2.6.3 First Aid and Medication

Contents

1. Home Remedies
2. First Aid
3. Medication Administration
4. Medical Emergencies
5. Monitoring and Notifications

1. Home Remedies

Body fluids and blood borne viruses: Separate guidance is provided in Body Fluids and Blood Borne Viruses Guidance

Home Remedies are medicines, suitable for children, which can be bought 'over the counter' without prescription, including Paracetamol.  The Home Remedies approved to be given to children are set out in Section 3, Home Remedies - First Aid, Home Remedies and Prescribed Medicines Guidance (NOTE: The Home Remedies that are permitted were changed in April 2009 - if you are not familiar with these changes, please read this guidance).

1.1 Aspirin

Although Aspirin may be purchased 'over the counter', without prescription; it may not be given to children unless prescribed by a medical practitioner.

1.2 Other Home Remedies

The other Home Remedies that are approved to be given to children are listed in Section 3, Home Remedies - First Aid, Home Remedies and Prescribed Medicines Guidance; which also provides guidance on their use. 

No other Home Remedies may be given to children without the written authorisation of a medical practitioner.

In any case, these Home Remedies may only be given to a child with appropriate Consent or having consulted the child's GP to ensure that no adverse reactions may result.

Home Remedies must normally be kept in a locked cabinet which is only accessible to staff.

If a child is permitted to keep his/her own Home Remedies, the arrangements for this must be set out in the Placement Plan.

Home Remedies, other than Paracetamol, should only be given for a maximum of 48 hours.  If the symptoms persist beyond that time the child should see a medical practitioner before further dosages are given.  However, if Paracetamol is given for 24 hours and the symptoms still persist, the child should see a medical practitioner before further dosages are given.

Where children are not deemed to be capable of administering Home Remedies themselves, care must be taken to ensure they consume the product as required, preferably in the presence of the member of staff.

Arrangements must exist in the home for regular stock checks to be undertaken of the Home Remedies kept in the home;  and for the disposal of those no longer in use or out of date.

2. First Aid

Body fluids and blood borne viruses: Separate guidance is provided in Body Fluids and Blood Borne Viruses Guidance

Fully equipped First Aid boxes must be kept in each home and in each vehicle used to carry children.  The Manager of the home must ensure that suitable arrangements exist to keep First Aid boxes equipped.

Children may administer their own First Aid if they have a suitable First Aid certificate or under the supervision of a certified member of staff.

If children are not deemed to be capable of giving First Aid themselves or under supervision, a certified member of staff must administer it.

3. Medication Administration

Body fluids and blood borne viruses: Separate guidance is provided in Body Fluids and Blood Borne Viruses Guidance

The following steps must be followed when administering medication:

• Staff must check the medication to ensure that it is prescribed for the young person in question.
• Staff must then check the Medication Administration Record (M.A.R) to ensure that the young person's name, name of medication, and the dosage instructions are correct and that any recent changes in therapy are taken into account.  Staff should also ensure that the dosage has not already been administered.
• The M.A.R must be checked to ensure that the details recorded match those of the pharmacy label on the medicine.
• Staff must then check to ensure how the medication is to be administered.
• Staff should sign the M.A.R immediately upon administration of medicine recording the date, time, dosage, balance, the staff members name and signature.
• Where medicines are administered by a Monitored Dosage System (M.D.S) the staff member must be able to easily identify the individual medicines and be able to distinguish particular instructions (i.e. before or after food).
• Staff must record the refusal or non administration of medicine including the reason why.
• Where there is a variable dosage or PR (Prescribed as Required) medicine there should ideally be adequate details on the M.A.R about how the appropriate dose should be selected, this should be selected, this should relate to the individuals Care Plan.

3.1 Designated Person

Each home must have a designated person responsible for looking after the medicines when young people are unable to manage their own medicines.  This may be the homes manager or a person delegated who has appropriate training and assessment and is deemed "competent" to carry out this role.

3.2 Record Keeping

The registered person or delegated individual will be responsible for ensuring that all medicines are recorded and that these records are maintained.  The standard of record keeping should ensure that records are properly completed, legible and current, providing a complete audit trail of medication administered.  The style or manner of the records is that the discretion of the individual home although advice relating to this should be obtained from the dispensing pharmacist.  The home must retain an up to date reference of current medication prescribed to each young person accommodated.

3.3 Receipt of Medicines

All medicines bought into the home, from whatever source, including discharge medication from hospital, medicines prescribed in an acute situation as well as medicines prescribed on a regular on going basis or those bought from another home should be recorded.

The record should show:

• Date of receipt
• Name, strength and dosage of medicine
• Quantity received
• Young person for whom medication is prescribed/purchased.
• Signature of the member of staff receiving the medicines.

At any given time the home should be able to identify the medicines prescribed for each individual young person.

3.4 Self Administration of Medicines

A record should be maintained of the medicines given to a self-administering young person, including date and signature of the responsible care worker.  This information will assist staff to monitor compliance with therapy.  A self-administering service user does not need to maintain a Medication Administration Record (M.A.R) chart.  This practice relates to medicines such as Ventolin and Becotide inhalers, staff in the homes should however monitor this in terms of good practice.

In all cases of self medication the home is to draw up an appropriate Risk Assessment plan relating to the possible risks and plans to reduce the risk around potential hazards of self medication to the service user and others.

3.5 Administration by Staff

The M.A.R (Medication Administration Record) chart must be kept in the home to record the administration of medicines, this includes both prescribed and non prescribed medication, and must be dated when the medicines are administered.  The signature of the person administering the medication must be linked to a specific medicine.  This is to facilitate audits at a later date and to ensure that the records are clear.  The person administering the medication must refer to the chart at the time of administration to ensure medication is administered appropriately.

The M.A.R chart should be checked by a second person and referenced back to the original prescription.  Where possible it is advisable to obtain printed M.A.R charts from the dispensing pharmacy.  The procedures on systems implemented by the home for the administration of medicines must respect the privacy and dignity of the young people.

Medicines that have been prescribed for a young person should under no circumstances be given to another young person or used for a purpose other than that which they were prescribed for.  All medicines must be administered strictly in accordance with the prescriber's instructions.

The administration of medicine may be undertaken by care staff who are trained to do so.  There are certain specialist invasive techniques which must be carried out by the appropriate professional (community nurse) these include:

• Subcutaneous injection of insulin
• Medicines administered by the vaginal or rectal route
• Giving oxygen
• Giving medicines through a Percutaneous Endoscopic Gastronomy (PEG) tube.

Each home should identify specific times of day when medicine will be administered, this may follow the pattern of meal times or will occur through direction from the prescribing GP who will give instruction.

3.6 Disposal of Medicines

To provide a full audit trail of medicines through a care home, a record is required to identify a removal from the home of a service user's medicines this record should detail the following:

• Date of disposal/return to pharmacy
• Name and strength of medicine
• Quantity removed
• Young person for whom medicine was prescribed/purchased
• Signature of staff member who arranges disposal of medicine

Unused medication which is being disposed of must in all instances be returned to the prescribing pharmacy and a record of the date of return/disposal should be included on the M.A.R chart.

3.7 Labelling of Medication

For a care home member of staff to administer a medicine it must have a printed label containing the following information:

• Young persons name
• Date of dispensing
• Name and strength of medicine
• Dose and frequency of medication

This information must be checked by the administering staff member to ensure the accurate dispensing of medicine.  Where appropriate staff should liaise with the dispensing pharmacy with a view to using their monitored dosage systems.

3.8 Non Prescribed Medicines

Non prescribed medication is another name for homely or household remedies, which refers to medicines available over the counter in community pharmacies.  There are a range of household medications, which can be maintained in the home, a list of which is contained in the young person's medical book. This includes basic remedies for indigestion, colds and flu remedies (not those containing Paracetamol).

3.9 Storage of Medicines

Young people responsible for their own medication should, where possible, be provided with a personal lockable drawer or cupboard, should a problem arise the home should have a risk assessment in place to have access to such with consent from the young person or those with PR (Parental Responsibility).

Where staff have the responsibility of handling medicines on behalf of young people there must be a designated secure drawer or cabinet maintained at a temperature suitable for the storage of medicines.

If the home uses a medicine cupboard it must be of suitable size and construction with a quality lock.  The security of medicines should not be compromised by the cupboard being used for non clinical purposes, for example housing electrical equipment.  The items for the medicine area or cupboard should not be part of the master system for the home.  Key security is integral to the security of the medicines, therefore, access should be restricted to authorised members of staff only.

Where staff are required to administer medicines a Control of Substances Hazardous to Health (COSHH) Regulations Assessment should be undertaken of those medicines, which must be handled.  Examples include external applications such as steroids, cytotoxic medicines such as Methotrexate.  The purpose of this assessment must provide staff with an understandable statement of personal risk, safe practice to be followed to minimise personal risk and what to do should the care worker come into contact with the product.

Additionally, the home must provide a separate secure and dedicated refrigerator to be used exclusively for the storage of medicines requiring cold storage such as insulin.  Whilst in use, the temperature of the refrigerator must be monitored daily using a maximum/minimum thermometer.  Staff must also have a clear understanding of what action to take should the temperature be outside the normal range (usually between 2 and 8 degrees centigrade) detailed on the medication itself.  The refrigerator should also be defrosted and cleaned regularly.

3.10 Refusal and Covert Administration

It is an individuals right to refuse medicines, staff must record the reason for refusal of the dose so this can be appropriately discussed at the time of a medication review.  Where a young person is considered incapable of giving consent to treatment, the GP and Social Services and family should be consulted in respect of previous instruction given by the young person.

There may be certain circumstances in which covert administration may need to be considered to prevent a young person missing out on essential treatment.  In this case a multi professional team, which includes the GP, Social Worker, family and carers must undertake and agree a decision, having assessed the care needs of the young person.  A written policy must be developed specific to the individual and recorded as part of the care plan, in this instance any agreement and use of covert administration of medicine must be reported to the Regulatory Authority.  To aid the young person in concordance with this, alternative formulations of the medicine i.e. liquid or powdered preparations must be explored.  A medicine should only be crushed and administered where this is proven not to alter the medicines pharmaceutical properties.

3.11 Procedure for Medicine Administration

Medication should never be removed from its original container in which a dispensing pharmacist or GP supplied it until the time of administration.  The best way of administering medicines is directly from the container in which it was prescribed, medicines can be placed in a small pot after removing it from the dispensed container as a way of hygienically handling it to a service user.  Medication should never be dispensed for someone else to administer at a later time or date.

The home must formulate its own procedure for the administration of medicine and ensure the staff are suitably trained for the procedure. The procedure must be in writing and available in the home, this is recommended both for the administration of both prescribed and homely remedies, the following issues must be carefully considered when developing the procedure:

• How the identity of the service user will be checked.
• The way that the members of staff check the service user's name, the name of the medication and the dosage instructions, noting in particular any recent changes in therapy and ensuring that the dose has not already been administered.
• The way the members of staff check that the MAR chart and the pharmacy label match, checking the name of the service user, name of medicine, strength, and number of dose units and frequency match.  If there is a discrepancy a check should be made with the pharmacy or person in charge before giving the medicine to the service user.
• The way the medicine is to be administered.
• That the person administering the medication should sign the administration record immediately after the medicine has been given.
• Where medicines are administered from a MDS system containing more than one type of medicine, the person administering the medicines must be able to distinguish each individual medicine and be aware of any specific instructions e.g. before food.
• How a record should be made if the medicine is refused or not administered, including the reason why.
• When there is a choice of dosage e.g. 1-2 tablets, the number of tablets administered is recorded.  Variable dosage or 'PRN' medicines should ideally have adequate details on the MAR chart about how the appropriate dose should be selected but these should also be referenced in the individual service users care plan.
• When reference should be made to the care plan, particularly if a medicine is not given to a service user on a regular basis or is supplied 'when required' or where 'necessary.'

The name, initials and staff number of the staff member responsible must be included in the young person's MAR chart and the home should provide a list of those staff who are authorised to give medicines which includes a record of their approved initials.

The home must also have a written policy for the action to be taken if a medicine administration error is identified.  Any problems about the medicines given to a young person should be discussed with the prescriber.

3.12 Administration of Medicines Away from the Care Home

Normally a young person or responsible adult will be given the dispensed containers of medicine when going on leave/holiday etc.  Secondary dispensing of medicines or use of unsuitable containers i.e. envelopes, is discouraged.  Appropriate entries in the home's records should indicate the absence of young people and details of the medicines, prescribed for the young person, removed from the home should be made.

3.13 Disposal of Medicines

The medicines which are held in the home at any given time should be appropriate to the current therapy of the young person, any surplus or unwanted medicines should be disposed of in the appropriate manner.

When a young person leaves the home, the medicines should be returned to the young person or responsible adult, unless the young person has positively consented to their safe disposal.

When there is a change in therapy and a product has been discontinued the surplus should be returned to the supplier.

All medicines have an expiry date some of which are shortened when the product is in use i.e. eye drops, information on which will be included with the medicine.

The normal procedure for disposal of medicines should be a return to the prescriber and the home should maintain a record of all medicines removed from the home.

3.14 Controlled Drugs

This section should be read in conjunction with Drugs and Substance Misuse Procedure.

The additional Homes Regulations 2001 do not include any additional requirements for recording the presence and use of controlled drugs, it is, however, recommended in specialist residential settings, schools and secure units as a matter of good practice.

The majority of controlled drugs are prescribed on NHS prescription forms for individually named service users.  "Stock" controlled drugs such as Methadone can only be ordered if the organisation has obtained a home office licence.

The home should maintain a separate secure storage area for the sole use of controlled drugs and these should not be stored with normal prescription medication.  When administering controlled drugs this should be witnessed and countersigned by another designated member of staff.  A separate record must also be maintained by the home for controlled drugs including receipt, administration and disposal.  This must take the form of a bound book or register with numbered pages.  The record must contain the balance remaining and a separate page for each young person.  This must be checked at each administration and also on a regular basis, i.e. monthly.

Controlled drugs which have been obtained on an NHS prescription, may be disposed of in the same manner as other medicines, however, it is recommended that a receipt be obtained from the pharmacy.

Stock controlled drugs may only be destroyed in the presence of an authorised person.  In such cases a record of the destruction must be made in the controlled drug register.

3.15 Non Prescribed Controlled Drugs

Some staff may have to deal with substances that have been removed from a service user.  As a licence is required to possess Schedule 1 controlled drugs, the home's staff can only take possession of them for the purposes of handing them over to the police for disposal.  Where staff find such substances within the home the following steps should be taken:

• Inform the Manager of the home.
• Contact the young person's Social Worker or Out Of Hours.
• Contact the local police to advise of removal and arrange for collection.
• Notify Regulatory Authority in writing
• Follow Child Protection Procedures as needed.
• Maintain a written record of action taken, signed by all concerned including signatures from the police officers upon removal.

3.16 Adverse Drugs Reaction Reporting

Any adverse reaction (ADR) or suspected ADR should be reported to the GP and/or supplying pharmacist for the young person, and discussed prior to further administration of the drug in question.  The GP or supplying pharmacist will then advise on any action required by the home and report this to the medicines and healthcare regulatory agencies.  The home's staff will liaise with the prescriber about the submission of a report as appropriate.  The staff must also maintain a record in the home of this process.

3.17 Training of Care Staff

Particular care should be taken to ensure that the appropriate staff members are suitably trained in the use of medication, and the individual home will have a written policy stating how frequently training updates are assessed.  At present, there is no legislation requiring specific medication training for staff working with children and young people, the National Minimum Standards Guidance relates to the care provided to older people and adults (18 - 65).  It is however considered good practice for staff in children's homes to receive training and guidance on the administration of medicines, which may form part of internal training.

4. Medical Emergencies

Body fluids and blood borne viruses: Separate guidance is provided in Body Fluids and Blood Borne Viruses Guidance

If a child is at risk or requires First Aid/Medical attention, staff should apply first-aid procedures if it is safe to do so, and notify a Manager as soon as possible. However, staff must not compromise or delay the process of getting medical help by doing so. If in any doubt, call medical help.

If there is a risk of serious harm, injury or staff are unable to manage safely, the Police should be notified.

Staff should always assess the situation and if a medical emergency, send for medical help and ambulance.

Before assistance arrives:

• Do not move the person
• Try to clarify why the emergency has occurred
• Collect any drug samples or spillages (e.g. vomit) for medical analysis
• Do not induce vomiting
• Keep the person calm, under observation, warm and quiet
• If the person is unconscious:
• Ensure that they can breathe and place in the recovery position
• Do not move them if a fall is likely to have led to spinal or other serious injury which may not be obvious
• Do not give anything by mouth
• Do not attempt to make them sit or stand
• Do not leave them unattended or in the charge of another child
• Notify parents/carers
• For needle stick (sharps) injuries:
• Encourage wound to bleed. Do not suck. Wash with soap and water. Dry and apply waterproof dressing
• If used/dirty needle seek advice from doctor

When medical help arrives, pass on any information available, including vomit and any drug samples.

See the following additional Chapters:

No further action, beyond making the situation safe and attempting to confiscate harmful drugs or substances, should be taken without a Manager's authorisation, preferably in consultation with the relevant social worker.

5. Monitoring and Notifications

Body fluids and blood borne viruses: Separate guidance is provided in Body Fluids and Blood Borne Viruses Guidance

The manager of the home must ensure that arrangements exist for monitoring Home Remedies, First Aid or Prescribed Medicines given to children, ensuring that these and other related health care procedures are adhered to.

Injuries, Accidents, diseases or illnesses of a serious nature, should be notified to managers and others outside the home; as set out in the Designated Manager's Appendix

End