Medication Procedures

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) has been returned to the home and is stored on the child/young person’s case file. If a parent does not have parental responsibility consent will need to be given by the named social worker.

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) or in the case of young people accessing short breaks prior to their first overnight stay.

The consent form will seek parental / 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 for young people who reside in the home. All unused, unwanted or surplus medication will be returned to the pharmacist for safe disposal. For young people who attend for short breaks it is the parents responsibility to provide sufficient medication to cover the length of their stay. Parents should be advised that medication will only be administered when prescribed by a GP or hospital unless it is classed as a homely remedy in which case parental consent to administer will be required.

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. Medication competency checks will be carried out annually for staff who administer medication.

All prescribed and controlled medication will be dispensed as directed. All prescribed medication received will be entered into the admission and discharge book specifically for the purpose, and medication that is no longer required will be returned to the Pharmacist for disposal is also entered in this book. 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 enter medication into the medication administration book and the young person Medication Administration Record ( MAR ) sheet when administering medication.

Staff will ensure that all medication is clearly labelled with the name of the child/young person and dated upon opening and is stored 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. All medication must be stored in a locked cabinet, used exclusively for the storage of medicines and out of reach of children and away from direct light and heat. It should be kept at a temperature below 25C. A thermometer should also be stored in the locked cabinet, which should be secured to a wall. The cabinet must be locked when not in use and staff/carers must retain a key to the cabinet.

All controlled drugs will be held in a locked cabinet within the locked medication cabinet. 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. Staff/carers should ensure that the temperature of the fridge is checked daily and recorded.

All medicines should be stored in their original container and be properly labelled. They should only be kept at a residential home for the time the child is there unless agreed with the manager. At the end of each respite period, therefore, medicines are to be returned to the child's parents/main carers.

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 clear 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 along with the young person’s parents and Social Worker. If an error occurs out of hours staff should contact 111 to discuss what support a young person may need and Emergency Duty Team (EDT). In the event of a adverse reaction following an error staff should seek emergency support via 999.

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 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;

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

Accurate transactions involving medication i.e. what is administered, time, dosage, refusal etc. will be recorded on the MAR 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 MAR sheet, child/young person’s daily log and reported to the Registered Children’s Homes Manager. 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.

6. Administration and Recording of Medication during Time Away from the Home

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.

When children are away on holiday, staff/carers 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/Home 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 with the exact number required; it should not be transferred to another container or envelope. If the medicine is to be taken away from the home, a separate clearly labelled container of medicine should be requested from the pharmacist. Any medication taken away from the home should be recorded.
If residential staff/carers are not directly administering a child's medication whilst they are away from home, instructions and guidance should be handed over to those who will assume this responsibility.
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, all appropriate records should be completed.

7. Home Remedies/Over the Counter Medication

Home remedies are any non-prescription medication available over the counter in community pharmacies. This also refers to homeopathic and herbal remedies. The only exception is aspirin which may not be given to children unless prescribed by a medical practitioner. These treatments are used for minor ailments without immediate consultation with a medical practitioner.

Home remedies can be given to children by staff/carers, only with parental / Social Worker consent.

These issues should be discussed at the time of the child's placement and set out in the child's Placement Plan. Checks should be made with the child's parents to ensure that the child has no record of an allergic reaction to any homely remedies, or any possible adverse reactions between home remedies and any regular prescribed medication the child may be taking.

Home remedies treatment should not be extended beyond two days without seeking medical advice. In the case of paracetamol, medical advice should be sought after 24 hours if the symptoms persist beyond that time.

The home should have an agreed list of Home Remedies that can be bought over the counter, preferably from a local pharmacist who can be contacted to provide pharmaceutical advice to the home/carer;
Advice should always be sought from the pharmacist about any potential interactions between the homely remedies and any prescribed medications the child may be taking. Children should not be administered both prescribed and non-prescribed medication unless signed consent has been obtained from the child's GP that it is safe to do so;
All home remedies 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 home remedies which have been administered.

Any home remedy purchased for the home should be recorded and stored safely in a locked cabinet unless it has been agreed that a child may retain their own medication in which case they should be stored in accordance with the agreed arrangements.

All non-prescription medication must detail when the medication was opened/started for use to ensure it is not kept it beyond the expiry period.

Following consultation with a pharmacist, if a home remedy is purchased specifically for a child, a label should be put on the container with the child's name. This medication must not then be used by anyone else within the home.

8. Prescribed Medication

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

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 have undertaken competency training. 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 MAR 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.

Were medication is given on a PRN basis to support young people when they become anxious e.g Diazepam then a Required Medication (PRN) form should be completed immediately following prescription.

11. Guidance on the Covert Administration of Medications

On occasion it may be necessary to administer medication to children/young people in a covert manner.

The guidelines seek to define this practice and enable staff 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.

12. Stock Checks

At least once weekly, a stock check should be undertaken of all prescribed medicines and Home Remedies kept - including those which a child retains and administers him or herself and a record kept of stock check findings.

Any prescribed medication and/or Home Remedies no longer in use or out of date must be disposed of.

In children's homes, the manager is responsible for ensuring that the stock checks take place and the frequency of these.

In the event of a discrepancy between the records and the medication actually stored, the manager must be informed and a full investigation carried out to establish the reasons for any discrepancies. Report incidents related to controlled drugs (including loss or theft) to your local NHS Controlled Drugs Accountable Officer (CDAO) at NHS England. You should also report incidents to the police and undertake a Regulation 40 notification to Ofsted

13. Disposal of Medication

Medication should be disposed of when:

The expiry date has been reached;
The course of treatment is completed;
A medical practitioner stops the medication.

All medication to be disposed of should be recorded

Wherever possible all medication, both prescribed and homely remedies, should be disposed of at a pharmacy. Medication should not be disposed of in other ways unless agreed with a pharmacist. The home should have a record of the preferred pharmacy to be used, including the name, address and telephone number.

Controlled medication must be disposed of at a pharmacy.

In all cases where medication has been taken to a pharmacy for disposal, this must be recorded and a receipt obtained from the pharmacist.

When a child leaves his or her placement, a signature must be obtained to confirm receipt of any medication that is handed over, along with instructions for its use, the reasons for it having been prescribed and any subsequent medication reviews/follow up appointments that the child may have.

In the event of a child dying whilst in the placement, the home must retain any medication the child was taking prior to or at the time of his or her death in order that it can be made available to the coroner.