The Importance of Keeping Accurate Medication Records in Schools

All educational institutions have responsibilities when it comes to managing records. Efficient record-keeping in schools is incredibly important, and there are various types of documents and files these institutions must manage. These records mainly relate to their pupils, but they can also include recording information about staff members, as well as processes and facilities.

Record-keeping in education is a huge responsibility, particularly pupils’ medication records. Schools must ensure that they are keeping these records efficiently and securely, as not to do so can not only have serious safety and safeguarding implications, but it can also have considerable implications for security and the school’s reputation.

In this article we will examine the importance of keeping accurate medication records in schools.

Medication Management in Educational Settings

Parents and/or carers have the prime responsibility for their child’s health and should provide school settings with detailed information about their child’s medical condition. Schools need to communicate this responsibility to all parents and/or carers, and they can do so, for example, via school parent/carer meetings, via the school prospectus and on the school website information section. It is important that schools are fully informed of all relevant information about pupils’ medical conditions and medication needs in order to protect pupils’ safety and well-being during school hours.

It is also crucial that all staff working in school settings understand how the setting will manage the administration of both prescribed and non-prescribed medicines, and also understand the setting’s responsibilities with respect to duty of care.

The school setting is required to have a policy on supporting pupils with medical conditions if the school setting is:

• A maintained school (mainstream or special)
• An academy
• A free school
• A pupil referral unit (PRU)

The policy should clearly outline the roles and responsibilities of all staff involved in administering medicines and should include a section on administering medicines that all staff can refer to. In addition, all staff must have appropriate training before giving prescription medicines or carrying out any medical procedures, for example administering first aid medication such as auto-injectors.

It is important that school settings have clear guidelines in relation to the administration of medication and that parents, carers, staff and young people are aware of these guidelines. Developing and implementing effective management systems to support individual children or young persons with healthcare needs enables them to play a full part in the life of the school.

If the school setting is providing non-prescription and prescription medicine to pupils under 16 years, they must have written consent from parents and/or carers. This applies to all cases, except in “exceptional circumstances” where the medicine has been prescribed without the knowledge of a parent and/or carer, for example contraceptive medication. In this case, school settings should encourage the pupil to involve a parent and/or carer, whilst also respecting the pupil’s right to confidentiality.

Where a pupil has a medical condition, the school setting should work together with the pupil and their parents and/or carers to develop an individual healthcare plan. This plan should set out clearly what medicines and support the pupil needs, and who will provide it. When developing an Individual Health Care Plan (IHP) the following should be considered:

• The medical condition, signs, symptoms and treatments
• The child’s resulting needs, including medication
• The level of support needed. If a child is self-managing their medication, this should be clearly stated with appropriate arrangements for monitoring
• Who will provide this support and their training needs
• Arrangements for written permission from parents and the headteacher for medication to be administered by a member of staff or self-administered by the pupil during school hours
• Arrangements for school trips or other school activities
• What to do in the event of an emergency, including who to contact, and contingency arrangements

Individual Health Care Plans (IHPs) should be kept securely with the individual pupil’s records and reviewed annually. The school should send annual reminders requesting parents/carers to inform the school if there are changes to medicine administration consent gained when the pupil joined the school or when medication administration began. If the school is not informed by the parent/carer of any changes then it may be presumed by the school that consent remains current.

In addition to the individual healthcare plans, schools should compile an asthma register. The asthma register is crucial as in larger schools and secondary schools in particular, there may be many children with asthma, and it will not be feasible for individual members of staff to be aware of which children these are. Consequently, schools should ensure that the asthma register is easy to access, and is designed to allow a quick check of whether or not a child is recorded as having asthma, and consent for an emergency inhaler to be administered. A school may wish to include, with parental consent, a photograph of each child, to allow a visual check to be made to prevent misadministration of medication.

Medicines should only be brought to school when it is essential, that is where it would be detrimental to the child’s health if the medicine were not administered during the school day, and school staff should only administer medicine at school when it would be detrimental to a child’s health, safety or school attendance not to do so. In addition, the medication must be in the original container as dispensed by a pharmacist and be accompanied by clear instructions for administration, dosage and storage, and staff should make sure to always give medications according to these written medical instructions.

If appropriate and competent to do so, after consultation with the parents and/or carers, pupils may be allowed to carry and administer their own medication, although they may require an appropriate level of supervision to do so. Monitoring arrangements may be necessary to ensure that the pupil does not pass it on to another child or that another child can not gain access to the medication.

School settings have a responsibility for the appropriate storage and care of medicines. It is vital that they keep to the storage instructions on the medication and ensure that they abide by the expiry date. School settings should safely dispose of any medications past their expiry date preferably by returning them to the parent for them to arrange for safe disposal. All medication in schools must be securely stored and kept out of reach of children.

Schools must ensure that policies, plans, procedures and systems for administering medication are properly and effectively implemented to align with their wider safeguarding duties.

It is vital that school settings keep a written record of all medication administered, to who, what was given, dosage, who by and when. Such records offer protection to staff and provide proof that they have followed agreed procedures.

Children are more susceptible to sickness due to their underdeveloped immune systems and their high exposure to germs at school. Common childhood illnesses and conditions that may require medicating at school include:

• Allergies
• Asthma
• Skin problems
• Eye conditions
• Gastrointestinal conditions such as vomiting and diarrhoea
• Neurological issues such as epilepsy, autism and headaches

Less common are long-term or chronic conditions such as cancer, diabetes or heart conditions.

Amongst the most common medications that are administered in school are:

• Antihistamine tablets or oral solutions
• Blue asthma inhalers
• Adrenaline auto-injectors such as EpiPens
• Buccal midazolam and rectal diazepam for epilepsy

As well as prescribed medication, some schools may administer non-prescription medications such as Calpol, provided that they have the parent’s/carer’s consent.

Ensuring Student Safety

Medications are administered every day in schools across the country and accurate medication record-keeping is vital for ensuring the health, safety and well-being of all students, as well as for legal compliance. Accurate records ensure that students receive the right medication, the correct dosage, and at the precise time required, minimising the risk of errors that could harm their health.

Medication non-adherence at school, which includes medication administration errors such as missing a dose, may potentially lead to a variety of physical and/or medical consequences including harm. For example, the impact of missing medication on children with ADHD may have a great effect on the student’s physical health, as well as impacting their schoolwork and friendships. Other potential risks and consequences of medication errors or mismanagement derived from not keeping accurate records might include causing poisoning or illness to students in relation to:

• The issue of the wrong medication
• Out-of-date medication
• Mis-timing of medication dosage
• Issue of incorrect dosage of medication
• Issue of medication to the wrong student

As part of general risk management processes, all schools should have arrangements in place for dealing with emergencies such as medication errors or mismanagement.

Those responsible for managing, updating, amending and securely keeping medication administration records and Individual Health Care Plans (IHPs) in schools have a duty of care to ensure that these records are accurately maintained.

Governing bodies have ultimate responsibility to 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.

Legal and Regulatory Compliance

Schools must comply with local regulations and guidelines governing the administration and management of medications in educational settings. This includes maintaining accurate records, ensuring that staff are appropriately trained, and that they are following established procedures for medication administration.

Section 100 of the Children and Families Act 2014 places a duty on governing bodies of maintained schools, proprietors of academies and management committees of PRUs to make arrangements for supporting pupils at their school with medical conditions.

There is no legal or contractual duty on school staff to administer medication or supervise a child or young person taking it; this is a voluntary role. Those members of staff who do volunteer should not be expected to provide such care unless training and support is provided and is subject to appropriate clinical governance. Also, the majority of governing bodies of maintained schools, proprietors of academies and management committees of PRUs have in place Employer Liability Insurance that provides full cover protection for all school staff who volunteer to administer medication within the scope of their employment.

Under the Children Act 1989, anyone caring for children including teachers, other school staff and day-care staff in charge of children, have a common law duty of care to act like any reasonably prudent parent, traditionally referred to as “in loco parentis”. Legally, whilst not bound by parental responsibility, teachers and school staff must behave as any reasonable parent would do in promoting the welfare, health and safety of children in their care. This might mean that in exceptional circumstances where parental consent is unobtainable, the member of staff acting in “loco parentis” should use their judgement to determine if any non-prescription medication should be given to a child if a health care plan is not in place, and this action should be recorded.

The Medicines Act 1968 specifies the way that medicines are prescribed, supplied and administered within the UK and places restrictions on dealings with medicinal products, including their administration.

Under the Misuse of Drugs Act 1971 and associated regulations the supply, administration, possession and storage of certain drugs are controlled. This legislation applies to schools as they may have a child who has been prescribed a controlled drug.

Section 21 of the Education Act 2002 provides that governing bodies of maintained schools must, in discharging their functions in relation to the conduct of the school, promote the well-being of pupils at the school. Section 175 provides that governing bodies of maintained schools must make arrangements for ensuring that their functions relating to the conduct of the school are exercised with a view to safeguarding and promoting the welfare of children who are pupils at the school. Part 3, and in particular paragraph 7, of the Schedule to the Education (Independent School Standards) Regulations 2014 sets this out in relation to academy schools and alternative provision academies.

Section 2 of the Health and Safety at Work Act 1974, and the associated regulations, provides that it is the duty of the employer, that is the local authority, governing body or academy trust, to take reasonable steps to ensure that staff and pupils are not exposed to risks to their health and safety.

Regulation 5 of the School Premises (England) Regulations 2012 (as amended) provides that maintained schools must have accommodation appropriate and readily available for use for medical examination and treatment and for the caring of sick or injured pupils. It must contain a washing facility and be reasonably near to a toilet. It must not be teaching accommodation.

Paragraph 24 of the Schedule to the Education (Independent School Standards) Regulations 2014 replicates this provision for independent schools (including academy schools and alternative provision academies).

Schools should also refer to the Special Educational Needs and Disability Code of Practice, if appropriate. Governing bodies’ duties towards disabled children and adults are included in the Equality Act 2010, and the key elements are as follows:

The NHS Act 2006 Section 2A provides for local authorities to secure improvements to public health, and in doing so, to commission school nurses.

The Human Medicines (Amendment) (No. 2) Regulations 2014 allow schools to buy salbutamol inhalers, without a prescription, for use in emergencies.

The Data Protection Act 2018 and GDPR place a duty on schools to process, store and dispose of any personal information securely and confidentially, and to use it only for the purpose for which it is intended.

Legislation and regulations are in place to safeguard pupils’ needs, safety and welfare from harm, and to protect the school’s setting from any liabilities. They provide a framework for the governance of safe medication administration.

Legislative and regulatory compliance of the above is monitored by local authorities and by regulatory bodies such as Ofsted, the Information Commissioner’s Office (ICO), and the Health and Safety Executive. Any breaches or non-compliance of legislation or regulations may result in financial penalties, legal repercussions and reputational damage.

Schools need to be aware that a parent could bring legal action alleging negligence should a pupil suffer harm from non-compliance with the school’s own policies and procedures and/or statutory or regulatory guidelines. Any legal action is brought against the employer rather than an employee directly.

• They must not discriminate against, harass or victimise disabled children and young people.
• They must make reasonable adjustments to ensure that disabled children and young people are not at a substantial disadvantage compared with their peers. This duty is anticipatory: adjustments must be planned and put in place in advance, to prevent that disadvantage.

Accountability and Communication

The information that schools may need to effectively administer medication to pupils should be gained through consultation between a healthcare professional such as a school nurse, parents/carers, the pupil, if appropriate, and the school. Schools should ask parents to complete a Consent Form to Administer Medicines if they want the school to agree to administer medication for their child. Verbal instructions should not be accepted. Only one parent with parental responsibility needs to consent to medicines being administered. Schools’ policies should be clear that consent does not have to be obtained every time medication is administered, but the form should be updated regularly, and it is the parents’ responsibility to notify the school of any changes required to the consent form or IHP.

Parents are responsible for ensuring that their child has a sufficient amount of medication which is in date and in the original container with a label from the pharmacist if the medication is prescribed, or a label from the parent if it is over the counter medication. Parents should be informed on the same day and a record kept if, for any reason, medication that a child normally receives is not administered.

In agreeing to medication being administered in school, Heads of Schools should be satisfied that it is necessary for medication to be administered during school hours, for example because the pupil will otherwise miss school and lose teaching time.

If a staff member is required to administer medication to pupils it should expressly say this in their contract of employment, and if it does not, then undertaking training to enable staff to administer medication to pupils is voluntary. Schools may wish to make staff aware of the insurance that is in place to cover this type of activity.

Suitable training should have been identified during the development or review of individual healthcare plans. Some staff may already have some knowledge of the specific support needed by a child with a medical condition and so extensive training may not be required. Staff who provide support to pupils with medical conditions should be included in meetings where this is discussed.

The relevant healthcare professional, usually the school nurse, should normally lead on identifying and agreeing with the school the type and level of training required, and how this can be obtained. Schools may choose to arrange training themselves and should ensure this remains up to date.

Training should be sufficient to ensure that staff are competent and 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. A first-aid certificate does not constitute appropriate training in supporting children with medical conditions. Healthcare professionals, including the school nurse, can provide confirmation of the proficiency of staff in a medical procedure, or in providing medication.

Records of all staff training undertaken, together with refresher dates, should be kept and updated as required. These records together with IHPs, medicine administration records and consent forms will need to be made available to regulatory inspectors, and to insurance providers and/or the court services, should any misadministration of medicine occur and/or a claim for negligence be made. Schools will normally also need to produce a copy of their policy on supporting pupils with medical needs and demonstrate how effectively it is implemented.

Emergency Situations and Allergies

There will be circumstances in which the school will be required to administer emergency medication, and all staff, whether or not it is part of their contractual duties, should take into account the needs of pupils that they teach and be aware of whom to contact in an emergency.

As part of a general risk management process all schools should have documented arrangements in place for dealing with general emergency situations.

The school’s policies and the IHPs should give details of how to deal with specific emergencies relating to a pupil’s medical needs, including when and what medication should be administered. Records must be updated if medication is administered.

Schools can hold salbutamol inhalers for emergency use but if a child diagnosed with asthma may need to use the school’s emergency inhaler, this possibility should have been explained in their IHP and the school should have asked for parent’s consent to administer the medication in the event of emergencies at the time of creating the IHP. As stated earlier, it is useful for schools to keep a record of asthma sufferers in case of emergencies.

Anaphylaxis is an acute, severe allergic reaction requiring immediate medical attention. It usually occurs within seconds or minutes of exposure to the allergen, which may be a certain food or other substance, but may occur after a few hours. Parental consent to administer an auto adrenaline injector in emergency situations should have been documented in the IHP. Parents will need to be informed immediately if the AAI has been administered, as they must renew it before the child returns to school.

If, in any emergency situation, an ambulance has been called and/or the child has been admitted to hospital, this must be recorded together with the details of the emergency, any actions taken and by whom.

Data Security and Privacy

As required by the General Data Protection Act 2018, school staff should treat medical information confidentially. Documents which contain information about an individual’s physical or mental health are sensitive personal data, or special category data under the General Data Protection Regulation.

Schools’ policies should contain a privacy notice which explains when and how that medical information about a pupil and their IHP, where one is in place, will be shared with relevant staff. Staff should consult with the parent/carer, or the pupil if appropriate, as to who else should have access to records and other information about the pupil’s medical needs and this should be recorded on the IHP. Access to medical records should be restricted to authorised individuals who have a legitimate need to know for pupils’ care purposes.

Schools must never display IHPs or asthma registers in a public place because of the sensitive information they contain. They have a responsibility to implement robust security measures, such as encryption, access controls and regular audits, to safeguard medical records from cyber threats and data breaches.

Schools must ensure the accuracy and integrity of medication records by recording information truthfully, objectively and without bias. Falsifying or altering medication records can lead to serious ethical and legal consequences and compromise.

Schools should retain documents connected to a pupil’s medical needs and the administration of medication until the child is 25 years old in accordance with the Department for Health and Social Care requirements regarding the retention of medical and health records. This will also mean that records are available if a child, on reaching 18 years old, decides to pursue a claim of negligence against the school. Records should be carefully reviewed by the school before they are destroyed at the end of the retention period.

Technology and Medication Management

Administering medication in schools is a crucial responsibility that ensures the well-being and health of pupils. Many pupils have medical conditions that require regular medication, and it is essential to provide them with the necessary support and care during school hours and to keep accurate records of medication administration.

Medical Tracker is the industry’s leading first aid, medication and care plan software. It provides educational establishments with the ability to remove paperwork relating to the health of students and staff including injuries, illnesses, mental health, medical conditions and medication. Features include:

• Real-time incident reporting
• Parent communication
• Actionable reports
• Injury, illness and mental health reporting
• Medical condition management
• Medication expiry tracking
• First aid qualification tracking
• Medication administration reporting
• Staff communication
• ISO 27001 certified

There is one centralised database for each school with multi-user access. It ensures records are accurate and compliant, and meets statutory guidelines. Parents and staff can be kept up to date via electronic notifications and parents are kept up to date in real time. Data can be analysed using actionable and pre-built reports.

Below is a selection of testimonials about Medical Tracker implementation and its impact on health and safety and medicine administration report management in schools:

Willingdon Community School is a popular high school based in Eastbourne, East Sussex, with over 1,010 students. Pupils join in Year 7 and are supported until GCSEs in Year 11. Rosie Beddows (Lead First Aider) spoke about how Medical Tracker has improved their school’s approach to health management:

• “Our old paper-based system was cumbersome and really hard to check on students’ medical and injury history. We can now even monitor medication intake and raise concerns with parents if there is an increase in regularity.
• Trends of illness or class absence due to medical room visits are accessible, highlighting potential safeguarding or pastoral support needed.
• As medication intake is recorded, parents can be contacted if concerns are highlighted linked to the regularity (as synced with the MIS system).
• Accurate information is recorded all in one place, abolishing the need for duplicate record books.
• Big picture is now possible for monitoring health and safeguarding patterns.
• Parents are automatically notified of injuries or health incidents.
• Accurate information relating to medical health is accessible in one click.”

St Nicholas Catholic School is a small academy based in Sutton Coldfield, Birmingham, accommodating over 200 children. They used paper-based notification slips, which didn’t always make it home to parents. Aiming to enhance health and safety provision across the school and engage parents positively, St Nicholas Catholic Primary School introduced Medical Tracker to help solve the following issues:

• Hours spent ringing parents to notify them of pupil injury.
• Paper slips were the main source of injury notifications, which often didn’t make it home!
• Parent frustration due to lack of communication about their child’s welfare.

Highlighting problems that Medical Tracker solved for the school, Head of School Claire Noble-Barton stated: “Notifications of injuries to parents are now reliable! We can now check if parents have received them, improving pupil safety.

• Parents no longer feel frustrated and out of the loop with their child’s health and well-being. Automatic parent emails are sent once an incident is recorded.
• By centralising all pupil health data, contact information and other important medical history (including medication administered) can be accessed (with a secure log-in).
• School staff save countless hours with automated parent communication.”

Claire finds Medical Tracker really easy to implement on the go, having access to it through a tablet or hand-held device. Consistency is achieved school-wide for all incident recording and reporting systems.

Regents Park Community College is a mixed comprehensive secondary school based in Southampton, Hampshire, supporting over 800 pupils. Welfare Officer Paula Simmons explained:

“The immediate difference was to staff workload and admin hours used chasing parents up for medication approval or notifying of injury. The whole injury process has been streamlined, as headteachers and other staff members can now be notified of an incident without needing to send separate emails. Parents are kept informed about their child’s medication administration; the college has several diabetic pupils. Parents are automatically informed when they have taken their insulin with the first aiders, logging their levels and dosage given. There can be repeat visitors to the first aid rooms throughout the school day, aiming to inform parents every time their child requires medical administration (or to even log the frequency of attendance), which is done automatically through email notification reducing the admin task of manually finding the numbers on SIMS and contacting the parent each time.

Parents are informed every time their child visits the first aid room, even if 3–4 times in one day. Without taking significant admin hours as all done online. Pupil medication is tracked easily, sending information like insulin levels and dosage the child has received. All pupil health information and data is centralised, including parent contacts from SIMS. I have already recommended Medical Tracker to any school in my network as it is just fantastic. Parents love it and we can’t wait to start using all the features. The training was really simple and the customer support are quick and helpful!”

Final Thoughts

As we have seen throughout this article, accurate medication administration record-keeping in schools is imperative for several reasons including:

• Ensuring that students receive the right medication, dosage, and timing, in order to minimise the risk of errors that could harm their health.
• Helping in implementing and monitoring student IHPs effectively.
• Facilitating communication between school staff, parents and healthcare providers, ensuring that everyone involved is informed about the student’s medication regimen and any changes or issues that arise.
• Providing valuable data for analysing trends in medication usage, identifying areas for improvement in medication administration management practices, and implementing changes to support student safety and well-being.
• Meeting statutory legal and regulatory compliance obligations.