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Training care home staff in the administration of buccal midazolam

What are the professional guidelines?

Care home providers should consider using an accredited learning provider. This is so care home staff who manage and administer medicines can be assessed by an external assessor.

Health professionals working in, or providing services to, care homes should work to standards set by their professional body. They should ensure that they have the appropriate skills, knowledge and expertise in the safe use of medicines for residents living in care homes. The new buccal midazolam training guideline may fit this purpose.

Why do some people need buccal midazolam?

Most people with epilepsy have seizures that last a short time and stop by themselves. Sometimes, a seizure can last too long and become status epilepticus. Some people may need emergency medicine to treat status epilepticus.

Status epilepticus (sometimes just called status) is seizure activity that lasts too long. It happens when a seizure doesn’t stop in the usual time, or when someone has seizures one after another without recovering in between. Status epilepticus can happen with any type of seizure.

Who can give buccal midazolam?

People who have had epilepsy awareness training and buccal midazolam training can give buccal midazolam

Epilepsy awareness training should include the following components:

Course content

Essential components

Desirable components

What is epilepsy?


Types of seizures


First aid


Seizures that last too long/status epilepticus


Care plans


Risk assessment




Interactive case discussions


Cultural awareness


Psychosocial issues


Buccal midazolam training should include the following components:

Course content

Essential components

What is buccal midazolam?

What are the different preparations?

Different ways it can be given

Practical demonstration using DVD or visual aids and use of water in a syringe to demonstrate on a volunteer

Identifying and using an individual’s buccal midazolam care plan

Recognising prolonged seizures (including non-convulsive)

Possible side-effects

When to seek medical help

Recording when buccal midazolam has been given


How often should buccal midazolam training be reviewed?

Care home providers should ensure that all care home staff have an annual review of their knowledge, skills and competencies relating to managing and administering medicines.

Care home providers should identify any other training needed by care home staff responsible for managing and administering medicines.

If there is a medicines-related safety incident, this review may need to be more frequent to identify support, learning and development needs.

Download a template buccal midazolam care plan or contact the Epilepsy Action Helpline to request a paper copy.

Event Date: 
Thursday 17 October 2019

Epilepsy Action would like to thank Phil Tittensor, who is chair of the Epilepsy Specialist Nurse Association (ESNA) for his advice when writing this document.

This information has been produced under the terms of Epilepsy Action's information quality standards.

  • Updated February 2020
    To be reviewed July 2022

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