First Aid, Home Remedies and Medication

Each Home must have a qualified First Aider on duty at all times.

First Aid boxes should have a white cross with a green background must be held in each home and should be carried in each of the vehicles used for the transportation of children.

Each box has an inventory that 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.

Recording: Each child should have permission for staff to administer first aid and non-prescription medication from a person with Parental Responsibility for them recorded in the relevant plan. Permission should be sought and arranged by the child's social worker.

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

There is an expectation that a specialist allergy nurse/consultant will help develop a Health Care plan which should be shared with all agencies working with the child.

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;
• 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 child 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 should be educated around their allergies and what to do in an emergency - a child 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 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.

The Registered Service Manager should liaise with AWW Children’s nurse to clarify any staff additional training needs, and any special considerations for the child. For further information, please contact the child’s health professional who deals with their allergies and check the NHS website or see Allergy UK Website.

Home Remedies are medicines that can be bought over the counter, after discussion with a pharmacist/GP. These include Paracetamol*, homeopathic, herbal, aromatherapy, vitamin supplements or alternative therapies. Best practice to see pharmacy (minor ailments) and purchasing over the counter medication from pharmacy, not local supermarkets.

Home Remedies can only be used by the child in the home with the approval of relevant social workers (as set out in children's Placement Plans) or as prescribed by a GP.

Home Remedies should be purchased for a named individual child.

When a Home 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 Risk Assessment.

Clarity must be sought from a medical professional as to how long a child continues to use Home Remedies before they arrange to see their GP.

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

All medicines must be administered strictly in accordance with the prescriber's instructions (or as advised on the packet in relation to Homely Remedies). Only the prescriber (e.g. GP) can vary the dose. Medicines must be locked away in the locked storage areas when not in use.

Unless a lone working risk assessment is in place, each process below including the checking, administration, and recording should be checked by a second member of staff.

Before administration, staff should:

• Wash their hands;
• Make sure they have a pen and any required record sheets;
• Enough glasses for each child receiving medication;
• A jug of water.

The procedure for administration is as follows:

• Check the child’s identity (a photo is normally kept in the child’s file). Only one child should be administered medication at a time, this reduces the risk of mistakes being made;
• Check the child's medical profile;
• Check the medication on the individual medication records corresponds with that on the child’s 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 package or container, add the date opened and the date when the medication must be used by;
• Measure or count the dose without touching the medicine;
• If the medication is a solid (such as a tablet) then these should be placed in the child’s hand for them to take. This is easy when medication is provided in blister packs. Staff must never place tablets in any alternative container, such as a cup, as this would be deemed as secondary dispensing which is illegal. A counting tray may be used to support administration, promoting accuracy and safety when pouring tablets from a bottle;
• If the medicine is a liquid, take care not to drip onto the label. Always use a medicine syringe to measure;
• Generally, if the medicine is a cream or ointment, then it should be squeezed directly onto the child’s finger for them to apply. This will be self-administered by the child unless for some reason they are not capable of doing so. If required to be applied by staff, then latex/PVC gloves must be worn. The amount of cream or ointment per application will be agreed with the Registered Service Manager and detailed to ensure consistency of application;
• When administering a Controlled Drug, a second member of staff, must check the dose prior to it being administered; All controlled drugs administered must be carefully recorded in the home’s Controlled Drug Recording book;
• Watch the child as they take their medicine to ensure administration is successful. Staff should be vigilant that medication is not being secreted or stored by the child;
• Offer the child a drink of water (where appropriate);
• Check that the medication is recorded in all the required records;
• Ensure that when recording the dose that the actual number is recorded e.g. 2 tablets or 1x 5 ml syringe measure;
• Print and sign your name against date and time of each medicine administered;
• Record when medicine has been refused / not taken and the reasons why;
• If a child 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 child refuses to take medication, under no circumstances should they be forced to do so;
• Medication must be kept in the original labelled (by the Pharmacy) containers and not put into weekly/daily medical boxes;
• After administration, the 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 that if the medicine is required to be taken before food, that this is done. Similarly, the administration of some medicines such as eye drops or inhalers may not be suitable to be given at mealtimes. Not all medicine administration times will fall in line with mealtimes.

Ensure follow 7 rights of medication administration are adhered to:

1. The right child;
2. The right medication;
3. The right dose;
4. The right time (two hour window);
5. The right route;
6. The right  documentation;
7. Also the right to refuse- Document refusal & reason given.

Child nauseous or vomiting

Seek advice from the prescriber or medical practitioner about continuing with medication administration while the child is unwell.

Swallowing Problems

Staff may find that some children may struggle with swallowing their medicines. The child's G.P should be contacted for an alternative. Under no circumstances should staff take it on themselves to crush or half tablets. If a GP should suggest this, then staff must request that medication is prescribed and issued in an alternative way, for example a liquid version or tablets in a smaller form.

Medication Refusal

When a child refuses to take their medicine, and the window of tolerance has passed, then the G.P. or NHS 111 should be contacted for advice. This information must be recorded and followed up. Children cannot be forced to take their medicines.

If a Child is Absent when the Medicine is Due

When a child is absent and their medication is due, this should be recorded. When the child returns, then staff must consider the time delay and seek advice if required from the Pharmacist, the G.P or NHS website (as appropriate depending on the time of day). 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. Staff must not hide any medicine in food or perform any other types of covert administration.

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 for themselves and make a record of any medical administration required during the period of time for when they were lone working.

As part of the lone working risk assessment, it will detail who will support the residential support worker in administering the medication.

This can be a problem when administering Controlled Drugs. It is important that the child receives their medicine at the correct time. Any administration of controlled drugs would always require two staff to administer. You cannot be a witness to something you have not seen happen. Where lone working applies the home will make necessary arrangements to ensure safe administration of controlled drugs.

Self-medication or active participation in the use of medication

When a child is working towards independence and can self-medicate. We would support them to safely administer their medication. This would be risk assessed individual for each child and would require an agreement to be signed off by the local authority/parent and registered Manager.

Spilled Medicines

When a medicine has been dropped on the floor or spilled then this must be safely disposed of, and a note must be made in the records. A second dose should be offered to the child (where a medication has spilled, leaving the remainder short for the completion of the course of the prescription, advice should be sought from the G.P as to how to make-up for the lost dosage).

When medicine has been spat out then this medication must be cleared away following the correct procedures and a note made in the records. However, a second dose must not be offered, as staff will not know how much has been absorbed. If this persists the G.P should be contacted.

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 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, advice must be sought from the child’s G.P. or another medical practitioner immediately or as soon as the error has been discovered. The child’s safety and well-being are paramount.

Monitor the child at regular intervals as advised. Make sure that these occasions are clearly recorded and any changes in the child’s condition noted and reported as appropriate.

Staff should without delay call an ambulance (or take a child immediately to hospital if that is what is advised) if the child begins to show any adverse reaction to the medication administered.

Staff must record in detail any advice that they have been given. They must inform their direct line manager or duty manager of the medication error.

Verbal Alterations

There may be times when it is necessary to stop or change the dose of a child's medication without receiving a new prescription. Verbal requests to change medication by the consultant or G.P must be confirmed in writing before any changes are permitted. These changes must be recorded on all relevant medication records including the Individual Medication Record in the child's file. Staff must note the change, the name of the Doctor, the time the confirmation of alteration was received and the date. Staff must not alter the dispensing labels. 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. Staff must record the advice that they have been given indicating the date and time and authorising Practitioner.

Drug Recalls

When a Drug Recall Notification is received then staff should check the medication to see if the home 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.

See also Lone Working.

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. Transported medication is required to go in a secure lock box.

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 parents/ carers. The person receiving the medication should countersign the record.

If the parent/ carers wish, 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. A booking out of medication record should be completed and signed by the person assuming responsibility for the medication.

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

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

If a child requires a skilled health task to be undertaken, this will only be carried out by trained staff, with the written authorisation of the prescribing Doctor in relation to the child concerned, and as set out in a Placement Plan or other written Health Care Plan.

Appropriate training will be provided, together with written guidance, as to how the skilled tasks will be performed and recorded.

If an overdose is suspected, hospital treatment should be sought without delay. Staff should try to find out what the child has taken and if possible, take a sample to give to a medical practitioner.

Possible signs of an overdose:

• Mild nausea/vomiting;
• Paler skin;
• Blue lips or fingernails;
• Not waking up or reacting to a loud noise;
• Shallow or disrupted breathing;
• Gurgling, snorting or snoring/choking sounds;
• Slow or very faint pulse.

It can take a long time between taking the substance and the first signs of an overdose; children may verbally 'boast' about having taken an overdose: even when there are no signs, but staff must consider that there is a chance an overdose has been taken and they must act in caution and seek medical attention.

What to do if someone is reacting to an overdose

• What to do if someone is reacting to an overdose;
• Lie them on the floor;
• Put them in the recovery position;
• Call the ambulance - 999 - inform the operator of the overdose;
• Do not leave the child alone, make sure they don't roll onto their back;
• Inform the ambulance team what the person has taken; try to gather all the packaging you can find;
• Get some help, keep other children away (but don't dismiss any valuable information that they may be trying to pass it on to you).

DON'T

• Walk the child around;
• Put the child in a cold bath/layer them up to heavily to generate warmth;
• Give them a drink.

Recording and Review

See also: Self - Harming and Suicidal Behaviour (including cutting, use and practices) Procedure.