Supporting Medical Needs and Administering Medicines

1. Purpose

Some of our learners have medical conditions such as asthma, allergies, epilepsy, diabetes or ADHD, and some take medicines during the day. A medical condition must never be a reason for a learner to miss out on their placement. This policy makes sure that:

• we know about every learner's medical needs before or on their first day;

• learners with significant needs have an individual healthcare plan that staff follow;

• medicines are stored, given and recorded safely;

• staff know what to do in an emergency.

2. Scope

This policy applies to every learner in Care Cove Alternative Provision, whoever commissions the place, on site at 37 Townhead Street and on every off-site session. It applies to all staff, agency staff, partner staff and volunteers. Staff medicines are covered only where they affect learner safety (section 9).

3. Law and guidance

• Supporting pupils with medical conditions at school (DfE). Statutory for schools; we follow it as good practice. No child with a medical condition should be denied a place or prevented from taking part because arrangements have not been made.

• Human Medicines Regulations 2012 (as amended in 2014 and 2017) and the government guidance on emergency salbutamol inhalers and spare adrenaline auto-injectors in schools.

• Misuse of Drugs Regulations 2001 for controlled drugs.

• Health and Safety (First-Aid) Regulations 1981 and the Health and Safety at Work etc. Act 1974.

• Equality Act 2010. Many long-term medical conditions are disabilities, so we must make reasonable adjustments.

• UK GDPR and the Data Protection Act 2018. Health information is special category data.

4. Roles and responsibilities

• The Clinical Advisor (Registered Nurse, 0.2 FTE) owns this policy; reviews medical information at admission; writes or reviews individual healthcare plans (IHPs) with families and health professionals; trains and signs off staff who give medicines; reviews the medication administration record (MAR) every month; advises on urgent clinical decisions, medication errors and suspected eating disorders; and liaises with GPs, school nurses and specialist teams with consent.

• The Head of AP makes sure enough trained staff are on duty every day to give medicines and respond to emergencies, including on off-site sessions, and holds a key to the medicines cabinet.

• Named trained staff give and witness medicines under this policy. Nobody is required to give medicines unless trained and willing, but every member of staff must act in an emergency, including calling 999.

• First aiders. A qualified first aider is on site at all operating times (see Health and Safety, including Fire and First Aid).

• The Administrator records medical information, consents and training on Connect and tracks expiry dates.

• The Director makes sure Care Cove's insurance covers staff who support medical needs and give medicines under this policy, and that facilities (the lockable medicines cabinet and refrigeration) are in place.

• Parents and carers give full, up-to-date information and written consent, supply medicines in date and in their original packaging, and tell us of any change.

• Learners are involved in their own plans and, where they are able, manage their own condition.

5. Information collected at admission

Before the first day, the key mentor and Administrator collect and record on Connect:

• medical conditions, diagnoses and the health professionals involved;

• every medicine the learner takes, including those taken at home that may affect them during the day;

• allergies and intolerances, including food allergies (also recorded under Food Safety, Allergens and Nutrition);

• GP details and emergency contacts;

• any existing IHP or allergy action plan from the school or health service, and the health sections of any EHCP;

• written consent for any medicine to be given at Care Cove, and for emergency treatment;

• any medical need for a phone exception (section 14).

Allergies and medicines show on the learner header on Connect and allergies show on the daily register, so every member of staff sees them without searching.

6. Individual healthcare plans

6.1 Who needs one

An IHP is needed where a condition could need emergency action or daily management at Care Cove, for example anaphylaxis risk, asthma needing more than occasional reliever use, epilepsy, diabetes, or any condition where the Clinical Advisor judges a plan is needed. Where a school or health team already has a plan, we adapt it for our setting rather than start again.

6.2 Writing and reviewing the plan

1. The Clinical Advisor drafts the IHP with the learner, parents and, where relevant, the specialist nurse or GP.

2. For a life-threatening condition, the plan is in place before the first day. Where that is not possible, the Clinical Advisor agrees interim arrangements from the information available, and the learner still starts on time.

3. The plan covers the condition and its signs; daily care; medicines (dose, timing, storage, who gives them); what to do in an emergency; trained staff; arrangements for off-site sessions; dietary needs; phone or device exceptions; and how the condition affects learning.

4. The plan is signed by the parent (and the learner where appropriate), stored on Connect, linked to the child plan, and shared with staff who need it.

5. It is reviewed at least every half term with the child plan, after any emergency, and whenever needs change.

7. Prescribed medicines

7.1 Conditions

We give a prescribed medicine only when all of these apply:

• a parent (or a learner aged 16 or over) has given written consent on our medicines form, stating the medicine, dose, timing and how long it is needed;

• it is in its original packaging as dispensed by the pharmacy, with the pharmacy label showing the learner's name, the medicine, the dose and the instructions;

• it is in date;

• it cannot reasonably be taken outside the hours the learner is with us.

The only packaging exception is insulin, which must be in date but will usually be in a pen or pump rather than the original box. We never accept medicines in envelopes, unlabelled bottles or another person's packaging, and we never change a dose on a parent's verbal instruction alone.

Medicines are handed by the parent or escort to a named member of staff at reception, never left in a learner's bag or locker. The receipt (medicine, quantity and expiry) is recorded on Connect.

7.2 Giving a medicine

1. Check the IHP and the MAR on Connect: is the dose due, and has it already been given?

2. Check the learner's identity, the pharmacy label, the dose, the time and the expiry date.

3. A second member of staff witnesses the check and the dose.

4. Give the medicine, or supervise the learner taking it, in private.

5. Record it on the MAR straight away: medicine, dose, time, who gave it and who witnessed it.

7.3 Refusals, missed doses and errors

• A learner is never forced to take a medicine. A refusal is recorded on the MAR and the parent is told the same day. If the refusal creates a risk, staff follow the IHP and seek advice from the Clinical Advisor or NHS 111.

• If a medicine is missed, given at the wrong time, given in the wrong dose or given to the wrong learner, staff tell the Head of AP and the Clinical Advisor immediately, seek medical advice (NHS 111, or 999 if the learner is unwell), tell the parent the same day and record it as an incident on Connect. The Clinical Advisor reviews every error.

7.4 Learners managing their own medicines

Where the IHP agrees it and the parent consents, a learner may take their own medicine under staff supervision. Learners who can manage their condition are encouraged to do so, because that is the independence they will need at school and in adult life.

8. Non-prescribed medicines

• Care Cove does not keep a stock of non-prescribed medicines, such as painkillers, for learners.

• A parent may supply a non-prescribed medicine in its original packaging with written consent stating the dose and maximum frequency. Before each dose, staff phone the parent to confirm when the last dose was taken, then give and record it as in section 7.2.

• Aspirin, or any medicine containing aspirin, is never given to a learner under 16 unless prescribed by a doctor.

• We do not give herbal remedies, supplements or products containing CBD.

9. Storage

• Medicines are kept in the lockable medicines cabinet, in a location shown on the site plan and known to all staff. The key is held by the Head of AP and named trained staff, never left in the lock; a spare key is kept by the Director.

• Medicines needing refrigeration are kept in a lockable medicines fridge, or in a sealed, labelled, locked box in a fridge learners cannot access, never loose among food. The fridge temperature (2°C to 8°C) is checked and recorded each operating day.

• Emergency medicines (reliever inhalers, adrenaline auto-injectors and hypo treatment) are never locked away. If a learner does not carry their own, they are kept in a clearly labelled emergency box, out of learners' reach but immediately available, and staff know where it is.

• Expired or unused medicines are returned to parents, who are asked to take them to a pharmacy. Needles go into a sharps bin supplied for the learner.

• Staff keep their own medicines locked in staff lockers, out of learners' reach.

10. Controlled drugs

Some medicines, including many ADHD medicines and buccal midazolam, are controlled drugs.

• Because of the risk of diversion and exploitation, learners do not carry controlled drugs at Care Cove. They are handed to a named member of staff on arrival.

• Controlled drugs, other than emergency rescue medicines (see the last point below), are stored in a locked, non-portable container within the medicines cabinet, with access limited to named trained staff.

• Two members of staff count and sign for controlled drugs on receipt and at every dose. Connect keeps a controlled drug record with a running balance. The Head of AP checks the balance weekly.

• Any discrepancy is reported at once to the Head of AP and the Clinical Advisor and investigated the same day. If theft is suspected, the Director informs the police.

• Controlled drugs are returned to the parent and signed for when no longer needed. Staff never dispose of them.

• Emergency rescue medicines that are controlled drugs, such as buccal midazolam for seizures, must never be locked away from the learner. They are kept in the emergency box (section 9), or carried by the trained adult supporting the learner, including off site, as the IHP sets out. Receipt, use and return are still counted and signed for by two staff.

11. Inhalers and adrenaline auto-injectors

• Learners with asthma carry their own reliever inhaler, and learners at risk of anaphylaxis carry their own adrenaline auto-injectors (normally two), as their IHP sets out. These never go into the phone lockers.

• If a learner cannot carry them, they are kept in the emergency box (section 9) and go with the learner whenever they leave the building.

• Staff check expiry dates every half term and remind parents four weeks before expiry.

12. Emergency salbutamol inhalers and spare adrenaline auto-injectors (optional)

The Human Medicines Regulations 2012 allow schools to obtain salbutamol inhalers and adrenaline auto-injectors without a prescription, for emergency use, and government guidance explains how. Holding them is optional. The exemption is written for schools, and Care Cove is not a school, so Care Cove does not currently hold spare emergency inhalers or auto-injectors. Each learner's own medicines (section 11) and a 999 call are our safeguard. We would hold them only if all of the following are met:

1. Written advice, for example from a community pharmacist or the supplier, confirms that Care Cove may lawfully obtain them, and the Clinical Advisor and the Director approve in writing.

2. A written protocol, approved by the Clinical Advisor and the SWMC, follows the government guidance: a register of learners with parental consent; storage, checking and replacement; training; and recording.

3. They are used only for learners on the register whose own device is unavailable or not working. For any other learner with signs of anaphylaxis, staff call 999 and follow the emergency operator's advice.

4. Every use is recorded on Connect and the parent is told the same day.

13. Off-site learning and trips

• Every off-site risk assessment includes each learner's medical needs and IHP.

• Learners carry their own inhalers and auto-injectors on every off-site session, including short walks to outdoor classrooms. The lead member of staff checks they have them before leaving.

• Staff carry a first aid kit, emergency contacts and a phone with access to Connect. Where a medicine is due during the session, a trained member of staff takes it, with the MAR or a paper record entered on Connect on return.

• Reasonable adjustments are made so learners with medical conditions can take part. A learner is excluded from an activity only on medical advice, never for convenience.

14. Phones and medical devices

Learner phones go into lockers at reception for the whole day. Where a learner needs a phone or device for a medical reason, for example a continuous glucose monitor that reads through a phone app or an insulin pump controller, the Head of AP agrees the exception with the learner, family and Clinical Advisor under Mobile Phones and Digital Devices. It is written into the IHP and the child plan, setting out where the phone is kept, who can see the alerts and how it is used, with limited use in a set place.

15. Mental health

Mental health conditions are medical conditions. Medicines for mental health are handled like any other prescribed medicine. Staff report changes in mood, behaviour or presentation to the DSL and key mentor. Self-harm is treated by a first aider, reported to the DSL as a safeguarding concern and discussed with the Clinical Advisor. A suspected overdose always means calling 999 straight away, even if the learner seems well. Urgent mental health risk follows the pathway in Therapeutic Practice and Clinical Governance: the learner is never left alone, the Clinical Advisor makes a same-day decision, staff use NHS 111, option 2 (24-hour mental health crisis line) or 999, and the DSL refers to the Sheffield Safeguarding Hub within 24 hours.

16. Emergencies

1. Call 999. Follow the IHP and the operator's instructions.

2. Send someone to meet the ambulance at the entrance, and give the paramedics the IHP and medicine details.

3. A member of staff goes with the learner to hospital and stays until a parent arrives. Learners are not taken to hospital in staff cars in an emergency.

4. The Head of AP or DSL phones the parent straight away.

5. Record the incident on Connect the same day. Any accident or injury to a learner is recorded, investigated and reported to the commissioning local authority's contract manager. If the incident is reportable under RIDDOR, the Director makes the RIDDOR report and sends a copy of the form to the commissioning local authority's contract manager straight away, as set out in Health and Safety, including Fire and First Aid.

17. Allergies and anaphylaxis

• Allergies are recorded on the learner's Connect record and shown on the daily register. Food allergen controls are set out in Food Safety, Allergens and Nutrition.

• Learners at risk of anaphylaxis have an IHP or allergy action plan.

• If a learner shows signs of anaphylaxis (difficulty breathing, swelling of the throat or tongue, wheeze, sudden weakness or collapse): give the adrenaline auto-injector straight away, call 999 and say "anaphylaxis", and keep the learner lying down with legs raised, or sitting up if breathing is difficult. Do not let them stand or walk. If there is no improvement after 5 minutes, give the second auto-injector. Stay with them.

• For an asthma attack, help the learner sit upright and use their reliever inhaler as their plan sets out. If there is no improvement, or at any point you are worried, call 999.

18. Staff training

Training is recorded on the Connect training matrix. The Clinical Advisor signs off each member of staff as competent before they give medicines.

19. No weighing or measuring

Nobody is weighed or measured at Care Cove, and staff do not comment on learners' bodies, weight or size. Where a learner's treatment needs weight monitoring, it is done by the health service, not by us.

20. Records

• Consent forms, IHPs, the MAR and the controlled drug record are kept on Connect, with access limited by role. During a system outage, staff use the paper MAR, which is entered on Connect afterwards.

• Records are kept in line with Data Protection, Retention and Information Sharing.

• Medication errors, emergencies and injuries are recorded as incidents on Connect.

21. Monitoring and review

• Monthly: the Clinical Advisor reviews the MAR, controlled drug records, errors and refusals.

• Half-termly: IHPs reviewed with child plans; expiry dates checked.

• Termly: the SWMC receives a summary of medication incidents and emergencies.

• This policy is ratified by the SWMC and reviewed every year, or sooner after an incident, a change in law or guidance, or a contract change. It is available to the commissioning local authority at any time.

22. Related policies

• 15 Health and Safety, including Fire and First Aid
• 25 Food Safety, Allergens and Nutrition
• 14 Therapeutic Practice and Clinical Governance
• 12 Special Educational Needs and Disabilities (SEND)
• 10 Mobile Phones and Digital Devices
• 26 Off-site Learning and Educational Visits
• 01 Safeguarding and Child Protection
• 17 Data Protection, Retention and Information Sharing
• 16 Transport and Escorting

Appendix A: Medication administration record (MAR) on Connect

Appendix B: Who's who

Document control and ratification

This policy is signed off by the Designated Safeguarding Lead and the Head of Alternative Provision, and ratified by the Social Work Management Committee. It is reviewed every year, or sooner after an incident or a change in law, statutory guidance or contract requirements, and it is available to any commissioning local authority on request.