Medication and Healthcare Procedures
RELATED CHAPTERPersonal Care and Relationships Procedure
1. Intimate Personal Care Guidelines
The young people we support often receive support from a number of carers over the course off the week, e.g.: parents, family support workers, school. This together with their limited understanding and/or poor communication skills makes them a very vulnerable group of children. It is important that we recognise the need to be sensitive to the feelings of the young person and to also be aware how vulnerable they must feel. Young people need to develop their understanding of social boundaries and as a staff member you may also need to support them and their parents to learn what is socially acceptable and what is not.
2. Safeguarding Children
It is important to recognise that we are supporting young people who are very vulnerable to abuse and that as a staff member attending to their personal care needs that you could be vulnerable to allegations of abuse. If any of the following incidents occur, report them as soon as possible to a Line Manager and record it on the young person's file. This is both to register any potential concerns and also to avoid and misunderstanding:
- You accidentally hurt the young person;
- The young person is sore and unusually tender in a particular (genital) area;
- The young person appears sexually aroused by your actions;
- The young person misunderstands or misinterprets something;
- The young person has a very emotional reaction without apparent cause (sudden crying or shouting).
3. Getting to Know People
Prior to providing personal care staff need to be introduced properly and get to know the young person. You need to be aware of any communication difficulties and how to understand the young person. Risk assessments indicate the support levels required for each young person in relation to personal care. As a service we aim to keep a balance between ensuring vulnerable children are not exposed to risk with respecting their rights to privacy and avoiding being over intrusive. Under no circumstances should a new member of staff undertake personal care unassisted until after indication and appropriate training has been undertaken. During the first few weeks new staff will 'shadow' experienced staff until the young people know them and they are confident and competent in maintaining personal care and supporting young people. Team Leaders will review children's support needs with new staff and record this in supervision.
Prior to understanding personal care it is important to establish with the young person who they would like involved in the process, this needs to be checked with them each time personal care is required. Guidance on consent is included in the Medication Procedures Policy. In developing Personal Profiles parents will be asked to advise on what personal care is required and how staff need to offer the support.
5. Gender Issues
It is preferable for support to be provided by the staff of the same gender as the young person using the services and generally that whilst it is recognised that female staff may need to provide this support to male young person's, the converse cannot occur. Situations where male staff are involved in helping female staff to provide any form of intimate personal care should also be avoided whenever possible. There should not be any situation (other than in an emergency) where a male member of staff is the sole provider of intimate personal care for a female service user. Female members of the team need to be sensitive to the fact that maturing young men may not want to be supported by staff of the opposite gender.
- Staff shift patterns generally allow for gender appropriate care however unforeseen circumstances can occur which may create difficulties. In these circumstances if there is no Manager or Team Leader on duty then they must contacted at home and informed so that a decision can be made on how the young person's personal care needs will be met;
- Manager may need to authorise overtime, change rosters or seek support from other staff teams. The Manager will also contact parents to inform them of the support being offered;
- If it is necessary for a male member of staff to be involved in personal care with a young lady then as soon as appropriate they should withdraw from the room and only be involved in playing a supportive role to a colleague;
- In such situations staff should use towels to preserve the dignity of the young person, averting their gaze when possible. At no time should a male carer be involved in care that involved genital contact. Staff must check with the young person that they have not been distressed by the support offered and offer reassurance accordingly;
- Where a female member of staff who is involved in providing intimate personal care to a male service user feels unduly embarrassed, distressed or sexually vulnerable or exploited, she should discuss the management of the situation with her Line Manager to determine appropriate action.
6. N.V.Q. Care Awards
Training in the NVQ Framework will underpin knowledge of appropriate personal care procedures as laid out within National Minimum Standards. Staff will ensure that the needs and wishes of the young person and their families are ascertained, respected and met whenever possible, bearing in mind ethnic, religious and cultural factors.
7. Personal Profiles
Personal Profiles are a vital method of identifying young people's needs in the area of personal care. Where young person have added risk assessments in place they should be referred to especially in relation to moving and handling. It needs to be recognised that young people's needs will change as they grow up or acquire new skills - the documents therefore need to be kept up to date. Where people need aids to help them with daily living skills an Occupational Therapy Assessment can be arranged for them.
Personal Profiles and Risk Assessments should be updated bi-annually more frequently if necessary.
8. Privacy and Dignity
You are dealing with young people and needs to be clear that you may generate feelings for them of embarrassment. Regard must always be given to privacy, their personal dignity and comfort.
- Before entering bedrooms knock and ask permission. Use locks on bathroom and toilet doors. Use dressing gowns and towels appropriately to preserve young people's dignity;
- Talk to young people throughout, give them options, ask their preferences, tell them what you are doing at each stage and check that they feel comfortable. 'Was that ok for you';
- Common sense is required to encourage young people to maintain good standards of personal hygiene. This will take time and patience when young people are reluctant to bathe regularly;
- Preparation is the key to good practise, you need to ensure that the materials needed to assist the young people are available to hand, and that you do not have to keep elsewhere to collect them.
9. A Positive Self Image
As a staff member you should encourage the young person to have image of their own body. Confident, assertive young people who feel happy their body belongs to them are less vulnerable to sexual abuse. As well as the basics like privacy, the approaches made to a young person's intimate care convey messages about what their body is 'worth'. Your attitude to the young person's care is important. As far as appropriate and keeping in mind the young person's age, routine care should be relaxed and fun. The young person's right to say 'NO' is respected. Acknowledge each young person's sexual and physical development, where possible discuss these changes.
10. Involving Young People in their own Intimate Care
Young people should be encourages as far as ability allows in their own intimate care, attempts should be made to avoid assisting a young person with tasks that they are able to perform alone. If a young person is able to help, If the young person is able to help, ensure that they are given the opportunity to do so. This is as important for tasks such as removing underclothes as it is for washing private parts of the young person's body. Support the young person in doing all that they can do, themselves.
11. Bathing Guidelines
All young people who use our services will need supervision in running a bath. To ensure this is done in safe manner we have set out 'Safe Bathing Guidelines' which must be strictly observed.
- Some young people particularly enjoy effective supervision throughout bathing. Staff should be in the bathroom at all times unless their Care Plan, risk assessment and a specific agreement has been confirmed by the Manager with the parents which indicates otherwise;
- If a young person has a medical condition with an identified risk, they must never be left alone in a bath or shower. Staff to be present at all times;
- Staff must ensure that the area is safe from hazards, i.e.: slipping on wet floor, chemical and/or products which the young person may misuse. Extra care will be taken in assisting a young person in and out of the bath/shower. Slip mats must be used;
- Bathroom aids that are used must be checked daily and kept in a clean condition. Staff will also adhere COSHH regulations in regard to cleaning materials;
- If you as a staff member determine that a young person's state of health has deteriorated or there are any concerns about aspects of their bathing need that are unclear - DO NOT BATH without advice from your Line Manager;
- Personal Profiles will identify if the young person prefers a shower to a bath or do not like having water running down their face;
- Read and check the Care Plan to ascertain if the young person has a risk assessment of bathing needs. If there is a risk assessment in relation to bathing, all advice must be strictly adhered to;
- Bathing or showering must only be carried out where it has been identified in the Placement Plan. In the event of an emergency situation, (i.e.: continence difficulty, vomiting and soiling) that is not covered by the Placement Plan, bathing procedures must be rigorously adhered to;
- Ensure you have all requirements i.e.: gloves, towels, flannels, soap equipment etc before proceeding to bathe the young person;
- Hot water taps all have safety regulators, which provide for the water to be mixed at the point of delivery. As the regulators can be subject to mechanical failure temperature record checks are made on a weekly basis or daily when the young person is bathed/showered. This must be signed for;
In running a bath/shower - the following guidance MUST be followed:
Bath temperatures must be taken and recorded before the young person has a bath;
- Cold water to be run before the hot, even if using mixing taps;
- A bath thermometer will be used to check the temperature of the water before child/young person enters the shower is supported into the bath. The temperature should not be above 43c;
- Once the water has been run ensure the taps are secured to prevent any subsequent water drips;
- Having first checked the water temperature with the bathing thermometer you should also then do so by hand to confirm the water feels comfortable;
- When using a shower ensure that the water has been flowing for a minute before the young;
- Hot water must never be added to a bath once the young person is in the bath;
- If a second bath is required, i.e.: if the young person has been incontinent, they must get out of the bath until fresh water has been run and the temperature has been retaken;
- Temperatures must be recorded and signed for.
12. Continence and Using the Toilet
When supporting young people with continence problems you may need to prompt them to use the toilet, or provide them with total assistance if they use incontinence pads. Incontinence aids must only be used where the young person has been assessed by an incontinence nurse as requiring them. You should anticipate that people might need to use the toilet somewhere between 6 and 8 times typically in any 24 hour period. Leaving young people who are unable to directly ask you for this support unattended is not acceptable, given that they may feel distressed and extremely uncomfortable.
Personal hygiene should dictate that where young people are incontinent that you should always wash soiled areas properly, this is essential not only for personal comfort but also to impede sores and limit the potential for urinary infection. Disposable wipes and gloves are available for use and these must always be worn during personal care.
Gloves, wipes, aprons etc must be kept locked away from the young people.
Staff must check Profiles for indications of allergic reactions of wipes, creams or soaps. Staff in summer will need to help young people to apply sun cream, wear clothing and hats and avoid undue exposure to the sun, especially where young person takes medication is being taken that heightens skin sensitivity.
During outings it may be necessary for female staff to support a young man who wishes to use the toilet and this can present problems. Where possible disabled toilets should be used. If this facility is not available assistance should be sought from venue staff to enable staff to support the young person in as dignified a manner as possible.
Personal Profiles should identify the level of support required with continence. Staff should encourage the young person to do as much as they are capable for themselves and build on skills to enable the young person to attend to their own needs independently, e.g.: wiping themselves, urinating standing up etc.
13. Dental Care
Promotion of good dental hygiene will involve you in supporting young people to brush their teeth twice daily. Toothbrushes need to be stored properly and are supplied by parents. New brushes are held in stock should the young person require them. Young people and their parents often need support in managing this area of personal care. Where appropriate advice can be sought from a dental hygienist.
Tooth brush must not be shared and must be disposed of when a young people goes home or sent home with them.
Young men you are supporting will need assistance with shaving daily. Personal Profile should indicate if people use electric razors, or wet-shave. When young people have sensitive skin you should help them to apply a moisturising cream to reduce any soreness resulting from shaving.
Personal Profiles should indicate appropriate creams to used. You will need to support young people in maintaining their own shaving equipment in good order. This should involve emptying and brushing out the shaver prior to and after use, putting the shaver on to recharge and generally safe storage.
Bic razors etc. must be disposed of and not shared.
You may need to help people with the care of their fingernails, by cleansing or filing. If nails require cutting then the school nurse should be informed or a parent carer.
16. Eating and Drinking
As a service we retain a responsibility for ensuring that young people who use our service are supported to maintain a healthy lifestyle to maintain a healthy lifestyle. This involves sitting down with young people to plan balance menus. Mealtimes are a major opportunity for social interaction, a time to sit down and talk to young people. Young people may need support with the appropriate table manners. You should also be conscious that some young people might choose to eat by themselves, or at different times of day.
- Some young people whom you support have difficulties in eating and drinking. Advice and Programmes are usually set up by the Speech and Language Therapy Services sometimes in conjunction with either the Dietician or Occupational Therapy. The risks some young people face can be severe, including that of choking or, of food continually entering the lung, leading to repeated and or chronic chest infections;
- Close monitoring may be essential of fluid and food intakes to prevent the risk of dehydration and or weight loss, this will involve completion of record charts and communication books may need filling in. Staff should offer support on sensible eating, look to regulate portion control and encourage eating fresh fruit and diet products;
- Again preparation is essential to ensure meal times are promoting a relaxed environment. The correct utensils required to support the young person should be to hand so that you can provide them with your undivided attention whilst supporting them.
17. Contagious Diseases
During you work you may be exposed to infections, illnesses or diseases which are contagious. You should always report any such occurrences to your Manager, who will in turn notify everyone required. They will have access to the 'Control of Infectious Diseases Procedures', and will talk to the Health & Safety Officer for advice. When you attend your G.P you should make clear to him/her the nature of your work, so that they can notify the Community Physician if required. If the situation is serious the Doctor may place you on sick leave until they determine the risk to others is past.
18. First Aid
A First Aid box is provided in each unit, there is a designated person who is delegated to ensure it is kept stocked. The delegated first aid person will undertake a 5 day training course. It is the responsibility of staff members to render treatment as required to any person who staying in the unit, member of staff, or other person(s) visiting. All other staff will complete their training in basic life saving techniques. The soundest first aid advice is call the experts, the emergency services.
- If a child takes any form of medication this must be administered following the MP3 Risk Assessment;
- If you are designated as Meds 1 you must have taken part in an accredited training course;
- All the children have on their files an MP1 and MP3 and MAR sheets to record administered medication;
- Take time out to look at these forms and understand them.