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Children’s Medication Policy

1. Purpose and Scope

1.1 Purpose

The purpose of this Medication Management Policy is to establish clear and robust guidelines for the safe handling, storage, administration, and disposal of medicines in domiciliary care settings for children. This policy ensures that all staff members adhere to best practices and legal requirements to safeguard each child’s health, well-being, and dignity while maintaining a high standard of medication management.

The policy aims to:

• Promote safe medication practices that prevent medication errors, misuse, and avoidable harm.
• Ensure legal and regulatory compliance with CQC standards, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, NICE guidance, and the Care Act 2014, alongside child-specific safeguards.
• Support each child’s independence by encouraging self-administration, where developmentally appropriate.
• Provide clear roles and responsibilities for all staff handling medications, ensuring accountability.
• Maintain accurate documentation and record-keeping to ensure medication administration is transparent, safe, and auditable.

1.2 Scope

This policy applies to all domiciliary care staff involved in any aspect of medication management for children, including:

• Care workers and support staff responsible for administering, assisting, or prompting medication.
• Registered managers and supervisors overseeing pediatric medication practices.
• Office-based coordinators and administrators responsible for maintaining medication records and stock levels.
• Trained healthcare professionals engaged in specialist medication administration (e.g., children’s nurses).

1.3 Compliance with Key Regulations and Guidance

All staff must comply with the following regulations and standards:

Care Quality Commission (CQC) Regulations

• Regulation 12 (Safe Care and Treatment): Ensures pediatric medicines are supplied in sufficient quantities, stored correctly, and administered safely.
• Regulation 17 (Good Governance): Requires clear governance, auditing, and risk management procedures for medication administration.
• Regulation 13 (Safeguarding Children from Abuse and Improper Treatment): Protects children from medication-related neglect, abuse, and improper treatment.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
All domiciliary care providers must have robust procedures in place for medication safety, infection control, and staff competency when caring for children.

National Institute for Health and Care Excellence (NICE) Guidance
NICE guidance NG67: Managing medicines for individuals receiving social care in the community outlines best practices for safe administration, recording, and reviewing medication management. Staff must incorporate considerations for pediatric dosing and monitoring.

Care Act 2014
The Care Act requires care providers to meet each child’s medication needs as part of overall care and support while ensuring person-centered care and dignity, alongside any relevant child-focused legislation (e.g., Children Act 1989).

1.4 Responsibilities of Staff

All domiciliary care staff involved in pediatric medication management must:

• Follow prescribed medication orders and only administer medication as per the child’s Medication Administration Record (MAR).
• Ensure each child’s informed consent is obtained, or that of the parent/guardian if the child lacks capacity.
• Encourage self-administration where possible, providing support and age-appropriate guidance.
• Safeguard against medication errors by following the five rights of medication administration:
  1. Right Person
  2. Right Medication
  3. Right Dose
  4. Right Time
  5. Right Route
• Report and document medication errors or refusals immediately in accordance with incident reporting procedures.
• Store medications securely in compliance with safety protocols (e.g., refrigeration for temperature-sensitive pediatric formulations).
• Dispose of expired or unused medications properly, ensuring safe disposal methods to prevent misuse or environmental harm.
• Undergo regular training and competency assessments to ensure they remain skilled in administering medication to children.

2. Governance and Accountability

2.1 Overview

Effective governance and accountability in medication management ensure safe, legal, and child-centered care for pediatric service users in domiciliary care settings. Governance involves clear roles, responsibilities, oversight, and auditing processes to ensure compliance with CQC regulations, best practice guidance, and internal policies.

All staff must understand their individual responsibilities and the wider organizational procedures that safeguard the correct handling of children’s medications. This includes record-keeping, audits, reporting medication incidents, and learning from errors.

2.2 Roles and Responsibilities

2.2.1 Registered Manager

The Registered Manager holds ultimate responsibility for medication governance and must:

• Oversee safe administration, storage, disposal, and recording of pediatric medicines.
• Ensure staff are trained, competent, and regularly assessed for children’s medication management.
• Implement systems for monitoring and improving medication safety.
• Address any medication-related concerns, complaints, or errors immediately.
• Ensure full compliance with CQC regulations.

2.2.2 Care Staff (Support Workers, Carers)

Care staff responsible for administering or assisting with children’s medications must:

• Follow prescribed medication orders strictly.
• Maintain accurate and up-to-date MAR charts.
• Report any concerns about medication safety to their manager immediately.
• Undergo regular medication training and competency assessments that focus on pediatric care.

2.2.3 Office Staff / Coordinators

Office-based staff supporting medication processes must:

• Ensure MAR charts are accurate and updated.
• Coordinate medication stock levels with pharmacies and suppliers.
• Schedule staff training and competency checks.

2.3 Compliance with Regulation 17 (Good Governance)

Regulation 17 – Good Governance requires effective systems and processes to ensure safe pediatric medication management, including:

Accurate Record-Keeping

• All medications must be clearly recorded on a MAR chart.
• Any changes to medication must be documented and communicated.
• Errors or missed doses must be reported and investigated.

Continuous Improvement

• Regular medication audits must be conducted to identify issues, trends, or risks.
• Feedback from staff, children, and parents/guardians must be used to enhance medication management.
• Staff training must be updated in response to new regulations or emerging risks.

Risk Assessments

• Each child should have an individual medication risk assessment to identify potential hazards.
• Storage and disposal of medicines should be regularly checked to prevent contamination, theft, or misuse.

2.4 Conducting Regular Audits & Risk Assessments

To ensure safe medication management, regular audits and risk assessments must be carried out, including:

2.4.1 Monthly Medication Audits

• Check MAR charts for missing entries or inconsistencies.
• Review medication errors and incidents.
• Verify controlled drug records.
• Ensure that all expired or unused medicines are disposed of correctly.
• Assess staff competency and training needs.

2.4.2 Individual Risk Assessments

• Identify specific risks for each child, such as:
  • Risk of self-administration errors.
  • Risk of adverse drug interactions.
  • Physical or cognitive impairments that may impact medication safety.
• Adjust care plans and medication protocols accordingly.

2.5 Adherence to Regulation 20 (Duty of Candour)

Regulation 20 – Duty of Candour requires openness and transparency in the event of medication-related incidents.

2.5.1 Reporting Medication Incidents

Any medication errors, near-misses, or adverse reactions must be:

• Immediately recorded in the incident log.
• Reported to the Registered Manager.
• Investigated to determine the cause and prevent future occurrences.
• Communicated to the child and/or their parent or guardian in a clear and transparent manner.
• Reported to CQC if required.

How to report:

1. Verbally
2. Inform the Registered Manager by email: {{org_field_registered_manager_email}}
3. Call the office: {{org_field_phone_no}}
4. Out of hours phone number: {{out_of_hours}}
5. Fill in a Medication Error Report form which can be obtained from the office.

2.5.2 Learning from Medication Errors

After a medication incident, a review meeting should be held to:

• Identify root causes.
• Implement corrective actions.
• Provide additional staff training if needed.
• Update policies and procedures to prevent recurrence.

2.6 Continuous Improvement & Staff Training

• Staff must complete annual medication management training focused on pediatric care.
• Regular competency checks should be conducted to assess knowledge and adherence to procedures.
• Training should cover:
  • Correct administration techniques for children.
  • Handling controlled drugs and emergency medications in pediatric contexts.
  • Recognising and responding to pediatric adverse drug reactions.
  • Reporting and learning from medication errors.

3. Medicine Supply and Stock Control (where our company is responsible)

Effective medicine supply and stock control is essential to ensure that each child receives the correct medication at the right time, in the right dose, and in the correct condition. All domiciliary care staff must follow strict procedures to prevent pediatric medication errors, shortages, and wastage while complying with CQC regulations, the Health and Social Care Act 2008, and NICE guidance.

3.1 Ensuring Adequate Stock Levels of Prescribed Medicines

To ensure that children do not run out of essential medications:

• Monitor stock levels daily and ensure medications are available when needed.
• Reorder medications well in advance to avoid running out, allowing for potential delays from pharmacies.
• Keep an emergency supply plan in place for essential and life-saving medications (if permitted under policy and guidance).
• Staff must immediately report any low stock levels to the registered manager or office team to arrange for replenishment.

3.2 Procedure for Ordering, Receiving, and Checking Medicines

Proper ordering, receiving, and checking of medicines ensures accuracy, safety, and compliance with prescriptions.

3.2.1 Ordering Medicines

• Staff must follow the prescribed medication plan for each child and check what needs reordering.
• Orders should be placed in good time (usually at least 7 days before medications run out).
• Only authorised staff can request medication orders from GPs or pharmacies.
• Ensure the correct strength, dose, and form of medication is ordered.
• Record orders in the Medication Administration Record (MAR) or stock control system.

3.2.2 Receiving Medicines

When receiving a medication delivery from the pharmacy, staff must:

• Check the medication against the prescription for accuracy.
• Ensure all medications are correctly labelled with the child’s name, dosage, and administration instructions.
• Check for damaged or missing medications and report any issues immediately.
• Ensure medications that require refrigeration are stored promptly at the correct temperature.

3.2.3 Checking Medicines

Upon receiving new medication:

• Verify the expiry date—do not accept expired medication.
• Check for changes in packaging or appearance and confirm with the pharmacist if unsure.
• Record the new stock in the MAR chart and ensure previous medications are rotated to use older stock first.

3.3 Recording Medication Supply and Checking Expiry Dates

3.3.1 Recording Medication Supply

• Keep a log of all medication deliveries and usage in a stock control record.
• Ensure the MAR chart is updated accurately when medication is received or administered.
• Controlled drugs must be logged separately in a controlled drugs register.

3.3.2 Checking Expiry Dates

• Check expiry dates weekly for all medications in stock.
• Pay special attention to liquid medications, eye drops, creams, and refrigerated items, as they may expire faster than tablets.
• Expired medications must be removed from circulation immediately and marked for disposal.
• Report any medication nearing expiry to the registered manager or office team so that replacements can be arranged.

3.4 Safe Disposal of Unused or Expired Medicines

To prevent misuse and ensure environmental safety:

• Expired or unused medications must never be given to children.
• Medications must be returned to the pharmacy for safe disposal—never throw them in the general waste.
• A Medication Disposal Log must be maintained, recording:
  • The name and quantity of medication disposed of.
  • The reason for disposal (e.g., expired, discontinued, no longer required).
  • The name of the pharmacy where the medication was returned.
• Sharps (e.g., insulin needles, syringes) must be placed in a designated sharps bin and disposed of following clinical waste regulations.

3.5 Responsibilities of Staff in Medicine Supply and Stock Control

• Care Staff must:
  • Monitor medication stock levels and report when running low.
  • Check labels, dosage, and expiry dates before administering medications.
  • Maintain accurate records in the MAR chart.
• Office Staff / Coordinators:
  • Oversee ordering and delivery of medication.
  • Communicate with GPs, pharmacists, and families regarding medication needs.
  • Ensure medication disposal procedures are followed.
• Registered Manager:
  • Conduct regular medication audits to ensure stock control compliance.
  • Investigate and address any medication supply issues.
  • Ensure all staff are trained in safe medication handling.

4. Safe Medication Management

Safe medication management is a critical part of providing high-quality care and ensuring the well-being of children. All staff must follow strict procedures when handling, storing, administering, and documenting medication use. This section provides clear instructions on administration procedures, storage requirements, and handling medication errors and omissions.

4.1 Administration Procedures

Proper administration of medication is essential to prevent errors, ensure effectiveness, and maintain safety. All care staff must adhere to Regulation 12 (Safe Care and Treatment) to ensure pediatric medicines are handled correctly.

4.1.1 Following Regulation 12 (Safe Care and Treatment)

• Always check the child’s name, prescription details, and MAR chart before administering medication.
• Follow the 5 Rights of Medication Administration:
  1. Right Person – Confirm the child’s identity using their care plan or MAR chart.
  2. Right Medication – Ensure the medication name matches the MAR chart and prescription.
  3. Right Dose – Administer the exact amount prescribed.
  4. Right Time – Give medication at the prescribed time to maintain effectiveness.
  5. Right Route – Follow the correct method of administration (e.g., oral, topical, injection, inhalation).

4.1.2 Ensuring Correct Dosage, Timings, and Administration Routes

• Medications must be administered exactly as prescribed; do not crush, split, or mix medications unless instructed by a prescriber.
• Use appropriate tools such as measuring spoons, syringes, or inhalers to ensure accurate dosage for children.
• If a child refuses medication, do not force them. Instead:
  • Encourage them to take it and explain its importance.
  • If they still refuse, record the refusal and report it to the manager.
  • Seek guidance if multiple doses are missed.

4.1.3 Observing for Side Effects and Adverse Reactions

Observe children for any unexpected reactions, such as:

• Allergic reactions (swelling, rash, difficulty breathing).
• Drowsiness, dizziness, confusion, or changes in mood or behavior.
• Stomach pain, nausea, vomiting, or diarrhea.

If an adverse reaction occurs:

• Stop administering the medication immediately.
• Call emergency services (999) if necessary.
• Report to the registered manager and document the incident.
• Notify the GP or pharmacist for further advice.

4.2 Storage Requirements

Proper medication storage is essential to maintain potency, prevent contamination, and ensure compliance with legal regulations.

4.2.1 Secure Storage of Controlled Drugs

• Controlled drugs must be stored in a locked, tamper-proof cabinet.
• Access to controlled drugs should be restricted to authorised staff.
• A Controlled Drugs Register must be maintained, recording:
  • Date and time of administration.
  • Name of the child.
  • Dosage given.
  • Signature of the administering staff.

4.2.2 Safe Storage of Medical Gases and Emergency Medicines

• Oxygen cylinders and other medical gases must be:
  • Stored in a well-ventilated area, away from heat sources.
  • Secured in an upright position to prevent accidents.
• Emergency medications (e.g., EpiPens, glucagon, naloxone) must be:
  • Stored in a readily accessible but secure location.
  • Clearly labelled for emergency use.
  • Checked regularly for expiry and replaced when needed.

4.2.3 Proper Temperature Control for Medications Requiring Refrigeration

• Certain medications (e.g., insulin, liquid antibiotics, eye drops) must be stored at 2–8°C.
• Refrigerators must be:
  • Dedicated only to medications (not for food storage).
  • Temperature monitored daily, with records kept.
  • Stock checked weekly for expired medications.

4.3 Medication Errors and Omissions

Despite strict procedures, errors can still occur. It is vital that staff follow clear reporting and corrective action protocols to protect children.

4.3.1 Immediate Reporting and Documentation of Medication Errors

A medication error occurs when:

• The wrong medication is given.
• The wrong dose is administered.
• The wrong child receives medication.
• The medication is given at the wrong time.
• The wrong route is used (e.g., given orally instead of by injection).
• A dose is missed without documentation.

What to do if an error occurs:

• Assess the child—check for any signs of harm or adverse reactions.
• Report immediately to the registered manager or supervisor.
• Where to report:
  a) Verbally
  b) Inform the Registered Manager by email: {{org_field_registered_manager_email}}
  c) Call the office: {{org_field_phone_no}}
  d) Out of hours phone number: {{out_of_hours}}
• Contact emergency services (999) if necessary.
• Document the incident in the MAR chart and incident report log.
• Follow the investigation process to prevent recurrence.

4.3.2 Procedures for Handling Missed Doses or Incorrect Administration

• If a dose is missed, staff should:
  • Check the prescription to see if the medication can still be administered.
  • Contact a GP or pharmacist if unsure.
  • Record the missed dose in the MAR chart.
  • Inform the child’s family or guardian if required.
• If a double dose is given accidentally:
  • Contact the GP or pharmacist immediately.
  • Monitor the child closely for any side effects.
  • Follow emergency procedures if necessary.

4.3.3 Investigation and Corrective Actions in Line with CQC Regulations

Every medication error must be investigated under the guidance of the Registered Manager. The Duty of Candour (Regulation 20) applies—children or their families must be informed if an error has occurred.

Investigations should include:

• Reviewing staff training records—was the error due to lack of pediatric knowledge?
• Checking medication processes—were there system failures?
• Identifying preventive measures—do procedures need to be updated?
• Providing additional training for staff if necessary.
• A Corrective Action Plan (CAP) must be put in place to prevent future errors.

4.4 Staff Responsibilities in Safe Medication Management

All Care Staff Must:

• Follow the 5 Rights of Medication Administration.
• Check for adverse drug reactions and report any concerns.
• Store medications securely and at the correct temperature.
• Document all medication administrations accurately.
• Report any errors or missed doses immediately.
• Complete regular medication training and competency assessments.

Registered Manager Must:

• Ensure CQC-compliant medication procedures are followed.
• Conduct regular medication audits to ensure safe practices.
• Investigate all medication errors and near misses.
• Provide ongoing staff training and competency checks.
• Maintain secure storage and accurate record-keeping.

5. Administration of Medicines in Children’s Homes

The safe administration of medicines in a child’s home is essential to ensuring well-being, maintaining dignity, and promoting independence. Staff must follow all legal and regulatory requirements while ensuring that medication is administered correctly and safely.

5.1 Gaining Informed Consent Before Administering Medication

Before administering any medication, staff must ensure that the child (or the parent/guardian, where appropriate) has given informed consent. This means that the individual with authority has been provided with all relevant information about the medication, understands the purpose, benefits, and potential risks, and agrees to proceed.

Always explain:

• What the medication is for
• The correct dosage and timing
• Any potential side effects or reactions

If a child lacks capacity to provide informed consent:

• Follow the guidelines set out in the Mental Capacity Act 2005, as applicable to minors who cannot fully decide.
• Involve family members or legal representatives if necessary.
• Document the decision-making process in the child’s care records.

If a child refuses medication:

• Do not force or pressure them.
• Record the refusal in the MAR chart.
• Inform the registered manager or healthcare professional if refusals are frequent or pose a risk.

5.2 Encouraging Children to Self-Administer Where Possible

Maintaining independence is a key aspect of person-centered care. Where appropriate, children should be supported to manage their own medication, either fully or partially, based on their developmental level and guidance from parents or guardians.

Assess whether self-administration is appropriate:

• Consider the child’s ability to understand dosages and handle medication safely.
• Check if there are any risks associated with self-administration.
• Document the assessment and review regularly.

Provide support based on individual needs:

• Full self-administration – The child takes full responsibility for managing medication if capable.
• Prompting – Staff remind the child to take medication but do not physically assist.
• Supervision – Staff observe the child to ensure the medication is taken correctly.
• Partial assistance – Staff may help with tasks such as opening containers or preparing doses but do not physically administer medication.

If a child’s ability to self-administer changes:

• Conduct a reassessment.
• Implement additional support or supervision if required.
• Update the child’s care plan and MAR chart.

5.3 Procedures for Staff Assisting with Medication

When assisting children with medication, staff must ensure they follow safe and correct procedures at all times.

Prompting Medication

• Remind the child when it is time to take medication.
• Do not touch or administer the medication unless the care plan specifies assistance.

Supervising Medication

• Observe the child taking medication and ensure they follow correct procedure.
• Record that the medication has been taken in the MAR chart.

Administering Medication

• Check the MAR chart to ensure the correct medication, dose, time, and route.
• Ensure the child is in a comfortable position before administration.
• Offer a drink of water if required to swallow tablets.
• Do not crush or alter medication unless instructed to do so by a healthcare professional.
• Remain with the child until they have taken the medication.
• Document the administration immediately in the MAR chart.

5.4 Maintaining Accurate Medication Administration Records (MAR)

Accurate record-keeping is essential for medication safety, compliance, and auditing purposes. The MAR chart must be completed for every medication administered, prompted, or supervised.

Completing the MAR Chart

• Clearly record the date, time, and dose of medication given.
• Use the correct codes to indicate whether the medication was administered, refused, or omitted.
• Ensure entries are made in real-time, never before or after actual administration.

Documenting Changes or Issues

• If a child’s medication is changed by a GP, update the MAR chart and notify the office.
• If a child refuses medication, record the refusal and report it to the registered manager if necessary.
• Record any errors, missed doses, or adverse reactions and follow the appropriate reporting procedures.

Auditing and Reviewing MAR Charts

• MAR charts should be checked regularly by senior staff to identify any discrepancies.
• Any issues identified should be investigated and addressed immediately.
• Records must be stored securely and retained for the required period as per regulatory guidelines.

6. Record-Keeping and Audit Process

Effective record-keeping and regular auditing are essential to maintaining safe medication management for children and ensuring compliance with regulatory requirements. All staff involved in pediatric medication administration must understand the importance of accurate documentation and proactive monitoring of medication processes.

6.1 Keeping Accurate and Up-to-Date MAR Charts

MAR charts are legal documents that provide a detailed record of all medications administered to a child. Staff must ensure that MAR charts are completed accurately and kept up to date to prevent pediatric medication errors and ensure continuity of care.

Recording Medication Administration Correctly

• Every time medication is administered, prompted, or refused, it must be recorded immediately in the MAR chart.
• Entries must be made in real time. Never fill out MAR charts in advance or leave entries incomplete.
• Ensure that the following details are recorded:
  • Date and time of administration
  • Name of the medication
  • Dose given
  • Route of administration (oral, topical, injection, inhalation)
  • Name and signature of the staff member administering the medication

Using Correct Notation and Codes

• Only use approved medication codes when recording administration, refusal, or omissions.
• If a medication is refused or missed, a reason must be documented clearly.
• If an error is made on the MAR chart, do not erase it. Draw a single line through the error, write “error,” and sign it.

Documenting Missed or Refused Doses

• If a child refuses medication, encourage them to take it and explain why it is important.
• If they still refuse, do not force them. Record the refusal in the MAR chart and notify the appropriate person (manager, GP, or family if necessary).
• If a dose is missed for any reason, document the reason in the MAR chart and report it immediately.

Handling Changes in Medication

• If a GP or healthcare professional changes a prescription, ensure the MAR chart is updated immediately.
• Remove or mark previous medication instructions as discontinued to prevent errors.
• Verify the new medication details with the pharmacy before administration.

6.2 Regular Medication Audits to Ensure Compliance

Regular audits of medication administration records and stock help identify errors, ensure compliance with policies, and improve safety.

Weekly MAR Chart Checks

• Senior staff or the registered manager should review all MAR charts weekly to check for:
  • Missing entries or incomplete records
  • Errors in documentation
  • Consistency between prescribed medication and what has been administered

Monthly Full Medication Audits

• Conduct a full audit of all medication administration records, stock levels, and storage practices.
• Verify that controlled drugs are recorded correctly in the controlled drugs register.
• Check for expired medications and ensure proper disposal procedures are followed.

Incident Review and Reporting

• Any medication-related errors, missed doses, or discrepancies identified during an audit must be reported and investigated.
• Staff involved in errors must receive additional training if needed to prevent future mistakes.
• Findings from audits should be shared with staff, and any corrective actions must be documented and implemented.

6.3 Ensuring All Medication Changes Are Documented and Communicated to Relevant Professionals

It is essential that all changes in a child’s medication regimen are clearly documented and communicated to the appropriate professionals to maintain continuity of care.

Updating MAR Charts and Care Plans

• When a medication is added, stopped, or the dose is changed, the MAR chart must be updated immediately.
• The new prescription must be checked against the original order to confirm accuracy.

Notifying the Relevant Professionals

• The registered manager must ensure that all medication changes are communicated to:
  • The GP or prescribing healthcare professional
  • The pharmacy supplying the medication
  • The child and their family or advocate, if appropriate
• If a change in medication affects the child’s health or care needs, update their care plan accordingly.

Ensuring Staff Awareness

• Staff must be informed of any changes in a child’s medication regimen before administering medication.
• A handover process should be in place to ensure all care workers on duty are aware of recent changes.
• Any uncertainty about a medication change must be clarified with the registered manager or healthcare professional before administration.

7. Staff Training and Competency Assessment

Staff training and ongoing competency assessments are essential to ensure that medications are administered safely to children and in compliance with legal and regulatory requirements. All staff involved in pediatric medication management must be trained and assessed regularly to maintain high standards of care and prevent medication errors.

7.1 Mandatory Medication Training

All staff responsible for administering, assisting with, or managing pediatric medications must complete a formal training program before undertaking these responsibilities. Training must include:

Understanding Medication Management Regulations and Policies

• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
• Care Quality Commission (CQC) medication standards
• National Institute for Health and Care Excellence (NICE) guidelines on medication safety

Types of Medications and Their Uses

• Commonly prescribed pediatric medications and their effects
• Routes of administration (oral, topical, injection, inhalation)
• Differences between prescription-only medications, over-the-counter drugs, and controlled substances

Safe Medication Administration Procedures

• How to check and use a MAR chart
• The five rights of medication administration (person, medication, dose, time, route)
• Handling, measuring, and preparing pediatric medications correctly
• Preventing and responding to medication errors

Recognising and Managing Side Effects and Adverse Reactions

• Signs of an allergic reaction
• Common side effects of pediatric medications
• When to seek medical advice or emergency help

Legal and Ethical Responsibilities

• Obtaining informed consent before administering medication
• Children’s rights in relation to medication decisions
• Safeguarding considerations when handling pediatric medications

7.2 Competency Assessments at Regular Intervals

Competency assessments must be conducted to ensure that staff have the necessary skills and knowledge to administer medications to children safely. These assessments should take place:

• Before a new staff member is permitted to administer pediatric medication independently
• Annually as part of routine performance evaluations
• Whenever an incident involving medication errors occurs
• Following any updates or changes in medication policies and procedures

The competency assessment should include:

Practical Demonstration of Medication Administration

• Checking the MAR chart and identifying the correct medication
• Administering medication following the correct procedure
• Recording medication administration accurately

Knowledge Check on Medication Safety

• Understanding pediatric medication side effects and interactions
• Knowing how to respond to a medication refusal
• Correct procedures for reporting medication errors

Observation and Supervision

• Senior staff should observe new or recently trained staff administering medications
• Feedback should be provided, and any areas for improvement should be addressed
• Staff must be retrained if any gaps in knowledge or practice are identified

7.3 Training on the Use of Controlled Drugs, Medical Gases, and Emergency Medications

Some staff members may be required to administer controlled drugs, medical gases, or emergency medications to children. Additional specialized training is required for these areas.

1. Controlled Drugs (CDs)
   • Understanding the legal framework for controlled drugs, including record-keeping requirements
   • Safe storage, handling, and administration of controlled drugs
   • Completing the controlled drugs register correctly
   • Disposal procedures for unused controlled substances
2. Medical Gases (e.g., Oxygen Therapy)
   • Safe storage and handling of medical gases
   • How to administer oxygen therapy safely
   • Identifying service users who require oxygen and understanding their care plans
3. Emergency Medications (e.g., EpiPens, Naloxone, Glucagon)
   • When and how to administer emergency medications
   • Recognizing the symptoms of anaphylaxis, hypoglycaemia, and opioid overdose
   • Ensuring emergency medications are stored correctly and checked for expiry dates

8. Compliance with National Guidance

All staff involved in medication management for children must follow national guidance to ensure safe, legal, and effective practices. Compliance with established guidelines helps prevent medication errors, safeguard children, and ensure the highest standards of care. Staff must understand and adhere to the relevant regulations, including NICE guidelines, CQC standards, and safeguarding requirements under Regulation 13.

8.1 National Institute for Health and Care Excellence (NICE) Guidelines on Medication Management

The National Institute for Health and Care Excellence (NICE) provides evidence-based recommendations for the safe handling, administration, and management of medicines in social care settings. Staff must follow NICE guidance to ensure that all pediatric medication-related activities align with best practices.

Person-Centered Approach to Medication

• Ensure that children are involved in decisions about their medication whenever possible.
• Respect individual preferences, including cultural and religious beliefs related to medication.
• Encourage and support children to self-administer if they are capable and it is safe to do so.

Safe Handling and Storage of Medicines

• Ensure that all medications are stored securely and at the correct temperature.
• Maintain a system for tracking and managing pediatric medication stock levels.
• Check expiry dates regularly and dispose of expired medications safely.

Administration of Medication

• Follow proper procedures for checking prescriptions, MAR charts, and medication labels.
• Adhere to the five rights of medication administration: right person, right medication, right dose, right time, right route.
• Document all medication administration accurately and immediately after it is given.

Monitoring and Review of Medication

• Regularly review each child’s medications to ensure they remain appropriate and effective.
• Report and document any side effects, adverse reactions, or changes in health conditions.
• Communicate with healthcare professionals to make adjustments to medication as needed.

8.2 Compliance with CQC Fundamental Standards for Medication Safety

The Care Quality Commission (CQC) sets out fundamental standards that all care providers must meet. Compliance with these standards ensures that children receive safe and effective care, particularly in relation to medication management.

Safe Care and Treatment (Regulation 12)

• Ensure that medications are supplied in sufficient quantities and administered correctly.
• Prevent errors by following standardized procedures for checking, preparing, and administering medication.
• Train and assess staff regularly to maintain high standards of pediatric medication safety.

Good Governance (Regulation 17)

• Maintain clear policies and procedures for pediatric medication management.
• Conduct regular audits and quality checks to identify and correct any issues.
• Keep accurate and detailed records of all medication activities, including administration, storage, and disposal.

Duty of Candour (Regulation 20)

• Be open and transparent with children and their families regarding medication errors or incidents.
• Report serious medication-related issues promptly to the registered manager and CQC if required.
• Take corrective action following medication incidents to prevent recurrence.

8.3 Adherence to Regulation 13 (Safeguarding Children from Abuse and Improper Treatment) to Prevent Medication-Related Abuse

Regulation 13 ensures that children are protected from abuse, including medication-related abuse or neglect. All staff must understand their role in safeguarding children from harm and must take immediate action if they suspect abuse.

Identifying Medication-Related Abuse

• Be aware of different forms of medication-related abuse, including:
  • Overmedication (giving unnecessary or excessive medication).
  • Under-medication (failing to give required medication or intentionally reducing doses).
  • Withholding medication as a form of control.
  • Giving medication without proper consent.
• Look for signs that a child may be experiencing medication-related abuse, such as unexplained drowsiness, agitation, confusion, or deterioration in health.

Taking Action if Abuse is Suspected

• If a staff member suspects that a child is being abused or neglected in relation to their medication, they must:
  • Report their concerns to the registered manager immediately.
  • Document the concern in the child’s records.
  • Follow the organization’s safeguarding procedures, including reporting to external authorities if necessary.

Where to report:

1. Inform the Registered Manager verbally
2. Inform the Registered Manager by email: {{org_field_registered_manager_email}}
3. Call the office: {{org_field_phone_no}}
4. Out of hours phone number: {{out_of_hours}}
5. Care Quality Commission (CQC): Call 03000 616161 for concerns about care standards or regulatory breaches.
6. Local Authority Child Safeguarding Teams: {{org_field_local_authority_authority_name}}, Link: {{org_field_local_authority_information_link}} for concerns related to abuse or neglect.

Preventing Medication-Related Abuse

• Ensure that all medication administration follows legal and ethical guidelines for children.
• Train staff to recognise and report signs of medication-related abuse.
• Maintain proper documentation to ensure transparency and accountability in pediatric medication management.

Covert Medication

Covert medication refers to the administration of medication in a disguised form (e.g., hidden in food or drink) without the child’s knowledge or consent. This practice is only permitted in exceptional circumstances where a child lacks the capacity or ability to consent and refusing medication would pose a significant risk to their health and well-being. Additional scrutiny applies when making decisions about children.

9. Legal and Ethical Considerations

The administration of covert medication in domiciliary care must comply with:

• The Mental Capacity Act 2005 (MCA) – Ensuring that decisions are made in the best interests of the child if they cannot fully comprehend the situation.
• National Institute for Health and Care Excellence (NICE) Guidelines – Ensuring best practices in medication management.
• Regulation 11 of the Health and Social Care Act 2008 – Ensuring consent is lawfully obtained.

Covert medication should never be used for convenience or as a form of control. It must always be a last resort and follow a multi-disciplinary assessment process involving parents/guardians and relevant professionals.

9.1 Conditions for Administering Covert Medication

Covert administration can only be considered when:

1. The child lacks capacity to make an informed decision about their medication.
2. The medication is essential for their health and well-being.
3. All reasonable efforts have been made to encourage voluntary compliance.
4. A best interests decision has been made involving appropriate professionals.

9.2 Assessment and Decision-Making Process

Before covert medication is administered, the following steps must be taken:

9.2.1 Mental Capacity Assessment

• A formal capacity assessment must be conducted to confirm the child lacks capacity to make decisions regarding their medication.
• The assessment must be documented and reviewed regularly.

9.2.2 Best Interests Meeting

A meeting must be held involving:

• The GP or prescriber (to confirm the necessity of the medication).
• The child’s family or legal representative (where appropriate).
• A pharmacist (to provide guidance on safe administration methods).
• The care manager or senior staff (to oversee compliance and documentation).

A best interests decision must be recorded, clearly stating:

• Why covert administration is necessary.
• Which medications are to be given covertly.
• How the medication will be administered (e.g., mixed with food or liquid).
• Who is responsible for oversight and review.

9.3 Safe Administration of Covert Medication

Once covert administration has been approved:

• Only the agreed medications should be given covertly.
• A pharmacist must advise on suitable mixing methods to ensure the medication remains effective (e.g., avoiding interactions with food or drink).
• Staff must document every administration in the MAR chart, specifying that it was given covertly.
• Care staff must never make unilateral decisions about covert administration—only those listed in the best interests meeting can authorize changes.

9.4 Regular Review and Monitoring

• The need for covert medication must be reviewed at least every three months or sooner if circumstances change.
• If the child gains capacity or understanding, covert medication must stop immediately.
• Regular checks should ensure medications remain necessary and effective.
• Any side effects or concerns must be reported to the GP or pharmacist.

9.5 Record-Keeping and Documentation

All decisions and actions regarding covert medication must be clearly documented, including:

• The capacity assessment report.
• Minutes from the best interests meeting.
• Written consent from relevant parties (e.g., family, legal representatives).
• Detailed records in the MAR chart indicating covert administration.
• Regular review dates and any changes made.

9.6 Staff Training and Compliance

All staff involved in medication administration must:

• Be trained in the Mental Capacity Act 2005 and best practices for covert medication.
• Understand how to seek guidance from healthcare professionals before administering covert medication.
• Follow the organization’s medication policy and legal requirements.

9.7 Safeguarding Considerations

Covert medication must not be used as a means of control or to sedate children unnecessarily. Any unauthorized covert administration will be considered a safeguarding concern and reported in accordance with local child protection policy.

10. Homely Remedies

Homely remedies refer to non-prescribed, over-the-counter (OTC) medications that can be used to treat minor ailments such as headaches, colds, indigestion, or mild pain. These medications can be administered safely within domiciliary care settings, provided they are managed in accordance with regulatory guidance, ensuring a child’s safety and compliance with best practices.

This section outlines how homely remedies are managed, administered, recorded, and monitored in domiciliary care, ensuring alignment with:

• The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Safe care and treatment.
• NICE Guidelines (SC1: Managing Medicines in Care Homes).
• CQC Standards on Medication Management.

10.1 Definition of Homely Remedies

Homely remedies include non-prescription medications such as:

• Pain relief – Paracetamol, ibuprofen (unless contraindicated).
• Cough and cold relief – Simple linctus, throat lozenges.
• Indigestion and heartburn relief – Antacids (e.g., Gaviscon).
• Constipation relief – Senna, lactulose.
• Diarrhea relief – Oral rehydration salts.
• Mild skin conditions – Emollients, antiseptic creams.

Homely remedies should never be used as a substitute for prescribed medication and must be approved for each child individually.

10.2 Conditions for Administering Homely Remedies

A homely remedy may only be administered if all the following conditions are met:

• The child has given consent (or a best interests decision has been made if they lack capacity), alongside parental agreement if required.
• The remedy is included in the child’s care plan and has been approved by a GP or pharmacist.
• The medication is suitable for the child based on their medical history, allergies, and current prescriptions.
• The homely remedy is not taken for more than 48 hours without consulting a healthcare professional.
• Care staff must not make independent decisions to administer homely remedies without authorization from a registered healthcare professional.

10.3 Obtaining and Storing Homely Remedies

• Homely remedies must be purchased by the child’s family or a designated healthcare professional.
• Medications must be stored separately from prescribed medication in a secure, labelled container.
• Expiry dates must be checked regularly, and any expired or unused remedies must be safely disposed of following the Medication Disposal Policy.
• Each child must have their own supply of homely remedies to prevent cross-contamination.

10.4 Safe Administration of Homely Remedies

Care staff must follow these guidelines when administering homely remedies:

• Check the care plan to confirm the remedy is authorized for the child.
• Follow the dosage instructions on the medication packaging or as advised by a pharmacist/GP.
• Check for contraindications—ensure the homely remedy does not interact with any prescribed medication.
• Obtain consent from the child or guardian before administering.
• Observe for any side effects and report any concerns immediately.

10.5 Documentation and Record-Keeping

All administration of homely remedies must be accurately recorded in the MAR chart, including:

• Date and time of administration.
• Name and dosage of the remedy.
• Reason for administration (e.g., mild headache, indigestion).
• Any observed effects (e.g., relief of symptoms, side effects).
• Signature of the care worker administering the medication.

If a child requires the same homely remedy for more than 48 hours, a GP or pharmacist must be consulted to determine if further medical intervention is required.

10.6 Staff Training and Competency

Care staff responsible for administering homely remedies must:

• Receive training in safe medication administration and homely remedies management.
• Understand how to check for contraindications and allergies.
• Be aware of the child’s preferences, religious beliefs, and cultural considerations regarding OTC medications.
• Competency assessments should be conducted annually to ensure staff remain proficient in administering homely remedies safely.

10.7 Safeguarding Considerations

• Homely remedies must never be used to sedate or control behavior.
• If a child repeatedly requests the same homely remedy, staff must notify a GP or healthcare professional to review any underlying health concerns.
• Any errors in administration or adverse reactions must be reported and documented in accordance with the Incident Reporting Policy.

10.8 Compliance and Auditing

• Regular audits of homely remedy administration will be conducted to ensure compliance with this policy.
• Feedback from children and families will be collected to improve care quality.
• Care plans and medication records will be reviewed periodically to ensure homely remedies remain appropriate for each child.

11. Controlled Drugs

Controlled Drugs (CDs) are medications regulated under the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations 2001 due to their potential for misuse, dependence, or harm. These medications include opioids, sedatives, and stimulants, among others.

In domiciliary care, strict procedures must be followed to ensure Controlled Drugs are stored, administered, recorded, and disposed of safely for children. This section outlines the management of CDs in accordance with:

• The Misuse of Drugs Act 1971.
• The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Safe care and treatment.
• NICE Guidelines (NG67: Managing Medicines for those receiving social care in the community).
• CQC Medication Management Standards.

11.1 Definition of Controlled Drugs (CDs)

CDs commonly used in domiciliary pediatric care include, but are not limited to:

• Opioid analgesics (e.g., morphine, oxycodone, fentanyl, tramadol, buprenorphine).
• Benzodiazepines (e.g., diazepam, lorazepam, temazepam).
• Stimulants (e.g., methylphenidate for ADHD).
• Antiepileptic drugs (e.g., pregabalin, gabapentin).

These medications are classified into five schedules under UK law, with Schedule 1 having the highest restrictions and Schedule 5 having the least. Most CDs in domiciliary care for children are Schedule 2, 3, or 4 drugs, which require stringent handling and documentation.

11.2 Storage of Controlled Drugs

• CDs must be stored in the child’s home in a lockable, tamper-proof storage box that meets British Standards (BS2881:1989 Security Level 1).
• The key to the CD storage must be kept by the designated responsible person (e.g., a parent, guardian, or authorized carer).
• If the child is unable to manage their own medication, the care provider must agree on a secure storage plan with the GP and family.
• CDs must never be left unattended or in unsecured locations.

11.3 Administration of Controlled Drugs

CDs must only be administered by trained, authorized care staff following these procedures:

• Check the MAR chart to confirm the prescription details.
• Verify the identity of the child before administration.
• Double-check the dosage against the prescription and medication label.
• Obtain consent from the child (or guardian if applicable) before administering.
• Administer the medication exactly as prescribed (e.g., oral, patch, injection).
• Record the administration immediately in both the MAR chart and the CD Register (if applicable).
• Monitor the child for side effects or signs of overdose (e.g., drowsiness, confusion, slowed breathing).
• Inform a GP or pharmacist if the child refuses the medication or has an adverse reaction.

Two-Person Check Requirement
For Schedule 2 CDs (e.g., morphine, oxycodone), a second trained staff member must witness administration and sign the CD Register, where possible. If only one staff member is present, a family member or another responsible individual should verify the dose.

11.4 Record-Keeping and Documentation

Every administration of a CD must be accurately recorded in:

• The MAR Chart:
  • Date and time of administration.
  • Name and dosage of the CD.
  • Route of administration (e.g., oral, transdermal).
  • Signature of the staff member administering.
  • Signature of the witness (if required).
• The CD Register (if applicable):
  • Running balance of CD stock.
  • Details of every dose administered.
  • Record of CD receipt (when supplied by a pharmacy).

Stock Reconciliation

• The remaining quantity of CDs must be counted and verified at every administration.
• Any discrepancies must be immediately reported to the care manager and investigated.

11.5 Disposal of Controlled Drugs

Unused, expired, or discontinued CDs must never be disposed of in household waste. Instead, they must be:

• Returned to the dispensing pharmacy for safe disposal.
• Documented in the CD Register with details of the return (date, medication name, quantity, and signature of the staff returning it).
• Where applicable, witnessed by a second authorized individual.
• If a CD patch (e.g., fentanyl) is removed, it must be folded in half and disposed of securely in line with pharmacy guidance.
• If a child passes away while in possession of CDs, the medication must be:
  • Stored securely until collected by a family member or pharmacist.
  • Recorded in the CD Register and signed off upon disposal.

11.6 Ordering and Receiving Controlled Drugs

• CDs must be prescribed by a GP or authorized prescriber.
• Medications must be collected from a registered pharmacy by the child’s family or an authorized representative.
• When receiving CDs, staff must:
  • Check the prescription details and quantity against the pharmacy label.
  • Record receipt in the CD Register (for Schedule 2 drugs).
  • Store the medication immediately in the secure CD storage box.

11.7 Staff Training and Competency

All care staff responsible for handling CDs must:

• Complete specialist training in Controlled Drug management for pediatric care.
• Understand legal classifications, safe administration, and storage requirements.
• Be able to identify signs of misuse, overdose, or dependence in children.
• Know how to document and report CD discrepancies or incidents.
• Competency assessments must be conducted annually to ensure compliance.

11.8 Incident Reporting and Safeguarding

• Any missing, lost, or stolen CDs must be reported immediately to:
  • The care manager.
  • The pharmacy and GP.
  • The police (if theft is suspected).
• If a child shows signs of dependence or misuse, staff must report concerns to the GP and safeguarding team.
• Any medication errors, overdoses, or adverse reactions must be recorded and escalated according to the Incident Reporting Policy.

11.9 Compliance and Auditing

• Regular audits of CD administration records and stock levels must be conducted to ensure compliance.
• Spot checks on CD storage and documentation may be carried out by senior management or CQC inspectors.
• Children’s care plans must be regularly reviewed to ensure CD use remains appropriate.

12. Transporting Medication

The safe transport of medication is critical in domiciliary care to ensure that children receive their prescribed medicines without delay, damage, loss, or contamination. This section outlines best practices for handling, storing, and transporting medication safely and legally in accordance with:

• The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Safe care and treatment.
• The Misuse of Drugs Act 1971 & Misuse of Drugs Regulations 2001 (for Controlled Drugs).
• NICE Guidelines (SC1: Managing Medicines in the Community).
• CQC Standards on Medication Safety.

12.1 General Principles for Transporting Medication

All medication transported within domiciliary care settings must be:

• Kept secure to prevent loss, tampering, or theft.
• Stored at the correct temperature to maintain efficacy.
• Handled confidentially to protect the child’s privacy.
• Recorded and tracked to ensure accountability and reduce risk of errors.

Care staff must never transport medication for unauthorized purposes or leave it unattended in public places.

12.2 Transporting Medication from Pharmacies to Children

When collecting medication from a pharmacy:

• Verify that the prescription is correct and matches the child’s details.
• Check labels and expiry dates before accepting the medication.
• Obtain a receipt from the pharmacy where applicable.
• Store medication in a secure container or bag that protects it from contamination or damage.

If the medication includes Controlled Drugs (CDs):

• Double-check the quantity and prescription instructions.
• Ensure a CD Register entry is made upon collection and delivery.
• Obtain a signature from the pharmacy staff upon collection.

12.3 Secure Handling of Medication During Transport

To prevent loss, damage, or contamination, staff must follow these procedures:

12.3.1 General Storage and Handling

• Tablets and capsules: Keep in original blister packs or pharmacy-labelled containers.
• Liquids and suspensions: Ensure lids are tightly sealed to prevent leaks.
• Creams, ointments, and inhalers: Store in sealed pouches to avoid cross-contamination.
• Temperature-sensitive medications: Store in an insulated bag or cold pack if refrigeration is required.

12.3.2 Transporting Medication in Vehicles

• Never leave medication unattended in a vehicle.
• Avoid extreme temperatures—store medication away from direct sunlight and excessive heat.
• Keep medications in a designated storage box or locked bag for security.
• For long journeys, monitor temperature-sensitive medications to ensure they remain within safe limits.

12.3.3 Handling Controlled Drugs (CDs) During Transport

• CDs must be transported in a locked container.
• Staff must carry the minimum quantity needed to reduce risk.
• A CD transport log must be completed to track movement.
• The recipient (child’s parent/guardian or responsible person) must sign for receipt.

12.4 Delivering Medication to Children

Upon arrival at the child’s home:

• Confirm the identity of the child before handing over medication.
• Check that the medication is correct and intact (no damage or leaks).
• Record the delivery in the child’s MAR.
• For Controlled Drugs, obtain a signature from the recipient in the CD Register.
• Provide safe storage advice if needed (e.g., refrigeration instructions).

If the child or parent refuses the medication delivery, staff must:

• Not leave the medication unattended.
• Return it to the pharmacy or care manager for further instruction.
• Document the refusal and inform the relevant healthcare professional.

12.5 Transporting Medication for External Appointments

If a child requires medication while attending an external appointment (e.g., hospital visit):

• Ensure the correct medication and dosage are packed securely.
• Provide clear administration instructions to healthcare providers.
• If a staff member accompanies the child, they must maintain responsibility for the medication and ensure it is safely returned if not administered.
• Any administered medication must be documented in the MAR chart upon return.

12.6 Handling Medication Returns and Disposal

If medication is no longer needed, expired, or refused, it must be returned to the pharmacy for safe disposal.

• Never dispose of medication in household waste or sinks.
• Record all returns in the MAR chart or CD Register (for Controlled Drugs).
• For deceased children, medications must be:
  • Stored securely until collected by a family member or pharmacist.
  • Returned to the pharmacy with documentation.

12.7 Documentation and Accountability

To maintain full traceability of transported medication:

• A medication transport log should record:
  • Date and time of collection and delivery.
  • Name of the child and medication details.
  • Name and signature of the person receiving the medication.
• For Controlled Drugs, additional records must be maintained in the CD Register.
• Any delays, errors, or losses must be reported immediately to the care manager.

12.8 Staff Training and Compliance

Care staff responsible for transporting medication must:

• Undergo training on secure pediatric medication handling and transport.
• Be aware of legal requirements, including those for Controlled Drugs.
• Understand how to store medication safely while in transit.
• Be familiar with procedures for reporting errors, missing medication, or security breaches.
• Regular compliance audits will be conducted to ensure safe and effective medication transport practices.

13. Review and Policy Updates

• Annual review of the policy or earlier if regulatory changes occur.
• Updates based on CQC recommendations and audit findings.

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