First Aid, Home Remedies and Medication
Related guidance
Amendment
In September 2024, this chapter was updated locally where required.
Each Home must have a qualified First Aider on duty at all times.
First Aid boxes should have a white cross with a green background must be held in each 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 First Aid Log, Accident Book (if there has been an accident), individual child's Daily Record and 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:
- 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.
Home Remedies are medicines that can be bought over the counter, including Paracetamol*, aspirin, homeopathic, herbal, aromatherapy, vitamin supplements or alternative therapies.
Home Remedies can only be used by the young people in the home with the approval of relevant social workers (as set out in children's Placement Plans) or as prescribed by a GP.
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 Daily Record 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 should keep the following records:
| Record | Purpose |
|---|---|
| First Aid Record | To record any administration of First Aid. (On Charms) |
| Accident Book Record | To record any accidents. (On Charms) |
| Medical Record | Individual record for each child, details of health related issues, medication used, name of GP. (On Charms) |
| Medication Administration Record (MAR) | Individual record for each child to record any medication (or Home Remedies) administered etc. |
All medicines brought into the Home from whatever source will be recorded on:
- Admission Pack (New arrival);
- Placement, Care and Pathway Plan;
- Positive Behaviour Support Plan where required;
- Medication MAR Sheet (Prescribed and Non-Prescribed);
- Controlled drug recording book (controlled medicines).
Upon admission, the home manager will ensure that a competent staff member is responsible for medication reconciliation. The following information should be provided where possible:
- Young person’s full name including date of birth and NHS number;
- GP details;
- Details of other contacts (for example consultant, specialist nurse);
- Known allergies and reactions to medicines and ingredients;
- Medicines the young person is currently taking including name, strength, form, dose, time, frequency and what for;
- Changes to medicines including medicines started, stopped, change of dosage and reasons why;
- Date and time of the last dose of any “when required” medication;
- Other information, including when the medicine should be reviewed and any other support required.
This information should be recorded on the child’s individual record within Charms. Where allergies are known these should be recorded as a ‘warning sign’ on the child’s record.
All medication prescribed or non-prescribed that are to be dispensed by care staff are to be stored in the appropriate secure cabinet/ safe or fridge specific for this purpose, so that products are stored at the correct temperature, not damaged, stolen or pose a risk to anyone else.
All controlled medication received into the home should be recorded on the child's Controlled Medication Log.
All other medication received into the home should be recorded on the child's individual MAR Sheets per medication.
As young people move into Staying Close arrangements, medication requirements will be reviewed as part of their Pathway plan, this will be done in consultation with the young persons’ GP and LAC Nurse.
Record Keeping
The Home will maintain complete and accurate record of all medicines used in the Home by each young person; these will be referenced within their individual log/ MAR Sheet, Positive Behaviour Support Plan and Charms profile. Any correspondence relating to medication management, including if a child is away from home at any time will be retained.
The records must be
- Legible;
- Signed and witnessed by staff who administer and witness for controlled drugs;
- Clear and accurate;
- Correct date and time;
- Completed as soon as possible after administration.
Record of medication
All medication into the home must be recorded:
- Full Name of young person;
- Date of Birth of young person;
- Weight of young person;
- Name of medication;
- Strength, form, dose, frequency and route of medication;
- Known allergies and reactions;
- Date of medication review/ monitoring;
- Special instruction of when medication should be taken;
- The administration initials must be recorded on the controlled medication log/ MAR Sheet.
Medication
Some young people will have prescribed medication, which is ongoing. This should be ordered on monthly basis where possible. Responsibility for ordering these medicines is that of the Registered Manager or a delegated person/member of staff.
When ordering, a note must be made of:
- The name of the young person;
- The name, strength, form and quantity of the medicine;
- The name of the surgery/G.P;
- When the prescription will be ready.
When ordering, staff should check stock levels before ordering. To minimise wastage and reduce risks of errors, stock levels should be kept to a minimum.
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.
Staff must take their ID when collecting medicines or controlled drugs.
When the medicines are collected, staff should check the medicine against the photocopied prescriptions that they have. Any discrepancies should be brought to the attention of the Pharmacy and rectified as soon as possible.
The Pharmacy will be able to give, and advice should be sought upon:
- 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.
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.
NOTE: all staff must be familiar with the following detailed guidance on the administration of medication:
| Circumstances | Relevant Guidanc |
|---|---|
| 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 Placement Plan.
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.
Care home staff should consider the following in the medication administration process, the six R’s of administration –
R – Right medication
R – Right route
R – Right dose
R– Right time
R – Young persons’ right to refuse
- Medicines that have been prescribed and dispensed for a young person must not, under any circumstances, be given to another young person or used for a purpose that is different from that which they were prescribed;
- Patient Information Leaflets, supplied with each medicine will be made available to the young person/ explained through a key work session. The original is to be retained at the home whilst the young person is taking the medication for easy reference.
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 be held by a senior/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:
- The expiry 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 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.
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:
- Wash their hands;
- Make sure they have a pen and any required record sheets;
- Enough glasses for each young person receiving medication;
- A jug of water.
The procedure for administration is as follows:
- Check the young person's identity (a photo is normally kept in the young person's file). Only one young person should be administered medication at a time, this reduces the risk of mistakes being made;
- Check the young person's medical profile;
- Check the medication on the individual medication records corresponds with that on the young person's medical profile;
- 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, add the date;
- Measure or count the dose without touching the medicine;
- If the medicine is a solid (such as a tablet) then carefully place into an appropriate container and offer to the young person. They may wish to put it in their hand or swallow straight from the container;
- 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 use a medicine syringe otherwise use a medicine spoon or measure as preferred by the young person, this could include using measuring scales;
- If the medicine is a cream or ointment, then it should be squeezed directly onto the young person's finger for them to apply. If required to be applied by staff, then latex/pvc gloves must be worn;
- When administering a Controlled Drug, a second member of staff, must check the dose prior to it being administered;
- Watch the young person as they take their medicine to ensure administration is successful;
- Offer the young person a drink of water (where appropriate);
- Check that the medication is recorded in all the required records;
- Print and sign your name against date and time of each medicine administered;
- Record when medicine has been refused / not taken and the reasons why;
- If a young person 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 young person 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 done. Similarly the administration of some medicines such as eye drops or inhalers may not be suitable to be given at meal times. Not all medicine administration times will fall in line with meal times.
- The Home encourages young people to self-administer their medicines whenever possible. This will improve their knowledge and competence and help preserve independence;
- Although self-administration is encouraged, it may not be appropriate to allow this in every case, and the Home will assess the risks associated with self-administration of medicines for each young person. Partial self-administration may be permitted in certain situations, particularly, for example, where the young person has a full understanding of the issues, but may have problems opening containers;
- The responsibility for the administration of medicines will form part of the Home’s assessment process and will be integrated into the young person’s Placement, Care and Pathway Plan, which will be reviewed regularly. Written medical consent is required to be provided by the parent or representative of the Local Authority who is deemed to have parental responsibility (PR) for that young person. This would be recorded on the ‘In-Possession Risk Assessment’;
- A record will be maintained of the medicines given to a self-administering young person within the Homes’ Medication Register;
- Where complete or partial self-administration is permitted, it must be kept in secure storage- provided for by the home. The young person will have sole access. (Staff must be able to have access too). The young person will be given education and learning on handling and management of their medication;
- Where the Home obtains (or administers) such medicines, on behalf of the young person, the medicine(s) will be added to the records of prescribed medicines/drugs;
- As there are risks that prescribed medicines may react with medicines purchased over the counter, prior to providing treatments for minor ailments that are non-prescribed or ‘home remedies’ for any young person staff must be clear about the ailments they are allowed to treat, for example, headache, heartburn, cough, sore throat. Therefore, the Home will seek advice from a GP/NHS Direct/Pharmacist to confirm that there are no contra indicators or side effects that may cause harm to the young person.
For many children it is widely acceptable and encouraged that they spend time out of the home with friends, family and enjoying the community without the support of adults/ staff. The amount of time spent unsupervised will be agreed with the child's social worker/ parent/ carers.
During their time out in community or any time unsupervised it is acknowledged that they may use or obtain items unknown to adults/ staff members and secrete these for their personal use. This may include types of medication, as well as objects to use to harm themselves with or cause harm to others.
Homes2inspire would expect staff to remain curious and interested in the children as they return home, enquiring about their time, experiences and 'checking-in' with them to be able to assess their well-being following a period of time out of the home. This 'check-in' can act as a way to be inquisitive and observational, especially if the child appears to be worried in any way.
It is acknowledged that staff cannot physically search a child, without immediate and/or serious concerns for their safety (see Searching Children/Bedrooms Policy) but should use professional curiosity, observations and relationships to encourage child to feel they can share their thoughts. Should staff be very concerned that a child is secreting items to bring into the home they may ask the child if they would show their pockets/ bag contents. It is recommended for child of high risk that this preventative measure be considered and approved within their plans. Where staff remain concerned, they should report to their manager/ on-call and discuss increased supervision or further intervention.
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. This information must be recorded and followed. Young people cannot be forced to take their medicines. Medication refusals should also be recorded on Charms and sent to Registered Home Manager for electronic signature.
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.
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 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.
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.
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.
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. The person receiving the medication should countersign the record.
If the parent/ carers 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 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.
This applies to specialist or skilled healthcare tasks, for example:
- For diabetic children;
- Physiotherapy programme;
- For the use of Buccal Midalozam;
- For the use of Rectal Diazepam.
If a child requires a skilled health task to be undertaken, this will only be carried out by trained staff, with the written authorisation of the prescribing Doctor in relation to the child concerned, 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.
The home manager has a responsibility prior to admission to ensure staff are suitably trained and competent in administering medication prescribed for specific individual health needs. For example, diabetic medication.
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.
- Mild nausea/vomiting;
- Paler skin;
- Blue lips or fingernails;
- Not waking up or reacting to a loud noise;
- Shallow or disrupted breathing;
- Gurgling, snorting or snoring/choking sounds;
- Slow or very faint pulse.
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.
- Lie them on the floor;
- Put them in the recovery position;
- Call the ambulance - 999 - inform the operator of the overdose;
- Do not leave the child/young person alone, make sure they don't roll onto their back;
- Inform the ambulance team what the person has taken; try to gather all the packaging you can find;
- Get some help, keep other children and young people away (but don't dismiss any valuable information that they may be trying to pass on to you).
- Walk the child/young person around;
- Put the child/young person in a cold bath/layer them up to heavily to generate warmth;
- Give them a drink.
The Home follows the codes within the Medication Books for the error of recording medication such as D – Destroyed, R – Refused. All staff will inform the Home / Deputy Manager should a written administrative error occur to ensure that the stock amount and written record is consistent and where appropriate the correct disposal of medication occurs and is recorded appropriately.
Should a staff member administer the incorrect medication or incorrect amount of medication to a young person, then the safeguarding processes must be followed. This includes all “near misses” and incidents that do not cause any harm.
This error must immediately be reported to the Home / On-call manager and medical attention must be sought for the young person straight away using NHS 111 or 999 where there is a life threatening emergency. Parents, Carer’s and the local authority must also be notified. Staff should record an accurate and detailed report of the medicine related safety incident including core information as follows;
- Name of the young person;
- Name of medication;
- Time administered;
- Details of the error;
- Details of the actions and who the incident has been reported to;
- Medical advice sought;
- Actions and Outcome.
This should be submitted to the home manager without delay.
The Local Authority Designated Officer and Ofsted must also be notified of the safeguarding concern within timescales. Where required, the Home Manager is responsible in ensuring a robust investigation takes place following all medication safeguarding concerns to establish the root cause of the incident and identify any lessons learned. See ‘Medication Error’ Flow Chart.
All young people have the opportunity to use an advocacy service or the right to an independent complaints service where they have concerns about their administration of medication.
Adverse Drug Reaction Reporting
Any adverse drug reaction (ADR) or suspected ADR will be reported to the GP and / or supplying Pharmacist for that individual young person and discussed before further administration of the drug in question.
In out of hours cases this should be referred to 111/ 999 for an emergency.
This matter must also be reported to the Home / on-call Manager as soon as possible.
Staff medication on the premises must be securely stored in a lockable cabinet or fridge and remains the responsibility of the individual staff member. Whilst consideration is given in relation to confidentiality, Staff must inform their manager if they are bringing any medicine on to the premises to ensure young people are safeguarded at all times.
Home Managers must ensure that those staff members only work directly with young people if medical advice confirms that the medication is unlikely to impair that staff member’s ability to carry out their responsibilities at work.
Homes2Inspire will ensure that the appropriate staff members are suitably trained and regularly updated in the use of this policy, with training being undertaken during the induction process. The home manager is responsible for ensuring that all staff have an annual review of their knowledge, skills and competencies relating to managing and administering medication. Supervisors should identify any other training needed by the staff members responsible for administering medication. If there is a medicine related safety incident, this review may need to be more frequent to identify support, learning and development needs. Where a young person has specific health needs in relation to a particular diagnosis further bespoke training in relation to this diagnosis will be sought for care staff in order for the health needs of the young person to be met.
Confidential information about young people should be treated confidentially and respectfully. Members of the care team should share confidential information only when it is needed for the safe and effective care of an individual.
Information that is shared, for the benefit of the community should be anonymised.
An individual’s right to object to the sharing of confidential information about them should be respected.
In circumstances where the safeguarding of an individual is paramount the sharing of information will be discussed with the Home Manager and where possible the social care team. If deemed relevant to the safeguarding of the individual information will be shared on a ‘need to know basis’.
Quality Assurance
The Home/ Deputy Managers are responsible for the quality assurance of records in the home.
Auditing of medication records should be completed on a daily basis by care staff during administration and during handover of their shifts.
This is recorded in the handover document (Charms system).
Managers should complete audits of the medication store and individuals’ records on a regular basis. These should be completed using the 'Manager Medication Audit' progress action on Charms.
Where errors are identified they should refer to Section 14 of this policy and relevant flow-chart.
The home receives monthly independent visitor audits, medication administration and record keeping forms part of this audit process.
The Home Manager completes a Quality of Care Review every six months, this may include a review of the medication management in the home.
Archiving of Records
The home has a policy regarding archiving of records. Relevant records must be retained in line with Children’s Homes Regulations – Regulation 36 and 37 (Schedule 3).
Details of any medicines kept for the child in the home, including details of:
- Any medicines which the child is permitted to self-administer;
- The administration of any medicine to the child;
- The disposal of any medicine.
These records will be scanned and saved on to the electronic system, Charms, under the child’s own profile.
Last Updated: September 16, 2024
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