Managing Medical Needs Nov 2015

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Managing Medical Needs and Infection Control in

Schools and Child Care Settings

Darton College

Managing Medical Needs and Infection

Control Policy

November 2015

Unlocking Potential Changing Lives


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Managing Medical Needs and Infection Control in Schools and Child Care Settings

The following gives guidance on the strategy for managing medicines, medical needs anddealing with infections within the workplace/school setting. nnual Care plans need to !ecomplete !y the individual services/schools working with Children and "oung #eople and$amilies.

Individual services have put a copy of the relevant care plans in their information sectionwithin the document.

%here appropriate a copy of the care plan should !e held in school or child care setting.This is to ena!le school staff to !e aware of any signs and symptoms a child may have and

the correct procedure to deal with these if re&uired.

'eneral #olicy Statement

The 'overnors and ()ecutive #rincipal of *arton College acknowledge that there is no legalduty which re&uires a mem!er of the school staff to administer medication to a student orparticipate in any medical procedure involving a student.

The 'overnors and ()ecutive #rincipal recognise that any provisions or arrangementscontained in this policy are voluntary and in addition to the school+s ealth and Safety #olicy.

The support of children with a medical need will !e in accordance with the uthority+sguidance on Managing Medical Needs and Infection Control in Schools and Child CareSettings.

Signed- #rincipal

*ate-

Signed- Chairperson of the 'overning ody

*ate-

0eview date- Novem!er 1234


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This guidance consists of-

3. Introduction %hat are the arrangements for managing medical needs in schools and settings5

%hat are the risks5

()isting regulations

1. 0esponsi!ilities for the management of medicines dministration of medicines

Self6dministration

Storage of Medicines

*isposal of Medicines

Individual ealth Care #lans

Infection Control rrangements

Medical $acilities

Training rrangements

7ia!ilities and Insurance

School 8isits, 9ourneys and :ff6site (ducation and %ork ()perience

Sporting ctivities

(mergency #reparedness

School ealth Service 0ecord ;eeping

;ey Monitoring 0e&uirements

rrangement 3 < dministering prescription medicinesrrangement 1 < dministering non6prescription medicines

ppendi) 3< Medical Needs Information and ction Cardsppendi) 1< =seful #oints of Contactppendi) >< Consent $orms and Medical 0ecords

uthorised !y ead of Corporate ealth, Safety and (mergency 0esilience

*ate of Issue Novem!er 1233

0eviewed/adapted !y *arton College Novem!er 123?


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1. Introduction

What are the arrangements for Managing Medical Needs in Schools and Settings?

Management of medical needs refers to the arrangements and provisions made for studentswho have conditions, illnesses, infections and/or disa!ilities which may re&uire action on!ehalf of the school either through the provision of information and guidance oremergency/intermediary treatment to deal with medical issues.

(ach school or setting needs to determine what their school arrangements are in terms of

making ad@ustments in the premises and work activities to cater for pupils with medicalneeds, administration of medicines, identifying and dealing with infectious diseases andproviding emergency intermediary treatment to deal with medical issues.

What are the risks?

$ailure to have arrangements in place for the management of medicines could result in aserious medical emergency, increased spread of infection, increased danger to vulnera!lepupils and others affected !y their actions and/or a misadministration of medicine.

Existing regulations

In general the ealth and Safety at %ork etc. ct 3AB places a duty upon the employer toensure the health, safety and welfare of persons not in their employment !ut may !e affected!y their work activities.

=nder part of the *isa!ility *iscrimination ct D**E 3AA?, responsi!le !odies for schoolsDincluding nursery schoolsE, must not discriminate against disa!led pupils in relation to theiraccess to education and associated services < a !road term that covers all aspects of schoollife including school trips, clu!s and activities.

The National Curriculum Inclusion Statement 1222 emphasises the importance of providingeffective learning opportunities for all pupils in terms of-

Setting suita!le learning challenges

0esponding to pupils+ diverse needs

:vercoming potential !arriers to learning

2. Resonsi!ilities

$irst and foremost, the eadteacher will make it clear to parents that they are responsi!le forensuring their child is well enough to attend school. If a child is acutely unwell they must !ekept at home.

"dministration of Medicines

There is no legal duty that re&uires staff to administer medicines. owever, anyone caringfor children including teachers, other school staff and day care staff in charge of children, has


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a common law duty of care to act like any reasona!le prudent parent. Staff need to makesure that children are healthy and safe. In e)ceptional circumstances, the duty of care could

e)tend to administering medicine and/or taking action in the event of an emergency. Thisduty e)tends to staff leading activities taking place off site such as visits, outings or field trips.

%here the #rincipal authorises the administration of prescription medicines in school, theadvice in arrangement 3should !e followed.

%here the #rincipal authorises the administration of non6prescription medicines in school,the advice in arrangement 1should !e followed.

Should the #rincipal decide that prescri!ed medicines shall not!e administered to any pupilunder any circumstances !y school staffF the eadteacher will communicate this toparents/carers. %here it is essential that medication is taken during the school day,parents/carers will !e e)pected to come into school to administer the medicine to their child.

ppendi) 3 contains advice and information cards on common medical pro!lemse)perienced in schools and child care settings which must !e implemented !y the school

when the eadteacher feels that it is necessary and appropriate to the needs of their pupils.

The information contained in each section is intended to provide an overview of the medicalcondition and to provide information which is felt useful and relevant for the school setting.owever, it is not e)haustive and therefore, links have !een provided to relevant we!sitesand organisations who can provide more e)tensive information and support in dealing withmedical issues. This information may !e useful when formulating individual ealth Care#lans Dsee !elowE.

Self#"dministration

It is good practice to support and encourage children, who are a!le, to take responsi!ility to

manage their own medicines from a relatively early age. The age at which children are readyto take care of, and !e responsi!le for, their own medicines, varies. s children grow anddevelop they should !e encouraged to participate in decisions a!out their medicines and totake responsi!ility.

:lder children with a long6term illness should, whenever possi!le, assume completeresponsi!ility under the supervision of their parent. ealth professionals need to assess,with parents and children, the appropriate time to make this transition.

If children can take their medicines themselves, staff may only need to supervise. The healthcare plan should say whether children may carry, and administer Dwhere appropriateE, theirown medicines, !earing in mind the safety of other children and medical advice from the

prescri!er in respect of the individual child.

%here pupils, parents and eadteachers deem it appropriate for the pupil to self6administermedicines, consent formM1should !e completed.


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Storage of Medicines

Medicines will !e stored strictly in accordance with product instructions paying particular noteto temperature and the original container in which dispensed. Never transfer medicines fromtheir original containers.

Staff will ensure that the supplied container is clearly la!elled with the name of the child, thename and dose of the medicine, the method and fre&uency of administration, the time ofadministration, and side effects and the e)piry date.

%here a child needs two or more prescri!ed medicines, each will !e in a separate container.

Children will !e informed where their own medicines are stored and who holds the key.

ll emergency medicines such as asthma inhalers and adrenaline pens will !e readilyavaila!le to children and will not !e locked away. The eadteacher should determinewhether pupils can carry their own inhalers and communicate this to parents/carers andemployees. This should also !e documented in individual health care plans.

:ther non6emergency medicines will !e kept in a secure place not accessi!le to children.

few medicines need to !e refrigerated. They can !e kept in a refrigerator containing food!ut must !e kept in an airtight container and clearly la!elled. There will !e restricted accessto a refrigerator holding medicines. It is accepta!le for a staff room fridge to !e used asstorage as long as medical items are clearly la!elled.

The school/setting will make special access to emergency medicine that it keeps. owever,it is also important to make sure that medicines are kept securely and only accessi!le tothose for whom they are prescri!ed.

$isosal of Medicines

Staff should not dispose of medicines. #arents/carers are responsi!le for ensuring that date6e)pired medicines are returned to the pharmacy for safe disposal. They will !e asked tocollect them at the end of each term. If medicines aren+t collected they will !e taken to alocal pharmacy for safe disposal.

Sharps !o)es will always !e used for the disposal of needles. Collection and disposalshould !e arranged with the clinical waste disposal contractor De.g. Cannon ygieneE or the7ocal uthority.

Indi%idual &ealth Care 'lans

#arents/carers have the prime responsi!ility for their child+s health and should provideschools and settings with detailed information a!out their child+s medical condition.

Individual health care plans must !e amended to include reference to oral medication ifadministration is re&uired for a period of eight days or more.

Individual health care plans need to include any restrictions on a child+s a!ility to participatein school activities such as #(/ cooking.


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Consideration must !e given to who it is necessary to issue ealth Care #lans to such as-

Class TeachersSMSs

School transport escorts

Those taking school visits and @ourneys

$orm M? contains a template 'eneral Individual ealth Care #lan which should !ecompleted for children who have a known medical condition which the school needs to havedetailed information a!out. The medical needs action cards may also include a specificealth Care #lan for certain medical conditions which the eadteacher may prefer to use.

dditionally, for those pupils who have a medical need which may impede their a!ility tosafely evacuate the premises in the event of an emergency, a #ersonal (mergency(vacuation #lanD#((#E may need to !e developed and implemented.

Infection Control "rrangements

(ach school should have a copy of and display the ealth #rotection gency D#E guidanceon infection control in schools and other childcare settings. It gives guidance on the mostcommon infectious diseases and the recommended action to take in the event of an out!reakoccurring. This document can !e downloaded from the # we!site using the following link-'uidance on Infection Control in Schools and other Child Care Settings

It should !e noted that taking preventative measures such as following good hygiene practice

are the !est ways to prevent the spread of infections. Therefore, good hand6hygiene should!e demonstrated and reiterated to children.

$urther information can !e o!tained from the # we!site. dditionally,appendi) 1providessome useful points of contact.

Staff should have access to protective disposa!le gloves and will follow precautions on theC:S assessment for clinical waste and !ody fluidswhen dealing with such su!stancesand disposing of dressings or e&uipment.

Medical (acilities

The (ducation DSchool #remisesE 0egulations 3AAA re&uire every school to have a roomappropriate and readily availa!le for use for medical or dental e)amination and treatment andfor the caring of sick or in@ured pupils. It mustcontain a wash !asin and !e reasona!ly nearto a water closet. It must not!e teaching accommodation. If this room is used for otherpurposes as well as for medical accommodation, the eadteacher must consider whetherdual use is satisfactory or has unreasona!le implications for its main purpose.

)raining "rrangements

Staff managing the administration of medicines and those who administer medicines willreceive appropriate training and support from healthcare professionals. This shall !erecorded on consent formM>.

The uthority accepts that teachers have a general professional duty to safeguard the healthand safety of the pupils in their care. %hilst this does not imply a duty to administermedication, appropriate staff may voluntarily undertake this duty as long as they receive
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training to ena!le them to do so. The eadteacher should, therefore, identify which staff arewilling to !e trained and make the necessary arrangements with the School ealth Service.

There should !e enough volunteers to cover holidays, illnesses and other a!sences. contingency plan should !e in place for circumstances when there are no mem!ers of trainedvolunteer staff present on a particular day for the administering of the treatment.

*ia!ilities and Insurance

(mployees who are not medical healthcare professionals will !e supported !y their schooland the 7ocal uthority in carrying out healthcare activities such as-

dministering $irst id in an emergency !y employees with a valid first aid certificate

#roviding assistance to a user in administering a ne!uliser, an inhaler and o)ygen

when following a written care plan dministering in@ections where the necessary training has !een undertaken De.g.

epipen trainingE dministering oral medication which has !een prescri!ed and directed !y a medical

professional provided the relevant consents have !een o!tained. dministering oral medication as directed and authorised !y a parent or carer provided

the relevant consents have !een o!tained.

$or &ueries a!out any other health care activities, the insurance section should !e contactedon 23114 BB>3A.

&ome to School )ransort

The local authority has a duty to ensure that pupils are safe during @ourneys. Most pupilswith medical needs do not re&uire supervision on school transport, !ut the 7ocal uthority willprovide appropriate trained escorts if they consider them necessary.

#rior to transport commencing, the Schools+ Transport service routinely re&uest informationa!out the pupils+ medical conditions from parents/carers and this ena!les them to develop anindividual health care plan. This information will !e provided to and kept with the escortassigned to the child. The schools+ transport service will organise any specific trainingre&uired, such as the use of epipens.

(ating and drinking is not permitted on vehicles to minimise the risk of children havingallergic reactions to some food groups.

#arents, school escorts and eadteachers should liaise regularly to ensure the pupil+smedical files are updated with any changes in their condition or medical treatment.

School +isits, -ournes and /ff#site Education or Work Exerience

It is good practice for schools to encourage children with medical needs to participate insafely managed visits. Schools and settings should consider what reasona!le ad@ustmentsthey might make to ena!le children with medical needs to participate fully and safely onvisits. This might include revising relevant visits and @ourneys risk assessments so that

planning arrangements will include the necessary steps to include children with medicalneeds and incorporate additional safety measures such as additional supervision, such as aparent or another volunteer accompanying a particular child. rrangements for taking anynecessary medicines will also need to !e taken into consideration. Staff supervising


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e)cursions should always !e aware of any medical needs, and relevant emergencyprocedures. copy of any health care plans should !e taken on visits in the event of the

information !eing needed in an emergency.

If staff are concerned a!out whether they can provide for a child+s safety or the safety ofother children on a visit, they should seek parental views and medical advice from the schoolhealth service or the child+s '#.

dditional risk assessments may need to !e carried out for pupils who, as part of ;ey Stage provision are educated off6site through another provider to ensure that the relevantprovisions are made for them at their place of study/work. The school is responsi!le forensuring that a work place provider has a health and safety policy which covers eachindividual student+s needs. #arents/carers and pupils must give their permission !eforerelevant medical information is shared on a confidential !asis with employers.

Sorting "cti%ities

Most children with medical conditions can participate in physical activities and e)tra6curricular sport. There should !e sufficient fle)i!ility for all children to follow in waysappropriate to their own a!ilities. owever, any restrictions on a child+s a!ility to participatein #( should !e recorded in their individual health care plan. ll adults should !e aware ofissues of privacy and dignity for children with particular needs.

Some children may need to take precautionary measures !efore or during e)ercise, and mayalso need to !e allowed immediate access to their medicines such as asthma inhalers.Staff supervising sporting activities should consider whether risk assessments are necessary

for some children, !e aware of relevant medical conditions and any preventative medicinethat may need to !e taken and emergency procedures.

Emergenc 'rearedness

%ithin the schools+ resilience arrangements, it may !e necessary to consider whichmedications need to !e taken to the evacuation point in case children have a medicalemergency or if staff will not have access to the premises for a lengthy period of time.

)he Role of the School &ealth Ser%ice

There are some children with a medical need which may re&uire dedicated support andadvice from specialist health professionals. dvice is provided within the guidance on themost common medical conditions and how to manage them. owever, it is not possi!le toincorporate every individual medical need / eventuality. $or e)ample there may !e childrenwho have-

palliative care needsF

cancerF

cystic fi!rosisF

had surgery and are reha!ilitating as they return to school.

In these circumstances individual health care plans should !e drawn up to identify the level

of support that is needed at school. Those who may need to contri!ute to any health careplan are-

the school health service or other health care professionalsF


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the eadteacherF

the parentDsE or carerDsEF

the child Dif sufficiently matureEF relevant teacherDsE, care assistant or support staff Dif applica!leEF

School staff who have agreed to administer medication / procedures.

Schools should normally use the School ealth Service, as a first point of contact if theyre&uire specific advice on individual medical needs of a child within school. This will ena!learrangements and procedures to !e put in place to ensure that ade&uate support is availa!lefor !oth the school and the child. owever, schools re&uiring advice on dia!etes shouldcontact the dia!etes nurses directly, since it is such a specialised area. The specialistdia!etes nurses are part of the children+s community nursing team.

The School ealth Service consists of the nursing team who are either !ased at New Streetealth Centre or at the local ealth Centre. School nurses are involved in health promotionand education. They encourage children to understand their development and care for theirhealth, making choices which promote their well6!eing. They offer support to children,parents and teaching staff on a wide range of health related issues. These include diet,e)ercise, se)ual health, emotional well6!eing etc. In addition the school nurse can provideaccess to information and support on a range of medical issues.(ach school has a named nurse. If a school needs to contact them or find out the name ofthe school nurse they should contact New Street ealth Centre on D23114E >>3>2.

The Children+s Community Nursing Team are !ased on The Children+s %ard at arnsley*istrict 'eneral ospital. They provide care and support to children with-

llergiesF

sthma / respiratory conditionsF

Cystic $i!rosisF

CancerF

*ia!etesF

#alliative care needsF

Some children who have had surgeryF

Special needs children who re&uire specialist support.

Record keeing

The following records must !e kept-

0elevant #arental consent forms for the administration of medicines and emergency

medical action DM3, M1 and ME found in appendi) >.

Training records in the administration of emergency medical action DM>E found in

appendi) >.

ny necessary additional risk assessment forms De.g. school visits and @ourneys,participation in sporting activities, etc.E


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ny specific Individual ealth Care #lans which have !een developed either from the

general template M? found in appendi) >or from the anne)es in the Medical Needs

Information and ction Cards found in appendi) 3.

ny #ersonal (mergency (vacuation #lan D#((#E which has !een developed for a

pupil with specific medical needs.
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0e Monitoring Reuirements

*etermine the schools+ arrangements for the administration of medicines and

implement the re&uirements of arrangement 3or arrangement 1as necessary

*etermine which information and action cards Dappendi) 3E are relevant to the pupils

in the school and implement the re&uirements of these arrangements

ssess the needs of pupils who have specific medical needs and develop an

individual health care plan using an appropriate format

Implement a system to ensure that the relevant consent and medical record forms are

completed and that staff know which forms should !e completed and where they arelocated.

Include arrangements for pupils who have specific medical needs in the relevant risk

assessments e.g., school visits and @ourneys, #(, off6site education and work e)perience

*isplay the # 'uidance on Infection Control #oster and communicate the

re&uirements of this to the relevant staff mem!ers

7iaise with other agencies as appropriate in order to maintain and share up6to6datemedical information where the relevant consent has !een sought from parents/carers.

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Medical Needs Information and Action Cards

"rrangement 1 "dministering 'rescrition Medicines

It is the #rincipal+s in consultation with the 'overnors+ decision whether to authorise theadministration of prescription medicines in school. If it is authorised, the following points should!e o!served-

3. #arents/carers should provide full written information a!out their child+s+ medical needs inthe form of a #arental 0e&uest/Consent $orm M3 or an individual ealth Care #lanDM?E.

1. Short6term prescription re&uirements should only !e !rought to school if it is detrimentalto the child+s health not to have the medicine during the school day. If the period ofadministering the medicine is eight days or more, there must !e an individual ealth Care#lan DM?E.

>. The school/setting will not accept medicines that have !een taken out of the container asoriginally dispensed nor make changes to prescri!ed dosages.

. The school/setting will not accept medicines that have not !een prescri!ed !y a doctor,

dentist, nurse prescri!er or pharmacist prescri!er unless it is done as part of an individualealth Care #lan. The school will inform parents of this.?. Some medicines prescri!ed for children are controlled !y the misuse of *rugs ct.

Mem!ers of staff are authorised to administer a controlled drug in accordance with theprescri!er+s instructions. child may have a prescri!ed controlled drug in theirpossession. The school/setting will keep controlled drugs in a locked non6porta!lecontainer to which only named staff will have access. record of access to the containerwill !e kept. Misuse of a controlled drug is an offence and will !e dealt with under theschools !ehaviour policy.

4. Medicines should always !e provided in the original container as dispensed !y apharmacist and should include the prescri!ers instructions for administration. In all casesthis should include-

Name of child

Name of medicine

*ose

Method of administration

Time/fre&uency of administration

ny side effects

()piry date

B. minimum of two people should !e responsi!le for administering medicine to a child.G. (ach time a child is given medication a record will !e made on formM3!y the person

who administered the medication

A. In cases where pupils can !e trusted to manage their own mediation it will !e encouragedand staff will o!serve/supervise this. The eadteacher will ensure that parental consentM1form has !een completed and returned to school !efore medication is administered.

32. If a child refuses to take medication school staff will not force them to do so. Theeadteacher will make an informed decision on the action to !e taken !ased on thearrangements agreed with the parent.

The school setting will refer to the *f(S guidance documentHManaging Medicines in Schoolsand (arly "ears Settings+ when dealing with any other particular issues relating to managingmedicines.

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https://www.education.gov.uk/publications/standard/publicationdetail/page1/DFES-1448-2005https://www.education.gov.uk/publications/standard/publicationdetail/page1/DFES-1448-2005


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"rrangement 2 "dministering Non # 'rescrition Medicines

3. =nless there are e)ceptional circumstances school staff mustnot administer non6prescri!ed medicines to any pupil.

1. The only permitted circumstances when a non6prescri!ed medicine can !e administeredto a pupil or self6administered are-

aE where a child suffers from acute pain such as migraines, a letter to support this isprovided !y a doctor and the parent provides consent using form M 1F

!E where a female pupil e)periences dysmenorrhoea Dperiod painsE and this is with theconsent of the parent using form M1.

> The medicine should either !e supplied !y the parent/carer or from the supply in schooland stored in a safe and secure place.

record will !e kept stating the medication dosage, time administered, !y whom and thereason. This will !e recorded on form M 1.

? %here a non6prescri!ed medicine is administered to a pupil the parents must !einformed in writing that day using the standard letter/form M 1.

4 No pupil under the age of 34 will !e administered aspirin.

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"endix 1

Medical Needs Information and "ction Cards

Contents

"nahlaxis

NN( 3- Care pathway for school child with an allergy/anaphyla)is

NN( 1- #rotocol and care plan on the management of a child who suffers from a severeallergic reaction

NN( >- ction plan for an anaphylactic reaction

"sthma

NN( 3- sthma management care plan

"thletes (oot

$ia!etes

NN( 3- Care pathway for school child with dia!etes.

NN( 1- 'uidelines for !lood glucose monitoring in schools.

Eiles

NN( 3- 'uidelines for administration of rectal diaJepam/!uccal midaJolam in epilepsyand fe!rile convulsions for non6medical/non6nursing staff in school/early yearssetting and respite care.

&eadlice

NN( 3- #arent information leaflet

Incontinence

NN( 3- #rocedure for managing incidents of incontinence in primary children

Infectious $iseases

+errucae

Medical -e3eller

Noro%irus

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"nahlaxis

$efinition of "nahlaxis

naphyla)is is an e)treme allergic reaction re&uiring urgent medical treatment. The whole

!ody is affected, usually within minutes of e)posure to the allergen. The most common typeof allergen is food, in particular peanuts, nuts, sesame, fish, shellfish, dairy products andeggs. %asp and !ee stings, natural late) Dru!!erE and certain drugs can also cause anallergic reaction.

ny allergic reaction, including the most e)treme form, anaphylactic shock, occurs !ecausethe !ody+s immune system over reacts in response to the presence of a foreign !ody, whichis wrongly perceived as a threat. In anaphylactic shock, !lood vessels leak, !reathingD!ronchialE tissues swell and the !lood pressure drops causing choking.

In its most severe form the condition can !e life6threateningF however it can !e treated withmedication. $urthermore once the cause of the allergy is known it can, wherever possi!le,

!e avoided.

Smtoms of "nahlaxis

Symptoms can vary and may depend on how or what type of contact has taken place withthe su!stance causing the allergy. Symptoms can !e split into two categories as detailed!elow-

Mild Smtoms

urticarial rash Dnettle rash/hivesEF

itching and/or sneeJingF

flushed face or neckF

swollen face/puffy eyes.

Moderate4Se%ere Smtoms

swollen lipsF

hoarse voice/feeling of lump in the throatF

coughF

vomiting and diarrhoeaF

difficulty in !reathing/or swallowingF

swollen tongueF feeling of faintnessF

!lue colour of the lips or faceF

loss of consciousnessF

!reathing stops, no pulse felt, heart stops.

Not all the symptoms may !e e)perienced. Some people find their reaction is always mild.$or e)ample, a tingling or itchy mouth and nothing more, which may !e treated with oralantihistamine D#iritonE. owever if there is a marked difficulty in !reathing or swallowing,and/or a sudden weakness or floppiness, these symptoms should !e regarded as seriousre&uiring immediate treatment.

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Medication and Control

In the most severe cases of anaphyla)is, children are normally prescri!ed a device forin@ecting adrenaline !y a &ualified medical practitioner. The device is called an (pipen which

looks like a fountain pen. It is pre6loaded with the correct dose of adrenaline and is normallyin@ected into the fleshy part of the thigh. drenaline acts &uickly to constrict !lood vessels,rela) smooth muscles in the lungs to improve !reathing, stimulate the heart!eat and helpstop swelling around the face and lips.

The needle is only revealed after the in@ection has !een administered. It is not possi!le togive too large a dose using this device. In cases of dou!t it is !etter to give the in@ectionthan to hold !ack. 0esponsi!ility for giving the in@ection should !e purely on a voluntary!asis and should not, in any case, !e undertaken without training from an appropriate healthprofessional. $ollowing the administration of an (pipen it should !e disposed of inaccordance with the protocol/ealth Care #lan.

$or some children the timing of the in@ection may !e crucial. There needs to !e a healthcare plan in place which clearly sets out suita!le procedures for each individual child so thatswift action can !e taken in an emergency.

$ollowing the administering of the (pipen an am!ulance should !e called and the parents ofthe child contacted. If there is no medical improvement in the child within five minutes asecond (pipen should !e given.

Storage of the Eien

The child may !e old enough to carry their own medication !ut, if not, a suita!le, safe, yetaccessi!le place for storage should !e found. The safety of other pupils should also !e

taken into account.

)he Management of "nahlaxis 3ithin the School

%hen a child is diagnosed with anaphyla)is information will !e passed on to the Schoolealth Service, Child+s '# or ealth 8isitor through a referral and information form. TheSchool ealth Service will then liaise with the school to allay fears surrounding the child+sdiagnosis of anaphyla)is. It is also e)pected that the parentDsE or carerDsE of the child willinform the school or if appropriate the school they are to !e admitted to, that the child isknown to suffer from a severe allergic reaction. %hen the pro!lem is identified, it isimportant to ensure that as far as is possi!le the child is treated normally. nne) 3to thesection outlines an e)ample of a care pathway.

If a child is likely to suffer a severe allergic reaction all school staff should !e aware of thecondition and know who is responsi!le for administering the emergency treatment andwhere it is stored. n e)ample of an action plan can !e found atnne) >to this sectionwhich could !e displayed on the classroom wall or staff rooms, etc.

Staff )raining

Specific training will !e arranged and delivered !y the appropriate staff within the Schoolealth Service within four weeks of the School ealth Service !eing notified of thediagnosis.

The training is to inform school/nursery staff on the specifics of allergy and anaphyla)is.This training can involve parents, school staff identified !y the eadteacher and appropriatehealth professionals. If parents are una!le to attend, the School Nurse/ealth 8isitor will

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contact the parents to inform them of the staff trained and procedures. $ormsM>andMwill need to !e completed and signed to provide indemnity for staff.

Training will need to !e updated annually for all school staff in order to maintain theindemnity involved in the administration of (pipen. =pdate sessions may also !e re&uired ifthe child+s circumstances change or staff change.

)he 'rotocol and &ealth Care 'lan for the Indi%idual Child

$or dealing specifically with an individual child who suffers from anaphyla)is an Individualealth Care #lan must !e drawn up and accepted !y the parents, the school and the Schoolealth Service.

This will deal with all of the following-

definition of allergyF

emergency procedure to !e adoptedF

treatmentF

food managementF

staff trainingF

precautionary measuresF

staff indemnityF

consent and agreement.

sample protocol ealth Care #lan for dealing specifically for anaphyla)is is attached atnne) 1to this section. It is important to stress that the precise content of the protocolealth Care #lan will !e dependent on the individual circumstances of each child. Theealth Care #lan should !e completed at the training session and copies sent to appropriateparties eg. school/nursery/School ealth/arnsley *istrict 'eneral ospital and parents.

"dministration of the Eien

*etails of the medical procedure for using the (pipen In@ector are outlined innne) 1to thissection.

$a to da olic measures 3ithin school

School Meals

$ood management and an awareness of the child+s needs in relation to the menu, individualmeal re&uirements and snacks in school are important factors to !e considered. Thecatering supervisor should also !e aware of the child+s particular re&uirements. It isreasona!le to e)pect that parents will provide the child with an appropriate packed lunch andclear guidance on sweets/snacks.

School +isits

$or outdoor activities/visits and @ourneys the school should ensure that the medical needs ofa child who suffers from anaphyla)is have !een addressed and the child+s medication istaken on the visit. It may !e appropriate for the child to !e accompanied !y a parent or anappropriately trained volunteer helper.

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"NNE5 1

C"RE '")&W"6 (/R SC&//* C&I*$ WI)& "N"**ER764"N"'&6*"5IS

Child diagnosed with anaphyla)is

0eferral and information sheet

School Nurse/Community children+s Nurse

rrange training in school as soon as possi!le after notification of diagnosis.

Complete care plan and check indemnity

*istri!ute care plans to relevant parties

0eview annually

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"NNE5 2

'R/)/C/* "N$ C"RE '*"N /N )&E M"N"7EMEN) /( " C&I*$W&/ S8((ERS (R/M " SE+ERE "**ER7IC RE"C)I/N

1 9"C07R/8N$

3.3 It is known that K may suffer an anaphylactic reaction if he/she eats or comesinto contact with

If this occurs he/she is likely to need medical attention and, in an e)tremesituation, his/her condition may !e life threatening. owever, medical adviceis that attention to his/her diet, and in particular the e)clusion of nuts, togetherwith the availa!ility of his/her emergency medication, is all that is necessary.In all other respects, it is recommended that his/her education should carry onas normal.

3.1 The arrangements set out !elow are intended to assist Ks parents and the

school in achieving the least possi!le disruption to his/her education, !ut alsoto make appropriate provision for his/her medical re&uirements.

2 $E)"I*S

1.3 The eadteacher will arrange for his/her teacher and other staff in school to!e !riefed a!out K+s condition and a!out other arrangements contained in thisdocument.

1.1 The school staff will take all reasona!le steps to ensure that K does not eatany food items unless they have !een prepared/approved !y the parents.

1.> K#arents will remind him/her regularly of the need to refuse any food items,which might !e offered to him/her !y other pupils.

1. In particular, K parents have the opportunity to provide for her-

1.? If there are any proposals which mean that K may leave the school site, priordiscussions will !e held !etween school and K+s parents in order to agreeappropriate provision and safe handling of his/her medication on the day.

1.4 %herever the planned curriculum involves cookery or e)perimentation withfood items, prior discussion will !e held !etween the school and parents toagree measures and suita!le alternatives.

1.B The school will hold, under secure conditions, appropriate medication clearlymarked for use !y designated school staff or &ualified personnel and showingan e)piry date.

ll used/e)pired medication must !e replaced !y K+s parents prior tocommencement of the ne)t attending school day.

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: "**ER76 RE"C)I/N

>.3 In the event of K showing symptoms of anaphyla)is, which are-

as descri!ed !y his/her mother, then the following steps should !e takenF

"*ER) "N/)&ERstaff mem!er, who will summon an am!ulance using AAA andstating ;C&I*$ E5'ERIENCIN7 SE+ERE "N"'&6*"C)IC RE"C)I/N


22/71


$E)"I*S /( )&E ME$IC"* 'R/CE$8RE (/R 8SIN7 )&E E'I'EN IN-EC)/R

#=77 :$$ '0(" S$(T" C#.

#7C( T( 7C; TI# :N T( MI* :=T(0 S#(CT :$ KS TI' D7%"ST( TI'E T 0I'T N'7(.

#0(SS 0* T: TI', :7* IN #7C( $:0 C:=NT :$ 32.

0(M:8( (#I#(N N* #7C( IN S0#S IN $:0 M=7NC( M(N.

MSS'( IN9(CTI:N SIT( $:0 32 S(C:N*S.

I$ N: IM#0:8(M(NT IN C:N*ITI:N $T(0 ? MIN=T(S N* N: M(*IC7SSISTNC( S 00I8(* 1N*(#I#(N T: ( *MINIST(0(*.

Care should !e taken to avoid accidental in@ury to the administering person. If thisoccurs, they should go to the nearest ccident L (mergency *epartment immediately

for treatment.

>.1 The administration of (#I#(N is safe for K, and even if it is given through mis6diagnosis, it will do him/her no harm.

>.> :n the arrival of &ualified am!ulance service, the teacher in charge will appraisethem of the medication given to K.

>. fter the incident a de!riefing session will take place, with all mem!ers of staffinvolved. School can contact the School ealth Service for advice and support.

>.? #arents will ensure replacement of any used medication prior to the commencement

of the ne)t school day.

= )R"NS(ER /( ME$IC"* S0I**S

.3 8olunteers from school staffF

have undertaken training to administer emergency medication.

Name of &ualified person giving training-

.1 training session was attended on !y mem!ers of schoolstaff named D.3E , it e)plained in detail K+s condition, the symptoms ofanaphylactic reaction and the procedures for the administration of medication.

.> $urther advice is availa!le to the school staff/volunteers at any point in the futurewhere they feel the need for further assistance. The medical training will !e repeatedat the !eginning of the academic year !y the school health advisor whocan !e contacted on 23114 >>322.

. arnsley Metropolitan orough Council provides a staff indemnity for any school staffvolunteers who agree to administer medication to a child in school, given the full

agreement of parents and school, in accordance with medical guidelines.Darvey. 9. 3AAAE

> )he Care 'lan has !een agreed and understood22


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Name- Signature- *ate-

23


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"NNE5 :

"C)I/N '*"N (/R "N "N"'&6*"C)IC RE"C)I/N

MI*$ 3 0ash E 7I+E1 Itching and/or sneeJing E 'IRI)/N

> $lushed face or neck E

Swollen face/puffy eyes E? Swollen lips E4 oarse voice, or a lump in the throat E

M/$ER")E B Cough E 7I+EG 8omiting and diarrhoea E E'I'ENA *ifficulty in !reathing and swallowing E

32 Swollen tongue E "N$E

SE+ERE 33 $eeling of faintness E IN&"*ER

31 lue colour to the lips and face E I(3> 7oss of consciousness E 'RESCRI9E$3 reathing stops, no pulse felt and heart stops E

naphylactic 0eaction

Reassure and kee calm

'ive (pipen to mid :uter thigh of 7eg/nl to the child for 3hom it is rescri!ed

Colleague to *ial AAA

fter ? Minutes

Improvement No improvement

0epeat (pipen

lways:!serveStay calm0eassure childStay with childCall AAA and inform parents.

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"NNE5 =

8SE(8* )E*E'&/NE N8M9ERS RE#"**ER7IES

naphyla)is campaign0egistered charity

%e!6site

#: o) 1B?, $arn!orough,ampshire '=3 4S231?16?121Ahttp-//www.anaphyla)is.org.uk/

ritish llergy $oundation0egistered charity

%e!6site

*eepdene ouse>2 ellegrove 0oad, ;ent*34 >#"2126G>2>6G?G>www.allergyfoundation.com

S:S Talisman DI* @ewelleryE Talisman Corner,13 'rays Corner, 7ey Street,Ilford, (sse) I'1 B0'2126G??6??BA

Supermarket $ree $romO lists sda 233>61>6?>?Marks and Spencer 2126B14G631>Tesco 2G226?2????Co6op 2G226>3BG1B

School Nursing/ealth Team 231146>>3>2

25
http://www.anaphylaxis.org.uk/http://www.allergyfoundation.com/http://www.anaphylaxis.org.uk/http://www.allergyfoundation.com/


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"sthma

7eneral information on "sthma

%here a child who suffers from asthma attends school, every effort should !e made to

encourage and help the child to participate fully in aspects of school life.

This can !e achieved !y helping staff and other pupils to understand asthma and avoid anystigma or misconceptions which are sometimes attached to the condition.

sthma is a condition that affects the child+s airways. sthma symptoms include coughing,wheeJing, a tight chest, and getting short of !reath. owever not every child will get all thesesymptoms.

Children with asthma have airways that are almost always red and sensitive DinflamedE. Theseairways can react !adly when someone with asthma has a cold or other viral infection or comesinto contact with an asthma trigger. Common triggers include colds, viral infections, house6dust

mites, pollen, cigarette smoke, furry or feathery pets, e)ercise, air pollution, laughter and stress.

%hen someone with asthma comes into contact with a trigger that affects their asthma, theairways do three things. The airway lining starts to swell, it secretes mucus, and the musclesthat surround the airway start to get tighter. These three effects com!ine to make the tu!es verynarrow, which makes it hard to !reathe in and out normally. This is called an asthma attack and itis at this point that a child will need to take a dose of their reliever medication. The affected childmay !e distressed and an)ious, and, if they e)perience several consecutive attacks the child+sskin and lips may !ecome !lue.

Medication and Control

sthma varies in severity. voiding known triggers where appropriate and taking the correctmedication can usually control asthma effectively. owever, some children with asthma will haveto take time off school or have distur!ed sleep due to asthma symptoms.

There are several medications used to treat asthma. Some are for long term prevention and arenormally used out of school hours and others relieve symptoms when they occur Dalthough theymay also prevent symptoms if they are used in anticipation of a trigger, e.g. e)erciseE.

%ithin the school environment, asthma medication is usually given through the use of inhalers. Itis good practice to allow children with asthma to take charge of and use their inhaler from anearly age with minimal support. This should !e recorded on formM1.

small num!er of children, particularly the younger ones, may use a spacer device with theirinhaler. Spacers make metered dose inhalers Dspray inhalersE easier to use and more effective.

(ach child+s needs and the amount of assistance they re&uire will differ. Staff are encouraged tooffer assistance when needed although this is purely on a voluntary !asis. The uthority willprovide indemnity for staff who volunteer to administer medication to pupils with asthma. $ormM>should !e used for this purpose.

Storage of Medication

Children with asthma must have immediate access to their reliever inhalers when they need

them. *elay in taking reliever treatment, even for a few minutes, can lead to a severe attack andin very rare cases can prove fatal. Children who are a!le to use their inhalers themselvesshould usually !e allowed to carry them with them in their pocket or pouch.

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If the child is too young or immature to take personal responsi!ility for their inhaler, staff shouldmake sure that it is stored in a safe !ut readily accessi!le place, and clearly marked with thepupils name.

t !reak time, in #( lessons and on school trips the inhaler should still !e accessi!le to the child.

0eliever inhalers must never !e locked up or kept in a central room away from the child. It isadvisa!le for all children to have a spare inhaler kept !y the school in an accessi!le place in casetheir own runs out, they forget to !ring it to school or lose their inhaler.

Children should not take medication which has !een prescri!ed for another child, however if achild took a puff of another child+s inhaler there are unlikely to !e serious adverse effects.

Some children may !e shy a!out taking their inhaler in front of others.

#arents should always !e informed if their child is taking their inhaler more often that they usuallywould.

"sthma attacksCommon signs of an asthma attack

Cough,

Shortness of !reath,

Wheeing,

Chest tightness

9eing unusuall uiet

$ifficult in talking43alking.

If a child has an asthma attack the school should follow the following procedure-

DiE (nsure that the reliever inhaler D!lueE is taken immediatelyF repeat the dose every fewminutes. If possi!le use the !lue reliever aerosol via a spacer device. 'ive 64 puffsspaced out evenly over a few minutes.

DiiE Stay calm and reassure the child. 7isten carefully to what the child is saying. lthough it+scomforting to have a hand to hold, staff should not put their arm around a child+s shoulderas this is restrictiveF reassure the child.

DiiiE elp the child to !reathe !y ensuring tight clothing is loosened. (ncourage the child to!reathe slowly and deeply whilst sitting upright or leaning forward slightly, in the most

comforta!le position for them. D7ying flat is not recommendedE. :ffer the child a drink ofwaterF

DivE Minor attacks should not interrupt the involvement of a pupil in school- they can return thechild to class when they are !etterF

Never leave a pupil having an asthma attack alone. If they do not have their inhaler and/orspacer on them, send another teacher or pupil to get it.

DvE Inform the child+s parents a!out the attack as soon as possi!le within that school day.

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Emergenc Situation

In an emergenc situation, school staff are reuired under common la3, dut of care, toact as a rudent arent 3ould.

Medical advice must !e sought and/or an am!ulance called if-

the reliever has no effect after ten minutesF

the child is either distressed or una!le to talkF

reathing is faster than usual and / or the child is using their tummy muscles to !reatheF

the child is getting e)haustedF

they are pale or !lue around the lipsF

you have any dou!ts at all a!out the child+s condition.

Continue to give reliever medication every few minutes until help arrives. *on+t worry a!outoverdosing since too much !lue inhaler is more !eneficial than too little.

child should always !e taken to hospital in an am!ulance. School staff should not take them intheir car as the child+s condition may deteriorate &uickly.

nne) 3to this section details an e)ample of an asthma management / care plan for a child.owever, it should !e noted that not all children who suffer from asthma will have one since it isdependent on the severity and sta!ility or their asthma which will have previously !een assessed.

"sthma in 'E and School Sorts

$ull participation in #( and sports should !e the goal for everyone and should !e accessi!le toall pupils at school, including those with asthma. ()ercise and activity is good for everyone andthe ma@ority of pupils should !e a!le to take part in most sports, e)ercise and activity. owever,many children with asthma may e)perience asthma symptoms during e)ercise.

$or some e)ercise is the only trigger, whilst others it is one of many triggers.

small minority of pupils with difficult to control asthma may find it difficult to participate fully ine)ercise !ecause of the nature of the asthmaF however, there have !een changes to #.(.ande)ercise in schools and other opportunities to try alternative ways of e)ercising.

Children with e)ertional symptoms will normally restrict themselves and care should !e taken notto push them, especially when they have symptoms.

Teachers taking #( classes have an important role in supporting and encouraging pupils withasthma. They should-

make sure that they know which children have asthmaF

!e encouraging and supportive to children with asthmaF

remind children whose asthma is triggered !y e)ercise to take a dose of reliever medicationa few minutes !efore they start the classF

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encourage children with asthma to do a few short sprints over a five minute period to warm

up, in particular !efore rushing into sudden activity when the weather is coldF

make sure children !ring reliever inhalers with them on all off6site activitiesF

make sure that children who say they need their asthma medication take their reliever

inhaler and rest until they feel !etterF

speak to the parents if they are concerned that a child has undiagnosed asthmaF

make time to speak to parents to allay their concerns or fears a!out children with asthma

participating in #(F

children should not !e forced to take part if they feel unwell. If a child has to sit out !ecause

of the asthma, try to keep them as involved as possi!le.

Record 0eeing

%hen a child is admitted to school it is e)pected that the parentDsE or carerDsE would inform theschool that their child suffers from asthma.

The School ealth Service also asks parentDsE or carerDsE to fill in School (ntry ealth Needsssessment &uestionnaires, the purpose of which is to highlight any health needs of individualchildren.

$rom this information the school should keep a register of all children who suffer from asthma.ll school staff should !e aware of which children have asthma within the school. The relevantconsent formDsE should !e completed for the administration of asthma medication.

If medication changes parents are e)pected to inform the school. mem!er of school staffshould have responsi!ility for maintaining the register ensuring that any spare reliever inhalersare not out of date Dthey usually have a two year e)piry dateE.

School )ris

No children should !e e)cluded from taking part in day trips and overnight stays !ecause of theirasthma unless advised to do so,

$a )ris< The child+s reliever inhaler should !e taken with them on the trip. If the child is a!leto take charge of their inhaler they should !e allowed to carry it with them in their pocket orpouch. If the child is too young or immature to take personal responsi!ility for it a mem!er of staff

should carry it.

Residential )ris< The child+s reliever inhaler should !e availa!le at all times throughout thetrip, and should !e carried !y themselves or a mem!er of staff. The preventer inhaler usually,!rown, orange or purple is normally only needed twice a day and arrangements should !e madefor either the child to carry the inhaler or for it to !e kept in the first aid !o).

$urther advice and guidance can !e found on the sthma =; we!site asthma.org.ukwhere youcan find resources specifically developed for schools and school aged children.

Schools can also contact the sthma Specialist Nurse--ackie Eaton @ena )homas

:ffice Tel- 23114 >1?3A :ffice Tel- 23114 >1?3A

29
http://asthma.org.uk/http://asthma.org.uk/


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Mo!ile Tel- 2BB4B1?A32 Mo!ile Tel- 2BBGG 342?B(mailF 9ac&ueline.eatonPnhs.net (mail- Jena.thomasPnhs.net

30
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


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"NNE5 1"S)&M" M"N"7EMEN) C"RE '*"N (/R

It should !e noted that not all children who suffer from sthma will have an individualmanagement / care plan. It will !e dependent on the severity and sta!ility of each child+s asthma.

I(.............................................................................. &"S-

increased coughF

increased wheeJeF

increased !reathlessnessF

or if he / she is needing to use the 0eliever D!lue inhalerE more than >6 hourly.

W&") )/ $/

give 6 4 puffs of 0eliever D!lue inhalerE using a spacer device if availa!leF

each puff should !e separate and spaced out evenly over a few minutesF

wait 32 minutes. If condition returns to normal the child can go !ack to classF

If no improvement give 3 puff of 0eliever D!lue inhalerE every >2 seconds. =p to 32

doses.

call child+s parents or seek medical advice.

ME$IC"* "*ER) 4 EMER7ENC6

I( )&E C&I*$ IS

!reathing faster than usualF

using his / her tummy muscles to !reatheF

having difficulty in speaking Ddue to asthma symptomsEF

having difficulty in walking Ddue to asthma symptomsEF

pale or !lue around the lipsF

appears distressed and e)hausted.

W&") )/ $/

*I7 AAA 6 ":= M=ST S((; M(*IC7 (7#F

give 3 puff of the 0(7I(8(0 D!lue inhalerE every >2 seconds up to 32 doses, using a

spacer device, if availa!leF

stay with the child until am!ulance arrivesF

keep giving reliever as outlined a!ove until help arrivesF

other treatmentF ..................................................................................

.............................................................................................................

.............................................................................................................


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"thletes (oot

$efinition

thlete+s foot is a common persistent infection of the foot usually caused !y a fungus. It causes

irritation and discomfort, mainly !etween the toes. The skin !ecomes inflamed and cracked andmay !leed.

The fungus that causes it lives on dead skin, hair and toenails and thrives in a warm moistenvironment. It can !e spread !y sharing damp towels and also !y picking it up from otherpeople+s shed skin scales.

)reatment

Treatment is simple and effective and is always advisa!le. There are various creams, powdersand sprays availa!le, which can !e !ought over the counter at the pharmacist.

're%ention

Children should generally !e advised not to share towels, shoes etc, whether someone hasathletes foot or not. $or the person who is affected, the !est precaution against them spreadingit, is to wear ru!!er flip6flops where other people are walking around in !are feet. This wouldo!viously !e applica!le to the side of the swimming pool, although a gym shoe or plimsoll would!e more appropriate for activities such as #( or dance.

Children with athlete+s foot should not !e e)cluded from swimming.


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$ia!etes

Introduction

*ia!etes is a condition in which the amount of glucose DsugarE in the !lood is too high !ecause

the !ody+s pancreas has stopped producing insulin. This is called type 3 dia!etes. owever weare now seeing small num!ers of children develop type 1 dia!etes which is when the !ody is stillproducing insulin !ut not using it effectively. This tends to coincide with a child !eing over weightand/or a strong family history of type 1 dia!etes.

Children with dia!etes normally need to have daily insulin in@ections, >64 times per day, to controltheir !lood glucose level. Some children and young people receive their insulin via an insulinpump. This is !ecoming more common and will certainly increase over time.

*ia!etes cannot !e cured, !ut it can !e treated effectively. The aim of the treatment is to keepthe !lood glucose level close to the normal range, so that it is neither too high DhyperglycaemiaEnor too low Dhypoglycaemia 6 also known as a hypoE.

)reating $ia!etes

Most children with dia!etes will !e treated !y a com!ination of insulin and a !alanced diet, withthe recommendation of regular physical activity.

Insulin

Insulin has to !e in@ected unless on an insulin pump. It is a protein that would !e !roken down inthe stomach if it was swallowed like a medicine.

Children and young people with dia!etes may re&uire different insulin regimes, from taking insulin

three and up to si) times per day. This may involve having insulin in@ections at lunch time and inthese instances it will !e documented in the child+s individual ealth Care #lan held in school,outlining the storage and safe keeping of insulin and where it is to !e administered, e.g. themedical room.

If a young child re&uires to have an insulin in@ection at school, the parent may need to visit schoolto administer the insulin in@ection and if there is a volunteer in school, that person can !e trainedand deemed competent !y a mem!er of the Children+s *ia!etes Team to administer insulin to thatchild. training package is availa!le.

aving more in@ections of insulin does not mean that a particular child+s dia!etes is not wellcontrolled. The main aim is to give them a more fle)i!le insulin regime to suit their individuallifestyle.

Most children can give their insulin from a very early age with minimal supervision. It is unlikelythat children under the age of eleven will re&uire insulin in@ections whilst at school.

care pathway for children with dia!etes can !e found atnne) 3to this section.

(ood

The child and family will have educated !y the paediatric dietician a!out healthy eating andsuita!le food choices. The diet for a child with dia!etes is a healthy eating diet, low in sugar and

low in fat with reasona!le amounts of car!ohydrates. The occasional treat is accepta!le.


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Eating times

Meals and snacks should !e eaten at regular intervals following a plan discussed !y the familyand their dietician. The child needs to eat at regular times in order to maintain sta!le !loodglucose levels. missed or delayed meal / snack could lead to hypoglycaemia.

Snacks may need to !e eaten in class, !ut if the times coincide they may !e !est eaten at !reak

time to avoid any fuss. If it is felt that the class should understand why the child is having asnack, the child should !e asked how they feel a!out having their dia!etes e)plained to the class.

It is important to know the times when the child needs to eat and make sure that they keep tothese times. They may need to !e near the front of the &ueue Dand at the same sitting each dayEfor the midday meal.

9lood glucose testing

ll children with dia!etes will need to monitor their !lood glucose levels whilst in school.Children with dia!etes need to ensure that their !lood glucose levels remain sta!le and maymonitor their levels using a testing machine at regular intervals. Most children will !e a!le to dothis themselves and will simply need a suita!le place to carry it out. If a young child is una!le tomonitor their !lood glucose levels a volunteer can !e trained to do so !y a mem!er of theChildren+s *ia!etes Team. training package is availa!le. $ormM> should !e used for thispurpose.nne) 1to this section outlines guidance for !lood glucose monitoring.

lood glucose testing involves pricking the finger, using a special finger 6 pricking device to o!taina small drop of !lood. This is then placed on a reagent strip, which is read !y a small, electronic!lood glucose meter. test takes a!out a minute in total.

Snacks

Snacks may need to !e eaten in class, !ut if the times coincide they may !e !est eaten at !reaktimes to avoid any fuss. This will !e discussed at the school meeting facilitated !y a mem!er ofthe Children+s *ia!etes Team

The choice of food will depend on the individual child !ut could include-

roll / sandwich

cereal !ar

one individual mini pack of dried fruit

a portion of fruit

two !iscuits, e.g. gari!aldi, ginger !iscuits

&oglcaemia A&oB

ypoglycaemia is the most common short6term complication in dia!etes and occurs when !loodglucose levels fall too low.

ypos are especially likely to happen !efore meals. This can happen as a result of-

too much insulin

not enough food to fuel an activity

too little food at any stage of the day

a missed meal or delayed meal or snack

cold weather

a child vomiting


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&o3 to recognise a ho

ypo+s fall into three categoriesF mild, moderate and severe. These will have !een discussed atthe school meeting and will !e detailed in the individual child+s health care plan, produced !y amem!er of the Children+s *ia!etes Team.

ypos happen &uickly, !ut most children will have warning signs that will alert them, or people

around them, to a hypo. The following symptoms, either individually or com!ined, may !eindicators of a hypo in a child with dia!etes.

hunger

sweating

drowsiness

glaJed eyes

pallor

trem!ling or shakiness

headache

lack of concentration

irrita!ility

mood changes especially angry or aggressive !ehaviour

(ach child may e)perience different symptoms and this should !e discussed when drawingup the individual health care plan. If a child is feeling hypo they should never !e sentanywhere unaccompanied.

)reating a mild ho

normal !lood sugar is !etween 6B mmols/l. nything or !elow should !e treated ashypo. If a child has a hypo, if they are a!le to, they need to test their !lood glucose level. If

not, treat as a hypo.

It is important that a fast acting sugar, such as > glucose ta!lets or 322mls of ordinary cokeor 7ucoJade is taken immediately. lternatively, for a mild hypo a small glass of fruit or fivesweets De.g. @elly !a!iesE can !e eaten. This will have !een discussed at the school meetingand will !e detailed in the individual child+s ealth Care #lan, produced !y a mem!er of theChildren+s *ia!etes Team.

The child should not !e left alone during a hypo, nor !e sent off to get food. The food must!e !rought to the child. If the child+s recovery takes longer than what is outlined in the careplan or in cases of emergency an am!ulance should !e called.

If the child has a moderate hypo, conscious !ut drowsy, the management of this will have!een discussed at the school meeting and will !e detailed in the child+s ealth Care #lan.

8nconsciousness

In the unlikely event of a child losing consciousness, they should not !e given anything !ymouth 6 not even ypostop Dconcentrated glucose gelE. They should !e placed in therecovery position Dlying on their side with the head titled !ackE. n am!ulance should then!e called, informing them the child has dia!etes. The child will come around eventually andshould not come to any immediate harm if they are kept in the recovery position.

$ia!etes and 'E


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*ia!etes shouldn+t stop children with the condition from en@oying any kind of physical activity,or !eing selected to represent school in team games, provided they have made some simplepreparations.

#reparations are needed !ecause all forms of physical activity, such as swimming, foot!all,gymnastics and walking, use up glucose. If the child does not eat enough !efore starting anactivity, their !lood glucose level will fall too low and they will e)perience a hypo.

The more strenuous and prolonged the activity, the more food will !e needed !eforehand,and possi!ly during and afterwards.

efore an activity it is important for the child to have an e)tra snack. If the activity is afterlunch, it may !e easier for the child to have a slightly larger lunch.

*uring an activity there should !e glucose ta!lets or a sugary drink near!y in case the child+s!lood glucose level drops too low, which could lead to a hypo. lso if the activity is off themain school campus !ack up supplies of hypostop will need to !e availa!le.

fter an activity the child may need to eat some starchy food, such as a sandwich or apacket of crisps, !ut this will depend on the timing of the activity Dfor e)ample, it may !efollowed !y lunchE and the level of e)ercise taken. %hile it is important that staff keep watchover all the children, the child with dia!etes need not !e singled out for special attention.This could make them feel different and may lead to em!arrassment.

Children with dia!etes should not use their condition as an e)cuse for not participating inany physical activity. If this does happen regularly, school should speak to the parentDsE orcarerDsE.

/)&ER C/NSI$ER")I/NS

Sickness

If the child is unwell, their glucose levels may rise. This can happen even if the child @ust hasa cold. igh !lood glucose levels may cause them to !e thirsty, and need to go to the toiletmore fre&uently. If staff notice this during the day, they should report it to the child+sparentDsE or carerDsE immediately. The child may need to go home to ena!le parents to takemore appropriate action, eg, to give e)tra insulin as previously discussed with the Children+s*ia!etes Team.

If the child vomits at school, start them sipping on a sugary drink, eg 7ucoJade, and call theirparentDsE or carerDsE. Should the child continue to vomit, treat this as an emergency and callan am!ulance. This will have !een discussed and will !e outlined in more detail in the

child+s individual ealth care #lan.

SC&//* )RI'S

$a )ris

'oing on a day trip should not cause any pro!lems, as the feeding routine will !e much likethat at school.

The child with dia!etes should take their insulin and in@ection kit, in case of any delays intheir usual in@ection time. The child will have to eat some starchy food following the in@ection,so should have some e)tra starchy food with them. They should also take with them their

usual hypo treatment. This will have !een discussed at the school meeting !eforehand.


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/%ernight stas

%ith overnight stays, the child+s routine will include insulin in@ections and !lood glucosemonitoring. Schools will need to ensure that either the child is a!le to do their own in@ectionsor that there is a mem!er of staff who is willing to take responsi!ility for helping within@ections and !lood glucose testing.

If any medical e&uipment has !een lost or forgotten, the paediatric department or ccidentand (mergency department at the nearest hospital, must !e contacted for help.

The Children+s *ia!etes Team will visit school !efore the planned overnight stays to discussthe management of the child+s dia!etes whilst away from home.

$or further information and guidance please contact the *ia!etes Specialist Nurse-

$enise 7i!son:ffice Tel- 23114 >1?3A(mail- denise.gi!sonPnhs.net


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"NNE5 1

C0( #T%" $:0 SC::7 CI7* %IT *I(T(S.

Child diagnosed with dia!etes

referral and information sheet

arrange training in school within a week of diagnosis

devise a health care plan and check indemnity

distri!ute care plan to relevant parties

review when child changes school or if specifically re&uested.

Dannual reviews to !e introduced in the near futureE


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"NNE5 2

78I$E*INES (/R 9*//$ 7*8C/SEM/NI)/RIN7 IN SC&//*S

Training will !e given to the relevant teachers / nursery nurses !y the paediatric dia!etesspecialist nurse. ll e&uipment to !e la!elled with the child+s name and stored safely whennot in use.

3 The procedure should !e carried out in a designated area e.g. medical room.#repare area 6 #aper towels / *isposa!le gloves / Cotton wool / lood glucosemeter / Test strips / *isposa!le !ag / $inger pricking device and lancet.

1 Child / young person to wash their hands using warm soapy water.

> #erson carrying out / assisting the child should wash and dry their hands and weardisposa!le gloves.

$inger pricking to !e carried out as previously agreed in the care plan.

? lood to !e placed on test strip, then to !e monitored according to the individualmachine.

4 Cotton wool to !e placed on finger until !leeding ceases.

B. 7ancet to !e placed in sharps !in

G 0esult to !e recorded in accordance with the care plan.

A ll disposa!le materials to !e disposed of in accordance with the yellow !ag system.

32 *ispose of gloves in yellow !ag, wash and dry hands thoroughly.

33 It is recommended that each child is to take their !lood glucose monitoring kit homeeach weekend for cleaning.


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Eiles

Introduction

(pilepsy is defined as having a tendency to have seiJures. They are sometimes called Hfits+.

SeiJures come from a temporary disruption of electrical activity in the !rain. %hat happensduring a seiJure will depend on where in the !rain the epileptic activity !egins and howwidely and rapidly it spreads. good source of information and guidance on themanagement of epilepsy in school is the epilepsy action we!site- http-//www.epilepsy.org.uk/where many resources are availa!le to download.

Management of Eiles in Schools

The uthority recognises that pupils who suffer from epilepsy may re&uire urgent medicaltreatment. owever, there are options availa!le to the eadteacher regarding the level ofemergency medical action the school is prepared to administer.

/tion /ne

%here a child is due to !e admitted to the school who suffers from epilepsy or who isdiagnosed with epilepsy at a later date the parentDsE or carerDsE and the uthority will !enotified in writing that the school staff will not administer the emergency medical procedureD0ectal *iaJepam or uccal MidaJolamE which is carried out to treat children who suffer froma prolonged seiJure.

The eadteacher will ensure that there is an agreed protocol/ealth Care #lan in place atschool for any child who suffers from epilepsy and make arrangements for the epilepsy

specialist nurse to deliver an awareness session to school staff on epilepsy.

If the situation arises where a child e)periences a ma@or seiJure the school will-

aE call for an am!ulanceF!E immediately contact the parentDsE or carerDsE

$irst id #osters are availa!le from the epilepsy action we!site !y following this link-http-//www.epilepsy.org.uk/info/seiJures/first6aid

/tion )3o

%here a child is either admitted to the school who suffers from epilepsy or is diagnosed withepilepsy at a later date the eadteacher will implement the following procedure

inform the uthorityF

inform all staffF

DIf emergency medication is prescri!edE re&uest volunteers to administer the

following emergency medication-- 0ectal *iaJepam

- uccal MidaJolam

- oth 0ectal *iaJepam and uccal MidaJolam

implement the agreed individual care planF

ensure all staff administering the emergency medication receive the

appropriate training and legal indemnity as set out on $ormM>F ensure that the provision of care can !e maintained for the school dayF
http://www.epilepsy.org.uk/http://www.epilepsy.org.uk/info/seizures/first-aidhttp://www.epilepsy.org.uk/http://www.epilepsy.org.uk/info/seizures/first-aid


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ensure staff record the use of 0ectal *iaJepam/uccal MidaJolam in the

nursing carde) Dspecial schoolE or on $ormM3.

In circumstances where seiJures do not stop after first dose of emergency medication has!een given the school will-

aE give the child a second dose if this is written in the protocol/care planF!E call for an am!ulance regardless of whether a second dose is givenFcE Immediately contact the parentDsE or carerDsE.

Seiures

There are a!out 2 different types of seiJure, some of which are more common in children.The most common seiJure school staff will come across are as follows-

)onic#clonic Seiures Are%iousl kno3n as grand#malB

Children who have tonic6clonic seiJures lose consciousness and fall to the ground. Their

!ody goes stiff and their lim!s @erk. %hen their seiJure is over, their consciousness returns!ut they may !e very confused and tired. It is important that you stay with them at this point,to make sure that they are alright.

"!sence Seiures

*uring an a!sence seiJure Dpreviously known as a petit6malE the child will !riefly loseconsciousness !ut will not lose muscle tone or collapse. Sometimes their eyes will flicker.The person stops what they are doing and may stare, !link or look vague for @ust a fewseconds. ecause of this, a!sence seiJures can sometimes !e mistaken for daydreaming orinattention. !sence seiJures are most common !etween the ages of si) and 31 years old.%hile these episodes may seem unimportant they can happen hundreds of times a day.

"ou may !e a!le to help your students who have a!sence seiJures !y providing writteninformation at the end of a lesson, and helping them catch up on things missed. There is nofirst aid needed for a!sence seiJures. =sually the pupil will !e a!le to continue with whatthey were doing !efore the seiJure although they may need reminding.

Moclonic Seiures

%hen a child has a myoclonic seiJure the muscles of any part of their !ody @erks. These

@erks are common in one or !oth arms and can !e a single movement or the @erking may

continue for a period of time. Myoclonic seiJures happen most often in the morning andteachers need to !ear in mind that a child may !e tired or lack concentration if they start

school after having one of these. There is no first aid needed for myoclonic seiJures unless

the child has !een in@ured in which case usual first aid procedures are used.

Comlex 'artial Seiures

comple) partial seiJure can !e difficult to recogniJe. It can appear to the onlooker that the

person is fully aware of what they are doing, !ut they may appear to act strangely, for

e)ample, plucking at their clothing, swallowing or scratching or @ust wandering aimlessly. The

specific symptoms of a comple) partial seiJure depend on which area of the !rain the

seiJure is occurring in. It is important to remem!er that a person e)periencing a comple)

partial seiJure cannot control their !ehavior, and their consciousness is altered so they


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cannot follow instructions and may not respond at all.

Comple) partial seiJures can !e misinterpreted as !ad !ehavior. In fact, the child will not

know what has happened and will not remem!er what they were doing !efore the seiJurestarted.

lthough there is no real first aid needed, it is important not to restrain the young person

unless they are in immediate danger. This is !ecause they may not recogniJe you.

"tonic Seiures

tonic seiJures cause a child to momentarily lose muscle tone and suddenly collapse.

In@uries can easily occurF particularly head in@uries as the pupil will often fall forwards and will

not !e a!le to put out their hands for protections during the fall. Safety headgear is

sometimes worn !y pupils who have fre&uent seiJures. There is no first aid needed for

atonic seiJures unless the child has !een in@ured in which case usual first aid procedures are

used.

Social Needs in the Classroom

#upils with epilepsy should !e included as far as possi!le in all school activities. ()tra

precautions and supervision may !e needed for some activities and sports, residential visits

and on transport. This should !e considered and included within the pupils individual care

plan.

)riggers

$or many pupils, seiJures happen without warning. :thers may know of certain Htrigger+

factors. These should !e discussed, written in the pupils care plan and communicated to therelevant parties. There are many different triggers !ut some are more relevant to school

settings than others.

#hotosensitive epilepsy is a form of epilepsy in which seiJures are triggered !y flickering or

flashing lights. :nly a!out five percent of all people with epilepsy have this form of the

condition, and it is most common in children and young people aged !etween seven and 3A.

SeiJures are most commonly triggered !y certain fre&uencies of flash or flicker. igh

contrast patterns such as !lack and white stripes, sunlight through !linds or reflection from

water can !e a trigger.

Computer and interactive white!oards are usually not a pro!lem as they either seem toflicker at a rate too fast to trigger a seiJure or not at all. Conventional Hcathode ray+ T8

screens could trigger in someone with photosensitive epilepsy, !ut viewing the screen from


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at least 1.? meters+ away will minimise the risk.

Stress can make a pupil with epilepsy more likely to have seiJures. $or young people,

stress a!out e)ams and assessment can !e reduced !y making sure any special

consideration or access arrangements Dsuch as e)tra time, separate invigilation or rest

!reaksE are organised well in advance. Information a!out applying for specialconsiderations/ad@ustments in e)ams is contained in the epilepsy action document H(pilepsy

#olicy for Schools+.

Emergenc Medication

Sometimes a pupil with epilepsy can e)perience a longer seiJure or a series of seiJureswithout regaining consciousness. If this continues for >2 minutes it is called Hstatus

epilepticus+ and is a medical emergency as it could lead to !rain damage and ultimately can

!e fatal.

The pupil+s individual healthcare plan with contain details of any medication such as rectal

diaJepam or !uccal midaJolam which may have !een prescri!ed to !ring the person out of a

prolonged seiJure or series of seiJures.

(mergency medication should only !e given according to the instructions on the healthcare

plan. There is no legal duty on teachers to give emergency medication !ut they can

volunteer to !e trained.

$or further information and guidance please contact the (pilepsy Specialist Nurse-

'hil McNult:ffice Tel- 23114 >>3>2(mail- phil.mcnultyP!arnsleypct.nhs.uk
http://www.epilepsy.org.uk/sites/epilepsy/files/images/services/epilepsyaction_schoolspolicy.pdfhttp://www.epilepsy.org.uk/sites/epilepsy/files/images/services/epilepsyaction_schoolspolicy.pdfhttp://www.epilepsy.org.uk/sites/epilepsy/files/images/services/epilepsyaction_schoolspolicy.pdfhttp://www.epilepsy.org.uk/sites/epilepsy/files/images/services/epilepsyaction_schoolspolicy.pdfhttp://www.epilepsy.org.uk/sites/epilepsy/files/images/services/epilepsyaction_schoolspolicy.pdf


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&ead lice

Introduction

ead lice are small insects that live on the human head, hair, eye!rows and !eards. They

have si) legs and no wings. They are a greyish !rown colour and when fully grown roughly>mm long. aving no wings, the head lice cannot fly or @ump and cannot swim.

ead lice are very common, especially among school age children. Transmission is viahead to head contact and it has nothing to do with personal hygiene. It takes one full minuteto crawl from one head to another.

To live the louse needs to keep warm and is usually found very close to the scalp. It feedstwice a day !y sucking the !lood off its host through the scalp.

The female can lay up to eight eggs per night in sacs glued to hair close to the scalp. Theyare the siJe of a grain of sugar, dull in colour and are very well camouflaged, making them

difficult to spot in dry hair. They take seven to ten days to hatch.

The empty egg sacs DnitsE are white and shiny and are much more noticea!le. :ncehatched the louse takes @ust seven to ten days to !ecome fully grown and a!le to mate.

lthough there appears to !e a particularly high incidence of head lice among primaryschool children they are a pro!lem for the whole community.

Managing the ro!lem of head lice 3ithin school

In managing the pro!lem of head lice the school should encourage promoting the preventionof them !y working with the School ealth Service and raising awareness with parents

through health education.

0outine head inspections !y school nurses are no longer performed. It has proved muchmore effective in com!ating the pro!lem to increase community awa

Documents

Managing Medical Needs Nov 2015