A guide to what anaphylaxis is, and how to support pupils at risk
There is no legal or contractual duty on teachers to administer medicine or to supervise a pupil taking it. This is a purely voluntary role and is recognised as such by the Government. While teachers have a general legal duty of care to their pupils, this does not extend to a requirement to routinely administer medicines. Support staff may, as part of their contract, have specific duties to administer medication.
Teachers may volunteer to administer medication but should be particularly wary about agreeing to administer medicines where:
- the timing of its administration is crucial to the health of the child
- some technical or medical knowledge is required
- intimate contact with the pupil is necessary (this would include administration of rectal Valium, assistance with catheters or use of equipment for children with tracheotomies).
Any decision on the part of a teacher to agree to administer medicines has to be a matter of individual choice and judgement. Apart from the obvious distress to a teacher who makes an error, all teachers who agree to administer medicines take on a legal responsibility to do so correctly. There is consequently always the risk that the teacher might be named in a legal claim for negligence. Generally, however, any teacher acting in accordance with agreed procedures would be regarded as acting in the interests of the employer and, since the employer would also be the subject of the action, the teacher would therefore be effectively indemnified against personal liability by the rules of ‘vicarious liability’.
The NEU advises that teachers and support staff who do volunteer to administer medicines should not agree to do so without first receiving appropriate information and training. The employer should arrange appropriate training in collaboration with local health services, which will also be able to advise on further training needs. While few schools benefit from a nurse on site, it is important that schools should be able to seek advice from a nurse where necessary.
The NEU will support members who do not wish to administer medicines or who feel that they are being unfairly pressurised to do so.
The local authority, academy trust or other responsible body, has principal responsibility for the safety and welfare of pupils. It is essential, therefore, that local authorities and other employers issue detailed policy guidelines to all schools, clarifying the areas of responsibility for medicines, together with the procedure to operate should there be a need for medication to be administered in school. Where an employer has issued guidelines which accord with the principles set out in this briefing, members should follow them carefully.
In cases of accident and emergency, teachers must, of course, always be prepared to help as they and other school staff in charge of pupils have their general legal duty of care to act as any reasonably prudent parent would. In such emergencies, teachers should do what is obviously necessary and appropriate to relieve extreme distress or prevent further and otherwise irreparable harm. Qualified medical treatment should be secured in emergencies at the earliest opportunity.
Children with long-term health problems
The NEU recognises that it is desirable for children with long-term recurring health conditions, such as asthma, epilepsy and diabetes, to be accommodated within school in order that they can continue their education.
For this to be done, however, proper and clearly understood arrangements for administration of medicines must be made. This will help ensure that children are comfortable with the arrangements. Parents should be encouraged to provide maximum support and assistance in helping the school accommodate the pupil. This would include measures such as self-administration (where necessary and only after approval from a GP) or parental supervision.
School policies and individual pupils’ health care plans
Every school should establish a clear policy on supporting individual pupils with medical needs, which must be understood by staff, parents and pupils. In addition, an individual health care plan should be drawn up and agreed for every pupil who may need medical care during the school day. The type of plan will vary according to the medical needs of the child, ranging from a short written agreement with parents to a more detailed document requiring the involvement of appropriate health professionals. Such care plans should be reviewed on a regular basis as agreed with parents. It is also important that the child’s teachers - including any supply or temporary staff - are made aware of the plan, and especially of what to do in cases of emergency. All medical details should be treated confidentially, and only be made available to others with the consent of the child/parent.
Parents are responsible for their child’s medication and children who are genuinely unwell should not attend school. Head teachers are, however, responsible for deciding whether the school can assist a pupil who needs medication during the school day.
Many pupils with long-term medical conditions will not require medication during school hours. Those that do may be able to administer it themselves.
Where this is not feasible, the following procedure is recommended.
- The smallest possible dose should be brought to the school, preferably by the parent, labelled with the name of the pupil in addition to clear written instructions for administration - including any possible side effects. It is not safe practice for staff managing medicines to follow re-labelled/re-written instructions or to receive and use re-packaged medicines other than as originally dispensed.
- Medicines should be stored safely until needed and children should know where their medicines are and be able to access them immediately.
- The medicine should be self-administered if possible, under the supervision of an adult. This may be the head teacher or someone acting with the head teacher’s authority. It is advisable to keep a written record of the date and time of the administration – indeed early years settings must do so by law. Staff managing medicines should ensure that the administration of the medicine is carried out and recorded in line with school and employer policies.
- If in doubt about any procedure, staff should not administer the medicines but check with the parents or a health professional before taking further action.
Safe storage of drugs in schools
The following advice in relation to storage of medication should be adhered to:
- Only prescribed medicines should be brought into school.
- Medicines should only be administered at school where it would be detrimental not to do so.
- Wherever possible children should be allowed to carry their own medicines and devices.
- Schools should not store large volumes of medication. As far as is practicable, the smallest possible dose of medicine should be brought into school. Doses of liquid medicines should not, however, be transferred from the original bottle as this would result in the loss of some of the medicine on the sides of the bottle. Medication should be stored strictly in accordance with product instructions, taking particular account of the correct storage temperature.
- Pupils should know where their own medication is stored and how to obtain it.
- Medicines should be stored in their original containers, clearly labelled with the name of the pupil, the name and dose of the drug, the frequency of administration, any likely side effects, and the expiry date. Parents are responsible for ensuring that this information is provided.
- Medicines should - subject to the exceptions below - be stored in a secure place such as a locked cupboard or a labelled airtight box in a refrigerator with restricted access.
- Some medicines, such as asthma inhalers and EpiPens, must be readily available to pupils and must not be locked away. Children who are capable of carrying their own inhalers should be allowed to do so, following consultation between parents and the head teacher. Generally, it is helpful if the school keeps a spare inhaler for that particular child, in case the original is mislaid. Schools are permitted to hold a spare salbutamol inhaler for emergency use, provided that parental consent has been given for its use in an emergency, should the child’s own inhaler not be available.
- Schools should not continue to store surplus or out-of-date medicines. Parents should be asked to collect the containers for delivery back to the chemist, and should routinely collect medicines held by the school at the end of each term. If parents do not collect all medicines, they should be taken to a local pharmacy for safe disposal.
- Sharps boxes (obtained by parents on prescription) should always be used for the disposal of needles.
- Local pharmacists can give advice about storing medicines.
- School staff may need to bring their own medication into school. This should be securely stored but does not need to be stored with pupils' medicines.
Staff should never volunteer to give non-prescribed medicines to children unless:
- there is specific prior written permission from parents; and
- it is carried out in accordance with the employer’s policy.
Children under 16 should never be given aspirin or medicines containing ibuprofen unless prescribed by a doctor.
Hygiene and infection control
All staff should be familiar with basic hygiene procedures and normal precautions for avoiding infection.
In particular, staff should have access to protective disposable gloves and should take special care when dealing with spillages of blood or other body fluids, or the disposal of dressings or equipment.
All schools should have arrangements in place for dealing with emergency situations. This could be part of a school’s first aid policy. Pupils should know what to do in the event of an emergency (eg informing a member of staff). Staff need to be fully aware of a school’s policy on emergency procedures, including the identity and role of the member of staff responsible for carrying them out. An appropriate member of staff should be available to accompany a child to hospital in an ambulance and to remain with them until the parent arrives. Staff should not take children to hospital in their own car.
A number of schools now hold automated external defibrillators (AEDs) on site, which can be used if a pupil or member of staff goes into cardiac arrest. The NEU supports the campaign to install AEDs in schools, as they could save the life of a pupil or member of staff. As with administering medicines, staff cannot be compelled to undergo training in administering AEDs but are able to volunteer to do so if their employer purchases an AED.
Action points for NEU health and safety representatives
Make sure that in your school:
- a copy of the DfE guidance is available and accessible
- your colleagues are aware of their responsibilities and rights and are indemnified by the employer should anything go wrong
- there is a medicines policy reflecting NEU/DfE advice, and a suitable individual health care plan has been agreed for each child with special medical needs in the school.
For more information, please read 'Administration of Medicines'