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The Health and Well-being Standard
Promoting the Health and Well-being of Looked-after Children
Managing Medicines in Care Homes NICE Guidelines
Health and Safety Executive Website
Health Care Assessment and Plans Procedure
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 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.
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 the First Aid Log, Accident Book (if there has been an accident), individual child's Daily Record and Medication Administration Record (MAR).
Home Remedies are medicines that can be bought over the counter, including Paracetamol*, aspirin, homeopathic, herbal, aromatherapy, vitamin supplements or alternative therapies.
Home 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.
Home Remedies should be purchased for a named individual child.
When a Home 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' Home 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 Home Remedies before they arrange to see their GP.
Recording: The administration of any Home Remedies must be recorded in individual child's Daily Record and Medication Administration Record (MAR).
*Paracetamol must not be given for more than two consecutive days without the approval of a GP/Medical Practitioner.
Each home should keep the following records:
| Record | Purpose |
| First Aid Log | To record any administration of First Aid. |
| Accident Book | To record any accidents. |
| Medical Record | 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 Home Remedies) administered etc. |
Some young people will have prescribed medication, which is ongoing. This should be ordered on monthly basis where possible. Responsibility for ordering these medicines is that of the Registered Manager or a delegated person/member of staff.
When ordering, a note must be made of:
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.
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.
Staff must take their ID 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.
The Pharmacy will be able to give, and advice should be sought upon:
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.
The receipt of medication should be recorded on the individual child's Medication Administration Record (MAR), if a Controlled Drug has been prescribed, 2 staff should record/sign the record.
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: Administration of Medication Guidance |
| For guidance on specific issues, e.g. refusal to co-operate, if a child is missing/absent, covert administration. | Appendix 2: Specific Issues re Administration |
| For the administration of medication away from the home e.g. if a child is on holiday or having contact with his/her parents. | Appendix 3: Administration away from the home |
| Skilled Health Tasks, e.g. for children with Diabetes. | Appendix 4: 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.
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.
All medicines must be kept in a safe/secure place, e.g. a locked cabinet that does not exceed 25°C. A key to this cabinet should be held by a senior/responsible member of staff on duty.
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.
All medicines have expiry dates, usually clearly stated on the label, upon expiry, they should be disposed of, see below.
Medication should be disposed of when:
Unless instructed by a GP/Pharmacy, unused/expired medicines should be returned to the Pharmacy, and a receipt obtained.
Return or disposal of medication 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 are required to record/sign the record.
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:
The procedure for administration is as follows:
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 without seeking advice from the G.P or Pharmacist. Any advice given should be recorded.
When a young person refuses to take their medicine, then the G.P. should be contacted for advice. This information must be recorded and followed. Young people cannot be forced to take their medicines.
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 Choices website (as appropriate depending on the time of day). To miss taking a medicine completely can be dangerous depending on the medical condition.
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.
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.
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.
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.
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.
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 Choices) immediately or as soon as the error has been discovered. Staff must record the advice that they have been given.
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.
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.
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.
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 due to be taken must be kept in the original labelled container.
Any medication taken away from the home should be appropriately recorded on the individual child's Medication Administration Record (MAR), showing what medication has been taken away/handed over to parents/ carers. The person receiving the medication should countersign the record.
If the parent/ carers wishes, a copy of the MAR 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.
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.
This applies to specialist or skilled healthcare tasks, for example:
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.
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.
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.
DON'T
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