1.6.7 Medication and First Aid

Contents

1. Introduction
2. Obtaining and Storing Medication
3. Controlled Drugs
4. Home Remedies/over the Counter Medication
5. Administration of all Medication
6. Stock Checks
7. Disposal of Medication
8. First Aid
9. Skilled Health Tasks (e.g. Diabetics, Physiotherapy Programme etc.)  
10. Recording 
11. Management of Medication Errors
12. Refusal of Medication
13. Emergency Admissions
14. Training

1. Introduction

This procedure relates to the provision and administration of medication and First aid in Children's Homes and Children's resources within the company.

This policy seeks to formalise the management of medicines for children and reflects legal requirements and the principles of good practice.

Children's homes are required by law to comply with the Care Standards Act 2000 and its associated regulations.

Medicines in the custody of the home must be handled according to the requirements of the Medicines Act 1968 and the guidelines from the Royal Pharmaceutical Society of Great Britain.

Children should be encouraged, where appropriate and following risk assessment, to retain and self administer and control their own medication in order to maximise their independence and retain control over their lives.

Some young people have been assessed as being unable to manage their own medication without assistance and need to be protected by the company policy and procedures for dealing with medicines.

Everyone involved in the care of a child is responsible for ensuring that his or her medication is managed appropriately. However the primary responsibility for the prescribing and monitoring of a child's condition remains with the general practitioner in consultation with other members of the health care team.

2. Obtaining and Storing Medication

Also see Section 3, Controlled Drugs

2.1 Obtaining Medication

Every child has a right to be able to see a GP of their choice (if appropriate). If a child is prescribed medication, staff should collect the prescription from the doctors (preferably with a child at the time of appointment) Staff are responsible for ensuring that medication is then collected from the pharmacy.

All medicines brought into the home from whatever source must be recorded as received within the Central Medical Log.

Staff should check that the medication is appropriately labelled with the details as that on the prescription and advice obtained from the GP in relation to its administration and care.

• Child's full name is identified.
• Name, strength and dose of medication
• Quantity received ( physical check against amount identified on label)
• Instructions

Where possible staff should request pre-packed medication rather than loose tablets in a bottle, although some medication cannot be pre-packed. If a medication has been pre-packed, it should be noted that the life span then becomes shorter (generally 3 months)

It is not acceptable that medication is labelled 'as directed' or 'as before'. If this happens staff should seek clarification from the pharmacist or the doctor and an appropriate label should be obtained and supplied.

Staff should always clarify with the pharmacist if the medication prescribed is categorised as a 'controlled drug' See Section 3, Controlled Drugs

All medication checked into the home must be checked, recorded and entered onto the appropriate systems (see Section 10, Recording)

Appropriate advice should always be sought re; side effects or any other food/medication that may contraindicate the effectiveness of the medication.

2.2 Storing/Retaining Medication

• Medicines must be stored in a locked cupboard within a locked room. Medicines should be stored below 25 C and away from sources of heat and moisture. Examples of places NOT suitable include kitchens, bathrooms and toilets and next to heaters.
• The key for the medicine cupboard must be kept separate from the main bunch of master keys and when not in use it should be locked in the main key cabinet. The designated person in charge of the shift takes responsibility for the safety and administration of the medicines within the home. (Any spare keys must be stored in a separate secure place that only designated staff have access to in an emergency.
• Medicines for external use must be stored in aspirate lockable cupboard or physically separate from internal medicines on a separate shelf in the medicine cabinet.
• All children's individualised medications should be kept separate within the cupboard allowing ease of access and safe administration.
• Staff who bring in their own medication to work must declare this to the manager of the home. In turn this must then be secured in a safe place for the duration of the shift.
• Should the staff member be responsible for escorting a child in a vehicle and they have their personal bag with them, they must as a matter of safe practice lock this in the boot of the car .
• In the unforeseen circumstances of the medication cabinet been damaged which in effect cannot be used to store medication safely the manager on call should be notified and a safe place agreed to enable the safety of medicines on site. 
• In consultation with the social worker, the manager should assess whether a child may retain and administer their own medication. If the child is permitted to do so and it is felt appropriate for their needs the arrangements must be set out in the child's care plan and the protocol must be included within their health care plan and reviewed regularly.
• Children responsible for their own medication must be provided with a personal lockable place following a risk management exercise that takes into consideration the environment and other children who maybe living in the same establishment. (refer to self administration)
• Medication requiring cold storage should be stored in a separate fridge that is dedicated for purpose. The temp of this fridge should be monitored - normal range is between 2-8 C .
• The security of medicines should not be compromised by cupboards being used for non clinical purposes e.g.; storing money or valuables.  

3. Controlled Drugs

This section should be read in conjunction with:

Section 2.1, Obtaining Medication

Drugs and Substance Misuse Procedure

The Misuse of Drugs Act (1971) brought together earlier legislation under one Act of Parliament. The Act classifies controlled drugs into one of three classifications, classes A,B and C. Controlled drugs are included in each of the classes according to the potential for harm they are thought to present to individuals and to society at large.

Any administration of controlled drugs for a child must be agreed with the Placing Authority/Social Worker and outlined in the child's Placement Plan.

When a child is prescribed or currently taking a controlled drug they must only be supplied for that individual child.

The controlled drug must be kept in a locked space (tin) within the medication cabinet.  The Manager must ensure that a 'stock' is not kept (e.g. no more than 28 days supply at a time). See Section 2.2, Storing/Retaining Medication

When administering a controlled drug, two Staff should be present - unless it has been agreed that less than two Staff may administer or that children/Parents may administer drugs themselves (see Section 2.2, Storing/Retaining Medication).

On each administration, the balance of the drug should be checked by the administering Staff and countersigned by the person witnessing the medication being given in both records.

For guidance on the administration medicines/drugs, See Section 5, Administration of all Medication

As with all unwanted medicines, any unused controlled drugs should be returned to the pharmacist and a certificate of disposal obtained and recorded (see Section 10, Recording)

4. Home Remedies/over the Counter Medication

Homely Remedies are any non prescribed medications that can be bought over the counter.

• All homes should have an agreed list of medications that can be bought from pharmacists who can provide pharmaceutical advice to the home.
• Advice should be sought from the pharmacist about any potential interactions between the homely remedies and any prescribed medications a child may be taking.
• All children must have a signed off authorisation sheet by their General practitioner ,which  highlights that the homely medication held within the home can be administered to them by staff taking into the contraindication of any medication or health issues, allergies they may have.
• Please note that the company has indicated that at no point should a child have any more than 16 Paracetamol in stock at any one time. Any child that requires pain relief and has a history of misuse of medication, soluble pain relief should be administered.
• Authorised homely remedies must not be given for any longer than 48 hours without referring to a General practitioner.
• Any homely remedies administered must in accordance with the dosage instructions appropriate to the child's age on the label or package insert of the product.
• Where there is a history of misuse of medication advice should be sought from a general practitioner.  Risk assessments should be put into place that clearly identifies the protocol of support specific to an individual.
• If a child is suffering from a minor ailment it may be appropriate to take them to a pharmacist to seek advice about treatment. The child's health history and current medication should be made known to the pharmacist and any medication purchased should be only used for the treatment of that child (see Section 10, Recording)
• All non prescribed medications must be administered in accordance with the manufacturer's advice on dosage and side effects.
• Each child must have their own personal record which indicates any homely remedies that have been administered. This record should also clearly indicate the reason for administration i.e.; cough/headache.
• Should the home be managing a central supply of homely medication that all children have permission to use i.e.; Cough medicine. A separate homely remedy stock balance sheet should be used for each item held within the home.
• All homely remedies should be stored within the locked medication cabinet. See Section 5.2, Self Administration
• The use of any complimentary or alternative remedies should be only administered following a discussion with the child's social worker and agreement with general practitioner.
• Once opened any supply of homely remedy should indicate the start date of administration and the expiry date once opened. Stock levels and checks re; expiry dates should be undertaken on a monthly basis.
• If a homely remedy is purchased for a specific young person this should be clearly labelled as such, whilst not defacing the actual detail of medication held within the box/bottle. 

5. Administration of all Medication

5.1 Normal Arrangements

For self administration, see Section 5.2, Self Administration of Medication.  Also see Section 12, Refusal of Medication

The procedures and systems implemented by the children's home for the administration of medication must respect the dignity and privacy of all children.

All medicines should be administered in accordance with the prescribers (or advised on the packet in relation to (Homely Remedies) instructions.

Consent to administer medication / First Aid / Homely Remedies must be obtained from the person who assumes parental responsibility for the child.

Where staff are involved with the administration of children's medication this must be included as part of the child's care plan which is agreed in writing by the child, placing authority.

Two staff should sign when receiving and administering medications wherever possible. Both staff are equally responsible and therefore should observe or partake in all tasks.

The procedure for administration should include;

1.	Read the instructions on the child's medication administration sheet.
2.	Check the prescribed dose has not already been given or cancelled.
3.	Select the medication required.
4.	Check the medication label wit the child's medication administration record sheet.
5.	Prepare the medication and double check with the administration instructions e.g.  Name of the child The Medication The dose The route of administration Check the identity of the child - with a witness Administer the medication Record the administration on the child's medication administration sheet.

When medications are administered this should be witnessed and signed by the two staff responsible immediately at the time of administration.

Should a staff be 'lone working' a child then this should be reflected in the child care plan in respect of safeguarding the child and ensuring that staff have clear protocol in this area. (This should be highlighted within the comments box on the medication administration sheet and cross referenced to the child's care plan)

If a medication is not taken this should also be recorded and the reason entered on  the child's medication administration sheet as to the reason (refusal/missing person etc..)

Should a staff be 'lone working' a child then this should be reflected in the child care plan in respect of safeguarding the child and ensuring that staff have clear protocol in this area (this should be highlighted within the comments box on the medication administration sheet and cross referenced to the child's Placement Plan).

If a child refuses to take an essential prescribed medication a manager must be informed and advice sought from a GP/Pharmacist (See Section 12, Refusal of Medication).

If medicines that are received from the pharmacist differ unexpectedly from those received in the past, the home must check with the pharmacist before administering the medication.

Prescribed medication should only be administered to the child that it has been prescribed or used for another purpose. (Medicines act 1968)

Medication should never be removed from the original container until the time of administration.

Once administered the medication must be returned immediately to safe storage.

In the case of prescribed creams being applied, the cream should be squeezed directly onto a child's finger to apply themselves. If necessary to be applied by staff , latex gloves must be worn and this agreed intervention should be recorded within the child's care plan.

If a child is reported as a 'missing person' at the time of expected administration staff should not only record this on the sheet but also within the homes absence log. The police should be notified at the time of reporting a child missing that they require medication and the reasons why they are prescribed this should it affect the safety and welfare of the child.

Medication should not be secondary dispensed for someone else to administer to a child at a later time or date.

Any adverse drug reaction or suspected adverse drug reaction should be reported to the General Practitioner before further administration of the medication is considered.

If a label becomes detached from a container or is illegible, the prompt advice of the person who made the supply must be sought.  Until then the container should not be used.

If medicines are being transported with a child then these should be stored and secured safely out of reach of a child i.e. in the boot of a car.

The time of administration must be carefully considered and respond to a child's needs. This should allow for special provisions such as when medicines are required in advance of food and medicines with specific dosage regimens.

See Section 5.2, Self Administration of Medication

A list should be maintained of the names and signatures of all staff who are authorised and trained to administer medication.

A record of medication should be retained for 75 years.

5.2 Self Administration of Medication

The child's appropriateness to self administer their medication must be subject to a risk assessment; this should involved not only the child but relevant health professionals , social worker , family (where applicable) and staff from the home.

If the self administration of one child self administering their medication be considered to have a possible impact on others that live in the same environment, this must be taken into account as part of the risk management process. If the safety of other children is considered to be a risk then the manager of the home must insist that medications continue to be administered and recorded by staff.

Each child should be supported to agree and sign a 'Self Medication Agreement' which highlights their responsibilities within this process.

A lockable space must be provided for the storage of medicines. It is the homes responsibility to ensure that the child understands that medicines must be locked away and ensures that this happens.

To gain maximum benefit medications should always be taken at the prescribed time. Staff are responsible for reinforcing the health professionals advice on this. If a child is concerned about their medication a referral should be made to the doctor or relevant health care professional.

The protocol in place should be detailed and cover the whole process as identified above and take into account the individualised stages that each child may require to gain their competencies in this area of independence.

The child's ability to administer their own medication must be reviewed at least every three months by the homes manager involving respectful others as required.

When a child is assessed as unable to safely administer heir own medication, staff should explain that they will take responsibility for the administration according to the doctors instructions.

The child's Placement Plan/Leaving Care Plan should always identify a child's independence in this area and the protocol in place to ensure that their welfare is safeguarded at all times.

5.3 Procedure for Administration and Recording of Medication during time away from the home

Any medication taken away from the home needs to be recorded as discharged in the homes Central Medication Log as well as on the child's Medication Administration Sheet.

Risk management exercise must be completed and protocol agreed should any medication be taken on home contact by a child / handed over to parents. Best practice indicates that a social worker and somebody with parental responsibility should acknowledge this practice to ensure that the child's welfare is safeguarded.

If Staff are not directly administering a child's medication whilst they are away from the home, instructions and guidance should be handed over to those who will assume this responsibility.

When children are away on holiday Staff should take the child's medical details along with medication administration sheets as well as some blanks should the child be taken ill whilst away and require medical attention/homely remedies.

Medications must be transported in a secure locked container.

If a child spends time away from the home, either on home visits, holidays or time spent at school, any medication due to be taken should be kept in the original container e.g. blister packet with exact number required and not transferred to another container or envelope.

Any medication taken away from the home should be recorded (see Section 10, Recording).

Any record of medication being taken away from the home needs to be countersigned by a witness.  The medication should always be handed over to someone responsible for the child while they are away.  Should a child return to the home with new or unused medication, again all appropriate records should be completed.

Secondary dispensing of medicines or use of unsuitable containers such as envelopes is discouraged.  If the medicine must be taken away from the home, a separate clearly labelled container of medicine should be requested from the pharmacist.

When a child takes medication away from the home, the records of medicines taken away from the home should be completed.

6. Stock Checks

The Manager or person delegated by the Manager should make stock checks of all medication as follows on a monthly basis.

The responsible person should;

• Check the actual stock balances against the homes records
• Expiry dates ( as per manufacturers instructions)
• Disposal ( recording/receipts)
• Frequency ( administered as prescribed)
• Sign and date the medication administration sheet to acknowledge that the stock checks have been completed. 

7. Disposal of Medication

Medicines no longer required, including refused and wasted doses should be returned to the Pharmacist. This practice also should take into account homely remedies and medications were the expiry date is reached, treatment is completed or discontinued.

All returns must be recorded and accounted for within the homes Central Medication Log .

Two staff must sign to acknowledge the reason why the medication has been returned as well as the quantity.

This record is also necessary when medication is transferred to another care provider or they are going on home contact/leave.

Where children are self administering insulin or any other medication with a syringe, a 'sharps box' must be provided.

It is the responsibility of GP's and Community nurses to safely dispose of any syringes or needles that they have used.

In the case of a child who dies before reaching the age of 18 years of age, their case records, which includes records of administration must be retained until 15 years from the date of death.

In the event of a death of a child, the medicines should be retained for 7 days, in case the coroners office or courts require them

8. First Aid

Also see the Medical Emergency section of the GPs, Dentists, Opticians, Hospitals Procedure.

Should any young person sustain a knock/blow to the head - medical advice and attention must be sought with immediate effect. Please refer to company Guidance Sheet.

All staff will be trained to the appropriate levels required in relation to their job role and the environment that they are working in.

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 for First Aid boxes to be audited in keeping with Section 6, Stock Checks.

First Aid boxes must have a white cross with a green background.  The inventory must include the quantity of each item in the box.  Antiseptic wipes should be used (not TCP).

Children are not normally permitted to keep/administer their own medicines.  However, they may do so in exceptional circumstances but only with the approval of the Manager and Social Worker.

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 and they are deemed to be suitably responsible and arrangements have been set out in the relevant Care Programme.

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

Other than for very minor injuries, professional medical attention must be sought as soon as possible (either take the child to see a medical practitioner or seek advice by telephone), even if the casualty's condition seems to improve following the administration of first aid.

In the event that a child requires administration of First Aid, a record of this should be made (see Section 10, Recording).

If an accident occurs, it must be reported and recorded.

9. Skilled Health Tasks (e.g. Diabetics, Physiotherapy Programme etc.)

Also see:

Section 2.2, Storage/Retaining Medication

Section 5.2, Self Administration of Medication

Invasive Procedures

If a child requires a skilled health task to be undertaken, this will only be undertaken with the written authorisation of the prescribing doctor in relation to the child concerned.  If required, appropriate training would be sought for Staff to ensure that they had the necessary level of skills before undertaking such duties.

Asthma Inhalers

All children who are prescribed inhales should have written recommendations from the prescribing doctor as to how these should be administered. This will in turn inform our protocol and risk assessments which should be in place to safeguard the child. 

All young people should be supported to have regular checks which are recorded and advice followed to ensure that staff monitor the effectiveness of the inhaler via reviews / asthma clinic.

All inhalers must be labelled with the child's name and is a child is self administering good practice to safeguard the child  indicates that a spare inhaler is always kept within the residential establishment or with staff whilst out with a child.

Diabetics

For all those young people who are diagnosed as having Diabetes protocol should be activated which informs the care / support that they require from the staff team involved in their care.

The child must be registered with the Diabetic Nurse and be encouraged to have their regular check ups and support in respect of their personal needs in this area.

All staff should be support and be provided with specialist training in these areas to ensure the welfare and health needs of the child remain a priority.

10. Recording

A Health Care Plan should be activated upon the admission of a child and should remain an active document whilst the child is in placement.

First Aid should be noted on the Child's health record sheet / incident report and medication administration sheet should a prescribed or non prescribed medication have been used.

The following records should be completed;

• All medications (prescribed / homely/controlled) should be entered into the home via the Central Medication Log
• 'Yellow' Medication Administration sheet should be used to record prescribed medications.
• 'White' Medication Administration Sheet should be used to record non prescribed medications (Homely Remedies)
• Controlled Medications should be recorded in bound log book containing 'Red' Medication Administration Sheets.
• Central supplies of Homely Remedies should also be recorded as administered on the 'Homely Remedies stock balance sheet'

11. Management of Medication Errors

The company recognises that, despite the high standards of good practice, care and training, mistakes may occasionally happen for various reasons.

Every employee has a duty and a responsibility to report any errors immediately to their line manager / manager on call and relevant health care professional. 

In the event that medication has been incorrectly administered;

• Report immediately to GP for advice ( On call / NHS direct)
• Follow the advice and instructions from medical professionals.
• Report to line manager / manager on call immediately.
• Report to relevant placing authority and family.
• Explain to the child (where appropriate)
• Monitor the child for side effects - record.
• Record the error on the medication sheet and in the child's notes.
• Record the advice given making sure this is detailed with the name of the professional giving the advice identified.
• Report as per company policy and procedures (incident process)

Mangers should encourage staff to report errors. These should be dealt within the company's policy and procedures with in a constructive manner that addresses the underlying reason for the incident and prevents recurrence.

All errors should be reported as incidents under the existing accident/incident reporting system.

12. Refusal of Medication

It is an individuals right to refuse medication. Staff must record the reason for the refusal and the advice given to the child.

A manager should be contacted and given details of the incident.

If the refusal relates to a prescribed medication that is considered of high importance in relation to the child's health i.e. Epilepsy or other significant health condition then medical advice should be sought with immediate effect. 

If the refusal occurs repeatedly this should be discussed with the child's GP, social worker and parents, where appropriate.  

To aid the child's concordance, alternative formulations of the medication that may be more acceptable, should be considered.

Please note Medications cannot be 'disguised' in any way to encourage a child to take the medication.

A medication should only be crushed when it has been shown not to alter the pharmaceutical properties of the preparation; advice of the community pharmacist should always be taken.

Medications should not be mixed together.

13. Emergency Admissions

In the case of emergency admissions, particular attention must be given to determining what medication, if any, is currently used.

Staff should check out what a child is currently taking with;

• At point of referral - in writing
• Social Work team.- in writing
• Family/carer where appropriate.
• Previous health care professionals.- in writing
• Child - if appropriate

No medication should be administered to a child if confirmation cannot be sought until medical advice is sought and approval given.

A child's health care notes held at the home must also reflect any medication admitted with a child and any discussions in relation to seeking approval for administration of medication upon arrival at the home.

14. Training

Medicines must be administered by designated and appropriately named staff who have had their competency assessed to the specifications of HSC 375.

The training for staff who are involved in the administration of medication must include;

• The Legal Implications relating to the 'Safe Administration of Medication'.
• 'Framework of Medication Administration' The responsibility of the care worker to ensure that medications are only administered to the child for whom they were prescribed.
• How to administer medication - safe practice as per policy and procedures.
• Recognising and Reporting side effects.
• Reporting Refusals and medication errors.
• Administration of 'Homely Remedies'
• Understanding the policy for record keeping and the records that implementation of such records.
• Expiry dates and disposal.
• Self administration.
• Supporting Medication away from the home.
• Understanding and use of Health Care Plans.

All staff must undergo a refresher course on a yearly basis on 'Safe Administration of Medication.

All staff will be instructed with regard to the knowledge and understanding requirements and will complete an assessment to demonstrate their competencies on ;

• HSC 375 (a) Prepare to administer mediation to an individual.
• HSC 375 (b) Administer, report on and monitor individuals medication.

End