Administration of medications in schools procedure

Audience

All state schools

Purpose

This procedure provides the process for administering medications to students when they are attending school or school-related activities, in accordance with the advice of the student’s prescribing health practitioner or as an emergency first aid response. Having clear, documented workplace procedures to manage the administration of medications facilitates safe systems of work that ensure student and staff safety, and supports schools to meet legislative requirements, including those relating to health and to work health and safety.

Overview

The administration of medications to students is only to occur when necessary during school hours or school-related activities, and when there is either medical authorisation for its administration or it is required as an emergency first aid response.

Administering medications to students is a task that is voluntarily performed by staff.

Sections 93(1) & (2) of the Medicines and Poisons Act 2019 require a responsible person (the principal) to have a substance management plan (SMP) in place (as outlined in this procedure) that details how risks associated with buying, possessing, administering and disposing of medications held at the school are managed. Section 94 requires all staff involved with the administration of mediation to comply with the school's SMP.

The procedure does not apply to pre-preparatory programs and/or outside school hours care service operated on the school site. These services deal with medications in accordance with the service’s policies and procedures which would reflect legislation that applies to that service.

Responsibilities

Principals/delegates

• develop and maintain a school-based SMP that will identify and record staff involved in the administration of medication to students:
  • assigned officers
  • health support staff
  • staff who are trained to administer emergency first-aid medication (i.e. asthma relievers and adrenaline auto-injectors).
    NOTE: The number of staff identified must account for planned and unplanned staff absences.
• make the SMP available to all staff
• communicate school processes to assigned officers and health support staff about safely administering medically authorised medication to students in accordance with all instructions (e.g. pharmacy label/medication order/Action Plan/school processes) and the Restrictive practices procedure (for 'as-needed' medication as a non-emergency response)
• follow approval processes for students who self-administer their medication as per the Guidelines for the administration of medications in schools
• have processes in place to ensure assigned officers and health support staff safely receive and store students’ medication, and dispose of it when required
• ensure assigned officers and health support staff are trained in administering medications as relevant to their roles
• ensure staff who supervise students are offered emergency first aid training as needed
• ensure documentation, recording and reporting processes are met in relation to the administration of medications
• determine the school's system for storing students' emergency first aid medication so that it remains with the student at all times, and communicate this system to staff and students
• determine and communicate the school's processes to ensure emergencies requiring the administration of medication are responded to appropriately and without delay (including situations when relief staff may be involved)
• communicate relevant requirements about medication management appropriately to parents/carers
• review the SMP:
  • as soon as practicable following a review incident
  • at least five years after the date of commencement or date of previous review.

Assigned officers and health support staff

• have knowledge of and comply with the school's SMP
• safely receive and store students’ medication, and dispose of if required
• safely administer medically authorised medication to students
• prepare relevant documentation and accurately record the administration of medication
• notify the principal/delegate if there is a medication administration error, or if medication is stolen, misused or diverted from the person to whom it was prescribed.

Staff who supervise students

• have knowledge of the school's SMP
• access OneSchool records to note which students have health needs that require medication, including those who are at risk of asthma and anaphylaxis
• follow the school's system to ensure that students’ emergency first aid medication is with them at all times
• assist a student requiring emergency first aid medication if required
• accurately record the administration of emergency first aid medication following administration
• notify the principal/delegate if there is a medication administration error, or if medication is stolen, misused or diverted from the person to whom it was prescribed.

Parents/carers/students

• provide information to the principal/delegate about the student’s health condition/s, including written information from qualified health practitioners, at enrolment or on diagnosis, and provide updated information when any information changes
• complete the Consent to administer medication form when medically authorised medication is to be administered to a student
• refer to the information for parents to ensure all documentation required for the safe administration of the medication is provided to the school
• ensure that enough well-maintained equipment, in-date medication and consumables, labelled clearly with the student’s name, are supplied
• collect unused medication from the school when it is no longer required or has expired
• discuss with the school administration if the student may be able to be responsible for self-administration of their medication and complete Section B on the Consent to administer medication form
• provide the Request for additional medication advice to the student's prescribing health practitioner and return the requested document/s to the school as soon as possible.

Process

Image 1 Process of administering medication in schools

1. Prepare

General preparation occurs to support students who need medication 

• Principal/delegate:
  • develops and reviews the SMP (using the SMP exemplar and referring to the guide as necessary)
  • considers completing relevant topics of the Administration of medication in schools (AMS) online training course available on QLearn (DoE employees only) to support the development of school processes
  • allocates time for assigned officers and staff to complete relevant topics of the Administration of medication in schools (AMS) online training course
  • arranges and allocates time for staff who supervise students to complete anaphylaxis and asthma management training, including practical training in the administration of emergency first aid medication
  • advises staff that they are provided with the same indemnity and legal assistance as all state employees, in accordance with the Queensland Government Indemnity Guideline.
• Principal/delegate, assigned officers and health support staff refer to the Guidelines for the administration of medications in schools for information on best practice.
• Principal/delegate considers the school's local context and:
  • sets up processes with assigned officers and health support staff to receive, store and dispose of medications
  • determines suitable processes for the safe administration of medication (refer to the Guidelines Appendix 2: 7 RIGHTS of safe medication administration in schools)
  • provides relevant information to staff and parents/carers (refer to the Process for principals: Communicating with parents/carers about the administration of medications).
• Assigned officers and health support staff are familiar with the process to safely administer medications in schools and safely handle and dispose of medication (refer to the Guidelines Appendix 2: 7 RIGHTS of safe medication administration in schools).
• Principal/delegate communicates to assigned officers and health support staff the process for how the school will respond to incidents involving medication side effects and errors (refer to the Health safety and wellbeing incident management guideline (DoE employees only) and the Guidelines Appendix 5: Responding to medication side effects, errors and incidents).

Preparation occurs for students who need medication

• Principal/delegate ensures they are aware of all students who require medication at school or during school-related activities.
• Principal/delegate ensures staff are provided with appropriate training (refer to the Process for principals: Staff training in the administration of medications).
• Principal/delegate ensures staff who supervise students, are advised of the medication requirements of the students they supervise, including being informed of: when medication is required, including specific warning signs, triggers or emergency responses (as outlined in a student's health plan); where medication is stored; and who will administer it.
• Principal/delegate has a localised process in place to ensure students requiring medication for health conditions are supported when supervised by relief teachers (e.g. timetabling trained staff to the class).

2. Receive

When student medication is brought to school

• Assigned officers ensure the required forms have been completed and signed (refer to the Guidelines Table 2: Forms for administering medication at school).
• Assigned officers and health support staff review the medication and dosage information on the consent form and/or medication order and check that it matches the pharmacy label (NOTE: often the pharmacy label is not able to be seen on insulin, so check the prescribing health practitioner’s letter authorising the insulin carefully).
• For ‘as-needed’ medication, assigned officers ensure parent/carer contact details are accurate as they may need to be contacted immediately prior to any administration.
• Assigned officers ensure there is medical authorisation e.g. there is a pharmacy label attached to the original container with the prescribing health practitioner’s name, or a medication order, or written instructions or Action Plan from the prescribing health practitioner.
  Where there is no evidence of medical authorisation, assigned officers or health support staff mark the missing documentation on the Request for additional medication advice and request parent/carer to provide this document to the prescribing health practitioner.
• Assigned officers attach all required forms (e.g. consent form, medication order, written instructions, action plan) to the relevant record form:
  • Record of medication administration (routine medication)
  • Record of medication administration (‘as-needed’ medication)
  • Record of medication administration (insulin).
• The principal/delegate will determine the system for assigned officers and health support staff to manage documentation following initial processing by the assigned officer.
• The principal/delegate will determine and communicate who (e.g. the principal/delegate, assigned officer or health support staff) will be responsible for:
  • contacting the pharmacy identified on the label to confirm the medication has been prescribed, if the pharmacy label is the only form of medical authorisation and the prescribing health practitioner’s name is not listed
  • requesting that the parent/carer contact the pharmacy identified on the label to seek clarification, if the pharmacy label is the only form of medical authorisation and the instructions on the pharmacy label are not legible or easily understood
  • requesting that the parent/carer seek clarification from the prescribing health practitioner if the information on the pharmacy label contradicts the information on the consent form or the medication order/Action Plan.
    NOTE: The student’s medication is NOT to be administered until clarification is received.

If the medication is for a student to self-administer

• Assigned officers will refer to the Guidelines (Appendix 3: Approval requirements for self-administration) to determine if principal/delegate approval is required.
• If principal/delegate approval is required:
  • the principal/delegate will:
    • refer to the Guidelines (Appendix 4: Risk assessment for determining self-administration) and, in consultation with the parent/carer/student and student’s health team, consider the factors and risks involved in safe self-administration of medication
    • approve student to be responsible for possession and self-administration of medication when it is considered that the student can confidently and competently undertake safe self-administration of medication at school
    • record any discussions with the parent/carer and student in OneSchool as a Record of Contact
    • ensure relevant staff are aware of students who are self-administering and self-managing their medications
    • notify staff that they should be trained and prepared to administer emergency medication to the student as a first aid response if required.
  • assigned officers will:
    • record the decision to allow the student to self-administer in OneSchool > under the Manage Student Details > edit Medical Conditions > add a comment in the Management field (e.g. student self-administers insulin as required). Once entered, this information should be visible in the Student Profile Additional Information section.
  • staff who supervise students will:
    • be familiar with the signs that the student is experiencing an asthma or anaphylactic reaction
    • be prepared to administer the student’s emergency medication without delay as a first aid response if required (regardless of whether or not the staff member has current first aid training).
• If principal/delegate approval is not required (i.e. for self-administration of asthma medication only):
  • the parent/carer/student will advise the school administration that they allow the student to be responsible for self-administration of their asthma medication
  • the principal/delegate will:
    • note those students who are self-administering asthma medication
    • notify staff who supervise these students that they should be prepared to administer asthma medication to the student as a first aid response if the student’s symptoms compromise their ability to self-administer it
    • consult with parent/carer/student if the decision for the student to self-administer their own asthma medication needs to be overturned due to health or safety issues and explain the reasons why
    • overturn the parent/carer/student decision if health or safety risks cannot be controlled or minimised effectively
    • if self-administration is overturned, ensure processes for staff administration of medication to the student are undertaken.
  • assigned officers will:
    • record the advice in the student’s OneSchool medical records by selecting Student details > Medical > Edit > Add new Medical Condition Details > select ‘Asthma – student self-administers (No Action Plan required. School will administer Asthma First Aid in an emergency’).
  • staff who supervise students will:
    • be familiar with the signs that the student is experiencing an asthma emergency
    • be trained and prepared to administer the student’s emergency medication to the student as a first aid response if required.

Once all documentation has been reviewed

• Assigned officers will:
  • provide information to the principal/delegate about students requiring medication to allow principal/delegate to determine school processes (e.g. staff to be involved, storage of medication, supervision)
• Principal/delegate will use this information to:
  • communicate relevant information about the administration of medications 
  • ensure relevant training is completed.

3. Administer

When medication is required as part of an emergency response

• For a student having an asthma flare-up or anaphylaxis, staff who are supervising the student will:
  • follow the asthma/anaphylaxis Action Plan and administer emergency first aid medication without delay
  • immediately phone emergency services (000), request ambulance services, stay on the phone and follow the advice given
  • follow the relevant incident management actions and timeframes in the Health safety and wellbeing incident management guideline (DoE employees only).
• For a student with health needs, health support staff will:
  • follow the student's Emergency Health Plan or Action Plan and any other written instructions from the prescribing health practitioner regarding the administration of the student’s medication
  • if required, immediately phone emergency services (000), request ambulance services, stay on the phone and follow the advice given
  • follow the relevant incident management actions and timeframes in the Health safety and wellbeing incident management guideline (DoE employees only).

When medication is required as a routine administration

• Assigned officers will:
  • observe standard precautions for infection control relevant to administering medications
  • follow school processes (that have been developed with reference to the Guidelines Appendix 2: 7 RIGHTS of safe medication administration in schools).

When medication is required 'as-needed' for a non-emergency response

• Assigned officers will:
  • contact the principal/delegate if the student is requesting the medication
  • observe standard precautions for infection control relevant to administering medications if the principal/delegate has approved its administration
  • follow school processes (that have been developed with reference to the Guidelines Appendix 2: 7 RIGHTS of safe medication administration in schools) if the principal approves the administration of the medication.

4. After administration of medication

After administering medication as an emergency response

• Health support staff will record information on the Record of administration of medication at school (‘as-needed’ medication) if the student’s medication has been administered as per their Emergency Health Plan or Action Plan.
• Staff who administer the school’s emergency first aid medication (e.g. to an undiagnosed student), will record the incident as per Recording first aid in the Managing first aid in the workplace procedure e.g. using the MyHR WHS Student First Aid Module (DoE employees only).
• Staff who administer the school’s emergency first aid medication where the emergency medication was administered due to a curriculum activity or other workplace factor (e.g. exposure to science experiment fumes or consumption of allergen causing an allergic reaction), will record the incident in MyHR Home > Workplace Health and Safety > Add New Incident> Injury/illness tab.
• The principal/delegate, or staff member designated by the principal, will contact parent/carer as soon as possible to advise them of the incident (record this contact in OneSchool).
• The principal/delegate will:
  • refer to the School alerts procedure to determine if notification of regional office and/or senior executives is required
  • ensure medication is replaced (individual student medication is replaced by parent/carer, emergency first aid medication is replaced by school).

After administering routine or as-needed medication as a non-emergency response

• Assigned officers or health support staff will:
  • immediately record details in the appropriate record sheet
  • notify the parent/carer if ‘as-needed’ medication has been administered
  • notify the classroom teacher and parent/carer if student refuses their medication to determine possible risks and any further actions
  • notify the parent/carer if the medication is approaching its expiry date or if the quantity is low.

If side effects, medication errors or adverse reactions occur

• Assigned officers or health support staff will IMMEDIATELY provide first aid and contact either:
  • Emergency services (000) if the student has:
    • collapsed; and/or
    • is not breathing or has difficulty breathing; and/or
    • severe nausea or is vomiting; and/or
    • another severe reaction (e.g. hives, swollen lips, face gone pale, sweating, chills); and/or
    • the student has consumed unauthorised medication with or without an observable reaction. OR
  • Poisons helpline (13 11 26) if the student has no observable adverse reaction following a medication error.

In all cases of side effects, medication errors and adverse reactions

• Staff will:
  • notify the principal/delegate as soon as possible to coordinate the response
  • record the incident and actions taken by staff (refer to the Guidelines (Appendix 6: Recording actions following medication side effects, errors and incidents).
• Following this, the principal/delegate will:
  • report the critical incident to regional office as per the School alerts procedure 
  • in the case of medication that has caused an adverse or atypical reaction for the student, advise the parent/carer that staff will not continue to administer this medication unless further written advice has been received from the prescribing health practitioner
  • review the effectiveness of first aid and emergency response processes and amend where improvements are identified
  • review, investigate, and implement corrective and preventative actions for work related incidents according to the Health, safety and wellbeing incident management procedure
  • communicate any change of practice to staff.

5. Storage and disposal of medication and equipment

To store medications

• The principal/delegate establishes and monitors procedures for safe and appropriate storage of medications (refer to the Guidelines Appendix 1: Considerations for storage of medications) to ensure that:
  • medication is stored in the original containers according to the manufacturer's instructions and special instructions from the pharmacist or prescribing health practitioner (including medication which needs to be stored below 25 ºC);
  • medication required for an emergency response is stored in a safe, unlocked location where it is always easily accessible to authorised people in the event of an emergency;
  • medication is stored (other than medication required for an emergency response) in a:
    • non-portable, locked space such as cupboard/cabinet reserved for medications only; or
    • secure fridge (if required) with authorised access only; or
    • location determined by the principal/delegate to meet the student’s individual health needs.
  • access to all medications is limited to people authorised to administer those medications; and
  • staff accommodate for students to access their medication to cause minimal disruption to the student's learning program and respects the student’s dignity.

To dispose of medications

• Health support staff and assigned officers will:
  • ask the parent/carer to collect medication from the school if unused or no longer required
  • advise parents/carers that unclaimed medications will be taken to a pharmacy to be disposed of
  • dispose of unclaimed medications at a local pharmacy (with the authorisation of the principal/delegate)
  • ensure safe disposal of sharps in accordance with the Safe handling and disposal of needles and syringes information sheet.
• Principal/delegate will provide health support staff/assigned officers authorisation when they are required to dispose of unclaimed medication.

When medication has been stolen, misused, or diverted from the person to whom it was originally prescribed

• Staff will notify the school principal/delegate.
• The principal/delegate will:
  • notify parents/carers to arrange a replacement dosage of the medication 
  • follow established procedures for missing property on school grounds 
  • contact Regional Office
  • contact police if required (NOTE: this is mandatory when controlled drugs are involved).

Definitions

Legislation

• Education (General Provisions) Act 2006 (Qld) sections 5 and 426
• Disability Standards for Education 2005 (Cwlth)
• Medicines and Poisons Act 2019
• Medicines and Poisons (Medicines) Regulation 2021 (Qld) Chapters 2,3,6; Schedule 13, Part 2, and Schedule 17
• Human Rights Act 2019 (Qld) Divisions 2 and 3
• Work Health and Safety Act 2011 (Qld)
• Work Health and Safety Regulation 2011 (Qld) section 42

Delegations/Authorisations

• Nil

Other resources

Guidelines

• Anaphylaxis Guidelines for Queensland State Schools
• Asthma Guidelines for Queensland Schools
• Guidelines for Queensland schools – Students with diabetes
• First aid kits and facilities
• Queensland Government Indemnity Guideline
• Guide to developing a Substance management plan for medicines - Queensland Health

Policies and procedures

• Inclusive education policy
• Infection control procedure
• Managing first aid in the workplace procedure
• Managing student's health support needs at school procedure
• Restrictive practices procedure
• School alerts procedure
• Supporting students with asthma and/or at risk of anaphylaxis at school procedure
• School excursions procedure
• International study tours procedure

Instructions

• Returning unwanted medicines
• Safe handling and disposal of needles and syringes

Reference documents

• Required forms for administering medication at school (DoE employees only)
• Queensland Health Departmental Standard - Substance Management Plans for Medicines

Superseded versions

Previous seven years shown. Minor version updates not included.

4.0 Administration of medication in schools

5.0 Administration of medication in schools

6.0 Administration of medications in schools procedure