Medication and Medical Emergencies

Contents

1. Linden Brook Medication Procedures
2. Medication Procedures for all other Calderdale Children's Homes
3. Medical Emergencies

1. Linden Brook Medication Procedures

FORMS: The following forms are referred to in this section, they are to be found in the Forms Library, accessible from the left hand side of this manual

1.1 Implementation

These guidelines are to be adhered to by all staff.

It is the responsibility of the Manager to ensure that each member of staff is conversant with these guidelines.

All permanent members staff are allowed to administer medication, casual staff can check medication. Each member of staff will be reviewed, through supervision, on an annual basis to ensure ongoing competencies and a record kept in the supervision file. This system can be utilised to assess those skills of all staff and enable them to administer medication.

New members of staff are not allowed to administer medication until they have attained the agreed level of competency. This requires the new staff member to demonstrate their understanding of the procedures to the satisfaction of the Manager. All staff must sign the form entitled Medication Procedure Training Record to ensure they have understood the procedures and have attained the necessary competence to administer medication.

1.2 Supply of Medicines

FORMS: The following forms are referred to in this section, they are to be found in the Forms Library, accessible from the left hand side of this manual.

It is the responsibility of each young person's parents or carers to sign, understand the Medical Consent Form which is part of the admission pack and then to ensure that there is an adequate supply of medication for the child, especially if s/he is only staying in the home for a short time e.g. at Linden Brook.

IT IS THE RESPONSIBILITY OF EACH YOUNG PERSON'S PARENT'S OR CARERS TO ENSURE THAT ALL MEDICATION SHOULD BE SUPPLIED IN THE ORIGINAL CONTAINERS, SUPPLIED AND LABELLED BY THE PHARMACIST OR DISPENSING GP.

ALL MEDICATATION IS CLEARLY LABELLED WITH NAME, MEDICATION NAME, DOSAGE AND TIMES TO BE ADMINISTERED.

STAFF ARE UNABLE TO ADMINISTER MEDICATIONS WITHOUT CLEAR AND CONCISE INSTRUCTIONS.

In addition, the label should also give:

1. Directions for use, these should be specific and clear;
2. Any precautions relating to the medication, e.g. storage details;
3. The expiry date;
4. Any additional information in relation to side effects or special instructions;
5. Staff are unable to accept the instruction give as directed, without the above being clear.

ANY ALTERATIONS MADE TO LABELS MUST BE SIGNED BY THE YOUNG PERSON'S PARENT'S OR CARERS. STAFF MUST NOT ALTER THE LABELS AT ANY TIME. IF A LABEL IS NOT OF A SUFFICIENT STANDARD, (THAT IS IT DOES NOT CONTAIN NAME, DOSAGE, TIME TO ADMINISTER MEDICATION) PARENT'S OR CARERS WILL BE CONTACTED AND ASKED TO RECTIFY IT IN PERSON.

Any changes of/to medication should be reported to staff prior to or on admission. We also ask for permission to approach the young person's Doctor for information of medications and any subsequent changes to be sent to us, this is to enable us to keep up to date with this information.

Any medications being sent via a third party e.g. school, should be handed directly to staff or bus escort/member of school team to ensure that it is stored safely throughout the day. This will then be handed directly to staff. Medication should not be given to children e.g. placed in the young person's bags as it is not always handed directly to staff, so giving a greater risk of being lost or taken by mistake.

Any missing medication or inconsistent information must be checked immediately with those responsible at the location medication has been transferred from/sent in from and with anyone responsible for the transfer i.e. school, school transport, outreach worker.

All medication received will be counted and recorded on the `"Medication Prescribed and Administration Record" sheet held in the office, next to the medication cupboard.

All medications should be returned to the parent/carers when they return to parents or transfer to another home and checked out and recorded in the appropriate records.

1.3 Administration of Medicines

Administration of the following medicines, without consulting a Doctor, following instructions, medication policy guidelines and with parental consent, should the need arise :

• Paracetamol for pain relief and temperature control;
• Simple Linctus for coughs;
• Immodium for diarrhoea.

An adequate supply should be maintained in the home and stored in the locked medicine cabinet.

Continuing symptoms must be reported to the young person's parents/carers and if necessary, school nurse and GP.

General barrier creams should be personalised and are specific to each child or young person.

If a label becomes detached from a container or becomes illegible, the advice of parents/carers, manager and/or a pharmacist will be sought in these instances.

Staff MUST NOT alter the labelling at any time.

Staff who have demonstrated their understanding of the procedure and attained the agreed level of competence should only administer medication.

Administration of medicines should be given by 2 staff, if possible.

Medication will only be administered if the parents/carers have completed the Medical Consent Form.

The following procedure for the administration of all prescribed medication is to followed:

1. All medication will be counted in on admission and likewise, will be counted out on discharge. This will be signed for and countersigned by the two members of staff on the Medication Administration Record;
2. Preparation of all medications to be done in the designated area. This is in the staff office, which contains a secure cabinet and fridge;
3. Get the required medication from the locked cabinet/fridge for the named individual, checking :
   • Name of young person;
   • Medication name and dosage;
   • The date - is the medication in date;
   • Time of administration;
   • That the dose has not already been administered.
4. The 'non-touch' technique should be used when administering tablets by emptying the tablet from the container into the container cap and then transferring onto a spoon or medication cup;
5. When administering liquid medication, the required dose should be poured into a measuring cup or syringe;
6. Where necessary to cut tablets in half, and only one half is administered, the remaining half should be retained in the original container/packaging and administered on the next opportunity when a tablet is needed or returned home/school with the young person;
7. With a second member of staff, check as above and check amount dispensed with amount prescribed;
8. Administer medication, using advice from parents/carers on preferred method of administration, this information is held within the care plan that parents/carers are asked to complete within the admission pack. Advice may also be sought from GP's or Pharmacist's as to the chosen method being suitable for the specified medication, i.e. crushed;
9. Both members of staff must sign the Medication Administration Record immediately after the medication is given.

If medication is not taken, record on Medication Administration Record and complete incident form, seek further advice where necessary.

When medication is dispensed but not taken it should be destroyed and not returned to the container. All instances of this nature require 2 members of staff to be involved, both of whom should witness the disposal of the medication and sign the Medication Administration Records and the Medication Incident Form.

Medication should never be given to any other child than the one for whom they are prescribed.

It is recommended that a current/recent copy of the British National Formulary (BNF), or a similar reference book, is available with easy access for all staff within the medication file and in each young person's file.

If a young person is prescribed or needs a non prescription "as required" or "when necessary" or "p.r.n." medication then clearly written instructions from the prescriber and or parent/carer must be recorded on the young person's medication administration record and details held within the young person's care plan. This must include the reasons for the administration, the time interval between doses, maximum dosage and the time span over which the "when necessary" medication is to be given.

A young person can bring homely/non prescribed medication in with them as agreed with the parent/carer. Each item must be clearly marked with the young person's name. Staff must only give medication following clear instructions on the box. Parental advice re symptoms, when to give etc. may be followed but only if this falls within the directions specified on that medication.

All such medicines must be treated in the same way as prescription medication. Recorded into and out of the unit and a record of any administration kept on the young person's medication administration record.

Advice should always be sought from a pharmacist about any potential interactions between the non-prescribed medicines and the young person's regular medication.

If a parent/carer wishes their child to have a non-prescribed over the counter medication (e.g. paracetamol) it should be sent in labelled for that young person only and must not be used for general administration. Instructions must be clearly written by the parent/carer of why, when and dosage for staff to adhere to.

1.4 Documentation

FORMS: The following forms are referred to in this section, they are to be found in the Forms Library, accessible from the left hand side of this manual

The Manager is responsible for the maintenance of the records to ensure that the recording system is adhered to.

There are 3 types of form available which should be used:

1. Medical Consent Form to be completed by parents/carers (see Forms Library);
2. Medication Prescribed and Administration Record Sheet (See Forms Library)
   
   A form for each child which details:
   1. The young person's name and doctor;
   2. Details of all medication, including name, strength, dosage and frequency of administration;
   3. Any known allergies;
   4. To be completed each time medication is given and signed by two members of staff.
3. Medication Incident Form (see Forms Library - medication form to follow)
   
   A form to be completed in the following situations:
   1. Medication refused;
   2. Medication not given;
   3. Noticeable side effects;
   4. Any other untoward occurrence i.e. spillage, young person "spitting" medication out of the mouth.

All incidents to be signed by member of staff reporting the incident and to be investigated by the Manager.

All medication sheets should be stored in the office of each individual's file. Old records should NOT be destroyed.

If there are any concerns in relation to the medication, advice should be sought from parents/carers in the first instance. If not available, the young person's GP, Paediatric Consultant or pharmacist should be contacted. If further advice is required the relevant Line Manager should be contacted.

1.5 Storage and Security of Medication

• All medicines will be stored in a lockable cabinet specifically designed to store medication;
• The cabinet should be in a room that is not accessible to young people;
• The cabinet should be used exclusively to store medication and should be kept locked at all times, except when medication is being dispensed;
• The keys to the medicine cabinet should be kept safe at all times and cabinet;
• Staff members bringing their own medication onto the premises should ensure it is named and kept in the medicine cabinet for safety purposes.

1.6 Days Out

Any medicines required for any individual will be dispensed in accordance with the administration procedure, clearly labelled and carried in a locked container, this must be stored safely.

1.7 Disposal of Medicines

All medication should be returned to parents/carers or transferred with them e.g. if they move to a new home, advising them of any medication that has reached its expiry date.

2. Medication Procedures for all other Calderdale Children's Homes

Procedures in relation to the misuse of non-prescribed drugs and other substances are contained in Smoking, Drugs and Substance Misuse Procedure.

2.1 Medication Administration Record (MAR Chart)

Reference is made below to MAR Charts, which is a chart or record of a child's medication.

Where possible it is advisable to obtain printed MAR Chart from the dispensing pharmacy.

However, homes may have their own MAR Charts, which should record the following:

• The name of the home;
• The Child's name;
• The medication/drug that has been prescribed;
• The name of the prescribing doctor;
• Dosage strength;
• Frequency;
• A day to day chart of administration (or refusal/non administration);
• The signature(s) of the person overseeing or administering the medication.

2.2 Administration Process

The following steps must be followed when administering medication:

• Staff must check the medication to ensure that it is prescribed for the young person in question;
• Staff must then check the MAR Chart (See Section 2.1, Medication Administration Record (MAR Chart)) to ensure that the young person's name, name of medication, and the dosage instructions are correct and that any recent changes in therapy are taken into account. Staff should also ensure that the dosage has not already been administered;
• The MAR Chart must be checked to ensure that the details recorded match those of the pharmacy label on the medicine;
• Staff must then check to ensure how the medication is to be administered;
• Staff should sign the MAR Chart immediately upon administration of medicine recording the date, time, dosage, balance, the staff members name and signature;
• Where medicines are administered by a Monitored Dosage System the staff member must be able to easily identify the individual medicines and be able to distinguish particular instructions (i.e. before or after food);
• Staff must record the refusal or non-administration of medicine including the reason why;
• Where there is a variable dosage or 'Prescribed as Required' medicine, there should ideally be adequate details on the MAR Chart about how the appropriate dose should be selected, this should be selected, this should relate to the individuals Care Plan.

2.3 Designated Person

Each home must have a designated person responsible for looking after the medicines when young people are unable to manage their own medicines. This may be the homes manager or a person delegated who has appropriate training and assessment and is deemed "competent" to carry out this role.

2.4 Record Keeping

The registered person or delegated individual will be responsible for ensuring that all medicines are recorded and that these records are maintained. The standard of record keeping should ensure that records are properly completed, legible and current, providing a complete audit trail of medication administered. The style or manner of the records is that the discretion of the individual home although advice relating to this should be obtained from the dispensing pharmacist. The home must retain an up to date reference of current medication prescribed to each young person Accommodated.

2.5 Receipt of Medicines

All medicines bought into the home, from whatever source, including discharge medication from hospital, medicines prescribed in an acute situation as well as medicines prescribed on a regular on going basis or those bought from another home should be recorded.

The record should show:

• Date of receipt;
• Name, strength and dosage of medicine;
• Quantity received;
• Young person for whom medication is prescribed/purchased;
• Signature of the member of staff receiving the medicines.

At any given time the home should be able to identify the medicines prescribed for each individual young person.

2.6 Self Administration of Medicines

A record should be maintained of the medicines given to a self-administering young person, including date and signature of the responsible care worker. This information will assist staff to monitor compliance with therapy. A self-administering service user does not need to maintain a Medication Administration Record (MAR Chart). This practice relates to medicines such as Ventolin and Becotide inhalers, staff in the homes should however monitor this in terms of good practice.

In all cases of self medication the home is to draw up an appropriate Risk Assessment plan relating to the possible risks and plans to reduce the risk around potential hazards of self-medication to the service user and others.

2.7 Disposal of Medicines

To provide a full audit trail of medicines through a care home, a record is required to identify a removal from the home of a service user's medicines this record should detail the following:

• Date of disposal/return to pharmacy;
• Name and strength of medicine;
• Quantity removed;
• Young person for whom medicine was prescribed/purchased;
• Signature of staff member who arranges disposal of medicine.

Unused medication which is being disposed of must in all instances be returned to the prescribing pharmacy and a record of the date of return/disposal should be included on the MAR Chart.

2.8 Labelling of Medication

For a care home member of staff to administer a medicine it must have a printed label containing the following information:

• Young person's name;
• Date of dispensing;
• Name and strength of medicine;
• Dose and frequency of medication.

This information must be checked by the administering staff member to ensure the accurate dispensing of medicine. Where appropriate staff should liaise with the dispensing pharmacy with a view to using their monitored dosage systems.

2.9 Non Prescribed Medicines

Non prescribed medication is another name for homely or household remedies, which refers to medicines available over the counter in community pharmacies. There are a range of household medications, which can be maintained in the home, a list of which is contained in the young person's medical book. This includes basic remedies for indigestion, colds and flu remedies (not those containing Soluble Paracetamol).

2.10 Storage of Medicines

Young people responsible for their own medication should, where possible, be provided with a personal lockable drawer or cupboard, should a problem arise the home should have a risk assessment in place to have access to such with consent from the young person or those with Parental Responsibility.

Where staff have the responsibility of handling medicines on behalf of young people there must be a designated secure drawer or cabinet maintained at a temperature suitable for the storage of medicines.

If the home uses a medicine cupboard it must be of suitable size and construction with a quality lock. The security of medicines should not be compromised by the cupboard being used for non- clinical purposes, for example housing electrical equipment. The items for the medicine area or cupboard should not be part of the master system for the home. Key security is integral to the security of the medicines, therefore, access should be restricted to authorised members of staff only.

Where staff are required to administer medicines a Control of Substances Hazardous to Health (COSHH) Regulations Assessment should be undertaken of those medicines, which must be handled. Examples include external applications such as steroids, cytotoxic medicines such as Methotrexate. The purpose of this assessment must provide staff with an understandable statement of personal risk, safe practice to be followed to minimise personal risk and what to do should the care worker come into contact with the product.

Additionally, the home must provide a separate secure and dedicated refrigerator to be used exclusively for the storage of medicines requiring cold storage such as insulin. Whilst in use, the temperature of the refrigerator must be monitored daily using a maximum/minimum thermometer. Staff must also have a clear understanding of what action to take should the temperature be outside the normal range (usually between 2 and 8 degrees centigrade) detailed on the medication itself. The refrigerator should also be defrosted and cleaned regularly.

2.11 Refusal and Covert Administration

It is an Individual's right to refuse medicines, staff must record the reason for refusal of the dose so this can be appropriately discussed at the time of a medication review. Where a young person is considered incapable of giving consent to treatment, the GP and Children's Services and family should be consulted in respect of previous instruction given by the young person.

There may be certain circumstances in which covert administration may need to be considered to prevent a young person missing out on essential treatment. In this case a multi professional team, which includes the GP, Social Worker, family and carers must undertake and agree a decision, having assessed the care needs of the young person. A written policy must be developed specific to the individual and recorded as part of the Care Plan, in this instance any agreement and use of covert administration of medicine must be reported to the Regulatory Authority. To aid the young person in concordance with this, alternative formulations of the medicine i.e. liquid or powdered preparations must be explored. A medicine should only be crushed and administered where this is proven not to alter the medicines pharmaceutical properties.

2.12 Administration of Medicines Away from the Care Home

Normally a young person or responsible adult will be given the dispensed containers of medicine when going on leave/holiday etc. Secondary dispensing of medicines or use of unsuitable containers i.e. envelopes, is discouraged. Appropriate entries in the home's records should indicate the absence of young people and details of the medicines, prescribed for the young person, removed from the home should be made.

2.13 Prescribed Controlled Drugs

Procedures for managing children who may have obtained non prescribed controlled drugs are provided in Drugs and Substance Misuse Procedure.

Controlled Drugs are drugs or chemical substances whose possession and use are regulated under the Controlled Substances Act.

The majority of controlled drugs are prescribed on NHS prescription forms for individually named service users. "Stock" controlled drugs such as Methadone can only be ordered if the organisation has obtained a home office licence.

The home should maintain a separate secure storage area for the sole use of controlled drugs and these should not be stored with normal prescription medication. When administering controlled drugs this should be witnessed and countersigned by another designated member of staff. A separate record must also be maintained by the home for controlled drugs including receipt, administration and disposal. This must take the form of a bound book or register with numbered pages. The record must contain the balance remaining and a separate page for each young person. This must be checked at each administration and also on a regular basis, i.e. monthly.

Controlled drugs which have been obtained on an NHS prescription, may be disposed of in the same manner as other medicines, however, it is recommended that a receipt be obtained from the pharmacy.

Stock controlled drugs may only be destroyed in the presence of an authorised person. In such cases a record of the destruction must be made in the controlled drug register.

2.14 Adverse Drugs Reaction Reporting

Any adverse reaction or suspected adverse reaction should be reported to the GP and/or supplying pharmacist for the young person, and discussed prior to further administration of the drug in question. The GP or supplying pharmacist will then advise on any action required by the home and report this to the medicines and healthcare regulatory agencies. The home's staff will liaise with the prescriber about the submission of a report as appropriate. The staff must also maintain a record in the home of this process.

3. Medical Emergencies

If a child is at risk or requires First Aid/Medical attention, staff should apply first-aid procedures if it is safe to do so, and notify a Manager as soon as possible. However, staff must not compromise or delay the process of getting medical help by doing so. If in any doubt, call medical help.

If there is a risk of serious harm, injury or staff are unable to manage safely, the Police should be notified.

Staff should always assess the situation and if a medical emergency, send for medical help and ambulance.

Before assistance arrives:

• Do not move the person;
• Try to clarify why the emergency has occurred;
• Collect any drug samples or spillages (e.g. vomit) for medical analysis;
• Do not induce vomiting;
• Keep the person calm, under observation, warm and quiet;
• If the person is unconscious;
• Ensure that they can breathe and place in the recovery position;
• Do not move them if a fall is likely to have led to spinal or other serious injury which may not be obvious;
• Do not give anything by mouth;
• Do not attempt to make them sit or stand;
• Do not leave them unattended or in the charge of another child;
• Notify parents/carers;
• For needle stick (sharps) injuries;
• Encourage wound to bleed. Do not suck. Wash with soap and water. Dry and apply waterproof dressing;
• If used/dirty needle seek advice from doctor.

When medical help arrives, pass on any information available, including vomit and any drug samples.

No further action, beyond making the situation safe and attempting to confiscate harmful drugs or substances, should be taken without a Manager's authorisation, preferably in consultation with the relevant social worker.