Medical

Procedures

Handbook

Supporting Pupils with Medical Conditions

This handbook has been compiled in accordance with the Department for Education’s statutory guidance

Supporting pupils at school with medical conditions.

There can be educational, social and emotional implications associated with medical conditions, and

therefore the School ensures that all pupils with medical conditions are properly supported so that they

have full access to education, including educational visits and physical education.

Arrangements put in place will be agreed between the parent and School Nurse and/or specialist health

professional. In doing so, such pupils can access and enjoy the same opportunities at School as any other

pupil.

In making the arrangements, the School will consider that many of the medical conditions that require

support at School will affect quality of life and may be life threatening. The School will therefore focus

on the needs of each individual pupil and how their medical condition impacts on their school life. This

will give parents and pupils confidence in the School’s ability to provide effective support for medical

conditions in School. The arrangements must show an understanding of how medical conditions impact

on a pupil’s ability to learn, as well as increase confidence and promote self-care. The School will ensure

that staff are properly trained to provide the support each pupil’s need.

In line with safeguarding duties, pupils’ health must not be put at unnecessary risk from, for example,

infectious diseases. As per the First Aid and Medical Policy, the School therefore do not have to accept

a pupil in School at times where it would be detrimental to the health of that pupil or others to do so.

Notifying the School of a medical condition

• Parents are expected to keep the School updated with any medical conditions that may be affecting

their daughter, by contacting the School Nurse as per the Administration of Medicines Policy.

• An individual healthcare plan must then be in place for the start of the relevant school term for any

pupils who have a condition that may require emergency care.

• At the start of every academic year an email will be sent to parents/carers of current pupils requesting

information on any changes to the pupil’s medical needs.

• New diagnoses of medical conditions must be reported to the School Nurse immediately, with

medical evidence and details of any treatment that may be required within School.

• The School does not have to wait for a formal diagnosis before providing support to pupils.

Individual Healthcare Plans

• Healthcare plans are required for all pupils with medical conditions who may require emergency care

or where medical conditions are long-term and complex. These include asthma, allergies, diabetes,

sickle cell and epilepsy.

• Healthcare plans will be developed with the pupil’s best interests in mind and ensure that the School

assesses and manages risks to the pupil’s education, health and social wellbeing, and minimises

disruption.

• Healthcare plans must be signed off by the parent/carer, the School nurse and/or the pupil’s specialist

healthcare professional.

• If a healthcare plan is not provided by the pupil’s specialist healthcare professional, then the School

Nurse will use the generic template which details an outline of the medical condition, symptoms,

triggers, management in School and who is responsible for the management – please see an example

in Attachment A.

• Healthcare plans must be updated annually, or earlier if evidence is presented that the pupil’s needs

have changed.

• Healthcare plans are easily accessible to all staff who may need to refer to them. Where

confidentiality issues are raised by the parent/child, there may be select designated individuals to be

entrusted with the information about the child’s condition.

• Where medication administration may be required, the School will adhere to its Administration of

Medication Policy.

Staff Training and Support

• All staff are trained annually on treatment for allergies (including anaphylaxis) and asthma. This

training is also included in induction for any new staff members.

• The Lead Nurse is responsible for identifying the type and level of training required by staff and

ensuring that appropriate staff have been trained and assessed in supporting individual pupil’s medical

needs and what is unacceptable practice. This training will be carried out either by the Lead School

Nurse, or by the individual’s specialist nurse.

• The Lead Nurse is responsible for ensuring that staff are competent and have confidence in their

ability to support pupils with medical conditions, and to fulfil the requirements as set out in individual

healthcare plans.

• Parents can be involved in staff training for their child’s medical needs to provide relevant information,

however, a parent will not be the sole trainer.

• Staff must not give any medication or undertake healthcare procedures without appropriate training.

The Pupil’s role in managing their own medical needs

• All medication other than those required in an emergency must be handed in to the School Nurse

immediately for safe storage.

• The School Nurse will discuss a pupil’s competency in managing their own medical needs with parents

when developing the healthcare plan and this will be identified on the plan.

• Pupils who are competent to do so should be encouraged to take their medicines themselves, once

obtained from the Nurse. The appropriate level of supervision will be decided between the parents

and the School Nurse.

• Pupils from Year 3 onwards are responsible for carrying their emergency medication and relevant

devices on them at all times (the School will also hold spare medication - please refer to the

Administration of Medicines Policy for details).

• If a pupil refuses to take medicine or carry out a necessary procedure, they will not be forced to do

so, and parents will be contacted to decide what action to take.

• If it is not appropriate for a pupil to self-manage, relevant staff will help to administer medicines and

manage procedures for them.

Managing Medicines on School Premises

• The School will hold a supply of the following medications:

• Paracetamol

• Ibuprofen

• Antihistamine (Cetirizine and Chlorphenamine Maleate)

• Salbutamol (for emergency use only)

• Adrenaline Auto-Injectors (for emergency use only)

• Parents can consent for these medications to be given either on the initial medical form, or verbally

to one of the School Nurses, and it will be noted on the pupil’s medical records.

• Medicine will only be administered at School when it would be detrimental to a pupil’s health or

School attendance not to do so.

• No pupil under 16 is given prescription or non-prescription medicines without their parent’s consent

– except in the exceptional circumstances where the medicine has been prescribed to the pupil

without the knowledge of the parents. In such cases, the School will encourage the pupil to involve

their parents while respecting their right to confidentiality.

• Pupils in Nursery to year 2 will not be given any non-prescription medication on site unless under

exceptional circumstances. These circumstances will be decided by the School Nurse.

• For Pupils in years 3 to 6, if the School Nurse decides that she feels the pupil requires non-

prescription medication that is held by the School, parents will be contacted.

• For Pupils in Senior School who are under 16, if the School Nurse decides that she feels the pupil

requires non-prescription medication that is held by the School, medication will be administered if

the parents have previously consented. A note will be given to the pupil and it is the pupil’s

responsibility to then give this to the parent to notify them of the medication that has been given. If

the School Nurse has medical concerns about a pupil in Senior School, then parents will be contacted

directly.

• For any pupils over the age of 16, if the School Nurse decides that she feels the pupil requires non-

prescription medication that is held by the School, no notification to parents is required, unless

specifically requested by parents and pupil.

• Where clinically possible, medicines should be prescribed in dose frequencies which enable them to

be taken outside of School hours. This includes short-term use of medication e.g. antibiotics.

• The School will only accept prescribed medicines if these are in-date, labelled, provided in the original

container as dispensed by a pharmacist and include instructions for administration, dosage and storage.

The exception to this is insulin, which must still be in date.

• All medicines and devices that may be required in an emergency, such as asthma inhalers and AAI’s,

are always readily available to pupils and not locked away. All pupils and staff are aware of where

these are held, both on site and off site (e.g. on School trips).

• When no longer required, medicine will be returned to parents to arrange for safe disposal. If a

medication has expired and has been replaced, the School will manage the safe disposal of this

medication.

• Sharp boxes are held in the School for the safe disposal of needles and other sharps.

• Controlled drugs must be handed in to the Nurse. Storage of any controlled drugs that may be

required by pupils will be discussed with parents on an individual basis and will be stored in the most

efficient and safest way for the pupils. A risk assessment will be carried out for all storage of

controlled drugs within the School.

• Passing any medication to another child for use is an offence. A pupil who has been prescribed a

controlled drug may legally have it in their possession if they are competent to do so, but passing it

to another child for use is an offence.

• Staff who may administer medicines will undergo ‘Administration of Medication’ training by the School

Nurse and will administer medication in accordance with the prescriber’s instructions.

• The School Nurse is responsible for monitoring expiry dates of pupil’s own medication held on site.

Parents will be given two weeks’ notice before a medication expires and it is the parent’s

responsibility to supply the School with a new, in date, medication or device.

• Parents will be notified three times about an expired medication. After these notifications, if parents

fail to supply the School with an in-date medication or device, the School can exclude the pupil if it

is deemed unsafe for them to be in School.

Record Keeping

• The School holds a record of all medicine that has been administered to a pupil, stating what, how

and how much was administered, when and by whom.

• Administration of Medication training for staff prior to trips also includes training for correct record

keeping so any medication administered off-site is logged.

Educational Visits

• The School Nurse will ensure that arrangements are made to support pupils with medical conditions

to participate in educational visits and sporting activities, unless evidence from a clinician (e.g. GP)

states that this is not possible.

• Trip Leaders must consult the School Nurse well in advance of any trip. Staff attending the visit will

be made aware of any medical conditions prior to the trip and will be given a copy of healthcare plans

for pupils who will be attending.

Emergency Procedures:

Anaphylaxis

What is Anaphylaxis?

Anaphylaxis is a severe and potentially life-threatening allergic reaction affecting more than one body

system such as the airways, heart, circulation, gut and skin. Symptoms can start within seconds or minutes

of exposure to the allergen and usually will progress rapidly. On rare occasions there may be a delay in

the onset of a few hours.

The common causes of anaphylaxis include foods such as peanuts, tree nuts, milk, eggs, shellfish, fish,

sesame seeds and kiwi fruit, although many other foods have been known to trigger anaphylaxis. Nonfood

causes include wasp or bee stings, natural latex (rubber), and certain drugs such as penicillin. In some

people exercise can trigger a severe reaction – either on its own or in combination with other factors

such as food or drugs (e.g. aspirin).

What are the symptoms of anaphylaxis?

There may be a dramatic fall in blood pressure (anaphylactic shock). The pupil may become weak and

floppy and may have a sense of something terrible happening. This may lead to collapse, unconsciousness

and – on rare occasions – death.

In addition to those severe symptoms listed above, there may also be:

• Widespread flushing of the skin

• Nettle rash (otherwise known as hives or urticaria)

• Swelling of the skin (known as angioedema) anywhere on the body.

• Swelling of the lips

• Abdominal pain, nausea and vomiting

Each pupil may react differently, and this will be noted on their healthcare plan.

What is the treatment for a severe reaction?

Pre-loaded auto-injectors (sometimes referred to as ‘pens’) containing adrenaline are prescribed for

pupils who are believed to be at risk of anaphylaxis. These are known as Adrenaline Auto-Injectors

(AAI’s), and there are three main brands prescribed in the UK:

• EpiPen

• Jext

• Emerade

The way each device is used is different, so it is important that pupils’ care plans are for the correct AAI.

Pupils in EYFS will have x2 AAIs carried in the medical bag by a designated member of staff who will

always be near the pupils at risk.

Pupils in Prep School will always carry one AAI on them, and one spare will be kept in the unlocked

Prep School Medical Room.

Pupils in Senior School are always expected to carry one AAI on them, and one spare will be kept in the

unlocked Senior School Treatment Room.

All staff are trained in administering AAIs at the start of every academic year. The School hold a spare

generic AAI in case of emergency only.

Management in School

When a pupil starts, a medical form is sent out asking for information about any allergens and the severity

of the reactions, so that the School have a list of all pupils with allergies that are at risk of anaphylaxis.

Parents of existing students are expected to update the School of any new allergies.

A list of girls with allergies is given to the Head of Catering who then labels the food. The School aims

to be ‘Nut-Free’ so there are no longer nuts included in any food prepared by the catering department

or allowed on the School premises.

High risk times of the day will be during break and lunchtime when pupils may be consuming potential

allergens. It is also necessary to take precautionary measures on outdoor activities, School trips, and

during lessons such as food technology and science classes.

All pupils with allergies will have a healthcare plan that has been created by their allergy specialist/doctor.

These may vary in appearance however will all contain the same information.

How to use an AAI

The treatment for a severe allergic reaction is an injection of adrenaline (also called epinephrine),

delivered into the muscle in the upper outer area of the mid-thigh. The adrenaline injectors prescribed

in the UK at present are

®, EpiPen® and Jext®. These injectors are easy to use and designed for self-administration or

administration by any suitably trained individual. If an injector has been prescribed, a pupil will carry at

least one at all times – with no exceptions. The emergency services (ambulance) should still be called

after use as symptoms may return after a short period and more than one injection of adrenaline may be

required to control the reaction.

Call the School Nurse immediately:

Senior: ANDRETH BECKLES ext. 3208 mob 07917 760877

Prep: CARMEL MULLEN ext. 3307 mob 07917 760878

Asthma

What is Asthma?

Asthma is a long-term condition that affects the airways – the tubes that carry air in and out of lungs.

It usually causes symptoms such as coughing, wheezing and breathlessness.

If someone with asthma comes across an asthma trigger, it can make symptoms worse and even bring on

an asthma attack. The airways react in three ways:

1. The muscles around the walls of the airways tighten so that the airways become narrower.

2. The lining of the airways becomes inflamed and starts to swell.

3. Sticky mucus or phlegm sometimes builds up, which can narrow the airways even more.

In an asthma attack all of these may happen together. Getting into a good routine of taking asthma

medicines and making the most of asthma reviews will help keep the width of the airways normal and

will help make narrowed airways go back to normal. When asthma’s well managed, most people should

be free of symptoms.

What’s an asthma trigger?

An asthma trigger is anything that can set off asthma symptoms. Someone with asthma may have just

one or two triggers, or several. Common triggers include colds and viruses, pets, cigarette smoke, cold

weather and pollen.

How is asthma managed?

There are several medications used to treat asthma. Some are for long-term prevention and are used

out of school hours, and others relieve symptoms when they occur (although these may also prevent

symptoms if they are used in anticipation of a trigger e.g. exercise).

Most pupils with asthma will relieve their symptoms with medication using inhalers. It is good practice

to allow children with asthma to take charge of, and use, their inhaler from an early age. Each pupil’s

needs, and the amount of assistance they require, will differ.

The main types of inhalers are:

• reliever inhalers – used when needed to quickly relieve asthma symptoms for a short time

• preventer inhalers – used every day to prevent asthma symptoms occurring

Some people also need to take tablets.

ALL PUPILS WITH ASTHMA MUST HAVE IMMEDIATE ACCESS TO THEIR RELIEVER

INHALERS (blue) AT ALL TIMES.

For pupils in Prep School, pupils’ own spare inhalers are kept:

In the unlocked medical room in Prep School

In the medical bags in EYFS

For pupils in Senior School, they carry their own inhalers at all times, and an emergency inhaler is available

in the treatment room in Senior School.

There are three locations around the School where spare emergency inhalers are kept. These are:

• In the treatment room in Senior School

• In the medical room in Prep School

• In the Sports Centre

Pupils with asthma should be encouraged to participate as fully as possible in all aspects of school life,

although special consideration may be needed before undertaking some activities. They must take their

reliever with them on all off-site activities.

What is an asthma attack?

The main symptoms of asthma are:

• wheezing (a whistling sound when breathing)

• breathlessness

• a tight chest, which may feel like a band is tightening around it

• coughing

The symptoms can sometimes get temporarily worse. This is known as an asthma attack and can often

be identified if the blue reliever isn’t helping, or the pupil needs to use it more than every four hours.

Asthma attacks can be fatal – three people die from asthma attacks in the UK every day. If a pupil is having

an asthma attack, it is vital that the School acts as soon as concerns arise.

The management of an asthma attack is described in the care plan on the following page. These are

placed in various locations around the School, and are guidelines on how to treat a pupil having an asthma

attack.

At the School, we recognise that asthma is a widespread, serious, but manageable condition. This

School welcomes all pupils with asthma and aims to support these children in participating fully in

school life. We endeavour to do this by ensuring we have:

• an asthma register

• up-to-date asthma guidelines

• an asthma champion and lead (Andreth Beckles and Carmel Mullen)

• all asthmatic pupils with immediate access to their reliever inhaler at all times

• all asthmatic pupils have an up-to-date asthma action plan

• an emergency salbutamol inhaler & spacer

• annual asthma training for all staff

Further information can be obtained from:

- School Nurse

- Asthma UK Website

- NHS Website

Diabetes

What is diabetes?

Diabetes is a lifelong condition that causes a person's blood sugar level to become too high.

There are 2 main types of diabetes:

1. type 1 diabetes – where the body's immune system attacks and destroys the cells that produce

insulin

2. type 2 diabetes – where the body does not produce enough insulin, or the body's cells do not

react to insulin

Type 1 diabetes is most common amongst children.

If a pupil has Type 1 diabetes, it means that they can no longer produce insulin because the cells in the

pancreas that produce insulin have been destroyed. Without insulin, the body cannot use glucose.

Diabetes cannot be cured, but it can be treated effectively. The aim of the treatment is to keep the

blood glucose level close to the normal range (4–7mmol), so that it is neither too high (hyperglycaemia)

nor too low (hypoglycaemia, also known as a hypo).

Over a long period of time, high glucose levels in blood can seriously damage the heart, the eyes, the feet

and the kidneys. These are known as the complications of diabetes.

But with the right treatment and care, people can live a healthy life. And there is much less risk that

someone will experience these complications.

Hyperglycaemia – “hyper”

This happens when your blood glucose levels are too high – usually above 7mmol/l before a meal and

above 8.5mmol/l two hours after a meal. There are several reasons why this may happen. It may be that

the pupil:

- has missed a dose of her medication

- has eaten more carbohydrate than her body and/or medication can cope with

- is stressed

- is unwell from an infection - has over-treated a hypo.

Signs and symptoms of a hyper

- passing more urine than normal, especially at night

- being very thirsty

- headaches

- tiredness and lethargy.

- Treating a hyper

Treatment of hypers will depend on what caused them. If they are a regular occurrence, contact your

diabetes healthcare team for a review of your medications and/or lifestyle. If your blood glucose level is

high for a short time, emergency treatment will not be necessary. But if it stays high you need to take

action:

• drink plenty of sugar-free fluids.

• if you are on insulin, you may need to take extra insulin.

• if you are feeling unwell, especially if you are vomiting, you must contact your diabetes healthcare

team for advice.

Hypoglycaemia – “hypo”

This is when blood glucose level (also called blood sugar) is too low, usually below 4mmol/l. This can

happen if the balance of diabetes medication (especially insulin), food consumption and physical activity

that a pupil does, sometimes isn’t right.

A hypo can happen quickly. Therefore it is important to know what the symptoms are and what to do if

you suspect a pupil is having a hypo.

Signs and symptoms of a hypo

Everyone has different symptoms, but the most common symptoms of a hypo are:

• trembling and feeling shaky

• sweating

• being anxious or irritable

• going pale

• palpitations and a fast pulse

• lips feeling tingly

• blurred sight

• being hungry

• feeling tearful

• tiredness

• having a headache

• lack of concentration.

Treating a Hypo

You must do something as soon as you notice symptoms of a hypo, or if a blood test has shown a pupil’s

blood glucose levels (also called blood sugar) are too low.

If you don’t act quickly, it could get worse and the pupil could start feeling confused and drowsy. The

pupil could also become unconscious or have a fit. This is called a severe hypo, and you would need

help to treat it.

Treat the hypo immediately. You can do this by getting the pupil to eat or drink 15 to 20g of a fast-

acting carbohydrate. This could be:

• three glucose or dextrose tablets

• five jelly babies

• About 100 to 200 ml of a sugary drink

• About 200 ml of fruit juice

• A tube of glucose gel

N.B most children with diabetes have their own preferred fast acting sugars.

IN THE UNLIKELY EVENT OF A PUPIL LOSING CONCIOUSNESS, PLACE IN THE

RECOVERY POSITION, CALL AN AMBULAND AND CALL THE SCHOOL NURSE.

Further information can be obtained from:

- School Nurse

- Diabetes UK Website

Epilepsy

Epilepsy is a common condition that affects the brain and causes frequent seizures.

Seizures are bursts of electrical activity in the brain that temporarily affect how it works. They can cause

a wide range of symptoms.

Epilepsy can start at any age, but usually starts either in childhood or in people over 60. It's often lifelong

but can sometimes get slowly better over time.

Epilepsy is usually a lifelong condition, but most people with it can have normal lives if their seizures are

well controlled.

Most children with epilepsy can go to a mainstream school, take part in most activities and sports, and

get a job when older.

For pupils with epilepsy, you may need to consider activities like swimming or climbing, in case they are

at risk of having a seizure whilst in a dangerous environment.

There are two main types of seizures:

• Generalised seizures – when the burst of electrical activity is happening throughout the whole

brain

• Focal seizures (previously called partial) – when the burst of electrical activity is happening in one

part of the brain

The symptoms of a seizure depend on which part of the brain the burst of electrical activity is

happening. Every child may show different signs and symptoms so any pupil with epilepsy will have an

individual care plan in place which will describe signs and symptoms, and what to do for them.

Some pupils may require emergency medication, in which case this will clearly be identified and

discussed with staff. Staff may undergo training to administer this medication via the School Nurse.

Only the nurses and trained members of staff are able to administer emergency seizure medication due

to its risks. Staff are advised to call 999 if they feel emergency medication is required.

Managing Focal Seizures

1. Remove from harmful objects (record time starts/stops)

2. Guide person away from danger

3. Talk quietly and reassure

4. Be prepared for a second seizure or may lead into a generalised seizure

5. The pupil may need to sleep

Managing General Seizures

1. Record the time the seizure starts and stops

2. Remove any hazards out of their way

3. Put something soft under their head

4. Let the seizure run its course, call 999 if concerned

5. When the jerking has stopped, place child in the recovery position

6. Stay with them until they are fully recovered

DO NOT attempt to move them unless they are in danger

DO NOT put anything in their mouth

DO NOT restrain their movements

CALL THE SCHOOL NURSE IMMEDIATELY

Senior: ANDRETH BECKLES ext. 3208 mob 07917 760877

Prep: CARMEL MULLEN ext. 3307 mob 07917 760878

CALL AN AMBULANCE IF:

If it is the first ever seizure

If one seizure goes into another (clusters)

The seizure lasts longer than normal or lasts for 5 minutes (call for an ambulance at around 3 minutes if

this happens)

They have difficulty breathing following the seizure (look blue)

Is not responding to you after seizure has stopped

They have injured themselves during the seizure

You are concerned about their condition

Attachment A

Healthcare Plan example