Medical Management Policy

Transcription

1 Medical Management Policy This document was: Generated by SMT/School Staff in October 2016 Reviewed/revised at a meeting of the Standards Committee held on 12 th January, 2017 Approved at a meeting of the full Governing Body held on 26 th January 2017 Review date: January 2018 Signed: Chairperson schools governing body, on behalf of the governing body Date: Signed: Headteacher Distribution: Staff, governors, pupils, parents and carers 1

2 This policy was designed for the pupils at Ysgol Ty Coch 1. Introduction There are an increasing number of children now entering special needs education who have significant medical difficulties and/or health related problems which require medical observation, assessment and management throughout the school day. This document has been drawn up to address many of the health-related issues that are currently presented at school. Please see Welsh Government documents: Access to Education and Support for Children and Young People with Medical Needs (2010) National Framework for Children, Young People and Maternity Services in Wales Welsh Assembly Government (2006) Aims Our aim is to ensure that all children and young people in our school continue to have access to as much education as their medical condition allows, so that they are able to maintain the momentum of their education and keep up with their studies. The nature of the provision will be responsive to the demands of medical conditions that can sometimes be changeable. Responsibilities The school has a designated contact responsible for the education of children and young people with medical needs. Included in this role is the responsibility to facilitate communication to all parties, ensure that the school is meeting the needs of all those identified and that written agreement is obtained in advance, from the parent/carer, for the child s medication to be administered during school time. 2

3 At the Tonteg site this person is Jean Bassett (School Nurse). At BYC, this person is Steve Bassett (School Nurse). Sarah Jones (Deputy Headteacher) is responsible for monitoring the work of the school nurses. The school nurses are responsible for: Maintaining a list of children and young people with medical conditions across the school Ensuring that all medical procedures are undertaken safely and in accordance with this policy Ensuring health care plans are accurate, up to date, regularly reviewed and signed by all parties. (This should be completed during annual review meetings) Maintaining excellent lines of communication with health professionals including community nursing team, SEN Health Visitor, Pediatricians and therapeutic staff Maintaining excellent lines of communication with the Headteacher and Senior Leadership Team to regularly appraise them of health issues across the school It is likely that decisions relating to health management are a product of multidisciplinary involvement. The GP or pediatrician normally acts as the lead professional in coordinating this broader care. In our school organization, the school nurses act as the lead professionals and all medical work undertaken on site should involve them directly. This also applies to children who qualify for continuing health care provision provided by community health team. Parents/Carers The school endeavours to work closely with parents and carers in all aspects of its work. Parents are full collaborative partners in the processes underpinning their child s education and the management of their health needs. Parents will have access to information, advice and support during their child s time in school. The school nurse is the school s contact point for health-related issues. The school nurse can assist in signposting the parent to other health related services. In addition, parents may contact Sarah Jones (Deputy Headteacher) or Dave Jenkins (Headteacher) on these matters. 3

4 Any complaints relating to medical management should be reported in line with the school s complaints procedure. 2. Health Care Plans/Medical Information The detailed information in the pupil s care plans enabled staff to obtain the relevant health information for each child at school, and are a valuable source of information. Each care plan contains the child s personal details, contact details, diagnosed condition, named professionals involved in the care of the child and current medication. This plan follows the child s ADLs and any other relevant information, all of which is provided by the parent/carer. There are currently two school nurses employed by the school. One is located at the Tonteg site and one is located at BYC. At present these care plans are updated annually by them as part of the annual review process. There is an Epilepsy nurse within the community health team and Health Visitor for SEN who updates the care plans of pupils with complex health needs and liaises with the school nurses on a regular basis. 3. Medication a. Generic medication Some pupils will require general medications that may or may not have been prescribed by their GP. For example - over the counter medications that have been bought by parents/carers and sent into school to be administered during a school day. In these cases a letter from/signed by the parent/carer, requesting the administration of the medication, must be received by the school nurse before the medicine will be dispensed to the pupil. She/he may choose to check with the parent/carer prior to administration why the medication has been chosen and give medical advice where needed. All such preparations must be in the original, undamaged pharmacy pre-labelled 4

5 packaging/bottle and must be appropriate for the age of the pupil. The medication must be current, within the use by date which must be clearly visible. b. Prescribed medication The parents/carers must notify the school nurse if they require the administration of prescribed medication, to their children, during the school day. The nurse will then send home the correct school medication administration request form for parents to complete and return to school. No medication will be administered by school staff until the completed form has been received at the school. In instances where a completed form has not been received it is the responsibility of the parents/carers to make arrangements to attend school to administer the medication. All prescribed medications must be sent into school in their original packaging with the patients details shown clearly on the pharmacy label. Expiry dates must always be checked to ensure that the use by date has not passed. Out of date medication will not be administered. It is the responsibility of the parent/carer to ensure that the medication is up to date. This must be administered according to the best practice of The Eight Rights of Medication Adminstration by Nursing Centre ( c. Controlled Drugs As above, the administering of controlled drugs is delivered with regard to the Eight Rights of Medication Adminstration. The eight rights include ensuring the right patient, the right drug, the right dose, the right route, right time, right reason, right response and right documentation. The supply, possession and administration of some medicines are controlled by the Misuse of Drugs Act and its associated regulations. Some may be prescribed as medication for use by children, e.g. Methylphenidate. 5

6 A child who has been prescribed a controlled drug may legally have it in their possession. However, for reasons of safety it is permissible for schools and settings to look after a controlled drug, where it is agreed that it will be administered to the child for whom it has been prescribed. Schools and settings should keep controlled drugs in a locked non-portable container, and only named staff should have access. A record should be kept for audit and safety purposes. The correct, appropriate storage of these medications (controlled drugs) is important in order to safeguard everyone. The school nurse has a designated area within the school s medical room where controlled drugs may be safely stored. A controlled drug, as with all medicines, should be returned to the parent when no longer required, to arrange for safe disposal (by returning the unwanted supply to the local pharmacy). If this is not possible, it should be returned to the dispensing pharmacist (details should be on the label). Misuse of a controlled drug, such as passing it to another child for use, is an offence The school has a policy in place for dealing with drug misuse. d. Rescue medications There are many pupils at school who require prescribed rescue medications. These are all individually packaged, labelled and safely stored within the medical room. Staff within the school are advised during medical training days of the location and purpose of these drugs and are all familiar with the safe and effective collection and administration of these when needed, be it in an emergency or for routine collection on out of school activities/events/visits etc. where they may be needed. (Please see Appendix 3). One such medication is buccal midazolam and detailed information and a training pack is available in nurse s office. 6

7 Oxygen and Suctioning Oxygen Protocols Oxygen is prescribed by a medical practitioner for use with named children. The use of oxygen is not transferable between children (or adults) and should be given in line with medication administration protocols. In assessing the need for and in administering oxygen: Be alert for signs of pallor, breathlessness or excessive coughing before administering oxygen or give oxygen as instructed by prescription advice. If using a pulse oximeter to check on oxygen saturation levels the SPO2 should fall below 95 before oxygen is given. Check the flow rate, as per the prescription. Check the mask size or canulae are correct for the child. With reassurance, place the mask over the child s nose and mouth ensuring a tighter seal as possible or place canulation inside nostrils. Turn on the oxygen to the required flow rate. Observe child whilst O2 therapy is being delivered. Stop O2 therapy as specified by prescription, when the child is recovered and breathing normally without distress. Clean mask or canula with moist wipe. Store in cool place away from heat sources and fire risk. A GP will prescribe oxygen and it will be delivered to home free of charge, there is a home care helpline number if there any difficulties experienced NB. HOMECARE HELPLINE Suctioning Protocols 7

8 Only a medical professional will dispense a suction unit for an individual person and this unit is not transferable. Normally children will keep their airways clear by coughing, sneezing, blowing their noses and by the protective mechanism of the gag reflex. The use of careful positioning can also help clear airways. Suction is a traumatic process and should only be used with care to help disabled children/ young people when less invasive treatments are ineffective. The main aim of suctioning is to maintain the airway and prevent aspiration of secretions or vomit. Healthy children do not normally require suction. Disabled children may not have learned or lost the co-ordination skills required to keep their airways clear. Severely disabled children may also lack the gag or cough reflex which prevents food being inhaled into the lungs. Suction can be administered orally and nasopharyngeal suction. This procedure may be taught by health care professionals who deem themselves competent to teach non-health professionals, i.e. Learning support assistants, carers and parents. Non-healthcare professionals will be covered by LA indemnity providing they follow local procedures Page 6, Access to Education and Support for Children and Young People with Medical Needs) Procedure Indications for giving Oral and Pharyngeal suction- Indications for suction. - The child/ young person s breathing becomes difficult due to vomiting or excessive secretions in the mouth or nose region. - The secretions are seen, heard or felt. Frothing or bubbling maybe seen from the nose or mouth. 8

9 - The children is coughing excessively and unable to clear their own secretions. - Poor cough. - The child s skin looks grey or blue, particularly around the nose or mouth. - Suction does not need to be undertaken routinely. Discussion with physiotherapists and medical / nursing staff may assist in planning effective care and this advice can be documented in a suction plan Contra - Indications o Stridor o Malignancy o Anti-coagulants o Broncho spasms. Equipment needed. o A Charged suction unit with tubing attached. o Suction catheter, should be appropriate for the age of child, size of nostril, amount of secretions and condition of mucosa. If suctioning orally, a large fr catheter can be used. o A catheter with an inbuilt y connector will make the control of suction less traumatic. o A smaller size yankauer sucker/catheter may be used, but care should be taken as it is more rigid! o Disposable gloves and aprons o Aqua gel o Appropriate clinical waste disposal bag, (yellow burn bag) o Bottle of cooled down boiled water. 9

10 Action 1. Explain procedures to child / young person to offer reassurance to reduce fears and anxieties. 2. Assess the need for suction, to ensure that suction is an appropriate course of action. 3. Check all equipment is readily available, in full working order and service date is valid, to avoid any delays in undertaking the procedure. 4. Ensure suction pressures are set correctly to minimise trauma to mucosal linings. (10 15 kpa young child) (15 kpa young person) 5. Ensure child is comfortable, secure position (preferable sitting up).ask for assistance from a second person if needed. Ideal position is lying on side with head up, in case of vomiting. 6. DO NOT USE ANY PHYSICAL RESTRAINT. Minimise trauma through rmovement, reassuring the child, and decreasing the risk of aspiration. 7. If child is receiving oxygen therapy ensure that flow is not interrupted, to reduce effects of hypoxia. 8. Wash hands and put on gloves and aprons, to help reduce risk of cross infection. 9. Switch on suction machine and attach appropriate suction catheter to tubing, to ensure there are no breaks in system. 10. Naso-pharyngeal Suction Measure a safe distance to pass catheter, from the tip of the nose to ear, dip tip of suction catheter into a small amount of aquagel. (Child under 2 years) Using gloved hand gently insert suction catheter straight back and down. (Child over 2 years) Gently insert the suction catheter upwards and backwards into the nose. Once the back of the nose is reached (a few centimetres only) apply intermittent suction whilst withdrawing the catheter quickly. The child may cough at this point. If the child coughs wait for them to recover before continuing. This may need to be repeated in the other nostril, to ensure all secretions are cleared. 11. Oral Suction - Gently insert appropriate suction catheter inside child s mouth and apply suction, taking care not to touch the back of the mouth.the child may cough. This will help avoid damage to inside of the mouth. 10

11 12. Dip the suction catheter and tubing into cooled boiled water with suction switched on, to flush through the secretions that have adhered to the tubing and maintain good standards of infection control. NEVER ALLOW THE COLLECTION BOTTLE TO FILL ABOVE THE LIMIT LINE. Switch off machine. 13. Discard suction catheter by wrapping glove around the catheter before disposal. Appropriate disposal should be made along with other waste, to ensure high standards of infection control are maintained. During suction observe for: Skin colour Respiration rate and colour Colour and thickness of secretions. Possible Complications Hypoxia. During suction the child receives less oxygen than normal, especially if the procedure takes longer than normal. Mucosal trauma from suction catheter. Discomfort and pain. Overstimulation of secretions as a result of too frequent suction. Infection due to poor standards of hygiene. Maintenance and Cleaning of Equipment It is the responsibility of the parents / carers to ensure that the suction machine is fully charged, cleaned daily and the service date is valid (though the trained carer/ nurse can organise servicing) It is the parents responsibility to ensure that the suction machine and associated equipment are sent to school / respite with the child daily. Carer / nurse will ensure that suction machine is charged in school when not in use. 11

12 If the equipment does not accompany the child to school then the child s needs will not be met, and therefore the child should not be at school. Suction catheters and gloves are single use only and should be discarded appropriately after use. 4. Health Conditions i) Epilepsy (There is a current epilepsy policy and training pack available at school - see epilepsy policy from Epilepsy Action Wales ) ii) Asthma: EACH PUPIL AT SCHOOL SHOULD HAVE A HEALTH CARE PLAN AT SCHOOL. ALL HEALTH CARE PLANS MUST STATE WHETHER THE PUPIL IS ASTHMATIC, AND THERE MUST BE DETAILS OF CURRENT MEDICATION, IF IT IS REQUIRED. THE PUPILS PARENTS/CARERS SHOULD ENSURE THAT THE SCHOOL ALWAYS HAS A SUPPLY OF RELIEVER MEDICATION THAT IS CORRECTLY LABELLED WITH CHILDS NAME, DOSAGE AND EXPIRY DATE. CLASS TEACHERS/ ASSISTANTS TO ENSURE THAT INHALERS ARE ALWAYS AVAILABLE AT ALL GAMES LESSONS AND FOR OUTSIDE VISITS/ ACTIVITIES etc. A PUPIL MAY TAKE ONE DOSE OF RELIEVER MEDICATION MINUTES PRIOR TO ACTIVITY, IF HE/SHE EXPERIENCES ACTIVITY INDUCED SYMPTOMS. ALL INHALERS TO BE STORED IN THE PUPILS CLASSROOMS (AS SAFELY AS POSSIBLE IT IS THE CLASS STAFF RESPONSIBILITY TO ENSURE THE SAFE AND APPROPRIATE STORAGE OF INDIVIDUAL PUPILS ASTHMA INHALERS, AS THERE NEED TO BE IN CLOSE PROXIMITY OF THE 12

13 CHILD.(CWMTAF HEALTH AUTHORITY, ASTHMA PROCEDURES,PROTOCOL AND GUIDELINES) ANY INHALERS ADMINISTERED MUST BE RECORDED ON THE APPROPRIATE DRUG ADMINISTRATION SHEET KEPT IN NURSE S ROOM. STAFF ARE ADVISED TO INFORM PARENTS/GAURDIANS IF A PUPIL HAS REQUIRED MORE MEDICATION THAN NORMAL, OR HAS CONSTANT SYMPTOMS. NB. The school nurse may choose to liaise with parents/carers in making appropriate referrals to specialized medical professionals when the need arises.eg. Respiratory nurses. iii) Percutaneous endoscopic gastrostomy (PEG) There are several pupils at school who have PEG s and therefore it is vitally important that all staff are made aware of the protocols and guidelines clearly set out in the Gastrostomy Care Policy given by the Health Department. There is a copy available in school. All staff who work with these pupils must ensure that they receive regular training updates. The school s senior management team are responsible for ensuring that staff have regular training in all aspects of care being given. iv) Diarrhoea and vomiting ( There are guidelines at school for the exclusion of individuals with infectious diseases) Diarrhoea Can be the result of taking certain medications, a change in diet or some bowel conditions associated with chronic diarrhoea. It may not always be due to an infection. However, unless there is documented evidence from a reliable source, any child with diarrhoea should be considered infectious. 13

14 Exclusion period Children should be excluded until recovered and free from symptoms for 2 days. Household contacts do not need to be excluded. Viral gastro-enteritis This is an illness in which diarrhea is accompanied by repeated vomiting. Exclusion period Children should be excluded until recovered and free from symptoms for 2 days Household contacts do not need to be excluded. Food poisoning. An illness affecting the digestive system that results from the consumption of contaminated food or water. Outbreaks are recognized by the occurrence of illness in individuals within a short period of each other, or in those who have attended the same event, or eaten the same food. Symptoms are usually of sudden onset with nausea, stomach cramps, vomiting and/or diarrhoea. It is advisable to discuss each case with the Health Protection team. Exclusion period Should be excluded and free from symptoms for two days. This may be extended on the advice of the Environmental Health Officer for certain infections such as Salmonella and E Coli. Household contacts do not need to be excluded unless they are symptomatic. 14

15 Dysentry This is an infection of the bowel causing diarrhoea. The diarrhoea may contain blood or mucous and may be accompanied by fever, pain, and vomiting. Hand washing should be supervised, and children and staff should be encouraged to frequently wash hands. Toilets and hand basins must be thoroughly and regularly cleaned. In an outbreak, toys and equipment should be cleaned, sand and water play should be suspended. Incubation period can range from hours to days depending on the type of infecting germs. Exclusion period Children should be excluded until free from symptoms for 2 days. It is advisable to discuss each case with the Health Protection Team. A good standard of hygiene is required at home and at school, to help prevent/contain such infections. v) Minor wounds, injuries and infections Minor wounds and injuries will be assessed by the school nurse and s/he will be able to determine if further medical advice and/or treatment may be required. In the absence of a qualified person a designated first aider will be called upon to make the assessment. The first aider must seek guidance from a member of senior management team in taking action in this capacity. (In addition, there are guidelines available at school for the exclusion of pupils with infectious diseases) 15

16 5. Infection Control (see statement of policy for infection control) This Policy also includes guidelines for HIV and Hepatitis. 6. Hepatitis B Immunisation for employees at risk (See guidelines for G.P.s) 7. Substance use/misuse Please note there is a policy available on substance use/misuse for staff. Substance use /misuse for pupils is included within medications at school guidelines. 8. Control of Substances Hazardous to Health (COSHH) All staff must: - Take care of their own and others safety during any work activity. - Report any potential risks to line manager. - Always use any protective clothing issued. - Refer to COSHH risk assessment forms, if you are unsure about any process. - Request that a risk assessment be undertaken if any new substances are being used. Directorate co-ordinators must: - Ensure all health risk assessments for staff have been undertaken and the appropriate action taken to prevent and control exposure. - Issue personal protection equipment when required. 9. Classroom tooth-brushing protocol There are clear guidelines available at school. 10. Children s Safeguarding There is an extensive policy available at school. 16

17 11. Intimate care There is a detailed policy available at school. 12. Home Visiting/ Lone Working/Buddy System There are appropriate risk assessments available at school to ensure safe practice. 13. Staff training in Medical Issues. At present the training offered to staff at school is relevant to the health conditions generally presented by pupils at school. These are: Epilepsy Awareness, and the administration of rescue medication. PEG feeding awareness via gastrostomy tubes, MIC-KEY /MINNIE buttons, Naso gastric tubes, ABBOTT feeding devices. CPR (Cardio Pulmonary Resuscitation) and emergency first aid skills. This training is offered when required by staff and is arranged and provided by both the school nurse and outside agencies such as specialized members within the community health team e.g. Diabetes nurse, Epilepsy nurse, ABBOTT nurse, Respiratory nurse. 14. First Aiders i) Roles ii) Responsibilities iii) Accountability. There are designated first aiders within the school who have attended a four day course and achieved a recognized certificate. A record is kept detailing when the staff training requires updating. First aiders are able to provide basic first aid, and in the absence of the school nurse may be called upon to deal effectively with minor wounds/injuries/illnesses etc. They will understand that they have to report any such event to their line 17

18 manager who will decide if further medical advice /treatment is required, and to notify parents/guardians accordingly. In addition it is the responsibility of these designated first aiders to ensure that the first aid box in their class/area is appropriately stocked, checked regularly, and replacement of stock is implemented. It is the responsibility of each individual first aider to ensure that their training is kept up to date every three years. They should have a record of the dates of their training, however the school office also has this record and may automatically inform staff of training updates. In addition these updates should be part of the individual s annual Continuing Professional Development (CPD) interview performed by line managers, and during this annual process both individuals and managers should be able to recognize any potential areas for gaps in knowledge and address training needs and/or development. There is also a new initiative where a group of four LSAs are undergoing additional health training and working through competencies to provide additional health support within the school. 15. Conclusion It has been recognized that there are an increasing number of children/young people entering education who have both additional educational needs, and health related conditions which are often quite complex health needs (physical and mental health). 18

19 Appendix: There are policies, protocols and guidelines available at school which include :- 1. Health Care Plan Template 2. Record of Regular Medication 3. Medication Sign in/out Form 4. Change of Medication Form 5. Agreement to Administer Non-Regular Medication Form 6. Agreement to Administer Regular Medication Form 7. Headteacher Agreement to the Administering of Medication 19

20 Appendix 1 - Health Care Plan Name of school/setting YSGOL TY COCH Childs name Group/class/form Date of birth Childs address Medical diagnosis or condition (Including any allergies) Date Review date Annually. Family Contact Information Name Phone no. (Work) Home Mobile 20

21 Name Phone no. (Work) Home Mobile G.P Name. Phone no. Name. Describe medical needs and give details of child s symptoms Daily care requirements (e.g. elimination, eating & drinking, communication, mobilisation, specialist equipment used, self-care skills, vision, hearing and including impact on daily activities such as sports, lunchtimes and school trips) Additional information/reports attached Please refer to filing cabinet in nurses room. 21

22 Describe what constitutes an emergency for child, and the action to take if this occurs Who is responsible in an emergency? (State if different for off site activities) School nurse/smt. Training needs identified MANDATORY STAFF MEDICAL UPDATES. The above information is to the best of my knowledge and accurate at the time of writing. I will inform the school/setting immediately in writing if there is any change in my child s medical information and/or treatment. Signature Parent/Guardian Date: Name/role of health professional completing the plan: Jean Bassett school nurse Signature: Date: 22

23 Health care plan Consent I parent / Carer s name Of (address) For (child s name) Confirm that all the information contained in this health care plan and the relevant reports attached (as appropriate) can be shared with other professionals / agencies (detailed below) involved with my child s care. SENCO / Head teacher Social services: File: Other: Please state Signature of parent / Guardian: Date: Name of professional completing the form: 23

24 Designation: Date completed: Review Date: (This form to be completed and filed in health professional s records) Notification form for child Health department regarding health care plan. Name of child: D.O.B. Address: School: Date Healthcare plan completed/reviewed: Health Visitor / school nurse: Next review date: Please return this information to Joanna Davies, schoolroom, community health office, Heol draw, church village, Nr Pontypridd, CF38 1UR 24

25 Appendix 2 Record of Regular Medication Administered in School 25

26 Appendix 3 Medication Sign In/Out Form 26

27 Appendix 4 Change of Medication Form 27

28 Appendix 5 Agreement to Administer Non-Regular Medication 28

29 Appendix 6 Agreement to Administer Regular Medication 29

30 Appendix 7 30

31 31