Medication related to specific conditions may also be addressed in Specific Medical Conditions.

1. Oral medication

General principles

Only when absolutely necessary should medication be prescribed for administration during school hours. In such circumstances a meeting with parents/legal guardians should be sought to outline the responsibility of school staff and the parents/legal guardians.

When a school accepts responsibility for the administration of medication to students, the school will owe a duty of care to those students to ensure that reasonable care is taken. The duty is to ensure, in the absence of the parent/legal guardian, that the student is given the correct dosage of the correct medication at the correct time, according to prescribed instructions.

A teacher or other member of school staff authorised by the principal may accept responsibility to give medication to a student while at a school or while the student is involved in school-approved activities, following a written request from a parent/legal guardian (Administration of Routine Medication Authorisation Form [PDF 28KB]). The staff member must feel competent and willing to administer routine medication. Staff have the right to refuse to administer routine medication if they feel uncomfortable or unqualified to do so. A staff member might in an emergency have an obligation to attempt to administer medication, despite reluctance or lack of experience. (See Introduction and Duty of Care)

Medication must be readily available to authorised staff. This is particularly important when the student goes on excursions. Alternative arrangements must be made with the parent/legal guardian for the administration of the medication if the person(s) who have agreed to administer it are not available.

Medication must be kept in a secure place. The security of the storage place will vary depending on the type of medication involved. Narcotic type drugs will require storage as per the Minimum Storage Requirements for Narcotic Substances Guidelines, available from the Department of Health and Human Services. A locked first aid cabinet can be used for non-narcotic drugs. Medications that need refrigeration should be under the control of school staff and not accessible to students.

(One exception, in selected cases, is that of inhaler therapy for asthma. With written permission from a parent/legal guardian, and with the approval of the school principal, the student may be responsible for the inhaler.)

Sometimes, a parent may ask that prescribed medication be administered at school (or a variation in dosage of a medication) on an 'as needed' (or 'prn') basis. This is appropriate only in very rare situations where it is necessary to maintain the child in school in spite of complex medical problems. Where this is needed, written guidelines, following Administration of Prescribed Medication Authorisation Form [PDF 29KB] as an example, should be provided by the child's medical practitioner. Close communication with the child's medical practitioner is needed to ensure that the guidelines are understood and followed, and changed as necessary, according to the child's condition.

Non-prescribed medication

Non-prescribed oral medication (such as analgesics and over-the-counter medication) should not be administered by teachers or other members of the school staff.

Fever, headache, earache, toothache are considered symptoms of conditions that require further investigation by the appropriate health practitioner. It is not recommended that school staff administer paracetamol or analgesics to students experiencing these symptoms.

Antibiotics and other short term medication

Should medication be prescribed by the student's medical practitioner and be required to be administered while the student is at school or involved in school-approved activities (eg excursions), a parent/legal guardian must arrange for:

• a request to the school to administer the medication (Administration of Routine Medication Authorisation Form [PDF 28KB]);
• the medical practitioner's specific prescribed instructions for administration on the pharmacist's label;
• the safe transfer of medication to the school; and
• medication to be delivered to the school in originally prescribed container only.

The principal must arrange for:

• the specified time and place to enable the student to receive medication;
• the appropriate distribution of medication to ensure that students receive the correct medication;
• official registration for the administration of medication (Administration of Medication Student Record [PDF 43KB]); and
• all unused medication to be returned safely to the parent/legal guardian in the original container on completion of the authorised period for administration.

Stimulant medication (Methylphenidate [Ritalin™ or Attenta™] and Dexamphetamine)

Increasingly schools are being involved in the administration of stimulant medications to students during school hours. Stimulant medications are 'Schedule 8' drugs that require particular care in administration and security.

Students should be supervised when taking stimulant medication. Students with ADHD are likely to forget medication at times, and this could make overall management difficult. Also, students may lose tablets, may impulsively offer them to others, or may be subjected to pressure or bullying to give away or sell tablets.

Schools need to develop a system to ensure that medication is given consistently at the recommended time(s). This should include plans for excursions, and for unplanned absences of the person who normally administers the medication. The system needs to be unobtrusive because students are often subjected to peer teasing or bullying about taking medication.

In addition to the guidelines defined for antibiotic and other short-term medication (as listed above) other procedures/guidelines include:

• Parent/legal guardians must arrange for a medical practitioner's authority to administer medication (Administration of Prescribed Medication Authorisation Form [PDF 29KB]or a medical practitioner’s letter with the same information). The parent/legal guardian is responsible for delivery of the medication to school in original container with medical practitioner’s instructions on the pharmacist’s label. The principal should accept medication provided in the original container only.
• In general, principals should accept the equivalent of one week of medication only at any one time. The principal or assigned representative must count the tablets and document appropriately.
• The principal must ensure that any medication left at the end of the week is returned to the parent/legal guardian in the prescribed container (not via the student).
• The principal is responsible for organising the completion of documentation in relation to the provision and administration of medication (Administration of Medication Student Record [PDF 43KB]).
• The person administering the medication should ensure that the medication is actually taken by the student. If the student refuses to take the medication, the principal is responsible for notifying the parent/legal guardians, as soon as possible.
• If a student misses a dose the principal is responsible for notifying parents or legal guardian as soon as possible.

Parent/legal guardians can assist the school in the administration of oral medication during school hours by:

• asking the pharmacist to supply two containers with the medical practitioner’s instructions for administration, one container for home and one for school; and
• asking the pharmacist to provide a portion of the required medication in a multi-dose pack with the medical practitioner’s prescribed instructions on the label. This is especially important if more than one medication, or more than one dose, is needed during school hours.

Record keeping

An official register for the administration of medication to students must be maintained. It should have a record of all occasions when medication is administered to a student (see Administration of Medication Student Record [PDF 43KB]). Record sheets should be kept with the medication.

Each entry on the record form should be completed by the person authorised to administer the medication, immediately the medication is administered. The form should contain:

• the name of the student receiving the medication
• the name of the medication administered
• the exact dosage of medication to be administered
• the method of administering the medication
• the name of the person on the school staff authorised by the principal to give medication to the student to whom the register entry refers
• the time the medication should be administered

When the medication is administered, these entries should be made:

• the signature of the person administering the medication
• the date the medication was administered
• the time the medication was administered
• student initials or signature, indicating he/she has received the medication, if appropriate
• the amount and type of medication administered

The school must develop systems for record keeping that maintain and respect confidentiality of the student/s and their medical condition requiring medication. In the case of HIV it is illegal to keep records relating to a person’s HIV status unless:

• procedures are taken for storing the information in such a way, for example using identification codes, that the identity of the person is not readily apparent from the face of the record
• the records are protected by security safeguards against loss, unauthorised access, use, modification or disclosure
• all reasonable steps are taken to develop and implement systems to protect the privacy of the person
• access is only to those who are authorised and require access
• where practical, HIV/AIDS related information should be stored separately from other information about the person
• forms and records are to be destroyed when they are no longer required.

2. Injected medication

Non-medical staff in schools should not routinely administer injections. Non-medical staff can administer injections only in an emergency where no other medical assistance can be obtained within the required time span. The most likely instance will be the administration of adrenalin for severe allergic (anaphylactic) reactions.

Where possible and medically advisable, students could be recommended to undergo appropriate medical treatment to reduce their likelihood of severe allergic (anaphylactic) reactions which may require emergency injections. Desensitisation programs may be applicable in the case of known allergies to, for example, jackjumpers or bee stings.

Where administration of adrenalin is necessary following an allergic reaction, an alternative to injections, for example, inhalers, could be explored with medical authorities.

When administration of an injection during school hours is necessary, a meeting with parents should be sought to outline the roles and responsibilities of school staff, and the guidelines to be followed. A medical action plan should be developed with the student's medical practitioner to provide clear guidelines to follow if an emergency arises. In the case of severe allergic reactions the need for treatment is usually urgent. It is therefore imperative that an emergency plan be in place.

A teacher or other member of school staff authorised by the principal to give an injection to a student may accept responsibility to give an injection to a student if an emergency arises, following:

• a written request from a parent/legal guardian (see Administration of Prescribed Medication Authorisation Form [PDF 29KB]);
• an individual medical action plan written by the student's medical practitioner; and
• adequate training from a qualified medical practitioner to undertake the medical action plan for the individual student. Training should include safe handling and disposal of syringes.

The staff member must be trained and feel competent and be willing to administer the injection. Staff have the right to refuse to administer injections if they do not feel comfortable or qualified to do so.

It is necessary for medication to be readily available to authorised staff to administer at appropriate times. This is particularly important when the student goes on excursions or to other venues away from the school. Alternative arrangements must be made with the parent for the administration of the medication if the person(s) who have agreed to administer it are not available.

Parents should ensure the safe delivery of the injections to the school. Injections must be kept in a secure place such as a locked first aid-type cabinet in a central location in a high school or in the classroom in a primary school. Injections that need to be refrigerated should be under the control of school staff and must not be accessible to students. The exception is when a student is likely to suffer extreme reactions to insect bites for example; in such a case the student may need to carry medication at all times as treatment may be needed immediately.

Used syringes should be placed in a disposable container (eg 'sharps' disposal container, coffee jar or hard plastic container with screw top lid). Syringe disposal containers or syringes must not be put in normal school rubbish bins. Arrange with DHHS, your local council or police for collection and disposal.

Should a student or staff member suffer a puncture wound from a discarded syringe, the following steps should be taken:

• wear disposable gloves
• remove the syringe from the skin, ensuring that the plunger is not depressed in any way
• place the syringe in a hard (glass, plastic) sealable container (from first aid kit) as outlined above. Syringes should be retained as they may need to be tested
• wash the site with soap and water and apply antiseptic, if available
• report the accident to the school principal
• if the injury occurs to a pupil, parents should be contacted
• a medical officer should be consulted

These procedures should be displayed prominently in an appropriate place.