Most healthcare professionals, especially nurses, know the “five rights” of medication use: the right patient, the right drug, the right time, the right dose, and the right route. And as a standard for safe medication practices in schools, where the prevalence of chronic conditions in children has steadily increased over the past fifty years, they are critical.
Today, an estimated 27 per cent of children have chronic health conditions. The four most common conditions include asthma, obesity, mental health conditions, and neurodevelopmental disorders. While the drivers of chronic conditions are complex and have multiple causes, environmental changes and genetics are likely key drivers for these common conditions.
The Australian Department of Health outlines the severity of chronic conditions, stating that “chronic conditions are the leading cause of illness, disability and death in Australia”. The increased prevalence of children required to take medication during school hours and the rise in the number and range of medications highlight the need to address medication management in schools to ensure a safe and supportive environment for children.
Need for medication administration in school environment
Given that administering medication to school students is one of the most frequent health-related activities undertaken in schools, policies and procedures relating to medical administration have developed over time to support students and guide teachers and other members of staff. Each department of education in each jurisdiction in Australia sets out guidelines in relation to administering medication.
Risks associated with medicines
The South Australian document Medication management in education and care procedure states:
Unsafe medication practices and medication errors are one of the leading causes of injury and avoidable harm in health care across the world, with error occurring at different stages of the medication use process: including prescribing, transcribing, dispensing, administration and monitoring practices. Medication errors occur most frequently during administration. Medication administration can result in severe harm, disability or death.
Need for a medication management policy
Two key things stand out from the above quote. Firstly, the harm is avoidable. Additionally, errors occur most frequently during the administration of medication. To minimise these risks, it is crucial that teachers and staff are supported in relation to their administration of medication to students in their care. Students having negative reactions to a medication can happen – even with supposedly safe over the counter (OTC) medications (such as paracetamol).
To help students stay safe, schools should have a medication management policy (that includes the administration of medicine) that sets out the school’s processes and protocols and is communicated to the school community.
Schools and staff in schools should ONLY administer prescription medications that have been prescribed by a medical practitioner and clearly show the name of the medication, the student’s name, dosage and frequency of the dosage. Schools and staff in schools should ONLY administer paracetamol or ibuprofen if their administration has been approved in writing by the student’s parent or carer.
Communication with parents/carers
Communication with the student, staff and other relevant stakeholders is vital to decrease the likelihood of harm occurring. A school’s policy should require an agreement from the parents in writing in relation to both the administration of paracetamol/ibuprofen and prescription medication. The policy should make it clear that it is the parents’ responsibility to provide the prescription medication and update the school if any requirements change in relation to the prescription medication.
Storage of medication and record-keeping
In relation to some chronic conditions, it is important that the student has immediate access to their medication in order to manage their condition (discussed further below). Examples of this would be asthma and anaphylaxis. In these circumstances, it may be appropriate for the student to carry their own medication. In other circumstances, prescribed medication should be stored safely with access restricted to staff members. All medication must be appropriately packaged and clearly show the name of the medication, the student’s name, dosage and frequency of the dosage.
Schools should also have a medical records policy in relation to students and maintain each student’s medical records in accordance with that policy. This policy should also require parents to keep the school regularly updated as to the status of existing medical conditions.
Self-medication by students
Parents/guardians of older students with certain chronic conditions may wish their child to self-medicate and carry medications with them. Procedures including a written agreement between the school and the student’s parents/guardians, would be required in these circumstances.
It is a complicated area. Although it may be sensible and fairly uncontroversial for a student with asthma to have their own Ventolin to self-administer, allowing students to bring more controversial medication to school for the purposes of self-administering is not as straightforward. The risk of ingestion by other students is real, as is the possibility the student themselves may over-administer. To reduce this risk, more controversial medication should only ever be administered by the school in accordance with strict protocols.
Decision-making around a student’s potential self-medication, should consider the student’s ability and maturity level, whether appropriate parental and medical advice has been received, the complexity of the medication administration required, the willingness of the student to self-administer and the support required in an emergency.
To determine whether a student should be able to self-administer medication, a checklist for self-administration may be beneficial to the principal/delegate in consultation with the parent and/or student. The Queensland Government’s Department of Education’s document Guidelines for the administration of medication in schools has an example Checklist for self-administration (as Appendix 3).
Training for staff
To decrease the risk of unsafe medication administration, staff members who volunteer to administer prescribed medication in schools should be trained regularly. It is usually the school nurse (if there is one) or administrative staff who in practice administer medication in a school. It is imperative that they receive training in relation to the school’s medical management policy and protocols in relation to the actual administration of medication (e.g. having two staff members present when administering the medication, confirming the medication, recipient and dosage before administering and recording the administering). There are online courses available to guide schools and staff to administer medication safely. In a number of jurisdictions, it is compulsory for staff in schools to undergo training in the administration of anaphylaxis medication with regular refreshers.
What should schools be doing?
Schools should have a policy (that the relevant staff are trained on) that addresses, among other things, maintenance of medical records, parent/guardian responsibilities, student individual health care plans, self-administration, staff administration, storage of medication, emergency care, staff responsibilities, implementation and consequences of a breach of policy. Schools should also:
- incorporate regular medication knowledge courses into their curriculum to create awareness in relation to medication-related risks
- engage in regular communication to parents/guardians through multiple channels about the school’s medication policy through parent knowledge evenings, the school newsletter and parent/ teacher nights
- encourage regular communication between parents/guardians and their children in relation to medication-related risks
- ensure that there are penalties for students who share medications and the consequences of being caught with banned medicines should be well-known and enforced.
By having clear guidelines in place, the health and safety of every child in the school community is better protected.
