6 Medicines in schools – a survey of stakeholders

Aim To determine the perspectives of stakeholders on how children’s medicines are dealt with in schools. Methods Stakeholders were children with long-term conditions or receiving intermittent medicines and their families, school staff and healthcare professionals. Between August 2015 and July 2016, children on long term therapy and their parents/guardians completed a paper-based questionnaire. Parents of children receiving intermittent medicines took part in a telephone survey. Other stakeholders completed electronic questionnaires. Questions related to medicine type, administration, storage, record-keeping, staff training, communication and problems encountered. Quantitative data are presented using summary statistics, free text responses were categorised by theme. Results Responses were received from 59 healthcare professionals, 24 parents of children with long term conditions and 15 children with long term conditions, 10 parents of children receiving intermittent medicines, 40 school staff and 11 school nurses. The age range of the children who completed the questionnaire (or had it completed by their parent) was 4–16 years. The number of regular medicines taken at school ranged from 0 to 4, the number of medicines taken at school when required ranged from 0% to 12. 72.5% of school staff respondents were from primary schools (±nursery), 20.0% from secondary and 7.5% from schools for pupils with special needs. Children needed to take oral and buccal medicines, inhalers, nebulised treatment, topical, rectal and injectables at school.57.6% of healthcare professional respondents were aware of problems encountered by patients with medicines at school. 47.1% of school staff respondents said there were challenges with the administration of medicines. 52.5% said there was some room for improvement in how they managed medicines at their school. 54.5% of school nurse respondents were aware of problems with medicines at school. 41.7% of parent and 66.7% of child respondents reported at least one problem. Four parents of children receiving intermittent treatment said that their child needed to take their medicine during the school day. One was very unsatisfied with how the medicines were dealt with at school. The most common problems reported by all stakeholder groups were missed doses, medicine not available when required and medicine supply running out. Medicines perceived to cause particular problems were: medicines needing fridge storage, antibiotics, inhalers, nebulisers, controlled drugs, buccal midazolam, rectal diazepam, insulin, hydrocortisone, Creon, carnitine, baclofen and Epipen. Clinicians and parents try to avoid children and young people needing to take medicines at school but this isn’t always possible. In general, schools are accommodating of the needs of children requiring medication at school but school staff reported a number of challenges such as appropriate storage and access to medicines, clear instructions, and liaising with healthcare practitioners. Schools reported a lack of expertise about medicines and therefore relied on adherence to systems, policies and procedures as an indication of the quality of medicines management. Conclusion There are challenges associated with medicines management at school. Future work should focus on addressing the areas of concern highlighted by stakeholders, in particular: storage of, and access to, medicines and communication about medicines.