The Health and Well-being Standard
Managing Medicines in Care Homes (NICE, 2014)
Children’s Act 1989: Care planning, Placement and Review (DfE)
The Handling of Medicines in Social Care (Royal Pharmaceutical Society)
Outcome:
The health and well-being needs of children are met; children receive advice, services and support in relation to their health and well-being. Children’s health and well-being outcomes are recorded in their relevant plans. Staff understand the child’s health and well-being needs and the options available to them. Each child has access to dental, medical, nursing, psychiatric, psychological advice, treatment or other services they may require. Staff understand their responsibility around the safe storage and dispensing of medications. Staff are clear around the legal boundaries surrounding administration of medication
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) and social worker has been returned to the home and is stored on the child/young person’s case file.
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).
The consent form will seek parental and social worker permission for staff to administer:
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 and using their own prepared administration packs. All unused, unwanted or surplus medication will be returned to the pharmacist for safe disposal.
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.
Staff will not make independent decisions regarding the administration of medication. All prescribed and controlled medication will be dispensed as directed.
All prescribed medication received will be entered into the young person’s medical file specifically for the purpose, and medication that is no longer required will be returned to the Pharmacist for disposal is also entered in this file. 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 ensure that all medication is clearly labelled with the name of the child/young person and dated upon opening and is stored in their own individual container within the locked medication cabinet.
Staff will ensure that no medication labelled for one child/young person is used by another.
All medication will be held in a designated locked area for the safe storage of medication. This will be the only area where medication will be stored. All controlled drugs will be held in a locked container within the designated locked area. 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.
On Administering Medicine Staff will:
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.
Medicines given by injection and rectally should only be administered by a first or second level Registered Nurse or a Doctor, with the exception of subcutaneous Insulin injections. In this case, an appropriately experienced Residential Practitioner who has been taught and assessed by the trainer can administer insulin. The trainer will accept full responsibility for said administration under their professional registration (there should be documentary evidence of training and the Residential Practitioner should be ‘signed’ as being competent by the trainer).
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.
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:
Any absence of the child/young person from the home should be recorded on the Medication Administration Record (MARS).
Accurate transactions involving medication i.e. what is administered, time, dosage, refusal etc. will be recorded on the MARS 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:
Any refusal of medication will be noted on the MARS sheet, child/young person’s daily log and reported to the Registered Children’s Homes Manager. The Manager will collate this information at the end of each week as part of the administrative routines and advise parent(s) and placing authority. 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.
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 case of children/young people who wish to take medication to school or other educational provider, the following procedure must be followed:
It is our policy that no “over the counter” medication is bought by staff. Any medication of this nature bought by the child/young person or their parent(s) or social worker will be removed and returned.
No homely remedies will be given to a child unless it has been prescribed by a doctor or dentist or advised by a Pharmacist.
Prescribed medication is defined as ‘as medication that is administered on the direction of a GP, dentist or hospital, according to specific instructions, which includes regular, PRN and controlled drug’s'.
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 be a qualified Residential Practitioner with relevant drug training and competency. 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.
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 PRN MARS form including:
The guidelines are issued in recognition of the fact that drug competent Residential Practitioner are required, on occasion, to administer medication to children/young people in a covert manner.
The guidelines seek to define this practice and enable competent Residential Practitioner to practice within a legal framework.
The guidelines cover the administration of medication to:
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:
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:
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.