Supporting pupils with medical conditions: Guidance on levels of training for school staff

Level 1 training - All staff

Read and understood the medical conditions policy. Staff are encouraged to participate in the recommended free online resources as part of CPD.

Anaphylaixis campaign AllergyWise online course

AllergyWise for schools is designed to ensure that key staff in schools are fully aware of the signs and symptoms of anaphylaxis, how to provide emergency treatment and the implications for management of severely allergic children from Key Stages 1 to 5 in an education setting.

Supporting children’s health asthma online course

Being aware of asthma and its triggers can help to ensure children with asthma in your care are safe and can get involved in the same activities as any other child without issue or harm.
This asthma module aims to help you support children who have asthma by:

• Raising your awareness of the condition and how it’s managed
• Exploring plans you may need to ensure that children with asthma in your care are supported

MindEd

Free educational resource on children and young people's mental health.

Level 2 training - Trained first aiders (including those who may be administering medicines/medical procedures)

As for level 1 and also attendance every three years at the following:

• School nursing service training: management of medical emergencies training for schools
• Ealing Health and Safety training includes First Aid training for schools

Level 3 training - Medical conditions co-ordinators/leaders

As for level 1 and also annual attendance at the following:

• School nursing service training - Management of medical emergencies training for schools and implementing the ‘supporting pupils with medical conditions’ policy for schools
• Ealing Health and Safety training - attend every three years. Includes first aid training for schools

Additional training for pupils with more complex needs (section 11.2 of the Supporting pupils with medical conditions in school policy)

For pupils with severe/complex medical conditions, who require specialist health professional input, there may be a decision to delegate certain health care procedures to a member of school staff. This health professional will carry out a risk assessment to identify if the procedure can be undertaken by the staff member or requires a registered nurse. Where the risk can be mitigated through appropriate training, the procedure may be delegated in partnership with the school/employer. The training package and competency assessment will be developed on an individual basis specific to the needs of the pupils. The decision to delegate should include the range of questions as detailed below.

• Is the procedure specified within the staff member’s role and job description?
• Does the employer have appropriate policies, procedures in place to support delegation?
• Has consent been gained from those with parental/legal responsibility and/or the young person?
• Is the delegation on a named CYP basis?
• Is the delegation specified within the child’s individual healthcare plan?
• Is the environment appropriate for the procedure to be carried out?

There are a number of clinical procedures which have been deemed appropriate for delegation by the Royal College of Nursing (2018), subject to the necessary training, assessment of competence and supervision of practice.

• Administering medicine in accordance with prescribed medicine, with pre-calculated dosage provided via naso-gastric tube, gastrostomy tube, orally or applied to skin, eyes and/or ears
• Injections (intramuscular or subcutaneous). These may be single dose or multiple dose devices which are pre-assembled with pre-determined amounts of medication to be administered as documented in the individual child’s care plan (preloaded devices should be marked when to be administered e.g. for diabetes where the dose might be different am or pm. In many circumstances there may be two different pens, one with short acting insulin and another for administration at night with long acting insulin)
• Inserting suppositories or pessaries with a pre-packaged dose of a pre-prescribed medicine
• Rectal medication with a pre-packaged dose i.e. rectal diazepam
• Rectal paraldehyde which is not pre-packaged and has to be prepared – permitted on a named child basis as agreed by the child’s lead medical practitioner i.e. paediatrician or GP
• Administration of buccal or intra-nasal Midazolam and Hypo Stat or Gluco Gel
• Assistance with inhalers, cartridges and nebulisers
• Emergency treatments covered in basic first aid training including airway management.
• Tracheostomy care for a stable stoma including suction using a suction catheter
• Emergency change of a tracheostomy tube.
• Nasal or oral suctioning which does not go beyond the back teeth and where there is an effective cough. This should be prescribed by a doctor, children’s respiratory nurse specialist or a paediatric respiratory physiotherapist
• Assistance with prescribed oxygen administration including oxygen saturation monitoring where required
• Administration and care of liquid oxygen administration
• Ventilation care for a child with a predictable medical condition and stable ventilation requirements (both invasive and non-invasive ventilation)
• Blood glucose monitoring and carbohydrate counting as agreed by the child’s lead nursing/medical practitioner. Example: GP, paediatrician, children’s diabetes nurse specialist
• Bolus or continuous feeds via naso-gastric tube or gastrostomy
• Bolus or continuous feeds using a pump via gastrostomy or jejunostomy
• Intermittent catheterisation and catheter care
• Supporting a child/young person to access a mitrofanoff
• Stoma care including the requirement to maintain patency of a stoma in an emergency situation prior to seeking advice from the registered nurse*

The following clinical procedures should not be undertaken by unregistered health and non-health qualified carers:

• Assessment of care needs, planning a programme of care or evaluating outcomes of a programme of care
• Re-insertion of a naso-gastric tube
• Re-insertion of percutaneous endoscopic gastrostomy tubes, balloon type gastrostomy tubes or low profile devices except as advised in an emergency*
• Intramuscular or sub-cutaneous injections involving assembling syringe or intravenous
• administration
• Programming of syringe drivers
• Filling of oxygen cylinders
• Laryngo Pharyngeal (Nasal or Oral) suctioning into the pharynx past the epiglottis but above the vocal cords, this should be carried out by a registered nurse due to the risk of laryngeal spasm
• Tracheal suctioning, this is specialist suctioning through the vocal cords and should only be carried out by a specialist and is not a procedure used in community settings
• Siting of indwelling catheters
• Medicine not prescribed or included in the care plan
• Ventilation care for an unstable and unpredictable child