Willoughby School - Administration of Medicines/First Aid

Willoughby Policies

Administration of Medicines / First Aid

JULY 2014

1 Willoughby School - Administration of Medicines/First Aid

SAFEGUARDING

This guidance relates to the SAFEGUARDING of pupils in the school. Medication is often vital and potentially also dangerous, so staff must be vigilant about correct doses and carrying out appropriate checks before administering. Should following investigation/checking/monitoring of medication a safeguarding issue arise (rapidly changing doses/types of medication etc. without appropriate designation or information etc) then the SAFEGUARDING POLICY must be adhered to.

Introduction

We consider that there are three distinct categories when pupils may require the administration of medicines or first aid.

1. Pupils with a specific medical condition 2. Pupils returning to school after a routine illness 3. Pupils who have accidents during the school day

Our practice will review the administration of medication whenever there is a change of staff, or the pupil’s medication record is amended.

This document has been written with advice from the DfES documents (Supporting Pupils at School With Medical Conditions), Guidance on First Aid , Managing Medicines in Schools and Early Years settings.

All medication will be administered following the guidance received on our individual ‘Medication Information and Consent’ form and where appropriate via Consultant endorsed documentation regarding the administration and prescription of emergency medications for certain conditions. Staff will need to be aware of any previous medications administered to a child in the home environment before administering further doses at school.

2 Parents are asked to inform school if they have administered any previous medication prior to the child coming to school on any given day.

Pupils With a Specific Medical Condition

Unlike many mainstream schools, special schools frequently have a higher proportion of pupils requiring the regular administration of medicines.

We are frequently asked to accept the responsibility for the administration of medicine to the pupil: -

 Where the timing of administration is crucial  Where some technical or medical knowledge or expertise is required  Where intimate contact is necessary

No school staff will be compelled to administer medication.

School will arrange appropriate training or instruction by the relevant professionals. Some staff have undertaken further external training to underpin good practice, however school training is thorough and sufficient and therefore does not preclude being named to administer medicines.

The following persons are trained and authorised to administer medicines. The process is coordinated by Adam Booker, Clare Stamp and Marie Kershaw who will administer medication if required to do so (see below for administering gastrostomy medication). In the event of one person being absent, the next named person will step in (shown in brackets).

Purple Kay Townend (Elizabeth Crosby) Gold and White Sharon Osborne (Michelle Willoughby) (swap termly)

Orange Nicola Booth (Sally Bannister)

The following staff may administer medication if the above are not available or in exceptional circumstances.

Marie Kershaw

Turquoise Alex Sismey (Pat Gray) Rest of Upper School Jenny Waddingham (Alex Sismey) Academy 1 Jane Ewles (Alex Sismey)

3 The following staff may administer medication if the above are not available. Anna Parsons Gwynneth Camm

Rachel Reid (Jenny Davis) will administer medication to Academy students when they are off site.

Gastrostomy Trained Staff

Marie Kershaw Sally Bannister Helen Purdy Mandy Beaver Kay Townend Pat Gray Nicola Booth Michelle Hird Katie Curran Dawn Tucker Elizabeth Crosby Sharon Osborne Emma Hill George Tucker Alex Sismey

Epipen and Anapen

A First Aider who is also trained in Epipen/Anapen will be called in the first instance. If one is not available other Epipen/Anapen trained staff are permitted to administer.

Buccal Midazolam and Rectal Diazepam

A First Aider who is also trained in Buccal Midazolam and Rectal Diazepam will be called in the first instance. If one is not available other Buccal Midazolam and Rectal Diazepam trained staff are permitted to administer.

See Appendix 1 on the administration of rectal diazepam/buccal midazolam.

Naso Gastric Medication

Staff trained in Naso Gastric medication (currently Emma Hill and Marie Kershaw) will be called in the first instance. If one is not available Kay Townend is trained in Naso Gastric and is permitted to administer under the direct supervision of a trained First Aider.

4 Oxygen

Oxygen for William Routledge is carried on his home wheelchair which either travels with him or if he is using another chair is in Academy 1. Oxygen for other students (currently Honey Gloster) is stored in the Resource Room Medical Cupboard when not in use. When Honey is in school her oxygen is with her at all times.

Staff Trained in Oxygen Therapy - Marie Kershaw, Pat Gray, Dawn Tucker, Sharon Osborne, Kay Townend, Nikki Booth, Michelle Hird, Katie Curran, Sally Bannister and Elizabeth Crosby.

Suction Therapy

There are number of students in school who require suction to clear secretions when they are unable to do it for themselves. Only staff trained to do suction therapy are permitted to carry it out. Currently students who have suction machines are Daniel Ingham, Abigail Sumner and Honey Gloster. Students should only receive suction using their named machine. Their suction machines are with them at all times when they are in school. Daniel and Abigail take theirs home daily. Honey’s two machines remain in school and are currently stored in the Early Years Hygiene Suite. It is the parent’s responsibility to ensure the suction machine is fully charged and cleaned out each day. It is the responsibility of Purple class staff to clean and charge Honey’s school suction machines.

Gastrostomy Pupils

Parents are asked to declare any special arrangements required when giving permission for pupils to use the Hot Spa. Where no special requests are stated on the permission form i.e. that a Gastrostomy requires covering with a special waterproof dressing, then school’s medical advice (Gowan,4.11.13, email) will apply, that these areas do not need covering. Where parents raise a request, further discussion will take place.

Medication Administration Guidelines

- A record of any medication administered must be kept, recording name, date, medication given, amount given, time, any side effects.

- Two members of staff should sign on the medication record sheet for all medication that is given in school. 5 - By signing for medication each person is confirming that they have checked that the information on the label, on the medication packet or bottle, matches that on the medication record sheet.

- The things that should be checked every time are:  Child’s name (does medication record sheet match label on medication?)  Name of medication (does medication record sheet match label on medication?)  Dose of medication (does medication record sheet match label on medication?)  Time it should be given (shown on medication record sheet)  Expiry date of medication (shown on label on the medication)  Amount actually given – either by tablet/spoon/syringe

- Both people who sign should have checked all of these things, as they are both signing to say that the correct medication is being given to the correct child.

Completed records of medication administered are retained within the cupboard in Resources room which is locked at all times.

The same guidelines should be followed when medication is administered by school staff on outings, trips and visits. The medication record sheet for that child should be taken on the outing and signed by two members of staff at the time the medication is given.

- With Emergency Medication All the above guidelines are also applicable to emergency medication, other than checking the time that it should be given which obviously cannot be specified for emergency medication.

What should be checked is that the Emergency Medication Guidelines for that child are followed; these should say the dose and when the medication should be given (eg. 5 minutes after the start of a seizure). These guidelines are found in the class information file, in the medication file in the medication cupboard and on the back of each classroom door.

In exceptional circumstances where medication that is normally taken at home before school is not administered for any reason the following will apply, however where this may occur it should be previously agreed with school.

6 1. Where school retains a spare dose/supply of medicine the correct dose can be measured / administered in school recording the details as required. Or

2. If no spare medication is kept in school, parent must send the pharmacy labelled medication in its original container/packaging which will then be administered within policy guidelines.

Parent to provide written parental instructions to cover such eventualities and parents are required to contact the school office by telephone to notify school of the specific instance/situation. Unlabelled medication should not be sent to school for staff to administer under any circumstances.

Where medication has been partially taken by a child at home, parents are not permitted to send the remainder into school. Should parents have any concerns over a specific situation they are invited to come into school to administer the remaining dose personally. Staff are not permitted to administer any medication which has not been drawn up in school (even if from the pharmacy labelled container).

The above policy is to ensure the safety and protection of pupils, parents, carers and staff. Should parents wish to discuss individual pupil medication needs they are asked to contact the school.

Currently when a different member of staff needs training to administer medication, Marie Kershaw instructs on the ‘Medication Administration Guidelines’ and ‘Storage of Medication’, as stated in the Administration of Medicines/First Aid policy. They are shown where the medication and records are kept and made aware of the ‘emergency medication administration’ sheets, which are on the door of each classroom in school.

They are made aware of any information regarding certain medications. This will vary from time to time depending on the medication in use at the time of the training.

The trainer also highlights the need for them to read the Medication and First Aid Policy so they are aware of the school’s policies and procedures. This can be found on G:drive/Staff Only/Policies/Medication and First Aid.

Storage of medications

7 School should not store large amounts of medication. The head may ask parents, carers to send in the required dose daily, but this is not always possible in our situation.

The majority of medications for students in school are kept locked in the Resources Room Store Cupboard. The exceptions to this are that Purple Class and Orange Class medications are stored in the locked medication cupboard in the Early Years Hygiene Suite and Turquoise Class daily medications are stored in a locked cupboard within their locked classroom store room. Turquoise emergency medications are stored in the Resources Room Store Cupboard due to lack of space in their cupboard.

Epipens/Anapens are stored in the relevant locked medication cupboard due to the risks to vulnerable children of storing them in the classroom. Epipens / Anapens should be stored in a box clearly marked with a red cross and the student’s name and photograph. This ensures quick and easy location of the medication in an emergency situation of a student going into Anaphylactic shock.

The medications should be kept within a container, which is clearly labelled with the pupils’ name and photograph. The medication itself should display the dispensing label - which shows the student's name, the name of drug, the dose of the drug, the expiry date and the frequency of administration. All these should be doubled checked when any medication is dispensed. For practical reasons it is unlikely to be possible to record remaining amounts. Class teachers, will keep asthma inhalers, out of pupil reach/access, but readily available if required. There is a fridge in the resource room medical cupboard for storage of any medications or milk feeds that require refrigeration. These should be labelled the same as for other medication.

Pupils Returning After A Routine Illness

In general where pupils have been prescribed antibiotics they should complete the course of medication before returning to school to ensure they are completely well.

However, there may be occasions when routine medicines may need to be administered to a pupil who has returned after illness. Each case will be assessed and the final decision is at the discretion of the Head Teacher. Parents will be required in the first instance to supply all relevant detail, name of child, name of medication, dosage, expiry date and signed letter of authorisation giving reasons for need.

8 We WILL NOT administer non prescribed medicines – e.g. Ibuprofen, Aspirin or Paracetamol unless in exceptional circumstances with the permission of the parent who has provided this medication along with written instructions.

Procedures For Administering Medicines

The smallest practicable dose should be brought to school, preferably by the parent, or via the taxi escorts with written consent and clear instructions for administration, giving the name of the pupil. This should be handed directly to a member of staff. Wherever possible the medication should be self-administered, under the supervision of an adult.

All parents, carers are asked to fill out a form defining all medications that the pupil takes at home and school, with dose and time. A copy of this information is kept in the office pupil records, and by all of the first aiders/those giving medicines. Parents are responsible for keeping school informed of any changes in medication.

Syringes for administering medicine will be used once only and sent home to parents for washing. Parents are asked to send in appropriate supplies of syringes. High standards of cleanliness of all equipment used must be maintained at all times. (Also see Infection Control Policy).

If we agree to administer medicines we must have a written record of: - - The date - The time of administration - The dose - Parental signed permission - Any rare side effects/reactions

Files containing current records of the administration of medications are kept in the following locations.

Purple Class students - in purple classroom White Class students – in white classroom Orange Class students - in orange classroom Gold Class students – in the resources room medical cupboard Turquoise class students - in turquoise classroom All other upper school students – the resources room medical cupboard

9 Record sheets should be single sided only, to prevent errors in administration.

In the resources room medical cupboard there is one file all completed records of administered medication. This is dated with the current academic year. A new file will be used each academic year.

Old records will be maintained in accordance with statutory guidelines for pupil records.

Refusing Medication

If pupils refuse to take medication, school staff should not force them to do so. The school should inform the parents as a matter of urgency and if necessary call the emergency services.

Disposal of medicines

School staff should not dispose of medicines. Parents should either collect or receive any medicines at the end of each term. Parents are responsible for disposal of expired medicines. School Trips

It is good practice for schools to encourage pupils with medical needs to participate in school trips, wherever possible. School will make any additional safety arrangements that are required, ensure that supervisors are aware of any medical needs and relevant emergency procedures. On all school outings staff carry all pupils’ emergency contact details and treatment advice. If staff are concerned about whether they can provide for a pupil’s safety, or the safety of others on a school outing, they should seek advice from the Senior Management Team who will contact the school health service or the Child’s G.P.

If medication is needed to be administered whilst on a school trip, outing or visit, if the person who usually administered the medication is out of school with the pupil they should administer it. If they are not it is the responsibility of the pupil’s teacher to organise that the medication is administered. This should be recorded on a record sheet in the same way as it is in school.

In the case of Academy students because they attend college on a weekly basis a named person Rachel Reid (Jenny Davis) will administer medication to Academy students when they are off site.

10 Transporting Pupils with Medical Conditions

Lincolnshire County Council in conjunction with parents / carers and medical professionals ensure that pupils who are transported to school have the relevant documentation and training for administering and transporting both pupils with medical conditions and their medication.

Pupils Who Have An Accident During The School Day

Accidents to pupils whilst in our care during the school day, or on a school activity out of school can occur despite our best endeavours.

Basic first aid will be administered.

Although all staff have the opportunity to train in basic first aid, it is advisable to send for support from a recognised/named first aider with the appropriate training, particularly in the case of more severe injuries. The decision of how many staff to train on the First Aid at Work course will be dependent upon overall numbers already trained and linked to department needs and budgetary availability.

Staff should wear protective gloves at all times when dealing with blood or bodily fluids.

All accident forms should be completed, including an accident record sheet (supply held in office) and the Head Teacher informed.

Named persons with recognised training currently in school are as follows: - Name Qualification

Name Qualification Date Expires Trained Jenny Waddingham First Aid at Work 13.9.11 22.9.14

Emma Hill First Aid at Work 10.12.12 9.12.16

Marie Kershaw Early Years First Aid / 8.2.12 7.2.15 First Aid at Work 19.5.11 12.5.14

Dawn Tucker Early Years First Aid / 26.6.12 15.9.15 11 First Aid at Work 13.3.12 12.3.15

Gwynneth Camm First Aid at Work 19.3.13 27.4.16

Maureen Ward First Aid at Work 23.4.13 18.5.16

Debbie Weston First Aid at Work 19.10.12 18.10.15

Alex Sismey First Aid at Work 26.9.12 25.9.15

Kay Townend Early Years First Aid 25.10.12 24.10.15

Karen Cuffe First Aid at Work 6.12.13 5.2.16

Please approach an appropriate First Aider within your department and if a First Aider is teaching, please try to approach another person if possible.

Named persons with the Early Years First Aid training are only able to administer first aid to children aged 8 or under unless they have First Aid at Work certificate. All trips offsite for Early Years pupils must be accompanied by a qualified Early Years First Aider.

Emergency Procedures

Should any pupil need medical attention beyond basic first aid or be in need of hospitalisation the following procedure should be followed.

 Inform the head teacher or senior member of staff.

 Should the pupil need hospitalisation, the ambulance service 999 contacted and medical support and advice should be sought.

 Contact the parents and discuss arrangements for collecting their child (when ambulance/999 is not applicable).

 In very exceptional circumstances staff may be asked by the Head to transport pupils to hospital, (ensure business insurance in place) in which case there should always be 2 members of staff available.

 Student records should accompany a pupil to hospital – name, address, telephone number of parents, the pupil’s religion, date of birth and any illnesses, allergies, medication information and actual medications. 12 N.B. In all hospital related cases an ambulance is called before contacting the parents.

Staff need to be fully familiar with parent’s completed details of ‘Medication Information and Consent’ and ‘Treatment Plan and Consent Form for Schools Use of Buccal Midazolam or Buccal Diazepam’.

Notification Of Unusual Occurrences

Sudden or unusual outbreaks such as diarrhoea, vomiting or fainting on a large scale, should be notified to the LCC Health & Safety and Health Protection Agency. Accidents involving hospital treatment or over 3 day absence will need recording on a PO3 form and notification to the Local Education Authority Health & Safety team. Cases will be assessed upon the specific circumstances.

List Of Notifiable Diseases

The document ‘RIDDOR Explained’ identifies information from the H.S.E. and RIDDOR requirements for reportable injuries and diseases. ‘Communicable Disease Guidance’ provides further guidance. See also Policy on Infection Control.

Good Practice

The administration of medicines procedure will be reviewed on a regular basis.

We will continue to liaise regularly with the consultant paediatricians about medical regimes of some of our pupils.

Parents are annually reminded to inform us of any changes in medication at home or school.

Every child will have a medication list and any required treatment plan.

All First Aiders / administrators of medication are immediately informed of any changes to medication and therefore are required to check pigeon holes frequently.

We continue to advise that staff are immunised against Hepatitis B. All staff should seek immunisation. 13 Transfer of medical skills

Staff will receive training from appropriate staff within school and from external professionals usually annually as appropriate. Volunteers from the school staff have undertaken to administer the medication.

Further advice is available to the staff at any point in the future if they feel the need for further assistance. The school staff and pupil’s parents should review the protocol at the beginning of each academic year. Any amendments of training requirements should be addressed with the assistance of the designated health professional.

Staff Indemnity

The county council provides a staff indemnity for any school staff member who agrees to administer medication to a child in school, with the full agreement of parents and school.

The Local Authority fully indemnifies its staff against claims for alleged negligence, providing they are acting within the scope of their employment, have been provided with adequate training and are following the LEA’s guidelines. For the purposes of indemnity, the administration of medicines falls within this definition and hence staff are reassured about the protection their employer provides. The indemnity would cover the consequences that might arise where an incorrect dose is inadvertently given or where the administration is overlooked. In practice indemnity means the Local Authority and not the employee will meet the cost of damage should a claim for alleged negligence be successful. It is very rare for school staff to be sued for negligence and instead the action will usually be between the parent and employer.

Please note – Staff will ensure they act within the boundaries of their specific training and qualification and refer any instance of which they cannot deal with on to an appropriately trained member of staff.

If staff identify that medication was not administered, or incorrect dosage or any problem or query, they are required to notify/seek immediate advice from a member of the Senior Management Team.

Review as changes occur

14 W:Medication and First Aid June 2014

15 APPENDIX 1

ADMINISTRATION OF RECTAL DIAZEPAM (STESOLID)/ BUCCAL MIDAZOLAM

School staff cannot be compelled to administer Rectal Diazepam/Buccal Midazolam/Buccal Midazolam, but may be willing to do so in certain circumstances. The administration of Rectal Diazepam/Buccal Midazolam may only be carried out by nominated ‘responsible’ persons according to the following procedure:

1.1 The rectal administration of drugs should be recorded in the individual pupil’s medical file immediately after it has been administered. The medication should be checked by a second person before administration to ensure that:

1.1.1 The dose is correct and the nominated person administering the medication is considered competent in the procedure.

1.1.2 All pupils who have a diagnosis of epilepsy and are considered prone to serial or status elpilepticus, should have a specific individual management plan on how to manage their condition. This must be prepared by the Head Teacher in consultation with the school’s medical personnel.

1.2 Only nominated ‘responsible’ persons are to undertake the administration of Rectal Diazepam/Buccal Midazolam.

1.3 The Head Teacher should ensure that nominated ‘responsible persons’ undertake re-training annually.

1.4 The administration of Rectal Diazepam/Buccal Midazolam by school staff must be closely monitored by the school’s senior management and fully recorded on the individual pupil’s medical file.

1.5 The Head Teacher remains fully accountable for the administration of Rectal Diazepam/Buccal Midazolam to pupils where this is administered by school staff.

1.6 There should be no expectation from the school that the administration of Rectal Diazepam/Buccal Midazolam should be carried out by school staff. If school staff refuse to undertake the task, which is their right, the Head Teacher in consultation with the school’s medical personnel must make other suitable arrangements.

16 Summary of Training

Evidence will be retained in staff personal files

Name Qualification /Provider Date of Date of Certificate/ Training Expiry Evidence Of Qualification M Kershaw First Aid at Work/Early Years First Aid 19.05.2011 12.05.2014 Yes 08.02.2012 07.02.2015 J Waddingham First Aid at Work 13.09.2011 22.09.2014 Yes D Tucker First Aid at Work/Early Years First Aid 13.03.2012 12.03.2015 Yes 22.06.2012 15.09.2015 G Camm First Aid at Work 19.03.2013 18.03.2016 Yes M Ward First Aid at Work 23.04.2013 18.05.2016 Yes E Hill First Aid at Work 10.12.2012 09.12.2016 Yes D Weston First Aid At Work 19.10.2012 18.10.2015 Yes Alex Sismey First Aid At Work 26.09.2012 25.09.2015 Yes Karen Cuffe First Aid At Work 06.12.2013 05.02.2016 Yes Kay Townend Early Years First Aid 25.10.2012 24.10.2015 Yes

M Kershaw Gastrostomy 07.10.2014 N/A Yes Nasogastric tube Device 26.01.2005 N/A Yes D Tucker Gastrostomy 07.10.2014 N/A Yes P Gray Gastrostomy 12.09.2013 N/A Yes M Beaver Gastrostomy E Hill Gastrostomy K Townend Gastrostomy K Curran Gastrostomy N Booth Gastrostomy 03.06.2014 N/A Yes H Purdy Gastronomy G Tucker Gastronomy A Sismey Gastronomy S Bannister Gastronomy 07.10.2013 N/A Yes E Crosby Gastronomy 07.10.2013 N/A Yes K Townend Gastronomy 07.10.2013 N/A Yes

T McKeigue Care and use of Gastronomy Feeding 07.03.2012 N/A Yes Devices M Hird Care and use of Gastronomy Feeding 07.03.2012 N/A Yes Devices

S Bannister Epipen 28.01.2013 N/A Yes N Booth Epipen 28.01.2013 N/A Yes A Brooks Epipen 28.01.2013 N/A Yes T Crawley Epipen 28.01.2013 N/A Yes K Cuffe Epipen 28.01.2013 N/A Yes J Davis Epipen 28.01.2013 N/A Yes 17 R Drewry Epipen 28.01.2013 N/A Yes L Elliott Epipen 28.01.2013 N/A Yes J Ewles Epipen 28.01.2013 N/A Yes P Fuller Epipen 28.01.2013 N/A Yes P Gray Epipen 28.01.2013 N/A Yes M Hird Epipen 28.01.2013 N/A Yes B Hotchkin Epipen 28.01.2013 N/A Yes M Kershaw Epipen 28.01.2013 N/A Yes R Lee Epipen 28.01.2013 N/A Yes T McKeigue Epipen 28.01.2013 N/A Yes A O’Connell Epipen 28.01.2013 N/A Yes A Parsons Epipen 28.01.2013 N/A Yes C Stamp Epipen 28.01.2013 N/A Yes R Slipper Epipen 28.01.2013 N/A Yes W Smith Epipen 28.01.2013 N/A Yes K Townend Epipen 28.01.2013 N/A Yes D Tucker Epipen 28.01.2013 N/A Yes J Waddingham Epipen 28.01.2013 N/A Yes W Waddingham Epipen 28.01.2013 N/A Yes D Weston Epipen 28.01.2013 N/A Yes M Willoughby Epipen 28.01.2013 N/A Yes

C Stamp Buccal Midazolam 17.09.2012 N/A Yes E Hill Buccal Midazolam 17.09.2012 N/A Yes A Parsons Buccal Midazolam 17.09.2012 N/A Yes G Tucker Buccal Midazolam 17.09.2012 N/A Yes Amanda Brooks Buccal Midazolam 17.09.2012 N/A Yes R Lee Buccal Midazolam 17.09.2012 N/A Yes P Fuller Buccal Midazolam 17.09.2012 N/A Yes B Hotchkin Buccal Midazolam 17.09.2012 N/A Yes R Drewry Buccal Midazolam 17.09.2012 N/A Yes J Davis Buccal Midazolam 17.09.2012 N/A Yes J Waddingham Buccal Midazolam 17.09.2012 N/A Yes S Needham Buccal Midazolam 17.09.2012 N/A Yes W Smith Buccal Midazolam 17.09.2012 N/A Yes S Bannister Buccal Midazolam 17.09.2012 N/A Yes N Booth Buccal Midazolam 17.09.2012 N/A Yes L Elliott Buccal Midazolam 17.09.2012 N/A Yes S Osborne Buccal Midazolam 17.09.2012 N/A Yes W Waddingham Buccal Midazolam 17.09.2012 N/A Yes T McKeigue Buccal Midazolam 17.09.2012 N/A Yes D Tucker Buccal Midazolam 17.09.2012 N/A Yes K Cuffe Buccal Midazolam 17.09.2012 N/A Yes T Crawley Buccal Midazolam 17.09.2012 N/A Yes A Sismey Buccal Midazolam 17.09.2012 N/A Yes K Townend Buccal Midazolam 17.09.2012 N/A Yes R Reid Buccal Midazolam 17.09.2012 N/A Yes K Curran Buccal Midazolam 17.09.2012 N/A Yes D Weston Buccal Midazolam 17.09.2012 N/A Yes E Crosby Buccal Midazolam 17.09.2012 N/A Yes M Willoughby Buccal Midazolam 17.09.2012 N/A Yes 18 R Slipper Buccal Midazolam 17.09.2012 N/A Yes M McKeigue Buccal Midazolam 17.09.2012 N/A Yes

G Tucker Rectal Diazepam 07.10.2013 N/A Yes P Gray Rectal Diazepam 07.10.2013 N/A Yes A Sismey Rectal Diazepam 07.10.2013 N/A Yes H Purdy Rectal Diazepam 07.10.2013 N/A Yes K Townend Rectal Diazepam 16.05.2011 N/A Yes M Kershaw Rectal Diazepam 29.11.2004 N/A Yes S Obsorne Rectal Diazepam 15.06.2009 N/A Yes

Emma Hill Naso Gastric Medication Marie Kershaw Naso Gastric Medication KayTownend Naso Gastric Medication (with FA supervision)

M Kershaw Oxygen 07.10.2013 N/A Yes P Gray Oxygen D Tucker Oxygen 07.10.2013 N/A Yes S Osborne Oxygen 07.11.2006 N/A Yes K Townend Oxygen 07.10.2013 N/A Yes N Booth Oxygen 07.10.2013 N/A Yes M Hird Oxygen 07.10.2013 N/A Yes E Crosby Oxygen 07.10.2013 N/A Yes S Bannister Oxygen 07.10.2013 N/A Yes S Smith Oxygen 07.10.2013 N/A Yes G Camm Oxygen 27.11.2008 N/A Yes

M Hird Oropharyngeal and Nasopharyngeal 24.03.2014 N/A Yes suction – named child M Kershaw Oropharngeal suction – named child 29.01.2014 N/A YesYes and 07.10.2013 N/A Theory training on oropharyngeal and nasopharyngeal suction – named child E Crosby Oropharyngeal and Nasopharyngeal 27.11.2013 N/A Yes suction – named child Theory training on oropharyngeal and 07.10.2013 N/A Yes nasopharyngeal suction – named child S Bannister Theory training on oropharyngeal and 07.10.2013 N/A Yes nasopharyngeal suction – named child M Hird Theory training on oropharyngeal and 07.10.2013 N/A Yes nasopharyngeal suction – named child S Smith Theory training on oropharyngeal and 07.10.2013 N/A Yes nasopharyngeal suction – named child E Crosby Theory training on oropharyngeal and 07.10.2013 N/A Yes nasopharyngeal suction – named child D Tucker Theory training on oropharyngeal and 07.10.2013 N/A Yes nasopharyngeal suction – named child

19 K Townend Theory training on oropharyngeal and 07.10.2013 N/A Yes nasopharyngeal suction – named child

S Bannister Nebuliser use 06.05.2014 N/A Yes M Kershaw Nebuliser use – named child 29.01.2014 N/A Yes N Booth Nebuliser use 06.05.2014 N/A Yes

S Bannister Administration of Suppositories – 06.05.2014 N/A Yes named child N Booth Administration of Suppositories – 06.05.2014 N/A Yes named child