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{{org_field_name}}
Registration Number: {{org_field_registration_no}}
Children’s Medication Policy
1. Purpose
The purpose of this policy is to ensure the safe handling, administration, and management of medications for children and young people at {{org_field_name}}. We are committed to protecting the health and well-being of each child by managing medicines in line with all legal requirements and best practices. This policy establishes clear procedures so that staff administer medicines safely, store and dispose of them properly, and maintain accurate records. By following this policy, {{org_field_name}} complies with the Regulation and Inspection of Social Care (Wales) Act 2016 and the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 – in particular, Regulation 58 which requires us to have robust arrangements for the safe storage, supply, recording, and disposal of medicines. Adhering to this policy ensures we meet Care Inspectorate Wales (CIW) standards and keep children safe from harm related to medication.
2. Scope
This Medication Policy applies to all staff members involved in the care of children at {{org_field_name}}, including care support workers, senior staff, and the management team. It covers the handling of all medicines – prescribed medications, over-the-counter remedies, and controlled drugs – for any child or young person living in our residential care home. It applies wherever medication is managed: on-site at the home, during off-site activities or appointments, and during any outings or home visits. The policy is focused on children’s services and is designed so that staff at all levels can understand and follow it. All employees must familiarize themselves with these procedures and adhere to them at all times. Any agency staff or health professionals administering or assisting with medicines in our home are also expected to follow these standards. In essence, this policy encompasses everything from ordering and storage of medicines, through to administration, recording, error management, and training of staff. It is meant to protect both the children in our care and the staff by setting clear guidelines and expectations.
Note: This policy is specific to the management of medications for children and young people in our care. It does not cover broader clinical treatments or invasive medical procedures, which are addressed in other healthcare policies if applicable. For guidance on emergency medical situations or other health issues, staff should refer to the relevant policies (e.g. First Aid Policy or Emergency Medical Treatment Policy) in conjunction with this medication policy.
3. Legislative and Regulatory Context
The management of medicines at {{org_field_name}} is governed by legislation, statutory guidance and regulatory requirements applicable to care home services for children in Wales. The service provider and Responsible Individual must ensure that this policy and the practices arising from it remain consistent with current legislation, statutory guidance and the service’s Statement of Purpose.
The principal legal and regulatory framework includes:
- Regulation and Inspection of Social Care (Wales) Act 2016, as amended: This is the principal statutory framework governing regulated care services in Wales. {{org_field_name}} must operate in accordance with its registration with Care Inspectorate Wales (CIW) and the requirements applying to the regulated service.
- Health and Social Care (Wales) Act 2025: This Act amends the Regulation and Inspection of Social Care (Wales) Act 2016 and, from 1 April 2026, introduces requirements affecting restricted children’s services, including children’s home services. Where these provisions apply to {{org_field_name}}, the service provider must ensure that its registration, legal status and Statement of Purpose remain compliant with the amended statutory framework.
- The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended: These Regulations set out the requirements applying to registered service providers and Responsible Individuals. In relation to medicines, Regulation 58 requires the service provider to have arrangements in place to ensure that medicines are stored and administered safely. These arrangements must include:
- maintaining a sufficient supply of medicines;
- effective ordering and re-ordering of medicines;
- accurate recording of medicines;
- safe handling of medicines;
- safe disposal of medicines; and
- regular auditing of the storage and administration of medicines.
Regulation 58 also requires the service provider to have a policy and procedures concerning the safe storage and administration of medicines and to ensure that the service is provided in accordance with those policies and procedures.
- Regulation 59 and Schedule 2 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended: The service must keep and maintain the records required by the Regulations. This includes, for each individual, a record of all medicines kept by the service for that individual and the date and time on which medicines are administered. Records relating to children must be retained for the period required by Regulation 59 and, where applicable, transferred to the placing authority when the service ceases to be provided to that child.
- Regulation 60 and Schedule 3 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended: The service provider must notify CIW and other specified authorities of events prescribed by the Regulations. A medication incident must therefore be considered against the statutory notification criteria. Medication errors are not automatically notifiable to CIW solely because they are medication errors; however, notification must be made where the circumstances meet a category specified in Regulation 60 and Schedule 3.
- Welsh Government Statutory Guidance issued under section 29 of the Regulation and Inspection of Social Care (Wales) Act 2016: The service provider and Responsible Individual must have regard to the current statutory guidance when meeting their regulatory responsibilities. In relation to medicines, the service must have systems for the management and oversight of ordering, re-ordering, reconciliation, storage of controlled and non-controlled medicines, administration including covert administration, recording and disposal. Arrangements must also support appropriate self-management of medicines, staff training and competency, medicines auditing and the safe undertaking of any medicines-related activities delegated by healthcare professionals.
- Social Services and Well-being (Wales) Act 2014: The principles of well-being, voice, choice, participation and safeguarding under this Act must be reflected in the way children and young people are supported with their health and medicines.
- Care Planning, Placement and Case Review (Wales) Regulations 2015, where applicable: For children who are looked after by a local authority, medicines management must be consistent with the child’s care and support plan, health plan, placement arrangements and relevant decisions made by the placing authority.
- Human Medicines Regulations 2012, as amended: Medicines must be obtained, supplied, handled and administered in accordance with applicable medicines legislation and the directions of an authorised prescriber.
- Medicines Act 1968, insofar as provisions remain applicable: Medicines must be handled within the applicable legal framework governing medicinal products.
- Misuse of Drugs Act 1971, Misuse of Drugs Regulations 2001 and Misuse of Drugs (Safe Custody) Regulations 1973, as amended: Controlled drugs must be handled, stored, recorded and disposed of in accordance with the requirements applicable to the particular controlled drug and the service.
- Mental Capacity Act 2005: The Mental Capacity Act applies to people aged 16 and over. Where a young person aged 16 or 17 may lack capacity to make a specific decision concerning medication, staff must follow the Mental Capacity Act 2005 and its Code of Practice, alongside any other applicable legal framework.
- Consent for children under 16: For a child under 16, decision-making must take account of whether the child has sufficient understanding and intelligence to make the particular decision, commonly referred to as Gillick competence. The Fraser guidelines relate specifically to contraceptive advice and treatment and must not be treated as a general test of competence for all medication decisions. Where a child is not competent to make the particular decision, lawful consent or authority must be established in accordance with the circumstances, including the rights and responsibilities of persons with parental responsibility, the placing authority and, where necessary, the court.
- Data Protection Act 2018 and UK General Data Protection Regulation: Medication information forms part of the child’s confidential health information and must be processed, shared, stored and retained securely and lawfully.
- Current national medicines guidance: {{org_field_name}} will have regard to relevant current national medicines guidance, including appropriate NICE guidance and Welsh medicines optimisation guidance, where this is applicable to children’s care home services and consistent with Welsh legislation and statutory guidance.
The service will keep this policy under review and update it when legislation, statutory guidance, CIW requirements, the Statement of Purpose or relevant national medicines guidance changes. Where there is any conflict between this policy and a statutory requirement, the statutory requirement will take precedence and the policy will be reviewed without delay.
4. Key Principles of Safe Medication Management
At {{org_field_name}}, we follow key principles to ensure that medication is managed in a child-centred and safe manner. These principles guide all staff actions related to medicines:
- Safety First: The health and safety of the child is our paramount concern when handling medications. We strive to eliminate errors and reduce risks at each step – from storage to administration – so that no child is harmed by incorrect or unsafe medication practices. This includes double-checking details and never taking shortcuts that could jeopardise safety.
- Child-Centred Approach: We consider the needs and rights of each child. This means involving children in age-appropriate ways in their medication routines and decisions. We respect their dignity and privacy (for example, administering medicines discreetly) and listen to their preferences or concerns about taking medicine. Wherever appropriate, especially for older young people, we encourage and educate them to take increasing responsibility for their own health and medicines, as long as it is safe (e.g. a 17-year-old responsibly using their inhaler).
- Consent and Understanding: Medicines must only be administered where there is lawful authority to do so and in accordance with the child’s or young person’s individual circumstances. The existence of a prescription must not, by itself, be treated as evidence that valid consent has been obtained for every medication decision.
Children and young people must be given information about their medicines in a way that is appropriate to their age, maturity, communication needs and level of understanding, and their views, wishes and feelings must be taken into account.
For a child under 16, staff must consider whether the child has sufficient understanding and intelligence to understand the particular proposed treatment or medication decision. Where the child is Gillick competent in relation to that particular decision, their consent and views must be respected within the applicable legal framework. The Fraser guidelines relate specifically to contraceptive advice and treatment and must not be used as a general test for competence in relation to all medicines.
Where a child under 16 is not competent to make the particular decision, staff must establish who has lawful authority to consent or make the relevant decision. This may include a person with parental responsibility or, depending on the child’s legal status and the scope of the relevant order or care arrangements, the placing local authority. Staff must not assume that every person involved in the child’s care has authority to consent to every form of treatment.
For young people aged 16 and 17, the Mental Capacity Act 2005 applies when considering whether the young person has capacity to make the particular decision. A young person must be presumed to have capacity unless it is established otherwise in accordance with the Act. Where the young person lacks capacity to make the particular decision, any decision made on their behalf must follow the applicable legal framework and must be properly documented.
Any disagreement, uncertainty about consent or parental responsibility, significant refusal of essential treatment, or proposed treatment that may involve restraint, covert administration or a deprivation of liberty must be escalated immediately to the Registered Manager and the relevant healthcare professional. Legal or placing-authority advice must be obtained where required.
The child’s or young person’s consent, refusal, views and any decision made by another person with lawful authority must be clearly recorded in the child’s records and reflected in the Personal Plan or Health Plan where relevant.
- Accountability and Accuracy: Every step of medicine management is done with a high level of accountability. Staff understand they have a duty of care to handle all medicines correctly . We maintain accurate records for every medicine received, administered, or disposed of, ensuring a clear audit trail. Two staff members check and sign where required (especially with controlled drugs or when disposing of medicines) to verify accuracy. If mistakes happen, we do not hide them – they are reported immediately so that the child can be protected and the error can be addressed. An open culture (duty of candour) is maintained, where staff can report issues or near-misses without fear, so we can learn and improve.
- Compliance with Prescriptions: We strictly follow the prescribing healthcare professional’s instructions. The pharmacy label and prescription directions are the authority for administration – staff do not change doses or times without an updated prescription. We give medicines only to the child for whom they are prescribed, at the correct dose, time, and route. We do not administer any medicine (including over-the-counter items) without proper approval and documentation.
- Confidentiality: A child’s medical information, including what medications they take, is kept confidential. Staff will share such information only with those who need to know for the child’s care (e.g. other caregivers on shift, healthcare providers, the child’s social worker or parent as appropriate). Medication records are stored securely.
- Continuous Improvement: We regularly review our medication procedures and incidents. Lessons learned from any errors, audits, or feedback are used to improve our systems. We stay updated on best practices (for example, new guidelines from healthcare authorities) and update training and policies accordingly. We want to ensure our approach to medication is always up-to-date, legally compliant, and reflecting the highest standard of care.
By embracing these principles, staff can ensure that the process of handling medications is not just a task, but part of providing nurturing, competent care. Safe medication management is a critical part of our commitment to high-quality care for children.
5. Roles and Responsibilities
Clear roles and responsibilities help ensure accountability in medication management. The following outlines who is responsible for various aspects of medication safety in our home:
- Responsible Individual (RI)/Nominated Individual: The RI ({{org_field_nominated_individual_first_name}} {{org_field_nominated_individual_last_name}}) holds ultimate oversight of the service and ensures that medication management meets regulatory standards. They are responsible for making sure the service has appropriate medication policies and that resources (training, storage facilities, etc.) are in place. The RI will review reports of medication audits and incidents as part of their quality monitoring duties. They must also ensure any serious medication incidents are reported to CIW or other authorities as required.
- Registered Manager (RM): The Registered Manager ({{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}) is in charge of implementing this medication policy on a day-to-day basis. The RM ensures that all care staff are trained and competent in administering medicines. They oversee ordering, storage, and record-keeping systems. The RM (or their qualified designee) must regularly audit medication records and stocks to detect and correct any issues. In case of any medication error or incident, the Registered Manager leads the investigation, takes appropriate corrective action, and, if required, notifies the relevant authorities (e.g. CIW, social services) of the incident. The RM is also available to provide guidance to staff who have questions or face challenges with any aspect of medication management.
- Deputy Manager (DM) or Senior Staff in Charge: In the absence of the Registered Manager, the Deputy Manager ({{org_field_deputy_manager_first_name}} {{org_field_deputy_manager_last_name}}) or the designated senior on duty will assume the manager’s responsibilities regarding medication. This includes authorising any urgent decisions (such as an emergency medical treatment or clarifying a prescription with a doctor), securing medication keys, and providing guidance to junior staff. The Deputy or senior staff must promptly inform the RM of any significant issues that arise in their absence.
- Care Staff (Residential Support Workers/Carers): Trained care staff are the ones who typically handle medications on each shift. Their responsibilities include:
- Administration: Administer medications to children strictly according to the prescriber’s instructions and this policy’s procedures (checking the “five rights”: right child, right medication, right dose, right time, right route). They must also ensure the child actually takes the medication and must never force a child against their will (see Section 6.4.4 on Refusal).
- Recording: Immediately record each medication given (or not given, if refused or omitted) on the MAR chart or relevant record, signing their name. If a second staff is witnessing (for controlled drugs or accuracy), both sign.
- Monitoring and Reporting: Observe the child for any adverse reactions or side effects, especially after a new medication or dose change. If the child appears unwell or has an unexpected reaction, staff should seek medical advice promptly and inform the manager. Staff must report any errors or near-misses immediately to the senior on duty/Manager, so that appropriate action can be taken to safeguard the child. Openness in reporting is encouraged – the priority is the child’s welfare, not blaming staff.
- Ordering and Stock Management: Keyworkers or designated staff may be responsible for ordering repeat prescriptions in a timely manner (so the child doesn’t run out of medication). All staff should be vigilant about medication quantities – if they notice supplies are low, they must communicate this to whoever handles ordering. When receiving new medication stock, staff should check it matches the prescription, note the quantity received, and update records (including the controlled drug register for any CDs).
- Storage and Security: Staff on shift ensure that medication cabinets are kept locked when not in immediate use and that keys are held only by authorised persons. They must also ensure medicines are stored appropriately (e.g. some may need refrigeration – see Section 6.3) and kept out of reach of children at all times. After each medication round or administration, they return medicines to storage and lock them away.
- Competency: Staff should only administer medication if they have received the required training and been assessed as competent. New or untrained staff must shadow experienced staff and should not give medicines alone. If a staff member is ever unsure about any aspect (for example, reading a prescription label, or whether a medicine measure is correct), they are expected to pause and seek advice from a senior staff, the manager, a pharmacist, or another healthcare professional before proceeding.
- Safeguarding Lead: The Safeguarding Lead ({{org_field_safeguarding_lead_name}}, {{org_field_safeguarding_lead_role}}) in our organisation should be consulted if a medication issue raises potential safeguarding concerns. For example, if a pattern of medication errors or deliberate withholding of medication were observed (which could indicate neglect or abuse), the Safeguarding Lead would guide staff on making a safeguarding referral to the local authority. All staff have a duty to recognise and report if misuse of medications is putting a child at risk of significant harm.
- Healthcare Professionals: While not our employees, various healthcare professionals play a vital role: the child’s GP or pediatrician prescribes medication and should be contacted for any medical advice or if changes are needed; pharmacists dispense medicines and are available to answer questions about how to give them or possible side effects; in some cases, community nurses may train our staff for specific tasks (e.g. using an inhaler with a spacer, administering an EpiPen). We maintain good communication with these professionals. Any directions given by a healthcare professional (doctor, pharmacist, nurse) regarding a child’s medication are to be followed and documented by our staff.
- Parents / Persons with Parental Responsibility / Social Workers: For children looked-after by the local authority, the social worker and/or birth parents (depending on who holds parental responsibility) should be kept informed about the child’s significant health and medication matters. While day-to-day administration is carried out by our staff, parents or guardians may need to give consent for certain treatments (especially non-routine or invasive ones) and should be informed of any new long-term medication or changes in health. We work in partnership with them – for example, ensuring that if a child goes on a home visit, the parent is given the proper medication and instructions (see Section 6.5). In non-emergency situations, we seek appropriate permissions for medical treatment as required by the child’s care plan.
Each member of staff must understand their responsibilities outlined above. The Registered Manager will ensure that this is discussed in staff inductions, training, and supervisions. Fulfilling these roles properly helps prevent mistakes and ensures that if an issue arises, it is caught and dealt with swiftly to keep children safe.
6. Medication Management Procedures
This section details the specific procedures to follow for managing children’s medications safely. All staff must follow these procedures at all times.
6.1 Admission and Initial Medication Assessment
When a child or young person is admitted to {{org_field_name}}, it is crucial to promptly gather accurate information about their health and medication needs. The following steps must be taken on admission (or prior, during the referral process, if possible):
- Healthcare Information Gathering: The key staff member (such as the child’s keyworker or the admitting senior) will obtain a detailed medical history from the placing authority or parent. This includes a list of all current medications the child is taking (prescribed or over-the-counter), the dosage and timing, the reason for each medication, and any known allergies or adverse reactions. If available, written documentation (like a hospital discharge summary or GP letter) should be obtained to verify this information.
- Check and Verify Medications Brought In: If the child arrives with any medication in their possession (for example, medication provided by a previous caregiver or hospital), staff should immediately document and secure it. Each medication should be in its original packaging with a clear pharmacy label. Check that the label matches the child (name, DOB), has current dosage instructions, and is in date. Count or measure the quantity of each medication upon admission. It’s good practice to have two staff do this together and both sign a receipt record, especially for controlled drugs. Any discrepancies or concerns (e.g. missing labels, damaged medication, or if the child claims to be on a medicine not provided) should be addressed by contacting the placing social worker or GP as appropriate.
- Secure Storage from the Outset: As soon as medications are received, they must be locked away in the designated medicine cabinet (see Storage section). Do not leave any medications unsecured during the admission process. Controlled drugs should be immediately placed into the controlled drug storage and logged in the CD register.
- Consent and Care Plan: Ensure that consent for administering medication has been discussed and agreed. For looked-after children, generally the local authority can consent to routine medical treatment, but it’s important to follow what’s outlined in the child’s care plan or Placement Plan. On admission, have the person with authority (parent or social worker) sign any necessary consent forms – for example, consent for the home to administer first aid and homely remedies (common non-prescription medicines) if needed. Appendix 1 (if provided by our organisation) may include a template “Consent for Administration of Homely Remedies” form for guardians to sign. Also, add the medication details into the child’s Personal Plan or Health Plan, including any specific instructions on how they prefer to take medicine, cultural or dietary considerations (like needing a spoonful of yogurt for a child who dislikes tablets), etc.
- GP Registration: If the child is not already registered with a local General Practitioner, initiate this process immediately. All children in our care should be registered with a GP near the home to facilitate prompt medical care and prescriptions. Provide the GP with the child’s medical background and current medication list. If the child is coming from out of area or has no current GP, the Registered Manager or delegated staff should arrange for registration within the first week of placement (sooner if the child has ongoing medication needs).
- Initial Medical Examination: In line with looked-after children healthcare guidelines, ensure the child gets an initial health assessment (usually within the first days or weeks of placement) by a doctor or nurse. This exam can review their medications and overall health. Any recommendations or changes in medication from this assessment must be noted and acted upon (with prescriptions updated accordingly).
- Medication Administration Record (MAR) Setup: Create a Medication Administration Record chart for the child from day one. List all the child’s medications on their MAR chart, including dose, frequency, and times they should be given. This chart will be used by staff to sign each dose given. If the child is not on any regular medication at admission, create a MAR that notes “No current medications” (so it’s clear) and use it if any medicine does get prescribed later. The MAR is a key document for continuity – if the child was using a MAR in a previous placement, attempt to get a copy or details of the last doses given to avoid double dosing or omissions.
- Communicate to Staff: During the child’s orientation and initial shift handover, inform all relevant staff about the child’s medication needs. For example, in the first shift handover after admission, the senior should brief the team: “Child A takes Medicine X 5 mg at 8am and 8pm – here is the MAR chart we’ve prepared. They have an inhaler as needed for asthma,” etc. This ensures everyone is aware from the start.
- Storage of Personal Remedies: If the child or family brought any non-prescription items (vitamins, herbal remedies, creams), treat these as medication too. Do not allow the child to continue taking anything unknown without checking with a healthcare professional. It may be necessary to temporarily hold those items and get advice from a GP or pharmacist on whether they are safe or should be continued. Always record whatever action is taken.
By thoroughly assessing and organizing a child’s medication needs at the time of admission, we set a safe foundation. This process prevents doses from being missed or duplicated during transition, and ensures we have the correct authority and information to care for the child’s health properly from their first day with us.
6.2 Prescriptions and Ordering Medication Supply
Maintaining a sufficient supply of each child’s medication is essential. Running out is not an option, as missed doses can harm the child. We have a clear system for ordering and re-ordering medicines:
- Registration with Pharmacy: {{org_field_name}} partners with a local community pharmacy to dispense most prescriptions for our children. Using a single pharmacy when possible allows better oversight (the pharmacy gets to know our home and can assist with advice or flag issues like interactions). At admission or when a new medication is started, we ensure the prescription is sent to our chosen pharmacy or that pharmacy details are updated with the GP surgery.
- Repeat Prescriptions: For medications the child takes regularly (e.g. daily tablets, inhalers, etc.), staff should know roughly how long the supply will last. A general rule is to request a refill from the GP about 2 weeks before the current supply runs out (or as per GP surgery guidelines). Each child’s keyworker or a designated “medication officer” on the team is responsible for managing repeat prescription requests. We keep a calendar or diary noting when repeats are due for each medication, so we can request on time. If a GP has put a medication on repeat, staff can request it directly from the surgery (by phone, online, or repeat slip) – otherwise, an appointment or call to the GP may be needed to authorise more.
- Acute Prescriptions: If a child needs a new medication urgently (for example, an antibiotic for an infection or a short-term course), the prescribing doctor will usually give a prescription directly or send it electronically to a pharmacy. Staff should arrange to collect the medicine from the pharmacy as soon as possible (the same day). Always confirm the child gets the first dose as prescribed – e.g. if an antibiotic is to start immediately, do not delay until next day. Use an on-call GP or emergency pharmacy service if necessary out of hours.
- Prescription Handling: When picking up medicines from the pharmacy, staff must check the dispensed items against the prescription before leaving: correct child’s name, right medication and strength, correct quantity, and that instructions match what the doctor said. If anything is unclear or seems wrong, ask the pharmacist to clarify or correct it on the spot. Transport medication back to the home safely (in a secure container, especially for controlled drugs).
- Maintaining Adequate Stock: We always maintain at least 4 weeks of regular medication where feasible (depending on how it’s prescribed; some controlled drugs might be prescribed in shorter supply). We never allow a situation where a child misses medicine because we forgot to reorder. If a medication is down to the last 7-10 days supply and no refill is in process, this is a red flag – staff should treat it as urgent to sort out. For as-needed (PRN) medicines that aren’t used often, keep an eye on expiry dates too so we can renew them if needed (e.g. an asthma inhaler that’s hardly used might expire – still important to have a valid one on hand).
- Emergency Backup: For certain critical medications (like an Epilepsy rescue med or an inhaler), it’s prudent to have a backup available in case one is lost or broken. We will liaise with doctors to have spare rescue medication if appropriate. Also, if a dose is wasted (e.g. pills dropped on floor), we ensure there is enough stock to still complete the course – otherwise, contact pharmacy/GP for advice.
- Controlled Drugs Ordering: Controlled drugs (CDs) often require a new prescription each time (no repeats) and have tighter controls. Staff should be aware that these prescriptions are legally valid only for a short time (28 days from issue) and require secure handling. When ordering a controlled drug, factor in the extra time to get the paper prescription (if needed) and pharmacist checks. Only specific persons (e.g. the manager or a staff authorised) may collect a controlled drug; they will need identification and may have to sign at the pharmacy.
- Documentation of Orders: Keep records of what has been ordered and when. For instance, if using an online GP ordering system, print or save the confirmation. When new stock arrives, update the child’s MAR chart if needed (e.g. if dose changed) and note the date received and new expiry date. Put newly received medication into storage promptly. For controlled drugs, enter the new stock into the Controlled Drug Register as a new entry (with date, amount received, and new total balance, signed by staff and ideally witnessed).
- Changes to Medication: Sometimes the GP or specialist will change a child’s dose or discontinue a medication. Such changes should come in writing (new prescription or doctor’s note). If a change is communicated verbally (say, GP calls and says increase dose), politely request a written confirmation (prescription or email/fax) for our records. Update the MAR chart immediately to reflect the new instructions, and clearly mark the old instruction as discontinued (do not erase it, just indicate stop date). Any remaining old medication that is no longer to be used should be removed from the medicine cabinet and set aside for disposal, to avoid any mix-up. Inform the child (if appropriate for their understanding) and the parent/social worker of the change.
- Use of Monitored Dosage Systems (MDS): Some pharmacies supply medications in blister packs or “dosette boxes” (especially for those on multiple tablets). If our pharmacy provides these for a child, ensure the packs are labeled properly for that child and that staff still cross-check each compartment with the MAR chart. While these systems can simplify administration, they are not foolproof – staff must remain vigilant. Do not transfer medicines into pill organizers by ourselves; if a child has complex regimens that might benefit from an MDS, consult the pharmacist.
- Homely Remedies Stock: We maintain a small stock of approved over-the-counter medications (homely remedies) at the home for minor ailments (see Section 6.8). These need to be purchased and replenished as they expire or get used. The manager or designated staff will keep an inventory of homely remedies (e.g. paracetamol, mild cough syrup) and check them periodically so we can reorder from a pharmacy or supermarket as needed. Even though these are non-prescription, they must still be in date and stored properly.
By managing prescriptions and supply proactively, we ensure continuity of treatment for each child. Effective ordering systems also demonstrate to CIW that we have “arrangements for maintaining a sufficient supply of medicines” as required. Staff should never become complacent – always check and plan ahead so that each child’s health needs are consistently met.
6.2.1 Medicines Reconciliation
Medicines reconciliation must be undertaken whenever {{org_field_name}} assumes, transfers or resumes responsibility for managing a child’s medicines and whenever there is a significant transition of care which may result in uncertainty about the current medication regimen.
This includes, where applicable:
- admission to the service;
- return from hospital;
- discharge from another healthcare setting;
- transfer from another care placement;
- significant medication changes;
- return from an extended home or family visit where medicines were managed by another person; and
- transfer to another service.
The purpose of medicines reconciliation is to establish an accurate and current list of all medicines the child is intended to receive and to identify and resolve discrepancies before they result in omitted, duplicated or incorrect treatment.
The reconciliation process must, so far as applicable, confirm:
- the child’s full name and date of birth;
- known allergies and adverse drug reactions;
- the name of each current medicine;
- formulation and strength;
- dose;
- route;
- frequency and administration times;
- the clinical purpose where this information is available and relevant;
- PRN instructions including indication, minimum interval and maximum dose where applicable;
- the date and time of the most recent dose where this is relevant;
- medicines recently stopped or changed;
- special administration or storage instructions;
- whether the child self-administers any medicine;
- quantities transferred to the service; and
- whether the medicines and written information received are consistent.
Information should be checked against appropriate reliable sources such as the current pharmacy dispensing label, current prescription information, hospital discharge documentation, information from the GP or prescriber, current MAR documentation, the child’s health plan and information supplied by the placing authority.
Where information from different sources does not agree, staff must not guess which instruction is correct. The discrepancy must be referred promptly to an appropriate healthcare professional for clarification.
Any unresolved discrepancy that could affect an immediate dose must be escalated without delay and professional advice obtained before administration.
The outcome of reconciliation, including discrepancies identified, enquiries made and changes confirmed, must be documented in the child’s records and relevant medication documentation must be updated.
6.3 Storage of Medicines
{{org_field_name}} must ensure that all medicines are stored safely, securely and in accordance with the requirements of the particular medicine, the manufacturer’s instructions, applicable legislation and each child’s assessed needs.
- General storage: Medicines managed by the service must normally be stored in a locked medicine cupboard, cabinet, trolley, refrigerator or other secure medicines storage facility which is suitable for its purpose and inaccessible to unauthorised persons and other children.
- Individual separation: Medicines must be organised so that each child’s medicines can be clearly identified and there is minimal risk of medicines being selected for the wrong child. Medicines must remain identifiable and appropriately labelled.
- Original packaging: Medicines must normally remain in the packaging or container in which they were supplied by the pharmacy or other authorised supplier, with the dispensing label intact. Staff must not routinely decant, repackage or relabel prescribed medicines.
- Access: Access to medicines must be restricted to the child where an approved self-administration arrangement is in place and/or staff who are authorised and competent to manage medicines. Keys, access cards or access codes for medicines storage must be controlled securely and must not be accessible to unauthorised persons.
- Controlled drugs: Controlled drugs must be stored in accordance with the legal safe-custody requirements applicable to the particular medicine and service. Where a controlled drug is required to be kept in a controlled-drug cabinet, the cabinet must comply with the applicable statutory requirements. Access must be restricted to authorised staff. Required controlled-drug records must be maintained accurately and stock discrepancies must be escalated immediately.
- Refrigerated medicines: Medicines requiring refrigeration must be stored in appropriate medicines refrigeration between the temperatures specified by the manufacturer, normally 2°C to 8°C where that is the stated storage range. The refrigerator must be secure from unauthorised access and medicines must be appropriately segregated. Temperatures must be monitored and recorded at a frequency sufficient to demonstrate that medicines have remained within the required range. Any temperature excursion must be reported promptly and advice obtained from the supplying pharmacy or other appropriate healthcare professional before affected medicines are used where their suitability is uncertain.
- Storage conditions: All medicines must be stored in accordance with the manufacturer’s instructions and protected from inappropriate heat, moisture, light or other conditions that may affect their quality.
- Emergency medicines: Emergency and rescue medicines, including adrenaline auto-injectors, rescue inhalers, emergency epilepsy medicines or other prescribed emergency treatments, must be sufficiently accessible to allow prompt administration when required. Their location and storage arrangements must nevertheless protect them from unauthorised access and must be determined through an individual risk assessment taking account of:
- the urgency with which the medicine may be required;
- the child’s ability to access and use the medicine safely;
- risks posed to the child or other children;
- any requirements for staff supervision;
- manufacturer storage requirements; and
- advice contained in the child’s Personal Plan, Health Plan or emergency treatment protocol.
Emergency medicines must not simply be left unsecured because rapid access may be required. All staff responsible for the child must know where the emergency medicine is located and how to obtain it without avoidable delay.
- Self-administration: Where a child or young person self-administers medicines, storage arrangements must be identified in their individual self-administration risk assessment. Where appropriate, secure personal storage such as a lockable cupboard or drawer may be provided. The arrangement must ensure that the young person can obtain the medicine when required while protecting other children from unauthorised access.
- Medicines requiring specialist arrangements: Where storage requirements are unclear, staff must obtain advice from the supplying pharmacist or other appropriate healthcare professional rather than make assumptions.
- Expiry dates: Medicines must be checked regularly to ensure they remain in date. Where a medicine has a shorter expiry after opening, the date of opening and revised expiry date must be recorded where necessary. Expired medicines must be removed from active stock promptly and dealt with under the disposal procedure.
- Discontinued medicines: Medicines that have been discontinued must be separated immediately from medicines that remain in use so that they cannot be administered in error and must be returned or disposed of through the approved medicines disposal process.
- Staff medicines: Medicines belonging to staff or visitors must not be stored where children can access them and must be kept separate from medicines belonging to children accommodated at the service.
- Storage checks and audit: Medicines storage, security, refrigerator records where applicable, expiry dates, stock arrangements and controlled-drug storage must form part of the service’s regular medicines audit arrangements. Any deficiency that presents an immediate risk must be corrected without delay.
6.4 Administration of Medicines and Record-Keeping
Administering medication to children is a critical task that must be done correctly every time. To ensure consistency and safety, staff should follow a standard procedure each time they give any medication. This section breaks down the process and key points to remember:
6.4.1 Preparation and Verification Before Administration
Before giving any medication, prepare and double-check the following:
- Review the MAR Chart: Take out the child’s Medication Administration Record (MAR) chart and see what medications are due at this time of day. The MAR chart lists each medication, the prescribed dose, and the scheduled times (e.g. Morning, Lunch, Evening, Bedtime). Identify which meds need administering now and note any special instructions (such as “with food” or “before meals” or any recent changes).
- Identify the Child: Ensure you are giving medicine to the correct child. This is especially important if multiple children are present or if you are new to the shift. Verify the child’s identity by name and, if needed, another identifier (date of birth or a photo ID kept in the file) – particularly if the child is new or if there are siblings with similar names. Never rely solely on another child saying “I’m so-and-so”; staff should personally know each child or confirm identity through records.
- Wash Hands: Clean your hands thoroughly with soap and water or use hand sanitiser before handling any medications or touching medicine cups, spoons, etc. This prevents contamination and also sets a hygienic example for the child. If administering eye drops, ear drops, or topical medications, wearing disposable gloves is recommended for cleanliness and to avoid absorbing any medicine yourself.
- Gather the Medication: Unlock the medicine cabinet and retrieve the exact medication needed for that dose. Check three things on the medication label: the child’s name, the medication name/strength, and the dose instructions. Confirm these match what’s on the MAR chart. For example, MAR says Give 5 ml of Amoxicillin at 8am – ensure the bottle label says the same (Amoxicillin 250mg/5ml, take 5ml every morning). Also check the expiry date on the bottle or pack – do not use if expired. If a medication requires preparation (like dissolving a tablet, or drawing up from a bottle), do that according to instructions. Only prepare one child’s medications at a time, to avoid mixing them up.
- Measure or Count Dose Accurately: Use appropriate tools to measure doses: the oral syringe or measuring cup for liquids (not household teaspoons, as they are not accurate), pill cutter for splitting tablets if allowed (note: only split if the tablet is scored and prescribed that way), and proper technique for other forms (like ensuring a dropper for eye drops is clean). Double-check the count of tablets or volume of liquid. If two staff are available, it’s good practice for one to prepare and another to verify before giving (especially for critical meds or controlled drugs). Both can initial the MAR in such cases to show double-checking.
- Child’s Readiness: Make sure the child is ready and in an appropriate state to take the medication. This might mean ensuring they are awake (never administer medication to a sleeping child), seated upright (for swallowing safety), and not eating something that could conflict (e.g. some meds need empty stomach). If the child is upset or not cooperating at the moment, you might need to calmly explain or wait a few minutes if it’s safe to do so, rather than rushing and risking a spill or refusal.
Always remember the “5 Rights” of medication administration as your mental checklist: the Right Child, Right Medication, Right Dose, Right Time, and Right Route. Some add a 6th right: Right Documentation (recording properly). Before giving the medicine, be certain all these rights are confirmed.
6.4.2 Process of Administering Medication to the Child
Once everything is prepared and verified, proceed to administer the medication with care:
- Explain to the Child: Approach the child in a friendly, non-rushed manner and explain that it’s time for their medication. Depending on age and understanding, you might say “This is your medicine for [reason]. Let’s take it now so you’ll feel better/ stay healthy.” Encourage and reassure if the child has any hesitancy. Older children might not need much explanation every time, but it’s respectful to inform them of what they’re taking.
- Assist as Needed: Give the medication in the prescribed route: If oral, hand them the tablet or liquid in a medicine cup/spoon – or assist them in taking it if they are very young. Offer a glass of water to help swallow pills. If it’s a liquid, ensure they swallow it all; if using an oral syringe for a small child, gently dispense it into the side of their mouth (never forcefully). For inhalers, help position the spacer and make sure they inhale at the right time; for creams, apply the correct amount to the correct area with gloves on, etc. Always follow any specific instructions (like “give with food” – in that case, administer it during or after a meal/snack).
- Ensure Ingestion/Completion: Observe that the child actually swallowed or received the full dose. For instance, check their mouth if there’s doubt they swallowed a tablet (some kids may cheek a pill). For liquids, confirm they didn’t spit it out. If any portion was not successfully taken (spat out, spilled, vomited immediately), see Section 6.4.4 on how to handle such situations. For eye/ear drops, make sure the drops went in properly. If applying a patch (like a pain relief patch), affix it securely to the correct site.
- Positive Reinforcement: Many children, especially younger ones, may dislike taking medicine. Use positive reinforcement – praise them for doing well after they take it, maybe use a sticker chart for cooperative medicine-taking if needed. Never frame medicine as punishment or say things like “if you don’t behave you won’t get your medicine” – medication is always a health need, not a reward or consequence. We maintain a calm, caring approach to build trust.
- Maintain Safety During Admin: If you’re administering to more than one child at the same time (for example, morning meds for multiple residents), do them one by one, completing one child’s meds (including documentation) before moving to the next. This prevents mix-ups. Lock the cabinet in between if you must step away or deal with an interruption. If the phone rings or some distraction occurs during a med round, try to finish what you were doing (if safe) or secure everything and start the process again for that dose – do not leave meds unattended. Avoid interruptions during medication rounds whenever possible; other staff should assist by handling other needs so the person administering can focus.
Privacy and dignity should be preserved. If a child is self-conscious about medicine (perhaps a teenager not wanting others to know they take a certain pill), be discreet. You can administer in a private area or quietly aside from the group. However, always have safety in mind – if you are alone with a child while giving medication, ensure professional boundaries and that you have informed another staff (for safety and accountability).
6.4.3 Recording and Documentation
Immediately after administering each medication (or if a dose was omitted/refused), proper recording is mandatory. Accurate record-keeping is part of safe administration and a regulatory requirement. Our practices include:
- MAR Chart Entries: For every medication given, the staff member initials or signs in the appropriate box on the MAR chart for that date and time. We use a consistent coding system for when a dose is not given as prescribed. For example:
- “O” or a specific code for if the child was out (not present to receive the dose),
- “R” for refused,
- “S” for self-administered (if the child took it themselves under supervision),
- “N” for not required (perhaps for a PRN that wasn’t needed),
- or other standard codes as defined on our MAR key.
If using codes, always accompany them with a brief note on the back of the MAR or in the daily log explaining the situation (e.g., “Refused – had stomach ache, will try later” or “On home visit – mother to give”). Never leave a MAR box blank; every scheduled dose should have a signature or a code. A blank could be misinterpreted as forgotten.
- Medication Administration Record (MAR) details: The MAR chart itself is a vital document. It should clearly list each medication’s name (ideally the generic name plus brand if important), the strength (e.g. 5 mg tablets), dose to give, route if not oral (e.g. “topical” for creams), and times to be given (or if PRN, how often allowed). The child’s name and date of birth are on the chart, and possibly a photo for identification. Staff must ensure any changes (new meds, discontinued meds) are updated on the MAR promptly and old entries are crossed off with a line (with date of discontinuation noted) to avoid accidental administration. We archive MAR charts as part of the care record; Regulation 59 and Schedule 2 in Wales require that we keep such records of medicines support. Typically, we keep MAR charts for a set period (at least 15 years for children’s medication records, since they are minors – as per guidance or organisational policy).
- Controlled Drug Register: In addition to signing the MAR, any time a controlled drug is given, staff must also immediately log it in the Controlled Drug (CD) Register. Record the date and time, child’s name, dose given, and remaining stock balance. Two staff should sign the CD register (one who administered and one who witnessed) to verify the entry. This double signing helps catch any discrepancies quickly. The balance in the register should always tally with the actual count of medication in the CD cabinet; if not, report it at once.
- PRN (“As Needed”) Medication Records: When giving a PRN medication, it’s important to document not only that it was given, but also why and whether it helped. For instance, if Paracetamol was given PRN for a headache at 2pm, note in the daily notes or on the back of MAR: “2pm – Complained of headache, 250 mg Paracetamol given. 3pm – child reports headache eased.” This creates a clear picture of usage and effectiveness, and helps in any review of the PRN’s necessity. It also prevents another staff from unknowingly giving an additional dose too soon. The MAR chart for PRNs might have a section to note the reason and outcome – staff should fill that in each time.
- Topical Treatment Records: For things like creams, ointments, or other external applications, we either include them on the MAR or have a separate chart (often called a topical MAR or Body Map) where staff record applications. For example, applying eczema cream – staff tick the area on a body map diagram if used and sign. This ensures consistency especially if multiple staff apply treatments across shifts.
- Error or Incident Reporting: If a mistake in administration is discovered (e.g., you realise you gave a medication at the wrong time, or a dose was missed, or the wrong child’s inhaler was almost given but caught in time), do not cover it up on the MAR. Instead, document what actually happened and then report the incident (see Section 6.9 on handling errors). For example, if a dose was given twice by accident, you might circle the relevant MAR entries and write an explanation in a note, but more importantly, an incident form will be completed. The MAR should reflect reality, not be retrospectively fixed to look “perfect”. Draw a line and note “error – see incident report” if needed. Honesty in documentation is critical for the child’s ongoing care (doctors need to know what the child actually received).
- Communication and Handover: In our daily shift handovers, medication given (or any issues) should be communicated. For example, “Child B refused their 2pm dose of antibiotic – I documented it, and we will try again with food later. Please attempt at teatime and note if taken.” Likewise, any PRNs given or any low stocks that could affect the next shift’s tasks must be passed on. We also maintain a communication book or health log for each child in which significant med info is recorded for continuity.
- Auditing Trail: Keep all records neat and legible. Use blue or black ink (never pencil or erasable ink). Do not use correction fluid on MARs; if you make a recording mistake, strike through with a single line and initial it, then write the correct entry. This is because MAR charts are legal documents and might be needed for audit or even legal scrutiny.
By maintaining rigorous documentation, we fulfill the legal requirement for record-keeping of medicines support and ensure continuity of care. It also provides evidence that our service is managing medication properly (CIW inspectors often review MARs and drug registers during inspections). Staff should take pride in keeping impeccable records – it is part of our professionalism and duty of care.
6.4.4 Managing Refusals, Missed Doses, and Other Issues
Children and young people might sometimes refuse to take their medication, or circumstances might cause a dose to be missed or not given fully. It’s important to handle these situations calmly, safely, and in accordance with guidelines:
- Refusal of Medication: A child has the right to refuse medication, and we cannot typically force them to take it. If a child refuses a dose:
- Encourage and Explain: Gently encourage them, find out why they don’t want it. Are they finding it tastes bad? Are they scared of side effects? Sometimes offering a drink or a different method (like mixing in yogurt if allowed, or using a straw for a bad-tasting liquid) can help – but do not disguise medication without proper authorisation; see Covert section if considering disguise.
- No Force or Coercion: Never physically force a child to take medication. This can be traumatic and is not permitted except possibly in extreme life-threatening emergencies under medical advice (which in a residential home is highly unlikely; that scenario would usually be handled by emergency services). Also avoid bribes or punishments; rather use positive reinforcement or give them a bit of time.
- Safety Consideration: Assess how critical the medication is. For example, refusal of a nightly vitamin tablet is not as urgent as refusing an anti-seizure medication. If it’s something essential (like insulin, or medication to prevent serious withdrawal effects), seek medical advice immediately if refused. For many routine meds, one missed dose might be okay, but if the child repeatedly refuses, it could harm their health.
- Inform and Record: Mark it as refused on the MAR chart with the appropriate code (e.g. “R”) and write a note about the circumstances (“refused after two attempts, said it tastes bad”). Notify a senior or the manager on duty of the refusal. Also, inform the child’s social worker or parent especially if the medication is critical or if refusals become a pattern – they might help address underlying causes or authorise an approach.
- Follow-Up: If the medication is important for immediate health, contact a healthcare professional for guidance. For example, if a child refuses their asthma controller inhaler, inform the GP at the earliest opportunity for advice on alternatives or strategies. The manager might arrange a meeting with the child (if they’re old enough) to discuss the importance of the med and address fears. In repeated refusal cases, possibly involve a healthcare professional to talk to the child, or review if the medication can be changed (different form or schedule that the child might accept).
- Missed or Delayed Doses: Sometimes a dose could be missed not due to refusal but due to an oversight or circumstance (staff error, or the child was away, etc.):
- If it’s realised soon after the scheduled time (say within an hour) and it’s safe per guidelines to still give it, do so and adjust timing of next doses if needed (pharmacist or GP can advise). If it’s a once-a-day med and only an hour or two late, typically give it and note as “late administration at [time]”.
- If a dose is completely missed (e.g. discovered at next time that the morning pill wasn’t given), do not double the next dose unless a doctor explicitly says so. In most cases, you skip the missed dose entirely once the time window passed, and continue with the next dose as normal. But check with a pharmacist/GP for each specific drug’s advice.
- Document the omission on the MAR (with a code or note) and inform the manager. We treat a missed dose as a medication incident that should be investigated (how did it happen – miscommunication at shift change? MAR not clear? etc. – see Errors section). If the child was away (e.g. on a home visit) and the caregiver there missed giving it, note that and ensure everyone knows to prevent reoccurrence (maybe better communication or sending reminders with the child in future).
- Vomited Dose: If a child vomits shortly after taking oral medication, it might not have been absorbed. If this happens:
- Do not re-administer immediately on your own judgment, as it may be hard to tell how much was absorbed and double dosing is risky. Instead, call a pharmacist or NHS 111/GP to ask if the dose should be repeated. Provide details like the drug name, dose, and how long after taking they vomited. Many medicines have guidelines (e.g., if within 15 minutes might redo, if after an hour maybe not, etc.) but get professional advice.
- Note on the MAR that the dose was vomited and that advice was sought, and what action was taken.
- Monitor the child in case the vomiting is a sign of illness or side effect. They might need medical review if they keep vomiting or miss important meds due to illness.
- Spit Out or Partial Intake: If you clearly see the child spit out a pill or only partially swallow medicine (maybe drooled out some liquid), treat similarly to a vomited dose. Estimate if any was taken and then seek advice for a replacement dose if needed. For example, if half a tablet was spat out, likely need guidance on giving another half etc., rather than guessing. Document accordingly.
- Medication Not Available: In the rare event a medication dose can’t be given because the medication is not available (e.g. stock ran out unexpectedly or was damaged), treat this as highly urgent. Contact a pharmacy or out-of-hours service immediately to obtain an emergency supply. If absolutely impossible to get that dose, inform the child’s doctor to get advice on risks. Document it thoroughly and consider it a serious incident – running out should not happen if ordering is done correctly, so an investigation will follow. Meanwhile, do everything possible to avoid harm to the child (sometimes a GP can authorise an alternative or a bridging dose of something similar). Keep the child and others informed as appropriate.
- Children Away from the Home: If the child is off-site (at school, with family, etc.) during a medication time and we expect someone else to give the dose, ensure arrangements are clear (see Section 6.5 on outings). If the dose ends up missed off-site, document as such and follow up with whoever was responsible to prevent it in future. If the child is at school daily and gets a lunchtime dose, coordinate with the school nurse/office – have a written agreement on how they report to us if a dose was missed or refused at school so we can respond appropriately.
- Persistent Refusals or Non-compliance: If a young person continually refuses a medication (especially older teens asserting independence), the team should arrange a review meeting with the child (if appropriate), their social worker, healthcare professional, and possibly family. We need to respect a competent young person’s choices but also ensure they’re informed of consequences. It may be that an alternative treatment can be found, or a different approach like counselling to address concerns. Document such discussions and outcomes in the care plan. If the medication is critical (like psychiatric meds or such), involve the prescribing doctor – sometimes they might decide to halt treatment if the person won’t comply, but that’s their clinical decision. Our role is to support the child and keep them safe, balancing their rights with their health needs.
In all cases of non-administration (for whatever reason), our responses should be guided by the principles of safeguarding the child’s health, transparency (noting and reporting accurately), and learning to prevent future issues. By handling refusals and missed doses methodically, we maintain trust (the child sees we won’t force them, but we do care enough to try alternatives) and comply with expectations that medication administration is overseen properly. Also, CIW and other authorities will expect to see that even challenges in administration are documented and managed, which this policy ensures.
6.4.5 Covert Administration of Medication
Covert administration means administering a medicine in a disguised form without the child or young person knowing that the medicine is being administered. It is a significant interference with autonomy and must never be used simply because a child refuses medication, because administration is difficult, or for staff convenience.
Covert administration must only occur in exceptional circumstances where there is clear lawful authority, the intervention is necessary and proportionate, less restrictive alternatives have been considered, and the arrangements have been formally agreed, recorded and kept under review.
Children Under 16
For a child under 16, staff must first consider whether the child is Gillick competent to make the particular decision about the medicine.
Where the child is competent to make the particular decision, their decision must not be overridden by staff through covert administration merely because staff, parents or professionals disagree with it. Any situation in which essential treatment is refused by a competent child must be escalated immediately to the prescriber, placing authority and Registered Manager and legal advice must be sought where required.
Where the child is not competent to make the particular decision, staff must establish who has lawful authority to make the decision. This may include a person with parental responsibility or, depending on the child’s legal status and relevant orders, the placing local authority. The child’s wishes and feelings must nevertheless be considered.
Where there is significant disagreement, persistent objection, uncertainty about who has lawful authority, or where the proposed intervention may involve restraint or amount to a deprivation of liberty, staff must not proceed solely on the basis of an internal care-home decision. The matter must be referred to the placing authority and relevant healthcare professionals and legal advice or court authority obtained where required.
Young People Aged 16 or 17
The Mental Capacity Act 2005 applies to young people aged 16 and over.
A young person aged 16 or 17 must be presumed to have capacity to make the particular medication decision unless it is established otherwise in accordance with the Mental Capacity Act 2005.
A young person who has capacity to make the particular decision must not be given medication covertly simply because they refuse it.
Where a young person aged 16 or 17 lacks capacity to make the particular decision, any decision to administer medicine covertly must be made lawfully in accordance with the Mental Capacity Act 2005 and any other applicable legal framework. The decision must be necessary, proportionate and in the young person’s best interests, and the least restrictive available option must be used.
Requirements Before Covert Administration
Except where immediate emergency treatment is lawfully required, covert administration must not commence until:
- the reason for refusal or difficulty taking the medicine has been explored;
- reasonable alternatives have been considered;
- the child’s or young person’s ability to make the particular decision has been appropriately considered or assessed;
- the prescriber has reviewed whether the medicine remains clinically necessary and whether an alternative medicine, formulation, route or timing could be used;
- appropriate persons with lawful decision-making authority have been identified and involved;
- the placing authority has been involved where applicable;
- appropriate healthcare professionals have contributed to the decision;
- a pharmacist has confirmed whether the particular medicine can safely be crushed, opened, mixed with food or drink, or otherwise altered;
- the legal basis for the decision has been established;
- the child’s or young person’s wishes and feelings have been considered;
- a written covert medication plan has been completed; and
- staff responsible for implementing the plan have received the necessary information and are competent to follow it.
Covert Medication Plan
The written plan must identify:
- the specific medicine or medicines authorised for covert administration;
- the reason covert administration is necessary;
- the legal basis for the decision;
- the child’s or young person’s competence or capacity in relation to the particular decision;
- the people and professionals involved in the decision;
- alternatives that were considered;
- exact instructions for how each medicine is to be administered;
- pharmacist advice concerning crushing, opening, mixing or altering the medicine;
- how administration will be recorded;
- what monitoring is required;
- what staff must do if the child does not consume the complete dose;
- circumstances requiring medical review or escalation; and
- the date or circumstances for review.
Staff must never crush tablets, open capsules or mix medicines with food or drink unless this has been confirmed as safe for the particular medicine by an appropriate pharmacist or other authorised healthcare professional.
Recording
Every covertly administered dose must be recorded accurately on the Medication Administration Record in the same way as any other administered medicine and in accordance with the agreed covert medication plan.
Staff must not falsify, obscure or omit records because administration was covert.
Review
The continued need for covert administration must be reviewed regularly and whenever circumstances change. Covert administration must stop when it is no longer necessary, lawful or proportionate.
The service must continue to work towards open administration wherever this can be achieved safely and lawfully.
Any member of staff who believes covert administration is taking place without proper authority must not continue the practice without escalation and must report the concern immediately to the Registered Manager in accordance with safeguarding and whistleblowing procedures where appropriate.
6.4.6 Self-Administration by Children and Young People
{{org_field_name}} recognises that children and young people should be supported to develop independence in managing their medicines where this is appropriate to their age, understanding, wishes, abilities and individual circumstances and where this can be achieved safely.
The service must not automatically assume responsibility for administering every medicine where a child or young person is able and wishes to manage some or all of their medicines themselves.
Individual Assessment
Before self-administration begins, an individual assessment and risk assessment must determine the level of support required.
The assessment must consider:
- the child’s or young person’s wishes and feelings;
- age, maturity and understanding;
- competence or capacity relevant to the particular decision;
- the nature and complexity of the medicine;
- whether the medicine is time-critical;
- ability to recognise the medicine and understand the dose, timing and route;
- ability to obtain appropriate help if a dose is missed or an error occurs;
- risk of accidental or deliberate overdose;
- risk of misuse, diversion, exploitation or sharing medicines;
- risks posed to other children living at the home;
- required storage arrangements;
- any relevant history of self-harm, substance misuse or medication misuse;
- requirements for monitoring;
- the level of prompting, assistance or observation required; and
- advice from the prescriber, pharmacist or other relevant healthcare professional where appropriate.
Self-administration may apply to all of a child’s medicines or only specified medicines. Different levels of support may therefore apply to different medicines.
Consent and Decision-Making
For children under 16, decision-making must take account of the child’s understanding and whether they are Gillick competent in relation to the particular decision. Where the child is not competent, staff must establish who has lawful authority to make the relevant decision.
For young people aged 16 or 17, the Mental Capacity Act 2005 applies where there is doubt about capacity to make the particular decision.
The child’s or young person’s views and wishes must always be taken seriously and properly recorded.
Care Planning
The agreed self-administration arrangements must be documented in the child’s Personal Plan or Health Plan and must specify:
- which medicines may be self-administered;
- the level of staff support required;
- where medicines will be stored;
- how medicines will be obtained and re-ordered;
- how administration will be recorded;
- how adherence will be monitored where this is required;
- what action staff must take if a dose is missed;
- circumstances requiring professional advice;
- the arrangements for medicines when the young person is away from the service; and
- when the assessment will be reviewed.
Storage
Medicines for self-administration must be stored in accordance with the individual’s risk assessment. Where appropriate, a secure lockable cupboard, drawer or medicines box may be provided for the young person’s individual use.
Storage arrangements must allow the young person to access medicines when they are required while preventing unauthorised access by other children.
Controlled Drugs and Other Higher-Risk Medicines
Controlled-drug status must not, by itself, be treated as an automatic prohibition on self-administration.
Where a child or young person wishes to self-administer a controlled drug or another higher-risk medicine, an individual risk assessment must determine whether this can be managed safely and lawfully. The arrangements must comply with any applicable controlled-drug storage, supply and recording requirements and professional advice must be obtained where necessary.
Where the assessment identifies that self-administration would create an unacceptable risk to the child, young person or others, staff will manage or supervise the medicine at the level necessary to control that risk. The reason for this decision must be recorded and reviewed.
Recording
The service must maintain an accurate record of medicines managed through self-administration.
The medication record must show, as applicable:
- that the medicine is self-administered;
- the agreed level of monitoring or support;
- confirmation that the medicine has been taken as prescribed where monitoring is required;
- who obtained or recorded that confirmation; and
- any refusal, omission, discrepancy or other concern.
Review
Self-administration arrangements must be reviewed at the frequency identified in the individual risk assessment and whenever there is a relevant change, including:
- a change in medicine;
- a change in physical or mental health;
- concerns about adherence;
- a medication error;
- suspected misuse or diversion;
- self-harm concerns;
- unauthorised access by another child; or
- a change in competence, capacity, understanding or ability.
Any restriction on self-administration must be proportionate to the identified risk and must not continue for longer than necessary.
6.5 Medication During Outings, Education, Home Visits and Other Off-Site Activities
A child’s medicines arrangements must continue safely whenever the child is away from {{org_field_name}}. The Registered Manager must ensure that responsibility for each medicine is clear and that there is an auditable record of medicines transferred from, administered away from and returned to the service.
General Requirements
Before a child leaves the service where medication may be required, staff must establish:
- which medicines will be required;
- the dose, route and time of administration;
- whether any medicine is required when needed or in an emergency;
- who will be responsible for administration;
- the storage requirements;
- whether refrigeration or other specialist storage is required;
- whether any controlled drug requirements apply;
- what records will be made; and
- how information about administration, refusal, omission or errors will be communicated back to the service.
Packaging and Labelling
Prescribed medicines taken away from the home must remain in the correctly labelled container or packaging supplied for that child by the dispensing pharmacy or other authorised supplier.
Staff must not routinely remove tablets, capsules or other medicines from their dispensed container and place them into an unlabelled or staff-labelled envelope, pot, bag, box or other improvised container.
Where a smaller quantity or separate supply is required for school, contact, a holiday or another period away from the service, staff must seek an appropriately dispensed and labelled supply from the pharmacy or obtain professional advice about a safe alternative arrangement.
School or Education Provision
Where a medicine is to be administered by school or education staff:
- written information and authorisation required by the education provider must be supplied;
- the medicine must be transferred in appropriately labelled packaging;
- responsibilities for administration must be agreed;
- arrangements must be made for recording each dose;
- the service must be informed of refusals, omissions, errors or other concerns; and
- the child’s medicines records at the home must make clear that responsibility for the relevant dose was transferred to the education provider.
Outings and Appointments
Where a member of {{org_field_name}} staff accompanies the child and remains responsible for medicines, the member of staff must:
- transport medicines securely;
- maintain required storage conditions;
- ensure medicines are inaccessible to unauthorised persons;
- administer medicines in accordance with the MAR, Personal Plan and prescribing instructions;
- carry any equipment required for safe administration;
- record administration at the time it occurs or on the approved off-site medication record; and
- transfer that information into the service’s records without avoidable delay where a separate approved record has been used.
Overnight Trips and Holidays Supported by Staff
A named competent member of staff must have responsibility for medicines arrangements during the trip.
Before departure, medicines taken from the home must be reconciled against the current medication record. Suitable secure storage must be available throughout the trip.
Administration, refusals, omissions and PRN use must be recorded contemporaneously.
On return, remaining medicines must be reconciled against the amounts supplied and doses recorded. Any discrepancy must be reported immediately.
Family Contact and Home Visits
Where medicines are transferred to a parent, relative, foster carer or other authorised person:
- the amount and identity of each medicine transferred must be recorded;
- medicines must be supplied in appropriately labelled packaging;
- clear administration instructions must be provided;
- any required emergency treatment information must accompany the child;
- the receiving person should acknowledge receipt in accordance with the service’s transfer procedure;
- responsibilities for administration and recording must be clear; and
- medicines returned to the home must be reconciled against the amount supplied and information available about doses administered.
Any unexplained discrepancy must be reported to the Registered Manager and investigated. Where the circumstances indicate a safeguarding risk, the safeguarding procedure must also be followed.
Controlled Drugs
Controlled drugs taken away from the service must be transported, stored, administered and recorded in accordance with the requirements applying to the particular controlled drug. An appropriate audit trail must be maintained.
Refrigerated and Temperature-Sensitive Medicines
Where medicines require specific temperature-controlled storage, suitable arrangements must be made before leaving the service. Manufacturer requirements and pharmacy advice must be followed. Medicines must not be used where there is uncertainty about whether storage conditions have been maintained until appropriate professional advice has been obtained.
Emergency Medicines
Required emergency medicines must accompany the child where the child’s assessment or healthcare plan indicates this is necessary. They must remain immediately accessible to the responsible person while being protected from unauthorised access.
Staff accompanying the child must know:
- where the emergency medicine is;
- when it is to be administered;
- how to administer it;
- what monitoring is required; and
- when emergency medical assistance must be requested.
Reconciliation and Records
Every transfer of responsibility for medicines must have a clear audit trail.
The service must be able to establish:
- what medicine left the service;
- how much left the service;
- who received it;
- which doses were administered;
- which doses were refused, omitted or otherwise not administered;
- what quantity was returned; and
- whether the remaining balance is correct.
Any discrepancy, medication error or unexplained loss must be escalated and managed in accordance with the medication incident procedure.
6.6 Disposal of Medication
Safe disposal of unused or expired medications is important to prevent accidental ingestion, misuse, or environmental damage. Under no circumstances should medications be thrown in general waste or down toilets/sinks. {{org_field_name}} follows these guidelines for disposal:
- Return to Pharmacy: Our primary method for disposing of medicines is returning them to a pharmacy, which will then handle proper disposal (incineration) in line with environmental regulations. We routinely return medications that are discontinued (no longer needed), expired, or belong to a child who has left the service. At least every month, a senior staff checks for any medications that need disposal and arranges a return. We use the pharmacy we work with, or any local pharmacy, as they are authorized to accept unwanted medicines for safe disposal.
- Authorisation and Records: When preparing medicines for disposal, two staff should verify what is being removed. They list out the drug name, strength, quantity being returned, and why (expired, etc.). For controlled drugs, special handling is required (see below). We maintain a “Medication Disposal Log” where we record each item returned, the date, and the pharmacy we returned it to. If possible, the pharmacy will provide or sign a receipt of drugs returned – we keep that for our records as evidence of safe disposal. This log ensures an audit trail so that no one suspects medication is unaccounted for. CIW may check that we have a clear process for disposal as part of proper medicine handling.
- Controlled Drugs Disposal: Controlled drugs cannot just be returned like others without proper oversight. Ideally, the pharmacy will send a licensed waste contractor or have a pharmacist witness the destruction of the controlled medication. Our role: we document in the Controlled Drug Register when a CD is disposed. For example, if a child’s morphine is discontinued and 5 tablets remain, we enter an entry “5 tablets returned to pharmacy for destruction on [date]” and have the pharmacist or receiving person sign the register (or another staff witness if pharmacy won’t sign). Many pharmacies are willing to sign the CD register upon taking the meds. If a police officer or other authorised person ever witnesses destruction on site (less common in children’s homes, more in nursing homes), that should be noted too. We never destroy controlled drugs by ourselves (like crushing and trashing) because of legal regulations – it must be denatured properly, usually by a pharmacist with a kit.
- Household Disposal is Prohibited: Staff are strictly instructed never to throw medications into the normal rubbish bin or flush them. It’s both a safety hazard (someone could retrieve from trash, or a child could, if not careful) and an environmental pollutant (drugs in water supply). Instead, always follow the return procedure. If absolutely in a rare case (like a tablet dropped in an irretrievable dirty place) and had to be disposed immediately, it should be rendered unusable (e.g. dissolved in some undesirable substance like soapy water and then disposed in a sealed container) – but generally, we avoid that by using pharmacy returns whenever possible.
- Sharps and Injections: If any medications involve sharps (like injection needles, lancets for blood tests, or epinephrine auto-injectors after use), these are disposed of in a sharps bin – a puncture-proof yellow container we keep for medical waste. Used sharps are immediately placed in the sharps bin by the person using them. When the sharps bin is about 3/4 full or at its time limit, we seal it and arrange for the local council or health authority to collect and replace it (they usually have clinical waste services). We never put loose needles in any bin. Spent epinephrine pens also go in sharps container (since they have a needle). This protects everyone from needle-stick injuries.
- Creams, Liquids, and Other Forms: For liquids or creams that expire, we tighten lids and include them in returns. If a bottle is opened and half-used, the pharmacy will still accept it for destruction. We place items in a bag – ideally separate liquids to avoid spills – and hand over. If something were to leak, handle carefully with gloves and clean up per hazardous waste protocols.
- Medication Belonging to Discharged Children: When a child leaves the home (either moving placement or going home permanently), we send their current medications with them to the next caregiver (with documentation). However, if anything is left behind or not needed, we dispose of it. We won’t keep another child’s medication for potential future use, even if it’s the same drug someone else takes – this is not allowed. Each prescription is specific to an individual. So any leftover belonging to a departed child is returned to pharmacy promptly. We note this in our disposal log as well.
- Homely Remedies Disposal: Over-the-counter medicines we keep (like Calpol, etc.) also have expiry dates. We check these routinely and dispose of any expired bottles or anything that’s been open too long. Even though they’re non-prescription, they should be treated with the same caution.
- Environmental Consideration: By using proper channels, we ensure medications do not contaminate the environment. The pharmacy’s disposal (incineration or proper chemical handling) is the safest. We also prevent misuse – for example, a strong painkiller thrown in the bin could be found by someone rummaging through trash, which is dangerous. So staff remain diligent about controlling medication waste as stringently as active meds.
Proper disposal practices are part of our overall medication management system. They protect everyone and prove our service’s thoroughness. We include training for staff on disposal procedures, and the manager audits that returns are happening and logs are kept. If CIW or an inspector asks “what do you do with expired meds?”, any staff should be able to confidently describe the above process, demonstrating our commitment to safe and responsible care.
6.7 Controlled Drugs: Special Handling Procedures
Some medications used by children are classified as Controlled Drugs (CDs) due to their potential for abuse or harm (examples in a child-care context might include methylphenidate for ADHD, certain strong painkillers, or sedatives). Controlled drugs have extra legal restrictions and must be handled with heightened security and documentation. In addition to the general medication procedures, we implement the following for controlled drugs:
- Identification of Controlled Drugs: Staff need to know which medications in our home are controlled drugs. The pharmacy label or accompanying literature often indicates this (it may have a symbol “CD” or the drug name is known to be scheduled). The most common CDs in children’s care might include: methylphenidate (Ritalin/Concerta), dexamfetamine, some anti-anxiety or sleep meds like Diazepam, pain meds like Codeine or Morphine (if ever prescribed post-surgery or severe pain), or even some seizure medications like phenobarbital. A list of schedule 2 and 3 drugs is available for reference (we keep a quick reference chart for staff). When in doubt, treat a medication as controlled until confirmed otherwise.
- Double-Locked Storage: As noted earlier, all controlled drugs are kept in a separate locked container within our locked medication cabinet. This is often referred to as double-lock storage. Only senior authorised staff should handle the key for this CD container. At the time of administration, the staff retrieves the CD and immediately relocks after removing the needed dose.
- Controlled Drug Register: Each controlled drug and each child for whom it is prescribed has a section (or page) in our bound Controlled Drug Register, which is a hardbound book with numbered pages (to prevent tampering). Whenever we receive a CD (for example, pharmacy delivers 30 tablets of Methylphenidate for Child X), we make an entry: date, “Received from Pharmacy – 30 tablets,” and the new running balance (30) is recorded, signed by staff (and ideally counter-signed by a witness). Each time we administer a dose, we enter: date/time, how much given, to whom (Child X), by whom and witnessed by whom, and the remaining balance. For example, “01/10/2025 08:00 – administered 1 tablet to [Child’s initials], balance 29. Signed A.Staff, Witness B.Staff.” If a dose is refused or spilled etc, that is also recorded (“01/10/2025 20:00 – dose (1 tablet) refused, wasted – disposed via pharmacy return, balance remains 29. Signed…”). Essentially, every movement of the drug is tracked so there is an auditable trail.
- Witnessing Administration: It is our policy that two staff should be involved in giving a controlled drug whenever possible. One staff (usually a trained senior or the one assigned to meds) will prepare and administer the CD to the child, and a second staff will witness the entire process – from checking the drug and dose, to seeing the child take it, to recording the details. Both then sign the MAR and the CD Register. This double-check significantly reduces errors and diversion (theft) and is considered best practice in care settings. If, due to exceptional circumstances, only one staff is available (which we try to avoid, especially at med times), then that staff must be extra diligent in documenting, and a manager should retroactively check the stock ASAP. But ideally, we plan shifts so that CD administration times have two staff.
- Counting and Reconciliation: Controlled drug stock counts are verified at every administration (the running balance is updated each time) and reconciled regularly, at least daily. Typically, at each shift handover, the outgoing and incoming senior staff will together count the controlled drugs for each child and compare to the register balance. We especially ensure counts at the end of the day. If any discrepancy is found – even one tablet missing or one extra – we treat it seriously: double-check our math, look for recording errors, etc. If it’s not immediately resolved by finding an entry mistake, the manager is informed immediately as this could indicate a serious issue (like a tablet miscounted, dropped, or worst case, misappropriated). We will investigate and if a loss or theft is suspected, it may have to be reported (to CIW, the police, and safeguarding as needed). But the strict regimen of counting helps catch issues early.
- Use for the Correct Child: Under no circumstance is a controlled drug prescribed for one child used for another, even if medically it’s the same drug needed. The prescription belongs to that specific individual. If another child needs it, they must have their own prescription. This avoids any legal breach and also keeps records straight.
- Transporting Controlled Drugs: If a controlled drug must be sent with a child off-site (like a home visit dose or to school), we handle it with caution. Preferably, arrange a separate prescription for the visit so the family can pick it up, or send only the exact dose needed in a clearly labeled container. The person receiving (parent or school staff) should sign for it. When it returns (if any left), recount and sign it back in. For example, if a child has an overnight with 2 CD tablets to take, we might sign out 2 tablets in the register (“sent with parent”), and upon return parent confirms whether taken or if one returned. Adjust balance accordingly. These steps maintain chain of custody.
- Disposal of Controlled Drugs: As mentioned in Section 6.6, disposal requires witness and documentation. When returning a CD to pharmacy, we ideally have the pharmacist sign the register. If a controlled drug is fully used up (empty bottle), we still keep record of final use. If any waste happens (like half a tablet not given or liquid spilled), we note it in register and attempt to have a witness. Even the residue of transdermal patches (some drug remains in a used patch) should be folded and disposed of securely (in sharps bin ideally) to prevent misuse. We log removed patches if relevant.
- Training and Authority: Only staff who have been trained in medication administration are allowed to handle controlled drugs. Newer staff should do this under supervision initially. All staff are made aware of the seriousness – mishandling a CD can have legal implications. Our induction covers controlled drug protocol. The manager authorises in writing which staff are permitted to sign the CD register and administer CDs. Typically, all senior care staff are included once trained.
- Storage Keys: As a further security measure, some homes use a separate key for the controlled drug cabinet. If we do this, that key might be kept by the manager or in a coded key safe accessible to authorised staff. We log key access. This ensures not just anyone can get to CDs, even if they access the main med cupboard.
- Audit by Pharmacy/Authorities: We may request our supplying pharmacist to do periodic audits of our controlled drug management. Also, CIW inspectors have the right to inspect controlled drug stocks and records during inspections. We maintain everything in an orderly way so it’s easy to audit – e.g. one could pick a random entry in the CD register and we can show the corresponding remaining stock and MAR entries. This transparency protects the staff and the organisation as well.
By following these stringent measures, we are aligned with legal requirements for controlled drugs and ensure that “medication storage and administration adheres to statutory and non-statutory guidance”. The added oversight not only prevents misuse and diversion (which could have serious consequences for the child and others), but also ensures the child consistently receives their needed medication without interruption or error. Controlled drugs often are critical to a child’s well-being (like focusing in school, controlling pain, etc.), so we treat them with the utmost care and responsibility.
6.8 “Homely Remedies” and Non-Prescription Medications
A homely remedy is a common over-the-counter (OTC) medicine or preparation used to treat minor ailments, which can be bought without a prescription (like paracetamol for a mild fever or a simple cough syrup). In a children’s care home, it’s practical to have some homely remedies available, so we don’t need to call a doctor for every minor complaint. However, their use must be carefully controlled and documented to ensure safety and avoid masking serious conditions. Our approach to homely remedies is:
- Homely Remedies Policy: {{org_field_name}} has a small list of approved homely remedy medicines that we may administer under specific conditions. Typically, this list is developed with input from a healthcare professional (like a pharmacist or GP) and might include items such as: Paracetamol (acetaminophen) for mild pain or fever, Calamine lotion for insect bites, simple linctus (cough syrup) for a mild cough, rehydration salts for mild diarrhoea, etc. Each listed item has conditions for use (e.g. “Paracetamol 500mg tablets – for headache or temperature above 37.5°C, one tablet for age over 12, not more often than every 4-6 hours, max 4 doses in 24h, not more than 3 days without doctor review”). We keep this policy/document accessible so staff know what they can give and how.
- Parental Consent: Upon admission (or regularly updated), we obtain consent from the person with parental responsibility for the use of homely remedies. This is often a standard form listing the OTC medicines we might use and asking for a signature. For looked-after children, the local authority (or foster parent if they share PR) usually can give this consent. We will not administer any non-prescribed medicine to a child unless we have this prior consent, except in an emergency where we’d call a medical professional anyway. If a parent/guardian has objections (e.g. some parents prefer no medicine unless prescribed), we respect that and then would seek medical advice whenever needed.
- Check Before Administering: Just because something is OTC doesn’t mean it’s always safe. Before giving a homely remedy, staff must check:
- Allergies or Contraindications: Ensure the child isn’t allergic to the ingredient and that it won’t interfere with any of their prescribed medications. For example, we wouldn’t give paracetamol if the child is already on a prescription that contains paracetamol, to avoid overdose. If uncertain about interactions, call a pharmacist for advice – they are happy to advise on OTC use.
- When it was last taken: If the child came from school having already been given Calpol by the school nurse, we need to know not to duplicate. Always ask the child (if old enough) or any accompanying adult when the last dose of any common OTC was, or check daily logs.
- Symptoms Justify Use: We use homely remedies for minor, short-term issues. If a child has moderate to severe symptoms, or we suspect a more serious illness (e.g. very high fever, severe pain, recurring issue), we contact a doctor instead of just giving OTC repeatedly. Homely remedies are meant as a stop-gap or first aid measure, not a long-term treatment.
- Dosage and Administration: Follow the package instructions or our homely remedy protocol for age-appropriate dosing. Never exceed the recommended dose or frequency. Use appropriate measuring devices for liquids. Explain to the child what you are giving (“This is some cough syrup to help your throat feel better”).
- Recording: Treat homely remedy administration with the same level of documentation as prescription meds. If we give any OTC medicine, we write it on the MAR chart (even if it wasn’t pre-printed on there, write it in a blank space or back side, including name, dose, time, and reason). For example, “Paracetamol 250mg/5ml syrup – gave 10ml at 2pm for headache, temp 38°C” and then sign. Also log it in the daily notes or a specific homely remedy log if we maintain one. This ensures we don’t accidentally double dose (especially if another shift comes on, they’ll see it was given) and provides a history if we end up needing a doctor (we can say “we gave paracetamol at these times but fever persisted”).
- Duration of Use: Generally, if a homely remedy is needed more than 48 hours (or per our protocol, maybe 72 hours at most) for the same symptoms without improvement, we will seek medical advice. For instance, a slight cold might be fine with lozenges and decongestant for a day or two, but if it’s lingering or worsening, time to call the GP. We don’t keep just treating a child’s potentially serious illness with OTCs.
- Stock and Storage: OTC medicines are stored in the locked medicine cabinet just like prescription meds (possibly in a separate “homely remedies” section). Although they are generally safer, they still must be inaccessible to children. We label them “stock use” and track how much is used to replenish. Check expiry dates regularly. And we store them by usage – internal vs external separate.
- Informing Healthcare Professionals: If we do end up taking the child to the GP or hospital, we inform them of any homely remedies we administered (e.g. “He’s had 2 doses of paracetamol since yesterday”). This is important for their assessment and to avoid overdose if they prescribe something additional.
- Examples of Minor Ailments and Remedies: Our staff are trained on a few common scenarios:
- Mild headache or fever: Paracetamol as per age dose. (Never give aspirin to under-16 due to risk of Reye’s syndrome.)
- Mild indigestion: Perhaps an over-the-counter antacid like calcium carbonate chewable if on our approved list.
- Mild cough or sore throat: Simple linctus or throat lozenges (sugar-free as appropriate) if age allows. Warm honey and lemon (for over-1-year-olds) can also be considered as a home remedy with guardian consent.
- Minor cuts/abrasions: Not a “medicine” per se, but antiseptic cream might be applied from our first aid supplies (with consent).
- Seasonal allergies (mild): Possibly an over-the-counter antihistamine for older children if previously tolerated – but usually we prefer a GP to approve regular use.
Each of these is detailed in our internal guide so staff use them correctly.
- No OTC without Approval: Staff should remember they are not doctors or pharmacists. They should not just give any OTC that a child requests or that pops in mind. We stick to the pre-approved list. If a child says “I usually take X for this at home,” we verify that – maybe call parent or check records – before giving, and ensure it’s on our approved list or get a quick OK from a pharmacist/GP. It’s also worth noting that some children might have cultural or home remedies – those can be comforting but we have to be cautious (e.g. herbal remedies can interact with meds). We’d consult before allowing any such remedy.
- Homely Remedy Log and Oversight: The manager or designated senior periodically reviews the usage of homely remedies. This is to ensure they’re not being overused or used inappropriately. Frequent requests for a certain remedy might indicate an unresolved health issue (e.g. constant need for pain relief – maybe the child has an underlying condition). The manager might then arrange a medical review for that child. We also ensure one staff isn’t habitually giving something without thought. Oversight keeps it all in check.
By implementing a homely remedies protocol, we align with guidance that “care homes should consider maintaining a stock of OTC medicines to address minor ailments”, but we do so in a structured, safety-conscious way. Children thus get timely relief for minor issues, and staff have clear boundaries for what they can do without a doctor. This enhances care while still respecting safety and regulatory compliance.
6.9 Medication Errors and Adverse Incidents
Despite best efforts and careful systems, medication errors can still occur. What’s crucial is how we respond to them – to protect the child involved, to learn from mistakes, and to prevent future occurrences. A medication error could be: giving the wrong medication, the wrong dose, to the wrong child, at the wrong time, by the wrong route, or failing to give a dose, or giving without proper authorisation. It could also include administering a medication in a manner not in line with guidelines (e.g. crushed when shouldn’t be) or discovering a significant discrepancy in controlled drug counts. Additionally, adverse drug reactions or events (where a child has a harmful or unexpected reaction to a medicine) are important incidents. Our policy for errors and incidents is as follows:
- Immediate Child Safety Measures: If an error is realized immediately (e.g., you gave a tablet and then see it was for another child), act at once: stop the child from consuming it further if possible (e.g. “spit it out!” if still in mouth). If already ingested or error noticed later, then depending on what and how much, be prepared to take emergency action. Check the child’s condition. Many errors might not cause immediate visible harm, but some can (e.g. an allergic reaction or overdose symptoms). If there are any concerning symptoms or if a dangerous medication was involved, call emergency services (999) without delay. Have the medication details on hand to tell them. If not an immediate 999 case, at least call a pharmacist or NHS Direct (111) for urgent medical advice – they can advise what to do (induce vomiting? probably not; monitor at home? go to A&E? etc.) based on the drug’s profile. For example, taking one extra blood pressure pill might just require observation, whereas taking someone else’s anti-seizure med might need urgent care. Never hide an error for fear of blame – the child’s life could depend on prompt action.
- Inform the Manager and Seek Medical Advice: Notify the senior on duty or the Registered Manager immediately about the incident. They can help assess and take over coordination. If needed, contact the child’s GP or out-of-hours doctor to explain the situation and get guidance on treatment or observation. If an antidote or specific treatment is needed (some overdoses have antidotes), they will direct us. Always err on the side of caution – even if the child seems fine, certain effects can be delayed. Medical professionals might say “bring them to A&E for evaluation” – follow that instruction. Bring the medication packaging along to show doctors exactly what was taken and in what quantity.
- Observe and Support the Child: Keep the child under close observation for any changes in condition. Check vital signs if trained to do so (pulse, breathing, level of responsiveness). Comfort them – they might be frightened if they know something went wrong. If they’re old enough, be honest but calm: “You were given the wrong medicine, so we’re having the doctor check you to make sure you’ll be okay.” If the child has any complaints (nausea, dizziness, etc.), note those and tell the healthcare providers.
- Documentation of Incident: As soon as the acute situation is handled, the staff involved (with manager’s help) must document the error in detail. We have a specific Medication Incident Report Form for this purpose. Include: date/time, who was involved, what happened (e.g. “Staff A gave Child B’s 8am pill to Child A”), how it was discovered, any immediate actions taken (like “called NHS 111, who advised to…,” “child taken to A&E,” etc.), and the child’s outcome/status. Also record it in the child’s daily log and on the MAR (properly annotate the MAR with “error – see incident report”). Don’t forget to also document any contacts (like conversation with GP or poison center, including names and times). This report helps for later analysis and is evidence we responded appropriately.
- Informing Parents/Placing Authority: We have a duty of candour to inform the child’s parent or legal guardian and social worker (if applicable) of any significant medication error, especially if it required medical attention or could have caused harm. The manager or senior should make that call as soon as reasonably possible (once the child is stable and immediate actions are done). Apologise for the incident, explain what happened and what is being done. Transparency is key to maintaining trust. If the child is old enough, they will likely tell their parent anyway; it’s better it comes from us professionally. Document that this communication happened.
- Notifying Regulatory Bodies: Certain medication errors may meet the threshold of a notifiable incident to CIW (the regulator). For example, if the child required emergency medical intervention or hospitalisation due to a medication error, we must notify CIW without delay. We fill out the appropriate notification form (Schedule 3 events – typically an accident or injury to a service user that requires medical treatment is notifiable). If in doubt whether it’s notifiable, err on side of notifying – CIW expects honesty and it’s part of our legal duties to report serious incidents. Additionally, if the error is due to staff malpractice or negligence that could be considered a safeguarding issue (like a pattern of errors or deliberate misuse), we also notify the Local Authority Safeguarding Team because a medication error can constitute neglect. The Safeguarding Lead (as mentioned in Roles) should be engaged in such a case.
- Investigation and Analysis: The Registered Manager will investigate how and why the error occurred. This isn’t about punishing staff but about preventing reoccurrence and ensuring accountability. They may interview those involved, review the environment (Was it a chaotic medication time? Were two med packs with similar names stored close together? Was the staff properly trained? etc.). If human error, was it a slip due to distraction or a lack of knowledge? We identify root causes: e.g., “medications for two children had similar names and were next to each other leading to confusion.” Based on findings, we implement corrective actions. This could include: additional training or supervision for the staff, changes in procedure (like separating where medications are stored, or introducing a second check for all meds, or improving handover communication if a dose was missed due to shift change). We also check if policy was followed – if not, remind or discipline as appropriate (for instance, if someone gave medication without checking MAR properly, that’s a performance issue to address).
- Learning and Prevention: All medication incidents are discussed in team meetings or handovers (respecting confidentiality but focusing on learning). For example, “We had an incident where X happened; remember everyone to always do Y.” This helps raise vigilance among the team. We might also update this policy or our protocols if the investigation reveals a need for change. The goal is continuous improvement – we treat errors as opportunities to strengthen our system. If patterns of similar minor errors are spotted (e.g. several late doses or recording mistakes), the manager will arrange a refresher training session for all staff.
- Support for Those Involved: Making a medication error can be very distressing for staff emotionally. Management will also ensure the staff involved are supported – e.g., debrief with them, reassure them if it was an honest mistake that we’re glad they reported it and that we’re focused on fixing the system. However, if negligence or misconduct is found (like a staff was under the influence or intentionally not following procedures), that is handled through disciplinary processes. In extreme cases it might lead to formal action or even referral to professional bodies or DBS if it constitutes harm to a vulnerable person. But most errors are unintentional and we handle them with a balanced approach of accountability and empathy.
- Adverse Drug Reactions: If the incident was not an “error” but a bad reaction (e.g. child breaks out in hives after a new antibiotic), we consider that an incident too. The steps differ slightly: ensure medical treatment for the reaction (antihistamines, doctor visit), mark the allergy in the child’s records, inform all relevant parties (so that drug is never given again). We or the GP might report it to the Yellow Card scheme (UK system for reporting drug adverse reactions). Also inform the child’s parent and social worker about the reaction. Keep documentation of the event. This is less about our systems and more about the child’s medical file – but it’s equally important to handle thoroughly.
- Continuous Monitoring: After any serious error, we may temporarily increase oversight (for example, manager might personally supervise med rounds for a week, or double checks instituted for all meds for a time) until satisfied the risk is mitigated.
In essence, we foster a culture where staff immediately report errors or near-misses, and we respond rapidly to protect the individual and learn from mistakes. This aligns with regulatory expectations that providers have systems to record and review incidents (including medication errors) and take action in response. By handling errors transparently and proactively, we ultimately improve the safety of our medication management for everyone.
6.10 Staff Training and Competency
Medication safety is directly linked to the knowledge and skills of the staff administering it. Therefore, {{org_field_name}} places a strong emphasis on proper training and assessment of competency for all staff involved in medication management, in line with regulatory requirements. Our approach includes:
- Initial Training: Every care staff member who will administer or handle medications must first complete a medication training program. This is typically a comprehensive course covering topics such as: understanding different types/forms of medicines, the “5 rights” of administration, how to read prescription labels, use of MAR charts, safe storage, infection control (like hand hygiene and glove use), recognizing side effects, what to do in emergencies (like allergic reactions or overdose), legal responsibilities, and our specific home’s policies. We often utilise accredited external training or e-learning modules followed by in-person discussion. New hires do this as part of induction. We also ensure training covers unique aspects of children’s medication (for instance, weight-based dosing for some meds, dealing with children’s refusal behaviors, concepts like Gillick competence for consent, etc.).
- Specialized Training: If a child has particular medical needs requiring special procedures, staff receive additional training specific to that. Examples: use of an Epilepsy rescue medication (like rectal diazepam or buccal midazolam) – staff would be trained by a qualified nurse or doctor in how and when to give it. Or if a child is diabetic on insulin – staff would be trained by a diabetic nurse in blood glucose monitoring and insulin administration technique. Any task that is a delegated healthcare task (something normally done by a health professional but delegated to care staff, e.g. gastronomy feeding, or administering an EpiPen) is taught by the appropriate professional and we keep a record of that competency sign-off. We adhere to any nursing delegation guidelines in such cases.
- Competency Assessment: Completing a course isn’t enough – each staff must demonstrate they can apply that knowledge. We implement competency assessments where a senior staff or the manager observes the staff member administering medicines (initially under supervision) and evaluates their performance. We use a checklist to ensure they: follow the 5 rights, can correctly fill out a MAR, understand the procedure for controlled drugs, know how to respond to refusal or error, etc. If they pass, the manager authorises them to administer medication unsupervised. If not, they get more training/shadowing until competent. This assessment is documented in their personnel file.
- Refresher Training: Medication practices and guidelines update over time, and skills can dull if not used. We require all staff to undergo refresher medication training at least annually. This may be a shorter course focusing on updates and common pitfalls, and/or a reassessment of competence. If there have been any errors or near-misses, those are anonymously incorporated into training as scenarios to learn from. We also update staff on any new policies (like if we introduce a new MAR chart format or new homely remedies protocol, etc.).
- Ongoing Supervision: The management conducts periodic spot checks. For example, the Registered Manager or deputy might randomly observe a medication round (especially for a new staff or after a change). They look to ensure procedures are followed (like checking MAR, identifying child properly, etc.). Feedback is given immediately – praise for good practice and correction for any deviations. Medication management is also a standard agenda item in staff supervision sessions and team meetings, where staff can discuss challenges or uncertainties. We encourage an environment where staff feel free to ask questions if unsure about a medication or procedure, rather than winging it.
- Training Records: We maintain a training matrix or log that shows when each staff completed medication training and when their next refresher is due. The Registered Manager (or training coordinator) ensures no one is scheduled to administer meds if their training is out-of-date or if they have not been signed off as competent. If due, they will be pulled from administering duties until refreshed – during that time, other trained staff or management cover. This protects residents from unqualified handling.
- Agency or Temporary Staff: If we use any agency staff, we verify their medication training credentials before allowing them to administer at our home. Ideally, agency staff should have up-to-date meds training and we give them an orientation to our specific system (location of MAR, keys, etc.). If we are not confident in an agency staff’s knowledge, we restrict them from medication duties and have our permanent staff handle it.
- Knowledge of Policy: Training includes knowledge of this Medication Policy and related procedures. Staff are provided a copy (or access to it electronically) and required to read it. We may have a short quiz or discussion to ensure understanding. When the policy is updated, changes are communicated to all staff and they may need to sign an acknowledgment of the update. In practice, staff need to not just know the theory but also know our home’s way of doing things, so part of internal training covers our forms, where things are, and who to contact in scenarios like a med error or after-hours question (e.g., on-call manager at {{org_field_out_of_hours}} for advice, NHS Direct, etc.).
- First Aid Training: While not medication training per se, we also ensure a good number of staff are first-aid trained so they can handle any medical emergencies or reactions promptly until professional help arrives. This complements medication safety (e.g., if a child chokes on a pill, staff with first aid can respond).
- Cultural and Child-Centred Emphasis: We train staff to administer medication in a manner that is respectful and child-friendly, as discussed in earlier sections. Role-playing might be used in training for how to gently persuade a child to take meds or how to explain things to them. The goal is not just technical accuracy, but also maintaining the child’s trust and comfort.
- Evaluation and Feedback: We periodically evaluate the effectiveness of our medication training by monitoring our medication error rates and staff confidence. If we notice repeated mistakes of a similar kind, we revisit our training content to address that gap. Staff are invited to give feedback on training – e.g. “Do you feel prepared to handle meds? Any areas you’d like more training on?” This helps tailor future sessions.
By ensuring “staff receive training and are competent before managing or administering medication”, we greatly reduce risks. CIW inspectors will often ask staff questions during visits to gauge their knowledge, or check training records – we strive for every staff member to answer confidently and correctly about our medication procedures. Moreover, well-trained staff lead to safe and smooth medication rounds, which directly benefits the health of the children in our care.
6.11 Audit and Quality Assurance
Regular auditing and oversight of medication practices are essential to maintain high standards and catch any issues early. {{org_field_name}} implements several layers of audit and quality assurance in line with regulatory expectations (Regulation 58 explicitly expects “regular auditing of the storage and administration of medicines”, and our own commitment to continuous improvement).
Our audit and QA activities include:
- Daily/Shift Checks: On each shift, the designated senior or staff in charge does basic checks, such as ensuring all medications have been given and signed for in the MAR before shift handover. They also ensure that the medication cabinet is locked and keys are accounted for. Any anomalies (like a signature gap) are to be rectified or reported immediately. For controlled drugs, as mentioned, count checks at each shift change act as a mini-audit every day.
- Weekly Medication Audit: Once a week, typically the Registered Manager or Deputy Manager conducts a more thorough audit. This may involve:
- Checking a sample of MAR charts for completeness and looking for any missed signatures or unexplained gaps.
- Cross-checking that quantities of a few medications in stock match what the records (MAR and recent orders) would predict. For instance, if Child A had 30 tablets at start of week and should have taken 7 by now, ensure around 23 are left.
- Inspecting the storage conditions and cleanliness of the med cabinet and fridge (temperature logs up to date, no expired meds present, etc.).
- Reviewing controlled drug register and counts thoroughly.
- Verifying that all medications have an entry on a MAR and that none have been overlooked (sometimes an audit might catch that a short course antibiotic wasn’t added to MAR properly, etc.).
Any discrepancies or concerns found are noted in an audit log and corrected. Even minor issues like a consistently late dose or a near-miss will be discussed with staff to reinforce proper practice.
- Monthly Management Review: The Registered Manager compiles a monthly medication management report or summary. This includes: number of medication errors or incidents that month (and brief description of each and actions taken), results of weekly audits (any recurring issues?), training completed or due, any feedback from pharmacists or external professionals, etc. This report is shared with the Responsible Individual ({{org_field_nominated_individual_first_name}} {{org_field_nominated_individual_last_name}}) as part of governance. The RI needs to be aware of how well medication is managed and if there are risks. The RI might provide input or resources if patterns of issues emerge.
- Quarterly Pharmacist Review: Where possible, we invite a pharmacist (for example, our dispensing pharmacy’s clinical pharmacist) to review our medication processes periodically. They might look at our storage, records, and MARs and give an objective assessment, possibly suggesting improvements (like a different layout for MAR, or new storage solutions, etc.). Although not mandated, this is good practice and shows our commitment to external oversight.
- Service Reviews and RI Visits: As part of the RI’s responsibilities, during their regular visits (at least quarterly as required by regulations), they will often check medication management aspects. They may talk to staff or children about medicines, check that audits are done, and mention their observations in their RI report. Similarly, our internal quality improvement plans include medication safety as a key point (since a failure here can have serious consequences).
- Care Inspectorate Wales (CIW) Inspections: We treat each CIW inspection as an opportunity to validate our systems. Inspectors commonly ask to see MAR charts, the medication storage, and might quiz staff. Through our ongoing audits and training, we aim to have no surprises – everything should already be in good order. If CIW ever gives recommendations (for example, “update your medication policy to include homely remedies” or “improve recording of refusals”), we incorporate those immediately and review in our next audit cycle to ensure compliance.
- Incident Analysis: All medication incidents (even minor ones) are aggregated and analysed over time. For instance, end of year we might look at how many errors occurred, of what type, and did our interventions reduce them. This analysis can reveal systemic issues (e.g. if most errors happen on night shift, perhaps night staff need more support or a second staff on duty at med time). We then adjust procedures accordingly. Such analysis is part of our quality assurance report and helps us demonstrate to regulators our proactive stance.
- Feedback from Children and Others: Although children might not directly “audit” meds, we pay attention to any feedback or complaints related to medication. If a child says “Staff sometimes forget my cream,” or a parent says “I found out he missed doses during a home visit,” we treat that as important feedback and investigate. We also encourage children (if age appropriate) to be involved in their medication management – some older youths might keep their own medication diary, which can be compared to MAR as a cross-check. This inclusion can empower them and provide an informal check on our processes (e.g. a teen might speak up if a staff tried to give them medicine at the wrong time because they know their regimen).
- Documentation Audits: Apart from MAR charts, we also audit things like: have all staff signed that they read the medication policy? Are all training certificates up to date (no one administering without training)? Are consent forms for homely remedies in place for each child? These paperwork checks are done periodically (e.g. quarterly file audit) to ensure nothing is missing in the overall system.
- Audit Trail and Corrective Actions: For transparency, we maintain records of our audits (like a weekly audit checklist and a monthly summary). These include any issues found and what was done about them. For example, an audit note might say “Found 2 tablets extra for Child Y’s med compared to MAR count – discovered dose on 5th was not signed but given. Spoke to Staff C, who acknowledged forgetting to sign. MAR corrected. Refresher on signing MAR given to all.” By keeping these, we can show improvement over time and accountability.
- Continuous Compliance: Essentially, our aim is that medication management becomes a routine that is ingrained – audits should hopefully find very little because everyone’s doing it right. But we never become complacent. Even if audits go well for months, we still continue them, because vigilance must be constant. Healthcare has shown that complacency is when errors creep back. So we keep the culture of “trust but verify” – trust staff are doing well, but still verify via audits for safety.
Effective oversight and audit ensure we maintain high standards and that any deviations are quickly corrected. This systematic approach satisfies our regulatory obligations to monitor quality and safety of our service (including medicines management). More importantly, it ensures that children in our care consistently receive the correct care with regards to their medications, which is a cornerstone of their overall health and well-being while at {{org_field_name}}.
6.12 Delegated Medicines-Related Healthcare Activities
Where a healthcare professional delegates a medicines-related healthcare activity to a member of staff at {{org_field_name}}, the activity must only be undertaken where the delegation is lawful, appropriate for the individual child, consistent with current national guidance and professional requirements, and within the competence of the member of staff.
Before accepting responsibility for a delegated medicines-related activity, the Registered Manager must ensure that:
- the activity has been assessed as suitable for delegation by an appropriately qualified healthcare professional;
- responsibility and accountability between the healthcare professional, service and member of staff are clearly understood;
- there are clear written child-specific instructions;
- any required healthcare plan, protocol or risk assessment is in place;
- the member of staff has received appropriate training from a suitably qualified person;
- the member of staff has been assessed as competent to undertake the activity;
- competency is documented;
- arrangements are in place for supervision and reassessment of competence;
- staff know the limits of the delegated activity and must not independently alter the prescribed procedure;
- staff know when and how to seek healthcare advice;
- appropriate equipment and medicines are available;
- administration and outcomes can be recorded accurately; and
- contingency and emergency arrangements are documented.
A member of staff must not undertake a delegated medicines-related activity if they have not been trained and assessed as competent or if they believe they are unable to perform the activity safely.
Competence must be reviewed at an appropriate frequency and whenever:
- the child’s treatment changes;
- the procedure changes;
- equipment changes;
- there is a medication or clinical incident;
- concerns arise regarding the member of staff’s practice; or
- the delegating healthcare professional requires reassessment.
Delegation does not authorise staff to make clinical decisions that have not been delegated to them. Where instructions are unclear, circumstances have changed or the child’s condition gives cause for concern, staff must stop and obtain advice from the appropriate healthcare professional.
Records of delegation, training, competency assessment and review must be retained in accordance with the service’s records management arrangements.
7. Medication Incidents, Escalation and Regulatory Notifications
Every medication error, omission, near miss, unexplained discrepancy, loss, suspected diversion, adverse medication event or concern about medicines management must be reported internally in accordance with {{org_field_name}}’s incident reporting procedure and escalated to the Registered Manager or senior person on duty.
The immediate priority following a medication incident is the child’s safety.
Staff must:
- assess the child’s immediate condition;
- obtain appropriate clinical advice without delay where the error or omission could affect the child’s health;
- contact emergency services where clinically required;
- provide accurate information about the medicine, dose, strength, route, timing and circumstances;
- follow the healthcare professional’s advice;
- continue appropriate monitoring;
- accurately record what occurred and the advice received;
- inform the Registered Manager;
- complete the required incident documentation; and
- ensure relevant persons and agencies are informed where required.
Medication records must reflect what actually occurred. Staff must never falsify, erase or retrospectively alter a medication record to conceal an error.
CIW Notification
A medication incident is not automatically notifiable to Care Inspectorate Wales solely because a medication error has occurred.
The Registered Manager and/or Responsible Individual must consider the circumstances against Regulation 60 and Schedule 3 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended.
A notification must be made where the incident meets an applicable statutory notification category, for example where the circumstances amount to or involve:
- abuse or an allegation of abuse involving the provider, a member of staff or volunteer;
- a serious accident or injury meeting the applicable regulatory threshold;
- an incident reported to the police;
- an event which prevents or could prevent the provider from continuing to provide the service safely;
- a child protection enquiry where this is a prescribed notification;
- another event expressly specified in Schedule 3; or
- another statutory notification requirement applicable to the particular circumstances.
Where a notification is required, it must be made without delay unless the Regulations specify a different timescale and must be submitted in the manner required by CIW, including through CIW Online where required.
Where the circumstances do not meet a CIW notification category, the medication incident must nevertheless be recorded, investigated and reviewed internally and must be reported to other relevant bodies where another legal, safeguarding, commissioning or professional reporting requirement applies.
Placing Authority and Safeguarding
For a child accommodated by the service, the Registered Manager must also consider whether notification to the placing authority is required under Schedule 3 or under the child’s placement arrangements.
Where a medication incident raises a concern of abuse, neglect, deliberate withholding, inappropriate restraint, deliberate overdose, diversion or other improper treatment, the safeguarding procedure must be followed immediately in addition to the medication incident procedure.
Investigation and Learning
Medication incidents and near misses must be reviewed proportionately to establish:
- what happened;
- why it happened;
- whether the child experienced or could have experienced harm;
- whether professional advice was obtained promptly;
- whether medication records were accurate;
- whether staffing, competency, communication, storage, ordering or other systems contributed;
- whether similar incidents have occurred previously; and
- what action is required to prevent recurrence.
Actions identified through investigation must be implemented, monitored and included in medicines audit and quality-assurance arrangements where appropriate.
8. Policy Review
To remain effective and up-to-date, this Children’s Medication Policy will be subject to regular review. {{org_field_name}} commits to reviewing this policy at least annually (every 12 months) and more frequently if needed. The Registered Manager ({{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}) together with the Responsible Individual will oversee the review process.
During each review, we will:
- Check for Changes in Law or Guidance: We will monitor any updates in Welsh legislation, CIW regulations, or national guidance that affect medication management. For example, if new statutory guidance is issued under RISCA, or if NICE publishes new guidelines on medicines in children’s social care, or if there are changes to controlled drugs regulations – these will be incorporated. Staying current ensures our policy remains RISCA and CIW compliant.
- Reflect on Practice and Feedback: We will evaluate how well the policy has been implemented over the period. This includes reviewing internal audit results (Section 6.11) and any medication incidents or near-misses we logged. If any patterns suggest that a part of this policy isn’t clear or isn’t working as intended, we will modify that section. We will also gather feedback from staff – since they use the policy daily, they might have suggestions to improve clarity or practicality. Additionally, any feedback from CIW (e.g. inspection reports) or from placing authorities, parents, or the children themselves will be taken into account. For instance, if staff found the procedure for outings cumbersome, we might streamline it, or if a child had issues with how we handle consent, we might address that.
- Ensure Alignment with Best Practice: We aim not just to meet minimum standards, but to follow best practices. Each review will consider current best practice recommendations in pediatric care and medicines management. We may consult with a pharmacist or nurse for expert input to see if there are better ways to do things (for example, new training methods, or better documentation tools). We also review related policies to ensure consistency – e.g. our Safeguarding Policy, in case of overlap, or our Record-Keeping Policy regarding MAR chart retention, etc., so that all policies work cohesively.
- Update and Re-Publish: If changes are made, the policy will be updated and re-issued. All staff will be notified of changes. Significant changes will be explained in a staff meeting or in a dedicated training refresher if needed. For example, if we add a new section on managing a specific type of medication or change a procedure, we will ensure everyone understands the new expectations. Staff may be asked to sign an acknowledgment of the revised policy. We will also update any training materials and forms to match the new policy. If changes affect children or their families (say we decide to implement a new consent form or a different approach to self-medication), we will inform them as appropriate to maintain transparency.
- Bilingual Availability: We mention that this policy is available in Welsh on request – at review, we will ensure the Welsh version (if produced) is also updated so both language versions stay in sync. This is part of respecting the Welsh language needs of staff or stakeholders.
- Record of Review: At the end of this document (below), the “Reviewed on” date will be updated to the latest review date, and a “Next review date” will be set (usually 1 year ahead, unless circumstances dictate sooner). The Responsible Person (usually the Registered Manager or a designated senior) will sign off on the updated policy. We keep past versions on file for reference and in case CIW wants to see how policies have evolved.
By diligently reviewing and updating our Medication Policy, {{org_field_name}} ensures that we remain compliant with the latest requirements and that we are continuously improving our care. Regular review is also a regulatory expectation and a hallmark of a learning organisation. It demonstrates to regulators, staff, and service users that we do not take medication management for granted – we are always looking to enhance safety and quality. As medicine and children’s needs evolve, so will our policy, thereby sustaining a high standard of care.
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}}
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