The Safe and Secure Handling and Administration of Medication in Schools for Pupils with Special Medical Needs MMSOP 49 [Version 1] Applies to:- School nurses working within schools for children with special medical needs Sub Committee for Approval Medicines Management Group Date of Approval 7 th July 2016 Review Date July 2019 Title of Lead Manager Complex Needs Lead for 0-19 Service Policy Author Summary key points:- Lisa Knight, Elly Wright This procedure will include the following: Requesting medication for use in school Receipt and storage of medicines Administration of medicines Disposal Records UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE TRUST WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION A completed Equality Impact Assessment will be available on the trusts website 1/10
Consultation Subject Experts Groups Consulted NICE Lead Consulted Infection Prevention and Control Approved (As required) Medicines Governance Pharmacist Complex Needs Lead for 0-19 Service Medicines Management Group N/A July 2016 Version Control Version Type of Change Date Approved Description of change No 1 New Document 7 th July 2016 2 3 4 CONTENTS Section Introduction 1. Statement of intent 2. Target group 3. Training requirements 4. Related procedures and policies 5. Main policy content 6. Requesting medication to be brought into school 6.1 Receipt of medication into school 6.2 Storage of medication 6.3 Medicines Administration Records Charts (MAR 6.4 Charts) Administration of medication 6.5 Disposal of medication 6.6 Equality impact assessment 7 References 8 2/10
Standard Operating Procedure for the Safe and Secure Handling and Administration of Medication in Schools for Pupils with Special Medical Needs 1. INTRODUCTION Pupils who attend school with medical conditions should be properly supported so that they have full access to education, including school trips and physical education. [Department of Education December 2015] Within specialist schools for pupils with special medical needs, administration of medication within the school environment is crucial to the health and well-being of the children and young people. The governing body of each school must ensure that arrangements are in place to support pupils with medical conditions; this is achieved in partnership with Wirral Community NHS Foundation Trust. The trust, as a provider of a specialist school nursing service is required to support effective systems to ensure that medicines are obtained, stored, administered, recorded and handled in a safe manner in line with Department of Education and Nursing and Midwifery Council recommendations. 2. STATEMENT OF INTENT The board is committed to ensuring that pupils within Wirral schools for children with special medical needs receive harm free outstanding quality care, based on best practice evidence. This procedure aims to outline safe systems for:- 2.1 Requesting medication for use in school 2.2 Receipt and storage of medicines within schools 2.3 Administration of medication within schools and on school trips 2.4 Disposal of medication 2.5 Records to be kept of medication to maintain a robust audit trail of all medication within the school The procedure should be read in conjunction with the trust s general policy for the safe handing and administration of medicines GP11. 3. TARGET GROUP The contents of this procedure apply to all registered nurses employed by the trust who work within the specialist school nursing service. 3/10
4. TRAINING REQUIREMENTS All staff in the trust are required to comply with mandatory training as specified in the trust s Mandatory Training Matrix. Staff are also required to comply with job relevant training in their service as specified within their service training matrix and on the Learning and Development Section within Staff Zone. 5. RELATED PROCEDURES AND POLICIES Please refer to relevant trust policies and procedures- always use Staff Zone to ensure the most recent version is accessed. 6. MAIN PROCEDURE 6.1 Requesting medication to be brought into school A standard form should be sent home to parents/carers requesting required medication and requesting consent to administer medication, outlining the need for fully labelled medication. As a minimum, parents/carers must supply medication to school for their child ensuring: Medication has been prescribed by a doctor or other authorised prescriber Medication is in date and dispensed recently (within 6 months) by a pharmacist Medication is in the original container dispensed by the pharmacist All labels are intact and legible Medication is handed to an adult for delivery to school nurse (e.g. transport escort) and never given to the child/young person to carry Wherever possible the practice of sending medicines between home and school each day should be avoided and should always be a temporary arrangement. The nurse should ask the parent/carer to request that the dispensing pharmacist split the supply between home and school should this occur. Where there has been a recent change in medication and the instructions for administration are not the same as the instructions on the pharmacy label, the medication will only be administered in line with the most recent instruction if there is a signed patient specific direction from the pupil s GP or consultant. This might take the form of a discharge summary or clinic letter. 6.2 Receipt of medication into school Receipt should be by an authorised or delegated person 4/10
Receipt of all medicine to be recorded on a stock sheet appropriately for each child including: Name of medicine received Quantity of medicine Strength Date received and shelf life where appropriate A running total of medication for each child should be maintained on the Medication Administration Record (MAR) Chart which will identify when medication needs to be requested from the child s parent/carer On receipt, all medicines should be checked against the child s list of current medication. Where discrepancies are noted, the nurse should contact the GP or supplying pharmacist as appropriate to check any alteration of therapy was intended. All discrepancies should be recorded immediately and reported. Receipt of controlled drugs (CDs) into school requires special care. When receiving a new supply of a CD in school the nurse must: Accurately record on the CD stock sheet recording: the name, strength, batch number, expiry date and quantity of the medicine received. This should also include the name of the child for whom the medicine is prescribed. In addition the MAR Chart should indicate medicines that are controlled drugs and a running total should be maintained. 6.3 Storage of Medication When a school nurse is on duty within the school, the school nurse is responsible for the control of access to medicinal products. Medication must be stored in an environment which does not threaten their integrity, in line with manufacturer s instructions. Medication that does not require storage in a refrigerator should be stored in locked cupboards away from heat and moisture and usually not above 25 C. The temperature of the room used to store medicines should be recorded each working day. In the event of the temperature going outside the recommended range, contact the trust pharmacist for advice. Medication that requires storage in a refrigerator should be stored in a lockable medicines refrigerator. Temperatures must be checked daily when storing medicine and should be maintained between 2 and 8 C. Signature sheets to record fridge temperature should be maintained by recording the minimum and maximum temperature and resetting the thermometer each working day. In the event of the temperature going outside the recommended range, contact the trust pharmacist for advice Keys for medicine cupboards are the responsibility of the senior nurse on duty and should be kept in an access controlled area only accessible to the school nurses and members of the school senior leadership team. 5/10
Internal and external medications to be stored separately Ideally where possible, each child s medication to be stored separately CDs should be stored in a locked, non-portable cupboard and the Nurse in Charge should keep the keys upon her/his person. Emergency Medication There may be some medication that needs to be readily available such as inhalers for asthma or buccal midazolam for fits. The storage of such medication needs to be considered on a case by case basis and individually risk assessed to balance potential risks. The outcome of any risk assessment must be recorded in the pupil s medical record together with recommendations to mitigate the risk of medication being locked away or readily available Storage of medical gases should be stored in line with GP11 Potentially hazardous substances in line with COSHH guidelines 6.4 Medicines Administration Record Charts (MARs) Each pupil is required to have a list of current medication within SystmOne and an up to date care plan. The list of medication must include all the medication the pupil is prescribed and not just those for which the school is responsible for administering. The administration of medication is to be recorded on a MAR chart specific to each child. The MAR chart must include all medication to be administered to the child during the hours the school is responsible for administering medication. Where there are additional medicines administered outside school hours, the MAR chart should include an alert highlighting the additional medication, this will enable the school nurse to check the pupil record should the full list of medication be required. Instructions for administration for each medicine must be the same as the instructions on the pharmacy label. The only exception for this would be where a medication had been recently altered and the school nurse has a patient specific direction (PDS) written and signed by the prescriber. In which case the PDS (or a photocopy of the document) must be kept with the MAR chart to authorise the administration of the medication. MAR charts need to be written by a registered nurse and checked by a second designated staff member. Both staff members should sign and date the chart. MAR charts can be hand written, or preferably generated electronically The chart should include a recent photograph of the child to aid pupil identification. 6/10
6.5 Administration of Medication Medication should not routinely be prepared to be administered at a later time; this is considered to be secondary dispensing which is not covered by the terms of the Medicines Act (1968). The act of preparing medicines for administration at a later time therefore creates an unlicensed product where the nurse is professionally accountable for this action. For this reason, for their own legal protection, school nurses should only operate within the requirements of this procedure. Medication should be prepared individually for each child immediately prior to administration. Where medication has been prepared by a school nurse, the administration should not be delegated unless the administration can be directly observed by the school nurse. During administration, the following checks should be undertaken: Be certain of the identity of the child to whom the medication is to be administered Ascertain that the prescribed dose has not already been administered Check the child is not allergic to the medication before administering it Know the therapeutic uses of the medicine, its normal dosage, side effects, precautions and contra-indications Know the contents of the child s care plan Check that the pharmacy label on the medicine is clearly written and unambiguous with clear information on: - The name of the medicine - The dosage - The name of the child - The frequency of administration - The route of administration Check the expiry date (where it is available) of the medicine to be administered Consider the dosage, weight where appropriate, method of administration, route and timing Administer or withhold in the context of the patient s condition Contact the prescriber or otherwise authorised prescriber without delay where contraindications to the prescribed medicine are discovered, where the child develops a reaction to the medicine Make a clear, accurate and immediate record of all medications administered, intentionally withheld or refused by the child, ensuring that the signature is clear and legible, it is also the nurse s responsibly to record the administration of medication administration that is delegated, (ensuring the administration is observed) When the MAR chart is completed, the chart must be scanned into SystmOne to provide a record of the administration of medication. 7/10
School trips There will be occasions when pupils are not within school at the time their medication is due to be administered. If this is the case, a member of the school teaching team will be delegated the task of administering the medication. When a member of the school teaching team administers medication, the same checks must be undertaken by the staff member as administration by a school nurse. The staff member must therefore check the original containers for medication to be administered, checking the child s name, medication, dose to be administered, route, frequency etc. If medicines are required to be prepared in advance, this should be done under the supervision of the school nurse, but by the staff member who will administer the medication. Preparing medicines in advance of administration must only occur when all alternatives have been exhausted as this activity is secondary dispensing and produces an unlicensed medicine. All medications must be fully labelled with the child s name, the name and dose of medication, route and frequency of administration. Whenever possible, staff should take the container issued by the supplying pharmacist which will contain the pharmacy label. The child s MAR chart should also be taken with the child to ensure that administration is recorded immediately. Medication administered via enteral feeding tubes Medication administered via enteral feeding tubes will generally be outside the medication s marketing authorisation, both for solid and liquid dosage forms. Doctors, pharmacists and nurses therefore accept liability for administration of the medication via this route. The trust has a service level agreement with Abbott Nutrition to provide support and education on enteral feeding tubes and administration of medicines via this route. Prior to administration of medicines via this route, guidance must also be sought from a pharmacist on whether the medication can safely be administered via this route. Nurses must retain a record of this guidance for a robust audit trail. The nurses must also ensure they have liaised with the dietetics department who will be able to advise on equipment and flushes. It is essential that the prescriber records the route on the pharmacy label or alternatively provides a signed patient specific direction that clearly indicates the route of administration. This is essential as it will provide evidence that the prescriber accepts responsibility for administration of medication outside the terms of its marketing authorisation. Medication must be administered via the smallest functional enteral syringe, this is important as smaller syringes can create too much pressure. Medication must be flushed with a 60ml enteral syringe. 8/10
Reuse of enteral syringes must be in line with the manufacturer s recommendations and for individual children only. Controlled drugs (CDs) Some CDs may be prescribed as medicine for use by children e.g. buccal Midazolam, and will be required to be kept in school. When administering a CD in school, these may be checked, administered and recorded by one Health Professional deemed competent to do so. If a second signatory is available to witness this process, this resource should be utilised. When a CD has been administered this must be recorded on the CD stock sheet, including the amount given and the new stock level In addition the MAR Chart should indicate medicines that are controlled drugs and a running total should be maintained. 6.6 Disposal of medication no longer required Expired medicines or those no longer required, should be sent home for disposal and recorded on the stock balance sheet. A letter to parents is required to accompany the medicine explaining the reason for the return of the medicine. As with all other medicines in school, CDs should be returned to the pupil s parent/carer for disposal when the medicine is no longer required or has expired. This should be recorded in the CD stock sheet and a new stock level entered. The record of medication stock should be amended accordingly when medication is returned to parents/carers 7. EQUALITY IMPACT ASSESSMENT (EIA) In line with the trusts commitment to meet its statutory requirements outlined in the Equality and Diversity Strategy each procedural document is screened using an Equality Impact Assessment (EIA) Screening Tool. This demonstrates the trust s commitment to equality and human rights by recognising that the experiences and needs of every individual are unique and strives to value and respect the diversity of staff, patients, carers and the public. EIA s support organisations to avoid discrimination on any grounds including age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex or sexual orientation. Carers are also protected from discrimination, as they are associated with people with a protected characteristic i.e. disabled people. Should staff become aware of any exclusions that do not comply with this statement would need to complete an incident form and an appropriate action plan put in place An equality impact assessment tool has been completed and forwarded to the Equality and Diversity Lead the EIA will be available on the trust s website. 9/10
8. References/ Bibliography a. Medicines Act 1968 b. Standards for medicines management NMC 2010 c. Supporting pupils at school with medical conditions, Department for Education December 2015 10/10