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The Health and Well-being Standard
Health Care Assessments and Plans Procedure
Self Harm and Suicidal Behaviour Procedure
Health Notifications and Access to Services Procedure
In July 2023, a new Section 2, Allergies was added.
The Home must have a qualified First Aider on duty at all times.
First Aid boxes should have a white cross with a green background. They must be held in the home and should be carried in each of the vehicles used for the transportation of children.
Each box has an inventory that 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.
Recording: Each child should have permission for staff to administer first aid and non-prescription medication from a person with Parental Responsibility for them recorded in the relevant plan. Permission should be sought and arranged by the child’s social worker.
The administration of First Aid must be recorded in the individual child's Daily Record and any other relevant record such as Oshens (online accident recording), significant incident form or Medication Administration Record (MAR).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:
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.
Home Remedies are medicines that can be bought over the counter, including Paracetamol*, homeopathic, herbal, aromatherapy, vitamin supplements or alternative therapies.
Home Remedies can only be used by the young people in the home if it is agreed with their social workers that they are competent to do sos (as set out in children's Placement Plans). Home Remedies may be or as prescribed by a GP or if recommended on the advice of a pharmacist.
Home Remedies should be purchased for a named individual child.
When a Home Remedy container is opened, staff should record the date of opening to ensure it is not kept beyond its expiry date.
No child may be permitted to 'self-administer' Home Remedies unless approved by their social worker, with the arrangements outlined in the Placement Plan.
Consideration should be given as to how long a child continues to use Home Remedies before they arrange to see their GP.
Recording: The administration of any Home Remedies must be recorded in individual child's and Medication Administration Record (MAR).
*Paracetamol must not be given for more than two consecutive days without the approval of a GP/Medical Practitioner.Each home will keep the following records, available on Clear Care:
| Record | Purpose |
| Significant Incident Form | To record any administration of First Aid that has required subsequent hospital admission, or to record a medical error. |
| Oshens Forms | To record any accidents or incident including assaults. |
| Medical Record | Individual record 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 Home Remedies) administered etc. |
For detailed information about controlled drugs (such as morphine, pethidine, methadone and Ritalin) see CQC information on Controlled Drugs.
Some young people will have prescribed medication, which is ongoing. This should be ordered on a regular basis where possible, such as a repeat prescription. Responsibility for ordering these medicines is that of the individual young person’s keyworker with the home's manager having overall responsibility. This may be delegated to a specific/member of staff.
When ordering a repeat prescription staff should check stock levels. To minimise wastage and reduce risks of errors, stock levels should be kept to a minimum (No more than six weeks stock to be held at any time).
Depending on the purpose of the home and its location, local arrangements may be in place for electronic ordering or collection of repeat prescriptions, including the provision of medication in blister packs as necessary. Where staff collect prescriptions from the GP/surgery they should 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. Staff should check with the Pharmacy as to when the prescriptions will be ready for collection.
As part of preparation for adulthood some young people may be encouraged to collect their own prescriptions. This should be written into their independence plan.
Staff in homes providing short breaks will be receiving supplies of medication from parents or carers, but these procedures apply.
Staff must take their ID when collecting medicines or controlled drugs from the Pharmacy.
When the medicines are collected or received from parents/carers, staff should check that the details of the medication are correct. The medication should be properly labelled with a dispensing label. This should include the name of the young person, the details of the medication and how the medication should be taken. Any discrepancies should be brought to the attention of the Pharmacy and rectified as soon as possible.
No prescribed medication should be administered if a dispensing label is not on the medication. Medicine prescribed to one child must never be administered to a different child.
Medication records must provide clarity on when certain medication should not be taken in conjunction with other types of medication.
The Pharmacy will be able to give, and advice should be sought upon:
Staff should also make sure that they have received a Patient Information Leaflet from the Pharmacy, this is usually in with the medication.
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 are required to record/sign the child’s record and the Home’s medication log. This will be checked by a member of the management team.
NOTE: all staff must be familiar with the following detailed guidance on the administration of medication:
| Guidance Required | Where to find it |
| 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 the arrangements outlined in the Individual Placement Plan. A self-administration risk assessment should be completed for each medication which should be reviewed regularly.
Administration should be recorded on the individual child's Medication Administration Record (MAR), if a Controlled Drug has been administered, 2 staff are required to record/sign the record.
Medicines kept in the Home must be stored in a secure place so as to prevent any child from having unsupervised access to them.
All medicines must be kept in a safe/secure place, e.g. a locked cabinet that does not exceed 25°C. A key to this cabinet should accessible by the responsible member of staff on duty.
Medicines that are taken internally should be stored separately to those used externally in the medicine cabinet, with liquids preferably on the bottom shelf.
*Medicines that require refrigerated storage should be kept in either a dedicated lockable fridge (in the staff office) or a locked box inside the food fridge.
All medicines have expiry dates, usually clearly stated on the label, upon expiry, they should be disposed of, see below.Medication should be disposed of when:
Unless instructed by a GP/Pharmacy, unused/expired medicines should be returned to the pharmacy, and a receipt obtained.
Return or disposal of medication should be recorded on the individual child's Medication Administration Record (MAR), and the receipt attached, if a controlled drug has been disposed of, 2 staff are required to record/sign the record. Disposal of Controlled Drugs must be recorded in the Disposal of Medication record with the receipt firmly attached.
All medicines must be administered strictly in accordance with the prescriber’s instructions (or as advised on the packet in relation to Homely Remedies). Only the prescriber (e.g. GP) can vary the dose. Medicines must be locked away in the locked storage areas when not in use. Before administration, staff should:
The procedure for administration is as follows:
Staff may find that some young people may struggle with swallowing their medicines. The young person's G.P should be contacted for an alternative. Under no circumstances should staff take it on themselves to crush tablets without seeking advice from the G.P or Pharmacist. Any advice given should be recorded.
When a young person refuses to take their medicine, then the G.P. should be contacted for advice on the first occasion. It should be written into their placement plan what action should be taken in the event of refusal to take prescribed medication including the effects that staff should look out for and when medical advice must be sought. This information must be recorded and followed. Young people cannot be forced to take their medicines.
When a young person is absent and their medication is due, this should be recorded. When the young person returns, then staff must consider the time delay and seek advice if required from the Pharmacist, the G.P or NHS Choices website (as appropriate depending on the time of day). To miss taking a medicine completely can be dangerous depending on the medical condition.
Covert administration is where a medicine is hidden in food and the person does not know that they are taking it. Staff must not hide any medicine in food or perform any other types of covert administration. If there is concern about the impact of persistent refusal of medication and the capacity of the child to make this decision, consideration should be given to whether a Best Interests meeting should be held.
On occasions staff may be required to work on their own for a period of time. It may be the case that the administration of a medicine will have to happen during this period. Staff should ensure that they double check for themselves and make a record of any medical administration required during the period of time for when they were lone working.
This can be a problem when administering controlled drugs. It is important that the young person receives their medicine at the correct time therefore the member of staff administering the medicine, must also record that they were lone working in the register. It is not acceptable for another staff member to sign the register when they come in. You cannot be a witness to something you have not seen happen. Young people can be a witness to the administration of their own medication if they are deemed competent to do so.
When a medicine has been dropped on the floor or spilled then this must be safely disposed of and a note must be made in the records. A second dose should be offered to the young person (where a medication has spilled, leaving the remainder short for the completion of the course of the prescription, advice should be sought from the G.P as to how to make-up for the lost dosage).
When medicine has been spat out then this medication must be cleared away following the correct procedures 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. If this persists the G.P should be contacted.If a label becomes detached from a container or is illegible, then staff must seek advice from the Pharmacist. Until this advice is received then the container should not be used.
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.
In the event of an error being made in the administration of any medication, advice must be sought from the young person's G.P. or another medical practitioner/ help line (e.g. NHS Choices) immediately or as soon as the error has been discovered. Staff must record the advice that they have been given. A medication error must be recorded on a significant incident form and a copy sent to the social worker and a copy kept on the young person’s file in the home.
There may be times when it is necessary to stop or change the dose of a young person's medication without receiving a new prescription. Verbal requests to change medication by the G.P must be confirmed in writing before any changes are permitted. These changes must be recorded on all relevant medication records including the Individual Medication Record in the young person’s file. Staff must note the change, the name of the Doctor, the time the confirmation of alteration was received and the date. Staff must not alter the dispensing labels. A note may be added saying 'Refer to record for new instructions'. Staff should check the next prescription to make sure these new changes have been implemented.
Any adverse drug reaction or suspected adverse drug reaction should be reported to the G.P before further administration is considered. Advice should be sought on whether the medicine should be stopped, or the treatment carries on. Staff must record the advice that they have been given indicating the date and time and authorising Practitioner.
When a Drug Recall Notification is received then staff should check the medication to see if the Home is holding any stock. If there is none in stock then the notification should be signed, dated and filed for reference.
When stock if found that is listed on the drug recall, then staff must follow the directions given after isolating the stock.
See also: Lone Working Procedure.
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 must be kept in the original labelled container.
Any medication taken away from the Home should be appropriately recorded on the individual child's Medication Administration Record (MAR), showing what medication has been taken away/handed over to parents/ carers or the young person. The person receiving the medication should countersign the record.
If the parent/carers wishes (or the young person depending on their age and ability), 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 returns.
If the person who is responsible for the child is a member of staff, then they must complete the documents for administration while they are away as normal.
The medication should always be handed over to someone responsible for the child, unless the child is of age/has capacity to do this for themselves and has completed a self-administration risk assessment tor the specific medication concerned.This applies to specialist or skilled healthcare tasks, for example:
If a child requires a skilled health task to be undertaken, this will only be carried out by staff, and as set out in a Placement Plan or other written Health Care Plan.
Appropriate training will be provided, together with written guidance, as to how the skilled tasks will be performed and recorded.
If an overdose is suspected, hospital treatment should be sought without delay. Staff should try to find out what the child/young person has taken and if possible take a sample to give to a medical practitioner.
Possible signs of an overdose:
It can take a long time between taking the substance and the first signs of an overdose; children/young people may verbally 'boast' about having taken an overdose: even when there are no signs, but staff must consider that there is a chance an overdose has been taken and they must act in caution and seek medical attention.
Please refer to the Self Harm and Suicidal Behaviour Procedure.
Promoting the Health and Well-being of Looked-after Children
Managing Medicines in Care Homes NICE Guidelines
Health and Safety Executive Website
CQC information on Controlled Drugs
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