Medication and First Aid

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Medication and First Aid

Note: This chapter does not deal with unforeseen emergencies. In an unforeseen medical emergency, foster carers must seek the advice of a health professional (e.g. by calling a GP or by dialling 999) and follow any instructions given.

Introduction
Home Remedies
First Aid
Allergies
Medication Administration
Safe Management of Controlled Drugs
Medical Emergencies
Complex Health Needs
Recording

1. Introduction

The fostering Agency wants all children to live in an environment that promotes and safeguards their health and wellbeing. Foster carers play a key role in protecting and promoting children's health. The Agency ensures that foster carers are prepared and supported to promote children making progress in relation to their health, education, and emotional, social and psychological well-being.

Children are helped to improve their health, and to manage any lifelong health conditions. Their health needs are identified (including their mental and sexual health needs, as appropriate), and they have access to local health services when they need them. Foster carers and Agency staff develop effective relationships with health professionals to promote good health.

Arrangements in relation to all medication and first aid must be discussed, agreed and recorded in the Placement Plan along with all delegated authority. Consents should be given and recorded.

2. Home Remedies

Home remedies are medicines, suitable for children, which can be bought 'over the counter' without prescription, including Paracetamol.

Foster carers will receive training in relation to the management and administration of medication.

Aspirin

Although aspirin may be purchased 'over the counter' without prescription, it may not be given to children unless prescribed by a medical practitioner.

Other Home Remedies

Other home remedies may only be given to a child with the consent of the parent (which should be recorded in the Placement Plan) and the child (if over 16) or having consulted the child's GP to ensure that no adverse reactions may result.

Home remedies must be kept in a locked cabinet that is only accessible to the foster carers, unless a child is permitted to keep their own home remedies, in which case the arrangements for this must be set out in the Placement Plan.

The foster carer should follow the instructions on the pack or label-making sure the Homely remedy can be given to the child, what the dosage is and the intervals between doses.

If symptoms persist or the child has an adverse reaction the foster carer must seek medical advice.

Where children are deemed not to be capable of administering home remedies themselves, care must be taken to ensure they consume the product as required, in the presence of a foster carer.

3. First Aid

Fully equipped first aid boxes must be kept in each home and in each vehicle used to carry children. The Supervising Social Worker for the foster carers must ensure that suitable arrangements exist to keep first aid boxes equipped and all items in the first aid box are in date.

Children may administer their own first aid under the supervision of a foster carer, or a foster carer may administer it.

If not, a foster carer must administer it.

Foster carers will attend first aid training including refresher training as required by the fostering Agency.

4. Allergies

A specialist allergy nurse/consultant will help develop a Health Care plan which should be shared with foster carers and 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 Epi Pen and calling for an ambulance;
Foster carers should be aware of the Plan and should have been trained to administer an Epi Pen 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 foster carers 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.

For further information see the NHS website or see Allergy UK Website.

5. Medication Administration

5.1 Administration of medicines

If foster carers are administering medication then they should have training around the medication administration. If it is appropriate a child or young person should administer their own medication.

The following steps must be followed when administering medication:

Check the medication to ensure that it is prescribed for the child in question and it is within the expiry date;
Ensure that the child's name, the name of the medication, and the dosage instructions are correct, and that the dosage has not already been administered;
Establish how the medication is to be administered;
Record each administration of the medicine including the date, time, dosage, balance, the carer's name and signature;
Record the refusal or non-administration of medicine including the reason why.

5.2 Receipt of Medicines

All medicines brought into the foster home from whatever source, including discharge medication from hospital, medicines prescribed in an acute situation as well as medicines prescribed on a regular ongoing basis or those brought from another home, should be recorded. Medication Administration Records (MARs sheets) should be used if a child takes medication regularly. MARs sheets can be printed by the chemist for use.

If a child takes a number of medicines, then dossette boxes or blister packs can be supplied by the pharmacy which contain the medicines for separate days and times. This can help keep track of what medication has been given.

Some medication cannot be put into blister packs such as epilepsy medication.

The record should show:

Date of receipt;
Name, strength and dosage of medicine;
Quantity received;
Expiry date;
Name of the child for whom medication is prescribed/purchased;
Signature of the carer receiving the medicines.

5.3 Disposal of Medicines

To provide a full audit trail of medicines, a record is required to identify a removal of the medication from the home. This record should detail the following:

Date of disposal/return to pharmacy;
Name and strength of medicine;
Quantity removed;
Name of the child for whom the medicine was prescribed/purchased;
Signature of the carer who arranges disposal of medicine.

6. Safe Management of Controlled Drugs

Some children and young people are prescribed controlled drugs. Examples of controlled drugs are morphine and pethidine for pain, methadone for withdrawal and Ritalin for hyperactivity.

ALL CONTROLLED DRUGS MUST BE STORED SAFELY BY BEING KEPT IN A LOCKED CABINET. NO MORE THAN 28 DAYS' SUPPLY SHOULD BE KEPT AT A TIME.

7. Medical Emergencies

If a child is at risk or requires first aid/medical attention, carers should apply first-aid procedures if it is safe to do so, and notify their Supervising Social Worker as soon as possible. However, carers must not compromise or delay the process of getting medical help by doing so. If in any doubt, call medical help.

If there is a risk of serious harm or injury, or the carers are unable to manage safely, the Police should be notified.

Foster carers should always assess the situation and in a medical emergency, send for medical help and an ambulance.

Before assistance arrives:

Do not move the person other than to remove them from immediate danger or place them into the recovery position;
Try to clarify why the emergency has occurred;
Collect any drug samples or spillages (e.g. vomit) for medical analysis;
Do not induce vomiting;
Keep the person calm, under observation, warm and quiet;
If the person is unconscious:
- Ensure that they can breathe and place in the recovery position;
- Do not move them if a fall is likely to have led to spinal or other serious injury which may not be obvious;
- Do not give anything by mouth;
- Do not attempt to make them sit or stand;
- Do not leave them unattended or in the charge of another child;
For needle stick (sharps) injuries:
- Encourage wound to bleed. Do not suck;
- Wash with soap and water. Dry and apply waterproof dressing;
- If used/dirty needle, seek advice from doctor.

When medical help arrives, pass on any information available, including vomit and any drug samples.

8. Complex Health Needs

Children with complex health needs may have substantial personal care needs and require bespoke support such as nasal suction, PEG feeding, moving, lifting and handling. This must be discussed, agreed and recorded in their Placement Plan together with arrangements around consent.

Training requirements for foster carers to enable them to carry out this invasive personal care must be clearly documented, as must the number of carers needed to undertake the tasks. This should be reviewed regularly and when changes occur. Clear health care plans should be in place to support the foster carer with each task including guidance for giving regular prescribed medication and other intermittent medication which may be needed for pain relief etc.

An invasive personal care procedure involves breaching the person's body. Examples include injections, or the insertion of a tube into an orifice such as mouth or rectum. Although physiotherapy does not fall within this definition, it raises similar issues in terms of the encroachment of a young person's physical space and should be treated in the same way as invasive practices.

There are two types of situation in which foster carers may need to give invasive personal care:

Routine administration. The child/young person needs invasive care on a regular basis. Examples: insulin injections, feeding or giving medication via a PEG (Percutaneous Endoscopic Gastrostomy) tube; or oxygen administration;

Note: Risk assessment should be in place if oxygen is in use in the household, and should be updated regularly;
Predictable emergencies. During medical emergencies such as epilepsy or anaphylactic shock (due to a severe allergic reaction), the carer may need to use invasive care such as the administration of rectal Valium in the case of epilepsy or the injection of adrenaline using an Epipen during anaphylactic shock.

9. Recording

First aid and records of all medicines that have been administered will be recorded. If advice is sought from a General Practitioner or Pharmacist, carers should include details of the discussions within the records as confirmation. If an accident occurs which results in a visit to GP/hospital, it will also need to be recorded and should be reported to the supervising social worker/ social worker. All serious accidents should be reported to Ofsted by the Agency. The definition of a serious accident is broken bones, child loses consciousness and where a child is admitted to hospital for more than 24 hours.

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