Administration of Medication
SCOPE OF THIS CHAPTER
This chapter relates to children placed in residential care and foster care. The procedure applies on the basis that consent to administer medication/first aid/home remedies has been obtained from a parent or person with Parental Responsibility for the child, which will be recorded on the child's Placement Information Record.
OTHER GUIDANCESafe and secure handling of medicines (The Royal Pharmaceutical Society of Great Britain)
1. Prescribed Medication
Also see Section 2, Controlled Drugs.
If a child is taking prescribed medication at the time of a placement, the child's social worker must inform the staff/carer before the placement of the medication the child is taking and the reasons why, and ensure that a supply of medication is provided in the original container clearly marked with the child's name, the dosage and when the medication should be given.
If the staff/carer have any concerns about the medication or require clarification about the dosage, they must contact the child's GP for advice.
Before the placement, depending on the child's age and level of understanding, a risk assessment must be carried out by the child's social worker, in consultation with the child, his or her parents and the staff/carers, as to whether the child should retain and administer his or her own medication. If the child is permitted to do so, the arrangements must be set out in the child's Placement Plan / Placement Information Record - see Section 4, Administration of All Medication.
If a child is prescribed medication during a placement, residential staff /foster carers should collect the prescription from the doctor's (preferably with the child at the time of the appointment). Staff/carers should ensure that the medication is then collected from the pharmacy.
When collecting medication, staff/carers should ensure that it is appropriately labelled with the details being the same as that on the prescription. It is not acceptable that medication is labelled 'as directed' or 'as before'. If this happens, the staff/carers should seek clarification from the pharmacist or doctor and an appropriate label should be obtained and applied.
Appropriate advice should be sought re: the side effects or any food/other medication that may affect the effectiveness of the prescribed medication. Staff/carers should also always ensure that they clarify with the pharmacist whether the prescribed medication is categorised as a 'controlled drug' (such as Ritalin).
Where possible, staff/carers should request pre-packed medication rather than loose tablets in a bottle. In any case, prescribed medication should be kept in their original containers, clearly marked with the name of the child for whom they have been prescribed and they should only be given to the named child as prescribed and set out on the container.
Asthma Inhalers: With regards to asthma inhalers, all children who are using inhalers should have a written recommendation from the prescribing doctor about how they should be administered. All inhalers must be labelled with the child's name. Risk assessments must be in place to indicate a child's capability to use their inhaler. Regular support via reviews/asthma clinic must be made available.
2. Controlled Drugs
This section should be read in conjunction with Section 1, Prescribed Medicines.
The Misuse of Drugs Act, 1971 classifies controlled drugs into classes A, B and C. Controlled drugs are included in each of the classes according to the potential for harm they are thought to present to individuals and to society at large.
When a child is prescribed or currently taking a controlled drug they must only be supplied for that individual child.
The controlled drug must be kept in a locked container within a locked medicine cabinet in a location agreed by the residential manager/supervising social worker. The manager/foster carer must ensure that a 'stock' is not kept (e.g. no more than 28 days supply at a time).
When administering a controlled drug, two people should be present - unless it has been agreed that one person may administer the drugs or that the child may administer the drugs him or herself. On each occasion the drug is administered, the remaining balance of the drug should be checked and recorded by the person(s) administering the drugs. See also Section 4, Administration of Medicines.
As with all unwanted medicines, any unused controlled drugs should be returned to the pharmacist and a certificate of disposal obtained and recorded (see Section 7, Disposal of Medication).
3. 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 consent. In some cases, the child's parent may request that the GP's consent should always be sought first. These issues should be discussed at the time of the child's placement and set out in the child's Placement Information Record. Checks should be made with the child's doctor and parents to ensure that the child has no record of an allergic reaction to any home 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.
- Each residential home/foster 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 home 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;
- The use of complementary or alternative remedies should only be undertaken following a documented discussion/agreement with the child's social worker;
- 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 (see Section 10, Recording) 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. See also Section 6, Stock Checks.
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.
4. Administration of all Medicines
NB When not in use, medication must be stored safely - see Section 5, Storage of Medication.
4.1 Self Administration by a Child
At the start of a placement, in consultation with the child, his or her parents and staff/carers, the child's social worker should assess whether the child may retain and administer his or her own medication. If the child is permitted to do so, the arrangements must be set out in the child's Placement Information Record and reviewed regularly, including suitable arrangements for the storage of the medicines and recording by the child of when he or she administers the medication.
Although it may be deemed inappropriate for children to hold their own medication, if appropriate the children should be encouraged to be pro-active in taking responsibility for their health needs i.e. asking for medication or booking health appointments. Risk assessments must be completed that indicate safe strategies.
Issues to be considered include:
- Does the child understand the importance of taking the medication regularly and at the correct time?
- Can the child safely store the medication?
- Is the child cooperative with staff/carers?
- Could the medication be taken and used by other children in the home?
- Does the medication have value if sold illegally?
Examples of medications that should be a child's responsibility are oral contraception and reliever inhalers.
The child should be encouraged to take the medication appropriately and this should include giving reminders on a regular basis.
If there are concerns that a child is not managing his or her medication appropriately there should be a review of the arrangements.
4.2 Administration by Staff/Carers
When administering medication, the following procedures must be followed:
- All medicines should be administered strictly in accordance with the prescriber's instructions or, in relation to home remedies, as advised on the packet;
- 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;
- Aspirin must not be administered to a child unless prescribed by a GP;
- All children must have an up-to-date medical record sheet for each prescribed/non prescribed medication;
- The staff member/carer responsible for administering medication to a child must be trained in the safe administration of medication;
- When removing the medication from the locked cabinet, the staff/carer must ensure that the cabinet is locked if it is left unsupervised;
- All medicines should be administered from the container in which they were dispensed;
- If prescribed medication with an expiry date is administered, e.g. eye drops, staff/carers should record on the container the date opened and the expiry date of the medication must be checked before administration;
- Before administering any medication, a check must be made that the correct name of the child is on the medication container and the records must be checked to ensure that the medication has not already being given/taken; this will clarify that the medication being administered is correct;
- The required dose should be given directly to the child and the staff/carer administering the medication must ensure that it has been taken;
- Once administered, the remaining medication must be returned immediately to safe storage;
- A check should be made to see whether the course has been completed;
- The administration of the medication should be recorded on all the appropriate records as set out in Section 10, Recording;
- If and when medication has been refused or not taken by a child, this must be recorded and the reasons why. If a child is refusing to take an essential prescribed medication, the residential manager/supervising social worker must be informed and advice sought from the GP/Pharmacist;
- If a child is absent when a medication is due - this should also be recorded;
- If the course has been completed, this must be recorded;
- In the case of prescribed creams being applied, the cream should be squeezed directly onto the child's finger to apply themselves. If it has to be applied by staff, latex gloves should be worn;
- In the event of an error being made in the administration of any medication, advice should be sought by either contacting the child's G.P. or another medical practitioner/help line;
- Any adverse drug reaction or suspected adverse drug reaction should be reported to the GP before further administration is considered;
- If a label becomes detached from a container or is illegible, the prompt advice of the person who made the supply must be sought. Until then, the container should not be used.
4.3 Procedure for Administration and Recording of Medication during time away from the home
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 (see Section 10, Recording).
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.
5. Storage of Medication
All medication must be stored in a locked cabinet kept below 25C. A thermometer should also be stored in the locked cabinet, which should be secured to a wall. Staff/carers must retain a key to the cabinet.
In a children's home, the locked cabinet will be in a staff office and all medication will be kept there unless the child's social worker has agreed following a risk assessment that the child may retain and administer his or her own medication in which case the medication must be stored as agreed as part of the risk assessment.
Should a child's medication require to be kept in a refrigerator i.e. insulin, a small lockable fridge should be used for the exclusive use of the storage of this medication. Staff/carers should ensure that the temperature of the fridge is checked daily and recorded.
Staff/carers should ensure that any medication to be applied externally is stored separately in the cabinet from medication to be taken internally.
6. Stock Checks
At least once a month, 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.
Any prescribed medication and/or home remedies no longer in use or out of date must be disposed of - see Section 7, Disposal of Medication.
In children's homes, the manager is responsible for ensuring that the stock checks take place; in foster homes, it is the responsibility of the foster carers.
7. 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 (see Section 10, Recording).
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.
8. First Aid
Fully equipped first aid boxes must be kept in each home and in each vehicle used to carry children. The manager of the home/foster carers' supervising social worker must ensure that suitable arrangements exist for the contents to be checked in keeping with Section 6, Stock Checks.
First aid boxes must have a white cross with a green background. The inventory must include the quantity of each item in the box.
Children may administer their own first aid only if they are considered to be capable of giving first aid themselves and have a suitable first aid certificate or do so under the supervision of a member of staff/foster carer. This will be confirmed in the child's Placement Information Record.
If children are not deemed to be capable of giving first aid themselves or under supervision, it must be administered by a member of staff/carer.
Other than for very minor injuries, professional medical attention must be sought as soon as possible following the administration of first aid (either take the child to see a medical practitioner or seek advice by telephone), even if the casualty's condition seems to improve.
In the event that a child requires administration of first aid, a record of this should be made (see Section 10, Recording). If an accident occurs, it must be reported and recorded.
9. Skilled Health Tasks (e.g. Diabetics, physiotherapy programme)
If a child requires a skilled health task to be undertaken, this will only be undertaken with the written authorisation of the prescribing doctor in relation to the child concerned. If required, appropriate training would be sought for staff/carers to ensure that they have the necessary level of skills before undertaking such duties.
The following records should be kept:
- First Aid should be recorded in a First Aid Record/Log;
- Prescribed medicines, home remedies and controlled drugs should be recorded in a Medication Log Book;
- Each administration of medication should be recorded on a Record of Medication Administration Sheet or other record authorised by a pharmacist or medical practitioner;
- The storage or stock checking of medicines/drugs should be recorded in the Medication Log Book or as required/agreed by a pharmacist or medical practitioner;
- The disposal of any medication should be recorded o the Medication Log Book.
Where children are permitted to retain and administer their own first aid, home remedies or prescribed medication, suitable arrangements must be made for the recording by the child of when he or she administers the medication and staff/carers must record instances where this occurs in the child's Daily Record.