First Aid, Homely Remedies and Medication


Contents

  1. First Aid
  2. Homely Remedies
  3. Key First Aid and Medication Records held in the Home
  4. Specific Issues Re Administration of Medication
  5. Administration Away from the Home
  6. Skilled Health Tasks
  7. Staff Medication

    Appendix 1: Safe Practice for the Administration of Medication Guidance


1. First Aid

Each Home must have a qualified First Aider on duty at all times.

First Aid boxes should have a white cross with a green background and must be held in each home and should be carried in each of the vehicles used for the transportation of children.

Each box has an inventory that must include the full quantity of each item stipulated in the box. When an item has been used, then it should be replaced as soon as possible.

Monthly first aid stock checks should take place.

Recording: Each child should have permission for staff to administer first aid and non-prescription medication from a person with Parental Responsibility for them recorded in the relevant plan. Permission should be sought and arranged by the child's social worker.

The administration of First Aid must be recorded in an accident book, individual child's Daily Record and a body map completed. Any accidents and administration of first aid must be shared with the local authority and those with parental responsibility.


2. Homely Remedies

Homely Remedies are medicines that can be bought over the counter, including Paracetamol*, aspirin, homeopathic, herbal, aromatherapy, vitamin supplements or alternative therapies.

Homely Remedies can only be used by the young people in the home with the approval of relevant social workers (as set out in children's Placement Plans) or as prescribed by a GP.

Homely remedies/medication MUST NOT be given to any child/young person already taking medication without prior consultation with the General Practitioner or Pharmacist. This consultation MUST be recorded in the child/young person's Health Record. For out of hours staff MUST consult with the NHS 111 advice line regarding homely remedies.

Homely Remedies should be purchased for a named individual child with consultation with the General Practitioner, Pharmacist or NHS 111 advice line. Adults MUST NOT purchase any homely remedies without consulting with the above.

The administration of homely medication must be recorded on a separate MAR sheet from the one where prescribed medication is recorded. Each child/young person receiving homely medication must have their own sheet.

When a Homely Remedy container is opened, staff should record the date of opening to ensure it is not kept beyond its expiry date.

No child may be permitted to 'self-administer' Homely Remedies unless approved by their social worker, with the arrangements outlined in the Placement Plan.

Consideration should be given as to how long a child continues to use Homely Remedies before they arrange to see their GP.

The child’s local authority and those with parental responsibility must be informed of any homely remedies purchased for the child and reasons for the medication being required is to be shared.

Recording: Any Homely Remedies brought into the home must be signed into the log book with a reason as to why they have been purchased and who the staff member has consulted with regarding what Homely Remedy to use. This must also be logged in the child’s health log and daily record. The administration of any Homely Remedies must be recorded in individual child's Daily Record and Medication Administration Record (MAR).

*Homely Remedies must not be given for more than three consecutive days without the approval of a GP/Medical Practitioner.


3. Key First Aid and Medication Records held in the Home

Each home should keep the following records:

Record Purpose
First Aid / Accident Log To record any accidents and administration of First Aid.
Individual Medical Record / Health File Individual record for each child, details of health related issues, medication used, name of GP.
Medication Administration Record (MAR) Individual record for each child to record any medication (or Homely Remedies) administered etc.

Medication

3.1 Ordering Ongoing Medication

Some young people will have prescribed medication, which is ongoing. This should be ordered on a monthly basis where possible. Responsibility for ordering these medicines is that of the Registered Manager or a Delegated Medication person/member of staff.

When ordering, a note must be made of:

  • The name of the young person;
  • The name, strength, form and quantity of the medicine;
  • The name of the surgery/G.P;
  • When the prescription will be ready.

When ordering, staff should check stock levels before ordering. To minimise wastage and reduce risks of errors, stock levels should be kept to a minimum.

3.2 Collecting Prescriptions

Staff should collect prescriptions from the GP/surgery and check to make sure that they have received all the prescriptions they have ordered and the quantities are correct before taking to the Pharmacy. If a medicine has directions of 'as directed' or 'as before' then the surgery should be asked to amend the prescription. A photocopy of the prescription should be made and stored until the medicine is received back from the Pharmacy. Staff should check with the Pharmacy as to when the prescriptions will be ready for collection.

3.3 Receiving/Collecting Medicines

Staff must take their Benecare identity badge when collecting medicines or controlled drugs.

When the medicines are collected, staff should check the medicine against the photocopied prescriptions that they have. Any discrepancies should be brought to the attention of the Pharmacy and rectified as soon as possible.

If required the Pharmacy will be able to give advice on the following:

  • Potential side effects;
  • Advice on how the medicine should be taken;
  • Advice on whether the medicine may be affected by any other medicine;
  • Advice on storage, including whether the medicine should be stored in the fridge;
  • If the medicine is a Controlled Drug.

Staff should ensure that the medicine has been properly labelled. If the medicine does not have a dispensing label on it then it should be returned to the Pharmacy. Staff should also make sure that they have received a Patient Information Leaflet from the Pharmacy, if it is not available then these are also available online.

The receipt of medication should be recorded on the individual child's Medication Administration Record (MAR) by two qualified members of staff. If a Controlled Drug has been prescribed, two qualified members of staff should record/sign the record.

3.4 Administration

NOTE: all staff must be familiar with the following detailed guidance on the administration of medication:

Circumstances Relevant Guidance
For detailed guidance on the administration of medication. Appendix 1: Safe Practice for the Administration of Medication Guidance
For guidance on specific issues, e.g. refusal to co-operate, if a child is missing/absent, covert administration. Section 4, Specific Issues Re Administration of Medication
For the administration of medication away from the home e.g. if a child is on holiday or having contact with his/her parents. Section 5, Administration Away from the Home
Skilled Health Tasks, e.g. for children with Diabetes. Section 6, Skilled Health Tasks

Medication should be administered as set out on the label or instructed by the GP/Medical Practitioner.

No child may be permitted to 'self-administer' unless approved by their social worker, with the arrangements outlined in the Placement Plan and subject to a through risk assessment being completed.

Administration should be recorded on the individual child's Medication Administration Record (MAR), if a Controlled Drug has been administered, 2 staff are required to record/sign the record.

3.5 Storage and Expiry Dates

All medicines must be kept in a safe/secure place, e.g. a locked cabinet that does not exceed 25°C. The room temperature where the medicine cupboard is kept must be recorded daily (maximum 25°C) on the MAR sheets when administering medication. Should the temperatures exceed this staff must consult with the manager on call prior to administering medication. NHS 111 must be consulted for advice as it may mean the medication is not able to be administered. Action taken must be recorded on the MAR sheet.

A key to this cabinet should be held by a senior/responsible member of staff on duty. Keys for medicine cupboards and clinical areas should be kept separate from other keys. Care must be taken to ensure any keys to medicine cupboards are properly controlled.

Medicines that are taken internally should be stored separately to those used externally in the medicine cabinet, with liquids preferably on the bottom shelf.

*Medicines that require refrigerated storage should be kept in either a dedicated lockable fridge (in the staff office) or a locked box inside the food fridge. A record of minimum and maximum temperatures for the refrigerator should be recorded daily and the thermometer reset each time when in use. If the temperatures fall outside the required 2°C - 8°C this should be reported and investigated.

All medicines have expiry dates, usually clearly stated on the label, upon expiry, they should be disposed of, see below.

3.6 Disposal

Medication should be disposed of when:

  • The expiry date has been reached;
  • The course of treatment is completed;
  • The medication has been discontinued.

Unless instructed by a GP/Pharmacy, unused/expired medicines should be returned to the Pharmacy, and a receipt obtained.

This should be recorded on the individual child's Medication Administration Record (MAR), and the receipt attached, if a Controlled Drug has been disposed of, 2 staff should record/sign the record.

Empty packaging should have confidential information removed and should then be discarded into a designated waste facility in the Home.

3.7 Record Keeping of Medicines

There is a statutory requirement for a system of recording medicines in all care Homes (Regulation 23, The Children’s Homes (England) Regulations 2015). Records of current medication must be kept for all children/young people, including those who are self-administering. (The Administration and Control of Medicines in Care Homes, London 2001 - Royal Pharmaceutical Society of Great Britain).

The following records relating to medicines should be kept:

  • All medicines received by the Home;
  • All medicines prescribed for children/young people in the Home;
  • All medicines administered in the Home;
  • All medicines transferred out of the Home or returned to the pharmacy for disposal.

All medicines brought into the Home, including from a hospital or another Home, should be recorded. The record should show:

  • Date of receipt;
  • Name and strength of medicine;
  • Appropriate dose;
  • Quantity received;
  • Child/young person for whom prescribed;
  • Signature of the staff member receiving the medicines.

The records should be properly completed, legible and current. They should be available for inspection. All records should be completed in black ink only, initialled and dated.

See: Appendix 1: Safe Practice for the Administration of Medication Guidance for detailed description of recording information.

3.8 Children/Young People Self Medicating

Where appropriate Benecare welcomes and supports the self-administration of certain medications. Where self-administration is taking place appropriate risk assessments must be in place and consent must be gained from parents/social worker. Where it is considered appropriate to let the child/young person keep possession of their medication(s) and self-administer at their discretion, the risk assessment should include appropriate storage and safety requirements and monitoring intervals. All checks should be documented on the back of the MAR Sheet. These records should be checked and the child/young person's continuing suitability to self-medicate must be reviewed at defined intervals.

If children/young people who are self-administering and have been risk assessed to store their own medication, should then request the same medication from the homes medical cabinet. Staff should enquire as to why they require this and direct back to their own supply where possible. If concerns arise then these should be investigated and the Registered Manager informed.

Where staff are supervising self-administration of medications they are required to have successfully completed the medication training.

3.9 Training

Before staff can administer medicines they must successfully attend and pass the required Medication Staff training. This training must be refreshed annually; staff are not permitted to administer medication if their training is out of date.


4. Specific Issues Re Administration of Medication

Swallowing Problems

Staff may find that some young people may struggle with swallowing their medicines. The young person's G.P should be contacted for an alternative. Under no circumstances should staff take it on themselves to crush tablets or mix medicines with other substances/ food without seeking advice from the doctor or pharmacist. Any advice given should be recorded.

Medication Refusal

When a young person refuses to take their medicine, then the G.P. and or NHS 111 advice line should be contacted for advice. This information must be recorded and followed. Young people cannot be forced to take their medicines. Any refusal of prescribed mediation must be notified to the child’s social worker and anyone that has parental responsibility for the child.

A refusal of medication must be logged as refused on the MAR sheet with a reason why in the comments section. Please also notify the registered manager or deputy manager on call.

If a Young Person is Absent when the Medicine is Due

When a young person is absent and their medication is due, this should be recorded. When the young person returns, then staff must consider the time delay and seek advice if required from the Pharmacist, the G.P or NHS 111 (as appropriate depending on the time of day). To miss taking a medicine completely can be dangerous depending on the medical condition.

Covert Administration

Covert administration is where a medicine is hidden in food and the person does not know that they are taking it. Staff must not hide any medicine in food or perform any other types of covert administration.

Lone Working

In some homes, staff may be required to work on their own for a period of time. It may be the case that the administration of a medicine will have to happen during this period. Staff should ensure that they double check for themselves and make a record of any medical administration required during the period of time for when they were lone working.

This can be a problem when administering Controlled Drugs. It is important that the young person receives their medicine at the correct time therefore the member of staff administering the medicine, must also record that they were lone working in the register. It is not acceptable for another staff member to sign the register when they come in. You cannot be a witness to something you have not seen happen.

Only in EXTREME circumstances can the member of staff administering a controlled drug do so without a second person present and they must record that they were lone working in the register. Prior to administration the manager on call is to be notified of the lone working administration to discuss safe administration. Issues of lone working and administrating medication will be looked into by the Manager monitoring the medication at the next audit.

Spilled Medicines

When a medicine has been dropped on the floor or spilled then this must be safely disposed of and a note must be made in the records. A second dose should be offered to the young person (where a medication has spilled, leaving the remainder short for the completion of the course of the prescription, advice should be sought from the G.P as to how to make-up for the lost dosage).

When medicine has been spat out then this medication must be cleared away following the correct procedures and a note made in the records. However a second dose must not be offered, as staff will not know how much has been absorbed. If this persists the G.P should be contacted.

Detached or Illegible labels

If a label becomes detached from a container or is illegible, then staff must seek advice from the Pharmacist. Until this advice is received then the container should not be used.

Secondary Dispensing

Staff must ensure that medicines stay in the containers supplied and labelled by the Pharmacist. Medicines must not be placed in daily or weekly medicine trays.

Verbal Alterations

There may be times when it is necessary to stop or change the dose of a young person's medication without receiving a new prescription. Verbal requests to change medication by the G.P must be confirmed in writing before any changes are permitted. These changes must be recorded on all relevant medication records including the Individual Medication Record in the young person's file. Staff must note the change, the name of the Doctor, the time the confirmation of alteration was received and the date. Staff must not alter the dispensing labels. A note may be added saying 'Refer to record for new instructions'. Staff should check the next prescription to make sure these new changes have been implemented.

Medication Errors

In the event of an error being made in the administration of any medication, advice must be sought from the young person's G.P. or another medical practitioner/ help line (e.g. NHS 111) immediately or as soon as the error has been discovered. Staff must record the advice that they have been given. Any errors must be notified to the manager on call.

All medication errors must be investigated by the Registered Manager and adults who make the errors will be removed from being able to administer medication until they are re trained. Any errors must be shared with the local authority and those with parental responsibility.

Any serious medication errors must be notified to Ofsted.

Intentional Overdose

If an overdose is suspected, hospital treatment should be sought without delay. Staff should try to find out what the child/young person has taken and if possible take a sample to give to a medical practitioner.

Possible signs of an overdose:

  • Mild nausea/vomiting;
  • Paler skin;
  • Blue lips or fingernails;
  • Not waking up or reacting to a loud noise;
  • Shallow or disrupted breathing;
  • Gurgling, snorting or snoring/choking sounds;
  • Slow or very faint pulse.

It can take a long time between taking the substance and the first signs of an overdose; children/young people may verbally 'boast' about having taken an overdose: even when there are no signs, but staff must consider that there is a chance an overdose has been taken and they must act in caution and seek medical attention.

What to do if someone is reacting to an overdose

  • Lie them on the floor;
  • Put them in the recovery position;
  • Call the ambulance - 999 - inform the operator of the overdose;
  • Do not leave the child/young person alone, make sure they don't roll onto their back;
  • Inform the ambulance team what the person has taken; try to gather all the packaging you can find;
  • Get some help, keep other children and young people away (but don't dismiss any valuable information that they may be trying to pass it on to you).

DON'T

  • Walk the child/young person around;
  • Put the child/young person in a cold bath/layer them up to heavily to generate warmth;
  • Give them a drink.

Recording and Review

See also: Self Harming and Suicidal Behaviour Procedure.

Adverse Drug Reaction

Any adverse drug reaction or suspected adverse drug reaction should be reported to the G.P before further administration is considered. Advice should be sought on whether the medicine should be stopped or the treatment carries on. Staff must record the advice that they have been given indicating the date and time and authorising Practitioner.

Any concerns of immediate danger to the child after taking their medication must be followed up with a call to the ambulance for the child to be medically assessed.

Drug Recalls

When a Drug Recall Notification is received then staff should check the medication to see if the home is holding any stock. If there is none in stock then the notification should be signed, dated and filed for reference.

When stock if found that is listed on the drug recall, then staff must follow the directions given after isolating the stock.


5. Administration Away from the Home

See also: Lone Working.

If a child spends time away from the home, either on home visits, holidays or time spent at school, any medication that is due to be taken must be kept in the original labelled container where possible.

Any medication taken away from the home should be appropriately recorded on the individual child's Medication Administration Record (MAR), and a medication handover form is to be completed showing what medication has been taken away/handed over to parents/ carers. The person receiving the medication should countersign the record.

A copy of the Patient information Leaflet (PIL) should be given with the medication.

The parent/ carers is to be given a copy of the MAR and this should be handed over to them, so that a record of administration can be kept; this may be handed back to the home when the child returns and the medication being returned to the home must be signed back in.

If the person who is responsible for the child is a member of staff, then they must complete the documents for administration while they are away as normal.

The medication should always be handed over to someone responsible for the child.


6. Skilled Health Tasks

This applies to specialist or skilled healthcare tasks, for example:

  • For diabetic children;
  • Physiotherapy programme;
  • For the use of Buccal Midalozam;
  • For the use of Rectal Diazepam.

If a child requires a skilled health task to be undertaken, this will only be carried out by trained staff, with the written authorisation of the prescribing Doctor in relation to the child concerned, and as set out in a Placement Plan or other written Health Care Plan.

Appropriate training will be provided, together with written guidance, as to how the skilled tasks will be performed and recorded.


7. Staff Medication

It is acknowledged that there may be occasions when staff require medication for their own health needs.

In these circumstances it is the responsibility of the staff member to inform their line manager of the medication they are taking and any potential impact it may have on their ability to fulfil their duties.

If staff require medication during their working hours or if medication taken outside of work may affect their ability to fulfil their duties then a risk assessment must be completed in consultation with the registered Manager/ line manager. This risk assessment must be in place for the duration of the course of treatment. Where this is a significant period or ongoing then the risk assessment must be appropriately reviewed and updated.

Where possible staff medication must be stored in a personal locker (if provided) which must be secured. If this facility is not available then medication should be kept in staff member’s vehicle, securely locked and out of sight. If this is not possible (for example, if the medication must be kept on the person) then this should form part of the risk assessment. In extreme circumstances it may be necessary to move staff to another area of the organisation if the risk of keeping medication on the person cannot be safely managed in the current working environment. Any such move may be necessary for the duration of the treatment.

If staff medication requires refrigeration then it must be placed in a separate, lidded container, clearly labelled as staff medication and kept in the medication fridge. This must only be whilst the member of staff is on duty and should be taken home when staff leave work.

Staff should be discrete when taking medication. If this is required during working hours then suitable arrangements should be agreed with the line manager/ shift runner. This should form part of any risk assessment.

Staff are not permitted to use the homely remedies stored in the home for the young people’s use. Any homely medication required by staff must be stored as specified above. Staff taking homely medication (for example pain killers) are advised to supply this themselves. If accepting medication from a colleague, staff do so at their own risk and should ensure they are familiar with the dose and PIL information of any medication. It remains the staff member’s responsibility to inform the Registered Manager/ line manager/ shift runner of any health issues which may arise during the working day.


Appendix 1: Safe Practice for the Administration of Medication Guidance

All medicines must be administered strictly in accordance with the prescriber's instructions (or as advised on the packet in relation to Homely Remedies). Only the prescriber (e.g. GP) can vary the dose. Medicines must be locked away in the locked storage areas when not in use. Before administration, staff should:

  • Wash their hands;
  • Make sure they have a pen and any required record sheets;
  • Enough glasses for each young person receiving medication;
  • A quiet area free from distraction to administer the medication.

The procedure for administration is as follows:

  • Check the young person's identity (a photo is normally kept in the young person's file). Only one young person should be administered medication at a time, this reduces the risk of mistakes being made;
  • Check the young person's medical profile;
  • Check the medication on the individual medication records corresponds with that on the young person's medical profile;
  • Check the Individual medication record sheet to ensure that someone else has not already given the medication;
  • Check the expiry date and use by date (where appropriate) on the medication;
  • Check the amount to be given at that time;
  • If opening a new container, add the date;
  • Measure or count the dose without touching the medicine;
  • If the medicine is a solid (such as a tablet) then carefully place into an appropriate container and offer to the young person. They may wish to put it in their hand or swallow straight from the container;
  • If the medicine is a liquid, take care not to drip onto the label. If the amount to be measured is less than 5ml, then use a medicine syringe otherwise use a medicine spoon or measure as preferred by the young person;
  • If the medicine is a cream or ointment, then it should be squeezed directly onto the young person's finger for them to apply. If required to be applied by staff, then latex/pvc gloves must be worn;
  • When administering a Controlled Drug, a second member of staff, must check the dose prior to it being administered;
  • Watch the young person as they take their medicine to ensure administration is successful;
  • Offer the young person a drink of water (where appropriate);
  • Check that the medication is recorded in all the required records;
  • Print and sign your name against date and time of each medicine administered;
  • Record when medicine has been refused / not taken and the reasons why;
  • If a young person is absent when medication is due- this should be recorded;
  • Do not sign for any medicines that you have not administered or witnessed yourself;
  • If a young person refuses to take medication, under no circumstances should they be forced to do so;
  • Medication must be kept in the original labelled (by the Pharmacy) containers and not put into weekly/daily medical boxes;
  • After administration the medicines should be returned to the cabinet immediately and the cabinet locked;
  • Each time you give medication, remember that it is important to consider the time of administration. Care should be taken to ensure that if the medicine is required to be taken before food, that this is done. Similarly the administration of some medicines such as eye drops or inhalers may not be suitable to be given at meal times. Not all medicine administration times will fall in line with meal times.

If in any doubt seek advice from another designated member of staff, from a senior member of staff, from the pharmacist or the child/young person's General Practitioner.

Similarly, if a child/young person refuses medication seek advice from the pharmacist or the General Practitioner who prescribed the medication.

If a medication has a when required dose (p.r.n.) it is usually prescribed to meet short term or an intermittent medical condition, i.e. it is not to be taken regularly. To ensure the medication is given as intended a specific plan for administration must be recorded and kept with the MAR sheet (see Appendix 1: Safe Practice for the Administration of Medication Guidance). Information on why the medication has been prescribed and how to give it should be sought from the prescriber or other health care professionals involved in the treatment of the child/young person.

Recording

The MAR sheets are a legal document and therefore only black ink is acceptable. Any entries on the MAR sheets detailing medication received into the Home which are handwritten are to be highlighted in pink.

The date on which creams, bottles and other short life preparations, e.g. eye drops, ear drops, are opened must be recorded on the container.

Expiry dates for these products once opened are as follows:

  • Cream in screw top tub containers - 1 month after opening;
  • Cream in a tube or in a container with pump tops - 3 months after opening;
  • Eye drops - 28 days after opening;
  • Cough medicines - 6 months after opening.

The information sheet (PIL) accompanying each medication prescribed for a child/young person must be put in a clear pocket on the child/young person's medical file. If there is no information sheet with the medication then a request should be made to the pharmacy for one or this can be printed online. This information should also be included in the child/young person's Health Care Plan, in particular any side effects and actions required in the event of reactions.

Storage

All medicines must be stored according to the instructions accompanying the medication.

There are separate storage areas for medicine as follows:

  • Prescribed medicines for internal use;
  • Prescribed medicines for external use;
  • Homely medications for internal use;
  • Homely medications for external use;
  • Controlled drugs cabinet (if required this cabinet will be fitted);
  • Lockable fridge for medicines requiring refrigeration.

All medicines must be clearly marked with the child/young person's name and should be stored in separate boxes with the child/young person's name clearly identified.