ESNA Midazolam Training Guidelines 2025

The Epilepsy Nurses Association (ESNA) has released the third edition of its Midazolam Training Guidelines (2025), the most comprehensive update yet to national best practice standards for the safe administration of emergency seizure medication in the community.

This is vital for anyone working in healthcare, as epileptic seizures are common but not all first-aiders or healthcare professionals are trained to act according to the correct guidelines. Administering rescue medication for epilepsy is not only a useful skill, but it can save a life in an emergency.

What are the New Guidelines for Midazolam Training?

The latest edition of the ESNA Midazolam Training Guidelines replaces the 2019 and 2022 versions, building on years of evidence, research, and consultation to ensure carers and healthcare professionals across the UK receive consistent, high-quality training when supporting people with epilepsy.

If healthcare professionals aren’t kept up to date with the latest techniques, it can put lives at risk, and any developments that may happen behind the scenes need to be made public as soon as they are proven effective.

The 2025 guidelines go far beyond a simple revision; they represent a complete refresh of the training landscape. Major changes include:

Broader Scope: The document now covers all emergency seizure medications, not just buccal midazolam – with reference to rectal diazepam and, in specialist cases, rectal paraldehyde.

Stronger Governance and Accountability: Commissioners, providers, trainers, and prescribers now share explicit accountability for ensuring training meets ESNA standards. Any deviation must be documented and justified in writing.

New Trainer Competency Framework: A tiered structure (Novice → Competent → Expert) now defines who can deliver training, minimum teaching qualifications (AET Level 3 or equivalent), peer endorsement, and two-year revalidation requirements.

ESNA Oversight for Train-the-Trainer Programmes: ESNA is now the official professional body for developing, accrediting, and monitoring all Train-the-Trainer (TTT) courses – ensuring national consistency, quality assurance, and robust governance.

Face-to-Face as Gold Standard: While hybrid and live-virtual formats are permitted under certain conditions, online-only, pre-recorded training is no longer acceptable for anyone expected to administer emergency seizure medication.

Defined Course Duration: Initial training must now last a minimum of six total learning hours (TLH), with refresher training every two years lasting at least three TLH. These are formally recognised as CPD-eligible hours, aligning with Ofqual Level 3 standards.

Expanded Core Curriculum: Mandatory modules now include epilepsy awareness, seizure recognition, SUDEP awareness, risk assessment, midazolam administration, and care planning. Optional and specialist modules can be added depending on role and setting.

Revised Carer Competency Checklist: ESNA recommends the use of a competency assessment tool to assess carer knowledge and skill through observation, discussion, and reflection – ensuring that attending training is not mistaken for competence.

Why these New Epilepsy Training Guidelines Matter

Epilepsy remains one of the most common neurological conditions, affecting over 600,000 people in the UK. For those at risk of prolonged or cluster seizures, timely and competent administration of emergency medication, such as buccal (oromucosal) midazolam, can be lifesaving.

However, studies like the 2025 REMIT report found that training standards, prescribing practices, and carer confidence still vary widely across the UK. ESNA’s new guidelines directly address this by introducing clearer national benchmarks, stronger governance, and a structured competency framework for all who teach or administer seizure rescue medicines.

In healthcare, developments to best practices happen often, but the training courses on offer rarely keep up. This can mean that healthcare providers are learning outdated methodology, or from data that could be misleading. The certification provided by these courses is essential for healthcare providers to stay compliant, and can be a key factor in their careers, as it’s a sought-after skill in a lot of healthcare settings.

But these new guidelines aren’t just for the benefit of healthcare professionals, they naturally focus on the people needing epilepsy care.

A Step Toward Safer, More Equitable Epilepsy Care

With any form of healthcare, the patient’s comfort and safety is paramount. The administration of rescue medications for epilepsy can be invasive, so experts have been working hard to develop guidelines that make it as safe and dignified as possible.

The new ESNA guidelines reflect learning from national reviews such as LeDeR (2023–24), which identified epilepsy as a leading preventable cause of death among people with learning disabilities.

By embedding consistent training and clear lines of accountability, ESNA aims to ensure that every person with epilepsy, regardless of where they live or who provides their care, receives safe, timely, and compassionate seizure management.

This is why our Buccal Midazolam Administration Training Course is heavily recommended for healthcare workers that specialise in learning disability support, as these courses can be tailored to focus more on those patients, and how the methodology and techniques can be adapted to better suit them.

All of our courses can be tailored to suit your team’s exact needs. Although the methodology rarely differs, we can pick more relevant studies, or expand on areas that your team will need to learn about. This can be done because all of our courses are taught by industry professionals, which know the new and old guidelines inside and out. They’re ready to guide you and your team with practical demonstrations backed up by the latest data, and their extensive knowledge means they’re more than happy to answer questions.

What This Means for Commissioners and Training Providers

We pride ourselves in the quality of our training courses, and always ensure that they follow the latest guidelines and feature the best data and supporting studies.

That’s why whenever guidelines are updated, we make sure to study them extensively and adapt our courses. In the case of the Midazolam Training Guidelines (2025), there are some important changes that we will integrate immediately.

Commissioners and training providers are now expected to:

Ensure all contracted epilepsy training complies with ESNA standards.

Confirm that trainers hold appropriate qualifications and revalidation.

Use the Competency Checklist to evidence skill, confidence, and safe practice.

This are fairly standard changes, but some training course providers are slow to update their courses, which reflects badly on them, impacts the course content, and could prevent the attendees from learning all that they should.

These expectations provide transparency, auditability, and assurance for regulators such as the Care Quality Commission (CQC), which is incredibly important for anyone working in the care industry.

When will these Guidelines Change Again?

ESNA plans to review these guidelines every three years, incorporating future NICE recommendations on nasal and intramuscular midazolam.

It’s important that all healthcare develops, and equally important for healthcare professionals to be up to date with the latest guidelines, with certification that shows this. The best way to learn is always through professionally taught training, and it gives you peace of mind that you’re providing the best care possible.

Most importantly, these updated guidelines will ensure consistency across the healthcare field. As an industry that thrives on collaborative efforts and shared information, these guidelines keep everyone working at a high level.

The Best Emergency Seizure Medication Training

As a specialist training provider, we deliver fully ESNA-aligned Buccal Midazolam and Emergency Seizure Medication courses, including Train-the-Trainer options. Our programmes meet and exceed the 2025 standards for duration, assessment, and trainer competence – helping you stay compliant and confident in your duty of care.

The best courses are taught by someone you trust. By only following the latest guidelines to the letter, and customising our courses to suit you, we ensure that you receive the best training, and can therefore improve the quality of care you provide.

Get in touch today to discuss ESNA-compliant training for your organisation.