Gateshead Children's Homes Procedures Manual

First Aid, Home Remedies and Medication

Regulations and Standards

Related guidance

1. First Aid

Each home must always have a qualified First Aider on duty.

First Aid boxes should have a white cross with a green background and must be held in each home, on each level of the home and should be carried in each of the vehicles used for the transportation of children. There must also be a First Aid box in the kitchen containing coloured Elastoplast dressings for anyone tasked with preparing food. All Staff must be aware of their location.

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.

A member of Staff appointed by the Manager, should periodically check stock, use by dates etc. and keep replenished as necessary.

Recording: Each child should have written 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 at the time of admission.

A written record (First Aid Log) must be kept of all first aid given to Children Staff and Visitors. This should detail name, date, time, reason for the intervention and be signed by the responsible member of Staff. If First Aid is followed up by any further treatment or external advice is sought, then this should be detailed on the medical record.

The administration of First Aid must be recorded in the First Aid Log (HS15), Accident Book (if there has been an accident), individual child's Daily Record and Medication Administration Record (MAR).

2. Allergies

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.

3. Home Remedies

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. In short break services parents/carers will give approval.

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.

4. Key First Aid and Medication Records held in the Home

Each home should keep the following records:

Record	Purpose
First Aid Log	To record any administration of First Aid
Accident Log	A log of all (staff and children) accidents (HS15 report)
Accident Record	Full details of any accident involving a child (HS 20 reports)
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.

4.1 Ordering Ongoing 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 home's manager or a delegated person/member of staff. In short break services, this is the responsibility of the parents/carers.

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 (No more than six weeks stock to be held at any time).

4.2 Collecting Prescriptions

Staff should collect prescriptions from the GP/surgery and check to make sure that they have received all the prescriptions they have, 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.

4.3 Receiving/Collecting Medicines

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 are required to record/sign the Controlled Drugs Record.

4.4 Administration

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 Placement Plan and a Risk Assessment has been completed by the Registered Manager. In short break services parents/carers will give approval.

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.

4.5 Storage and Expiry Dates

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.

4.6 Disposal

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. This needs to be kept in the Disposal of Medication Record book.

In short break services parents/carers are responsible for the disposal of medication.

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.

5. Appendix 1: Administration of Medication Guidance

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;
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 mealtimes. Not all medicine administration times will fall in line with mealtimes.

6. Appendix 2: Specific Issues re Administration of Medication

6.1 Swallowing Problems

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.

6.2 Medication Refusal

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.

6.3 If a Young Person is Absent when the 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.

6.4 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.

6.5 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 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.

6.6 Spilled Medicines

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.

6.7 Detached or Illegible labels

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.

6.8 Secondary Dispensing

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.

6.9 Medication Errors

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.

6.10 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 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.

6.11 Adverse Drug Reaction

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.

6.12 Drug Recalls

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.

7. Appendix 3: Administration Away from the Home

8. Appendix 4: Skilled Health Tasks

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;
Gastronomy.

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.

9. Appendix 5: Guidance: Intentional Overdose

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:

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.

What to do if someone is reacting to an overdose:

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 it on to you).

DON'T

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.

Recording and Review

Please refer to the Self Harm and Suicidal Behaviour Procedure.

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