Do You Need Training to Administer Midazolam?

Do You Need Training to Administer Midazolam?

When someone experiences a prolonged seizure, the actions taken in those next few minutes can make a life-changing difference. Buccal midazolam is an emergency rescue medication used to stop prolonged or repeated seizures, but despite how commonly it is prescribed in schools, care homes and supported living settings, there is still confusion around one important question:

Do You Actually Need Training to Administer Midazolam?

In our professional opinion, the answer is absolutely yes.

At Teach Health, our nurse trainers have been delivering epilepsy and buccal midazolam training for more than 30 years to over 50,000 school staff, adult carers and healthcare professionals across the UK. All training is delivered by registered nurses with clinical experience in epilepsy management and follows current ESNA, NICE, CQC and Department for Education guidance.

Most importantly, our training is built around the realities of supporting people with epilepsy in real-world situations, not just textbook theory.

Midazolam Is Not “Just Another Medication”

One of the most dangerous assumptions people make is thinking that buccal midazolam is simply another routine medicine.

It is not.

Midazolam is a Schedule 3 controlled drug and a potent sedative. When administered appropriately it can stop a seizure and potentially prevent serious complications. However, if given incorrectly, at the wrong time, or in excessive doses, it can depress breathing and create significant risk.

Equally important is understanding that giving the medication is only one part of the emergency response.

The person still requires:

close observation,
monitoring of breathing and colour,
correct positioning,
post-seizure support,
and clear escalation if recovery does not happen as expected.

Administering buccal midazolam safely requires calm decision-making, understanding seizure presentation, following an individual care plan and knowing exactly when emergency services are needed.

That level of confidence does not come from watching a short video or receiving a quick handover from another member of staff.

Why Proper Training Matters

The biggest mistake organisations make is assuming that a quick demonstration or informal handover is “good enough”.

In reality, administering midazolam is a specialist medicines procedure that requires:

structured, evidence-based training,
competency assessment,
understanding of epilepsy,
and regular refresher training.

Good training should never focus only on the technical administration steps. It should also build confidence, decision-making skills and teamwork so staff feel prepared to act under pressure.

Seizures are distressing to witness. They often happen unexpectedly and can understandably trigger panic in carers or staff who do not feel adequately prepared. However, training changes how people respond.

When people know what to do, they are far more likely to override panic by focusing on the procedure they have practised and understood.

Real-World Experience Matters

At Teach Health, we believe midazolam training should be delivered by healthcare professionals with real clinical experience supporting people with epilepsy.

There is a huge difference between learning from slides and learning from nurses who have:

witnessed different seizure types,
administered buccal midazolam in real emergencies,
supported recovery afterwards,
communicated with families,
and followed individual epilepsy care plans in practice.

That practical experience allows trainers to answer the difficult “what if?” questions that staff genuinely worry about.

For example:

What if the person is eating when the seizure starts?
What if they are being hoisted?
What if they are in the bath or swimming?
What if they are injured during the seizure?
What if the medication has expired?
What if the prescribed dose differs from the care plan?

These are the situations staff remember because they reflect real life.

A Case Study: When Lack of Training Delays Treatment

One situation that many school staff and adult carers will recognise, happened in a supported living setting where a young person with epilepsy experienced a prolonged convulsive seizure during an evening meal.

Several staff members were present, but despite genuinely wanting to help, nobody immediately took control of the situation.

Different staff members had different ideas about what should happen:

nobody immediately started timing the seizure,
some believed they should “wait a bit longer,”
others were unsure who was authorised to administer the medication,
and the care plan remained in the emergency bag while staff tried to call senior staff members.

By the time buccal midazolam was administered, the seizure had significantly exceeded the agreed threshold. The young person required emergency hospital admission.

With clearer procedures, proper training and regular scenario practice, the situation could likely have been managed far earlier and with much greater confidence.

Why Refresher Training Is So Important

Epilepsy practice evolves constantly.

In 2025, seizure classifications were updated significantly, reducing the number of seizure types from 63 to 21 to create a more practical and clinically useful framework. A newly recognised seizure type — epileptic negative myoclonus — was also added.

These changes matter because seizure descriptions are now based more heavily on the full sequence of symptoms rather than only the first observable sign.

This means detailed witness accounts are now more important than ever.

Staff need to understand:

what happened first,
how the seizure progressed,
what recovery looked like,
and how to accurately document the event afterwards.

This information can directly affect diagnosis and treatment decisions.

Refresher training helps staff:

stay updated with guidance
deepen understanding through experience
revisit emergency procedures
and maintain confidence

For schools, refresher training is generally recommended annually in line with Department for Education guidance. ESNA guidance recommends refresher training every two years, although many organisations choose more frequent updates depending on risk levels and staff turnover.

Competency Means Different Things in Different Settings

One important issue often overlooked is that competency requirements differ between settings.

In Schools

In schools, buccal midazolam administration is usually a delegated healthcare task for named staff supporting a specific pupil.

Training therefore focuses heavily on:

understanding the child’s epilepsy care plan,
recognising their individual seizure presentation,
knowing exactly when medication should be given,
and following escalation procedures safely.

In Adult Social Care

In adult social care, buccal midazolam sits within a wider medicines administration framework regulated by the Care Quality Commission (CQC).

Competency therefore also includes:

medicines administration principles,
checking prescriptions,
following medication administration records (MARs),
understanding risk assessments,
documenting administration appropriately,
and demonstrating competency through formal assessment.

A one-size-fits-all approach to training simply does not work.

The Emotional Side of Seizure Care

One aspect often missed in online articles is the emotional impact seizures have on the person experiencing them.

Post-seizure care matters enormously.

People with lived experience frequently describe feeling:

frightened,
exhausted,
confused,
embarrassed,
or emotionally distressed afterwards.

Good training teaches staff not only how to administer medication, but also how to support the person compassionately during recovery and preserve dignity throughout the incident.

Virtual Training Can Be Highly Effective

There is still a misconception that face-to-face training is always superior.

In reality, virtual training can be just as effective when it is:

interactive,
scenario-based,
professionally facilitated,
and supported by robust competency assessment.

At Teach Health, our virtual sessions include:

live discussions,
real-life case studies,
scenario questions,
quizzes,
and opportunities for staff to ask questions openly.

This flexible approach allows services to maintain high standards while improving accessibility and reducing travel costs.

So — Do You Need Training to Administer Midazolam?

Yes.

Not simply because regulations or policies say so, but because the person experiencing the seizure deserves support from someone who feels calm, competent and prepared.

Administering buccal midazolam safely involves far more than giving a medicine.

It requires:

understanding epilepsy
recognising seizure patterns
following individual care plans
monitoring recovery
knowing when to escalate and communicating clearly under pressure.

Most importantly, it requires confidence built through high-quality, practical training.

Looking for Buccal Midazolam Training?

Teach Health provides accredited epilepsy and buccal midazolam training for:

adult services
care homes
supported living services
community care providers
schools & nurseries
colleges
SEND settings

Training is available:

face-to-face
live virtual
group-based
or individual

All sessions are delivered by experienced registered nurses with clinical epilepsy experience and aligned to current NICE, ESNA, CQC and Department for Education guidance.

If your organisation supports someone prescribed buccal midazolam, now is the time to review whether your staff feel genuinely competent and confident, not simply certified.

In a seizure emergency, preparation, confidence and clear decision-making can make all the difference.

Frequently Asked Questions

Can untrained staff administer buccal midazolam?
No. Buccal midazolam should only be given by staff who have had appropriate training and have been assessed as competent, following the person’s individual care plan.

How often should midazolam training be refreshed?
Specialist epilepsy guidance typically recommends refreshing midazolam training at least every two years, but in schools, annual updates are usually expected and are considered best practice.

Is virtual midazolam training acceptable?
Yes. Virtual training can be acceptable and effective if it is interactive, delivered by a suitably skilled trainer, covers the same learning outcomes as face‑to‑face training, and includes a clear process for assessing competence.

Is buccal midazolam a controlled drug?
Yes. Midazolam is classified as a controlled drug, so schools and care providers should follow their medicines policy and any local guidance on safe storage, record‑keeping, and disposal.

About the author

This article was written by the clinical team at Teach Health, specialists in epilepsy and health training for adult social care and education settings across the UK.

While every effort has been made to ensure the accuracy of the information in this article, the author does not accept liability for any inaccuracies or for actions taken based on this information.