At Woodland’s we recognise that parents have the prime responsibility for their child’s health and that it is their responsibility to provide school with information about their child’s medical condition. Parents, should obtain details from their child’s General Practitioner (GP) or paediatrician, if needed. The school doctor or nurse or a health visitor and specialist voluntary bodies may also be able to provide additional background information about specific conditions. Since September 2002 schools and LEAs have been under a duty:
• not to treat less favourably disabled pupils or students, without justification,
than pupils and students who are not disabled
• to make reasonable adjustments to ensure that disabled pupils and students are
not put at a substantial disadvantage in comparison to those who are not disabled
At Woodlands we are committed to these principles. Aims It is the aim of this policy to provide
• procedures for managing prescription medicines which need to be taken during
• procedures for managing prescription medicines on trips and outings • a clear statement on the roles and responsibility of staff managing administration
of medicines, and for administering or supervising the administration of medicines
• a clear statement on parental responsibilities in respect of their child’s
• the need for prior written agreement from parents5 for any medicines to
• the circumstances in which children may take any non-prescription medicines • the school or setting policy on assisting children with long-term or complex
• policy on children carrying and taking their medicines themselves • staff training in dealing with medical needs • record keeping • safe storage of medicines • access to the school’s emergency procedures • risk assessment and management procedures
At Woodlands we recognise that there is no legal duty that requires school or staff to administer medicines. However, where staff are willing, they should follow the following guidelines:-
• Parents should provide full information about their child’s medical needs, including
• Medicines should only be bought to school when essential; that is where it would be
detrimental to a child’s health if the medicine were not administered during the school ‘day’.
• The school should only accept medicines that have been prescribed by a doctor,
dentist, nurse prescriber or pharmacist prescriber. However as part of our ‘loco parentis’
role we may also administer mild analgesics such as Calpol, or over the counter cough remedies. However, a child under 16 should never be given aspirin or medicines containing ibuprofen unless prescribed by a doctor.
• Medicines should always be provided in the original container as dispensed by a
pharmacist and include the prescriber’s instructions for administration.
• The School should never accept medicines that have been taken out of the container as originally dispensed nor make changes to dosages on parental instructions.
• No child under 16 should be given medicines without their parent’s written consent. • Any member of staff giving medicines to a child should check:
the child’s name prescribed dose expiry date written instructions provided by the prescriber on the label or container11
• 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. If staff have any other concerns related to administering medicine to a particular child, the issue should be discussed with the parent, if appropriate, or with a health professional attached to the school or setting.
• The schools should also arrange for staff to complete and sign a record each time they
give medicine to a child. Form 6 can be used for this purpose. Good records help demonstrate that staff have exercised a duty of care.
Helpful advice for parents about prescribed medicine
It is helpful, where clinically appropriate, if medicines are prescribed in dose frequencies which enable it to be taken outside school hours. Parents could be encouraged to ask the prescriber about this. It is to be noted that medicines that need to be taken three times a day could be taken in the morning, after school hours and at bedtime. The Medicines Standard of the National Service Framework (NSF) for Children6 recommends that a range of options are explored including:
• Prescribers consider the use of medicines which need to be administered only once
or twice a day (where appropriate) for children and young people so that they can be taken outside school hours
• Prescribers consider providing two prescriptions, where appropriate and practicable,
for a child’s medicine: one for home and one for use in the school or setting, avoiding the need for repackaging or relabelling of medicines by parents Educational Visits It is good practice for schools to encourage children with medical needs to participate in safely managed visits. Schools and settings should consider what reasonable adjustments they might make to enable children with medical needs to participate fully and safely on visits. This might include reviewing and revising the visits policy and procedures so that planning arrangements will include the necessary steps to include children with medical needs. It might also include risk assessments for such children. Sometimes additional safety measures may need to be taken for outside visits. It may be that an additional supervisor, a parent or another volunteer might be needed to accompany a particular child. Arrangements for taking any necessary medicines will also need to be taken into consideration. Staff supervising excursions should always be aware of any medical needs, and relevant emergency procedures. A copy of any health care plans
should be taken on visits in the event of the information being needed in an emergency. Travel sickness medication is administered in the same way as other medication at Woodlands Junior School – parents should fill in a form, medication should be in the original packaging, the adult administering should make a record and another adult should witness the administration. If staff are concerned about whether they can provide for a child’s safety, or the safety of other children on a visit, they should seek parental views and medical advice from the school health service or the child’s GP. See DfES guidance on planning educational visits Sporting Activities Most children with medical conditions can participate in physical activities and extra-curricular sport. There should be sufficient flexibility for all children to follow in ways appropriate to their own abilities. For many, physical activity can benefit their overall social, mental and physical health and well-being. Any restrictions on a child’s ability to participate in PE should be recorded in their individual health care plan. All adults should be aware of issues of privacy and dignity for children with particular needs. Some children may need to take precautionary measures before or during exercise, and may also need to be allowed immediate access to their medicines such as asthma inhalers. More details about specific health conditions can be found in Chapter 5. Staff supervising sporting activities should consider whether risk assessments are necessary for some children, be aware of relevant medical conditions and any preventative medicine that may need to be taken and emergency procedures. Short -Term Medical Needs Many children will need to take medicines during the day at some time during their time in a school or setting. This will usually be for a short period only, perhaps to finish a course of antibiotics or to apply a lotion. To allow children to do this will minimise the time that they need to be absent. However such medicines should only be taken to school or an early years setting where it would be detrimental to a child’s health if it were not administered during the school day. Long-Term Medical Needs It is important to have sufficient information about the medical condition of any child with long-term medical needs. If a child’s medical needs are inadequately supported this may have a significant impact on a child’s experiences and the way they function in or out of school or a setting. The impact may be direct in that the condition may affect cognitive or physical abilities, behaviour or emotional state. Some medicines may also affect learning leading to poor concentration or difficulties in remembering. The impact could also be indirect; perhaps disrupting access to education through unwanted effects of treatments or through the psychological effects that serious or chronic illness or disability may have on a child and their family. The Special Educational Needs (SEN) Code of Practice 2001 advises that a medical diagnosis or a disability does not necessarily imply SEN. It is the child’s educational needs rather than a medical diagnosis that must be considered The school needs to know about any particular needs before a child is admitted, or when a child first develops a medical need. For children who attend hospital appointments on a regular basis, special arrangements may also be necessary. It is often helpful to develop a written health care plan for such children, involving the parents and
relevant health professionals. This can include:
• details of a child’s condition • special requirement e.g. dietary needs, pre-activity precautions • and any side effects of the medicines • what constitutes an emergency • what action to take in an emergency • what not to do in the event of an emergency • who to contact in an emergency • the role the staff can play
Form 2 provides an example of a health care plan that schools and settings may wish to use or adapt. Self-Management It is good practice to support and encourage children, who are able, to take responsibility to manage their own medicines from a relatively early age and schools should encourage this. The age at which children are ready to take care of, and be responsible for, their own medicines, varies. As children grow and develop they should be encouraged to participate in decisions about their medicines and to take responsibility. Older children with a long-term illness should, whenever possible, assume complete responsibility under the supervision of their parent. Children develop at different rates and so the ability to take responsibility for their own medicines varies. This should be borne in mind when making a decision about transferring responsibility to a child or young person. There is no set age when this transition should be made. There may be circumstances where it is not appropriate for a child of any age to self-manage. Health professionals need to assess, with parents and children, the appropriate time to make this transition. If children can take their medicines themselves, staff may only need to supervise. The medical plan should say whether children may carry, and administer (where appropriate), their own medicines, bearing in mind the safety of other children and medical advice from the prescriber in respect of the individual child. Where children have been prescribed controlled drugs staff need to be aware that these should be kept in safe custody. However children could access them for self-medication if it is agreed that it is appropriate. Refusing Medicines If a child refuses to take medicine, staff should not force them to do so, but should note this in the records and follow agreed procedures. The procedures may either be set out in the policy or in an individual child’s health care plan. Parents should be informed of the refusal on the same day. If a refusal to take medicines results in an emergency, the school or setting’s emergency procedures should be followed. Safety Management All medicines may be harmful to anyone for whom they are not appropriate. Where a school or setting agrees to administer any medicines the employer must ensure that the risks to the health of others are properly controlled. This duty is set out in the Control of Substances Hazardous to Health Regulations 2002 (COSHH). Controlled Drugs The supply, possession and administration of some medicines are controlled by the
Misuse of Drugs Act and its associated regulations. Some may be prescribed as medication for use by children, e.g. methylphenidate. Any member of staff may administer a controlled drug to the child for whom it has been prescribed. Staff administering medicine should do so in accordance with the prescriber’s instructions. A child who has been prescribed a controlled drug may legally have it in their possession. It is permissible for schools and settings to look after a controlled drug, where it is agreed that it will be administered to the child for whom it has been prescribed. Schools and settings should keep controlled drugs in a locked non-portable container and only named staff should have access. A record should be kept for audit and safety purposes. A controlled drug, as with all medicines, should be returned to the parent when no longer required to arrange for safe disposal (by returning the unwanted supply to the local pharmacy). If this is not possible, it should be returned to the dispensing pharmacist (details should be on the label).Misuse of a controlled drug, such as passing it to another child for use, is an offence. Woodland’s has a policy in place for dealing with drug misuse7. Storing Medicines Large volumes of medicines should not be stored. Staff should only store, supervise and administer medicine that has been prescribed for an individual child. Medicines should be stored strictly in accordance with product instructions (paying particular note to temperature) and in the original container in which dispensed. Staff should ensure that the supplied container is clearly labelled with the name of the child, the name and dose of the medicine and the frequency of administration. This should be easy if medicines are only accepted in the original container as dispensed by a pharmacist in accordance with the prescriber’s instructions. Where a child needs two or more prescribed medicines, each should be in a separate container. Non-healthcare staff should never transfer medicines from their original containers. Children should know where their own medicines are stored and who holds the key. The head is responsible for making sure that medicines are stored safely. All emergency medicines, such as asthma inhalers and adrenaline pens, should be readily available to children and should not be locked away. Many schools and settings allow children to carry their own inhalers. Other non-emergency medicines should generally be kept in a secure place not accessible to children. Criteria under the national standards for under 8s day care require medicines to be stored in their original containers, clearly labelled and inaccessible to children. A few medicines need to be refrigerated. They can be kept in a refrigerator containing food but should be in an airtight container and clearly labelled. There should be restricted access to a refrigerator holding medicines. Local pharmacists can give advice about storing medicines. Access to Medicines Children need to have immediate access to their medicines when required. The school or setting may want to make special access arrangements for emergency medicines that it keeps. However, it is also important to make sure that medicines are only accessible to those for whom they are prescribed. This should be considered as part
of the policy about children carrying their own medicines. Disposal of Medicines Staff should not dispose of medicines. Parents are responsible for ensuring that date-expired medicines are returned to a pharmacy for safe disposal. They should also collect medicines held 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 should always be used for the disposal of needles. Sharps boxes can be obtained by parents on prescription from the child’s GP or paediatrician. Collection and disposal of the boxes should be arranged with the Local Authority’s environmental services. The sharps disposal box is in the medical room. Hygiene and Infection Control All staff should be familiar with normal precautions for avoiding infection and follow basic hygiene procedures19. Staff should have access to protective disposable gloves and take care when dealing with spillages of blood or other body fluids and disposing of dressings or equipment. Emergency Procedures As part of general risk management processes all schools and settings should have arrangements in place for dealing with emergency situations. This could be part of the school’s first aid policy and provision. Other children should know what to do in the event of an emergency, such as telling a member of staff. All staff should know how to call the emergency services. Guidance on calling an ambulance is provided in Form 1. All staff should also know who is responsible for carrying out emergency procedures in the event of need. The office staff are usually responsible for calling emergency services at Woodlands. A member of staff should always accompany a child taken to hospital by ambulance, and should stay until the parent arrives. Health professionals are responsible for any decisions on medical treatment when parents are not available. Staff should never take children to hospital in their own car; it is safer to call an ambulance. In remote areas a school might wish to make arrangements with a local health professional for emergency cover. The national standards require early years settings to ensure that contingency arrangements are in place to cover such emergencies Individual health care plans should include instructions as to how to manage a child in an emergency, and identify who has the responsibility in an emergency, for example if there is an incident in the playground a lunchtime supervisor would need to be very clear of their role. Written by: Sharon Wade Ratified on: Useful Documentation Code of Practice for Schools – Disability Discrimination Act 1995: Part 4 (Disability Rights Commission, 2002). Ref: COPSH www.drc-gb.org/thelaw/practice.asp Order:Disability Rights Commission Tel: 08457 622 633. Drugs: Guidance for Schools (DfES, 2004) Ref: DfES/0092/2004 www.teachernet.gov.uk/drugs/ Guidance on First Aid for Schools: a good practice guide (DfES, 1998) Ref: GFAS98. www.teachernet.gov.uk/firstaid Health and Safety: Responsibilities and Powers (DfES, 2001) Ref: DfES/0803/2001. www.teachernet.gov.uk/responsibilities/ Health and Safety of Pupils on Education Visits: a good practice guide (DfES, 1998) Ref: HSPV. www.teachernet.gov.uk/visits/. Also three part supplement: Part 1 – Standards for LEAs in Overseeing Educational Visits (DfES, 2002) Ref: DfES/0564/2002; Part 2 – Standards for Adventure (DfES, 2002) Ref: DfES/0565/2002; Part 3 – Handbook for Group Leaders (DfES, 2002) Ref: DfES/0566/2002. Home to school travel for pupils requiring special arrangements (DfES, 2004) Ref: LEA/0261/2004 www.teachernet.gov.uk/wholeschool/sen/sentransport/ Improving Attendance and Behaviour: Guidance on Exclusion from Schools and Pupil Referral Units (DfES, 2004) Ref: DfES/0354/2004 www.teachernet.gov.uk/exclusion Insurance – A guide for schools (DfES, 2003) Ref: DfES/0256/2003 www.teachernet.gov.uk/management/atoz/i/insurance/index.cfm?code=keyd School Admissions Code of Practice (DfES, 2003) Ref: DfES/0031/2003 www.dfes.gov.uk/sacode/ Special Educational Needs Code of Practice (DfES, 2001) Ref: DfES/0581/2001 www.teachernet.gov.uk/teachinginengland/detail.cfm?id=390 Standards for School Premises (DfEE, 2000) Ref: DFEE/0029/2000 www.teachernet.gov.uk/sbregulatoryinformation Work Related Learning and the Law (DfES, 2004) Ref: DfES/0475/2004 www.dfes.gov.uk/qualifications/document.cfm?sID=2 Department of Health (including joint publications) Guidance on infection control in schools and nurseries (Department of Health/Department for Education and Employment/Public Health Laboratory Service, 1999) Download only from: Wired for Health at www.wiredforhealth.gov.uk/doc.php?docid=7199 National Service Framework for Children and Young People and Maternity Services: Medicines and Children and Young People. Website: www.dh.gov.uk/healthtopics (click on Children’s Services). Order:DH Publications Tel: 08701 555 455 Ofsted Inspecting schools – Handbook for inspecting nursery and primary schools Ref: HMI 1359. Inspecting schools – Handbook for inspecting secondary schools Ref: HMI 1360. Inspecting schools – Handbook for inspecting special schools and pupil referral units Ref: HMI 1361. All Ofsted 2003. Priced. Order: The Stationery Office Tel:0870 600 5522 Or view online at www.ofsted.gov.uk/schools LEA Framework 2004 – Support for health and safety, welfare and child protection (Ofsted, 2004) Website only: www.ofsted.gov.uk/lea/index.cfm?fuseaction=inspectionGuidance
Allergy UK Allergy Help Line: (01322) 619864 Website: www.allergyfoundation.com The Anaphylaxis Campaign Helpline: (01252) 542029 Website: www.anaphylaxis.org.uk and www.allergyinschools.co.uk Association for Spina Bifida and Hydrocephalus Tel: (01733) 555988 (9am to 5pm) Website: www.asbah.org Asthma UK (formerly the National Asthma Campaign) Adviceline: 08457 01 02 03 (Mon-Fri 9am to 5pm) Website: www.asthma.org.uk Council for Disabled Children Tel: (020) 7843 1900 Website: www.ncb.org.uk/cdc/ Contact a Family Helpline: 0808 808 3555 Website: www.cafamily.org.uk Cystic Fibrosis Trust Tel: (020) 8464 7211 (Out of hours: (020) 8464 0623) Website: www.cftrust.org.uk Diabetes UK Careline: 0845 1202960 (Weekdays 9am to 5pm) Website: www.diabetes.org.uk Department for Education and Skills Tel: 0870 000 2288 Website:www.dfes.gov.uk Department of Health Tel: (020) 7210 4850 Website:www.dh.gov.uk 58 Disability Rights Commission (DRC) DRC helpline: 08457 622633 Textphone: 08457 622 644 Fax: 08457 778878 Website: www.drc-gb.org Epilepsy Action Freephone Helpline: 0808 800 5050 (Monday – Thursday 9am to 4.30pm, Friday 9am to 4pm) Website: www.epilepsy.org.uk Health and Safety Executive (HSE)
HSE Infoline: 08701 545500 (Mon-Fri 8am-6pm) Website: www.hse.gov.uk Health Education Trust Tel: (01789) 773915 Website: www.healthedtrust.com Hyperactive Children’s Support Group Tel: (01243) 551313 Website: www.hacsg.org.uk MENCAP Telephone: (020) 7454 0454 Website: www.mencap.org.uk National Eczema Society Helpline: 0870 241 3604 (Mon-Fri 8am to 8pm) Website: www.eczema.org National Society for Epilepsy Helpline: (01494) 601400 (Mon-Fri 10am to 4pm) Website: www.epilepsynse.org.uk Psoriasis Association Tel: 0845 676 0076 (Mon-Thurs 9.15am to 4.45pm Fri 9.15am to 16.15pm) Website: www.psoriasis-association.org.uk/ Sure Start Tel: 0870 000 2288 Website: www.surestart.gov.uk
NEPHROLOGY 2001; 6 , 266–269 Nephropathy in type 2 diabetes: current therapeutic strategies University of Melbourne Department of Medicine, St. Vincent’s Hospital, Victoria, Australia SUMMARY: Diabetic nephropathy is currently the commonest cause of end-stage renal failure inmost countries with a Western lifestyle. In addition to progressing to end-stage renal disease, patientsw
Al Prof. Eolo Parodi Direttore di "Il Giornale della Previdenza dei Medici e degli Odontoiatri" Via Torino, 38 - 00184 Roma e per conoscenza Alla Federazione Nazionale Ordini dei Medici - FNOMCeO Piazza Cola di Rienzo 80/A - 00192 Roma Alla Associazione Italiana Sclerosi Multipla - AISM Vico chiuso Paggi, 3 - 16129 Genova Ordine dei Medici Chirurghi e degli Odontoia