CHILDREN S RESIDENTIAL SERVICES: Residential Short Breaks

April 2016

Author: Reviewed by RuthFrance / Last updated: 30th April2016
Next update: April2017

Appendix 2

CHILDREN’S RESIDENTIAL SERVICES: Residential Short Breaks

PRESCRIPTIVE MEDICATION

1.Introduction

1.1 Medication plays an important role in the care and support of

young people ‘looked after’ in the Department’s residential setting.

1.2 By their very nature , medicines held in the Homes require that clear

procedures and guidelines are in place in order to minimise

potential risk.

1. General

2.2 The Home’s Manager is responsible for all medicines and for ensuring

these procedures are consistently applied.

2.3 All staff must be familiar with and have a working knowledge of

the Departmental policy [Appendix A ]

1. Receipt of Medication

3.1Upon admission a Medical Information Sheet must be completed in

respect of all young persons [Appendix B ]

3.2For young people who are prescribed medication, written directions for the administration of medication are requested from the prescribing practitioner.

Any subsequent changes to dosage or administration are also requested from the prescribing practitioner. This is to ensure that the correct up to date does is administered where children may be subject to frequent changes in medication, and where the printed pharmacy labels may not reflect the latest dose prescribed. On admission, the medication provided by carers must be checked to ensure it is correctly labelled with the patient’s name, the name of the drug, dosage and frequency, and any other special instructions. If the labelling is detached or defaced the GP, or pharmacist must be consulted. Such information must then be recorded on the Medication Monitor Chart [ Appendix C ]

3.3For those young people prescribed medication following admission,

the same procedures (3.2) will apply

3.4All medicines must be stored in a lockable cabinet not generally accessible to young people. Medication counts should be carried out by 2 staff at the start and finish of each shift, and two staff should check and sign for any medication to be discharged at the end of a child’s stay.

1. Administration of Medication

4.2 All medicines must be administered in accordance with the

prescribing G.P’s / pharmacist’s instructions. Paracetamol may be administered in the event of an elevated temperature or pain in accordance with the Administration of Paracetamol protocol 2.16 (b)

4.3 Medicine should be administered to 1 young person at a time and

wherever possible 2 members of staff present to cross check the

young person with the medication.

4.4 Once administered, the Medication Monitor Chart must be

completed immediately

4.5 If a young person refuses to take prescribed medication this must

also be recorded and professional advice sought. If appropriate this should also prompt a review of the young persons risk assessment and placement plan.If medication is not given due to request from a parent or carer, this should be recorded and a duplicate signature obtained from the carer.

4.6 Any adverse reactions to medication must be recorded within the

young person risk assessment and placement plan, with appropriate

action to be taken noted. Where appropriate professional advice be

sought to ensure that the young persons needs can be met.

4.7 Any spillage must also be recorded.

4.8If a young person requires medicines to be given via their feeding tube, then the protocol for this should be discussed and agreed with the

prescribing practitioner, and reflected in the child’s records and agreed

with their social worker and parents.

4.9Normally tablets should not be crushed and capsules should not be opened: either to make them easier to swallow or to hide them from a young person as this may effect the way that the medicine works.

4.10Covert administration of medicines. ‘Covert’ is the term used when

medicines are administered in a disguised format without the knowledge or consent of the person receiving them, for example, in food or in a drink.

Covert medication is sometimes necessary and justified, but should never be given to young people who are capable of deciding about their medical treatment. Giving medication by deception is potentially an assault. The covert administration of medicines should only take place within the context of existing legal and best practice frameworks to protect the person receiving the medicines and the care workers involved in giving the medicines.

Children should always be informed that they are being given medication regardless of whatever means this is administered.

Staff must always seek the appropriate medical advice regarding administration of medication. If medication needs to be given in a covert manner, or in any different manner than indicated on the medicines information sheet, written guidance should be obtained and kept on the young person’s file from the appropriate prescribing practitioner.

Any administration of medication in a covert or other manner must be fully covered by and recorded within their placement plan and risk assessment and agreed by all those involved with the care of the child. This practice must also be regularly reviewed to ensure that the child’s needs can be met and that their welfare is promoted.

See also:

Rights, risks and limits to freedom. Guidance for practitioners considering restraint in residential care. Mental Welfare Commission for Scotland. June 2006

Covert medication. Mental Welfare Commission for Scotland. November 2006

Mental Health Law Briefing: The covert administration of medicine Number 101

UKCC position statement on the covert administration of medicines

1. Disposal of Medication

5.2 As soon as medication ceases to be required it should be returned

to the pharmacist and a record of disposal must be entered on the

Medication Monitor Chart.

(This Policy Is a Supplement to the KMBC SSD Policy and does not supersede Any Part of it.)

Outside Activities – Medication Policy – see also KMBC SS Policy.

1. Introduction

Within the Children’s Residential Service there may be occasions were

during an activity / outing/ holiday from the home, prescribed medication

may need to be administered to a child / young person.

1.2This guidance should be read in conjunction with the KMBC SSD Policy

for the administration of oral medication to children.

1. Action

2.1On outings / activities within the community, it may not be possible to

keep medication in a lockable cupboard.

2.2Medication should be stored in a lockable container, to be in the

possession of a designated worker.

2.3Unused medication is to be recorded and returned to the home.

2.4In every other respect the administration of medication should follow the

KMBC SSD Policy.

Appendix A

Knowsley Social Services

Policy for the Administration of Oral Medication to Children.

1. Introduction

1.1This policy does not cover the administration of controlled drugs, the administration of non prescriptive medication including home remedies or the practice of invasive treatments.

1.2Children / young people may require assistance and Knowsley MBC Social Services staff, will be required to administer prescribed if this is part of an individual care package being planned for the service user and is indicated following a risk assessment.

1.3This policy is designed for all staff, who are involved with the oral administration of medication. Clear and concise guidelines in the form of a protocol for the administration, storage and disposal of medication, and a checklist, are provided with this policy which meet the legal requirements of the Medicines Act 1968. This act states:-

“The Act provides that no person shall administer a Prescription Only Medication, otherwise than to himself, unless he is a practitioner or is acting in accordance with the directions of a practitioner.”

1.4Knowsley MBC will only take responsibility for the administration of

medication to service users if clear instructions are supplied by the practitioner, i.e. doctor.

1.5Procedures for each service area will include guidelines for the receipt, administration, storage, disposal and recording of medication. Staff responsible for handling medication will be given relevant training on administration and recording practices.

1.6Where there are tasks in which staff act in ‘Loco Parentis’, such as administering eye drops, ear drops, ointments or creams, staff should be given appropriate guidance on how to administer the medication and the necessary hygiene regulations required, by a practice nurse, health visitor or GP or LAC Nurse.

Protocol for Administration, Storage and Disposal of Medication.

This Policy will cover the administration of medication to service users where the need is identified within a package of care.

1. Notification of Medication To Be Administered.

2.1The dispensing pharmacist will be asked to label each item with the name of the drug, the person for whom it has been prescribed and full instructions of the dosage and timings of administration, and any other special instructions.

2.2This policy does not cover the administration of non-prescriptive medicines.

2.3Medication will only be administered on an “as required” basis (P.R.N) on clear

written instructions from a qualified practitioner i.e. GP

See Appendix 1. Medication Review Form.

2.4Newly prescribed medication or revised medication to be entered onto

Medication Review Form.

3Supply of Medication

3.1The service user or his/her carer will normally obtain medication. It may be necessary for home carers or outreach workers to take a prescription to the pharmacist and collect the medication for the service user.

3.2It is preferable to have tablets supplied in blister packs, giving details of correct

dosages and timings or in pre-packed personal dispensing systems.

3.3If the service user is away from own home, i.e. respite care. Medicines should

be supplied on a short-term prescription.

3.4Medicines should be entered on the Medication Record Card when received.

3.5Medication should not be removed from service users own home by home carers

or other Service Provision Division Staff.

4Administration

4.1Where staff are working in isolation, he/she is responsible for the administration

of medication. Where a number of staff are on duty together, the senior member of staff will identify the responsible person.

4.2Staff will be given adequate training in procedures before being asked to carry

out these tasks.

4.3Medication will be administered strictly in accordance with appropriate practitioners’ instructions.

4.4Labels on containers must NOT be altered or removed. If the label becomes detached, then advice must be sought from the supplying pharmacist.

4.5Liquid medication should never be transferred from one container to another.

4.6A standard Medication Record Card will be used throughout the service to

record the receipt, administration and disposal of medication.

4.7Staff administering the medication should read the label on the container and

check this against the Medication Record Card to ensure correct person, medication, dose and time.

4.8Medication not taken by the service user should be recorded on the Medication Record Card.

4.9The preferred method of administration is NOT to touch the medication by hand, but to transfer from the container onto a spoon. If this is not possible, protective gloves should be worn, or hands washed before and after administration. It is acceptable to transfer medication direct form its container onto service users own hand, if this method is preferred by service user.

4.10Medication should not be left with the service user to take at a later time. Staff should observe the service user actually taking the medication, then record thus, by initialling the Medication Record Card.

4.11Medication dropped or spilt accidentally must be disposed of immediately and re-administered. A note to this effect must be made on the Medication Record Card.

4.12Medication that is vomited back up should not be re-administered, but recorded on the Medication Record Card and relevant carers notified.

4.13It is the service user’s right to refuse medication. It this occurs, an attempt must be made by staff to persuade the person to co-operate. If this is unsuccessful then it should be recorded on the Medication Record Card and relevant carers informed. In circumstances where a service user constantly refuses medication and this is likely to cause deterioration of health, medical advice should be sought urgently.

4.14Services Provision Staff will not normally administer controlled drugs i.e. Morphine, Pethidine which have to be administered by a G.P or Registered Nurse. However, in some circumstances controlled drugs are dispensed into a monitored dosage system by a GP. In this event staff could administer or assist the service user to take the medication.

4.15Tasks of a nursing nature that are required to be carried out on a regular basis should be case planned and dealt with by suitable qualified professional, i.e. District Nurse, Health Visitor, Community Psychiatric Nurse or Community Nurse for people with a Learning Disability. This in particular refers to stoma care, leg ulcer care or injections.

4.16Not withstanding the terms of the above Policy, in exceptional circumstances medication may be administered other than the oral route, e.g. a service user who has a diagnosis of epilepsy and a history of Status Epileptics would be given Rectal Diazepam. In such circumstances staff must comply with the following conditions.

a)Identified as a risk by the care manager on the service users plan.

b)The risk assessment will describe the individual’s usual seizure, including duration and will give time specific directions for when an emergency procedure will be implemented.

c)Parent/carers will have given permission and instructed Social Services staff to administer such medications as Rectal Diazepam in an emergency.

d)Staff working in isolation would not administer rectal diazepam, but would call Emergency Services.

1. Storage

5.1All medication should be stored in a lockable cupboard, in the original container

as received from the pharmacist.

5.2Medicines for internal and external use should where possible be stored separately.

1. Disposal of Medication

6.1Prescribed medicines that are not used should be returned to the pharmacist and the disposal recorded on the Medication Record Card.

Checklist for Procedure.

1. Only administer medication to one person at a time.

2a.Where an individual member of staff works in isolation, they have an increased responsibility to double check all details at each stage. Staff working in isolation would not administer invasive medication.

2b.Where two members of staff are present:

One to check correct names on container, correct medicine, dose, time.

Two to check Medication Record Card and person.

3.Provide water, to be taken with tablets and capsules.

1. Transfer tablets or capsules from the container onto another receptacle, i.e. plastic spoon provided. Do not touch by hand.

1. Give medication to service user and observe that it is swallowed.

1. If a service user is unable to handle medication then staff must wash hands immediately prior and following handling it. Alternatively, use disposable gloves.

1. Record on the Medication Record Card that the medicine has been taken by initialling in the space provided.

1. Record also if a service user refuses medication

Record if medication spilt or dropped and re-administer.

Record if medication is regurgitated but do NOT re-administer.

Knowsley Social Services

Children and Families Division

Medication Review Form

To the Physician

To enable the carers to accurately administer your prescription, please print the prescription details in the form below for each drug prescribed.

Name:

D.O.B:

Drug / Dose / Time / Route / Further Instructions

Signed:Date:

Print Name:

Medical Information Sheet

Appendix B

Child’s Name: …………………………………………………….Date of Admission: ………………………………………

Home Address: ……………………………………………………Date of Birth: ………………………………………………

………………………………………………………………………Medical Condition:……………………………………………….

……………………………………………………………………………………………………………………………………………..

Telephone Number: ………………………………………………..Diet or Allergies: …………………………………………………

Next of Kin Telephone Number: ………………………………….……………………………………………………………………..

…………………………………………………………………….

Doctors Name: ……………………………………………………..

Doctors Address: ……………………………………………………

………………………………………………………………………..

………………………………………………………………………..Date Form Completed:……………………………………………

Doctors Telephone Number: ………………………………………Signed: …………………………………………………………….

Medication Monitor Chart

Appendix C

Date: / Additional Notes:
Name:
Medication:
FRIDAY / SATURDAY / SUNDAY / MONDAY / TUESDAY / WEDNESDAY / THURSDAY
Time / Time / Time / Time / Time / Time / Time
Sign / Sign / Sign / Sign / Sign / Sign / Sign
Time / Time / Time / Time / Time / Time / Time
Sign / Sign / Sign / Sign / Sign / Sign / Sign
Time / Time / Time / Time / Time / Time / Time
Sign / Sign / Sign / Sign / Sign / Sign / Sign
Time / Time / Time / Time / Time / Time / Time
Sign / Sign / Sign / Sign / Sign / Sign / Sign