All children have the same rights for admission to playgroup or Pre-school setting.
Under part 4 of the D.D.A. pre-school must not discriminate against disabled pupils. Schools should be making reasonable adjustments for disabled children including those with medical needs and for the individual disabled child in their practices and procedures and in their polices.
Staff must be positive as this will benefit the child and provide a positive attitude from their peers for children with medical needs. We may need to alter the physical environment and planning duties not covered by the part 4 duties.
It is important that responsibility for the child’s safety is clearly defined and that each person involved with children who have medical needs is aware of what is expected of them. Each child’s needs must be judged individually as they may vary in their ability to cope with poor health or a particular medical condition. Those who may need to contribute to a health care plan include:-
The head of the setting.
Parent/Carer.
The child if appropriate.
Care assistant or support staff if applicable.
Staff who are trained to administer medicines.
Staff who are trained in emergency procedures.
Most children who have medical needs can attend the setting regularly sometimes with support. However some children may need extra care and supervision with some activities to make sure these children and others are not put at risk.
Prescribed Medicines
An individual health care plan for a child with medical needs must be made to identify the level of support that is needed for staff, parents and the child. Staff are guided by the child’s GP or paediatrician and should agree with parents how often they should jointly review the health care plan. If medicines are prescribed in frequent doses parents are encouraged to ask the prescriber to consider that they be taken out of school hours and administered only once or twice a day (where appropriate). Prescribers may also be asked to consider providing two prescriptions, where appropriate and practical for a child’s medicine: - one for home and one for the setting avoiding the need for repackaging or relabelling of medicines by the parents.
Staff managing the administration of medicines must receive the appropriate training and support from health professionals. Medicines should always be provided in the original container as dispensed by a pharmacist and include all original instructions.
Settings should never accept medicines that have been taken out of the original container dispensed or make any changes to dosage on parental instructions.
Parents and Carers
Parents as defined in section 576 of the education act 1996, include any person who is not a parent of a child but has parental responsibility for or care of a child. The phrase “care of the child” may include a person who is involved in the full-time care of a child on a settled basis, such as a foster parent, but excludes baby sitters, child minders, nannies and school staff. If a child is “looked after” by a Local Authority, the child may either be on a care order or be voluntarily accommodated. It only requires one parent to agree or request that medicines are administered, if parents disagree over medical support this must be resolved by the Courts. If parents have difficulty understanding or supporting their child’s medical condition themselves, local health services should be contacted to provide additional assistance.
Controlled Drugs
This is not applicable to this setting.
Non-prescribed Medicines
Staff should never give a non-prescribed medicine to a child unless there is specific prior written permission from the parents. Where a non-prescribed medicine is administered it should be recorded on form 5 or 6.
A child under 16 should never be given aspirin or medicines containing ibuprofen unless prescribed by a doctor.
Short-Term Medical Needs
Many children will need to take medicines at some time during their time at pre-school. This is usually for a short period, perhaps to finish a course of antibiotics or to apply lotion. To allow children to do this will minimise the need to be absent, these medicines should only be taken to the setting if it is detrimental to the child’s health.
Long-term Medical Needs
It is important to have all information about the medical condition of any child with long-term medical needs. If a child is inadequately supported this may have a significant impact on the way they function in and out of the setting. It may affect cognitive and physical abilities, behaviour and their emotional state. For children who attend hospital appointments or who are admitted on a regular basis it helpful to all concerned to develop a written health care plan. This should involve parents as well as the relevant health care professionals.
This can include:
Details of a child’s condition.
Special requirement e.g. dietary needs, pre-activity precautions.
Any side affects of the medicines.
What constitutes an emergency.
What action to take in an emergency.
What not to do in the event of an emergency.
Who to contact in an emergency
The role the staff can play.
Use the form provided with policy.
Record Keeping
Parents should tell the setting about the medicines that their child needs to take and provide details of any changes to the prescription or the support they require. However staff must make sure that the information given is the same as the prescriber’s. Medicines must be always provided in the original container dispensed by the pharmacist and include the prescribers instructions. In all cases it is important to check the written details as listed in administrating medicines. Parents must fill in forms 3a and 3b to record all details of medicines. Staff should check that all details provided by parents and in particular cases by a paediatrician or specialist nurse are consistent with instructions on the container. Form 4 can be used to confirm, with the parents, that a member of staff will administer medicine to their child. To protect staff and prove that they have followed the agreed procedures they are asked to fill in forms 5 and 6 to keep a log of the medicines given.
Administering Medicines
No child under 16 should be given medicines without their parent’s written consent. Any member of staff administering medicines to a child should check:
The child’s name
Name of medicine
Method of administration
Time/frequency of administration
Prescribed dose
Any side effects.
Written instructions provided by the prescriber on the label or container.
Expiry date
If a member of staff is in any doubt about administering medicine to a particular child, the issue should be discussed with the parent if appropriate or with a health care professional attached to the setting. Each time a medicine is administered a written record must be made. Use form 5 or 6 for this, staff should complete and sign each time. In certain circumstances such as the administration of rectal diazepam it is good practise to have the dosage witnessed by a second adult.
Self Management
This is not appropriate in this setting at this time but we will reassess if necessary.
Refusing Medicines
If a child refuses to take their medicine, staff should not force them to do so, but should put a note in the records and follow the agreed procedure. This procedure should be set out when making the individual child’s health plan. Parents must be informed of the refusal on the same day. If a refusal to take medicines results in an emergency our emergency procedure must be followed.
Educational visits and activities
It is important to encourage children with medical needs to participate in safely managed visits. We need to be aware that reasonable adjustments may need to be made for the child to participate fully and safely on visits. This may include planning arrangements and risk assessments with additional safety measures such as an additional supervisor, a parent or another volunteer to accompany a particular child with medical needs. Staff supervising excursions should always be made aware of any medical needs and the relevant emergency procedure. A copy of the health care plan must be taken on visits in the event of information being needed in an emergency.
When doing sports activities some children may need to take precautionary measures before or during exercise and may need to have immediate access to medicines such as asthma. Staff supervising sporting activities should consider this when doing their risk assessment.
Insurance
To be covered for public liability for life saving or invasive medication (e.g. rectal diazepam for epilepsy or adrenaline injections/epicenes for anaphylactic shock caused by reaction to substances such as nuts.) To extend the pre-schools cover we will need to send copies of the following to the insurance team at the Pre-school Learning Alliance for appraisal:-
a) A letter from the child’s GP/Consultant stating the child’s condition and the treatment required.
b) Parent’s/Guardians written consent to allow staff to administer medication.
c) Proof of staff training in the administration of such medication by a qualified nurse of GP.
When a child requires help with everyday living e.g. breathing apparatus, colostomy bags or feeding tubes, and has a key worker, the playgroup will need to forward the following to the insurance team at the Pre-School Learning Alliance for appraisal:-
a) A letter from the child’s GP/ consultant stating the child’s condition and the treatment required.
b) Parent’s/guardian’s written consent to administer treatment.
c) Written confirmation that the key worker has the relevant medical training or experience to administer the treatment. This can include training by the parents.
There must be an assessment of the risks to the health and safety of staff, children and others and measures put in place to manage and identify risks. This must be reviewed on a regular basis.
Employers
Employers must make sure that their insurance arrangements provide full cover in respect of actions which could be taken by staff in the course of their employment. It is the employer’s responsibility to make sure that the proper procedures are in place and that staff are aware of the procedures. For children with special medical needs employers must make sure all staff are fully trained and that their training is updated on a regular basis. Employers must support the staff to use their best endeavours at all times particularly in emergencies.
Storing medicines
Medicines should be stored safely in a lockable cupboard, with 34emergency medicines i.e. asthma inhalers and epipens, should be readily available to children and not locked away. A few medicines need to be refrigerated. These should be in an airtight container, clearly labelled. There should be restricted access to the fridge holding medicines.
