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The administration of rectal medication in schools
Increasingly children with epilepsy are prescribed rectal diazepam or rectal paraldehyde to minimise the occurrence of seizures. If their special medical needs are met by the administration of these drugs, they will be able to attend school regularly and have access to the normal curriculum.
Schools may have a full-time nurse who is available to administer rectal medication to pupils on the school premises. When such cover is not available, other arrangements will have to be considered.
No pressure should be put on individual teachers to undertake the responsibility of administering medicines or supervising a child taking them especially if the teacher is unwilling to do so.
However, staff in schools frequently agree voluntarily to administer some form of rectal medication. In so doing they require reassurance, support and training from management, education authorities and health care personnel for the following reasons:
Ideally there should be a consistent policy on the administration of rectal medication issued to all schools at national and local authority level and, in the case of grant aided, independent or self-governing school, from the relevant governing bodies or boards of management. The employer (in the case of most schools, the Education Authority) should provide indemnity cover, usually through insurance cover, to employees undertaking the administration of rectal medication. Such indemnity will normally be conditional on the employee following agreed and stated procedures. These are likely to include the use of individuals care plans endorsed by the child's GP and certificated training from an approved nurse or doctor.
Examples of a child's individual care plan and a training programme for staff are given in Appendix 9 and Appendix 10.
Parental rights and responsibilities
Ultimately it is parents, as the child's main carers who have responsibility for his/her health. They should give relevant information to the school about their child's medical condition and any medication involved in treatment. No pupil should be given medication without consent. More detailed information on this matter is contained in the section entitled 'The Legal Background'.
The religious beliefs of the child and his/her family and any cultural sensitivities related to aspects of intimate care must be discussed with parents and, where ever possible, with the child. All staff involved in delivering intimate care should be made aware of these issues relating to individual children and taken into full account in practices.
Sharing information between home and schools is important to secure the best care for pupils but the consent of parents and children who are able to give such consent is needed for the headteacher to pass on information about their child's health to schools staff or other agencies. Their agreement is also needed for any exchange of information between the GP and the school about a child's medical condition either directly or via the School Health Service (see also the section entitled 'Confidentiality'.)
It will be important for the school to agree with parents on the level of support which it can provide for the administration of rectal diazepam or rectal paraldehyde. Where available resources do not meet with parental expectations, advice should be sought from the school nurse or doctor, the child's GP or, if necessary, the Education Authority.
Elements of good practice
Excursions and residential experiences
Arrangements for any pupil on rectal medication will need to take account of excursions outwith the school. Apart from a trained member of staff, there should be sufficient adults to ensure that, if medication has to be given, this can be done with as much discretion and dignity as possible. The safety of the rest of the group will also have to be maintained. Sometimes a parent might be invited to accompany a particular pupil.
Parents of children with conditions requiring emergency intimate care in a public place should be asked about their own procedure for dealing with such a situation. Where possible, the same routine should be followed to reassure the child in a potentially frightening situation.
Occasionally there may be unforeseen staffing difficulties or concerns about a child's medical status related to epileptic seizures. Under such circumstances a headteacher may judge it unwise for a child on rectal medication to take part in a particular excursion or activity. It may be possible to postpone the trip but this may be difficult, for example, in the case of a residential holiday. It is helpful to discuss these possibilities with parents from the outset, perhaps when drawing up the first individual care plan, so that expectations are not unrealistic and the action is not misinterpreted as being discriminatory.
Staff considering taking pupils on a residential excursion whether at home or abroad should consult 'The Protection of Young People in the Context of International Visits' (see Bibliography).
Photography/video cameras
Photographs are rightly used by schools for display purposes to allow pupils, parents and visitors to view activities pursued by the pupils. Photographs are also increasingly being used as a rich form of evidence to place in pupils' Records of Achievement. With the advent of lightweight digital video and camcorders, many schools use videos to record pupils' attainments over time and form a valuable source of assessment evidence to share with parents. Videos are also used to allow pupils to recall field trips, concerts and enjoyable class experiences.
In order to protect all adults and pupils, there must be a very clear policy set down by the school regarding the taking of photographs and the use of video cameras. Parents/guardians should be asked on an annual basis to give their consent to their child being photographed/videoed. Staff need to guarantee that the privacy and dignity of pupils will be respected at all times. Where the pupil(s) concerned are able to give their consent to be photographed/videoed then such consent should be obtained before any photographs/videos are taken. Visitors to the school and students on work placement must be made aware of the school's code of practice and the headteacher must be content with the purpose and use to be made of any photographs/videos taken.
Vetting and supervision of staff, volunteers, students and escorts
It is known that abusers seek out situations where they have access to children. Children with disabilities are a particularly vulnerable group and may be targeted by such individuals. There is an obligation on local authorities to ensure that staff who have substantial, unsupervised access to children undergo police checks. Employers should take every precaution to protect children from abusers and should include in their recruitment practice police checks with the Scottish Criminal Records Office (SCRO) and declaration of convictions. Posts which involve work with children are exempt from the provisions of the Rehabilitation of Offenders Act, 1974. Not all criminals however, will declare their offences and extra care must be taken in taking up both personal and professional references.
Foreign students/trainees/employees can and should be vetted using international police links.
All those working with children should be closely supervised throughout a probationary period and should only be allowed unsupervised access to children once this has been completed to their supervisor's satisfaction.
It is not appropriate for volunteers to carry out intimate care procedures and students should only do so under the supervision of a trained member of staff, following consultation with the student's college supervisors.
Transport
The management of the transport of children with disabilities causes great concern to staff in schools and is an important issue for consideration. Close collaboration between the school and those responsible for organising transport is essential in drawing up guidelines for drivers and escorts. Escorts should be familiar with and in sympathy with the school's attitude and practice in order to provide a consistency of approach. The way in which children are treated during their journey to school can have a significant effect on the rest of the day.
Under normal circumstances intimate care should be planned so as not to coincide with time spent in transit in a bus or car. However in an emergency, this may become necessary and, although the surroundings will be less than ideal, the principles of privacy and dignity should be adhered to and, wherever possible, due regard should be given to gender issues.
Escorts are responsible for the care of children on the school journey. They should be physically able to carry out their responsibilities and trained to handle children and to meet intimate care needs.
A proforma, held by the escort, should accompany each child, giving details of any emergency procedures which might be necessary, contact phone numbers andemergency stopover points eg hospitals en route. Escorts should carry an emergency medication kit and materials necessary for intimate care. A mobile phone should be available in the vehicle to summon the emergency services if necessary. Escorts should be aware of the child's individual needs, specific seating requirements and, where relevant to the transport situation, any medical or behavioural problems. Consultation with parents and school on these matters is very important. This information should be shared on a 'need to know' basis only and confidentiality must be respected. Particular care should be taken not to discuss the child's circumstances within earshot of other children or parents.
At all times the safety and protection of the child should be paramount.
Restraint
In any situation where restraint may be considered, the following advice should be taken into consideration. Physical restraint should only be used as a very last resort in carrying out intimate care procedures with an uncooperative child where the restraint is absolutely necessary for the child's comfort and safety and where verbal persuasion has been unsuccessful in securing the child's compliance.
Any member of staff who uses restraint in any situation with a child in his/her care should always be able to justify the reasons for doing so. The likely circumstances should be identified in the child's care plan which will be subject to regular review. Physical contact should be limited to what is appropriate and should involve only the minimum force necessary to protect children at imminent risk of harming themselves or others.
The use of restraint requires knowledge, skill and judgement and the nature of the child's needs and disability must be taken into account. Staff must be careful not to over-react and should try, where possible, to de-escalate the situation. Where possible, colleagues should be summoned to witness and assist if necessary.
Where the use of physical restraint is necessary as part of established procedure to enable staff to carry out intimate care with an uncooperative child, medical practitioners and parents/carers should be consulted, methods of restraint discussed, and permission sought. Circumstances and procedures should feature in the agreed care plan for the child. This is a sensitive area of practice, as the use of any kind of force might be construed as an assault on the child; but also, failure to use it to keep a child safe, could be construed as failure in the duty of care.
Organisations have to take responsibility by providing a clear policy which sets out a standardised method of restraint of proven effectiveness. All staff should be trained in that method, and kept up-to-date with new techniques. Consistency in the method of restraint used within any agency or authority should be achieved.
A policy document should be formulated in consultation with parents/carers and health professionals and should address issues such as the legal situation and protection of both children and staff. The following points should be noted:
For further advice and information - see Bibliography (in particular, materials available from The Centre for Residential Child Care)
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