First Aid, Prescribed and Non Prescribed Medication

Contents

1.	First Aid
2.	Allergies
3.	Non Prescribed Medication
	3.1	Misuse of Prescription Drugs and Overdose
4.	Key First Aid/Medication Records held in the Community
	Appendix 1: Administration of Medication Guidance
	Appendix 2: Specific Issues Re Administration of Medication
	Appendix 3: Administration away from the Home
	Appendix 4: Skilled Health Tasks

1. First Aid

Each Home must have a qualified First Aider on duty at all times.

First Aid boxes must be held in each home and in vehicles used for the transportation of children, these should have a white cross with a green background.

The inventory 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. Antiseptic wipes should be used where necessary, TCP should not be used.

Recording: The administration of First Aid must be recorded in the following places as appropriate: Daily Log, (if there has been an accident) Accident Record, individual Child's Daily Record and Medication Administration Record (MAR).

2. Allergies

A specialist allergy nurse/consultant will help develop a Health Care plan which should be shared with all agencies working with the child/young person.

The Care and Placement Plan and Health Care Plan should contain the following:

• All known allergies and associated risks including spotting the signs and symptoms of an allergic reaction and anaphylaxis for the child/young person;
• Preventative measures should be detailed in the Plan - for example taking daily antihistamines for hay fever, making sure cleaning products and gloves are hypoallergenic, and washing powder is suitable for skin conditions;
• Actions to take when a young person has an allergic reaction. The plan should describe exactly what to do and who needs to be contacted in the event of an emergency. For example, when to use an EpiPen and calling for an ambulance;
• All staff should be aware of the Plan and should have been trained to administer an EpiPen by a suitable qualified health professional;
• The child/young person should be educated around their allergies and what to do in an emergency - a young person may be able to self-administer their own EpiPen or take antihistamines. If this is the case this should be recorded;
• Medication should be easily accessible so staff and/or the child/young person can access their medication in an emergency situation;
• A record should be kept of each episode and any medication given should be recorded on Medication Administration Record ( MAR) sheet.

For further information, please contact the child or young person’s health professional who deals with their allergies and check the NHS website or see Allergy UK Website.

3. Non Prescribed Medication

Each home has a list of Non Prescribed Medication that may be used, and this list is regularly reviewed and approved by a local GP/Medical Practitioner.

Non Prescribed Medication are medicines that can be bought over the counter, including Paracetamol and Ibuprofen.

Non Prescribed Medication are only for the use of the children/young people in the home, with the approval of relevant social workers (and set out in children's Placement Plans) or as prescribed by a GP or recommended by a Pharmacist. Non Prescribed Medication must be administered according to the administration instructions on the packet/bottle or as directed by a GP/Medical Practitioner.

Non Prescribed Medication may be purchased for named individual Children/Young People, if this is the case the containers should be labelled with the child's name. Some Non Prescribed Medication may be purchased to be available within the medication cabinet for use by any of the Child/Young Person E.g. Paracetamol.

When a Homely Remedy container is opened, staff should record the date of opening to ensure it is not kept beyond its expiry date.

Non Prescribed Medication should be stored in a locked cabinet, this may be with prescribed medications however they should be stored on separate shelves/areas of the cabinet; all medications should be clearly labelled.

No Child/Young Person may be permitted to 'self-administer' Non Prescribed Medication unless approved by their social worker, with the arrangements outlined in their Placement Plan.

Recording: The administration of any Non Prescribed Medication must be recorded in the individual Child's Daily Records and Medication Administration Record (MAR).

3.1 Misuse of Prescription Drugs or Overdose

When Children/Young People overdose on over-the-counter or prescription drugs (e.g. Paracetamol) as a form of self harming, this will be understood within the child's pathology. Where such use is understood as a plea for attention, Clinical Team led by the Director/Registered Manager and senior staff will discuss staff responses. The Childhood First treatment methodology means these children are more likely to be positively responded to, that is: to be given the attention they are craving rather than simply removing the danger and then ignoring the child so as not to encourage further incidents (a response recommended by many other treatment methodologies). However, responses will be tailored to the individual child and their circumstances. Children who are vulnerable to misusing over-the-counter drugs will be supervised on shopping trips. All medication within the community is stored and used safely. Where misuse is long-term or entrenched, it is unlikely that children are best placed in a Childhood First community and they may well need a different specialist placement.

4. Key First Aid/Medication Records held in the Community

Each Community should keep the following records:

Accident Record	To record any accidents
Medical Records	Individual records 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 Non Prescribed Medication) administered.
Non Prescribed Medication Record	Central record of Non Prescribed Medication in stock and administered.

Medication

4.1 Ordering Ongoing Medication

Some Children/Young People will have prescribed medication on a long term basis. This should be ordered on monthly basis where possible. Responsibility for ordering these medicines is that of the Registered Manager or a delegated member of staff.

Staff should check stock levels before ordering. To minimise wastage and reduce risks of errors, stock levels should be kept to a minimum, ideally no more than 6 weeks' stock should be stored.

4.2 Collecting Prescriptions

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. In some cases, the GP surgery and pharmacy will be linked and prescription requests will be sent directly to the pharmacy for dispensing, in this case staff should ensure they check the medication is correct on collection.

4.3 Receiving/Collecting Medicines

Staff must take their ID when collecting medicines or controlled drugs.

When the medicines are collected, staff should check the medicine dispensed against the medication ordered. Any discrepancies should be brought to the attention of the pharmacy and rectified as soon as possible.

The pharmacy will be able to give advice on:

• Potential side effects;
• Advice on how the medicine should be taken;
• Advice on whether the medicine may be affected by any other medicine;
• Whether the medicine should be stored in the fridge;
• If the medicine is a Controlled Drug.

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 for each medication, if this has not been received the pharmacy should be contacted and one requested.

The receipt of medication should be recorded on the individual child's Medication Administration Record (MAR), if a Controlled Drug has been prescribed, 2 staff should record/sign the record.

4.4 Administration

NOTE: All staff must be familiar with the following detailed guidance on the administration of medication:

For detailed guidance on the administration of medication	Appendix 1: Administration of Medication Guidance
For guidance on specific issues, e.g. refusal to co-operate, if a child is missing/absent, covert administration	Appendix 2: Specific Issues re Administration
For the administration of medication away from the home e.g. if a child is on holiday or having contact with his/her parents	Appendix 3: Administration away from the home
Skilled Health Tasks, e.g. for children with Diabetes	Appendix 4: 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 arrangements outlined in their Placement Plan.

Administration should be recorded on the individual child's Medication Administration Record (MAR), if a Controlled Drug has been administered, 2 staff should record/sign the record.

Gloves, pill pots and other equipment will be available to assist in the administration of medication as required.

4.5 Storage and Expiry Dates

All medicines must be kept in a safe/secure place, e.g. a locked cabinet that does not exceed 25C*. Responsibility for the key lies with the senior/responsible member of staff.

Medicines that are taken internally should be stored separately to those used externally in the medicine cabinet, with liquids preferably on the bottom shelf.

All medicines have expiry dates or use by dates, usually clearly stated on the label, ahead of the expiry date they should be disposed of.

* Medicines that require refrigerated storage should be kept in either a dedicated lockable fridge (in a staff office) or a locked box inside the food fridge. In both cases the maximum and minimum temperature should be recorded on a daily basis on the relevant record. Both these temperatures should be between 2 and 8C.

4.6 Disposal

Medication should be disposed of when:

• The expiry date or use by date has been reached;
• The course of treatment is completed;
• The medication has been discontinued.

Unless instructed by a GP/Pharmacy, unused/expired medicines should be returned to the pharmacy, and a receipt or signature of receipt obtained.

This should be recorded on the individual child's Medication Administration Record (MAR). If a Controlled Drug has been disposed of, 2 staff should record/sign the record.

4.7 Sharps

Any sharps (e.g. razors, broken glass, needles etc.) should be disposed of in a sharps bin located in the locked medication cupboard.

Disposable razors may be purchased for Children/Young People's use and these should be stored in a locked cabinet/cupboard when not in use. Some young people have their own razors which are also kept in in a locked cabinet/cupboard. If required razors may be signed in/out, razors should all be returned when finished with and signed back in. The senior member of staff should be informed of any razors unaccounted for without delay.

Appendix 1: Administration of Medication Guidance

Checklist: If you wish, you may print out this Appendix, click here to download a PDF version, then print it off.

All medicines must be administered strictly in accordance with the prescribers instructions or as advised on the packet in relation to Non Prescribed Medication. Only the prescriber (e.g. GP/Pharmacist) can vary the dose. Medicines must be locked away in the locked storage areas when not in use and the keys for these areas must be kept in the key cabinet.

Before administering medication, staff should wash their hands and ensure they have everything needed to administer and record the Child/Young Person's medication.

The procedure for administration is as follows:

• Check the child's identity (a photo is normally kept in the young persons file). Only one child should be administered medication at a time, this reduces the risk of mistakes being made;
• Check the child's medical records;
• Check the medication on the individual medication records corresponds with that on the Child/Young Person's medical records;
• Check the individual medication record sheet to ensure that someone else has not already given the medication;
• Check the expiry date and use by date (where appropriate) on the medication;
• Check the amount to be given at that time;
• If opening a new container, record the date opened;
• Measure or count the dose without touching the medicine. (See COSHH assessment);
• If the medicine is a solid (such as a tablet) then carefully place into a medicine pot and offer to the child. They may wish to put it in their hand or swallow straight from the medicine pot;
• If the medicine is a liquid, take care not to drip onto the label. If the amount to be measured is less than 5ml, then a medicine syringe should be used otherwise a medicine spoon or measure should be used;
• If the medicine is a cream or ointment, then it should be squeezed directly onto the Child/Young Person's finger for them to apply. If necessary to be applied by staff, then latex/pvc gloves are available to be worn;
• When administering a Controlled Drug, another member of staff prior to it being given must check the dose;
• Watch the child as they take their medicine - some Children/Young People may not swallow the dose;
• Offer the child a drink of water (where appropriate);
• Check that the medication is recorded in all the appropriate records;
• Sign your name against each medicine administered;
• Record when medicine has been refused / not taken and the reasons why;
• If a child is absent when medication is due this should be recorded;
• Do not sign for any medicines that you have not administered or witnessed yourself;
• If a child refuses to take medication, under no circumstances should they be forced to do so;
• Medication must be kept in the original labelled (by the pharmacy) containers and not put into weekly/daily medical boxes;
• After administration the medicines should be returned to the cabinet immediately and the cabinet locked;
• Each time you give medication, remember that it is important to consider the time of administration. Care should be taken to ensure that if the medicine is required to be taken before food, that this is made to occur. Similarly, the administration of some medicines such as eye drops or inhalers may not be suitable to be given at meal times.

Appendix 2: Specific Issues Re Administration of Medication

Swallowing Problems

Staff may find that some Children/Young People may struggle with swallowing their medicines. The child/young person's GP should be contacted for an alternative. Under no circumstances should staff crush tablets without seeking advice from the doctor or pharmacist. Any advice given should be recorded in the Child/Young Person's Placement Plan.

Medication Refusal

When a child refuses to take their medicine for 3 consecutive days, the GP or Pharmacist should be contacted for advice, depending on the type of medication it may be important to call after 1 refused dose This information must be recorded and followed. Children cannot be forced to take their medicines.

If a Young Person is Absent when the Medicine is Due

When a Child/Young Person is absent and their medication is due, this should be recorded. When the Child/Young Person returns to the community, then staff must consider the time delay and seek advice from the pharmacist, or GP depending on the time of day. To miss taking a medicine completely can be dangerous depending on the medical condition.

Covert Administration

Covert administration is where a medicine is hidden in food and the Child/Young Person does not know that they are taking it. Community staff must not hide any medicine in food.

Spilled Medicines

When a medicine has been dropped on the floor or otherwise spoiled this must be stored in the pot for medication awaiting disposal in the locked medication cabinet and this should be recorded in the records. A second dose should be offered to the child.

When a medicine has been spat out then again this must be placed in the pot for medication awaiting disposal 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. The GP or pharmacist should be contacted for advice.

Detached or Illegible labels

If a label becomes detached from a container or is illegible staff must seek advice from the pharmacist. Until this advice is received then the container should not be used. The pharmacist may be able to produce a new label.

Secondary Dispensing

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.

Medication Errors

In the event of an error being made in the administration of any medication, advice must be sought from the Child/Young Person's GP or other medical practitioner/ help line immediately or as soon as the error has been discovered. Staff must record the advice that they have been given.

Verbal Alterations

There may be times when it is necessary to stop or change the dose of a Child/Young Person's medication without receiving a new prescription, for example verbal requests to change medication by the GP. These changes must be recorded on the Individual Medication Record in the file. Staff must note the change, the name of the doctor, and the date and time the request was received. Staff must not alter dispensing labels. A note may be added saying 'Refer to record for new instructions'. Staff should check the next prescription to make sure these changes have been implemented.

Adverse Drug Reaction

Any adverse drug reaction or suspected adverse drug reaction should be reported to the GP or other medical practitioner (e.g. NHS Choices) before further administration is considered. Advice should be sought on whether the medicine should be stopped or the treatment carries on.

Drug Recalls

If a Drug Recall notification is received staff should check the medication to see if the community is holding any stock. If there is none in stock then the notification should be filed for reference.

If stock is found that is listed on the drug recall, staff must follow the directions given after isolating the stock.

Appendix 3: Administration away from the Home

If a Child/Young Person spends time away from the Community, either on home visits, holidays or time spent at school and is away from the home's staff, any medication due to be taken must be kept in the original labelled container.

Any medication taken away from the Community should be appropriately recorded on the individual child's Medication Administration Record (MAR), showing what medication has been taken away/handed over to carers/parents. The person receiving the medication should sign a record to reflect the handover of the medication.

If the carer/parent/school wishes, a copy of the MAR 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/Young Person returns.

The medication should always be handed over to someone responsible for the child.

If the person who is responsible for the Child/Young Person is a member of staff, then they must complete the documents for administration while they are away as normal.

Appendix 4: Skilled Health Tasks

This applies to specialist or skilled healthcare tasks, for example:

• For diabetic children;
• Physiotherapy programme;
• For the use of Buccal Midazolam (for stopping seizures);
• For the use of Rectal Diazepam (for stopping seizures).

If a Child/Young Person requires a skilled health task to be undertaken, this will only be carried out with the written authorisation of the prescribing doctor in relation to the Child/Young Person concerned, and either set out in a Placement Plan or other written plan.

Appropriate training would be provided, together with written guidance, included how the skilled tasks would be recorded.