Medication Policy

REGULATIONS AND STANDARDS

The Health and Well-being Standard

RELEVANT GUIDANCE

Managing Medicines in Care Homes (NICE, 2014)

Children’s Act 1989: Care planning, Placement and Review (DfE)

Promoting the health and well-being of Looked After Children (DfE and Department of Health and Social Care. 2015)

Misuse of Drugs Act 1971

The Handling of Medicines in Social Care (Royal Pharmaceutical Society)

Outcome: 

The health and well-being needs of children are met; children receive advice, services and support in relation to their health and well-being. Children’s health and well-being outcomes are recorded in their relevant plans. Staff understand the child’s health and well-being needs and the options available to them. Each child has access to dental, medical, nursing, psychiatric, psychological advice, treatment or other services they may require. Staff understand their responsibility around the safe storage and dispensing of medications. Staff are clear around the legal boundaries surrounding administration of medication


Contents

  1. What we Expect
  2. Storage of Medication
  3. Administration of Medication
  4. Recording
  5. Children / Young People who Wish to Self Medicate
  6. Over-the-Counter Medications
  7. Homely Remedies
  8. Prescribed Medication
  9. Controlled Drugs
  10. PRN Medication
  11. Guidance on the Covert Administration of Medications


1. What we Expect

Staff are advised of the importance attached to the adherence of this policy Failure to follow these procedures may potentially cause harm to the health and welfare of children/young people and, as such, may leave staff open to disciplinary action.

Staff will not be permitted to administer any medication to any child/young person placed in the Children’s Home until consent from the parent(s) and social worker has been returned to the home and is stored on the child/young person’s case file.

The consent process will normally be completed at the planning meeting stage before or very shortly after the child moves into the Children’s Home (in the case of an emergency admission).

The consent form will seek parental and social worker permission for staff to administer:

  • Prescribed medication;
  • Controlled drugs; and
  • Emergency first aid.

All prescribed medication shall only be prescribed by the General Practitioner or the hospital. Staff will have prescriptions dispensed only by the chemist used by the Children’s Home and using their own prepared administration packs. All unused, unwanted or surplus medication will be returned to the pharmacist for safe disposal.

Staff will be permitted to administer and dispense medication only if deemed competent to do so by the Managers. Competence will normally be determined by successful completion of training in this area.

Staff will not make independent decisions regarding the administration of medication. All prescribed and controlled medication will be dispensed as directed.

All  prescribed medication received will be entered into the young person’s medical file specifically for the purpose, and medication that is no longer required will be returned to the Pharmacist for disposal is also entered in this file. Any controlled substances will be recorded in a separate booklet which is secure from any wear and tear and all recording will be as per the Misuse of Drugs Act.

Staff will ensure that all medication is clearly labelled with the name of the child/young person and dated upon opening and is stored in their own individual container within the locked medication cabinet.

Staff will ensure that no medication labelled for one child/young person is used by another.


2. Storage of Medication

All medication will be held in a designated locked area for the safe storage of medication. This will be the only area where medication will be stored. All controlled drugs will be held in a locked container within the designated locked area. Any medicines requiring storage in a fridge will be kept in a designated fridge in the designated area or, in an emergency, in a locked container in the house fridge until the manager can make proper provision.


3. Administration of Medication

On Administering Medicine Staff will:

  • Check to verify correct identification of the child/young person. Check picture and documentation in medical file;
  • Select the required medication; check expiry date and dosage required. Staff should ensure that they only administer medicines that have a pharmacy-dispensing label attached to the container;
  • Dispense the required dosage into a medicine measure (liquids) or plastic cup (tablets/capsules) without touching the medication. Ointments should be applied according to manufacturer’s instructions; eye and ear drops applied directly according to manufacturer’s instructions;
  • Check the medication record and give the medication to the child/young person;
  • Administer the drug as prescribed, offering a glass of water to aid swallowing, as needed.

Should staff have any doubts, concerns or have made any medical errors in administering medication, it is their responsibility to contact the doctor immediately and follow their advice, record in the daily records and healthcare sections of the child/young person’s file. The Registered Children’s Homes Manager should be notified immediately.

Medicines given by injection and rectally should only be administered by a first or second level Registered Nurse or a Doctor, with the exception of subcutaneous Insulin injections. In this case, an appropriately experienced Children’s Care Officer who has been taught and assessed by the trainer can administer insulin. The trainer will accept full responsibility for said administration under their professional registration (there should be documentary evidence of training and the Children’s Care Officer should be ‘signed’ as being competent by the trainer).

Any error in administration must be brought to the attention of the Registered Children’s Homes Manager at the earliest opportunity. It is important to observe the child/young person and to report the error to the GP or on-call GP and follow instructions. Ensure all conversations and instructions are recorded and followed.


4. Recording

A complete record should be kept of ordering, receipts, dates and times of administration and dates of disposal of all medicines.

A medication record should be kept for each child/young person, the entries signed by the prescriber and showing:

  • The name, home address and age of the child/young person;
  • The name of the medicine;
  • The dose;
  • The route of administration;
  • The frequency, date and time for administering each dose;
  • The date of prescribing;
  • In red any known drug hypersensitivity;
  • Any special requirements; and
  • Children/young persons name and ‘known as’ name.

Any absence of the child/young person from the home should be recorded on the Medication Administration Record (MARS).

Accurate transactions involving medication i.e. what is administered, time, dosage, refusal etc. will be recorded on the MARS form that will be located in the child/young person’s medical file. The form will be completed immediately and as a true record of events. No blank spaces will be left on the form for interpretation.

Staff will ensure they are giving:

  • The correct medication;
  • The correct dosage;
  • To the correct child/young person;
  • At the correct time;
  • In the correct manner; and
  • That the expiry date of the medication has not passed

Any refusal of medication will be noted on the MARS sheet, child/young person’s daily log and reported to the Registered Children’s Homes Manager. The Manager will collate this information at the end of each week as part of the administrative routines and advise parent(s) and placing authority. Where refusal by the child/young person is a regular feature, an appointment with the GP will be arranged to review the effectiveness of the regime. The Registered Children’s Homes Manager will act immediately in cases where refusal of medication involves the medical stability of the child/young person e.g. epilepsy or diabetes medication.


5. Children / Young People who Wish to Self Medicate

Children/young people will only self-medicate where the Registered Children’s Homes Manager is of the opinion that the particular child/young person is competent to do so and risk assessments will have been undertaken with the child/young person, staff, the prescribing authority and the social worker.

In all circumstances any Controlled Drugs will continue to be held in the secure location (unless other arrangements have been agreed and provided for by the placing authority). This will not normally be permitted within Children’s Homes as the risks associated with this practice are normally unacceptable. This may be no reflection on the child/young person to whom the medicine belongs but may be due to the nature of potential behaviours of the other children/young people resident in the Home.

Should a request be made to self-medicate by a child/young person resident in the Home the Registered Children’s Homes Manager will contact the child/young person’s social worker and GP to discuss:

  • In the first instance the nature of the medication will be considered; with regard to the potential consequences of misuse of the medication either deliberately or not deliberately;
  • An assessment of the age, maturity and understanding of the child/young person making the request will be undertaken;
  • In all cases where it has been agreed that self-medication can take place, staff will keep the bulk of the medication and dispense an agreed amount at the start of the day/week;
  • An ‘in depth’ Risk assessment will be completed and kept in the Care Plan;
  • A self administration agreement form will be signed by both the child/young person and a staff member detailing arrangements for storage and use of the medication.

In the case of children/young people who wish to take medication to school or other educational provider, the following procedure must be followed:

  • Staff must contact the school / educational provider to determine their willingness and ability to administer medication;
  • Send a letter detailing all aspects of the administration of the medication;
  • Supply a medication administration signature sheet;
  • Check the storage of the medication; and
  • Set up regular reviews.
Where any staff arrive at an off-site visit and discover that the risk assessment or policy cannot be adhered to, the on call manager will be immediately contacted for amendments to be made. In the case of a situation arising that cannot be managed in this way, a decision will be taken; via the care planning process to include all those involved in the child/young person’s care.


6. Over-the-Counter Medications

It is our policy that no “over the counter” medication is bought by staff. Any medication of this nature bought by the child/young person or their parent(s) or social worker will be removed and returned.

7. Homely Remedies

No homely remedies will be given to a child unless it has been prescribed by a doctor or dentist or advised by a Pharmacist.


8. Prescribed Medication

Prescribed medication is defined as ‘as medication that is administered on the direction of a GP, dentist or hospital, according to specific instructions, which includes regular, PRN and controlled drug’s'.


9. Controlled Drugs

Controlled Drugs as defined as ‘preparations that are subject to the prescription requirements of the Misuse of Drugs Act 1971’. Young people are not to self administer controlled drugs. All Controlled Drugs must be checked by two people, one of whom must be a qualified Children’s Care Officer with relevant drug training and competency. Guidance around storage or any information required should be obtained from the prescribing pharmacy. As part of best practice following guidance from the Royal College of Pharmacology, all controlled drugs are to be kept double locked within the home. All recording of controlled drugs is to be kept in a separate bound book such that records are unalterable.


10. PRN Medication

Children/young people who require PRN medication (e.g. eczema cream) will have details of the medication recorded on their young person’s files. Details of the nature of the child/young person’s condition and the need to administer medication will have been discussed at the initial planning meeting or very shortly after the child/young person moves into the home in the case of an emergency admission.

Information available to staff, in the event of having to dispense this medication, will be addressed in the medication file on the PRN MARS form including:

  • The amount of the drug to be given as PRN;
  • The frequency of this medication within a 24 hour period;
  • The specific circumstances under which it should be given e.g. pattern of epilepsy, specific behaviours; and
  • Any other interventions that might be used prior to using PRN medication.


11. Guidance on the Covert Administration of Medications

The guidelines are issued in recognition of the fact that drug competent Children’s Care Officers are required, on occasion, to administer medication to children/young people in a covert manner.

The guidelines seek to define this practice and enable competent Children’s Care Officers to practice within a legal framework.

The guidelines cover the administration of medication to:

  • Children/young people who do not have the capacity to give informed consent;
  • Children/young people who are given covertly administered medication with their full knowledge and consent;
  • Children/young people with swallowing difficulties.

Capacity to make decisions is based on a ‘here and now’ principle. It is possible that a person will be considered to have capacity at some times for some decisions and not at others. A person may withdraw consent at any time. It is not enough that they have consented ‘at some time’.

A person over 18 is defined as having the capacity to consent if:

  • They can understand and remember the information they were given about treatment;
  • They are able to interpret the information given and make a meaningful decision based on this information;
  • They can communicate their decision by talking, using sign language or by any other means.

Disagreeing with the information presented does not result in the person not having capacity.

Capacity is always assumed. It must be shown that the person does not have capacity; in order for another person to make decisions, which must then be shown to be in the best interests of the person under the Mental Health Capacity Act 2005.

Informed consent can only be obtained if the person has been given a full explanation of the nature, purpose and likely effects of the medication, and there is no pressure or coercion and that the person has capacity.

Consent to treatment must always be sought in the first instance. On occasion the child/young person may consent to treatment but prefer to take medication that is presented in food or drinks. In this case all communication with the child/young person and involved others should be clearly documented in the notes and specific care plan written. It is not necessary to confirm this method of administration at each drug round as this may cause unnecessary distress to the child/young person. However, the Care Plan must be evaluated in conjunction with the child/young person at pre-planned and regular intervals.

Where the child/young person does not meet one or all of the requirements for having capacity to consent to the proposed treatment then the following must be taken into consideration prior to giving medication covertly:

  • Lack of capacity must be discussed with the child/young person as far as possible, with the nearest relative, the GP and / or the Consultant Psychiatrist and any other relevant involved professionals and a team decision formed and recorded;
  • All decisions to covertly administer medication must be made in the best interests of the child/young person; and not the interests of the team, relatives or organisation;
  • The decision must take into account the previous known views of the child/young person and the information available on these views from relatives and involved others;
  • The aims and implications of the covert administration of medication must be fully explained in the care plan along side the information set out above and review dates;
  • The Care Plan must be reviewed at regular, pre-planned intervals by the team and take into consideration that the child/young person may be judged to have periods where they have capacity to consent. There should always be a risk assessment in place duly signed by all parties;
  • Covert administration must not continue if the child/young person is seen to be able to enter into the decision making process at any time.

Where a child/young person may or may not have capacity to consent but is unable to communicate their views, there should be no need to administer medication in a covert manner. The child/young person should be told that they are receiving medication and if they spit it out or otherwise demonstrate refusal this should be respected and the above steps followed, if deemed appropriate. A relevant Care Plan demonstrating that the best interests of the child/young person have been taken into consideration must be in place and reviewed regularly.

Refusal to take medication must not always be followed by the covert administration of medication. If one of the previous processes has not been followed then you would be acting illegally and breaching your code of professional conduct.