date of issue, dosage and instructions and expiry date.

Non-prescription medication

Schools should have a clear policy on how they will manage over-the-counter or non-prescription medications. School staff can administer non-prescription medication when they have written consent from the pupil’s parent/carer.

It can be beneficial for schools to seek permission to be able to administer some non-prescription medications in the event of a child becoming unwell during the school day. For example, administering children’s paracetamol (e.g. Calpol) to a pupil who has developed a high temperature can prevent them from becoming more seriously unwell.

Schools may choose to specify which non-prescription medications are appropriate and can be administered, e.g. children’s paracetamol or antihistamines.

As with prescription medication, school staff can only administer non-prescription medications that are supplied in the original container.

Consent from the pupil

As well as written consent from the parent/carer, staff should seek verbal consent from the pupil before administering medication.

It’s important that medication is administered in a private setting, away from distractions and that the pupil’s confidentiality is maintained. Some pupils may not like taking medication, so talking to them beforehand and agreeing a method can avoid difficulties administering the medication, e.g. having a drink ready for the pupil to have afterwards to help deal with any unpleasant taste.

Seeking consent and promoting the pupil’s independence as much as possible is likely to make the process easier for the pupil and the staff member and help to avoid issues such as pupils spitting medication out (something that can be more common with younger age pupils).

Promoting independence and allowing pupils to do as much of the process for themselves as possible will support pupils to become more responsible and independent in managing their own medications. For pupils with long-term medical conditions this can be important for building their level of self-confidence and sense of responsibility over their own wellbeing.

The importance of school procedures

It is essential that schools have very clear procedures for parents/carers, pupils and staff to follow when a pupil needs medication to be administered during the school day.

It is usually a headteacher’s responsibility to work with the school’s governing body to develop a policy and procedure for how the school will support pupils with medications.

It is then the headteacher’s role to implement the policy.

This should include:

• Identifying named staff who are responsible for creating Individual Health Care Plans (IHCP) for pupil’s who need medication.
• Ensuring that the staff involved in handling and administering medications are sufficiently trained and competent.
• Establishing a robust communication and information sharing procedure to ensure that all relevant staff are aware of the pupil’s medical needs and how to support them.
• Identifying named staff who parents/carers must report medical needs to.
• Clear processes for storing and handling medication.

The importance of medication policies and procedures

Schools must ensure that they have written medication policies and procedures in place for staff and parents/carers to follow. The policies and procedures should be written with reference to the relevant legislation and guidance.

Policies and procedures should provide staff with step-by-step guidance and all the information they need to be able to safely handle and administer medication.

Effective policies and procedures help to:

• Ensure staff are working in compliance with legislation.
• Provide organisation and promote effective communication.
• Provide staff with support and guidance.
• Reduce the risk of medication errors occurring.
• Provide parents with information to follow.
• Set expectations and standards for everyone involved.

Accountability vs responsibility

When it comes to medication handling and administration it’s important that we’re clear on what a staff member is accountable for and what they are responsible for.

• Accountability means accepting responsibility or liability for the outcome of your actions. Staff must be able to explain and give reasons for their actions and decisions.
• Responsibility is having a duty to do a defined set of tasks or functions and carrying out those tasks to the best of your ability. Being responsible for handling and administering medication means that a staff member must have some knowledge so must be trained and supervised until competent.

In reference to medication administration this means that:

• A staff member may be responsible for administering medication.
• They are responsible for doing this to the best of their ability.
• They are responsible for carrying out this duty in line with the school policy.
• They are accountable for the outcome of any actions they take which were not in line with the school policy or the training they’ve received.

The importance of accountability

Accountability is particularly important when it comes to medication handling and administration as it means staff are responsible for:

• Only carrying out tasks they have been trained to.
• Keeping their knowledge up to date.
• Never carrying out tasks they are not trained in.
• Being aware of the limitation of any training they have had.
• Following school policies and procedures.
• Reporting any concerns.

When a staff member has been made responsible for administering medication, they are accountable for the outcome of this. This means that they should not delegate the task to other staff members who may not be trained or competent.

What are medication errors?

There are many ways to minimise the risk of a medication error occurring; however, they may still occur. Medication errors can lead to minor symptoms and inconvenience or could have very serious consequences and can even lead to death.

Medication errors could be:

• Forgetting to administer a medication.
• Giving the wrong medication.
• Giving too much or too little of a medication.
• Giving a medication the wrong way (i.e. via the wrong route).
• Giving medication at the wrong time.

If you make a medication error, you must never ignore it or try to cover it up. This will lead to more harm to the pupil and more serious consequences for yourself and the school.

Managing a medication error

School medication policies must contain a clear procedure for staff to follow in the event of a medication error occurring. Staff should be supported and encouraged to be open and transparent when it comes to errors, so the focus should be on what they can do to prevent a more serious situation developing.

In the event of an error staff should:

• Stay calm.
• Check all the information again to be clear on what the error is.
• Report the error to a more senior/experienced staff member.
• Ask the senior staff member to come and check the pupil.
• Contact the pupil’s parent/carer to inform them of the error and agree next steps.
• Arrange for advice to be sought from the pupil’s GP.
• Document the error on the Medication Administration Record (MAR).
• Complete an incident report.

If at any point after the medication has been administered the pupil starts to show signs of being unwell, staff should call 111 for immediate advice and support.

If the pupil loses consciousness, experiences difficulties breathing, or shows any other signs of serious illness staff should call 999.

The importance of training

As this unit has illustrated, administering and handling medication is a responsibility that staff and schools should take seriously, as when not done safely and to a high standard there can be severe consequences for everyone involved.

By completing training on the handling and administration of medication staff will be more knowledgeable and confident. They will have a good understanding of the procedures to follow to safely administer medication and how to significantly minimise the risk of medication errors occurring.

Being able to administer medication quickly and effectively in emergency situations, e.g. during an asthma attack or a seizure, can prevent a pupil from becoming significantly unwell and can even save lives.

Having good training in place and robust policies and procedures ensures that the school environment is accessible and inclusive and there are reduced barriers to pupils accessing learning.