c03c children’s medication guidance for staff · c03c children’s medication guidance for staff...

Updated November 2018. To be implemented by February 2019. Review due November 2019. Carers Trust is a registered charity in England and Wales (1145181) and in

Scotland (SC042870). Registered as a company limited by guarantee in England and Wales No. 7697170. Registered office: 32-36 Loman Street, London SE1 0EH.

Crossroads Care trade mark is a collective mark. © Carers Trust 2018

C03c

Children’s medication guidance for staff This document is provided to Carers Trust East Midlands (now referred to as ‘the organisation’) as a Network Partner of Carers Trust.

Table of Contents SCOPE ........................................................................................................................................ 1

INTRODUCTION.......................................................................................................................... 2

TYPES OF MEDICATION SUPPORT.......................................................................................... 2

STORAGE OF MEDICATION ...................................................................................................... 4

GENERAL RULES FOR HANDLING MEDICATION .................................................................... 4

RESPONSIBILITY FOR MEDICATION ........................................................................................ 5

RECORD KEEPING..................................................................................................................... 5

COLLECTION OF PRESCRIPTIONS .......................................................................................... 6

UNSUCCESSFUL ADMINISTRATION OF MEDICATION ........................................................... 7

MEDICATION ERRORS .............................................................................................................. 7

DISPOSAL OF PRESCRIBED MEDICATION ............................................................................. 8

CHANGES TO MEDICATION ...................................................................................................... 8

SIDE EFFECTS OF / ADVERSE REACTIONS TO MEDICATIONS ............................................ 8

TAKING MEDICATION OUT OF THE HOME .............................................................................. 9

LEARNING AND DEVELOPMENT .............................................................................................. 9

APPENDIX 1 Types of medication .......................................................................................... 10

APPENDIX 2 Administration of medication from compliance aids .......................................... 11

APPENDIX 3 Medication support flowchart ........................................................................... 12

APPENDIX 4 Paraffin-based creams, lotions and ointments .................................................. 13

1.0 SCOPE

1.1 This guidance is about children and young people with care needs, aged 17 and under. There is separate guidance (B02c) for adults aged 18 and over. 1.2 The aim of this document is to protect both staff and the children / young people using the service by ensuring medication is managed and administered safely. 1.3 See Appendix 1 for examples of different types of medicine referred to in this document. 1.4 You also need to read the autonomy and independence policy (D08).

Carers Trust Children’s medication guidance for staff

Updated November 2018 Review due November 2019

© Carers Trust 2018 2 of 13

2.0 INTRODUCTION

2.1 We will work with a child or young person’s parent / carer to find out whether they can give the child or young person their medication before you visit, but this may not always be possible. 2.2 Children and young people have the right to manage and take their own medication if they are able and want to do so. If their age or condition means that they can’t do this, or they need help to take it, you may be asked to support them. 2.3 You are not allowed to offer any kind of help or support with a child or young person’s medication unless you have been trained to do so and it is written in their care and support / personal plan. 2.4 This applies to medicines that have been bought over the counter (such as common pain killers and cough remedies) as well as to those that have been prescribed by a doctor, because some over-the-counter medicines (for example Paracetamol, Ibuprofen) can cause adverse reactions if they are taken with other medication.

You must not help a child / young person to take over-the-counter medicines unless it has been agreed by the care planner / assessor, and it is written in the care and support / personal plan.

You must not give advice about over-the-counter medications or how to treat minor ailments such as common coughs and colds.

If you are unsure about what to do in any situation, contact your line manager. 3.0 TYPES OF MEDICATION SUPPORT 3.1 These are:

General support (assisted self-medication)

Administration of medication

Administration of medication by specialised technique. See Appendix 3 for medication support flowchart. 3.2 A care planner / assessor will assess the type of medication support, if any, each child or young person needs and this will be written in their care and support / personal plan. Under no circumstances can you extend / change what you do or how you help a person with their medication (even slightly) without it first being agreed with the care planner / assessor and written in the care and support / personal plan. 3.3 General support (assisted self-medication)

3.3.1 You can only offer general support with medication to a child or young person who:

has been assessed as competent to take responsibility for their own medication

can let you know what help they need you to give them.

3.3.2 When you are giving general support, you will always be working under the direction of the child or young person and only doing what they ask you to do. You are not required to select the dose, the medication or the time it is to be given. 3.3.3 You can offer general support from a compliance aid1 filled by a pharmacist but also from one filled by someone other than a pharmacist (such as the child or young person’s parent /

1 Also called a dossette box, monitored dosage system or blister pack.




carer or other family member), because the child or young person is responsible for the medication they are taking from it, they just need your help to take it. 3.3.4 General support can include giving the child or young person an occasional prompt or reminder to take their medication. However, if you are having to remind them frequently, or they appear confused or unclear about their medication, let your line manager know because it could mean they are no longer able to take responsibility for it.

3.4 Administration of medication 3.4.1 You are only allowed to administer medication from:

an original container (for example, bottle, packet, foil strip) supplied and labelled by a pharmacist

a pharmacy-filled, sealed compliance aid – see Appendix 2 for details. 3.4.2 When you administer medication, always check you are giving:

the right dose

of the right drug

by the right route

to the right person

at the right time The child or young person also has the right to refuse their medication. 3.4.3 Also, before you give the medication:

check the MAR2 chart and ask the person concerned to make sure it hasn’t already been given by someone else

check it has not gone past its use-by date (do not give out-of-date medicine)

ask the child or young person if they are ready to take it. 3.4.4 ’As required’ (PRN) medication The child or young person’s care and support / personal plan and MAR chart will specify the reason each ‘as required’ medication is to be given (for example ‘for shoulder pain’, ‘for indigestion’). The care and support / personal plan will also state how the child or young person will indicate they need the medication if they are unable to communicate verbally. Before you give PRN medication:

first establish that the reason the medication is being requested matches the reason given on the MAR chart and do not give it for any other reason than the one stated

make sure there has been enough time between doses by checking written records and asking the child or young person and / or their parent / carer when they last took it

check that the dose you give will not exceed the maximum dose permitted over 24 hours.

Once given, record the date and time you gave it on the MAR chart, using the 24-hour clock. 3.5 Administration of medication by specialised techniques

3.5.1 Administering medication by specialised technique is referred to as a specialised task. See Appendix 1 for examples.

2 Medication Administration Record




3.5.2 Before you can administer medication using a specialised task you need to be given client-specific training from a relevant professional. This will be updated at least once a year. 3.5.3 Once you have completed the training, you will be assessed to ensure you are competent to carry out the specialised task safely and that you feel confident and capable to do it.

3.5.4 You can opt out of giving medication using a specialised technique if you prefer not to take on this level of responsibility. 4.0 STORAGE OF MEDICATION

4.1 It is important that a child or young person’s medication is:

stored in a safe, secure place so that it isn’t misused or taken by accident

stored away from direct heat and as per manufacturers’ instructions

kept separate from medicine belonging to other people in the household.

4.2 The child or young person’s care and support / personal plan will state where the medication is to be stored. If you become concerned it isn’t being stored safely, talk to the parent / carer, make a record on the client report form and then if necessary, discuss it with your line manager. 5.0 GENERAL RULES FOR HANDLING MEDICATION The guidance below applies to all medication. 5.1 ALWAYS:

provide only the medication support detailed in the care and support / personal plan

wash your hands before and after helping with or administering medication. 5.2 NEVER:

give help with medication unless it is written in the care and support / personal plan

give medication to a child or young person against their wishes

try to disguise, crush or tamper with medication, (for example by hiding it in food or drink) unless it is written in the care and support / personal plan

change the time or dose of medication or alter things in any way

give over-the-counter medication (such as Paracetamol or Ibuprofen) to a child or young person unless it is written in the care and support / personal plan

buy over-the-counter medication for a child or young person with care needs

carry medication belonging to a child or young person, except when authorised to do so on the care and support / personal plan (for example when taking them on trips out, collecting prescriptions or disposing of unwanted medication)

use a child or young person’s medication for yourself

give your own or anyone else’s medication to a child or young person

transfer medication from an original container to another

fill or help a child or young person or their parent / carer to fill compliance aids

give support with or administer medication from a container if the label has come off or you can’t read it

change or re-attach labels to medication containers

put spoilt or unused medication back into its container (see 9.2 below)

leave medication out for the child or young person to take later.

If in doubt, STOP – contact your line manager or the person on call and ask for advice.




5.3 Touching medication

5.3.1 Try to avoid directly handling medicines wherever you can. For example, push tablets out of the packaging directly into a pot / onto a spoon / into the child or young person’s hand. 5.3.2 If the care planner / assessor has risk assessed that you have to handle the medication or if it would be harmful if you touched it, it will be written in the care and support / personal plan that you must wear disposable gloves. 5.4 Creams, lotions and ointments

5.4.1 If you are required to apply a medicated lotion, cream or ointment to a person’s skin, you will need to wear disposable gloves to protect both you and them. 5.4.2 You need to be aware that creams, lotions or ointments that contain paraffin are a potential fire risk. Examples include E45 cream and lotion, Zinc ointment, Sort White Paraffin. If you are aware that a child or young person is using products containing paraffin and have any concerns, inform your line manager / the person on call straight away. See Appendix 4 for more details. 6.0 RESPONSIBILITY FOR MEDICATION 6.1 Child or young person competent to take responsibility for own medication

Always work under their direction.

Do not automatically assume they will consent to the help you are offering.

If you suspect the child or young person is having difficulties managing their medication (for example, forgetting to take it, getting confused, frequently mislaying it) or have any concerns, report the matter to your line manager.

6.2 Child or young person not competent to take responsibility for own medication

6.2.1 Even though you are taking responsibility for the child or young person’s medication, give an explanation of what you are intending to do and why and let them help if they are able.

6.2.2 Any action you take must be in the child or young person’s best interests - see the autonomy and independence policy (D08) for details. If you have any concerns about their medication, mention the matter to their parent / carer as appropriate, and contact your line manager / person on call to discuss it. See examples of possible concerns below.

They get upset about taking their medication.

They are excessively drowsy.

You recognise side effects of the medication that the child or young person is unable to express (for example they are becoming more confused).

6.3 Safeguarding concerns 6.3.1 Medication can be misused in various ways, including for example:

being given excessively or inappropriately to control a person’s behaviour

deliberately giving or withholding it as a form of punishment or to cause harm. 6.3.2 If you suspect this is happening or have any concerns, get in touch immediately with your

line manager / person on call to discuss it. 7.0 RECORD KEEPING 7.1 Poor record keeping can put people receiving medicines support and care workers at risk and result in preventable mistakes.




7.2 General support 7.2.1 Record exactly what you did on the client report form. For example:

if you opened a container, record it, including details of which container you opened

if you reminded a child or young person to take their medication, record it (but remember, if this is happening frequently, inform your line manager).

7.2.2 If it is written on a child or young person’s care and support / personal plan that you can help them with non-medicated products (such as hand lotions, sun cream or cosmetic moisturisers), make a record on their client report form whenever you do it. 7.3 Administering medication (including by specialised techniques) 7.3.1 A care planner / assessor will record on the MAR chart:

the name and date of birth of the child or young person taking the medication

the name of their GP practice and pharmacy

the name of the medication

the dose of the medication

the time it is to be administered

further special instructions (for example ‘to be taken with food’)

any stop or review dates. 7.3.2 You need to sign or initial the appropriate section on the MAR chart:

against each medication given

each time you give it

when you give it.

Do not rely on your memory to sign the MAR chart later – you might forget to do it or get the details wrong. Remember, this is a legal record of the medication administered to the child or young person receiving care. See also Appendix 2 regarding administration of medication from a pharmacy-filled sealed compliance aid. 7.3.3 You are not allowed to copy details of medication onto a MAR chart unless you have been trained to do it. 7.4 Records also need to be kept of:

unsuccessful administrations of medication (see 9.0 below)

suspected adverse reactions to medication (see 13.0 below). 7.5 Client report forms and MAR charts need to be transferred to the office as directed by your line manager. 8.0 COLLECTION OF PRESCRIPTIONS

8.1 You will not normally be expected to collect a child or young person’s prescription from the pharmacy. However, in some circumstances, where a family member is not able to collect it, the care planner / assessor may ask you to do it on their behalf. Details of what you have to do will be written in the care and support / personal plan. 8.2 Once you have collected the medication:

keep it out of sight while transporting it (for example in a bag or in the boot of your car)




take it immediately to the child or young person’s home

check the medication with the parent / carer to make sure it’s correct

place the medication in a safe place as agreed with the family and as detailed on the care and support / personal plan (see 4.0 above)

record what you have done on the client report form. 8.3 If you have any questions about a prescription you have been asked to collect, discuss the matter with the child or young person and / or their parent / carer, and if necessary get in touch with your line manager or the person on call for advice. 8.4 If you are asked to collect a prescription in an emergency and it is not written in the care and support / personal plan, contact your line manager or the person on call and ask them what to do. 9.0 UNSUCCESSFUL ADMINISTRATION OF MEDICATION 9.1 If you are supposed to be giving medication to a child or young person but are not able to (for example because it is not available / missing, or they refuse to take it):

record what happened on both the client report form and the MAR chart using the key provided at the top of the form – do not leave an unsigned ‘gap’ on it

report the matter immediately to your line manager / the person on call and to the child or young person’s parent / carer.

9.2 If medication is taken out of its packaging, then refused or not taken, or if it is spoilt in any way, do not place it back in the container. Contact your line manager / the person on call who will find out from the pharmacist how you are to dispose of it. 10.0 MEDICATION ERRORS 10.1 Examples of errors include:

giving the wrong medication

giving the wrong dose (too little or too much)

failing to give medication

giving medication at the wrong time

failing to sign for medication given

medication given to the wrong person

missed doses. 10.2 If you make a mistake with medication or notice someone else (such as a colleague, professional or staff from another agency) doing so. you have a duty to:

let your line manager / the person on call know straight away

discuss with your line manager / the person on call what the parents need to be told and who is going to tell them

record your mistake on the MAR chart as appropriate and on the client report form.

10.3 Your line manager / the person on call will check with a healthcare professional (such as the child or young person’s doctor) what action needs to be taken and may ask you to complete an incident report form (DT03). 10.4 If you make a mistake and don’t report it, or try to cover it up or make false entries on records, this may be dealt with under the disciplinary policy.

http://www.xrds.org.uk/dsweb/Get/Document-4951/DT03%20Incident%20report%20form.doc




11.0 DISPOSAL OF PRESCRIBED MEDICATION

11.1 You will not usually be expected to dispose of a child or young person’s unused medication. If you are required to do so, it will be documented in the care and support / personal plan. This will involve for example:

making a list of the medication (name, quantity, dose)

taking it directly to the pharmacy from the child or young person’s home

asking the pharmacy for a receipt which you then need to pass on to your line manager

recording what you did on the client report form. 12.0 CHANGES TO MEDICATION

12.1 Where you are giving medication support, the child or young person’s parent / carer has to let the organisation’s office know if their medication gets changed in any way so that the care planner / assessor can record the changes. 12.2 If you notice that a child or young person’s medication has been changed, politely remind their parent / carer that they need to tell the office and if necessary, check with your line manager that they have done so. 12.3 The child or young person and / or their parent / carer may tell you about short notice changes to the child or young person’s medication when you arrive at their home and there may not have been time for the changes to be written up in the care and support / personal plan or on the MAR chart. This could include for example:

a dose of existing medication being reduced or increased

medication being stopped

new medication being prescribed short-term medication being prescribed (such as a course of antibiotics).

12.4 If this happens:

do not act solely on the verbal instructions of the child or young person or their parent / carer

contact your line manager / the person on call so that they can check out the changes and get back to you to tell you what to do.

13.0 SIDE EFFECTS OF / ADVERSE REACTIONS TO MEDICATIONS 13.1 If you think that medication is causing side effects, do not ignore it – see below for what action to take. 13.2 Examples of emergency side effects / adverse reactions include:

difficulty in breathing

swelling of the eyes, tongue or face

unresponsiveness or drowsiness. If this happens:

immediately begin emergency first aid as required

call 999 or 112 for an ambulance

contact your line manager / the person on call for further advice and support

record the incident on the client report form.




13.3 Examples of common side effects / adverse reactions include:

sudden changes in mood

feelings of nausea

pains in the abdominal region

unusual rashes

a dry mouth

blurred vision

difficulty passing urine

diarrhoea and vomiting

unsteady on their feet when before there was no problem

blood in the faeces. If you suspect the child or young person is experiencing any of the above:

immediately inform your line manager or the person on call, who will contact the child or young person’s parent / carer to discuss what action to take

record the incident on the client report form. 14.0 TAKING MEDICATION OUT OF THE HOME

14.1 If you are taking a child or young person out of their home and they need to take medication with them (either for routine use or in an emergency, such as to treat an epileptic seizure), the care planner / assessor will have made all the necessary arrangements and details will be written in the care and support / personal plan.

If the child or young person is able and willing to carry and take their own medication, they will be asked to do so.

If the child or young person is not able to take responsibility for their medication, then you will be authorised to carry and administer it on their behalf.

14.2 The care and support / personal plan will include:

details of the medication to be taken outside of the home

the circumstances in which you are required to give it

details of the medication support needed

who will carry the medicine/s

the container to carry it in. 14.3 Your line manager will let you know what records need to be made, for example:

how you record taking the medication from and returning it to the home

whether the medicine was used or returned unused to the home. 14.4 If you need extra training your line manager will make sure you have received it and are competent to do the task before you provide the service. 15.0 LEARNING AND DEVELOPMENT

15.1 See learning and development guidance (E13c). 16.0 ACCEPTANCE 16.1 You are required to sign to indicate that you have received, read and understood the content of this guidance as directed by your line manager and on completion of training, it is your personal responsibility to follow it. Failure to do so may result in disciplinary proceedings.

http://www.xrds.org.uk/dsweb/View/Collection-2090




APPENDIX 1 TYPES OF MEDICATION General medication This includes:

oral preparations (medications taken by mouth), including controlled drugs: tablets, capsules, mixtures, lozenges, liquids, sub-lingual medication

topical applications (applied to the skin): medicated liquids / lotions / creams / ointments, transdermal patches

drops and ointments to ears, nose and eyes

inhaled medication (via inhalers and spacers). Medication administered by specialised techniques This includes:

suppositories and micro-enemas (inserted into the rectum)

pessaries (inserted into the vagina)

buccal medication (inserted between the gum and cheek)

injections.




APPENDIX 2 ADMINISTRATION OF MEDICATION FROM COMPLIANCE AIDS These are also called ‘monitored dosage systems’, blister packs’ and dossette boxes’. The only compliance aid you are allowed to administer medication out of is one that is filled and sealed by a pharmacist. You are not allowed to administer medication from an unsealed container filled by a child or young person or their parent, carer, family member or anyone else.

If you are administering medication from a pharmacist-filled, sealed compliance aid, the following information about the contents will be documented on the MAR chart:

precise details of the compartment within the compliance aid that tablets are to be taken out of (for example “lunchtime” dose)

the name of the medication

the dose of the medication

the time the medication is to be given

any further special instructions.

Your manager has to make sure that you are trained how to identify tablets taken from a compliance aid before you give them.

The pharmacist will provide a picture or description of each tablet, (including for example its size, shape, colour, dose and any inscription on it), so that you can match the tablet to the description.

You are required to:

identify each tablet within a pharmacist-filled compliance aid before you give it

check to make sure the contents match the medication recorded on the MAR chart

sign or initial the MAR chart for each individual tablet given

inform your line manager / the person on call immediately if the contents don’t match or you can’t identify the tablets

record that you have / have not administered medication on the client report form.

Do not administer medication if:

you are not able to positively identify it

there is a discrepancy between the contents of a particular compartment and the medication listed on the MAR chart.




APPENDIX 3 MEDICATION SUPPORT FLOWCHART

Has child or young person been assessed as competent to take responsibility for their own medication?

Yes

Is child or young person able to tell you what they need

and to take their own medication with your help??

Yes

General Support

EXAMPLES

Child or young person asks you to:

- remove cap from bottle / open packaging

- pop tablets from blister / foil

- pour out liquid

- pass medication to person with care needs to take / apply

- pass inhaler / spacer.

An occasionalreminder to take medication.

No

Administration

EXAMPLES


- select, prepare, measure medication

- place medication in person’s mouth

- apply medicated cream, lotion, ointment, patch

- insert ear, nose, eye drops

- administer inhaled drugs via inhaler / spacer

No

Any assistance given to a child or young person who lacks capacity is classed as

administration

EXAMPLES


- select, prepare, measure medication

- help child/ young person to access their medication (for example open packaging, pop tablets from blister / foil)

- give medication to person to take

- regularly prompt child/young person to take medication

- place medication in child/young person’s mouth

- apply medicated cream, lotion, ointment, patch; insert ear, nose, eye drops

- administer inhaled drugs




APPENDIX 4 PARAFFIN-BASED CREAMS, LOTIONS AND OINTMENTS Examples include such products as E45 cream and lotion, Zinc Ointment BP, White Soft Paraffin. These may be prescribed but are also readily available to buy as over-the-counter products. They are used extensively to treat a wide range of common skin conditions such as dry, itchy skin, eczema and dermatitis. The paraffin ingredients contained in such preparations present a fire risk when the product or materials that have absorbed it come into contact with a naked flame or source of ignition, such as a cigarette. The risk is therefore increased when:

such products are used extensively or on large areas of the body causing clothing, bedding and bandages to become soaked in it

the person using the product or other members of the household smoke. Anyone using paraffin-containing preparations must:

keep away from open / gas fires, hobs and naked flames (such as candles)

not smoke

keep away from others who are smoking or using naked flames

regularly change / wash clothing and bedding that comes into contact with paraffin-containing preparations.

Care planners / assessors will risk assess each child or young person individually in relation to the above and enter details of their assessment into their care and support / personal plan.

Ian Turnbull, Chairman

c03c children’s medication guidance for staff · c03c children’s medication guidance for staff...

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