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CH167-Children and Young People’s Medication Policy

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Children and Young People’s Medication Policy

1. Purpose

The purpose of this policy is to ensure the safe, effective, person-centred and legally compliant management of medicines for children and young people receiving care and support from {{org_field_name}}.

This policy supports compliance with the Health and Social Care Act 2008 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including Regulation 9 Person-centred care, Regulation 10 Dignity and respect, Regulation 11 Need for consent, Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 16 Receiving and acting on complaints, Regulation 17 Good governance, Regulation 18 Staffing and Regulation 20 Duty of candour.

This policy reflects CQC expectations for medicines management and medicines optimisation, NICE guidance on managing medicines in care homes, and relevant professional guidance. It sets out how {{org_field_name}} will assess medicines needs, obtain consent, administer medicines safely, record medicines accurately, respond to medicines incidents and ensure staff are trained and competent.

The policy ensures that children and young people’s medicines are managed safely, with appropriate consent, dignity, confidentiality, safeguarding oversight and partnership working with parents, carers, people with parental responsibility, placing authorities, prescribers, pharmacists and other healthcare professionals.

2. Scope

This policy applies to all staff at {{org_field_name}} who are involved in assessing, receiving, ordering, transporting, storing, administering, supporting, recording, auditing, returning or disposing of medicines for children and young people under the age of 18 who live in, stay at, or receive care from the care home.

This policy applies to prescribed medicines, homely remedies, over-the-counter medicines, PRN medicines, controlled drugs, emergency medicines, high-risk medicines, topical preparations, inhalers, injections, nutritional products, enteral feeds, appliances, oxygen or medical gases where applicable, and delegated healthcare tasks involving medicines.

This policy applies in the care home, during escorted outings, temporary leave, school attendance where medicines support has been agreed, hospital appointments, transfers, short breaks, respite stays and any other situation where {{org_field_name}} has agreed responsibility for supporting or managing a child or young person’s medicines.

Staff must only provide the level of medicines support agreed in the child or young person’s medicines care plan, risk assessment and consent documentation.

3. Related Policies

This policy must be read in conjunction with:

4. Policy Details

4.1 Prescribing and Consent

Medicines must only be administered or supported where there is a valid prescription, prescriber’s direction, agreed homely remedy protocol, or written authorisation for over-the-counter medicines, and where the child or young person’s medicines care plan confirms the level of support to be provided.

Consent must be obtained and recorded before staff administer or support medicines. Consent may be given by the young person aged 16 or 17 where they have capacity to consent; by a child under 16 where they are assessed as Gillick competent for the specific decision; by a person with parental responsibility where the child is not able to consent for themselves; by a court or other lawful authority where required; or in an emergency where action is necessary to preserve life or prevent serious deterioration while urgent clinical advice is sought.

Gillick competence must only be used when assessing whether a child under 16 has sufficient understanding and maturity to make the specific decision about the medicine. The assessment and outcome must be recorded.

Young people aged 16 and 17 must be presumed to have capacity to consent unless there is evidence that they may lack capacity. Where a young person aged 16 or 17 may lack capacity, staff must follow the Mental Capacity Act 2005 principles, complete or obtain an appropriate capacity assessment, and ensure that any best interests decision is recorded.

Where a child or young person is looked after, subject to a care order, accommodated by a local authority, or where parental responsibility is shared, staff must confirm who has legal authority to consent to medicines and record this in the care plan before medicines support begins.

Refusal of medicines must be respected unless there is a lawful basis for urgent intervention. Staff must record the refusal, assess immediate risk, inform the Registered Manager, parent or person with parental responsibility where appropriate, and seek advice from the prescriber, pharmacist, NHS 111, 999 or other relevant healthcare professional according to the level of risk.

Over-the-counter medicines must not be administered unless there is written consent, the medicine is suitable for the child or young person’s age, weight, allergies, diagnosis and other medicines, and the maximum dose in 24 hours is clear. Staff must check whether the child or young person has already received the same or a similar medicine from parents, school, hospital or another setting to prevent overdose.

4.2 Medicines Assessment and Care Planning

Before {{org_field_name}} agrees to administer or support a child or young person with medicines, the Registered Manager or delegated competent person must ensure that a medicines assessment is completed.

The assessment must identify the child or young person’s current medicines, allergies, sensitivities and adverse reactions; the reason each medicine is prescribed or used, where known; the dose, route, timing, formulation, maximum dose and any special instructions; and whether medicines are regular, PRN, short course, emergency, controlled, high-risk or specialist medicines.

The assessment must also identify the level of support required, including prompting, assisting, administering, observing, recording or ordering; consent arrangements and who has parental responsibility; the child or young person’s wishes, preferences, communication needs and ability to self-administer; storage arrangements; monitoring requirements; side effects; escalation actions; and when urgent help is required.

A medicines care plan must be in place before staff administer or support medicines, except in a genuine emergency. The care plan must be reviewed whenever medicines change, following a medicine-related incident, following hospital discharge, following a change in risk, or at least monthly as part of medicines governance.

4.3 Safe Storage and Labelling

Medicines must be stored safely, securely and in accordance with the prescriber’s instructions, pharmacy label, manufacturer’s instructions, the child or young person’s medicines care plan and {{org_field_name}} medicines procedures.

Medicines must be stored in a locked medicines cupboard, trolley, room, fridge or other secure storage facility appropriate to the medicine and the assessed risks. Access must be restricted to authorised and competent staff.

Medicines must remain in their original packaging with the pharmacy dispensing label attached. Staff must not administer medicines from unlabelled containers, altered labels, loose tablets, unclear instructions, expired medicines or medicines prescribed for another person.

Medicines requiring refrigeration must be stored in a dedicated medicines fridge unless the risk assessment confirms another safe arrangement. Fridge temperatures must be monitored and recorded each day the fridge is in use, with action taken and recorded if the temperature is outside the required range.

Controlled drugs must be stored, recorded, administered, checked and disposed of in line with controlled drugs legislation, {{org_field_name}} Controlled Drugs Policy and local pharmacy arrangements.

Emergency medicines, including adrenaline auto-injectors, rescue medicines, inhalers, epilepsy rescue medicines and diabetes emergency treatments, must be readily accessible to trained staff while remaining safe from unauthorised access. Staff must know where emergency medicines are kept and must check expiry dates and availability at the frequency stated in the care plan.

Medicines required during outings, leave, school attendance, hospital appointments or activities must be transported securely, protected from heat, cold or damage, and accompanied by clear administration instructions and records.

Sharps, needles, lancets and injectable medicines must be stored and disposed of safely using approved sharps containers and clinical waste procedures.

Expired, discontinued, refused or surplus medicines must be recorded and returned to the supplying pharmacy, parent, person with parental responsibility or agreed responsible person in line with the care plan and local disposal arrangements. Staff must not dispose of medicines in household waste, sinks or toilets.

4.4 Administration Procedures

Only trained, competent and authorised staff may administer or support children and young people with medicines.

Before administering or supporting any medicine, staff must check the child or young person’s identity, allergies, medicine name, strength, dose, route, time, formulation, expiry date, storage requirements, current MAR chart, medicines care plan and any special instructions.

Staff must follow the rights of medicines administration, including the right child or young person, right medicine, right dose, right time, right route, right reason, right documentation and right to refuse.

Staff must not administer a medicine where instructions are unclear, the label is missing or altered, the dose has changed without written confirmation, the medicine appears damaged or contaminated, the medicine has expired, or the child or young person’s condition suggests that clinical advice is required.

Handwritten MAR entries, transcribed instructions or changes to medication instructions must be checked and signed by two competent staff members and supported by written evidence from the prescriber, pharmacy or discharge documentation.

Verbal instructions must only be accepted in exceptional circumstances from an appropriate healthcare professional. The instruction must be documented immediately, read back for confirmation, and followed by written confirmation as soon as possible.

A second trained and competent staff member must check controlled drugs, high-risk medicines and any medicine where the care plan, risk assessment, prescriber, pharmacist or organisational procedure requires a second check. Where a second check is not possible, the reason and risk control must be recorded and escalated to the Registered Manager.

Staff must remain with the child or young person until the medicine has been taken, unless the care plan confirms that self-administration is safe. Administration must be recorded immediately after the medicine has been given, not before.

Where a medicine is refused, missed, delayed, unavailable, vomited or spat out, staff must record this using the correct MAR code and escalate according to the care plan, medicine type and level of risk.

4.5 PRN Medicines

PRN medicines must only be administered where there is a clear PRN protocol in place.

The PRN protocol must state what the medicine is for, the signs or symptoms that indicate it may be needed, the dose, route, minimum time between doses, maximum dose in 24 hours, when the medicine must not be given, expected effects, possible side effects, monitoring requirements and when clinical advice must be sought.

Staff must record the reason for giving a PRN medicine and the effect of the medicine after administration. Lack of effect, repeated use or increased need must be escalated for clinical review.

4.6 Controlled Drugs

Controlled drugs must be managed in accordance with legal requirements, {{org_field_name}} Controlled Drugs Policy, pharmacy advice and the child or young person’s care plan.

Controlled drugs must be stored securely, recorded in the controlled drugs register where required, checked at each administration, and included in routine balance checks.

Administration of controlled drugs must be recorded on the MAR chart and, where required, in the controlled drugs register. Records must include the date, time, dose, balance remaining, signatures of staff involved and any discrepancy.

Controlled drug discrepancies must be reported immediately to the Registered Manager and investigated without delay. Where required, the pharmacy, prescriber, safeguarding team, police, CQC or controlled drugs accountable officer must be notified.

4.7 Specialist and Emergency Medications

Where children or young people require specialist, high-risk or emergency medicines, these must only be administered by staff who have received child-specific training and have been assessed as competent for that specific medicine, route, device and care plan.

Specialist and emergency medicines may include insulin, glucagon, epilepsy rescue medicine, rectal diazepam, buccal midazolam, adrenaline auto-injectors, inhalers, nebulised medicines, oxygen or medical gases, enteral medicines, PEG or gastrostomy medicines, anticoagulants, immunosuppressants, medicines requiring blood test monitoring, or any other medicine identified as high risk.

An individual protocol must be in place for specialist or emergency medicines. The protocol must state the diagnosis or condition being treated, signs and symptoms requiring the medicine, dose, route, device, timing, maximum dose, repeat dose instructions, monitoring before and after administration, side effects, adverse reactions, when to call 999 or NHS 111, when to contact the prescriber, parent or person with parental responsibility, and what records must be completed.

Where a healthcare professional delegates a healthcare task involving medicines to care home staff, the delegation must be documented. Staff must not accept or carry out delegated tasks unless they have been trained, assessed as competent and authorised by the Registered Manager.

Staff must not vary specialist medicine doses, omit doses, give correction doses, use rescue medicines outside the written protocol, or change timings unless this is clearly prescribed or confirmed by an appropriate healthcare professional and recorded.

4.8 Supporting Self-Administration

Children and young people will be supported to self-administer medicines where this is appropriate to their age, maturity, capacity, wishes, health condition and risk assessment.

A self-administration risk assessment must be completed before self-administration begins and reviewed whenever medicines, risks or circumstances change.

The assessment must consider whether the child or young person understands the medicine and what it is for, whether they can take the correct dose at the correct time and by the correct route, risks to the child or young person and others, safe storage, whether the child or young person may keep medicines in their room or on their person, risks of overdose, misuse, missed doses, sharing medicines, coercion or self-harm, and arrangements for monitoring, recording and review.

Where self-administration is agreed, the care plan must clearly state what the child or young person will do independently, what staff will supervise or check, how records will be maintained and when staff must intervene or escalate concerns.

4.9 Record Keeping and Audit

Each child or young person who receives medicines support must have an individual MAR chart or electronic MAR record.

MAR records must include the child or young person’s full name and date of birth, known allergies, sensitivities and adverse reactions, medicine name, strength, formulation, dose, route, frequency, start date and stop date where applicable, special instructions, PRN instructions and maximum doses, prescriber or pharmacy details where available, staff signature or initials, date and time of administration, relevant non-administration codes, reason and outcome for PRN medicines, and running balance for controlled drugs where required.

Staff must complete records immediately after administration or support. Records must be factual, legible, accurate, contemporaneous and must not be altered without a clear audit trail.

The Registered Manager or delegated medicines lead must audit MAR charts, controlled drugs records, stock balances, fridge temperatures, PRN protocols, medicine returns, errors, omissions and actions taken at least monthly and more frequently where risk indicates.

Audit findings must be recorded, analysed for themes and used to improve practice. Action plans must include the action required, responsible person, timescale and evidence of completion.

4.10 Training and Competency

Staff must not administer, support or manage children and young people’s medicines until they have completed appropriate training, been assessed as competent, and been authorised to do so by the Registered Manager.

Training and competency must be appropriate to the staff member’s role and the medicines tasks they perform. This must include safe medicines handling and administration, child and young person consent, Gillick competence, parental responsibility and capacity, safeguarding and professional boundaries, allergy and anaphylaxis awareness, MAR chart and eMAR recording, PRN medicines, controlled drugs where relevant, homely remedies and over-the-counter medicines, medicine errors and omissions, storage, refrigeration, stock checks, disposal, infection prevention, hand hygiene, sharps safety, specialist medicines and delegated healthcare tasks where relevant.

Staff supporting children or young people with a learning disability, autism or both must receive learning disability and autism training appropriate to their role, in line with the legal requirement and the Oliver McGowan Code of Practice.

Where children or young people are prescribed psychotropic medicines, staff must understand and apply STOMP and STAMP principles where relevant, including monitoring side effects, supporting medication reviews and escalating concerns about over-medication.

Competency must be assessed before staff practise independently, then reviewed at least annually, after any medicine-related incident, following prolonged absence, where a new medicine task is introduced, or where supervision, audit or practice concerns indicate a need for reassessment.

Competency records must be retained and must show the training completed, assessor, date, outcome, any restrictions on practice and date for review.

4.11 Medication Errors and Reporting

All medicine errors, near misses, missed doses, delayed doses, wrong doses, wrong medicines, administration to the wrong person, recording errors, storage failures, stock discrepancies, adverse reactions, refusals with risk, or concerns about misuse or diversion must be reported immediately to the Registered Manager or person in charge.

Staff must take immediate action to protect the child or young person from harm. This may include contacting the prescriber, pharmacist, NHS 111, 999, parent, person with parental responsibility, placing authority, safeguarding team or other relevant healthcare professional.

All incidents must be recorded using the incident reporting process and reflected in the MAR chart, care notes and medicines records as appropriate.

The Registered Manager must ensure that medicine incidents are investigated proportionately, including root cause analysis where required. The investigation must identify immediate actions, contributory factors, learning, duty of candour requirements, safeguarding considerations and whether external notification is required.

Where a medicine incident results in harm, significant risk of harm, abuse, neglect, unsafe practice or a notifiable safety incident, {{org_field_name}} must follow its safeguarding, statutory notification and duty of candour procedures.

Children, young people, parents and those lawfully acting on their behalf must receive a timely and honest explanation of what happened, what action has been taken, any apology required under the duty of candour, and what will be done to reduce the risk of recurrence.

Themes from medicine incidents, near misses and audits must be reviewed through governance meetings and used to improve training, supervision, staffing, systems and care planning.

4.12 Partnership with Families and Professionals

{{org_field_name}} works in partnership with children and young people, parents, carers, people with parental responsibility, placing authorities, GPs, paediatricians, pharmacists, community nurses, specialist nurses, schools and other relevant professionals to ensure safe and coordinated medicines management.

On admission, return from hospital, transfer from another service, respite stay, short break or change in placement, staff must confirm the child or young person’s current medicines as soon as possible and on the same day wherever practicable.

Hospital discharge summaries, clinic letters, pharmacy labels, prescriptions and professional instructions must be checked against the MAR chart and care plan. Any discrepancy must be clarified before staff administer the medicine, unless urgent clinical advice confirms it is safe to proceed.

Parents and people with parental responsibility must be kept informed of medicine changes, incidents, concerns, refusals and reviews, unless there is a lawful reason not to share information.

Medication reviews must be requested or supported where medicines change frequently, PRN medicines are used regularly, side effects are suspected, the child or young person’s condition changes, psychotropic medicines are used, or there are repeated refusals, errors or omissions.

Communication must be accessible to the child or young person and their family. Where language, literacy, disability, sensory need, neurodiversity or communication differences create barriers, reasonable adjustments must be made.

4.13 Safeguarding, Misuse and Diversion of Medicines

Medicines concerns may be safeguarding concerns where they involve deliberate harm, neglect, omission, misuse, diversion, coercion, unauthorised administration, inappropriate restraint, inappropriate sedation, over-medication, under-medication or failure to seek medical advice.

Staff must report any concern that a child or young person’s medicines are being misused, withheld, shared, diverted, stolen, administered inappropriately or used to control behaviour without lawful authority.

The Registered Manager must consider whether the concern requires referral to the local authority children’s safeguarding arrangements, the placing authority, police, CQC, the controlled drugs accountable officer, professional regulator or other relevant body.

Medicines must never be used as a form of punishment, restraint, convenience, behavioural control or sedation unless this is clearly prescribed, clinically justified, lawful, in the child or young person’s best interests, and subject to appropriate review.

4.14 Covert Administration

Covert administration means giving medicine in a disguised form without the child or young person knowing it is being given. It must never be used for staff convenience, to save time, to manage behaviour, or without lawful authorisation.

Covert administration must not be used for a child or young person who has capacity or is Gillick competent to make the specific decision about the medicine.

Covert administration may only be considered in exceptional circumstances where the child or young person lacks capacity or competence for the specific medicine decision, refusal of the medicine places them at risk of significant harm, a best interests or lawful decision-making process has taken place, relevant people have been consulted, the pharmacist has confirmed how the medicine can be given safely, and the decision, method, review date and monitoring arrangements are recorded in the care plan.

Any covert administration arrangement must be reviewed regularly and immediately if the child or young person’s capacity, competence, risk, medicines or circumstances change.

4.15 Homely Remedies and Over-the-Counter Medicines

Homely remedies and over-the-counter medicines must only be used where {{org_field_name}} has an approved homely remedies procedure, written parental or lawful consent, and clear guidance from a pharmacist, GP, prescriber or agreed protocol.

The child or young person’s care plan must state which homely remedies or over-the-counter medicines may be used, the symptoms they may be used for, dose, route, frequency, maximum dose, contraindications, allergies and when medical advice must be sought.

Staff must check that the child or young person has not already received the same or similar medicine from another source, including parents, school, hospital, respite care or another staff member.

Homely remedies and over-the-counter medicines must be recorded on the MAR chart, including the reason given and the outcome.

4.16 Allergies, Sensitivities and Adverse Reactions

Allergies, sensitivities and previous adverse reactions must be recorded clearly on the care plan, MAR chart and any electronic medicines system.

Staff must check allergy information before administering or supporting any medicine.

Where allergy information is missing, unclear or contradictory, staff must escalate this to the Registered Manager and seek clarification before administering medicines, unless emergency clinical advice confirms otherwise.

Suspected adverse reactions must be treated as a clinical concern. Staff must seek medical advice according to the level of risk, record the concern, inform the Registered Manager and update the care plan where required.

4.17 Ordering, Supply and Stock Control

Where {{org_field_name}} is responsible for ordering or managing medicines supply, this must be carried out by trained and authorised staff in line with the care plan and local pharmacy arrangements.

Medicines received into the care home must be checked against the prescription, MAR chart, pharmacy label and care plan. Any discrepancy must be investigated and resolved before administration unless urgent clinical advice confirms it is safe to proceed.

Stock levels must be monitored to reduce the risk of missed doses, overstocking, expired medicines or unsafe storage. Staff must report low stock, missing medicines, damaged medicines or supply problems promptly to the Registered Manager or delegated medicines lead.

Medicines must not be borrowed from another child or young person, shared between residents, or used after the stop date or expiry date.

4.18 Medicines During Outings, Leave and Transfers

Where a child or young person requires medicines during outings, home leave, school attendance, hospital attendance, appointments or transfer to another service, staff must plan in advance so that medicines remain available, secure and correctly recorded.

The care plan must state who is responsible for carrying, storing, administering and recording medicines during the outing, leave or transfer. Emergency medicines must remain accessible to trained staff at all times.

Medicines sent with parents, people with parental responsibility, escorts, schools, hospitals or another service must be recorded, including the medicine name, quantity, date, time, person receiving the medicine and expected arrangements for return or onward management.

When the child or young person returns to the care home, staff must check and record any medicines administered while away from the service and update the MAR chart and care notes as required.

4.19 Psychotropic Medicines, STOMP and STAMP

Where a child or young person is prescribed psychotropic medicines, staff must understand the purpose of the medicine, expected benefits, possible side effects, monitoring requirements and review arrangements.

{{org_field_name}} will support the principles of STOMP and STAMP where relevant. Staff must monitor and report concerns about side effects, over-sedation, behavioural changes, physical health concerns, emotional changes, increased use of PRN medicines or medicines being used inappropriately to control behaviour.

Psychotropic medicines must be reviewed by the appropriate prescriber or specialist at agreed intervals and whenever there are concerns about effectiveness, side effects, deterioration, repeated incidents or changes in presentation.

Medicines must not be used to control behaviour unless they are prescribed, clinically justified, lawful, proportionate, in the child or young person’s best interests and subject to regular review.

5. Compliance Framework

This policy supports compliance with the following legislation, regulations and guidance:

6. Policy Review

This policy will be reviewed at least annually or sooner where required.

An earlier review will take place following:

The review will be led by the Registered Manager in collaboration with the medicines lead, safeguarding lead and relevant staff.

Staff will be informed of policy changes, and additional training, supervision or competency checks will be completed where changes affect practice.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.

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