HLS-PR-009: Administration of Routine and Emergency Medication in Schools

• Health (Drugs and Poisons) Regulation 1996 (Qld) ss. 18(3), 30(2) http://www.legislation.qld.gov.au/LEGISLTN/CURRENT/H/HealDrAPoR96.pdf
• Workplace Health and Safety Act 1995 (Qld) Parts 1-17 http://www.legislation.qld.gov.au/LEGISLTN/CURRENT/W/WorkplHSaA95.pdf
• Education (General Provisions) Act 2006 (Qld) s 426 http://www.legislation.qld.gov.au/LEGISLTN/CURRENT/E/EducGenPrA06.pdf
• Right to Information Act 2009 (Qld) http://www.legislation.qld.gov.au/LEGISLTN/CURRENT/R/RightInfoA09.pdf
• Information Privacy Act 2009 (Qld) http://www.legislation.qld.gov.au/LEGISLTN/CURRENT/I/InfoPrivA09.pdf

• HLS-PR-003: First Aid /strategic/eppr/health/hlspr003/index.html
• HLS-PR-004: Infection Control and Management of Prescribed Contagious Conditions /strategic/eppr/health/hlspr004/
• HLS-PR-005: Health and Safety Incident Recording and Notification /strategic/eppr/health/hlspr005/
• SCM-PR-002: School Excursions /strategic/eppr/schools/scmpr002/
• SMS-PR-027: Enrolment in State Primary, Secondary and Special Schools /strategic/eppr/students/smspr027/
• LGS-PR-003: Crown Acceptance of Legal Liability for Actions of Crown Employees /strategic/eppr/legal/lgspr003/

Statement of intent

This procedure aligns with the expectations for all Education Queensland personnel and legislative obligations to ensure all students who require medication at school are appropriately supported, enabling participation in the full range of school activities according to the advice of their prescribing health practitioner.

Medication able to be administered includes:

• routine medications - required regularly for maintenance of a specific health condition (e.g. medication to treat cystic fibrosis)
• emergency medications - required for the emergency first-aid treatment of medical conditions (e.g. Midazolam for specific seizures, adrenaline auto-injectors for anaphylaxis, Ventolin for asthma).

For the purposes of this procedure, medications are categorised as prescription medications and over-the-counter medications.

Medication can be administered via a number of routes. The most common route of medication administration in schools is orally. Other more specialised routes include medication administered via a gastrostomy tube or other feeding tubes, insulin injections for diabetes, use of adrenaline auto-injectors for anaphylaxis.

A request to administer medication by school staff during school hours should be considered only when there is no other alternative in relation to the treatment of specific medical conditions and when a prescribing health practitioner has determined that the administration of medication at school is necessary. The request to administer medication by school staff should be made using the Request to administer medication at school form 84k

IMPORTANT NOTE:
Medication required for medical emergencies, such as for anaphylaxis, diabetes, epilepsy or asthma attack are to be accessible at all times. EMERGENCY MEDICATION SHOULD NOT BE STORED IN A LOCKED CABINET. It should be stored in a safe, accessible place for emergency use wherever the student may be.

If the incorrect dosage of medication or the incorrect medication has been administered to a student the POISONS INFORMATION CENTRE should be contacted immediately on telephone 131 126 and the advice given followed. The appropriate documentation per HLS-PR-005: Health and Safety Incident Recording and Notification should be completed. For other medication errors (e.g. missed dose, dose refusal) the student's parent/carer or prescribing health practitioner should be contacted and appropriate records maintained.

Staff are not to administer any over-the-counter medications (including paracetamol or similar medications) without the correct authorisation from a medical practitioner.

Guidelines for the Administration of Medication in state schools outlines specifically the:

• administration of all medications
• administration of routine prescription medications
• administration of emergency medications
• administration of over-the-counter medications
• self-administration or assisted administration of medications.

All medications will require authorisation from a medical practitioner or a prescribing health professional.

Procedures for storage and administration of first aid medication, including first aid kit and contents, are outlined under HLS-PR-003 First Aid.

Responsibilities

• provide emergency first aid by:
  • administering first aid when there is no student specific plan,
  • following the student's Individual and Emergency Health Plan
• document details in the Health and Safety Incident: SMS Data Entry Form 310k if incident required parental notification and/or ambulance assistance, and/or serious injury occurred.

• ensure staff are aware of:
  • Guidelines for the administration of medication in state schools
  • Protocols for safe administration of medication in state schools
  • Flowchart: administration of routine and emergency medication in state schools 60k
• distribute Request to administer medication at school 84k forms to parents/carers:
  • at the beginning of the school year
  • on enrolment, or
  • when required (changed medication, newly prescribed medication).
• ensure parents/carers are aware that they should notify the school about their child's health. Schools may choose to do this using the school newsletter item. A reminder to parents/carers to notify the school about your child's health
• ensure request to administer medication at school 84k and other required documentation is completed for all medication administration, both by the parent/carer and the school
• establish school-specific procedures for the administration of medications and ensure all relevant staff are familiar with these procedures
• identify staff members willing and able to receive training on administration of medication for health conditions
• seek support from appropriately qualified health professionals, including Education Queensland Registered Nurse for assistance with student health issues and training in the administration of medication
• meet with students' parents/carers to discuss the responsibilities of both parties
• ensure an emergency health plan is developed for those students who require the administration of medication to manage an emergency medication
• ensure procedures have been implemented for all staff, including temporary relief teachers and other staff, to be informed of all students who require the administration of medication, and where possible, and to be fully aware of warning signs, triggers and emergency responses for health conditions requiring medication or other management as outlined in a student's emergency health plan
• ensure school staff, especially designated first aid personnel, are trained in the recognition and management of a health-related emergency for students and staff
• approve student to be responsible for self-administration of medication and self-management of health conditions
• consult with parent/carer and student/s regarding arrangements for the self-administration of medications and self-management of health conditions, including:
  • consideration of whether the student is responsible enough to undertake self-administration of medication at school
  • agreement between the student, parent/carer and school on where medication is stored; where and how it is administered, together with a written request from the parent/carer stating guidelines and procedures from the medical practitioner
• notify the parent/carer of their responsibility to supply medication so it is available to be administered to the student when required
• if required, notify the parent/carer when the medication quantity is low or approaching its expiry date
• if advised by the parent/carer that the medication is no longer required (i.e. change in medication order/dose) request that the parent/carer visit the school for the medication to be returned directly to them in its original container (not via the student)
• promote a culture of recording and reporting medication errors and develop procedures to minimise errors
• notify the parent/carer if the student misses a dose of medication including if the student refuses to take the medication or if any other medication error occurs
• in the case of stolen or misused medication, including Schedule 8 Drugs, or medication diverted from the person to whom it was originally prescribed:
  • follow established procedures for missing property on school grounds
  • notify parents/carers
  • contact Regional Office
  • contact police as required.
• be aware of the role of the Education Queensland Registered Nurse.

• participate in training provided by a qualified health practitioner addressing issues such as storage, dosage and administration of medication
• ensure parent/carer permission has been received Request to administer medication at school 84k
• follow the Guidelines for the administration of medication in state schools when administering medication
• follow the Protocols for safe administration of medication in state schools
• be aware of potential medication errors and follow procedures to minimise errors
• administer medication directly from the original medication container
• notify principal if student refuses their medication
• if the information on the medication container contradicts the request of the parent/carer, do not administer medication and seek clarification (between the pharmacy, prescribing health practitioner and family)
• record details of all medication administered in the routine medication administration: sign off sheet 121k to be completed by the person authorised to administer the medication, immediately the medication (routine and emergency) is administered, including when students are on school outings, excursions and camps
• in the case of stolen or misused medication, or medication diverted from the person to whom it was originally prescribed notify the school principal and follow established procedures for missing property on school grounds.

Storage and disposal of medication

• establish and monitor procedures for safe and appropriate storage of medication according to the manufacturer's instructions and special instructions from the pharmacist or prescribing health practitioner (including medication which needs to be stored below 25C)
• store medication in a non-portable, locked space such as cupboard/cabinet reserved for medications only
  Note: medication required for emergencies, such as adrenaline auto-injectors or asthma relievers must be accessible at all times and not stored in a locked cabinet. The medication should be stored in safe, accessible place for emergency use wherever the student may be.
• limit access to all stored medications to persons authorised to administer medications
• store in original containers in a manner that assures security and efficacy
• ensure accessing medication causes minimal disruption to the student's learning program
• discuss arrangements with the school if medication is to be carried by the student and the student will not be traveling directly home from school, ensuring the medication is stored in a secure area while the student is at school
• ensure safe disposal of sharps
• dispose of unused and unclaimed medication by:
  • advising the parent/carer to collect the medication from the school, or
  • returning medications to any pharmacy to be disposed of through the Returning Unwanted Medicines .

• notify the school in writing of any requests and/or guidelines provided by the students' prescribing health practitioner concerning medication administration
• submit a Request to administer medication at School 84k form to the principal for the administration of medication that must occur during school or an extended school activity such as a camp or excursion, at the commencement of long-term medical treatment and thereafter
  • at the beginning of the school year
  • on enrolment, or
  • when medication is prescribed at other times throughout the year.
• where possible ask the prescribing health practitioner if the required medication is available in a form which minimises or eliminates the need to administer medication at school
• discuss the option with the dispensing pharmacist to supply the medication in a multi-dose pack with clear administration directions (particularly when multiple medications are prescribed)
• provide the medication in person or via a delegated adult in a safe manner to the school and in the original container (rather than send medication with the student)
• provide an emergency health plan when medication is prescribed to manage emergency health conditions/situations
• ensure the medication supply has not expired and is adequate for the agreed time period, and replenished as required (school may notify)
• notify the school in writing (with an accompanying letter from the prescribing health practitioner) when changes occur to the students' routine or emergency medication
• obtain in writing advice from the prescribing health practitioner if the dose is to be varied in response to specific criteria (e.g. blood glucose level, behaviour)
• advise school in writing and collect medication when it is no longer required at school
• notify the school in advance (in writing) if medication is being transported with the student for purposes other than administration at school (respite, shared parental arrangements).

Forms

• Request to Administer Medication at School 84k
• Routine Medication Administration - Sign off Sheet 121k

• Guidelines for the administration and self-management of health conditions
• Protocols for safe administration of medication in state schools

Other relevant documents

• Self-administration of medication and self-management of health conditions/strategic/eppr/health/hlspr009/administration.html
• Newsletter item (A reminder to parents/carers to notify the school about your child's health)/strategic/eppr/health/hlspr009/newsletter.html
• Definitions/strategic/eppr/health/hlspr009/definition.html
• Flowchart: administration of routine and emergency medications in state schools 60k/strategic/eppr/health/hlspr009/flowchart.pdf
• Individual and Emergency Health Plan /strategic/eppr/health/hlspr009/individual.html

Contacts

For further information, please contact:

• HLS-PR-009: Administration of Routine and Emergency Medication and Management of Health Conditions - Version: 1.0, 2.0