Co-op Academy Grange wishes to ensure that all pupils with medical conditions receive appropriate care and support at school. This policy has been developed in line with the Department for Education Guidance - Supporting Pupils at School with Medical Conditions (Dec 2015).

Co-op Academy Grange endeavours to ensure that all its pupils achieve success in their academic work, in their relationships and in their day-to-day experiences at school. Some of our pupils are likely to have medical needs which mean that additional measures are required to ensure that they are enabled to have full access to the curriculum, that the impact of their medical difficulties upon their life in school is minimised as far as possible, and that all staff who work with the pupils understand the nature of their difficulties and how best to help them.

While there is no legal or contractual duty on teachers to administer medicine or supervise pupils taking their medicine, nevertheless we would wish to support our pupils where we can. Pupils with special medical needs have the same right of admission to school as other children and cannot be excluded from school on medical grounds alone.

Teachers and support staff are in loco parentis and may need to take swift action in an emergency, both in school and off site, for example during school trips.

The prime responsibility for a pupil’s health lies with the parent or carer who is responsible for the pupil’s medication and should supply the school with any relevant information.

The policy is implemented in conjunction with the Child Protection and Safeguarding Policy.

1. Key Roles and Responsibilities

Trust

The Trust is responsible for:

The overall implementation of the Supporting Pupils with Medical Conditions Policy and procedures of the Co-op Academy Grange.
Ensuring that Supporting Pupils with Medical Conditions Policy does not discriminate on any grounds including: ethnicity/national origin, culture, religion, gender, disability or sexual orientation.
Ensuring that any complaints regarding this policy are handled as outlined in the Trust’s Complaints Policy.
Ensuring that pupils with medical conditions are able to participate fully in all aspects of school life.
Ensuring that relevant training is delivered to staff members who take responsibility to support children with medical conditions.
Ensuring that information and teaching support materials regarding supporting pupils with medical conditions are available to members of staff with responsibilities under the policy.
Promoting cooperation between relevant partners and stakeholders regarding supporting pupils with medical conditions.
Ensuring the level of insurance in place reflects the level of risk.

Principal

The Principal is responsible for:

The day-to-day implementation of the Supporting Pupils with Medical Conditions Policy and associated procedures.
Ensuring the policy is developed effectively with partner agencies.
Making staff aware of this policy.
Identifying designated members of staff to collect medicine from parents/carers and making all staff aware of this.
Ensure written records are kept of any and all medicines administered to individual pupils, and across the school population including medicine that is being self- administered by pupils.
Liaising with healthcare professionals regarding the training required for staff.
Making relevant staff aware of pupil’s medical conditions.
Supporting individual pupil’s NHS care plans to be implemented.
Ensuring sufficient trained members of staff are available to implement the policy and deliver NHS Care plans in normal, contingency and emergency situations.
Ensuring the correct level of insurance is in place for staff who support pupils in line with the policy.
Contacting the school nursing service to inform them about any child who has a medical condition that they are not aware of.
Keeping staff updated to any change in policy or legislation on supporting pupils with medical conditions.

Staff members

Staff members are responsible for:

Taking appropriate steps to support children with medical conditions.
Where necessary, making reasonable adjustments to include pupils with medical conditions into lessons.
Administering medication, where this is part of their job role and they have received suitable training.
Keeping a register of all medicines that are brought into school, and sign on receipt of the medication.
Recording all medicine that has been administered in the pupils ‘medicine record log’.
Ensuring if a pupil is on short term medication then, at the end of the course of treatment the short term consent form should be marked ‘treatment completed’ and should be retained in the expired consent form folder for future reference.
Where appropriate, undertaking training to achieve the necessary competency for supporting pupils with medical conditions.
Informing the Director of Care and Wellbeing if they do not feel competent in administering medicine/procedure that they have been trained in.
Keeping a record of their competency training and informing the Director of Care and Wellbeing prior to the expiry date of the training.
Administering medicine/procedure in accordance with the pupil’s NHS Care Plan.
Familiarising themselves with procedures detailing how to respond when they become aware that a pupil with a medical condition needs help.
Acting in line with their job descriptions and accepting training in new tasks when they are described in Individual Healthcare Plans.

The NHS

The National Health Service is responsible for:

Providing support, advice and guidance to schools and their staff through a School Nursing Service and associated therapy services.
Providing suitable training to school staff in supporting pupils with medical conditions to ensure NHS Care Plans can be delivered effectively, including by reviewing and amending annually the training packs used to train nominated staff.
Providing annual training and declaring that the nominated staff member is competent to undertake the task independently on date of receiving the training, and providing that member of staff with a record that they have reached the required standard.
Providing regular competency checks of the clinical practice of trained and nominated staff, so that the Head of school and Trust have reassurance that standards of clinical practice in delegated tasks are maintained.

Parents/Carers

Parents/carers are responsible for:

Keeping the school informed about any changes to their child/children’s health.
Completing a parental consent form for school to administer medicine before bringing medicine into school.
Ensuring a responsible person brings medicine into school, hands it over to the designated person, and signs the register once the medicine has been handed over.
Making sure they provide the school with the medicine their child requires and keeping it up to date.
Ensuring medicine they send into school has been prescribed by a medical practitioner e.g. Doctor or dentist (prescription medicine) NOT over the counter medicine.
Ensuring the medicine they bring into school has a prescription label which clearly states the name and address of the pharmacy, the pupil’s name, date and dosage.
Collecting any leftover medicine when it is no longer required.
Discussing medication with their child/ren prior to requesting that a staff member administer the medication.
Where necessary develop a NHS Care Plan for their child in collaboration with the School Nursing team and other healthcare professionals.

2. Definition

“Medication” is defined as any medicine that has been prescribed.
“Prescription medicine” is defined as any drug or device prescribed by a doctor
A “staff member” is defined as any member of staff employed by the Trust, including teachers.

3. Training of staff

Teachers and support staff will, where appropriate to their role, receive training on supporting pupils with medical conditions as part of their induction. Safeguarding practices will be discussed during the training.
Teachers and support staff will receive regular and ongoing training as part of their professional development.
The clinical lead for this training is the School Nursing Team.
No staff member may administer prescription medicine or undertake any healthcare procedure, without undergoing training specific to the responsibility and reaching the required standard of competence, including administering medication.

4. The role of the student

Children who are competent will be encouraged to take responsibility for managing their own medicine and procedures whenever possible.
When it is safe to do so pupils will be allowed to carry their own medicines and devices.
If pupils refuse to take medication or to carry out the necessary procedure, parents will be informed so that alternative options can be explored.
Where appropriate pupils will be encouraged/supported to take their own medication under the supervision of a trained member of staff.

5. Care Plans

Where necessary, an NHS care plan will be used as the basis for an Individual Healthcare Plan developed in collaboration with the pupil, parent/carer, and medical professionals.
NHS Care Plans will be enabled as set out by health professionals wherever possible. It is the responsibility of the Healthcare Assistant to manage this process by assessing care plans and advising staff about risks and mitigations.
All Care Plans will be easily accessible whilst preserving confidentiality.
All Care Plans will be reviewed when a change to the child’s medical circumstances is identified. It remains the responsibility of the school to manage this, advised by the relevant medical or health specialist.
Where a pupil is returning from a period of hospital education or prolonged absence from school, the school will work with the clinicians, LA services and other support services to ensure the Care Plan identifies the support the pupil needs to reintegrate.

6. Medicine

Where possible it is preferable for medicines to be prescribed in a frequency that allows the pupils to take them outside of school hours. For example, unless in school time of administration is expressly stated on the prescription label, medications prescribed to be taken three times per day or less will not be administered in school.
If this is not possible, prior to staff members administering any medicine. The parent/carer of the pupil must complete and sign a parental agreement for the school to administer the medicine.
All medicines brought into school should be prescription medicine only. Over the counter medicine will not be accepted by staff, unless it is dispensed to the student by a pharmacist.
No pupil under 18 years of age will be given medication containing Aspirin without a doctor’s authorisation.
Controlled drugs may only be taken on school premises by the individual to whom they have been prescribed. Passing such drugs to others can be an offence. All controlled drugs must be signed in and double locked whilst on site.
A half termly audit must be carried out of all the controlled drugs on site by the school nursing team or designated person.
Medications will be stored in a dedicated Medicines Cabinet. Medication ‘in transit’ will be signed in and stored securely whilst on site, travelling securely, where required, in lock bags.
All medications left over at the end of the course will be returned to the pupil’s parents/carers to be disposed of. If parents/carers do not collect the unused medication then it will be taken to the pharmacy by a designated person to be disposed of.
When taking medication to the pharmacy to be disposed of by the designated person. A receipt should be collected and kept as proof of disposal.
Written records should be kept of all mediation administered in school to students.
Pupils will always be provided with access to their medication on request if it is indicated in their Care Plan.
Any side effects of the medication will be recorded on CPOMs as part of the safeguarding process, family will be informed and relevant staff will be advised to monitor any unusual side effects and report them to the care team.

7. Emergencies

Medical emergencies will be dealt with under the school’s emergency procedures.
Where an NHS Care Plan is in place it should detail:

What constitutes the threshold of an ambulance call out.
Action to be taken in an emergency

Pupils will be informed in general terms of what to do in an emergency such as telling a member of staff.
If a pupil needs to be taken to the hospital in an emergency. A member of staff will remain with the pupil until their parent/carer arrives.
In case of an emergency whilst on a school trip the Trip Risk Assessment should be followed.

8. Avoiding unacceptable practice

The following behaviour in unacceptable:

Ignoring medical evidence or opinion.
Ignoring the views of pupils and their parents/carers.
Assuming that pupils with the same condition require the same treatment, without referring to the Individual Healthcare Plan or NHS Care Plan.
Sending pupils home frequently or preventing them from taking part in activities at school.
Penalising pupils with medical conditions for their attendance record where the absences relate to their condition.
Making parents feel obliged or forcing parents/carers to attend school to administer medication which should be administered within the school day, or to provide medical support, including toilet issues.
Passing on training informally between team members, when competence is required to carry out a delegated task safely.
Refusing to allow pupils to eat, drink or use the toilet when they need to in order to manage their condition.
Not following the school's child protection and safeguarding practices and procedures.

9. Insurance

Staff who undertake responsibilities within this policy, and in line with care plans and the training and competency assessments they have been given, are covered by the school's insurance, which include the DfE Risk Protection Arrangements (RPA).
Full written insurance policy documents are available to be viewed by members of staff who are providing support to pupils with medical conditions.

10. Complaints

Details of how to make a complaint can be found in the Trust’s Managing Complaints Policy.

Use of emergency salbutamol inhalers in school

From 1st October 2014, the Human Medicines (Amendment) (No. 2) Regulations 2014 allow schools to keep a salbutamol inhaler for use in emergencies. The inhaler can be used if the pupil’s prescribed inhaler is not available (for example, because it is broken, or empty). This change applies to all primary and secondary schools in the UK. Schools are not required to hold an inhaler – this is a discretionary power enabling schools to do this if they wish.

At Co-op Academy Grange we will be holding Emergency Salbutamol Inhalers and we will ensure that it will only be used by children, for whom written parental consent for use of the emergency inhaler has been given, who have either been diagnosed with asthma and prescribed an inhaler, or who have been prescribed an inhaler as reliever medication. A child may be prescribed an inhaler for their asthma which contains an alternative reliever medication to salbutamol (such as terbutaline). The salbutamol inhaler should still be used by these children if their own inhaler is not accessible – it will still help to relieve their asthma and could save their life.

We have arrangements for the supply, storage, care, and disposal of the inhaler and spacers in line with the Trust Policy on Supporting Pupils with Medical Conditions. Also in place will be the following:

Pupils Health Care Plan in each relevant classroom of pupils in the school that have been diagnosed with asthma or prescribed a reliever inhaler, a copy of which will be kept with the emergency inhaler. There will be a list in the front, of all children who have parental permission for the use of the Emergency Inhaler. This allows staff to have a quick check for initiating the emergency response.
Ensuring that the emergency inhaler is only used by children with asthma with written parental consent for its use. (The draft letter for consent at Appendix A will be used for this)
Keeping a record of parental consent on the asthma register will also enable staff to quickly check whether a child is able to use the inhaler in an emergency.
Consent will be updated regularly – ideally annually - to take account of changes to a child’s condition.
Appropriate support and training for staff in the use of the emergency inhaler in line with the Trust’s wider policy on Supporting Pupils with Medical Conditions.
Keeping a record of use of the emergency inhaler as required by Supporting Pupils at School with Medical Conditions Policy and informing parents or carers that their child has used the emergency inhaler. The draft letter at Appendix B will be used to notify parents.
Having at least two members of staff responsible for ensuring the protocol is followed.
The use of an emergency asthma inhaler should also be specified in a pupil’s individual healthcare plan where appropriate.

The emergency kit

Our emergency asthma inhaler kit includes:

A salbutamol metered dose inhaler;
At least two single-use plastic spacers compatible with the inhaler;
Instructions on using the inhaler and spacer/plastic chamber;
Instructions on cleaning and storing the inhaler;
Manufacturer’s information;
Checklist of inhalers, identified by their batch number and expiry date, with monthly checks recorded;
Note of the arrangements for replacing the inhaler and spacers;
A list of children permitted to use the emergency inhaler as per parental consent form;
A record of administration (i.e. when the inhaler has been used).

Two emergency kits will be kept in the Care Team Room which is known to all staff, and to which all staff have access at all times. The inhaler and spacer will not be locked away but will be out of the reach and sight of pupils. The emergency inhaler will be clearly labelled to avoid confusion with a child’s inhaler.

Storage and care of the inhaler:

There will be least two named members of staff that will have responsibility for ensuring that:

On a monthly basis the inhaler and spacers are present and in working order, and the inhaler has sufficient number of doses available;

That replacement inhalers are obtained when expiry dates approach;

Replacement spacers are available following use;

The plastic inhaler housing (which holds the canister) has been cleaned, dried and returned to storage following use, or that replacements are available if necessary;

An inhaler should be primed when first used (e.g. spray two puffs). As it can become blocked again when not used over a period of time, it should be regularly primed by spraying two puffs.

To avoid possible risk of cross-infection, the plastic spacer should not be reused. It can be given to the child to take home for future personal use.

The inhaler itself however can usually be reused, provided it is cleaned after use. The inhaler canister should be removed, and the plastic inhaler housing and cap should be washed in warm running water, and left to dry in air in a clean, safe place. The canister should be returned when it is dry, and replaced, and the inhaler returned to the designated storage place. However, if there is any risk of contamination with blood (for example if the inhaler has been used without a spacer), it should also not be reused

but disposed of.

Responding to asthma symptoms and an asthma attack:

Salbutamol inhalers are intended for use where a child has asthma. The symptoms of other serious conditions/illnesses, including allergic reaction, hyperventilation and choking from an inhaled foreign body can be mistaken for those of asthma, and the use of the emergency inhaler in such cases could lead to a delay in the child getting the treatment they need. For this reason, the emergency inhaler should only be used by children who have been diagnosed with asthma, and prescribed a reliever inhaler, or who have been prescribed a reliever inhaler AND whose parents have given

consent for an emergency inhaler to be used.

Common ‘day to day’ symptoms of asthma are:

Cough and wheeze (a ‘whistle’ heard on breathing out) when exercising

Shortness of breath when exercising

Intermittent cough

These symptoms are usually responsive to use of their own inhaler and rest (e.g. stopping exercise). They would not usually require the child to be sent home from school or to need urgent medical attention.

Signs of an asthma attack include:

Persistent cough (when at rest)

A wheezing sound coming from the chest (when at rest)

Being unusually quiet

The child complains of shortness of breath at rest, feeling tight in the chest (younger children may express this feeling as a tummy ache)

Difficulty in breathing (fast and deep respiration)

Nasal flaring

Being unable to complete sentences

Appearing exhausted

A blue / white tinge around the lips

Going blue

If a child is displaying the above signs of an asthma attack, the guidance below on responding to an asthma attack should be followed.

CALL AN AMBULANCE IMMEDIATELY AND COMMENCE THE ASTHMA ATTACK PROCEDURE WITHOUT DELAY IF THE CHILD

Appears exhausted

Has a blue/white tinge around lips

Is going blue

Has collapsed

Responding to signs of an asthma attack:

Keep calm and reassure the child.

Encourage the child to sit up and slightly forward.

Use the child’s own inhaler – if not available or there is a problem i.e.: broken, empty, out of date, not in school, use the emergency inhaler which is located in the Care Team Room.

Remain with the child while inhaler and spacer are brought to them.

Immediately help the child to take two puffs of the salbutamol via the spacer immediately.

If there is no immediate improvement, continue to give two puffs every two minutes up to a maximum of 10 puffs, or until their symptoms improve. The inhaler should be shaken between puffs.

Stay calm and reassure the child. Stay with the child until they feel better. The child can return to school activities when they feel better.

If the child does not feel better or you are worried at ANYTIME before you have reached 10 puffs, CALL 999 FOR AN AMBULANCE.

If an ambulance does not arrive in 10 minutes give another 10 puffs in the sameway.

The child’s parents or carers should be contacted after the ambulance has been called.

A member of staff should always accompany a child taken to hospital by ambulance and stay with them until a parent or carer arrives.

Recording use of the inhaler and informing parents/carers:

Use of the emergency inhaler should be recorded. This should include where and when the attack took place (e.g. PE lesson, playground, classroom), how much medication was given, and by whom. Supporting Pupils with Medical Conditions Policy requires written records to be kept of medicines administered to children. The child’s parents must be informed in writing so that this information can also be passed onto the child’s GP. The draft letter at Appendix B will be used to notify parents.

Staff

Any member of staff may volunteer to take on these responsibilities, but they cannot be required to do so. These staff may already have wider responsibilities for administering medication and/or supporting pupils with medical conditions.

In the following advice, the term ‘designated member of staff’ refers to any member of staff who has responsibility for helping to administer an emergency inhaler, e.g. they have volunteered to help a child use the emergency inhaler, and been trained to do this.

ALL staff are informed of:

Symptoms of an asthma attack, and ideally, how to distinguish them from other conditions with similar symptoms;

Staff who administer inhalers have appropriate training

Aware of the asthma policy;

Aware of how to check if a child is on the register;

Aware of how to access the inhaler;

Aware of who the designated members of staff are, and the policy on how to access their help;

Administering salbutamol inhalers through a spacer;

The school nurses deliver this training each year to all members of school staff.

Designated members of staff are trained in:

Recognising asthma attacks (and distinguishing them from other conditions with similar symptoms);

responding appropriately to a request for help from another member of staff;

recognising when emergency action is necessary;

Making appropriate records of asthma attacks.

Appendix A

CONSENT FORM: USE OF EMERGENCY SALBUTAMOL INHALER

Child showing symptoms of asthma / having asthma attack

1. I can confirm that my child has been diagnosed with asthma / has been prescribed an inhaler [delete as appropriate].

2. My child has a working, in-date inhaler, clearly labelled with their name, which they have in school that is kept in the designated area in the classroom.

3. In the event of my child displaying symptoms of asthma, and if their inhaler is not available or is unusable, I consent for my child to receive salbutamol from an emergency inhaler held by the school for such emergencies.

Signed:……………………………………………

Date: ………………………………………………

Name (print)……………………………………………………………

Child’s name: ….………………………………………………………

Class: ………………………………..

Parent’s address:

……………………………………………………………………………………

Parent’s telephone: ………………………………

Appendix B

LETTER TO INFORM PARENTS OF EMERGENCY SALBUTAMOL INHALER USE

Child’s name: ……………………………………………………

Class: …………………………………………..

Dear…………………………………………….,

This letter is to formally notify you that………………………………………………..has had problems with his / her breathing today. This happened when …………………………………………………………………

……………………………………………………….…………………………………………………………………………………………………………………………………………………………………………………………….

A member of staff helped them to use their asthma inhaler.

They did not have their own asthma inhaler with them, so a member of staff helped them to use the emergency asthma inhaler containing salbutamol. They were given ……… puffs.

Their own asthma inhaler was not working, so a member of staff helped them to use the emergency asthma inhaler containing salbutamol. They were given ……… puffs.

Although they soon felt better, we would strongly advise that you have your seen by your own doctor as soon as possible.

Yours sincerely

Supporting Pupils at School with Medical Conditions Policy