First Aid, Home Remedies and Medication

• Each Home must have a qualified First Aider on duty at all times;
• First Aid boxes must be held in each home and vehicle used for the transportation of children, they should have a white cross with a green background;
• The inventory must include the full quantity of each item stipulated in the box. When an item has been used, then it should be replaced as soon as possible. Antiseptic wipes should be used where necessary (not TCP).

Recording

The administration of First Aid must be recorded in the First Aid Log, (if there has been an accident) Accident Book, individual Child's Daily Record and Medication Administration Record (MAR).Book (if there has been an accident), individual child's Daily Record and Medication Administration Record (MAR).

A specialist allergy nurse/consultant will help develop a Health Care plan which should be shared with all agencies working with the child/young person.

The Care and Placement Plan and Health Care Plan should contain the following:

• All known allergies and associated risks including spotting the signs and symptoms of an allergic reaction and anaphylaxis for the child/young person;
• Preventative measures should be detailed in the Plan - for example taking daily antihistamines for hay fever, making sure cleaning products and gloves are hypoallergenic, and washing powder is suitable for skin conditions;
• Actions to take when a young person has an allergic reaction. The plan should describe exactly what to do and who needs to be contacted in the event of an emergency. For example, when to use an EpiPen and calling for an ambulance;
• All staff should be aware of the Plan and should have been trained to administer an EpiPen by a suitable qualified health professional;
• The child/young person should be educated around their allergies and what to do in an emergency - a young person may be able to self-administer their own EpiPen or take antihistamines. If this is the case this should be recorded;
• Medication should be easily accessible so staff and/or the child/young person can access their medication in an emergency situation;
• A record should be kept of each episode and any medication given should be recorded on Medication Administration Record (MAR) sheet.

For further information please contact the child or young person’s health professional who deals with their allergies and check the NHS website or see Allergy UK Website.

• Each home's Statement of Purpose should list the Home Remedies that may be used, this list should be approved by a local GP/Medical Practitioner;
• Homely Remedies are medicines that can be bought over the counter, including Paracetamol*, homeopathic, herbal, aromatherapy, vitamin supplements or alternative therapies;
• Homely Remedies are only for the use of the young people in the home, with the approval of relevant social workers (and set out in children's Placement Plans) or as prescribed by a GP;
• Home Remedies should be purchased for named individual children, the containers should be labelled with the child's name;
• When a Homely remedy container is opened, staff should record the date of opening to ensure it is not kept beyond its expiry date;
• No child may be permitted to 'self-administer' Home Remedies unless approved by their social worker, with the arrangements outlined in the Placement Plan.

Recording

The administration of any Home remedies must be recorded in individual Child's Daily Record and Medication Administration Record (MAR).

^{*Paracetamol must not be given for more than two consecutive days without the approval of a GP/Medical Practitioner.}

Each Home should keep the following records:

Medication

Checklist: If you wish, you may print out this Appendix, Click Here download a PDF version, then print it off.

All medicines must be administered strictly in accordance with the prescribers (or as advised on the packet in relation to homely Remedies) instructions. Only the prescriber (e.g. GP) can vary the dose. Medicines must be locked away in the locked storage areas when not in use and the keys for these areas must be kept in the key press.

Before administration, staff should:

• Wash their hands;
• Make sure they have a pen that works;
• Enough glasses for each young person receiving medication;
• A jug of water;
• A supply of clean dry medicine tots.

The procedure for administration is as follows:

• Check the young persons identity (a photo is normally kept in the young persons file). Only one young person should be administered medication at a time, this reduces the risk of mistakes being made;
• Check the young persons medical profile;
• Check the medication label corresponds with what is written on the MAR chart;
• Check the medication on the Individual Medication records corresponds with that on the young persons Medical Profile;
• Check the Individual medication record sheet to ensure that someone else has not already given the medication;
• Check the expiry date and use by date (where appropriate) on the medication;
• Check the amount to be given at that time;
• If opening a new container, add the date of opening;
• Measure or count the dose without touching the medicine. (See COSHH assessment);
• If the medicine is a solid (such as a tablet) then carefully place into a medicine pot and offer to the young person. They may wish to put it in their hand or swallow straight from the medicine pot (however keep direct handling to a minimum);
• If the medicine is a liquid, take care not to drip onto the label. If the amount to be measured is less than 5ml, then use a medicine syringe otherwise use a medicine spoon or measure;
• If the medicine is a cream or ointment, then it should be squeezed directly onto the young person's finger to apply themselves. If necessary to be applied by staff, then latex/pvc gloves must be worn (ensure the young person is not allergic to latex etc);
• Prior to administering a Controlled Drug, another member of staff  must check the dose and both must sign the MAR and CD register;
• Watch the young person as they take their medicine to ensure the dose is taken properly - some are known not to swallow the dose;
• Offer the young person a drink of water (where appropriate);
• Check that the medication is recorded in all the appropriate records;
• Print and sign your name against each medicine administered;
• Record when medicine has been refused / not taken and the reasons why;
• If a young person is absent when medication is due- this should be recorded;
• Do not sign for any medicines that you have not administered or witnessed yourself;
• If a young person refuses to take medication, under no circumstances should they be forced to do so. Contact the GP if medication is regularly refused;
• Medication must be kept in the original labelled (by the pharmacy) containers and not put into weekly/daily dosette boxes;
• After administration, remaining medicines should be returned to the cabinet immediately and the cabinet locked;
• Each time you give medication, remember that it is important to consider the time of administration. Care should be taken to ensure additional directions are followed e.g. to be taken before food.

Swallowing Problems

Staff may find that some young people may struggle with swallowing their medicines. The young person's doctor should be contacted for an alternative. Under no circumstances should staff take it on themselves to crush tablets without seeking advice from the doctor or pharmacist. Any advice given should be recorded.

Medication Refusal

When a young person refuses to take their medicine, then the G.P. should be contacted for advice. This information must be recorded and followed. Young people cannot be forced to take their medicines.

If a Young Person is Absent when the Medicine is Due

When a young person is absent and their medication is due, this should be recorded. When the young person returns to the unit, then staff must consider the time delay and seek advice from the pharmacist or the doctor. To miss taking a medicine completely can be dangerous depending on the medical condition.

Covert Administration

Covert administration is where a medicine is hidden in food and the person does not know that they are taking it. Residential staff must not hide any medicine in food without the correct protocol being in place signed by the GP/paediatrician.

Lone Working

In some homes, staff may be required to work on their own for a period of time. It may be the case that the administration of a medicine will have to happen during this period. Staff should ensure that they double check themselves and record the period of time for when they were lone working.

This can be a problem when administering Controlled Drugs. It is important that the young person receives their medicine at the correct time therefore the member of staff administering the medicine, must also record that they were lone working in the register. It is not acceptable for a staff member to sign the register if they have not witnessed the administration.

Spilled Medicines

When a medicine has been dropped on the floor then this must not be administered but instead it should be stored correctly for disposal and a note must be made in the records. A second dose should be offered to the young person.

When a medicine has been spat out then again this must be placed to one side for disposal and a note made in the records. The doctor should be contacted for advice as to whether to offer a second dose.

Detached or Illegible labels

If a label becomes detached from a container or is illegible, then staff must seek advice from the pharmacist. Until this advice is received then medicines from the container should not be used.

Secondary Dispensing

Staff must ensure that medicines stay in the containers supplied and labelled by the pharmacist. Medicines must not be placed in daily or weekly medicine trays.

Medication Errors

In the event of an error being made in the administration of any medication it must be reported to the line manager and advice must be sought from the young persons G.P. or another medical practitioner/ help line immediately or as soon as the error has been discovered. Staff must record the advice that they have been given. If applicable the safeguarding lead should be contacted.

Verbal Alterations

There may be times when it is necessary to stop or change the dose of a young person's medication without receiving a new prescription. Verbal requests to change medication by the doctor must be confirmed by e-mail before any changes are permitted. These changes must be recorded on the Individual Medication Record in the file. Staff must note the change, the name of the doctor, the time the e-mail was received and the date. Staff must not alter the dispensing labels but should amend the MAR chart accordingly, sign the MAR and ask someone to witness then also sign the amendment. A note may be added saying 'Refer to record for new instructions'. Staff should check the next prescription to make sure these new changes have been implemented

Adverse Drug Reaction

Any adverse drug reaction or suspected adverse drug reaction should be reported to the G.P. before further administration is considered. Advice should be sought on whether the medicine should be stopped or the treatment carries on.

Drug Recalls

When a Drug Recall notification is received then staff should check the medication to see if the unit is holding any stock. If there is none in stock then the notification should be signed, dated and filed for reference.

When stock if found that is listed on the drug recall, then staff must follow the directions given after isolating the stock.

If a child spends time away from the Home, either on home visits, holidays or time spent at school, any medication due to be taken must be kept in the original labelled container.

Any medication taken away from the Home should be appropriately recorded on the individual child's Medication Administration Record (MAR), showing what medication has been taken away/handed over to carers/parents. The person receiving the medication should countersign the record.

If the carer/parent wishes, a copy of the MAR should be handed over to them, so that a record of administration can be kept; this may be handed back to the home when the child returns.

If the person who is responsible for the child is a member of staff, then they must complete the documents for administration while they are away as normal.

The medication should always be handed over to someone responsible for the child.

This applies to specialist or skilled healthcare tasks, for example:

• For diabetic children;
• Physiotherapy programme;
• For the use of Buccal Midalozam;
• For the use of Rectal Diazepam.

If a child requires a skilled health task to be undertaken, this will only be carried out with the written authorisation of the prescribing doctor in relation to the child concerned, and either set out in a Placement Plan or other written plan.

Appropriate training will be provided, together with written guidance, included how the skilled tasks will be recorded.