ESNA Buccal Midazolam Guidelines 2026: Key Changes to Emergency Seizure Medication Training

The Epilepsy Specialist Nurses Association (ESNA) has published its updated ESNA Buccal Midazolam Guidelines 2026, providing revised best practice recommendations for the training, assessment and governance of emergency seizure medication administration in community settings.

For organisations delivering or commissioning Buccal Midazolam training, epilepsy awareness training, or emergency seizure medication training, understanding these recommendations is important when reviewing workforce competence, governance arrangements and clinical safety systems.

Whilst the ESNA Buccal Midazolam Guidelines are not mandatory requirements or legislation, they are likely to influence future commissioning decisions, training programmes, competency frameworks and quality assurance processes throughout health, social care and education sectors.

In this article, we examine the key changes and explore how Guardian Angels Training has already incorporated many of these principles into its epilepsy and rescue medication training programmes.

What Are the ESNA Buccal Midazolam Guidelines?

The ESNA Buccal Midazolam Guidelines are best practice recommendations developed by the Epilepsy Specialist Nurses Association to support the safe administration of emergency seizure medication by professional carers and support staff.

The guidance focuses primarily on:

Buccal Midazolam administration
Emergency seizure medication training
Epilepsy awareness
Competency assessment
Governance and accountability
Train-the-Trainer standards
Emergency care planning
Risk management

The 2026 edition replaces the previous 2023 guidance and reflects updated evidence, expert consensus and developments within epilepsy care.

Why Were the ESNA Midazolam Guidelines Updated?

The revised guidance was developed following:

Findings from the REMIT (Rescue Epilepsy Medication and Training) study
Feedback from epilepsy specialists and educators
Advances in epilepsy care
Concerns regarding variation in training quality across the UK
A desire to improve consistency in emergency seizure medication training

The overarching aim is to support safer, more consistent care for people who may require emergency seizure medication during prolonged or cluster seizures.

ESNA Buccal Midazolam Guidelines 2026: Summary of Key Changes

Area	Previous Position	2026 ESNA Recommendation
Training Duration	Variable	Recommended minimum 6 learning hours initially, 3 hours refresher
Refresher Training	Recommended	Recommended every 1–2 years
Trainer Standards	Less defined	New competency-based trainer framework
Train-the-Trainer	Variable approaches	ESNA proposes national oversight model
Assessment	Attendance often accepted	Greater emphasis on demonstrated competence
Delivery Methods	Mixed approaches	Face-to-face identified as preferred approach
Competency Reviews	Variable	Two-yearly revalidation recommended
Curriculum	Core epilepsy content	Expanded curriculum including SUDEP, governance and risk assessment
Online Training	Widely used	Online-only training not recommended for medication administrators
Governance	Limited detail	Stronger focus on accountability and documentation

Greater Emphasis on Buccal Midazolam Competency Assessment

One of the most significant messages within the ESNA Buccal Midazolam Guidelines is that attendance alone should not automatically be considered evidence of competence.

The guidance recommends that organisations assess learners using a combination of:

Practical demonstration
Scenario-based discussions
Verbal questioning
Written questioning
Observation of practice

This reflects a growing movement throughout healthcare towards competency-based assessment rather than attendance-based certification.

For organisations supporting people with epilepsy, this means ensuring staff can demonstrate safe decision-making and practical skills, not simply attend a training course.

Face-to-Face Buccal Midazolam Training Remains the Preferred Approach

The ESNA guidelines identify face-to-face training as the preferred method for teaching practical skills including:

Seizure first aid
Seizure recognition
Emergency response
Buccal Midazolam administration

However, the guidance also recognises that:

Blended learning may be appropriate
Live virtual learning may be suitable in certain circumstances

The guidelines advise against relying solely on pre-recorded online learning where staff are expected to administer emergency seizure medication.

Recommended Duration for Buccal Midazolam Training

Initial Buccal Midazolam Training

ESNA recommends a minimum of:

6 Total Learning Hours

Including:

Theory
Practical demonstrations
Skills development
Reflection
Assessment

Buccal Midazolam Refresher Training

ESNA recommends a minimum of:

3 Total Learning Hours

Recommended every one to two years.

Expanded Epilepsy Training Curriculum

The updated guidance extends beyond medication administration and includes broader epilepsy-related learning.

Epilepsy Awareness

Causes of epilepsy
Diagnosis
Seizure classification
Triggers
Treatment options

Emergency Seizure Management

Seizure first aid
Status epilepticus
Escalation procedures
Emergency services involvement

Safety and Governance

Risk assessment
Accountability
Documentation
Safeguarding
Communication

SUDEP Awareness

For the first time, Sudden Unexpected Death in Epilepsy (SUDEP) is firmly embedded as a core training topic, reflecting growing recognition of its importance in epilepsy care.

ESNA Buccal Midazolam Train-the-Trainer Recommendations

One of the most widely discussed aspects of the updated guidance is ESNA’s proposal to oversee Buccal Midazolam Train-the-Trainer programmes.

The recommendations include:

Defined trainer competency levels
Educational qualification recommendations
Revalidation every two years
Ongoing CPD
Clinical oversight
Quality assurance arrangements

The intention is to improve consistency across epilepsy Train-the-Trainer programmes and support safer emergency seizure medication training nationally.

How Guardian Angels Training Already Aligns With and Exceeds Many ESNA Buccal Midazolam Guideline Recommendations

Whilst the publication of the ESNA Buccal Midazolam Guidelines 2026 is an important development, many of the recommendations reflect approaches that Guardian Angels Training has championed for many years.

Competency Before Certification

Long before the publication of the updated guidance, Guardian Angels Training had already adopted a competency-focused approach through:

Practical assessment
Scenario-based learning
Competency discussions
Reflective practice
Knowledge assessment
Workplace competency frameworks

Programmes That Meet or Exceed Recommended Learning Hours

Many of our epilepsy and Buccal Midazolam training programmes already meet or exceed the learning hours now recommended within the ESNA guidance.

Strong Governance and Quality Assurance

Guardian Angels Training is proud to be:

Skills for Care Quality Assured Learning Service (QALS)
Holder of the Skills for Health Quality Mark
Trusted by NHS organisations, hospices, social care providers, local authorities and educational establishments throughout the UK

Experienced Clinical Educators

Our trainers possess extensive experience in epilepsy care, emergency seizure medication, learning disability services, community healthcare and clinical education.

Established Train-the-Trainer Expertise

Guardian Angels Training has delivered Train-the-Trainer programmes and regulated teaching qualifications for many years, including the Level 3 Award in Delivering Training and Level 3 Award in Education and Training.

Frequently Asked Questions About the ESNA Buccal Midazolam Guidelines

Are the ESNA Buccal Midazolam Guidelines mandatory?

No. The ESNA Buccal Midazolam Guidelines are best practice recommendations rather than statutory requirements or legislation.

Has Buccal Midazolam training changed in 2026?

The updated guidance places greater emphasis on competency assessment, governance, trainer standards and practical learning.

How long should Buccal Midazolam training last?

The guidance recommends a minimum of six learning hours for initial training and three learning hours for refresher training.

Does Buccal Midazolam training require practical assessment?

The guidance recommends that competence should be demonstrated through questioning, observation, practical activities and scenario discussions.

Who can deliver Buccal Midazolam training?

The guidance outlines recommendations for healthcare professionals, Train-the-Trainer facilitators and certain non-clinical in-house trainers operating under appropriate governance arrangements.

Final Thoughts

The ESNA Buccal Midazolam Guidelines 2026 represent the most comprehensive guidance ESNA has produced regarding emergency seizure medication training.

Although the document does not introduce new legal requirements, it provides a detailed benchmark that organisations may choose to use when reviewing epilepsy training, Buccal Midazolam administration training and Train-the-Trainer programmes.

The strongest themes throughout the guidance are competency, consistency, accountability and patient safety.

Looking for Buccal Midazolam Training?

Guardian Angels Training delivers:

Epilepsy Awareness Training
Buccal Midazolam Training
Emergency Seizure Medication Training
Buccal Midazolam Train-the-Trainer Programmes
Epilepsy Instructor Training
Competency Assessment Programmes

Contact Guardian Angels Training today to discuss your requirements.