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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
Recording and Reporting of Accidents Procedure
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 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.
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.
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. |
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:
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 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:
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.
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.
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.
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.
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.
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 brought into the Home, including from a hospital or another Home, should be recorded. The record should show:
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
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
See also: Self Harming and Suicidal Behaviour Procedure.
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.
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 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.
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.
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.
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:
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.
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:
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.
All medicines must be stored according to the instructions accompanying the medication.
There are separate storage areas for medicine as follows:
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.
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