Crossroads Care Children’s medication procedure

C.03b

Children’s medication procedure for managers

1.0 SCOPE

1.1 This procedure and accompanying policy and guidance (C.03a and C.03c) relate to children and young peopleaged 17 or under. Please see the separate adults’medicationpolicy, procedure and guidance(B.02a, B.02b and B.02c) regardingpeople aged 18 and over.The intended outcome of this set of documents is to protect both staff and the children / young people using the service by ensuring the safe and effective handling of medication within Crossroads Care schemes.

1.2 General medication includes:

  • all tablets, capsules, mixtures and liquids to be taken orally (by mouth)
  • liquids, lotions, creams and ointments for topical application (including ear, nose and eye drops)
  • transdermal patches
  • inhaled medication, including the use of inhalers and nebulisers.

1.3 Medication may also be administered by specialised techniques, for example via a percutaneous endoscopic gastrostomy (PEG).

1.4 This procedure and the accompanying policy and guidance will be read in conjunction with the following:

  • children’s personal care policy, procedure and guidance (C.02a, C.02b and C.02c)
  • autonomy and independence policy (D.08).

1.5 The term “parent / person with parental responsibility” as defined in Section 2 of the Children Act 1989 is used throughout the children’s medication policy documents when referring to matters relating to consent.

  • Having parental responsibility is legally distinct from being recognised as a child’s mother or father.
  • Parental responsibility means all the rights, duties, powers, responsibilities and authority which by law a parent of a child has in relation to the child and their property.
  • The term “parent” does not include professional support staff or carers (unless they are also the parent / person with parental responsibility).
  • If a manager has any doubt as to who has parental responsibility of a particular child or young person, then this will need to be established.

2.0 responsibilities OF MANAGERS

2.1 Managers are required to have systems in place to ensure that all staff work according to the children’s medication policy, procedure and guidance when planning or providing care.

3.0 service planning AND REVIEW

3.1 A designated staff member trained in risk assessment and care planning (referred to as a care planner) willcarry out a suitable risk assessment (CT.02) of tasks involvingmedication and prepare a detailed care plan before care is commenced.

3.2 At the initial assessment visit the care planner will determine whethermedicationcan be taken by the child or young person unaided (where appropriate)and if not,whether it can be administered by theirparent / carer prior to the commencement of an episode of care. If there is no alternative, the care planner will assess what help with medication is required and whether this can be provided by Crossroads Care staff.

3.3 Where care workers are required to offer support with or administer medication, therisk assessment will include and clearly document the following:

  • a current list of medication being taken by the child or young person(including the name of the drug, the dose, route and frequency of administration)
  • how the medication is to be taken, for example orally, topically,by inhalation or specialised technique
  • the nature and level of support the care workeris required to provide(see 6.0 below)
  • common side-effects of the prescribed medication
  • arrangements for the storage of and access to medication in the home
  • arrangements for the filling of compliance aids if these are used (see 6.5.3 below)
  • how the child or young person communicates (including non-verbally), particularly how they indicate unhappiness, pain or distress
  • the arrangements for the supply of medication, for example by use of a repeat prescription service
  • any other ‘need to know’ information relating to associated hazards, risks and relevant precautions or actions to be taken in an emergency.

3.4 Staff are not authorised to administer medication unless they are trained and competent to do so and the task is specified in the care plan.The care plan will clearly state whether any help with medication is required and if so, the level of support to be provided.

3.5 Medication will only be listed in a child or young person’s care plan where:

  • staff are involved in providing support with or administering it
  • there is a reliable system in place to ensure the list is kept up to date at all times.

3.6 It is recommended as good practice that, where possible, care planners identify the location of an up to date current list of medication (for example the repeat prescription list supplied by the pharmacy) that staff could access in case of emergency.

3.7Requests for support with non-prescribed or general sale medication will only be agreed with the written instruction of an authorised prescribing practitioner (for example General Practitioner (GP), Paediatrician, pharmacist or Registered Nurse) to confirm it is safe for the child or young person to take. Details will be documented in the care plan.

3.8Where there is a request from the child or young person or their parent / carer for their medication to be given in food or drink, the care planner will need to seek confirmation from the child or young person’s GP or other authorised prescribing practitioner prior to agreeing to administer the medication in this way.

3.9 Crushing or otherwise altering medication can also affect its efficacy and any requests to administer medication in such ways need to be referred to the GP or pharmacist for approval.

3.10 Covert administration of medication

3.10.1 Disguising medication (for example, providing medicine in food or drink) without the consent and knowledge of the child or young person (if appropriate to their age and condition) is referred to as ‘covert administration’ and could potentiallybe regarded as assault.

3.10.2 The covert administration of medicines must only take place under the specific written direction of the child or young person’s GP or other relevant medical practitioner following a best interests assessment and within the context of existing legal and best practice frameworks, such as the Children Act,to protect the child or young person receiving the medicines and the staff involved in giving the medicines. In such cases it is important that the GP provides this advice in writing – verbal advice is not sufficient.

3.10.3 Action agreed following the ‘best interest’ consultation process will be fully recorded in the child or young person’s care plan and medical records. See the autonomy and independence policy(D.08) for further details regarding best interests.

3.11 Medication records will be reviewed, updated and where necessary, amended annually or whenever there is a change to the child or young person’s medication, whichever is sooner, to ensure they remain valid.

4.0 STORAGE OF MEDICATION

4.1 Medication needs to be kept safe from inappropriate or accidental misuse during the period of care.

4.2The care planner willascertain whethermedicationis stored in an identified secure place away from sources of direct heat and according to manufacturers’ requirements.

4.3Where medication is to be administered it is preferable that it is kept separate from medicines belonging to other people in the household.

4.4 If care planners are not satisfied that medication is being stored safely and no suitable arrangement can be made to address this, they may decide to withdraw the service or may decline to provide assistance with medication during the period of care.

4.5Care workerswill be instructed that if storage arrangements are not in accordance with the care plan or are becoming lax, theyneed to discuss it with the child or young person’s parent / carer. If the matter remains unresolved, the care worker is required to inform their line manager.

5.0 CONSENT

5.1 Written consent will need to be obtained for all levels of assistance with medication (see 6.0 below). This includes consent for any support with or administration of medication (including by specialised techniques) that the child or young person takes either on a regular or on an “as required” basis. A model care plan,which incorporates an appropriate consent form is available at CT.03.

5.2 Written consent can be given by a competent child or young person and / or the child or young person’s parent / person with parental responsibility as appropriate. For detailed information regarding consent, please refer to the children’s personal care procedure (C.02b).

6.0 THE THREE LEVELS OF MEDICATION SUPPORT

6.1 There are three different levels of support with medication depending on the needs of the child or young person. These are:

  • general support
  • administering medication
  • administering medication by specialised techniques.

6.2 The levels of support apply to:

  • prescription only medication[1] (POM)
  • pharmacy only items[2] (P)
  • general sale list medication[3] (GSL).

6.3There is a risk thatnon-prescribed remedies / GSL medicines (for example Paracetamol, Ibuprofen) may cause adverse reactions when taken with other prescribed medication. Therefore support with or administration of non-prescribed remedies / GLS medicines will only be included in a care plan with the written authorisation from a prescribing practitioner or pharmacist.

6.3.1 If added to the care plan, non-prescribed remedies and GSLs will be treated as if they were prescribed medication and recorded accordingly.

6.3.2 Managers need to instruct care workers that they are not permitted to:

  • provide support with or administer non-prescribed remedies / GSL medicines unless they are included in the child or young person’s care plan
  • offer advice on the treatment of minor ailments.

6.4 Please note that some nurses and pharmacists are now authorised to prescribe certain types of medication (see 3.7 above).

6.5 Generalsupport with medication

6.5.1 This level of support is given when the child or young person:

  • is able to takeoverall responsibility for their own medication
  • the care worker has not been required to select the medication.

6.5.2 General support includes:

  • manipulation of a container (for example opening a bottle or pouring outliquid medication) at the request of the child or young person
  • an occasional reminder or prompt from the care worker to a child or young person to take their medication (a persistent need for reminders may indicate thechild or young person does not have the ability to take responsibility for their medication).

6.5.3A child or young person may be able (where appropriate) to retain independence to take their own medication by using a compliance aid, for example where the they find it hard to open packs and bottles or if they are having difficulty remembering whether or not they have taken theirmedication.

  • If the compliance aid is a pharmacist-filled, sealed blister pack, the care worker may offer general support to the child or young person to access and take their medication as described in 6.5.2 above.
  • If the compliance aid is an unsealed, compartmentalised container filled by the child or young person’s parent / carer, the care planner will need to assess that the necessary arrangements are in place to minimise the risk for potential error. They will then need to document in the child or young person’s care plan that the care worker is allowed to offer general support to the child or young person to access / take their medication from the unsealed compliance aid.

Please note: Care workers are only allowed to offer general support with medication contained in an unsealed compliance aid filled by a family member when the child or young person is able to take overall responsibility for their own medication.

6.5.4 Although care workers are not taking responsibility for the administration of the medication when offering general support, they need to be instructed to remain vigilant to ensure the child or young person takes their medication correctly and to contact their line manager / the person on call immediately with any concerns.

6.6 Administering medication

6.6.1 This level of support involves care workers giving medication to the child or young person. It will only be offered if an assessment identifies that the child or young person is unable to take responsibility for their own medication and needs assistance.

6.6.2 Medication will only be given from the original container into which it was dispensed and only to the child or young person for whom it was prescribed. An original container includes:

  • a pharmacist-labelled bottle or packet
  • a pharmacist-filled, sealed blister pack (restrictions apply – see 7.10 below).

Care workers will notadminister medication from containers filled by anyone other than a prescribing practitioner or pharmacist.

6.6.3Administration of medication by the care worker may include:

  • selection and preparation of medication for immediate administration
  • selection and measurement of a dose of liquid medication
  • selection and administration of sub-lingual medication
  • selection and instillation of ear, nose or eye drops
  • application of a medicated cream / ointment
  • application of a transdermal patch
  • selection and administration of medication via an inhaler or nebuliser
  • regularly prompting a child or young person to take their medication when they are not able to take responsibility for their own medication.

6.6.4Care workers are not permitted to administer medication if they have not received the necessaryinformation, instruction and training or do not feel confident and competent to do so. It is the responsibility ofthe line manager to ensure that care workers are not given duties they are not capable of carrying out.

6.6.5 When informed by a care worker that there is a problem with medication (including the contents of a blister pack), the line manager / person on call will contact the child or young person’s pharmacist / duty pharmacist for advice on what action to take to resolve the issue.

6.6.6 Where a label becomes detached from an individual item of medication or is illegible, the medication must not be used and will need to be returned to the pharmacist. Care workers will be instructed never to alter labels or re-attach them to containers.

6.7Administering medication by specialised techniques

6.7.1 Administration of medication by any specialised technique is referred to as a specialised task.

6.7.2 Specialised tasks involving medication include:

  • rectal administration (for example diazepam for epileptic seizure)
  • buccal administration (for example midazolam for epileptic seizure)
  • administration of medication through a percutaneous endoscopic gastrostomy (PEG)
  • administration of insulin using a pen device
  • monitoring of infusion pumps (such as syringe drivers) for volume and battery life.

Please see Appendix 1 at the end of this document for the full list of specialised tasks.

6.7.3 The care planner will ensure that the specialised task protocol is followed before agreeing to administer medication using a specialised task and prior to commencing care. Please see Appendix 2 at the end of this document for full details of the specialised task protocol, including training requirements.

6.7.4 Specific model protocols are available for the following specialised tasks:

  • Administration of insulin using a pen device (DT.06)
  • Administration of buccal midazolam (DT.08).

6.8 ‘As required[4]’ (PRN) medication

6.8.1 General support with / administration of ‘as required’ medication needs to be subject to a suitable risk assessment. Details, including the indications for offering the medication, will be recorded in the care plan explaining the checking procedure to be followed.

6.8.2 Care workers will be instructed to follow the accompanying children’s medication guidance (C.03c). This states thatbefore giving support with or administering ‘as required’ medication, care workers are required to check that:

  • administration will not exceed the maximum dose to be taken over 24 hours
  • there has been sufficient time lapse between doses.

In practice care workers will do this by referring to written records and by asking the child or young person (where appropriate) and / or their parent / carer, in order to establish how much medication has already been taken and when.

7.0 DAILY RECORDS

7.1 Whatever the level of support agreed(see 6.0 above), detailed records of allmedication handling will be entered on the client report form, including general support, administration of medication and administration by specialised technique.

7.2 When medication has been administered (including by specialised technique), this will be recorded on the drug administration form (DT.02) as well as on the client report form.

7.3 Records will also be kept of:

  • all prompts to take medication
  • non-successful administrations of medication
  • any suspected adverse reactions to medication.

7.4Wherestaff from anotherorganisation(such as community nurses), also administer medication it may be assessed as appropriate to share forms. Copies of allcompleted drug administration forms will need to be taken in order to ensure that full and accurate medication records are available in the Crossroads Care office. Where another organisation’s forms are used (including those supplied by the pharmacist with sealed blister packs) thecare plannerwill ensure that they record all necessary information as outlined at 7.9 and 7.10 below.

7.5Records will be written in black ink. Care workers will always sign or initial their records. A list of all staff signatures and initials will be kept in the office for cases where verification may be required.

7.6Care workers need to inform their line managerif record sheets (including client report forms and drug administration forms)are running low in the home so that arrangements can be made for new forms to be issued.

7.7 Completed client report forms and drug administration forms need to be transferred to the Crossroads Care office routinely (at least monthly or as required by local commissioner agreements) and also when the service ceases. Managers need to have a system in place which ensures the timely return and checking of client report forms and drug administration forms prior to filing.

7.8General support

7.8.1 When offering general support the care worker willbe instructed to record on the client report form exactly what they did.

For example they need to record on the client report form if they:

  • reminded a child or young person to take their medication
  • offeredsupport by opening a container, with details of which container was opened.

7.9 Administration of medication

7.9.1 When administering medication (including by specialised techniques) more detailed records are required. The following details need to be provided as instructions for care workers on the drug administration form:

  • the name of the child or young person taking the medication
  • the name of the medication
  • the dose of the medication
  • the time it is to be administered
  • any further special instructions.

7.9.2 Care workers willbe instructed to sign / initial the appropriate section of the drug administration form for each separate medicine given, each time it is given.