Policy for Management of Medication in
London Borough of Barnet’s
Childrens’ Homes
This Document has been developed with the LAC Nurse as a guideline for residential staff in the residential setting. It cannot outline every possible circumstance which may arise in relation to medication.
Introduction
These procedures have been designed to support staff with recording, storing and the administering of medications which are prescribed and non- prescribed. No member of staff should administer medication unless they have read and understood these procedures, and have been given in house training to record, store and administer medication. This is to ensure that the likelihood of errors happening are minimised.
If prior to administering a medication you are unclear or unsure about a medication you are giving out you are responsible for seeking clarification either by contacting the prescribing doctor, CIC Nurse, Pharmacist, National Health Direct or unit manager. Medication must not be withheld due to lack of action of a member of staff seeking clarification or as a form of punishment.
Staff responsible for administering medication will be identified on the handover sheet and all staff bringing medication in to the building are responsible for accurately recording in the correct places.
At the point of collecting medication staff should ascertain if a medication is a controlled drug by asking the pharmacy or the prescribing doctor.
Young people are entitled wherever possible to choose or retain their own GP (if the home is in their catchment area), where young people are to be registered with new GP, they must be given relevant medical information by staff especially in the case of specific medical conditions.
At the point of admission, the staff need to ask each young person and their caregiver what medication they take. This discussion should be take place during the placement planning meeting.
During these procedures we will make reference to the following 4 types of medication.
A Prescribed Medication – A prescription is required to obtain these medications.
· These are recorded in the prescribed medication book and on a prescribed medication form kept in a medication cabinet. Forms are filed in the young persons file once completed.
· Medication not completed must have an explanation recorded on the sheet and a record of any conversations had with the prescribing doctor.
· The balance must be counted and missing tablets accounted for and recorded at the end and beginning of each handover.
· They are kept in the prescribed medication cabinet.
· Temperature recordings are kept at the back of the prescribed medication book
B Controlled Prescribed Medication – A prescribed medication containing drugs that are controlled under the Misuse of Drugs legislation. More information can be found under appendix 1
· These are recorded in the prescribed medication book and controlled medication book
· The balance must be counted and missing tablets accounted for and recorded at the end and beginning of each handover.
· Administration of these tablets require two signatures, one whom is a witness to it being given
· Missing tablets must be reported to a line manager ASAP.
· They are kept in the controlled medication cabinet and must be kept locked.
C Non Prescribed – Paracetamol and Ibuprofen tablets (not including other medication containing Paracetamol or ibuprofen)
· These are recorded on a non-prescribed medication cabinet. Forms are filed in the young person’s file once they are full or completed. A new sheet must then be started.
· Staff must mentally risk assess if ongoing use of these tablets require a doctors’ appointment
D Household – All other medications purchased over the counter
· All purchases are recorded in the household medication book
· Individual records are kept on a household medication form specific to the young person receiving the household medication. Completed or full forms will be filed in the young persons file.
Always check that the medication you are giving does not clash with other medication given, particularly if it is non prescribed or household e.g. many cough medicine contains paracetamol and should not be used at the same time due to a possibility of overdosing.
1 Storage
1.1 Medication will be stored in a locked cabinet at the point it enters the building and the relevant books and paperwork completed – see recording. There are three separate cabinets. One for prescribed, one for Controlled medication and one for non-prescribed and household medication
1.2 The temperature of the prescribed cabinet will be monitored and recorded at the back of the prescribed medication. The temperature will be kept at below 25°.
1.3 Any medication that is required to be stored in a fridge will be. The fridge temperature will be monitored, recorded daily, and kept between 2° and 8°C.
1.4 One member of staff will be nominated on each shift to be responsible for medication, this person is responsible for ensuring that the medication they are taking over is all accounted for and no medication is missing. This person will preferable be, in this order, first aid trained, a permanent member of staff an As and When member of staff or an agency member of staff that has received the relevant training by a competent member of team. To evidence they have counted it and agreed it is correct they should record this in the running log book and sign.
1.5 Young people who self-administer are responsible for the safe keeping of their own medicines, which should be stored in a place only accessible to that young person. A risk assessment must be completed before they can self medicate.
1.6 Any prescribed medicines not in use (once medical advice has been sort) or beyond ‘use by’ date should be returned to the pharmacist. If returned to the pharmacist the book should be stamped by the pharmacist as evidence of its return.
1.7 What is locked in Controlled Medication Cabinet?
· Prescribed Controlled medication
· Controlled medication recording book
1.8 What is locked in the prescribed Medication Cabinet?
· Prescribed current medication (not including controlled drugs).
· Record book.
· Thermometer.
· NOTHING ELSE.
1.9 What is locked in the Non- prescribed / Household Medication Cabinet?
· Paracetamol tablets – general painkiller.
· Ibuprofen tablets - anti-inflammatory painkiller/muscle pain/period pains. Ibuprofen should not be given to asthma sufferers
· House hold medication currently in use.
· One record book for paracetamol and ibuprofen.
· One record book for any ‘house hold medication’.
NOTE - Under no circumstances should aspirin or products containing aspirin be given to children under the age of 16.
2 Good Practise when Administering Medication
· Check PIR health section to ascertain any identified issues and consent for medical treatment has been signed
· Always check that the medication does not clash with other medication given, particularly if it is non prescribed or household medication e.g. many cough medicine contains paracetamol.
· If a young person has not taken prescribed medication on three concurrent occasions staff must contact the prescribing doctor to get advice about what to do next. This must be clearly recorded on the medication sheet.
· Wash Your Hands and maintain a high level of hygiene.
· Prepare all medication with the office door shut.
· Pour or tip the medication into a plastic pot.
· Lock away the remaining medication.
· Leave the office taking the medication to the young person.
· Try to make sure you see the young person taking the medication.
· Link works should monitor their link child’s medication if they are self medicating and staff can check daily by asking e.g. have you taken your medication today?
3 Prescribed Medication Book (including controlled medication)
This book is kept in the prescribed medication cabinet and records all prescribed medication coming into the building. The following headings must be used.
1) Young persons name
2) Date medication prescribed
3) Amount prescribed
4) Storage e.g. Prescribed or controlled drugs cabinet
5) Administration e.g. 1 tablet 4 times a day after meal at regular intervals or every 4hrs
6) Date entered into book
7) Staff signature
8) Date Medication Completed (or discarded at pharmacy)
9) Staff signature (or pharmacy stamp)
4 Controlled Medication - Additional Recordings and Administering
4.1 When the medication first enters the building it will be entered into 2 books, one for all prescribed medication and another specifically for controlled medication.
4.2 The recording should have the following information:
1) Amount prescribed.
2) Put in the date that is on the medication packaging.
3) Date medication given
4) Time medication given (please use 24hr clock)
5) Young persons name
6) Amount given on this occasion
7) Any tablets discarded due to dropping or missing when counted
8) Signature of person giving the medication
9) Signature of witness (if no member of staff available to witness then the young person could sign as medication should not be delayed where possible)
10) Amount of medication left from that specific medication box
Please note
There are stickers in the controlled drugs cabinet that can be stuck on medication packaging or put in the medication book to help identify quickly that it is a controlled drug.
5 Prescribed Medication - Additional Recordings and Administering
5.1 Follow steps in section 3 of these procedures.
5.2 For each medication complete a medication forms which can be found in
Staff information: template file.
5.3 Clearly state specific instructions on how to administer e.g. with food and times it should be administered e.g. AM or PM or 3times a day at 8.00, 13.00, 17.00.
5.4 Ensure all sections of the medication form are completed and signed
6 Stopping or Ending a Prescribed medication (including controlled mediaction)
6.1 Encourage young people to finish all courses, which have been prescribed to them.
6.2 Consult with the prescribing doctor/clinic/hospital or when this is not possible with the LAC Nurse as to the implications of not finishing the medication course.
6.3 When a young person has finished their course of medication, or the current prescribed medication has all been used, or the child has refused to finish the course and the medication is returned to a chemist, the ‘prescribed medication book’ kept in the medicine cabinet must be completed. If returning prescribed medication to a pharmacy you must get the prescribed medication book stamped/signed on the corresponding page.
6.4 If a young person’s medication routine is changed or stopped on the direction of a doctor this must be recorded.
7 Accounting for Lost or Damaged
7.1 As discussed earlier in section 1.4 staff are required to count medication and sign before taking over the responsibility for it. Any missing medication must be accounted for at this point.
7.2 If prescribed medication is dropped and not usable then it must be recorded on the young peoples file.
7.3 Controlled medication which are missing must be reported to a manager ASAP and could result in the police being informed.
7.4 If a controlled medication is dropped this should be held within the controlled medication cabinet until it can be given to the unit manager to sign off.
7.5 If medication is lost or unusable staff should consider if they need to ring the doctor for further medication e.g. antibiotics as it may impede on recovery.
7.6 Non prescribed medication such as paracetamol and ibuprofen tablet should be accounted for and damaged tablets recorded in the non prescribed book.
8 Administration of Non Prescribed and Household Medication
8.1 Check why the young person has requested the non prescribed or household medication.
8.2 Before administering any non-prescribed medication or household medication a risk assessment will need to be undertaken to assess whether it is appropriate for the young person to be brought the non-prescribed medication. This does not need to be a paperwork exercise but you must think about any other prescribed, non-prescribed or household medication the young person is on and seek advice re if it would conflict with the medication you intend to purchase. If the young person has a known life threatening or major illness such as HIV or diabetes we must not buy any over the counter household medication – they must be seen by a GP.
8.3 If the young person has a history of the illness (e.g. hay fever, cold sores, mouth ulcers, head lice) you can purchase the required Household medication however if this is the first time they are displaying the symptoms they MUST have a doctor’s diagnosis.
8.4 Discuss any household medication you intend to purchase with the pharmacist.
8.5 Are there any reasons why they should not have it? E.g.: Allergies, asthma (with Ibuprofen). If this is unclear please consult with the guardian or social worker.
8.6 Consider if a doctor’s visit is necessary. As headaches and stomach pains may be due to a bigger issue. Emergency treatment maybe needed. Contact NHS direct/doctor/hospital if in any doubt.
8.7 If the young person is going to self-administer a risk assessment will need to be carried out.
8.8 Check that we have medical consent signed in relevant LAC document.
ALWAYS FOLLOW GUIDANCE ON PACKET.
If a young person suspects they are pregnant they will need to have a test at a local family planning centre. As an alternative you could contact the outreach Looked after children’s worker at Claire Simpson House (located in Barnet Hospital) and they may agree to come to the unit to carry out the test.
If a young person requires the ‘morning after pill’ [emergency contraception] you can give them information and support as to where they could obtain the medication from (some chemist give this free or you can attend a family planning clinic or A&E) – this needs to be taken within 72 hours of having unprotected sex. Make sure the young person has had some aftercare including advice and information about other forms of contraception
9 Recording for Non Prescribed and Household Medication
9.1 In the medication file each y/p should have a separate Paracetamol and Ibuprofen ‘non prescribed’ sheet – enter the tablet on to the correct sheet. A new sheet does not need to be started until the whole sheet is full.