Document Details Guidance For The Use Of Emergency Rescue Medication for Children With Epilepsy (Administration Of Buccolam)

Transcription

1 Title Document Details Guidance For The Use Of Emergency Rescue Medication for Children With Epilepsy (Administration Of Buccolam) Trust Ref No Local Ref (optional) Main points the document Guidance on the use of Buccolam covers Who is the document Practitioners working in Children s services aimed at? Author Tash Grocott/ Rita O Brien Approval Process Approved by Medicines Management Group (Committee/Director) Approval Date 13/7/2016 Initial Equality Impact Yes Screening Full Equality Impact No Assessment Lead Director Associate Medical Director Category Guidance Sub Category Review date 30/7/2019 Distribution Who the policy will be Children s community nursing / Dental service distributed to Method Via website Document Links Required by CQC Yes Required by NHSLA Yes Other Amendments History No Date 1 July 2013 Version 1 3 July 2016 Reviewed - No changes 4 5

2 GUIDANCE FOR THE USE OF EMERGENCY RESCUE MEDICATION FOR CHILDREN WITH EPILEPSY ADMINISTRATION OF BUCCOLAM Midazolam Oromucosal Solution Pre filled Oral Syringe 1.0 Why do we administer Buccal Midazolam? 1.1 The majority of children who have epilepsy usually recover within a short period of time after a seizure. However there are occasions when this does not happen and the child goes into a prolonged seizure will vary from child to child. 1.2 A child who has experienced a prolonged seizure of Status Epilepticus may be prescribed Buccal Midazolam, by their Doctor, in order to treat further prolonged seizures or serial seizures without recovery in between. 1.3 There are different preparations of Buccal Midazolam and it is essential that training is accessed for the preparation prescribed. 2.0 Buccolam 2.1 Each pack of Buccolam contains 4 single use syringes each containing same dose of medication, individually packed in protective plastic tubes. 2.2 Each dose comes is sealed tamper proof plastic tube containing one pre filled ready to use oral syringe, which is colour coded according to strength. Each oral syringe contains one dose of Buccolam which is clear colourless liquid. There is a plastic cap on the end of the syringe. This must be removed before administering the medication. 2.3 The patient information that comes with Buccolam outlines colour coding for general age ranges. However there may be some circumstances where a child may be prescribed a dose outside this age range. 2.4 Buccolam is a medication from the group of drugs called benzodiazepines that effect the central nervous system. Buccolam has a muscle relaxant and anti-convulsant properties. Page 2 of 6

3 3.0 Buccal 2.5 All medication has the potential to cause side effects. The side effects of Buccolam may include drowsiness, shallow breathing (respiratory depression) confusion, nausea and vomiting. 3.1 The buccal area is the space between the inside of the cheek and the gum of the lower jaw by the back teeth. 3.2 Buccolam is absorbed directly into the bloodstream from this area. Buccolam should not be swallowed, but if swallowed accidently will not cause any harm. 4.0 Individual Authorisation Form 4.1 An individual authorisation form is required for each child. This is because the dose and the point at which the medication should be administered during the seizure, will be different for each child. 4.2 The authorisation from should clearly state: The child s details The product and dose to be given When the Buccolam is to be given e.g. after 5 minutes Included on the authorisation form should be an indication of when an ambulance is to be summoned. 4.3 The authorisation form must be updated annually or whenever there are any changes to the child s emergency rescue medication details. 4.4 Whenever emergency rescue medication (Rectal Diazepam or Buccal Midazolam) is being administered to a child for the first time in a school setting a paramedic ambulance must always be summoned. 5.0 Procedure for administering BUCCOLAM (Midazolam Oromucosal Solutions ) Where possible two members of staff should be involved in this procedure Check that the child s details match the pharmacy label on the medication and on the authorisation form and ensure it is the correct medication (Buccolam) and dose for the individual child. Check that the medication is within the expiry date Check at what stage in the seizure it should be given (e.g after 5mins) Page 3 of 6

4 Break the tamper proof seal and remove the oral syringe from the protective plastic tube. Put on latex free gloves (this is optional) Remove and throw away the oral syringe cap before use, to avoid choking. Explain to the child what is going to happen Wipe away any excess saliva Part the child s lips and carefully insert the tip of the oral syringe into the Buccal area of the child s mouth, between the cheek and the gum of the lower jaw but the back teeth. Slowly drip the Buccolam solution into this area until the oral syringe is empty. If the child s teeth are clenched together they do not need to be parted. Remove the oral syringe from the child s mouth It is not a problem if a small amount of medication is swallowed. Ensure the child s privacy and dignity is maintained as much as possible at all times Do not leave the child unattended until he/she has fully recovered. Two adults must be present during the procedure to check the medication and its administration. 6.0 Disposal 7.0 Storage 6.1 After administering the Buccolam it is advisable to keep the used oral syringe until the child is fully recovered. Ambulance staff may wish to check which medication has been given. Once checked the used oral syringe can be disposed of in a closed waste bin. 7.1 Buccolam should be stored at room temperature (not in a refrigerator) and not exposed to strong sunlight. 7.2 Weekly checks must be made to ensure the correct amount of medication is in place and is in date. 7.3 Buccolam should be kept in its original container and be clearly labelled with the child s name. The Buccolam should be kept as part of a kit and stored in an accessible place but must be out of reach of other children. The kit should comprise of: An authorisation from signed by the child s Clinician or Epilepsy Specialist Nurse A form to record administration of the medication Buccolam oral syringe in its sealed protective plastic tube. Paper tissues Page 4 of 6

5 8.0 Recording 8.1 After administering the Buccolam it is important to record that you have done so. The form you use should include details of the medication you gave, the dose given, the route of the administration of the Buccolam should also be included. 8.2 The incident should also be recorded, including a description of the seizure, duration and action taken. Information about what happened to the child following the administration of the Buccolam should also be included. 9.0 Reporting 9.1 The administration of Buccolam medication should be reported to the parents/carers as soon as possible so that replacement medication can be obtained Carrying the Buccolam kit (e.g. on day trips) 11.0 Training 10.1 When off school premises, the Buccolam should be kept as part of a kit with the appropriate equipment and paper work and should always be looked after by the member of staff who has responsibility for administering it ( should it be required) It must never be left unattended Staff who has volunteered to administer Buccolam (emergency rescue medication) must receive training for each individual child, from a qualified health care professional e.g. Epilepsy Specialist Nurse, School nurse Training must be updated annually Authorisation Form 12.1 The authorisation form must be updated annually or whenever there are any changes to the child s emergency rescue medication details. Page 5 of 6

6 Buccal Midazolam Oromucosal Solution in a pre filled Oral Syringe (Buccolam) AUTHORISATION FORM I, the Prescriber.(Child s Clinician) (base and tel no: ) Give permission for the Buccal administration of a Buccolam pre filled oral syringe by staff who have received specific training. I take full responsibility for this medication to be given as outlined below. SIGNED: DATED: SIGNED: DATED: Parental consent for school / other carers NAME OF CHILD:.D.O.B:. NHS NO: SCHOOL HOME ADDRESS: OTHER SETTING: DOSE TO BE ADMINISTERD: ONE MG PRE FILLED ORAL SYRINGE ROUTE: BUCCAL To be given if seizure lasts longer than: minutes Special Instructions (if required) When to call for a paramedic Ambulance: Whenever any emergency rescue medication is being given to this child for the first time in school/setting. If the seizure has not resolved after minutes following administration of Buccolam. INSTRUCTIONS FOR ADMINISTRATION Break the tamper proof seal and remove the oral syringe from the protective plastic tube. Remove and throw away the oral syringe cap. Place the tip of the oral syringe into the Buccal area of the child s mouth, between the cheek and the gum of the lower jaw by the back teeth. Slowly drip the Buccolam solution into this area until the oral syringe is empty. Remove the oral syringe from the child s mouth. Page 6 of 6