Administration of Medication

Also see Section 2, Controlled Drugs.

All children must have their medical health requirements written in their Placement Plan at the start of their placement, as well as written parental consent to the administration of the medication.

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, their parents and the staff, as to whether the child should retain and administer his or her own medication. If the child is permitted to do so, the arrangements for this must be set out in their Placement Plan - see Section 4, Administration of All Medication.

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.

Where the child takes regular medication there should be a letter from the GP/relevant consultant setting out the type of medication, dosage and the time the medication should be given. For children receiving respite care, any changes must be notified to the staff/carer by the parents and confirmed by the GP/consultant in writing prior to the child's next placement.

For children with serious medical conditions, see also Section 12, Children with Serious Medical Conditions.

In any case where the staff/carer have any concerns about the medication or require clarification about the dosage, they must contact the relevant medical professional or child's GP for advice.

When receiving medication, staff must check that the medication is for the relevant child, within its expiry date and, in relation to children receiving regular medication that the instructions on the label are in accordance with the letter from the GP/consultant. For children receiving Short Breaks or respite care, staff must also ensure that sufficient medication has been given to cover the length of the child's stay.

If a child is prescribed medication during a placement, residential staff should collect the prescription from the doctor's (preferably with the child at the time of the appointment). Staff should ensure that the medication is then collected from the pharmacy.

When collecting medication, staff 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, staff 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, whether the medication should be stored in a fridge, how the medication should be taken and if any food/other medication may affect the effectiveness of the prescribed medication. Staff 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 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.

All received medication in to the home should be recorded on the medicines profile sheets.

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, which indicate a child's capability to use their inhaler. Regular support via reviews/asthma clinic must be made available.

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. A ‘stock’ of controlled drugs must not be kept in the home.

The controlled drug must be kept in a locked medicine cabinet, which is securely fitted to the wall in a location agreed by the home's manager.

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 themself. 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 8, Disposal of 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, only where consent has been sought.

In the case of children receiving short breaks, the consent from the child's GP 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 Plan. 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 2 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.

1. Each residential 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/staff;
2. 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;
3. The use of complementary or alternative remedies should only be undertaken following a documented discussion/agreement with the child's social worker;
4. All home remedies must be administered in accordance with the manufacturer's advice on dosage and side effects;
5. 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 13, 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 beyond the expiry period. See also Section 7, 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.

Injections, enemas and /or suppositories should only be administered by a qualified nurse or doctor. In some case suppositories (epilepsy medications, etc) can be administered by residential staff that have completed the appropriate training.

N.B. When not in use, medication must be stored safely - see Section 6, Storage of Medication.

Swallowing Problems

Staff may find that some children and young people may struggle with swallowing their medicines. The child/young person's G.P should be contacted for an alternative. Under no circumstances should staff alter any medicines by crushing, diluting, cutting or opening a capsule without seeking advice from the G.P or Pharmacist. Any advice given should be recorded.

Medication Refusal

When a child or young person refuses to take their medicine, then the G.P. should be contacted for advice. This information must be recorded and followed. Young people cannot be forced to take their medicines.

If a young person is absent when their medicine is due

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

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.

Lone Working

In some homes, 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 self-check and make a record of any medical administration required during the period of time for when they were lone working. They must record that they have self-administered the medication and give a reason why.

When a controlled drug needs to be administered and it is important that the young person receives their medicine at the correct time, 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.

Verbal Alterations

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 and witnessed at the time, by a second person before any changes are permitted. Confirmation in writing must be requested from the GP to reflect and outline the change (this may in the form of an email or letter).

All 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/medical practitioner spoken to, the time the confirmation of alteration was received and the date.

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 new changes have been implemented. Where children access the home for a short break staff should contact the family/carer prior to their

It is the responsibility of the registered manager to ensure the safe storage of all medication in the home.

All medication must be stored in a locked cabinet, used exclusively for the storage of medicines and out of reach of children and away from direct light and heat. It should be kept at a temperature below 25C. A thermometer should also be stored in the locked cabinet, which should be secured to a wall. The cabinet must be locked when not in use and staff must retain a key to the cabinet.

Where medication needs to be stored in a refrigerator e.g. insulin or some antibodies a small lockable fridge should be used for the exclusive storage of medication. Staff should ensure that the temperature of the fridge is checked daily and recorded.

In a children's home, the locked cabinet will be in a staff only area and all medication will be stored within this area. Where a child's social worker has agreed and following a risk assessment, that the child may retain and administer his or her own medication, this must be stored safely and as agreed within the placement plan.

All medicines should be stored in their original container and be properly labelled. They should only be kept in the home for the time the child is there unless agreed with the manager. At the end of each short break/respite period, medicines are to be returned to the child's parents/main carers.

A weekly stock check should be undertaken of all prescribed medicines stored in the home, 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 8, Disposal of Medication. 

In children's homes, a manager is responsible for ensuring that the stock checks take place.

In the event of a discrepancy between the records and the medication actually stored, the manager must be informed and appropriate action followed.

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 13, 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 requested 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 upon request.

Fully equipped first aid boxes must be kept in each home and in each vehicle used to carry children. A manager must ensure that suitable arrangements exist for the contents to be checked in keeping with Section 7, 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. This will be confirmed in the child's Placement Plan.

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 13, Recording). If an accident occurs, it must be reported and recorded.

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.

If a child requires a skilled health task to be undertaken, this will only be carried out with the written authorisation of the prescribing doctor. Appropriate training would be sought for staff to ensure that they have the necessary level of skills before undertaking such duties and as set out within the child’s placement or healthcare plan.

For children who suffer from severe medical conditions and who require rapid intervention, e.g. epilepsy, it is essential that staff follow the clear action plan that is contained in the child's Placement Plan, e.g. calling for an ambulance or contacting the child's parents.

All staff must ensure that emergency aid is sought immediately to ensure that the child receives full medical assistance.

Any emergency 'as required' medication must be provided and available to use as necessary during a child's stay in the placement.

The following records should be kept:

• First Aid should be recorded in a First Aid Record/Log;
• Individual detail of Prescribed medicines, Home Remedies and controlled drugs should be recorded on children's medication profiles. Records must be kept of all medications received and when disposed of or handed to the child's parents on discharge, e.g. for children receiving short breaks;
• Each administration of medication should be recorded on a Medication Administration Record for each individual child;
• Disposals of any medications should be recorded on the medication administration sheet or specific disposal forms.

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 must record instances where this occurs in the child's Daily Record.