Administration of Medications in Schools

Version Number

5.0

Implementation Date

19/01/2016

Scope

All state schools

Purpose

Provides requirements for the administration of medications to students whilst attending school or school-related activities, in accordance with the advice of the student’s prescribing health practitioner or as an emergency first aid response.​​

Overview

The administration of medications to students by school staff is only considered when a prescribing health practitioner has determined that it is necessary or when there is no other alternative in relation to the treatment of a specific health need.

Schools require medical authorisation to administer any medication to students (including over-the-counter medications such as paracetamol or alternative medicines).

Responsibilities

The principal is responsible for the:

  • safe administration of medications to students for whom they are prescribed
  • safe receipt and storage of students' medication whilst attending school or school-related activities
  • training of staff in the administration of medications for students with specialised health needs.

Process

Procedure in a medical emergency
All school staff

After administration of emergency medication

 

Administration of medications
Principals

Communication with parents/carers:

  • Advise parents/carers that before any medication can be administered to their child at school, they will need to complete the appropriate record sheet:
  • Make both types of record sheets available to parents/carers (e.g. on enrolment, when medication changes, newly prescribed medication).
  • Advise parents/carers that medication will only be administered if it is prescribed, in the original container and has a pharmacy label. If the medication is more complex with specific administration requirements then a letter from the medical practitioner should be provided.
  • Review the student’s routine or emergency medication requirements annually or as required and meet with students' parents/carers where necessary to discuss the responsibilities of both parties, e.g. ensuring appropriate supply of medication is made available if required.
  • Advise parents/carers to notify the school in writing:
    • of any requests and/or guidelines provided by the students' prescribing health practitioner or pharmacist concerning medication administration
    • when medication is no longer required to be administered at school if changes occur in the dosage requirements for students' routine medication
    • and provide an accompanying letter/action plan from the prescribing health practitioner) when emergency medication changes occur
    • in advance if medication is being transported with the student for purposes other than administration at school (respite, shared parental arrangements, before and after school care).
  • If advised by the parent/carer that the medication is no longer required (e.g. due to change in medication) request that the parent/carer or adult authorised by the parent visit the school to personally collect unused medication.  All medication is to be returned in its original container. If there is a failure to collect then notify the parent/carer of planned disposal arrangements.
  • Where relevant, notify the parent/carer of the procedure to develop Individual and Emergency Health Plans or provide Action Plans in accordance with the Management of students with specialised health needs procedure.
  • Where appropriate, discuss with the parent/carer the process for approving self-administration of medications at school, as per Guidelines for the administration of medications in schools.
  • Refer to Communication regarding the administration of medications in schools for newsletter and website examples.

Communication with Staff

  • Ensure staff are aware of medication related emergency procedures.
  • Ensure health plans are accessible to all relevant staff who provide direct supervision or are assigned to support students with a specialised health need or health procedure.
  • Ensure staff who administer medications are aware of:
  • Refer to the Guidelines for the administration of medications in schools to establish:
    • school-specific procedures for the administration of medications and ensure all relevant staff are familiar with these procedures
    • procedures for secure storage and transportation of medication if the student is required to carry it on public transport or to out-of-school hours venues.
  • Refer to the First Aid Guideline to establish school-specific emergency procedures and ensure relevant staff are familiar with these procedures.

Training and Support

  • Ensure that sufficient staff are familiar with requirements of the Guidelines for the administration of medications in schools to administer medications safely.
  • Ensure that sufficient staff undergo specialised health needs training required to administer medication in accordance with students’ Health Plans where required.
  • Ensure necessary training, assessment and ongoing supervision is provided by the State Schools Registered Nurse (SSRN) or other qualified health practitioner to school staff who volunteer to administer specific medication to students with specialised health needs in accordance with their health plan.
  • Contact Regional Office to determine alternative local solutions where there is insufficient staff available to administer specific medications for specialised health procedures.
  • Ensure procedures have been implemented for all staff, including relief teachers, to be informed of the students they supervise who require medication.
  • Ensure supervising staff are aware of warning signs, triggers and emergency responses for health conditions requiring specific medication or other management as outlined in the student's Individual Health Plan and Emergency Health Plan and which staff are trained to administer medications.

Self-administration

  • Note the students whose parents/carers have approved for them to self-administer their asthma medication (as recorded in OneSchool medical records).
  • Approve students to be responsible for self-administration of medication and self-management of health conditions under the following conditions:
    • consultation has occurred with parent/carer and student/s regarding arrangements for the self-administration of medications and self-management of health conditions and the risks associated with self-administration in a school setting
    • the parent/carer, school and prescribing health practitioner, as required, have determined the student is responsible enough to undertake self-administration of medication at school
    • the parent/carer has provided the school with written advice supporting self-administration as provided by the prescribing health practitioner
    • agreement has been reached amongst the student, parent/carer and relevant school staff as to where medication is stored and where it is administered.
  • Notify staff if students are self-administering medication and ensure staff are aware of self-administration and self-management of medications and health conditions.
  • Ensure staff who supervise students who self-administer by injection or injecting pump are provided with training by a qualified health practitioner.

Stolen or Misused Medication

  • In the case of stolen or misused medication, including controlled drugs, or medication diverted from the person to whom it was originally prescribed:
    • notify parents/carers to arrange a replacement dosage of their medication
    • follow established procedures for missing property on school grounds
    • contact Regional Office
    • contact police if required (mandatory for loss of controlled drugs).

Administering medication to students
School staff

Prior to administration

  • ensure the parent has provided a signed Administration of medication at school (routine/short-term medication) or Administration of medication at school (emergency medication) record sheet
  • encourage parent/carer to administer the first dose of a new routine/short-term medication for their child and provide advice of any potential side effects of medication if new medication is being administered
  • refer to Appendix 1: Setting up a safe system to administer routine/short-term medication in the Guidelines for administration of medications in schools to inform school’s procedures
  • be familiar with the process in Appendix 1: Administering routine/short term medication  (INCLASS protocols) in the Guidelines for administration of medications in schools, for best practice in administering medications in schools
  • observe standard precautions for infection control relevant to administering medications
  • ensure medication to be administered has medical authorisation e.g. the original container is labelled ‘Prescription medication’ or ‘Controlled drug’ or the pharmacy label attached to the original container has the prescribing health practitioner’s name.
  • after reviewing the pharmacy label instructions on receipt of medication, if the information contradicts the request from the parent/carer, do not administer medication and seek clarification from the parent/carer.

During Administration

  • follow Appendix 1: Administering routine/short term medication (INCLASS protocols) in the Guidelines for the administration of medications in schools
  • check the instructions as per pharmacy label prior to administration and follow specific instructions, e.g. to be taken with food
  • dispense medication directly from the original medication container in the presence of the student and administer as soon as possible. It is not best practice to dispense into bags or cups with names on prior to the student arriving as medication may deteriorate or be otherwise compromised
  • notify the classroom teacher and parent/carer if student refuses their medication to determine possible risks and any further actions
  • notify the parent/carer if the student misses a dose of their routine/short-term medication or if any other medication error occurs.

After Administration

Medication Errors

  • If the incorrect dosage of medication or the incorrect medication has been administered to a student:
    • if the student has collapsed or is not breathing, phone 000 immediately (including mobiles), request ambulance services and follow the advice given
    • if there is no immediate adverse reaction, phone POISONS INFORMATION CENTRE on 131 126 and follow the advice given
    • record the incident of incorrect dosage or incorrect medication as a ‘Near miss’ (if demonstrating no side effects) or ‘injury illness’ (if demonstrating side effects) in MyHR Workplace Health and Safety
  • Notify the principal and the student's parent/carer of all medication errors (e.g. missed dose, dose refusal, incorrect dosage, incorrect medication).

Response to Side Effects

  • If the student has collapsed or is not breathing after receiving medication, immediately phone 000 and follow the advice given.
  •  If the student presents with side effects (atypical symptoms or behaviours), advise the parent/carer so that they may seek medical advice, notify the principal and record any event related to side effects of medication in student records.

Stolen Medication or Misused Medication

  • When medication is stolen or misused, or diverted from the person to whom it was originally prescribed, notify the school principal.

Storage of Medication

  • Establish and monitor procedures for safe and appropriate storage of medication in the original containers according to the manufacturer's instructions and special instructions from the pharmacist or prescribing health practitioner (including medication which needs to be stored below 25 degrees Celsius).
  • Store medication (other than emergency medication) in a:
    • non-portable, locked space such as cupboard/cabinet reserved for medications only
    • in a secure fridge if required with authorised access only
    • or as directed in the student’s Individual Health Plan, Emergency Health Plan or Action Plan.
  • Ensure that emergency medication is stored in a safe, unlocked location where it is easily accessible to the authorised student and staff at all times in the event of an emergency.
  • Limit access to all prescribed medications to persons authorised to administer medications.
  • Ensure accessing medication causes minimal disruption to the student's learning program.

Disposal of Medication and Equipment

Online Resources

Review Date

31/01/2018
Attribution CC BY

Controlled drugs (Schedule 8 drugs)
Prescription medication, such as Ritalin and Dexamphetamine, which have the potential to cause dependence or be abused. These are controlled substances and are to be located in a locked cabinet when not being administered.

Health Plans
An overarching term describing documents completed by medical practitioners or qualified health practitioners which provide the school with directions or guidelines to support students with specialised health needs. Health plans include Action Plans, Emergency Health Plans and Individual Health Plans.

> Action Plan
Developed by a medical or qualified health practitioner to provide guidelines to support a student with their specialised health need/s, for example anaphylaxis or asthma. There are a variety of nationally approved and standardised Action Plan preform as developed by peak medical organisations available for medical or qualified health practitioners to complete.

> Emergency Health Plan (EHP)
Developed when a student’s health needs may require a response from school staff that extends beyond basic first aid. It provides clear step-by-step directions of how to safely manage a predictable medical emergency specific to certain chronic health conditions and the correct use of emergency medication. The plan is developed by a qualified health practitioner, in consultation with the school staff, parent/carer, student, medical and other health professionals. The plan is developed and risk assessed for the context of the school or school related activities and is for use in these settings only.

> Individual Health Plan (IHP)
Provides school staff with an understanding of a student’s health condition and the reasonable adjustment required to accommodate the student on a daily basis at school and to inform school planning. The plan is developed by a qualified health practitioner, in consultation with the school staff, parent/carer, student, medical and when necessary, other health professionals. The plan is developed and risk assessed for the context of the school or school related activities and is for use in these settings only.

Medical authorisation
For the purposes of this procedure, medical authorisation may take the form of a prescribing health practitioner’s letter, an Action Plan or Individual/Emergency Health Plan signed by the health practitioner or the original medication with a completed current pharmacy label.

Medical practitioner
A doctor registered with the Medical Board of Australia, through the Registers of Practitioners, Australian Health Practitioner Regulation Agency (AHPRA).

Medication error
Any preventable error in administration that may cause or lead to harm to a student. Medication errors in a school environment occur for a variety of reasons, for example:

  • poor recording of medication administered to students
  • misreading label
  • poor labelling
  • a student taking another student’s medication
  • confusion over dose required.

A medication error includes any failure to administer medication as prescribed for a particular student, including failure to administer the right medication:

  • to the right student
  • within appropriate timeframes
  • in the correct dosage
  • by the correct route.

Medications
For the purposes of this procedure, medications are categorised according to the method for purchasing the medication (over-the-counter medications, prescription medications) or the frequency within which the medication is administered (emergency medication, routine medication, short-term medication).

> Emergency medications
Medications required for the emergency treatment of medical conditions, e.g. Midazolam for specific seizures, adrenaline auto-injectors for anaphylaxis, blue reliever for asthma. 

> First aid emergency medications
Medications which are dispensed in devices that non-medical personnel can be trained to use as a first aid response and retained in the school’s first aid kit, e.g. adrenaline auto-injectors for anaphylaxis, asthma reliever for asthma.

> Over-the-counter medication (OTC)
Medications for self-treatment, purchased from pharmacies, supermarkets, health food stores and other retailers, without advice from a medical practitioner. Examples include cold remedies, cough syrups, anti-fungal treatments, non-prescription analgesics such as paracetamol as well as alternative medicines (traditional or complementary) such as herbal, aromatherapy and homoeopathic preparations, vitamins, minerals and nutritional supplements.

> Prescription medication
Medications prescribed by a prescribing health practitioner under the Health (Drugs and Poisons) Regulation 1996 (Qld), are dispensed by a pharmacist. It is often difficult for parents/carers to obtain a separate written authority from their medical practitioner to give to the school, as the pharmacist and the doctor recognise that the doctor's prescription is the legal written authority required. Therefore, the presentation of the original medication container with an attached prescription pharmacy label constitutes a medical authority.

> Routine medication
Prescription medication required regularly for management of a specific disorder, e.g. attention deficit hyperactivity disorder; or health condition, e.g. cystic fibrosis. epilepsy, diabetes. 

> Short-term medication
For the purposes of this procedure, prescription medication required for acute conditions, e.g. one course of antibiotics to treat infection.

Pharmacy label
A label attached to  the original prescription medication container including the:
student’s full name

  • strength and description/name of the medication
  • dose and route of administration (may include the duration of therapy)
  • initials/logo of the pharmacist taking responsibility
  • time or interval the medication is to be taken
  • any other relevant directions for use, e.g. whether the medication is to be taken with food.

The pharmacy label may also include the name of the medical practitioner, which indicates that it has been prescribed.

Prescribing health practitioner
A health professional who has completed the appropriate training, giving them the authority to prescribe certain medications under the Health (Drugs and Poisons) Regulation 1996 (Qld) e.g. medical practitioner (doctor), dentist, optometrist, nurse practitioner.

Qualified Health Practitioner
A health professional with the relevant licencing, skills and knowledge to assess, plan and evaluate care.  This can be the student’s treating medical practitioner/health team or State Schools Registered Nurses (SSRN).  Qualified Health Practitioners are registered with the Australian Health Practitioner Regulation Agency or eligible for membership in the relevant national professional body.

Reasonable adjustment
A measure or action (or a group of measures or actions) taken by an education provider that has the effect of assisting a student with a disability to participate in education on the same basis as a student without a disability, and includes an aid, a facility, or a service that the student requires because of his or her disability  (Ref: Section 3.3 in the Disability Standards for Education 2005 at http://docs.education.gov.au/node/16354)

Route of administration
The method by which medication is administered may include:

  • oral: given via the mouth i.e. swallowed in the form of a tablet, capsule or liquid
  • sublingual: placed under the tongue and absorbed via the mucous membrane
  • enteral: given via nasogastric or gastrostomy tube
  • topical: substance applied directly on the skin or area directed as  a cream, ointment, skin patch, ear/eye drops
  • inhalation: such as inhalers and spacers for asthma
  • injection: a needle given into a fat layer or muscle through the  skin such as adrenaline auto-injector or insulin
  • rectally: suppositories or enemas.