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CHILDREN, FAMILIES

AND EDUCATION

CHILDREN'S SOCIAL SERVICES

POLICY & GUIDANCE MANAGEMENT AND ADMINISTRATION OF

MEDICATION - RESIDENTIAL RESPITE & FOSTERING

SERVICES

Document Owner: Policy & Performance Manager (LAC) Authorised: 1 October 2007 Review Date: 1 October 2010

Management_and_Administration_of_Medication_Policy_and_Guidance_1208.doc

CONTENTS

MANAGEMENT AND ADMINISTRATION OF MEDICATION RESIDENTIAL, RESPITE AND FOSTER CARE

Page

Section 1 – Legislative and Policy Context • Introduction • Legal context • Policy Statement • Clinical Tasks • Monitoring and Review

3 3 3 4 5

Appendix 1 – Guidance for Residential Respite Units • Definition of Respite Unit • Training • Health assessments • Consent • Emergency admissions • Care Plan • Receiving patients own drugs

6 6 7 7 8 8 8

• Additional medicines • Recording PODs • Receiving and recording controlled drugs • Monitored dosage systems • Prescription of unlicensed medicines • Use of non prescription medication • Medication records • Medication profile • Storage of medication • Storage of oxygen • Disposal of medication • Methods of disposal • Children Attending School

9 9 9

10 10 10 11 12 12 11 12 14 14

• Method of administering medicines • Giving medicines safely • Self medication • Administration of invasive medicines • Administration of medicines in an emergency • Arrangements for short periods away • Medication errors and incidents

14 14 16 16 17 17

17-18

References

18

Management_and_Administration_of_Medication_Policy_and_Guidance_1208.doc 1

Page Appendix 2 – Guidance for Foster Carers • Definitions • Training • Health assessments • Consent • Emergency placements • Care Plan • Receiving child’s own medication • Additional medicines • Receiving and recording controlled drugs • Use of non prescription medications • Monitored dosage systems • Prescription of unlicensed medication • Completing the medications Record • Storage of medication • Storage of Oxygen • Disposal of medication • Methods of Disposal • Giving medicines safely • Self medication • Administration of invasive medicine • Administration of medication in an emergency • Arrangements for short period away • Medication errors and incidents • References

19 19 20 20 21 21 21 22 22 22 23 23

23-24 24 25 25 25 26 27 27 27 28 28 29

Appendix 3 – Residential, Respite and Foster Carers – clinical Tasks • Introduction • Mandatory Procedures • Definitions • Assisting with specific clinical tasks

Category 1 – Acceptable/routine Category 2 – Negotiable Category 3 – Children in foster care or respite care only Category 4 – Not to be performed by Social Services staff in any circumstances

• Emergency Procedures • Cardiac and Respiratory Resuscitation • Intimate Personal Care Tasks

30 30 31

31-33

33 33 34


CHILDREN, FAMILIES AND EDUCATION

CHILDREN’S SOCIAL SERVICES

MANAGEMENT AND ADMINISTRATION OF MEDICATION RESIDENTIAL RESPITE SERVICES

FOSTER CARERS

SECTION 1 – LEGISLATIVE AND POLICY CONTEXT Introduction The policy statement sets out Kent Children’s Social Services policy and procedure relating to the management and administration of medication within residential and residential respite units for Kent Looked after Children and Children in Need. It applies to all care staff working in children’s residential homes and respite units that are owned and managed by Kent County Council. It applies to foster carers who care for Kent Looked After Children in the home environment. Guidance on clinical tasks, and further procedural guidance specific to the residential or fostering setting follows in the respective appendices. Legal Context This document has been developed to comply with: • The Medicines Act 1968 • The Misuse of Drugs Act 1971 (Controlled Drugs) • The Misuse of Drugs Regulations 2001 (Scheduled Drugs) • National Minimum Care Standards for Foster Care • Supplementary Standards for Care Homes Accommodating Young People aged 16 and

17 – standard 20. • Children’s Homes Regulations and National Minimum Standards – standard 13. • The administration and control of medicines in Care Homes and Children’s Services – the

Royal Pharmaceutical Society 2003 Policy Statement This policy seeks to promote best practice for the: • Management of prescribed and over the counter medicines within residential homes and

reflects the requirements of the National Minimum Care Standards for residential establishments.

• Management of medicines in foster homes and reflects the requirements of the National Minimum Care Standards for Foster Care.

It is Kent’s policy that only medicines prescribed for the individual user may be administered to that person and must not be used by anybody else. Each respite establishment is required to have a procedure, which clearly states the member of staff who is responsible at any given time for:


• The receipt and recording of Patient’s Own Drug’s (PODS) entering the unit • The security of medicines – including the possession of keys. • The administration of medicines to particular children or young people • The recording of the administration of medicines. Designated and appropriately trained staff must administer all medicines, including controlled drugs. Another designated appropriately trained member of staff must always witness the administration of controlled drugs and sign the Medication Administration Record (MAR) sheet to say that they have done so. Everyone involved in the care of children and young people is responsible for ensuring that his or her medication is managed appropriately. The primary responsibility for the prescription of medication rests with the prescribing healthcare professional, while responsibility for overall co-ordination of prescribed medications rests with the G.P. Young people should be encouraged, where appropriate following a risk assessment, to retain, administer and control their own medication in order to maximise their independence and retain control over their own lives. Some children and young people who have been assessed as being unable to manage their own medication without assistance need to be protected by the Directorate’s policy. Assistance with medication should only be provided by foster carers, Family link carers, and/or respite staff when the child or young person has been determined as unable to administer their own medicines. It is the responsibility of relevant health professionals to explain the implications of the importance of medication and any potential side effects to carers and the staff who administer medication. In whatever situation medication is administered, respect for the dignity of the individual should be maintained at all times. The safety of the child, and wherever this is consistent with their welfare, their wishes, is paramount. This is particularly so in the use of rectal medication. Needs arising from the culture, ethnicity and religion of the child and family, will be assessed and respected. Clinical Tasks The prime role of Social Services respite staff and foster carers is to provide social care and not to undertake tasks which would normally be completed by trained nursing/medical personnel, (even though some staff or carers may have nursing qualifications). Parents/relatives/carers should be made aware that nursing care will not be provided by Social Services staff or foster carers. Nursing care can however be requested from Health Care staff, to be undertaken in Social Services establishments or in the foster carer’s/service user’s home. The responsibility and accountability for all delegated health care tasks remains with the health professional (most commonly the GP or district nurse) who is delegating the task to a CSS residential workers and foster carers. The health professional is responsible for ensuring that the CSS residential worker or foster carer is trained to undertake the delegated task and if an incident should occur when that residential


worker or foster carer is undertaking the task for which they were trained and is working to the agreed care plan, the liability rests with the PCT. If a CSS residential worker or foster carer works outside the care plan or undertakes a task that they have not been asked nor trained to do then that individual may be liable and Children’s Social Services may commence disciplinary procedures. Under the Children Act 1989 health authorities and NHS Trusts have a duty to comply with requests from local councils to help them provide support and services to children in need. This duty has now passed to Strategic Health Authorities and PCTs. There are important conditions attached to each category of task, which must be fulfilled before Children’s Social Services staff undertake any care. In particular, it should be noted that because a task appears on a Category 1 or 2 list (Appendix 3), does not mean that a member of CSS will automatically perform the task. Monitoring and Review

This policy will be reviewed in line with current CFE Directorate practice.


APPENDIX 1 GUIDANCE FOR RESIDENTIAL RESPITE UNITS

MEDICATION PROCEDURES Definitions Controlled drugs – these are medicines with potential for abuse for which special legal precautions are necessary. A current list of these can be obtained from www.homeoffice.gov.uk/drugs/licensing or individual queries can be made to the community pharmacist; Homely remedies – these are medicines that can be obtained without a prescription (over the counter preparations), which homes may buy from community pharmacies following consultation with appropriate medical professionals; MAR sheets – medication administration record sheets, which show the individual administration of medicine to a resident. Some of the larger community pharmacies e.g. Boots, have a supply of their own forms and homes are advised to use these; MDS – monitored dosage system which is medication supplied by the pharmacy in pre-measured doses; PCT – Primary Care Trust; PODS – patient’s own drugs; POM – Prescription-only medication; Training

Residential workers who are required to administer medication to meet specific needs identified in care plans will be trained. The training must relate to specialist medication such as application of gastrostomy feeding; suction machine, pessaries, oxygen, enema suppositories, safe use of emergency epilepsy medication; use of Epi-pens or particular inhalers, or managing diabetes, but should also include: • Introduction to medicines and prescriptions • Medicine supply, storage and disposal • Safe administration of medication • Physiotherapy • Quality control and record keeping • Accountability, responsibility and confidentiality


Health assessments

All Children in Need and Looked after Children should have an initial health assessment as part of the core assessment process prior to admission to care or a respite facility. Any requirements arising from the health assessment should be detailed in the child’s Care Plan.

These requirements will be reviewed twice yearly for children under the age of 5, and annually for those over the age of 5.

Parents and other primary carers are required to provide written information from their GP or consultant regarding their child’s prescribed medical needs, including clear instructions for any medication. Clear instructions should also be given about what consequences and actions should follow if medication is missed, vomited, or refused. This should include contra-indicators too. The Placement Agreement meeting should cover the whole care environment for the child, including details of physiotherapy, and any equipment used. The Essential Information Record Parts 1 and 2 must be completed in accordance with procedures for all Looked after Children. Emergency procedures must be discussed prior to planned admissions to residential units and every effort should be made to discuss them where placements are unplanned, and the child has a high level of medical needs. Subsequent changes to a child’s/young person’s medical regime will require further confirmation from the medical professional in writing. Consent

The written consent of the person with parental responsibility (parent or might be a District Manager for a Looked after Child) must be obtained prior to any medication being administered. The MAR/01 form should be completed by the social worker with the child’s parent (or the young person, if considered competent to do so). In some cases the written consent of the health professional delegating the task must also be gained and both consents retained on the child or young person’s care plan and file. It is unlikely that a child or young people accessing Kent’s residential and respite units will wish or be considered competent to administer his or her own medication but if the question arises this must be discussed, agreed and clearly recorded by the social worker. A young person’s competence to administer his or her own medication is subject to the Gillick ruling: Under the Gillick ruling (Fraser Guidelines) in 1985, the parental right to determine whether or not a child or young person under the age of 16 will or will not have medical treatment (including medication) terminates if and when the young person achieves sufficient understanding and intelligence to enable them to understand fully what is proposed. In addition, where the young person is 16 or 17, either the parent (or those exercising parental authority) or young person can consent to treatment independently though neither can override the other or exercise a veto. Normally it is a doctor who decides if a young person is Gillick competent, although any health professional is able to do so.


Assessing competence should include an assessment (within a risk management framework) of the young person’s understanding of how to store, retain, administer and dispose of medication, and comply with the Directorates’ policy and procedure set out below. Emergency Admissions

In the case of emergency admissions, particular attention must be given to determining what medication, if any is currently used. If no information is available from the carer or family, the responsible officer must contact the relevant health professional to confirm the details in writing of the medication prescribed before undertaking any administration. This must be recorded on the relevant MAR chart and individual care plan. Care Plan All arrangements for medication, particularly if medicine is not given regularly or is supplied ‘when required’ should recorded in the Care plan With medications such as inhalers and the contraceptive pill, if the young person is deemed competent (according to the Gillick/Fraser Guidelines) and articulates a wish to administer his/her medicine, s/he should be allowed to do so. This should be clearly detailed on the care plan. In addition, a Medicines Administration Record MAR/01 must be completed to provide a clear understanding of each child/young person’s medication and how it should be administered. It must include information on any precautions or side effects;

Receiving Patient’s Own Drugs The registered manager must ensure that there is a protocol in place for receiving and recording PODS that enter the unit to be administered to children. To be acceptable the POD must: • Be received into the unit from the child’s home, school, a hospital or a pharmacy; • Have the correct child’s name on the label; • Be in the original pack dispensed by a pharmacy or dispensing doctor; • Have a date of dispensing within the last 3 months and contents within expiry date shown

on the container or packaging; • Be in a clean condition and showing no signs of deterioration; • Have clear and legible instructions (or a patient information leaflet); • Not have more than one medication in the pack; • Have contents that correspond to the label on the pack; • The total amount of medication supplied should be specified on each container, which

makes it easier to check if the medicine has been taken correctly; • Where the medical condition is serious and/or long term written guidance from a GP

and/or consultant is needed for each child’s medication and further guidance if changes in medication occur;

• Written information is required when a child is prescribed homeopathic/alternative medication by a recognised practitioner. If a child is prescribed both conventional and alternative medication the information must reflect any possible effects one might have on the other and written confirmation from the GP that it is acceptable for use;


Additional medicines Additional medication needed whilst a child is in placement will be obtained after consultation with the parent/social worker and named local GP and dispensed by the named local pharmacist. It should meet the criteria set out above. The registered manager or designated residential worker should see the prescription forms before they are submitted to the pharmacy for dispensing. If an item on the prescription was not originally requested then ‘not dispensed’ should be written in the margin of the prescription next to the item. At this stage the reverse of the prescription form should be signed and details of payment or exemption completed unless prior arrangements have been made with the nominated pharmacy. Recording PODS The written record must show: • Date of receipt • Name and strength of medication • Quantity received (for short term placements exact number of tablets must be recorded

and agreed with the parents/carers) • Resident for whom the medication is prescribed • Signature of the member of staff receiving the medication • Expiry date of medication Medication not used must be returned to the parent/carer and they will be required to sign and confirm the amount returned and for its receipt (MAR05). Receiving and recording controlled drugs A child or young person’s own PODS may be controlled drugs (CD). Controlled Drugs (CD) are medicines that are prescribed to treat severe pain, induce anaesthesia or treat drug dependence. They can cause dependence or misuse in varying degrees. They are classed according to the extent of harm they may cause when misused. Controlled drugs must be stored and administered under certain restrictions; they should be labelled as such on the containers (CD). A child or young person’s controlled drugs may be used if the medication meets the criteria set out above and the container is labelled CD. They should be recorded in a bound log and the total amount double signed for on arrival and leaving. Special arrangements much be made for the storage of controlled drugs as set out below Controlled drugs must be stored and administered under certain restrictions: • A separate controlled drugs bound log with numbered pages must be maintained; • The total amount must be signed for on arrival and departure by two staff members; • The bound book will include the balance remaining for each product with a separate

record page for each young person taking a controlled drug; • The balance remaining should be confirmed each time a controlled drug is administered • It is a legal requirement that a record is made each time a controlled drug is

administered; • There should be no crossings out or obliteration of any kind in this record.


Special arrangements much be made for the storage of controlled drugs as set out below. Monitored dosage systems PODS in monitored dosage systems will not meet the criteria set out above and, therefore, may not be used. In exceptional circumstances, monitored dosage systems may be used if they are part of a young person' self-medication scheme when a young person is being prepared for adulthood. In such a case the supplier must be approved by the health professional. Prescription of unlicensed medication This is unlikely to be an issue for Residential Respite units but might be an issue for Looked after Children placed in residential units. Few medications are licensed specifically for use by children. Therefore, if there is any doubt about the status of the medication being prescribed this should be checked with the parent concerned who would be expected to provide all relevant information regarding the child’s diagnosed condition and the medication prescribed. In the event that any medication prescribed for a Looked after Child by an appropriately registered doctor/consultant is unlicensed for use with children staff should ask the relevant health professional to send a copy of the ‘Unlicensed Products Patient Consent Form’ to the child’s social worker who must arrange for it to be completed by whoever has parental responsibility for the child. The social worker or birth parents (if appropriate) may wish to contact the doctor concerned for further information before the ‘Unlicensed Products Patient Consent Form’ is signed. No medication should be taken by the child before the ‘Unlicensed Products Patient Consent Form’ is signed and returned to the doctor. A copy of the ‘Unlicensed Products Patient Consent Form’ should kept in the child’s file as a record. Use of non prescription medications Over the counter medication such as cough linctus, creams etc. may be supplied by parents and can be used so long as they are in date, in appropriate containers and directions for use are clear and comply with the stated maximum dosage on the packet. They must be received and recorded in the same way as other medication. Respite Units may only use other paracetemol-based homely remedies to treat minor ailments with the formal written consent of the parent or adult with parental responsibility. Other residential units may use homely remedies to treat minor ailments such as: • Mild pain • Cough • Constipation • Mild skin conditions It should be noted that some over-the-counter preparations might adversely interact with prescribed medicines. Advice must be sought in advance from a relevant health professional


and written consent obtained from the person with parental responsibility or the young person before any administration takes place. If a residential unit wishes to maintain a list of homely remedies, this should be devised in conjunction with the local pharmacist and should include specific details for care staff such as: • Indications for use • Name of medicine • Dose and frequency • Maximum dose and period of treatment • Cautions

Prescription medicines and those requiring invasive administration (e.g. suppositories) cannot be included in this list. A homely remedies stock record must be maintained and consideration given to expiry dates. It is good practice to note on the labels when the medications were first opened. Treatment with a non-prescription medicine should not continue for more than three days without medical assessment. A procedure for the administration and recording of homely remedies must be used. Most MAR sheets include a section for recording the administration of non-prescription medication. If there is any concern about any contra-indication with an existing medication, then staff should contact the appropriate health care professional. Medication Records • Looked after children care plans will provide full information on a child/young person’s

individual needs, including their health and medication needs; • The MAR/FC/ should be attached to the Placement Information Record • The Medicines Administration Record (MAR/01) will contain all the information needed for

the child’s stay. A new form must be completed for each placement. The relevant sections of the MAR01 should be completed to log and monitor the usage of medication during the child/young person’s stay and to record any refusals or errors;

• A medication profile as set out below; • In Residential Children’s Units the Gastrostomy Feed Form (Part 4) and Supplementary

Fluid Form (Part 5) should be completed; Residential Children's Units will return children’s records to the social worker to be incorporated into the child’s file, which will be retained at the Unit/County Archives for 15 years. The medicines administration record must be kept to ensure that medicines are given as prescribed:

• A record of any new bottles/containers of medication obtained for the child or young

person. • A medication profile, which records the child or young person’s medication regime. • A record of administration and disposal, recording the date, time, medicine and amount

given, also the signature of the foster carers who gave the medicine. If the medicine is refused or wasted, the residential worker responsible for its safe disposal must record


this on the medication profile. The prescribing health professional should be informed of any refused doses as appropriate.

The residential worker will monitor the condition of the child or young person and report any unexpected change in condition, which may or may not be due to an adverse reaction to the prescribed medication, to the responsible health professional. Medication Profile

This should show for each child and young person:

• The full name and date of birth. • Details of any known medication sensitivity e.g. penicillin.

The following details about each prescribed medication.

• It’s generic name. • The form of the medicine. • The amount in the bottle/container when originally dispensed. • The strength of the preparation. • The dose • The route of administration e.g. by mouth, topically etc. • The time(s) it should be administered. • Any special instructions, for instance whether it should be given before or after food. • If the medicine is discontinued and/or returned to the pharmacy with the permission of

the appropriate responsible person then this should be recorded.

Ideally the medication profile and the record of administration should be kept on the same sheet. If they are on separate sheets, the two must be kept together.

Completed sheets should be returned to the child or young person’s main file. Copies should be retained on the unit’s records. Storage of medication

• All medicines should be stored in a safe and lockable cabinet; • Creams and oral preparations must be stored on separate shelves; • Controlled drugs must be stored in a separate locked cupboard/safe, which is made of

metal to a defined gauge, with suitable hinges, a double locking mechanism and fixed to a solid wall or floor with rag bolts. The security of the location must be considered. A system must be put in place to ensure that only authorised personnel have access and that the quantity of the drugs can be verified;

• All medications should be kept at a temperature not exceeding 25 degree C. • Some medication need to be kept in a refrigerator and a lockable fridge should be

available for this purpose in residential respite units; • The temperature should be checked daily with a maximum/minimum thermometer. The

normal range is between 2 and 8 degrees centigrade and any variation from this should be reported immediately. If this occurs the home should contact a pharmacist to check information on individual products, as some of the medication may need to be destroyed and replaced. The refrigerator must be cleaned and defrosted regularly;


• In other residential establishments medication that needs to be kept in a fridge should not be kept in the fridge that is accessible to children;

• Medication must not be stored from one stay to the next; The keys for the medicines cupboard refrigerator or clinical area should be kept separate from other keys and not be part of the master key system. The person in charge or their designated officer should hold the keys. Storage of Oxygen If a child is prescribed oxygen the respite unit should discuss storage and administration with the pharmacist who supplies the oxygen. Oxygen cylinders should be stored safely under cover and not subject to extreme temperatures. This should be in a dry, clean well-ventilated area away from highly flammable liquids, combustibles and sources of heat and ignition. A statutory warning notice should be displayed in any room/area where oxygen is stored, stating;

‘Compressed gas. Oxygen: No Smoking. No naked lights.’ An oxygen concentrator may be supplied if the child requires continuous oxygen, which the GP can arrange. NB - in the case of fire, following evacuation of the residents, it is the responsibility of the Registered Manager or delegated officer, to inform the fire brigade officer that oxygen cylinders are present and where they are located. Disposal of medication As medicines are the personal property of the person for whom they are prescribed, their permission should be sought for the disposal of any medicines where appropriate. Respite units should return medication to the parent/carer at the end of a stay as set out above. Other residential units should dispose of medicines when:

• The expiry date is reached. If no expiry date is recorded, then the dispensing pharmacist

must be contacted to ascertain the shelf life of the medicine; • For eye preparations, the date of opening should be recorded on the label and the

contents discarded 4 weeks later, unless there is a specific statement on when it should be discarded by the pharmacist written on the container;

• A course of treatment is completed, or the doctor stops the medicine or the dosage is changed;

• The child or young person for whom the medication is prescribed dies. N.B. This medication must be retained for 7 days in case a coroner’s court requires it.

• Any unused medicine is not collected for any reason. Methods of Disposal


• All medicines that meet the criteria above should be disposed of by returning them to a pharmacy;

• Controlled drugs, which are no longer required, must be returned to a pharmacy. The residential worker must sign the child / young person’s medication profile to record that they have done this and the pharmacist’s signature must also be obtained as receiving the drugs;

• A missed or wasted dose should be disposed of in accordance with advice offered by a pharmacist. Most pharmacists will supply a bottle for wasted doses. Refusal of medicine should be seen as a compliance problem and advice sought from the GP or pharmacist.

• Health professionals must dispose of their own injection equipment; • For children who self-administer ‘sharps’ boxes would need to be provided to the home. Children attending school Formal written arrangements must be in place for the transfer of each child’s medicine between the residential unit and the school. Methods of administrating medicines Medicines may be given in the following ways: • Orally - tablets or linctus • Topically – creams and ointments • Inhaled – asthma inhalers • Injections – for diabetes • Rectally – e.g. rectal diazepam used for fits Giving medicines safely The unit must have a written procedure in place for the administration of medication to ensure safety and reduce risk of mistakes occurring. Staff should be suitably trained in the use of medication. It is good practice to have a list of staff who are authorised to handle and administer medicines, with the signature that they use on the MAR sheet. Sample signatures of Residential Workers administering medicines are required in residential children’s homes. Checklist: • Wash hands before handling medication • Explain to the child how to take the medication, e.g. chew, swallow whole, inhale, apply

to the skin, with or without water; • Carefully check the identity of the child or young person; • Check the medicine you are about to give particular attention to ml/mg dosage; • Check that the dose has not been changed; • Ensure that the dose has not been given by somebody else; • Check the details on the container against the medication record; • Measure syrups with a syringe to ensure accuracy; • Ensure that the child or young person has swallowed the medicine before they leave.

Tell them when they will need their next dose; • Do not leave the room during the administration of medication. If it becomes necessary

to do so ensure all drugs are locked away;


• Record that the medicine has been given and taken; • Record if the medicine has been offered and refused or wasted. • Details of any medication administered prior to arrival should be requested from the

parent. This should be recorded; • Ensure the sensitivity/ allergy box is checked; • Ensure that medicines prescribed for one service user must never be given to another

service user, or used for a different purpose; • If the medicines received from the parents/carers differ unexpectedly from those received

for the same child in the past, the unit must check with the appropriate health professional before administering the medication.

• Identify the appropriate medicine container/s checking the label/s and record match. If there is a discrepancy, the unit must check with an appropriate health professional before giving the medicine to the child. If the label becomes detached or illegible, contact the appropriate health professional for advice;

• It is good practice to date all containers when they are first opened; • Administer the medication in accordance with any special instructions e.g. to be taken

after food; • Sign the administration record immediately after the medicine has been given; • Where there is a choice of, e.g. 1-2 tablets, record the number administered; • Record if the medicine is refused or not administered, and state the reason, using the

code applicable to your system; • Reference should be made to the care plan, particularly if medicine is not given regularly

or is supplied ‘when required’; • A Medicines Administration Record must be completed to provide a clear understanding

of each child/young person’s medication and how it should be administered. It must include information on any precautions or side effects;

• Medication will be given at times stipulated, and following discussion with the child’s parents/primary carers. In all situations the child’s best interests should be paramount;

• The residential worker should ensure that the child has swallowed the medicine and that the course/dose has been completed;

• Medication related to activity, such as Ritalin, needs to be carefully planned so that the child’s normal routine and behaviour is not adversely affected. Discussion with parents/carers may allow this to be planned in such a way that the child’s activities are not curtailed, whilst still allowing safe administration. Advice should be taken from the specialist medical practitioner;

• With medications such as inhalers and the contraceptive pill, if the young person is deemed competent (according to the Gillick/Fraser Guidelines) and articulates a wish to administer his/her medicine, s/he should be allowed to do so. This should be clearly detailed on the care plan;

• A method and protocol for the administration of medicines, which meets the needs of the child or young person, should be adopted as recommended by Health and social work professionals. The method and protocol will be individual for each child;

• The removal of medicines from their original containers into other containers by anyone is not allowed, as it increases the risk of mistakes being made and puts both carers and children and young people at risk;

• Whilst accompanying a child or young person on an activity in the community, staff must ensure that the medication is carried in its original containers. An approved container is one that has been supplied by a pharmacist or prescribing GP. If the activity is a regular one it may be possible for a separate bottle of medication to be supplied as part of the original prescription. The MAR/01 form must accompany the child if they are taking medication off site/outside the Unit.

• If a child or young person is concerned about their medicines they should be referred to their doctor.


• To gain maximum benefit, medicines should always be taken at the prescribed times and as directed – some are coated for slow release and should not be crushed. Other variations should be noted and adhered to.

• Refusal of medicine should be seen as a compliance problem and advice sought from the GP or pharmacist.or parent initially. For young people for whom this is a recurring issue, management plans need to be included in the care plan.

Self medication If a child or young person in a residential children’s home is assessed as capable of looking after and administering their own medication, staff should monitor that they keep the medicines with them or store them in a lockable space. Medication policies of the child’s school, where relevant, should be requested by the child’s social worker.

If there is concern about a child or young person’s ability to administer their own medicines safely, the residential worker together with the young person should consult with the social worker, and the child’s parent(s) if possible and agree how much responsibility the young person is able to undertake. Where there is doubt, and it is assessed as safe to do so, the young person should be given charge of their own medicines for a trial period. After this, the residential worker should check whether or not the young person has taken the medicine as prescribed and a decision should be made by the involved professionals (e.g. GP or consultant) and recorded in the child’s personal file as to whether or not they can cope with their medicines in the long term. The child or young person’s ability to administer their medicines should be reviewed on a regular pre-planned basis.

Administration of invasive medicine All invasive treatment, which can be planned for, will require the involvement of the appropriate health professional. This will be outlined in the care plan and discussed at the Placement Agreement meeting. The health professional (often the community paediatric nurse) should be invited to attend the Placement Agreement meeting to fully discuss procedures. These treatments include injections; vaginal pessaries, insulin preparation and administration; catheterisation; stoma; nebulisers; suction; naso-gastric tubes. The Unit should be clear who the named community health professional is to offer advice on procedures, including oral hygiene, storage of medicines and equipment, infection control, disposal of clinical waste etc. In some cases staff may be expected to carry out procedures under the supervision of the health professional. Administration of such medication may only be undertaken by the registered carer, who must have received appropriate training. For medicines administered other than orally, see the Management and Administration of Medication - Clinical Tasks Appendix 3 for guidance. Administration of medication in an emergency


Residential workers need to read this section in conjunction with the Management and Administration of medication - Clinical Tasks Appendix 3. The administration of medication in an emergency whether rectally (e.g. Diazepam) or by injection (e.g. Adrenaline) may only be undertaken by trained and approved staff, and as detailed in the individual service user’s care plan. The supervision process should be used to record an employee’s willingness to undertake such training. The health professional who is responsible for defining the circumstances under which such medications can be given, must prescribe emergency medication. The GP should set out in writing when it should be used, how much should be given and any necessary precautions. If there is no suitably trained member of staff available to administer the medication the emergency services must be called. However, adrenaline may be life saving and might be advised over the telephone by a doctor to be given by staff. An emergency is defined as a life-threatening situation. Written consent must be sought from the person with parental responsibility if the child or young person is likely to need rectal diazepam or other emergency medication to control convulsions or any other medical condition that requires urgent attention, setting out their agreement to care staff undertaking this procedure. Wherever feasible, the resident’s preference concerning the gender of administration staff should be respected.

If an emergency situation should arise in a public place the emergency services should be called but if the situation becomes potentially life threatening, administration of rectal diazepam may be conducted within the criteria set by the GP whilst providing the maximum privacy possible. If an emergency situation should arise during transportation, depending on the criteria provided by the prescribing GP every effort must be made by the driver and escort to call on the assistance of the emergency services. Administration of medication outside of the unit

It may be necessary from time to time to administer medication outside the unit, e.g. school journey, dining room, or when out on trips. When ever possible the administration policy should be followed. On such occasions the senior member of staff on duty must arrange for medicines to be taken in their original containers and given to the designated member of staff for administering and safekeeping. Residential workers must be mindful of where to store the medication bearing health and safety concerns in mind.

If this is a regular occurrence the resident could be issued with an alternative supply by the GP or pharmacist, and this should be recorded as administered on the MAR sheet. Medication errors and incidents

Despite the high standards of good practice and care, mistakes may occasionally happen for various reasons. Any error in administration or refusal of medication must be notified to the child’s parents/primary carers and reported immediately to the appropriate medical professional so


as to prevent harm to the child or young person and line management. Any errors should be documented on the MAR/01 form. If need be the Unit should consult with the GP or hospital Accident and Emergency Department. The child or young person’s parent(s) and Ofsted must also be informed by the Manager of the Service of any error in writing if the belief is, following consultation with a health professional, that the error could have led to harm or injury. Residential workers who report errors should be dealt with in a constructive manner that addresses the underlying reason for the incident and prevents recurrence. If an error occurs the manager must meet with the employee in person and go through the guidance with them to ascertain their level of understanding. Errors should be reported as incidents under the existing accident/incident reporting system. Managers must differentiate between those incidents where there was a genuine mistake, where the error resulted due to pressure of work or where reckless practice was undertaken and concealed. A thorough and careful investigation taking full account of the position of staff and circumstances should be conducted before any managerial or professional action in line with Disciplinary procedures is taken. References UN Convention on the Rights of the Child The Fraser Guidelines, www.dh.gov.ukNHS Best Practice Statement, Scotland Nasogastric & Gastrostomy Tube Feeding for children being cared for in the community, Nursing & Midwifery Practice Development Unit 2003 The Administration & Control of Medicines in Care Homes & Children’s Services, Royal Pharmaceutical Society of Great Britain, June 2003 Unit Policy for Administration of Medication & Health Procedures, Kent County Council, Residential Care, February 2006


APPENDIX 2

GUIDANCE FOR FOSTER CARERS MEDICATION PROCEDURES

Definitions Controlled drugs – these are medicines with potential for abuse for which special legal precautions are necessary. A current list of these can be obtained from www.homeoffice.gov.uk/drugs/licensing or individual queries can be made to the community pharmacist; Homely remedies – these are medicines that can be obtained without a prescription (over the counter preparations), which homes may buy from community pharmacies following consultation with appropriate medical professionals; MAR sheets – medication administration record sheets, which show the individual administration of medicine to a Looked after Child. Some of the larger community pharmacies e.g. Boots, have a supply of their own forms and homes are advised to use these; MDS – monitored dosage system that supplies medication in pre-measured doses by the pharmacy; PCT – Primary Care Trust; PODS – patient’s own drugs i.e. child’s own medication; POM – Prescription only medication; Training

Foster carers who are required to administer medication to meet specific needs identified in care plans will be trained. The training must relate to specialist medication such as application of gastrostomy feeding; suction machine, pessaries, oxygen, enema suppositories, safe use of emergency epilepsy medication; use of Epi-pens or particular inhalers, or managing diabetes, but should also include: • Introduction to medicines and prescriptions • Medicine supply, storage and disposal • Safe administration of medication • Quality control and record keeping • Accountability, responsibility and confidentiality


Health assessments

All Looked after Children should have an initial health assessment as part of the core assessment process prior to admission to care. Any requirements arising from the health assessment should be detailed in the child’s Care Plan. The Social Worker will need to check with the GP if there are any long term health needs prior to admission to care. These requirements will be reviewed twice yearly for children under the age of 5, and annually for those over the age of 5. Emergency procedures must be discussed prior to planned admissions to care and every effort should be made to discuss them where placements are unplanned, and the child has a high level of medical needs. Where there is a high level of medical need parents primary carers may be required where appropriate and possible to provide written information from their GP or consultant regarding their child’s prescribed medical needs, including clear instructions for any medication. This information as well as what consequences and actions should follow if medication is missed, vomited, or refused should be recorded on the Placement Information Record. This should include contra indicators too. Where there is any doubt the social worker may wish to check with the GP whether other medication has been prescribed. Subsequent changes to a child’s/young person’s medical regime will require further confirmation from the medical professional in writing. The Placement Agreement meeting should cover the whole care environment for the child, including details of physiotherapy, and any equipment used. The Essential Information Record Parts 1 and 2 must be completed in accordance with procedures and given to the foster carer. Consent

The written consent of the person with parental responsibility (parent or might be a District Manager) must be obtained prior to any medication being administered. Where a health professional has been performing a medical task for a child and, following agreement and appropriate training, wishes to transfer this task to the carer, the written consent of the delegating health professional must also be gained and both consents retained on the child or young person’s care plan and file. The carer must also retain copies of the consents in their own records. The MAR/FC form should be completed by the social worker with the child’s parent (or the young person, if considered competent to do so). Consent to medical treatment may not be forthcoming in a contested case where there has been an emergency admission. The child’s welfare is the paramount consideration and legal advice should be sought from the outset. A young people may express the wish or be considered competent to administer his or her own medication but if the question arises this must be discussed, agreed and clearly recorded by the social worker. A young person’s competence to administer his or her own medication is subject to the Gillick ruling:


Under the Gillick ruling (Fraser Guidelines) in 1985, the parental right to determine whether or not a child or young person under the age of 16 will or will not have medical treatment (including medication) terminates if and when the young person achieves sufficient understanding and intelligence to enable them to understand fully what is proposed. In addition, where the young person is 16 or 17, either the parent (or those exercising parental authority) or young person can consent to treatment independently though neither can override the other or exercise a veto. Normally it is a doctor who decides if a young person is Gillick competent, although any health professional is able to do so. Assessing competence should include the young person’s understanding of how to store, retain, administer and dispose of medication within a risk management framework, and comply with the Directorates’ policy and procedure set out below. Emergency placements

In the case of emergency placement, particular attention must be given to determining what medication, if any is currently used. If no information is available through the carer or family, the social worker must contact the relevant health professional to confirm the details in writing of the medication prescribed before undertaking any administration. This must be recorded on the relevant MAR/FC chart and individual care plan. Care Plan All arrangements for medication, particularly if medicine is not given regularly or is supplied ‘when required’ should recorded in the Care plan With medications such as inhalers and the contraceptive pill, if the young person is deemed competent (according to the Gillick/Fraser Guidelines) and articulates a wish to administer his/her medicine, s/he should be allowed to do so. This should be clearly detailed on the care plan. In addition, a Medicines Administration Record MAR/FC must be completed to provide a clear understanding of each child/young person’s medication and how it should be administered. It must include information on any precautions or side effects. Receiving child’s own medication The foster carer should check the medication to ensure that: • It is received from a responsible source; • Have the correct child’s name on the label; • Be in the original pack as dispensed; • Have a date of dispensing within the last 3 months and contents within expiry date shown

on the container or packaging and is still the current dosage for the child; • Be in a clean condition and showing no signs of deterioration; • Have clear and legible dosage instructions; • Not have more than one medication in the pack; • Have contents that correspond to the label on the pack; • The total amount of medication supplied should be specified on each container, which

makes it easier to check if the medicine has been taken correctly


Additional medicines Additional medication needed whilst a child is in placement will be obtained after consultation with the parent/social worker and named local GP and dispensed by the named local pharmacist. It should meet the criteria set out above. The foster carer should check the prescription forms before they are submitted to the pharmacy for dispensing. If an item on the prescription was not originally requested then the item should be struck through. At this stage the reverse of the prescription form should be signed and details of exemption completed unless prior arrangements have been made with the nominated pharmacy. Receiving and recording controlled drugs All medication should be handled with great care and kept out of the reach of children. However, a child or young person’s own medication may be controlled drugs (CD) e.g. Ritalin. Controlled Drugs (CD) are medicines that are prescribed to treat severe pain, induce anaesthesia or treat drug dependence. They can cause dependence or misuse in varying degrees. They are classed according to the extent of harm they may cause when misused. Particular care must be taken when storing or administering controlled drugs and the container should be labelled (CD). A young person’s controlled drugs may be used if they meet the criteria above and the container is labelled CD. They should be recorded clearly on the MAR/FC and the total amount double signed for on arrival and leaving. Use of non prescription medications Over the counter medication such as cough linctus, creams etc. may be supplied by parents and can be used so long as they are in date, in appropriate containers and directions for use are clear and comply with the stated maximum dosage on the packet. They must be received and recorded in the same way as other medication. Foster carers may also use homely remedies to treat minor ailments such as: • Mild pain • Cough • Constipation • Mild skin conditions • Travel sickness It should be noted that some over the counter preparations might adversely interact with prescribed medicines. Or may be contra indicated for some children Advice must be sought in advance from a relevant health professional and written consent obtained from the person with parental responsibility or the young person before any administration takes place. Prescription medicines and those requiring invasive administration e.g. suppositories cannot be included in this list.


It is important that consideration is given to expiry dates on homely remedies. It is good practice to note on the labels when the medications were first opened. Treatment with a non-prescription medicine should not continue for more than three days without medical assessment. A procedure for the administration of homely remedies must be used. MAR/FC sheets include a section for recording the administration of non-prescription medication. Monitored dosage systems Medication in monitored dosage systems may be used if it is correctly packaged and accompanied with instructions. A monitored dosage systems may be used if they are part of a young person' self-medication scheme when a young person is being prepared for adulthood. In such a case the supplier must be approved by the health professional. Prescription of unlicensed medication All children with complex needs may have some unlicensed medication within their treatment regime. However few medications are licensed specifically for use by children. Therefore, if a foster carer has any doubt about the status of the medication being prescribed this should be checked with the doctor/parent concerned who would be expected to provide all relevant information regarding the child’s diagnosed condition and the medication prescribed. In the event that any medication prescribed for a Looked after Child by an appropriately registered doctor/consultant is unlicensed for use with children staff should ask the relevant health professional to send a copy of the ‘Unlicensed Products Patient Consent Form’ to the child’s social worker who must arrange for it to be completed by whoever has parental responsibility for the child. The social worker or birth parents (if appropriate) may wish to contact the doctor concerned for further information before the ‘Unlicensed Products Patient Consent Form’ is signed. No medication should be taken by the child before the ‘Unlicensed Products Patient Consent Form’ is signed and returned to the doctor. A copy of the ‘Unlicensed Products Patient Consent Form’ should kept in the child’s file as a record. Completing the Medications Record (MAR/FC) Foster carers should keep a written record of medication that shows: • Date of receipt • Name and strength of medication • Quantity received (for short term placements exact number of tablets must be recorded

and agreed with the parents/carers) • Looked after Child or young person for whom the medication is prescribed • Signature of the foster carer receiving the medication


• Expiry date of medication - foster carer should complete comments box regarding whether they consider the supplied medication is fit for use.

Medication not used must be returned to the parent/carer and they will be required to sign and confirm the amount returned and for its receipt (MAR/FC). The Medicines Administration Record (MAR/FC) comprises a record of administration and the medication profile. It will contain all the information needed for the child’s stay. A new form must be completed for each young person. It will require the recording of the following information about the child:

• The full name and date of birth. • Details of any known allergies and/or medication sensitivity e.g. penicillin • Looked after children care plans will provide full information on a child/young person’s

individual needs, including their health and medication needs; • Current dosages and medications etc • A record of any new bottles/containers of medication obtained for the child or young

person. The following details about each prescribed medication.

• The generic name or brand name where clinically important • The form of the medicine. • The strength of the preparation • The dose • The route of administration e.g. by mouth, topically etc. reflect what is on form • For respite account of what handed over • The time(s) it should be administered.

Ideally the medication profile and the record of administration should be kept on the same sheet. If they are on separate sheets, the two must be kept together. The MAR/FC form should be attached to the Placement Information Record. The foster carer will monitor the condition of the child or young person placed with them and report any unexpected change in condition, which may or may not be due to an adverse reaction to the prescribed medication, to the responsible health professional. The foster carer will return children’s records to the social worker to be incorporated into the child’s file, which will be retained in the local office until the case is closed when it is transferred to County Archives Unit/County Archives for 15 years. Storage of medication If the child or young person is unable to safely store their own medicines, the foster carer must take responsibility for safe storage. • All medicines should be stored in a safe and lockable cabinet. Foster carers must ensure

that medicines are not available for misuse by anyone in the household; • Creams and oral and external preparations must be stored on separate shelves; • All medications should be kept at a temperature not exceeding 25 degree C. • Some medication needs to be kept in a refrigerator. Where this is the case it should be

kept in a lockable box in the fridge, where assessed to be safe e.g. for very young children, a childproof lock on the fridge will be sufficient;


• The temperature should be checked regularly with a maximum/minimum thermometer. The normal range is between 2 and 8 degrees centigrade and any variation from this should be reported immediately. If this occurs the foster carer should contact a pharmacist to check information on individual products, as some of the medication may need to be destroyed and replaced. The refrigerator must be cleaned and defrosted regularly;

• Medication must not be stored from one stay to the next; • If a child moves to self caring they should be encouraged to keep a lockable box in their

own room. The keys for the medicines cupboard or box should be kept separate from other keys. Storage of Oxygen If a child is prescribed oxygen the carer should discuss storage and administration with the company who supplies the oxygen. This should be discussed and recorded in the placement agreement. Oxygen cylinders should be stored safely under cover and not subject to extreme temperatures. This should be in a dry, clean well-ventilated area away from highly flammable liquids, combustibles and sources of heat and ignition. A statutory warning notice should be displayed in any room/area where oxygen is stored, stating;

‘Compressed gas. Oxygen: No Smoking. No naked lights.’ An oxygen concentrator may be supplied if the child requires continuous oxygen, which the GP can arrange. Disposal of medication As medicines are the personal property of the person for whom they are prescribed, their permission should be sought for the disposal of any medicines where appropriate. Respite and other foster carers should return all medicines to the parents/carers when the child returns home and ask them to sign for its receipt using MAR/FC. In longer term placements foster carers should only dispose of medicines when: • The expiry date is reached. If no expiry date is recorded, then the dispensing pharmacist

must be contacted to ascertain the shelf life of the medicine; • For eye preparations, the date of opening should be recorded on the label and the

contents discarded 4 weeks later, unless there is a specific statement on when it should be discarded by the pharmacist written on the container;

• A course of treatment is completed, or the doctor stops the medicine or the dosage is changed;

• The child or young person for whom the medication is prescribed dies. N.B. This medication must be retained for 7 days in case a coroner’s court requires them.

• Any unused medicine is not collected for any reason. Methods of Disposal

• All medicines should be disposed of by returning them to a pharmacy; • A missed or wasted dose should be disposed of in accordance with advice offered by a

pharmacist. Most pharmacists will supply a bottle for wasted doses. Refusal of medicine should be seen as a compliance problem and advice sought from the GP or pharmacist.

• Health professionals must dispose of their own injection equipment;


• For children who self-administer ‘sharps’ boxes would need to be provided to the home and local arrangements confirmed for disposal

Giving medicines safely The foster carer should check the following before administering any medicines: • Explain to the child what they are about to do; • Check dosage instructions; • Details of any medication administered prior to arrival should be requested from the

parent. This should be recorded; • Ensure the sensitivity/ allergy box is checked; • Ensure that medicines prescribed for one child must never be given to another, or used

for a different purpose; • If the medicines received from the parents/carers differ unexpectedly from those received

for the same child in the past, the carer must check with the appropriate health professional before administering the medication;

• Identify the appropriate medicine container/s checking the label/s and record match. If there is a discrepancy, the unit must check with an appropriate health professional before giving the medicine to the child. If the label becomes detached or illegible, contact the appropriate health professional for advice;

• It is good practice to date all containers when they are first opened; • Administer the medication in accordance with any special instructions e.g. to be taken

after food; • If liquid, measure the dosage using the spoon or measuring cup provided • Record if the medicine is refused or not administered, and state the reason; • Medication will be given at times stipulated, and following discussion with the child’s

parents/primary carers. In all situations the child’s best interests should be paramount; • The carer should ensure that the child has swallowed the medicine and that the

course/dose has been completed; • Medication related to activity, such as Ritalin, needs to be carefully planned so that the

child’s normal routine and behaviour is not adversely affected. Discussion with parents/carers may allow this to be planned in such a way that the child’s activities are not curtailed, whilst still allowing safe administration; Timing of medication should be discussed with health care professional if need to change to fit household pattern.

• For children with special medical needs a method and protocol for the administration of medicines, which meets the needs of the child or young person, should be adopted as recommended by Health and social work professionals. The method and protocol will be individual for each child;

• The removal of medicines from their original containers into other containers by anyone is not allowed, as it increases the risk of mistakes being made and puts both carers and children and young people at risk;

• If a child or young person is concerned about their medicines they should be referred to their doctor;

• To gain maximum benefit, medicines should always be taken at the prescribed times and following any additional instructions given on the label or in the PATIENT INFORMATION LEAFLET;

• Refusal of medicine should be seen as a compliance problem and advice sought from the GP or pharmacist.or parent initially. For young people for whom this is a recurring issue, management plans need to be included in the care plan.


Self medication If a child or young person is assessed as capable of looking after and administering their own medication, the foster carer should monitor that they keep the medicines with them or store them in a lockable space. Liaison with the child’s school, nursery etc., should be the responsibility of the child’s social Worker.

If there is concern about a child or young person’s ability to administer their own medicines safely, the foster carer together with the young person should consult with the social worker, and the child’s parent(s) and agree how much responsibility the young person is able to undertake. Where there is doubt, and it is assessed as safe to do so, the young person should be given charge of their own medicines for a trial period. After this, the foster carer should check whether or not the young person has taken the medicine as prescribed and a decision should be made by the involved professionals and recorded in the child’s personal file as to whether or not they can cope with their medicines in the long term. The child or young person’s ability to administer their medicines should be reviewed on a regular pre-planned basis.

The foster carer should record that the medicine has been given and taken and record if the medicine has been offered and refused or wasted.

Administration of invasive medicine All invasive treatment, which can be planned for, will require the involvement of the appropriate health professional. This will be outlined in the care plan and discussed at the Placement Agreement meeting. The health professional (often the community paediatric nurse) should be invited to attend the Placement Agreement meeting to fully discuss procedures. These treatments include injections; vaginal pessaries, insulin preparation and administration; catheterisation; stoma; nebulisers; suction; naso-gastric tubes. The foster carer should be clear who the named community health professional is to offer advice on procedures, including oral hygiene, storage of medicines and equipment, infection control, disposal of clinical waste etc. In some cases foster carers may be expected to carry out procedures under the supervision of the health professional. Administration of such medication may only be undertaken by the registered carer, who must have received appropriate training. For medicines administered other than orally, see the Management and Administration of Medication - Clinical Tasks for guidance. Administration of medication in an emergency Foster carers need to read this section in conjunction with the Management and Administration of medication - Clinical Tasks guidance. The administration of medication in an emergency whether rectally (e.g. Diazepam) or by injection (e.g. Adrenaline) may only be undertaken by carers who have received specific training and as detailed in the child’s care plan. The supervision process should be used to record an carer’s willingness to undertake such training. The health professional who is responsible for defining the circumstances


under which such medications can be given, must prescribe emergency medication. The Health Care Professional (GP) should set out in writing when it should be used, how much should be given and any necessary precautions. If the carer is not trained to administer the medication the emergency services must be called. Written consent must be sought from the person with parental responsibilities if they are likely to need emergency medication to control convulsions or any other medical condition that requires urgent attention, setting out their agreement to foster carers undertaking this procedure. Wherever feasible, the young person’s preference concerning the gender of administering person should be respected.

If an emergency situation should arise during transportation, depending on the criteria provided by the prescribing GP every effort must be made by the driver and escort to call on the assistance of the emergency services. Arrangements for short periods away (for example, school, day trips and outside activities) When a child or young person is engaged in an activity in the community, the foster carer must ensure that the medication is carried in it's original containers. An approved container is one that has been supplied by a pharmacist or prescribing GP. Medication errors and incidents

Despite the high standards of good practice and care, mistakes may occasionally happen for various reasons. Any error in administration (or refusal of essential medication) must be notified to the child’s social worker reported immediately depending on the seriousness of the case,and to the appropriate medical professional so as to prevent harm to the child or young person. Any errors should be documented on the MAR/FC form. If need be the child or young person should attend the hospital Accident and Emergency Department. The child or young person’s parent(s) and Ofsted must also be informed by the Manager of the Service of any error in writing if the belief is, following consultation with a health professional, that the error could have led to harm or injury. Foster carers who report errors should be dealt with in a constructive manner that addresses the underlying reason for the incident and prevents recurrence. If an error occurs the child’s social worker and a representative from the Fostering Service must meet with the foster carer in person and go through the guidance with them to ascertain their level of understanding. Errors should be reported as incidents under the existing accident/incident reporting system. The investigation must differentiate between those incidents where there was a genuine mistake, where the error resulted due to pressure of work or where reckless practice was undertaken and concealed. A thorough and careful investigation taking full account of the


position of of the carer and circumstances should be conducted before any professional action in line with Disciplinary procedures is taken. References UN Convention on the Rights of the Child The Fraser Guidelines, www.dh.gov.ukNHS Best Practice Statement, Scotland Nasogastric & Gastrostomy Tube Feeding for children being cared for in the community, Nursing & Midwifery Practice Development Unit 2003 The Administration & Control of Medicines in Care Homes & Children’s Services, Royal Pharmaceutical Society of Great Britain, June 2003 Unit Policy for Administration of Medication & Health Procedures, Kent County Council, Residential Care, February 2006 July 2007


APPENDIX THREE MANAGEMENT AND ADMINISTRATION OF MEDICATION -

RESIDENTIAL RESPITE & FOSTER CARERS CLINICAL TASKS

Introduction

This document details specific health care tasks, which may be carried out by Children’s Social Services residential workers, and foster carers, in order to minimise disruption to the child or young person. Mandatory Procedures General Principles – Children’s Social Services residential workers or foster carers must have received appropriate training and the required protocol must have been established before the tasks listed in Category 1 and 2 are undertaken. Examples of protocols can be found in the appendix.

Training - the tasks identified in Categories 1 and 2 all require training to have been given first hand by a health care professional. However, tasks in category 1 can take the form of generic training in how to carry out the identified task, whereas tasks identified in category 2 must be trained specifically in relation to the service user for whom it is to be carried out. Residential workers and foster carers must sign to say that training has been received and understood. The trainer must also sign and date this. Children’s Social Services workers and foster carers are not permitted to pass on any training they have received for these tasks to others. Competence to complete these tasks must be re-assessed annually by the health care professional delegating the task or the line manager of the employee or the social worker for the child, whoever is the most appropriate, and this should be recorded. A review of training needs must take place whenever there is a change in circumstances or where there is concern expressed about the ability of the member of staff to perform a specific task.

In case changed local or national guidance requires urgent re-training, managers must be able to easily access information as to which workers or foster carers are trained to perform a particular task. Training section hold data on courses attended by staff. Tasks listed in Category 3 are identified as tasks that must only be carried out by a trained health care professional and may not to be carried out by Children’s Social Services residential workers.

Developing Individual Protocols - before carrying out any of the clinical tasks that have been identified as being within the Directorate’s remit, it must have been agreed that: • The child or the person with parental responsibilities has given their written consent to

that task being carried out on the grounds that is in their best interest. Where possible,


consent (not necessarily written) must be sought when, and each time, the procedure is carried out.

• The residential worker and their manager or the foster carer is willing to undertake the procedure.

• The residential worker or foster carer has received appropriate training from a health care professional and /or qualified trainer.

• An appropriate health care professional has given clear instructions by means of an individually established protocol and has confirmed the competence of Children’s Social Services residential worker or foster carer to perform the task.

• The protocol should be reviewed at least annually by the health care professional delegating the task or the line manager of the residential worker or the social worker for the child, whoever is the most appropriate. The outcome of the review must be recorded. CSCI recommend that protocols are reviewed on a six monthly basis.

• The protocol must be kept safely and be easily accessible to the person performing the care task.

Definitions Acceptable/routine - the task is within the range of activity normally undertaken by Children’s Social Services residential workers and foster carers as long as they have received the appropriate training and the Directorate protocol has been established. Negotiable – Children’s Social Services may perform these health care tasks where the individual residential worker or foster carer feels confident and willing to carry out this higher level of task. This will have been negotiated between the health care professional (who remains ultimately accountable) and the individual worker and their line manager, or foster carer and the service user and/or their carer prior to the establishment of the Directorate protocol. Assisting with Specific Clinical Tasks CATEGORY 1 Acceptable/routine • Replacing a bag to an existing catheter, emptying and measuring urine, if required • Application of topical creams and ointments • Ear drops, eye drops and ointments • Mouth care • Fitting supports, artificial limbs, or braces • Awareness of pressure care in relation to prevention and good practice • Assisting with the cleaning of a supra-pubic catheter site CATEGORY 2 Negotiable • Putting on penile sheaths • Connecting sheath to urine bag • Fitting prescription support stockings, following advice from an appropriate health

professional as to how frequently this task should be performed • Administering laxative suppositories • Administering rectal diazepam [Stesolid] or midazolam, only as an emergency procedure

and subject to ongoing review • Changing two piece system of stoma • Emptying, changing/replacing urostomy bags • Emptying, changing/replacing colostomy bags


• Emptying, changing/replacing ileostomy bags • Assisting with obtaining midstream urine specimens, or a faecal specimen, which has

been medically requested (NB This includes obtaining a specimen by way of an in-dwelling catheter but not by intermittent catheterisation)

• The taking of a capillary blood test (finger prick test) • Applying a replacement dressing, without otherwise cleaning or treating the site • Administering routine, pre-measured doses of medicines via an inhaler or nebuliser as a

regular procedure for chronic conditions only • Administering pre-set doses of insulin • Administering oxygen • Gastrostomy tube feeding, by flushing water through the tube before and after the feed

and attaching feed tube to PEG/PEJ • Cleansing of gastrostomy tube sites • Oral aspiration of excess saliva from the front of the mouth • Fitting Transcutaneous Nerve Stimulation (T.E.N.s) machines, only where their use has

been approved by the GP or other appropriate health care professional • Cleansing and inserting false eyes • Administering anaphylactic pens, as an emergency procedure only • Taking of temperature only when there are clear guidelines in any protocol from health on

the action required and the health staff to be alerted if the temperature should exceed certain pre-defined limits. Care staff will not be expected to interpret any temperature readings.

This list is not exhaustive and there may be occasions when managers would be willing to negotiate to establish an individual protocol, based on the experience and willingness of their staff to be trained and the nature of the task. CATEGORY 3 Children in foster care or respite care only Exceptionally, the following tasks may be undertaken in order to provide foster care or respite care for children only, when the protocol has been additionally agreed by the Children’s Social Services Disabled Children’s Services Manager and the designated Service Manager in the relevant PCT who has the lead for children’s services for the county: • Aspiration of naso-gastric tube • Naso-gastric tube feeding • Oral suction • Suction through tracheostomy tube • Administration of medicine via a gastrostomy tube • The administration of pre-measured doses of medicine via a naso-gastric tube • Administration of rectal enemas CATEGORY 4 Not to be performed by Social Services staff in any

circumstances • The management of supra-pubic catheters, other than emptying the urine bag and

cleaning the site • Intermittent catheterisation • Bladder compression • Management and treatment of pressure ulcers • Manual evacuation of the bowel • Administration of microlax enemas • Insertion of prescribed vaginal pessaries


• Taking of venous blood samples • Taking pulse or blood pressure readings • The administration of medicines through a nebuliser for acute or emergency conditions • Giving any medicines via injection (except insulin in residential care) • Flushing to unblock any tube or line • Nasal washing • Assisting with the cleaning and replacement of tracheostomy tubes • Assisting with the dialysis process • Assisting with syringe driver pain relief systems • Fitting of prescribed supports for the control of hernias Emergency Procedures - an emergency is defined as a life threatening situation so there will be occasions when a child or young person’s personal safety may be at risk and where urgent intervention is required. However, whatever the circumstances, residential workers or foster carers should not put themselves at risk. If a residential worker or foster carer is seriously concerned about a child or young person’s physical condition and they have had the appropriate first hand training from a health care professional and feel confident of intervening in an emergency situation, they can do so only as a first aid measure, and whilst ensuring that an ambulance is called through the 999 emergency service. This particularly applies to the administration of rectal diazepam [Stesolid] (Valium)/Midazolam, when a child or young person has a seizure and there is a risk of Status Epilepticus occurring. The preferred course of action is for an ambulance to be called using the 999 emergency service. Rarely, more immediate intervention will be necessary and this may be carried out by named staff members in accordance with the procedures established in the seizure management plan. As long as the procedures established above can be met, the administration of rectal diazepam is a task that may be delegated to CSS residential workers or foster carers. In all circumstances the service user’s GP and family or carer should be informed. Cardiac and Respiratory Resuscitation - in the event of a service user appearing to suffer a cardiac or respiratory arrest, an ambulance must be called using the 999 emergency service. In addition, emergency life saving procedures should be carried out by a trained first aider, if one is available.

There may be situations when residential workers or foster carers are unsure whether resuscitation is appropriate due to serious illness or disability. If there is concern about the likelihood of cardiac or respiratory failure in a seriously ill or profoundly disabled person, then the child or young person’s doctor must give written guidance as to what procedure is to be carried out. It will be kept with the service user's medication profile.

At no time must a residential worker or foster carer make a decision themselves based on the child or young person’s physical condition or age whether to resuscitate and they should therefore always administer first aid and call the ambulance service as stated above, unless otherwise advised by the doctor.


Intimate Personal Care Tasks - care should be taken by staff not to confuse intimate personal care tasks with clinical tasks. Intimate personal care will however often be necessary to allow a clinical task to be carried out.

For further clarification refer to the Privacy and Respect policy. July 2007


children, families and education children's social services · 2014-12-13 · version 1.2...

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