POLICY FOR SUPPORTING CHILDREN WITH MEDICAL NEEDS
IN THE ASSESSMENT NURSERY
This policy has been written according to guidelines issued by the Department of Health and the Department for Education and Employment, in the good practice guide ‘Supporting Pupils with Medical Needs’ (1996), ‘Managing Medicines in Schools and Early Years Settings (2005) issued by the Department of Health and the Department for Education and Skills.
This policy is written by and for staff employed by the local education authority and working in an educational role within the Cleveland Unit Assessment Nursery.
This includes teachers, nursery nurses, teaching assistants, dinner supervisory assistants and assistants working on a 1:1 basis, supporting individual children. These members of staff are all managed by the Head Teacher of the Unit.
Support staff employed by other agencies and working as dedicated support for individual children will be working under the protocol of those agencies.
INTRODUCTION
The staff at the Cleveland Unit believes that no child who has been offered a place in the Assessment Nursery should lose that place because of medical needs. Every effort will be made to make sure that those medical needs will be met safely and considerately through joint planning between parents, Unit staff and health professionals. It is understood that, in rare cases, a child’s medical needs may be too complicated and their health too unstable to allow them to take up a full place in the Nursery. Each child will be considered as an individual. Appropriate and alternative arrangements will be made for the education, therapy and assessment of such children.
ROLES AND RESPONSIBILITIES
Parents (defined in section 576 of the Education Act 1996) include any person who has parental responsibility for the child. It is important that staff recognise who has parental responsibility for a child. Parents are asked to provide clear information about their child’s needs in terms of medication, tube feeds, medical care at registration on admission to the Nursery. They MUSTinform Unit staff in writing or by visiting of any changes in a child’s medical needs e.g. change of dose or advice. Full and clear information is vital to ensure that medical needs are met. It requires only one parent to agree to or request that medicines are administered. Where parents disagree over medical support, this must be resolved by the Courts.
The employer
The local authority has a health and safety policy, which incorporates managing the administration of medicines and supporting children with complex health needs. They also ensure that their insurance/indemnification arrangements provide full cover for their staff who volunteers to administer medication within the Nursery day.
The Manager and the Management Group
The Manager is responsible for putting into practice the local authority’s policy, and is supported by the management group (instead of a board of governors). The management group has general responsibility for the Unit’s policies.
The Manager accepts responsibility for any staff member who volunteers to give medication and/or carry out medical care procedures within the Nursery day.
The Manager agrees provision and updating of training to meet children’s medical needs, and ensures that all parents and staff are aware of policy and procedures for managing children’s medical needs.
Where a parent’s expectations appear unreasonable, the Manager seeks advice from health professionals e.g. health visitor, and agrees what support can be provided.
Teachers and education support staff
Teachers and support staff have a duty of care to all children in their group. It is the teacher’s responsibility to share information about the medical needs of those children with support staff. It is the responsibility of support staff to be aware of and follow care plans and to understand the information shared.
Staff may volunteer to administer medical care and medications. They will receive appropriate training in order to understand and carry out the care plans for children in their group. As far as is reasonable, staff will try to meet the requests of parents.
Escorts and drivers accompanying children on home-school transport work within the guidelines and protocol given by their line managers in the councils of Middlesbrough and Redcar and Cleveland. They receive training as deemed appropriate by those managers and do not work under the line management of the Unit. Drivers and escorts know what to do in the case of a medical emergency. Information about individual children in their care may be shared with escorts and drivers. This is also the responsibility of their manager, although it is recognised that some parents may also share such information themselves.
Visiting students in the Unit are supervised by the teacher in whose group they are based and will not be asked to handle medical equipment or administer medication, at any time, unless in case of extreme emergency.
Supply staff are not expected to take on the responsibility of giving medication and/or medical care. They may volunteer to do so, if they have appropriate experience or training, matching the needs of individual children.
Other professionals
Clearly, there is a range of other professionals involved in the medical care of children who have medical needs. Their advice and support will be requested as appropriate. Some procedures require close working and written and/or counter signed advice and planning.
The Manager will asked for initial and/or updated training from other professionals as required or when requested by other staff.
LONG AND SHORT TERM MEDICAL NEEDS
Many children who attend the Unit have medical care needs in addition to their educational and therapeutic needs. Some of this care may need to be carried out during the Nursery day. This care may be long or short term and may include giving any of the following:
- medication (prescription and non-prescribed)
- prescribed lotions/creams
- food supplements added to/replacing meals/snacks
- tube feeds by nasogastric/gastrostomy tube, gravity fed or using a pump
- oxygen
- asthma medication using nebuhaler or nebuliser
- emergency medication for epilepsy
- emergency medication for severe allergic reaction.
We discourage the use of non-prescribed medicinesbut there are times when a child may be generally in good health and well enough to attend nursery but be uncomfortable due to constipation, muscle cramps etc. This is more likely to happen in our nursery because of the children’s special needs and disabilities. If a child suffers regularly from frequent or acute pain the parents are encouraged to refer the matter to the child’s GP.
Written permission is completed for all medicines and includes a check that the medicine has previously been administered without adverse effect (see Form 3a - appendix A). Because many of our children are transported into nursery by the LA, we will authorise medicines following a telephone call or note in the home-school diary from parents/carers but we always follow this up with a signed form 3a. We also complete a head teacher’s agreement to administer medication. No medication is given without this form being completed.
All medicines, including tube feeds are recorded on Form 6 - (see Appendix B) and the parents informed via a medicine record in the home-school diary. If emergency medication is used, this is recorded on the same form and staff will inform parents by phone call, or as arranged and agreed with them, in the child’s individual health care plan.
For prescribed medicines, parents are encouraged to ask prescribers if it is possible for medicines to be prescribed in doses which allow it to be given outside Nursery hours.
Basic health care needs for each child are discussed parents at registration, and recorded on a Emergency Health Care Plan, signed by parent(s) and Manager, so that both are clear what can and cannot be provided. If a child’s care needs require staff to take action on a regular or emergency basis, this is recorded on the Emergency Plan, signed by Manager and parent. Some care is recorded on a form from a health professional e.g. epilepsy protocols.
TRANSPORT AND STORAGE OF MEDICATION
Some medicationand/or medical equipment is carried to and from the Unit each day that the child attends and some (where possible) is kept in the unit. If using home-school transport, parents should inform the bus escort that medication/equipment is in the child’s bag.
If equipment is bulky, it may have to be carried separately and will be stored on the transport in accordance with guidelines from the local authority.
Medication should be brought to the Unit in the original container, as dispensed by the pharmacist or bought in store. Prescribed medicines must include the original label with the child’s name, date of birth, name of medication, dose, time to be given and an expiry date. This is the same when parents are asked to supply a small store of medication to be kept at the Unit for a child’s use e.g. asthma medication.
Medication is stored according to the instructions on the package. If it needs to be stored in a cool temperature, it is kept in a fridge in the staff room, which is restricted to children’s resources only.
Medication for use on that day will be kept in the child’s classroom. It is kept in a locked cupboard, labelled as storage for medication. It is critical that medication for emergencies e.g. asthma inhalers, epipen is kept close to the child; it will be carried by staff to other areas of the building/outdoors, if this is the case.
Medication and medical equipment needed by children are taken on educational visits, with a child’s individual health care plan.
Due to the young age of children in the Unit, medication is stored out of reach of children and no child is given access to their own medication.
DISPOSAL OF MEDICINES
Ordinarily, staff will not dispose of medicines. Parents are asked to ensure that the medication taken to the Unit is within date. Staff check expiry dates on medication stored at the Unit for emergency use. This is returned to parents on expiry, at the end of term, or when the child leaves the nursery. Should medication be overlooked, staff will return it to the pharmacy.
As an exception to this, staff routinely disposes of liquid dietary supplements which have been partly used, at the end of the nursery day.
Sharps boxes are used for the disposal of needles, if requiredand this is dealt with by James Cook University Hospital system.
RECORDING INFORMATION ABOUT MEDICAL NEEDS
When a child is given a place at the Unit’s Assessment Nursery, there is a registration interview between parents, class teacher and the assigned key person. This is when a child’s medical needs are discussed fully and recorded in writing.
This important and confidential information is recorded on the appropriate forms, which have been drawn up in accordance with guidelines from the Department of Education and Skills and the Department of Health (see appendices).
The forms are reviewed at least six monthly, at the review of the individual education plan.
The information is stored safely and remains confidential: it is shared with staff that need to know about the child in nursery. It is the responsibility of the class teacher to ensure that class staff understand each child’s medical needs and condition.
It is the responsibility of parents to inform staff of changes to prescriptions, introduction of new medication and/or changes in diagnosis. New or changed information must be communicated in writing and health care plans amended accordingly. Staff should ensure, asfar as possible, that this ‘new’ information is the same as that provided by the prescriber and/or doctor. This includes changesin dose/rate settings for pumps delivering tube feeds via gastrostomy or naso gastric tubes.
When medication is administered by staff at the Unit, this is recorded on Form 6. It is witnessed by a second member of staff. It is also recorded on a form in the child’s home-school diary.
Occasionally, staff may be asked to observe and record specific behaviours for health or medical staff e.g. suspected epileptic seizures.
HEALTH CARE PLANS
Individual health care plans identify the level of support needed by a child requiring daily medical care and/or medication and for children whose medical condition may result in a medical emergency. It is recorded on Form 2 (see appendices).
In the unlikely event that there is no member of staff available who can attend to a child’s medical needs, it may not be safe to allow that child to attend the Unit, until those staff are available again. The Manager will contact the parents to explain the situation.
In giving medication/carrying out medical care procedures, every effort is made to treat a child with care and dignity, according to the needs and preferences of the child and family.
Staff follow basic hygiene procedures and have access to protective, disposable clothing.
Staff follow reasonable guidance and suggestions from parents and health professionals, to encourage children to take prescribed medication. However, if a child refuses to take it, staff do not force a child and parents are informed, so that they can decide what to do.
If no medication/equipment is brought to the Unit, by a child who needs it regularly, parents are contacted by phone as soon as possible and asked what is to be done. If parents cannot be contacted, staff may ask for advice from health personnel, such as children’s community nurses or consultant paediatrician.
Some children who require a high level of specific care may be accompanied by a dedicated health care worker: such carers are trained to meet the needs of an individual child in the Unit and are not responsible for medical needs of other children in class.
Health staff provide general guidelines for the care of children who have gastrostomies and the administration of adrenaline in case of severe allergic reaction (see appendices).
If parents feel that their child’s medical needs are not being met by Unit staff safely and appropriately, they should talk or write to the class teacher, in the first instance. If this is not possible or not satisfactory, they should contact the Manager. Usually, matters can be addressed. If parents remain unsatisfied, they may wish to make a formal complaint. Relevant phone numbers are available on the website for the council and in the Unit’s handbook. The head teacher can also provide such information. The complaint will be dealt with as quickly as possible, and Unit staff will be kept informed and asked to comment, as appropriate.
Health care plans, emergency and prescription medication, as well as medical equipment is taken on educational visits on and off site.
If there are no staff trained to meet a child’s specific needs available to accompany a child on a visit, it may not be safe to include the child. However, the Manager and class teacher may decide it is appropriate to invite the child’s parent to accompany the group.
COMMON CONDITIONS
There are a number of common conditions affecting children attending the Unit nursery. The following section outlines basic information about those conditions, which may vary in presentation from one child to another. Further in-depth information about each condition is available from charities supporting children who are affected and specific information for individual children is be found in their health care plans.
ASTHMA
Asthma affects many children attending the nursery. We encourage them to take part in all activities as fully as possible and appropriate. It is the responsibility of parents to share information with Unit staff, about their child’s asthma at registration, or, if it develops later, as soon as diagnosed.
The information is recorded in a health care plan (see Form 1 in appendices) and shared with staff who have immediate contact with the child. This includes managing day to day care, administering preventive and/or emergency medication, recognising an emergency and what to do.
Asthma medication is very important and will accompany the child at all times. It is the responsibility of parents to ensure that correct and current medication and equipment is sent to nursery with the child. Parents may be asked to request that a spare inhaler and medication are prescribed so that these may be kept in the Unit, in case of emergency.
Supporting children who have asthma is an integral part of the work of the Unit. All guidelines above, describing how to manage additional health needs, apply.
EPILEPSY
Epilepsy affects many children attending the nursery. We encourage them to take part in all activities as fully as possible and appropriate. It is the responsibility of parents to share information with Unit staff, about their child’s epilepsy at registration, or, if it develops later, as soon as diagnosed.
The information is recorded in a health care plan (see Form 1 in appendices) and shared with staff who have immediate contact with the child. This includes managing day to day care, administering regular and/or emergency medication, recognising an emergency and what to do. Paediatric first aid training (all staff) includes basic information about epilepsy.
Emergency medication is very important and will accompany the child at all times. It is the responsibility of parents to ensure that correct and current medication is sent to nursery with the child.
Supporting children who have epilepsy is an integral part of the work of the Unit. All guidelines above, describing how to manage additional health needs, apply.
SEVERE ALLERGIC REACTION
Some children attending the nursery are affected by acute severe allergic reaction. We encourage them to take part in all activities as fully as possible and appropriate. It is the responsibility of parents to share information with Unit staff, about their child’s condition at registration, or, if it develops later, as soon as diagnosed.