First Aid, Home Remedies and Medication

Some young people will have prescribed medication, which is ongoing. This should be ordered on monthly basis where possible. Responsibility for ordering these medicines is that of the young person.

When ordering, a note must be made of:

• The name of the young person;
• The name, strength, form and quantity of the medicine;
• The name of the surgery/G.P;
• When the prescription will be ready.

The Pharmacy will be able to give, and advice should be sought upon:

• Potential side effects;
• Advice on how the medicine should be taken;
• Advice on whether the medicine may be affected by any other medicine;
• Whether the medicine should be stored in the fridge;
• If the medicine is a Controlled Drug.

Short breaks signing in:

• The member of staff signing the medication in must ensure that all medication is recorded accurately on the MAR chart. Due to the nature of short break's services sometimes changes of medication are made in the community and not reflected on the medication label. In order to accommodate changes must be authorised by a medical practitioner;
• If the dosage has changed or differs from the label then a doctor's letter/email must be attached to the MAR chart, insert see doctor's letter/email. Email the whole staff team to ensure that they are all aware of the changes.

NOTE: all staff must be familiar with the following detailed guidance on the administration of medication:

Medication should be administered as set out on the label or instructed by the GP/Medical Practitioner.

All medicines must be kept in a safe/secure place, e.g. a locked cabinet that does not exceed 25°C. A key to this cabinet should be held by a senior/responsible member of staff on duty.

Medicines that are taken internally should be stored separately to those used externally in the medicine cabinet, with liquids preferably on the bottom shelf.

_{*Medicines that require refrigerated storage should be kept in either a dedicated lockable fridge (in the staff office) or a locked box inside the food fridge.}

All medicines have expiry dates, usually clearly stated on the label, upon expiry, they should be disposed of, see below.

Where the service is storing a quantity of oxygen cylinders, details of appropriate storage can be found in the Medicines, Ethics and Practice: A Guide for Pharmacists or in the BOC booklet 'Gas safe – with medical gases'. Oxygen can be kept in the individual service user's room taking account of relevant safety advice and displaying the appropriate safety notices. Emergency service personnel should be told about the oxygen cylinder storage areas.

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

When a young person is absent and their medication is due, this should be recorded. When the young person returns, then staff must consider the time delay and seek advice if required from the Pharmacist, the G.P or NHS Choices website (as appropriate depending on the time of day). To miss taking a medicine completely can be dangerous depending on the medical condition.

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 young person (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).

In the event of an error being made in the administration of any medication, advice must be sought from the young person's G.P. or another medical practitioner/ help line (e.g. NHS Choices) immediately or as soon as the error has been discovered. Staff must record the advice that they have been given. A significant error must be reported internally and to Ofsted within 24 hours. The incident form (see Local Resources) must be used for internal reporting purposes.

Following reports being received from staff concerned, a meeting will be held with line managers to discuss the error.

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.

When a Drug Recall Notification is received then staff support young people to check their medication. 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.

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

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.

When a young person is absent and their medication is due, this should be recorded. When the young person returns, then staff must consider the time delay and seek advice if required from the Pharmacist, the G.P or NHS Choices website (as appropriate depending on the time of day). To miss taking a medicine completely can be dangerous depending on the medical condition.

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.

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 another staff member to sign the register when they come in. You cannot be a witness to something you have not seen happen.

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 young person (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.

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.

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.

In the event of an error being made in the administration of any medication, advice must be sought from the young person's G.P. or another medical practitioner/ help line (e.g. NHS Choices) immediately or as soon as the error has been discovered. Staff must record the advice that they have been given. A significant error must be reported internally and to Ofsted within 24 hours. The incident form (see Local Resources) must be used for internal reporting purposes. If medication errors are made then these must be recorded on the back of the MAR sheet.

• The name of the service user;
• The medication missed or miss-administered and details;
• Contact with NHS Direct, carers or family following advice sought from the manager or the person on call;
• Manager informed/on call informed – according to urgency;
• Confirmation that medication error report has been written;
• Registered authority informed if required to do so. Advice to be sought from the manager or the person on call;
• Confirmation that service users GP has been informed following advice sought from the manager or the person on call.

Following reports being received from staff concerned, a meeting will be held with line managers to discuss the error.

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 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 young person'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.

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.

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.

A locked facility must be available in bedrooms for the storage of medication.

A full list of all self-administered medication must be recorded on the appropriate self-medication record sheet with pharmacy details and quantity brought in.

A suitable receptacle must be in the bedroom for the disposal of dressings, rubber gloves and empty medication packaging. This should be emptied daily: when necessary a sharps box must be provided for the disposal of lancets and needles. Individual service users may be assessed as responsible for cleaning their own rooms and therefore disposing of dressings/sharps etc. In these circumstances the situation must be monitored regularly by the Manager and staff team.

The NMS for Children's Homes also includes a standard for self-administration. It is important to emphasise that the prescribed medicines are the property of the service user for whom they are prescribed and care staff should not assume that these may automatically be removed from the service user. If the home take receipt of medication and pass it onto the YP the YP must sign to confirm they have received it.

In all cases it is the responsibility of the Manager is to make a risk assessment of the situation.