Medication management procedure This is a mandated procedure under the operational policy framework. Any edits to this procedure must follow the process outlined on the creating, updating and deleting operational policies page.
Overview This procedure is for all staff working in education and care to manage medications in an education and care setting.
Read this procedure along with any relevant health support planning procedures that describe managing specific conditions.
Scope This procedure applies to educators, early childhood development specialists, principals, directors and education support staff working in education and care.
It describes:
• the roles and responsibilities for safe and effective medication management practices in education and care settings
• how to plan and manage children and young people requiring medication administration in education and care
• the first aid response for emergency medication administration
• education and training for medication management.
This procedure applies from the time a child or young person is enrolled until they leave the education and care service.
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Contents Medication management procedure .................................................................................................................. 1
Overview .......................................................................................................................................................... 1
Scope ............................................................................................................................................................... 1
Detail................................................................................................................................................................ 4
Medication background............................................................................................................................... 4
Medication definition .................................................................................................................................. 4
Medication management in education and care ........................................................................................ 4
Authority to administer ............................................................................................................................... 8
Administering medication in education and care services ........................................................................ 12
Storage, security and disposal of medication ............................................................................................ 16
Medication errors, incidents and queries ................................................................................................. 18
Training and education .............................................................................................................................. 18
Communication and risk management ..................................................................................................... 20
Definitions ..................................................................................................................................................... 21
Access Assistant Program (AAP) ................................................................................................................ 21
aurally ........................................................................................................................................................ 21
controlled drug .......................................................................................................................................... 21
Creon® ....................................................................................................................................................... 21
education and care service ........................................................................................................................ 21
emergency medication .............................................................................................................................. 21
high risk medications ................................................................................................................................. 21
inhaled ....................................................................................................................................................... 21
Intranasal midazolam (INM) ...................................................................................................................... 21
midazolam ................................................................................................................................................. 22
orally .......................................................................................................................................................... 22
PRN ............................................................................................................................................................ 22
restricted schedule 4 medicines ................................................................................................................ 22
topically ..................................................................................................................................................... 22
Supporting information ................................................................................................................................. 22
Related legislation ..................................................................................................................................... 23
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Related policy documents ......................................................................................................................... 23
Record history ............................................................................................................................................... 23
Approvals ................................................................................................................................................... 23
Revision record .......................................................................................................................................... 24
Contact .......................................................................................................................................................... 24
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Detail Medication background The World Health Organisation describes unsafe medication practices and errors as one of the leading causes of injury and avoidable harm in health care across the world. Medication errors often happen during administration and can result in severe harm, disability or death.
Poor communication with the ‘patient’ contributes to medication errors. This includes where a person doesn’t communicate well, for example children, people with disabilities and people who do not speak the same language as the person administering the medication.
Medication management for children and young people has additional challenges. A small error in the dose may have a much greater risk of harm compared to an adult. Prescribing medications to children and young people often requires weight-related dose adjustments.
The groups known to be at greater risk of medication incidents include children, older people and people with multiple health conditions.
Medication definition In this procedure ‘medication’ includes all prescribed, non-prescribed, over the counter and alternative therapies (vitamins, minerals, supplements) that are administered in an education and care service.
‘Medication’ in this context doesn’t include sunscreen, nappy rash cream, moisturising lip balm, lubricating eye drops or moisturiser (emollient) where they are unmedicated. It doesn’t include Creon® or items included in a hypo kit.
Where education and care staff are unsure if the product contains medication, they can contact their local pharmacy or the Medicines Information Service at the Women’s and Children’s Hospital (8161 7555) for advice.
Medication management in education and care
Duty of care The education and care service has a duty of care to take ‘reasonable precautions’ during the period of care to minimise risks.
For medication, ‘reasonable precautions’ includes making sure:
• the child or young person is presenting for their medication administration
• the medication is administered as directed in the medication agreement (DOC 173KB)
• all medication rights (DOC 137KB) are met.
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Site requirements All education and care services must have medication management processes in place that:
• are consistent with this procedure
• include strategies to monitor, review and improve medication management practices
• routinely remind education and care staff, parent or guardians, children and young people, and local prescribers about the medication management process for education and care services
• support children and young people to participate safely and fully in their education.
First dose Children and young people should not be given a first dose of a new medication at an education or care service. Due to the dangers of an adverse reaction the first dose must be supervised by a parent, guardian or health professional.
An exception to this is emergency medications, including Ventolin or adrenaline, and midazolam (where this has been prescribed).
Route of administration Education services can only administer medication aurally, orally, inhaled or topically.
Complex medication administration including subcutaneous injections, administration through a gastrostomy tube or rectal administration can’t be given by education staff. Go to complex medication administration.
Three times a day administration Generally, medication that requires administration three times per day can be administered outside of school hours. At home in the morning, after school and in the evening.
Medication ‘to be taken as required’, ‘as directed’, or ‘PRN’ Medication that is labelled ‘to be taken as required’, ‘as directed’, ‘PRN’ (or similar) doesn’t provide enough information and can’t be administered by the education staff.
An exception to this is where a child or young person has been approved to carry and administer their own medication. Go to self-administration of medication.
The medication agreement (DOC 173KB) must say the time of administration. Education and care staff can’t make a clinical decision about when to give medication based on a child or young person’s symptoms or behaviour.
An exception to this is where there is an:
• emergency medication management plan (DOCX 121KB) to administer midazolam for seizures
• ASCIA action plan for anaphylaxis or allergy that includes adrenaline or antihistamine on the plan
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• asthma care plan (PDF 269KB) that includes Ventolin on the plan.
Monitoring post administration Education and care staff can observe and document behaviours post administration to advise the parent, guardian or treating health professional. Staff can’t interpret behaviour in relation to a medical condition or monitor the effects of the medication.
Observations can be documented on the medication advice form (DOC 156KB) and sent to the parent or guardian.
Unmedicated creams, balms or drops Education and care staff can apply unmedicated products, including sunscreen nappy rash cream, lip balm or moisturiser at the request of the parent or guardian.
The parent or guardian must give clear instruction on when and how much (if relevant) to administer.
There must be an agreed approach to how this is documented and communicated between the staff and parent or guardian. This may include:
• verbal agreement and expectation with no documentation, for example, nappy rash cream is applied at every nappy change
• completing a medication log (DOC 203KB) every time the unmedicated product is applied
• advising by text message or email that the product has been applied.
General use emergency response medicines Education and care services can store and administer the following general use medications for emergency response (does not apply in family day care or respite care program):
• adrenaline autoinjector (EpiPen® or EpiPen®Jr or Anapen®) for emergency treatment of anaphylaxis
• reliever puffer for example salbutamol (Ventolin®) for emergency treatment of asthma.
Pain relief such as paracetamol or ibuprofen are not permitted in education and care services as medication for first aid. They can mask signs and symptoms or serious illness or injury.
Controlled drugs Controlled drugs (also known as drugs of dependence or Schedule 8 drugs) are prescription medicines that have a higher potential for misuse, abuse and dependence. The use of drugs of dependence are regulated by the Controlled Substances Act 1984 and the Controlled Substances (Poisons) Regulations 2011 and monitored by the Drugs of Dependence Unit (DDU).
Controlled drugs that may be prescribed to children and young people and administered in an education and care service include:
• psychostimulant medication for the management of ADHD, for example methylphenidate (Ritalin®) or dexamphetamine
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• pain relief for long term chronic pain management, for example oxycodone (Endone®) or fentanyl patch.
All controlled drugs are clearly labelled.
The principal or director is responsible for all controlled drugs that are held on site. They can delegate the authority to manage and administer to staff.
To make sure there is a combined understanding of the requirements for controlled medicines the authorisation to administer controlled medicines (DOC 109KB) form must be completed by the principal or director and the authorised person.
Restricted schedule 4 medicines Schedule 4 medicines that have a high potential for abuse, misuse, diversion and misappropriation are referred to as Restricted Schedule 4 Medicines. They are be handled in line with Schedule 8 medicines (see medication storage, security and disposal).
The SA Health Storage and Recording of Restricted Schedule 4 (Prescription Only) Medicines Policy Directive (PDF 321KB) has a current list of Schedule 4 medicines that are restricted in South Australia.
Restricted Schedule 4 medicines prescribed to children and young people attending an education or care service may include clonidine, diazepam, clonazepam, and midazolam.
Oxygen Where a child or young person requires oxygen they must be referred to the Access Assistant Program or Encompass.
Creon® (pancreatic enzyme replacement supplement) A medication agreement is not required for children and young people with cystic fibrosis that have been prescribed Creon®.
Creon® (pancrelipase) contains digestive enzymes and is used to improve food digestion in people with cystic fibrosis who cannot digest food properly. Creon® is not a medicine in the context of this procedure.
Go to cystic fibrosis for more information.
Contents of hypo kit for diabetes management For children and young people with diabetes there will be times when they get hypoglycaemia (blood
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glucose levels too low).
A ‘hypo kit’ must be readily available (with the child or young person, or in class). The hypo kit will contain items that bring blood glucose levels back up.
This may include glucose tablets, jelly beans, non-diet soft drinks, muesli bars, dry crackers. These items are not a medicine.
Go to diabetes for more information.
Complex medication administration Children and young people with complex medication requirements may be eligible for support from the Access Assistant Program or Encompass.
The Access Assistant Program flowchart (PDF 95KB) (staff login required) or Encompass frequently asked questions resource can help to determine when additional supports are needed.
Transport Safe transport must be provided to and from the education and care service, and for excursions or offsite activities.
Consider all children and young people with a known health condition, and if they need medication to be given in an emergency.
Authority to administer Medication can’t be administered in an education or care service without written advice on a medication agreement (DOC 173KB) (with the exception of emergency medication for anaphylaxis and asthma).
Medication can’t be administered by education and care staff where:
• a medication agreement has been modified, overwritten or is illegible
• any of the ‘medication rights’ are in doubt (refer medication rights checklist (DOC 137KB)).
All sections of the ’medication instructions’ must be completed and match the pharmacy label on the medication.
All requirements listed in the ‘authorisation and release’ section must be checked and parent or guardian details entered.
The ‘agreement’ section must be completed by a treating health professional where the medication is:
• a controlled drug
• oxygen
• pain relief (ie paracetamol, ibuprofen) that is needed regularly or administered for more than 72 hours (3 days) in a week.
Education and care services can contact their local pharmacy or the Medicines Information Service at the Women’s and Children’s Hospital (phone (08) 8161 7555; email: medinfo@sa.gov.au) for information on
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medication.
There are specific requirements for administration of scheduled medications and where there are multiple or high risk medicines prescribed, invasive administration techniques, frequent dose changes or emergency medications.
Schedules Scheduling is a national classification system that controls how medicines and poisons are made available to the public. They are classified into Schedules according to the level of regulatory control required. The schedules are published in the Standard for the Uniform Scheduling of Medicines and Poisons (SUSMP).
Unscheduled
• Medications that are sold in other retail outlets (ie supermarkets) in addition to pharmacies i.e. antacids (e.g. Mylanta®, Gaviscon®), paracetamol, aspirin, ibuprofen.
• Medication agreement can be completed by parent or guardian only.
• If pain relief medications are required to be administered more than 72 hours in a week the ‘agreement’ section must be completed by health professional.
Schedule 2
• Medications that are sold over the counter in a pharmacy without a prescription.
• Medication agreement can be completed by parent or guardian only.
• If pain relief medications are required to be administered more than 72 hours in a week the ‘agreement’ section must be completed by health professional.
Schedule 3
• Pharmacist only medicines that do not require a prescription and are substantially safe in use but require professional advice or counselling by a pharmacist to purchase.
• Medication agreement can be completed by parent or guardian only.
• If pain relief medications are required to be administered more than 72 hours in a week the ‘agreement’ section must be completed by health professional.
Schedule 4
• Medications that legally require a prescription from a doctor or dentist to be dispensed.
• Medication agreement can be completed by parent or guardian only.
• If pain relief medications are required to be administered more than 72 hours in a week the ‘agreement’ section must be completed by health professional.
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Restricted Schedule 4
• Prescription only medicines that don't have sufficient addictiveness or risk of abuse to be classified as Schedule 8, but for which a significant addiction/abuse risk exists.
• Restricted schedule 4 drugs have additional prescription and recording requirements compared with schedule 4.
• Medication agreement can be completed by parent or guardian only.
• If pain relief medications are required to be administered more than 72 hours in a week, the ‘agreement’ section must be completed by health professional.
• An emergency medication management plan must be completed by a health professional for midazolam. If a child or young person is prescribed medication that needs to be administered in emergency situations, at least one of the three HSP153 agreements available on the Supporting children and students with seizures or epilepsy website page must be completed by a parent or guardian and health professional (neurologist, paediatrician, specialist physician, general practitioner or neurology nurse).
Schedule 8 (controlled drugs)
• Schedule 8 (controlled drugs) have high potential for abuse and addiction. The possession of these medications without authority is an offence. The doctor must have a permit to prescribe schedule 8 medications. The possession of these medications without authority is an offence.
• Medication agreement must be completed by a health professional.
• Authorisation to administer controlled medicines (DOC 109KB) must be completed by principal or director and authorised staff member.
High Risk Medicines
• One or more high risk medications (ie Intranasal midazolam; Schedule 8 medicines, Restricted Schedule 4 medicines, insulin).
• Medication agreement must be completed by health professional.
• Requires a health support agreement (DOCX 128KB).
Polypharmacy
• Five or more oral medications (to be administered in education or care).
• Medication agreement must be completed by a health professional.
• Requires a health support agreement (DOCX 128KB).
• May be high or complex care needs that require referral to the Access Assistant Program.
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Administration via feeding tube
• For example gastrostomy, jejunostomy and nasogastric
• Requires referral to the Access Assistant Program or Encompass.
Oxygen
• Requires referral to the Access Assistant Program or Encompass.
Single medication agreement A single medication agreement (DOC 173KB) is used for one medication to be administered to a child or young person.
Multiple medication agreement A multiple medication agreement (DOC 210KB) is used for multiple medications to be administered to a child or young person.
The multiple medication agreement only needs to include medications to be given in the education or care service, and does not necessarily need to include all medications currently prescribed for the child or young person.
Intranasal midazolam (INM) medication agreement An emergency medication management plan is completed by a neurology specialist or paediatrician for a child or young person prescribed midazolam as an emergency response for seizures.
A seizure management plan (DOC 254KB) must also be completed.
Go to seizures and epilepsy for further information.
Medication administration without an agreement Medication can’t be administered in education and care services without a medication agreement unless it is included in an ASCIA action plan or asthma care plan (PDF 269KB).
Where a child or young person requires medication in an education or care service and a medication agreement is not available, arrangements must be made for the parent or guardian to attend the site to give the medication.
An exception to this is where the decision making tool for medication administration (DOCX 157KB) is completed (go to self-administration of medication).
Medication agreement review date and end date All medication agreements should be reviewed at least annually for continuing medication.
Where a ‘review date’ has expired, the medication agreement remains valid until an updated form is received. A review date is NOT an expiry or end date.
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Where an ‘end date’ is included on the form, the medication agreement is no longer valid when that date has expired. A new medication agreement must be completed.
Administering medication in education and care services The 8 rights documented in the medication rights checklist (DOC 137KB) are regarded as standard measures for safe administration practices in education and care services. This checklist must be followed every time medication is administered in education and care services. Two staff members must be present during medication administration.
For single staff services (ie family day care, Respite Care program and rural care), medication instructions must be checked and confirmed with the parent or guardian at handover. This includes when the child is dropped off and picked up. When administering medication, double check each step of the medication rights checklist (DOC 137KB).
Where any ‘medication rights’ are in doubt, do not administer medication. You need to:
• document in medication log (DOC 203KB)
• contact the parent or guardian
• complete a medication advice form (DOC 156KB).
Who is responsible for providing medication to the education and care service? The parent or guardian is responsible for providing all medication and administration equipment. They should be encouraged to give and collect any medication in person where possible. Where this is not possible, the education and care staff, in consultation with the parent or guardian, should discuss and agree on safe methods of transport and transfer.
All medications must be provided in an original pharmacy container and have a pharmacy label with:
• child or young person’s name
• date of dispensing
• name of medication
• strength of medication
• dose (how much to give)
• when the dose should be given
• other administration instructions (ie to be taken with food)
• expiry date (where there is no expiry date the medication must have been dispensed within the last 6 months).
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Who is responsible for administering medication during attendance at an education and care service? Principals and directors are responsible for ensuring education and care staff are available and appropriately trained for the administration of medication in an education or care service and during school related activities.
Education and care staff who administer medications must be competent and willing to administer the medication.
Can staff refuse to administer medication? Education and care staff have the right to refuse administering medication if they feel uncomfortable or unqualified to do so.
In an emergency situation, staff have a duty of care to administer medication if the response requires the medication to be administered immediately to prevent serious illness, injury or death (go to administering first aid emergency medication).
Self-administration of medication The decision for a child or young person to carry their own and/or self-administer medication is made by the principal or director (or nominated delegate), in consultation with the parent or guardian and young person by completing the decision making tool for medication administration (DOCX 157KB).
Controlled or restricted medicines can’t be carried or self-administered by the child or young person.
Children and young people are encouraged to carry and self-administer some medications in line with their age and stage of development, providing they:
• are able to recognise their symptoms and seek support if required
• have the correct technique to administer the medication
• understand and apply safe medication management practices.
Some children and young people may choose to self-administer as they recognise the early stages of deterioration but may require assistance if their condition worsens.
Staff should not expect children and young people experiencing a medical emergency to self-administer their own medication. Education and care staff must be prepared to administer emergency medication.
Correct dosage of medication Medication must be administered to one child or young person at a time.
Medication should be administered in the same room where the medication is kept. Medication can be administered in another location provided it is safe to do so and all medication rights are met.
All medication received at education and care services needs to be received intact. If ½ or ¼ tablets are required pill cutters should be used. Staff administering the medication can cut tablets as stipulated in the
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medication agreement.
Providing medication in a Webster pack is considered best practice for safe medication management. As it is the pharmacist that prepares the webster packs, it is still considered the ‘original pharmacy packaging’. In the case of cut tablets it is also best practice to have these provided in Webster Packs as medication must be received intact and not pre-cut by parents/carers. School staff are able to cut tablets if necessary, by asking the parent/carer to supply a pill cutter or alternatively purchase one from a pharmacy.
If more than one medication is in each blister education staff should administer all of the contents of that blister as directed and indicate that they have done this on the medication log under Right dose, Right strength, Right Route. Because the Webster Pack has been prepared by a pharmacist there is not a need to count or identify each individual medication. One medication log for each child can be completed for multiple tablets in a blister of a Webster Pack.
When medication has been administered, education staff should complete the child’s medication log (DOC 203KB) and, if necessary, the controlled medicines register (DOC 200KB) (have 1x controlled drug register for each child – tally the tablets you have for that child on a daily basis).
Hand hygiene and standard precautions should be followed prior to, during and after medication administration for each child and young person.
Two education and care staff (with the exception of single staff services ie family day care, Respite Care program and rural care) are needed to administration medication to a child or young person. This makes sure:
• medication rights (DOC 137KB) are checked
• the medication administration is supervised
• information documented in the medication log (DOC 203KB) is correct.
Post medication administration and documentation
Medication log The medication log (DOC 203KB) must be completed each time medication is required to be administered.
One medication log is required for each child, and for each medicine.
Both staff members must print their name and initial the medication log confirming all details are correct and the medication rights checklist (DOC 137KB) has been followed. For single staff services a single name and initial is appropriate.
When all rows on the medication log have been completed, or when the medication is no longer required, the log must be closed. Give a copy to the parent/guardian. Keep the original filed in the child or young person’s record.
Medication advice form When medication has not been administered the parent or guardian must be notified immediately. They will advise if alternative arrangements are required for administration.
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Complete a medication advice form (DOC 156KB) for any of the following:
• medication has not been administered (including when the child or young person has refused to take the medication)
• a medication incident has occurred (including a medication error)
• post administration observations are required to be documented and communicated to the parent or guardian, or treating health professional.
The medication advice form must be sent to the parent or guardian, and a copy retained in the child or young person’s record.
Post administration observation Observations of the child or young person post administration can be documented on the medication advice form (DOC 156KB) and forwarded to the parent/guardian.
Education and care staff can observe and document behaviours post administration to advise the parent or guardian, or treating health professional.
Education and care staff can’t interpret behaviour in relation to a medical condition or monitor the effects of the medication.
Response to side effects If the child or young person has collapsed or is not breathing following medication administration, call 000 (ambulance) and follow standard first aid.
If the child or young person presents with unusual symptoms or behaviours following medication administration, but it’s not a medical emergency contact the parent or guardian immediately and follow their advice.
Document the side effects, advice given and action taken in the medication log (DOC 203KB) and complete a medication advice form (DOC 156KB).
Refusal to take medication There may be a number of reasons why a child or young person refuses to take their medication.
Education and care services cannot use restrictive practices to make a child or young person take their medication.
It is important to encourage children and young people to take their required medications, and this may include making allowances for an alternative time and location for administration (for example not in the classroom or not around peers).
When a child or young person refuses to take their medication, notify the parent or guardian immediately. Follow the advice given by the parent or guardian provided it meets the requirements of this procedure. The parent or guardian may need to attend to administer the medication.
Document in the medication log (DOC 203KB) and on a medication advice form (DOC 156KB).
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Administering first aid emergency medication Education and care staff must administer medication in response to a medical emergency for children and young people diagnosed with a health condition, or as a first aid response for children, young people, staff and visitors.
Adrenaline autoinjector (EpiPen® or Anapen®) and asthma reliever inhaler (Ventolin®) Adrenaline autoinjectors and asthma reliever puffers can be given as a first aid response to any child, young person, staff or visitor having anaphylaxis or an asthma attack.
Where a child or young person has been prescribed an adrenaline autoinjector (EpiPen®) or reliever puffer for emergency medication, this should be administered in line with their ASCIA action plan or asthma care plan (PDF 269KB). Go to anaphylaxis and severe allergies and asthma for more information.
Prescribed emergency medication Some children and young people may need other medications as an emergency response.
These may require specialised training for example midazolam for the emergency treatment of seizures.
Additional training is required to develop required competencies and ensure the safest option to manage risks to the child or young person’s health (go to training and education).
All emergency medication must be prescribed by the treating health professional, documented in a medication agreement and administered in line with the care plan or individual first aid plan (DOCX 120KB).
Storage, security and disposal of medication
Storing medication Medication must be stored safely and securely. All medication must be stored in line with manufacturer’s instructions. Generally, this will be in a locked cupboard or container in a cool (below 25 degrees), dry place out of direct sunlight.
All medication must be stored in the original container with a pharmacy label. If unpacked or decanted the medication integrity may be compromised and medication errors may occur.
There are some important exceptions:
• Emergency medication must be stored safely, and must be easily accessible at all times.
• Asthma reliever inhalers (Ventolin®) must be readily available at all times, including prior to and during exercise. Generally children and young people are responsible for their own inhalers. The need for a child or young person to have ready access to their inhaler should override any concerns about misuse by others.
• Some medications may need to be kept in the fridge. An appropriate refrigerator, with restricted access, should be identified and the medication should be placed in a closed plastic container with
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the lid clearly marked ‘medication’. Keep it on a separate shelf in the fridge.
Storing controlled drugs The storage and security of controlled drugs requires increased governance and accountability to reduce the risk of misuse, abuse and diversion.
Controlled drugs must be stored in a locked cupboard or storage area. Only authorised persons are to have access to controlled drugs. Authorisation to manage and administer controlled drugs must be approved by the principal or director. Complete an authorisation to administer controlled medicines (DOC 109KB) form.
All controlled drugs at the education or care service must be recorded on the controlled drugs register (DOC 200KB). A stock count is required daily, endorsed with the names and signatures of two staff members (or one staff member in single staff settings). This can be done at the same time as the medication is administered. This register does not replace the need to complete the medication log (DOC 203KB). Any discrepancies with the medication count this must be reported to the police.
All transactions involving controlled drugs must be recorded on the controlled drugs register (DOC 200KB). When controlled drugs are delivered to the education or care service or given back to the parent or guardian, they must sign the controlled drugs register.
Quantity of medication kept at education and care services Where the medication is routine and required regularly, arrangements can be made with the education or care service to store up to a week or term’s supply on site.
Medication that is required short-term should be provided daily or weekly.
All medication must be provided in an original pharmacy container with a pharmacy label. Providing medication in a Webster pack is best practice for safe medication management.
Emergency medications may be stored at the education or care service at all times.
Disposal of unused, damaged or expired medication Unused, damaged or expired medication must be safely disposed of.
Prescribed medication should be returned to the parent or guardian. If the parent or guardian is unable to be contacted or does not claim the medication, it should be taken to a pharmacy for safe disposal. The parent or guardian must be advised in writing if medication is returned to a pharmacy.
The shelf-life of most medications is around 2-3 years from the date of manufacture. If stored correctly, the integrity of the medication should remain intact. It is important to regularly check medication kept at the education or care service for integrity and expiry.
Where a child or young person’s prescribed medication expiry date is nearing or the integrity of the medication is in doubt, contact the parent or guardian to replace the medication. General use medication should be returned to a pharmacy and replaced.
If the integrity of the medication is in doubt a pharmacist can inspect it to provide advice as to whether it is safe or requires replacement.
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Disposal of medication administration equipment Used syringes, pen needles, cannulas and lancets must be disposed of in an Australian standards-approved sharps container. They are puncture-proof and have a secure lid. These containers are usually yellow and are available from pharmacies, local councils and organisations such as Diabetes SA.
All education and care services should ensure they have sharps disposal kits available including a sharps container, disposable gloves and safe practice instructions for the disposal of needles and syringes into the sharps container.
It is the parent or guardian responsibility to ensure appropriate options are in place for the disposal of their child and young person’s medication administration equipment. This should be documented in the child or young person’s health support agreement (DOCX 128KB).
Medication errors, incidents and queries If the incorrect dose or incorrect medication has been administered to a child or young person, do all of the following:
• If the child or young person has collapsed or is not breathing phone 000 (ambulance) immediately and follow standard first aid.
• If there is no immediate adverse reaction phone the Poisons Information Centre on 131 126 and follow the advice given. If the advice indicates the child or young person is able to remain at the education and care service, ensure additional supervision to monitor for any delayed adverse reactions
• Notify the parent or guardian.
• Document in the medication log (DOC 203KB).
• Complete a medication advice form (DOC 156KB) and forward to the parent or guardian. Keep a copy in the child or young person’s file.
• Report on Incident and Response Management System (IRMS) (staff login required).
• Review medication management and administration procedures at the education and care service to identify areas for improvement.
The local pharmacy or the Medicines Information service at the Women’s and Children’s Hospital can assist with non-urgent medication information and advice:
• email: medinfo@sa.gov.au
• phone: (08) 8161 7555.
All medical incidents that require medical treatment and all near miss medication administration incidents must be reported on IRMS (staff login required)within 24 hours of the event.
Training and education The Women’s and Children’s Hospital Disability Services have developed a paediatric medication safety
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online program. Staff managing medication in education and care services should complete this online program.
Specialised training is required for administration of some medications including:
Adrenaline autoinjectors • Adrenaline is emergency medication for anaphylaxis.
• Emergency response for anaphylaxis is included in the HLTAID012 Emergency First Aid Response training.
• Australasian Society of Clinical Immunology and Allergy (ASCIA) free e-training course on anaphylaxis management in education and care services.
Insulin • Insulin is medication used to manage blood glucose levels in people with diabetes.
• National Diabetes Services Scheme Diabetes in Schools online training.
• Refer to Women’s and Children’s Hospital Endocrinology and Diabetes Department for training and advice from a diabetes nurse educator (phone 8161 6402).
Midazolam • Midazolam is emergency medication for seizures.
• An emergency medication management plan must be completed.
• Go to seizures and epilepsy for training providers.
Oxygen • Where a child or young person requires oxygen, they must be referred to the Access Assistant
Program or Encompass.
• Emergency oxygen therapy can only be administered by trained staff or emergency services officers (ambulance officers), nursing or medical practitioners.
Salbutamol (Ventolin puffers) • Salbutamol is used to treat asthma and as an emergency medication for an asthma attack.
• Emergency response for asthma is included in the HLTAID012 Emergency First Aid Response training.
• Asthma Australia free online course, Asthma First Aid for Schools.
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Communication and risk management
Communication Go to health support for general communication strategies.
Communication strategies where a child or young person requires medication must be developed with an assurance that parents and guardians understand the content, and should include:
• staff awareness of all children and young people currently enrolled who require administration of medication during attendance where this is required as an emergency response
• regular communication with parent or guardians of children and young people requiring medication administration during attendance to provide assurance that appropriate management, risk minimisation and emergency response strategies are in place including receiving copies of the medication log (DOC 203KB) and medication advice form (DOC 156KB) as required
• parent or guardians to communicate any changes to the child or young person’s risk factors to ensure education and care staff have up-to-date information
• where age appropriate, communication with the peers of the child or young person with a medical condition, to identify early signs of deterioration and risk minimisation strategies.
Risk minimisation strategies Risks associated with maintaining and administering medications at education and care services include:
• medications not provided
• administration incident
• loss of medication (through spillage or poor management)
• theft or misuse of medication
• deterioration of the medication due to incorrect storage or transport
• access to medication (particularly for emergency medications)
• expiry of medications.
To reduce these risks:
• strict medication administration processes must be followed
• medications should be stored according to specific requirements and with consideration to the safety of staff, children and young people and the wider school community
• the health support agreement (DOCX 128KB) should be used to support and document decision making for children and young requiring health support in the context of the individual site.
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Definitions Access Assistant Program (AAP) Supports children and young people with a disability and/or who have complex health support needs so they can participate in education and care services.
aurally Where products are administered into the ear, usually to treat conditions of the ear such as ear infections or excessive ear wax.
controlled drug Also: Schedule 8 medications, Schedule 8 drugs, S8’s, drugs of dependence. Prescription medications that are likely to cause dependence or be abused.
Creon® A pancreatic enzyme replacement supplement that is used to improve food digestion in people with cystic fibrosis who cannot digest food properly. Creon® is not a medicine in the context of this procedure.
education and care service Includes children’s centres, preschools, schools, family day care, home based childcare, Respite Care programs.
emergency medication Medication required for the emergency first aid treatment of specific medical conditions ie adrenaline autoinjector for anaphylaxis, reliever puffer (Salbutamol (Ventolin®)) for asthma, midazolam for seizures.
high risk medications Medications that have a high risk of causing significant patient harm or death when used in error. Includes insulin.
inhaled Where a substance is breathed into the lungs, usually through the mouth or mouth and nose.
Intranasal midazolam (INM) Emergency medication prescribed to treat seizures that is administered through the nose.
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midazolam Also intranasal midazolam, INM. Emergency medication prescribed to treat seizures.
orally A route of administration where a substance is taken through the mouth.
PRN Medicines that are taken “as needed” are known as “PRN” medicines. “PRN” is a Latin term that stands for “pro re nata,” which means “as the thing is needed.”
restricted schedule 4 medicines Also: Restricted S4, S4R. Schedule 4 medicines that are liable to abuse, i.e. benzodiazepines (e.g. diazepam) and tramadol. For this group of medicines, the traditional storage and record keeping requirements for a Schedule 4 medicine are inadequate to provide the level of accountability required.
topically Where a product is applied directly onto the outer body surface.
Supporting information HSP120 – Health support agreement (DOCX 128KB)
HSP121 – Safety and risk management plan (DOC 128KB)
HSP124 – Individual first aid plan (DOCX 120KB)
HSP125 – Guide to planning health support (DOC 87KB)
HSP151 – Medication agreement (DOC 173KB)
HSP152 – Multiple medication agreement (DOC 210KB)
HSP153 – Emergency medication management plan
HSP154 – Decision making tool for medication administration (DOCX 157KB)
HSP155 – Medication log (DOC 203KB)
HSP156 – Medication rights checklist (DOC 137KB)
HSP157 – Medication advice form (DOC 156KB)
HSP158 – Controlled medicines register (DOC 200KB)
HSP159 – Authorisation to administer controlled medicines (DOC 109KB)
Medication administration (flowchart) (PDF 127KB)
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Medication error, incident, query or advice (flowchart) (PDF 130KB)
Medication in education and care services: information for families
Related legislation Code of Practice First Aid in the Workplace 2012 (PDF 713KB)
Controlled Substances Act 1984 (SA)
Controlled Substances (Poisons) Regulations 2011 (SA)
Controlled Substances (Controlled Drugs, Precursors and Plants) Regulations 2014 (SA)
Disability Discrimination Act 1992 (Cth)
Disability Standards for Education 2005 (Cth)
Education and Early Childhood Services (Registration and Standards) Act 2011 (SA)
Education and Care Services National Regulations
National Disability Insurance Scheme Act 2013 (Cth)
State Records Act 1997 (SA)
Work Health and Safety Act 2012 (SA)
Related policy documents Duty of care to children and young people policy (PDF 182KB)
First aid and infection control standard (PDF 239KB)
Record history Published date: April 2024
Approvals OP number: 100 File number: 18/07542 Version: 3.2 Policy Officer: Project Officer, Health Support, Inclusive Teaching and Learning Policy sponsor: Director, Disability Policy and Programs, Inclusive Teaching and Learning Responsible Executive Director: Executive Director, Support and Inclusion Approved by: Director, Disability Policy and Programs, Inclusive Teaching and Learning Approved date: 28 March 2024 Next review date: 28 October 2027
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Revision record Version: 3.2 Approved by: Director, Disability Policy and Programs Approved date: : 28 March 2024 Review date: 28 October 2027 Amendment(s): Update name of RN delegation program to Encompass and reference to Emergency medication management plan for midazolam administration.
Version: 18/07542 V3.0 Approved by: Director, Disability Policy and Programs Approved date: 6 May 2020 Review date: 6 May 2023 Amendment(s): Updated to reflect plain English and removed reference to Education Regulations 2012 as not relevant to this procedure.
Version: 2.0 Approved by: Director, Disability Policy and Programs Approved date: 22 May 2019 Review date: 22 May 2020 Amendment(s): Updated to reflect change to process (parental authorisation).
Version: 1.0 Approved by: Senior Executive Group Approved date: 10 August 2018 Review date: 10 August 2019 Amendment(s): New procedure developed.
Contact Health Support, Disability Advice and Research Team
Phone: 8226 0515
Email: education.health@sa.gov.au