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Registration Number: {{org_field_registration_no}}

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Children’s Medication Policy

1. Purpose

The purpose of this policy is to provide a clear framework for the safe management, support, administration, recording, storage, supply, handling and disposal of medicines for children receiving domiciliary support services from {{org_field_name}}.

{{org_field_name}} will manage medicines in accordance with the Regulation and Inspection of Social Care (Wales) Act 2016, the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, including Regulation 58 relating to medicines, the Social Services and Well-being (Wales) Act 2014, the Children Act 1989, the Children Act 2004, applicable medicines legislation and current Welsh Government and Care Inspectorate Wales statutory guidance.

The service will ensure that:

• medicines are stored, handled and administered safely;
• arrangements are in place, where the service has responsibility, to maintain a sufficient supply of medicines and to manage their ordering and re-ordering;
• medicines are accurately recorded, received, reconciled, handled and disposed of;
• regular auditing of medicines management, including storage and administration, is undertaken;
• the level of medicines support required by each child is assessed and clearly recorded in the child’s personal plan;
• children are supported to manage their own medicines as independently as is safe and appropriate having regard to their age, understanding, competence, assessed needs and risks;
• medicines are administered only by staff who have received appropriate training and have been assessed as competent for the medicines activity they undertake;
• specialist or delegated medicines activities are undertaken only where appropriate delegation, instructions, training and competency arrangements are in place;
• the child’s views, wishes and feelings are taken into account and valid consent or other lawful authority for medicines support is established and recorded;
• medicine-related concerns, errors, safeguarding matters and adverse events are responded to promptly and reported to the appropriate persons and authorities where required; and
• medicines records and information are maintained accurately, securely and confidentially.

2. Scope

This policy applies to:

• All staff, including care workers, supervisors, and managers, involved in medication administration.
• Children receiving care services, whether short-term or long-term.
• Parents, guardians, and healthcare professionals involved in a child’s medication management.
• External agencies, such as GPs, pharmacists, and paediatric specialists.

It covers:

• Prescription and non-prescription medications.
• Roles and responsibilities of staff in medication administration.
• Storage, documentation, and disposal of medicines.
• Emergency medication procedures.
• Safeguarding and consent considerations.

3. Roles and Responsibilities

3.1 Responsibility of the Registered Manager

The Registered Manager ({{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}) is responsible for:

• Ensuring staff receive appropriate training in children’s medication administration.
• Monitoring medication records and conducting audits to ensure compliance.
• Ensuring up-to-date policies and procedures in line with regulatory changes.

3.2 Responsibility of Care Staff

Staff members involved in medication administration must:

• Follow prescribed medication instructions precisely.
• Ensure correct dosages, timings, and administration routes.
• Record all medication given and report any errors immediately.
• Report any side effects or concerns to the appropriate healthcare professional.
• Ensure they have completed necessary training and competency checks.

3.3 Responsibility of Parents and Guardians

Parents/guardians must:

• Provide accurate, up-to-date medication information.
• Supply medication in original packaging with pharmacy labels.
• Inform the service of any changes to the child’s prescription.

4. Prescribed and Non-Prescribed Medicines

4.1 Prescription Medicines

Prescription medicines must only be supported or administered in accordance with the current authorised directions for that medicine and the child’s personal plan.

Before staff undertake medicines support, the service must have sufficient and current information to identify:

• the child’s name and identity;
• the name of the medicine;
• the strength and formulation of the medicine;
• the prescribed or authorised dose;
• the route of administration;
• the required time or frequency of administration;
• any specific administration instructions;
• any known allergies or relevant adverse drug reactions;
• the reason for any “when required” medicine, where applicable;
• any relevant monitoring or escalation instructions; and
• who is responsible for obtaining, ordering or re-ordering the medicine.

Medicines supplied for an individual child should normally remain in the original container or packaging in which they were supplied and must have a clear and current dispensing label where applicable.

Staff must not alter prescribed doses, administration times or routes on their own initiative. Where directions are unclear, incomplete, conflicting or cannot safely be followed, the medicine must not be administered until appropriate clarification has been obtained from an authorised healthcare professional, unless urgent emergency instructions from an appropriate healthcare professional require otherwise.

Any change to a prescribed medicine must be confirmed through an appropriate and reliable source and reflected in the child’s medicines records and personal plan without avoidable delay.

4.2 Non-Prescription and Over-the-Counter Medicines

Non-prescription or over-the-counter medicines may only be supported or administered where there is lawful consent or other lawful authority, the medicine is appropriate for the child, and its use is recorded within the child’s agreed medicines arrangements or personal plan.

Staff must follow the manufacturer’s instructions and any advice or directions provided by an appropriate pharmacist, prescriber or other healthcare professional.

Staff must not independently diagnose a condition, recommend treatment outside their role, exceed the stated dose or frequency, or administer a non-prescription medicine where there is uncertainty about its suitability, interactions, contraindications, duration of use or compatibility with the child’s prescribed medicines.

The administration of a non-prescription medicine must be recorded in the child’s medicines record, including the medicine, dose, date, time and member of staff administering or supporting the medicine.

Where symptoms persist, recur, deteriorate or give rise to concern, appropriate healthcare advice must be sought.

4.3 Assessment of Medicines Support and Self-Management

The child’s need for medicines support must be assessed as part of their overall assessment and personal planning arrangements.

The personal plan must clearly identify:

• the medicines support the child requires;
• what the child can safely do independently;
• what parents, persons with parental responsibility or other representatives will undertake;
• what staff are authorised to undertake;
• any identified medicines-related risks and how those risks will be managed;
• arrangements for ordering or obtaining medicines where the service has accepted that responsibility;
• arrangements for storage and access;
• the records staff are required to complete; and
• any specialist instructions, emergency procedures or healthcare professional involvement required.

Children must be supported to participate in managing their medicines and to develop independence where this is safe and appropriate to their age, understanding, competence, assessed needs and personal outcomes.

The service must not assume responsibility for a medicine or medicines activity unless this has been assessed, agreed and recorded.

The child’s medicines support arrangements must be reviewed whenever their medicines, health needs, abilities, risks or circumstances materially change and as part of the review of their personal plan.

4.4 Covert Administration

Covert administration means administering a medicine without the child’s knowledge, for example by disguising the medicine in food or drink.

Medicines must not be administered covertly for convenience or merely because a child refuses a medicine.

Where covert administration is being considered, there must be clear lawful authority for the arrangement having regard to the child’s age, competence and, where applicable, mental capacity and best interests. The child’s views, wishes and feelings must be considered.

A decision to administer medication covertly must involve appropriate healthcare professional input and must be documented. Advice must be obtained from the prescriber and/or pharmacist about whether the medicine may safely be administered in the proposed manner.

Where covert administration is authorised, the child’s personal plan and medicines records must clearly specify:

• the medicine concerned;
• the reason covert administration is necessary;
• the lawful basis for the decision;
• who was involved in making the decision;
• how the medicine is to be administered;
• any pharmacist or prescriber instructions;
• how each administration will be recorded; and
• when the arrangement will be reviewed.

Covert administration must cease if the legal or clinical basis for it no longer exists.

4.5 Delegated Medicines and Healthcare Activities

Where a healthcare professional delegates a medicines-related or healthcare activity to a member of care staff, the service must ensure that the delegation is consistent with current national guidance and the relevant healthcare professional’s professional responsibilities.

Staff must not undertake a delegated activity unless:

• the activity is within the service’s Statement of Purpose and the individual’s agreed care arrangements;
• the activity has been appropriately delegated by a healthcare professional where professional delegation is required;
• clear individual-specific instructions are available;
• the staff member has received appropriate training;
• the staff member has been assessed as competent to undertake the activity safely;
• appropriate supervision, review and escalation arrangements are in place; and
• the activity and the staff member’s actions are appropriately recorded.

A member of staff must not undertake a delegated medicines activity where they are not competent, where the instructions are unclear or where the child’s condition or circumstances have changed so that the activity can no longer safely be carried out as instructed.

5. Medication Administration Procedures

5.1 Checks Before Administration

Before administering or supporting the administration of a medicine, staff must check the child’s current personal plan, medicines administration record and the medicine to be administered.

Staff must establish that:

• they are authorised, trained and competent to undertake the required medicines activity;
• the correct child has been identified;
• the correct medicine has been selected;
• the medicine belongs to the child;
• the medicine is within its expiry date and is suitable for administration;
• the medicine’s label and current authorised directions correspond with the medicines administration record and personal plan;
• the correct dose is being given;
• the correct route of administration is being used;
• the medicine is being administered at the correct time or frequency;
• any specific instructions relating to the medicine have been followed;
• relevant allergy information has been checked;
• there is no evidence from the medicines administration record or other records that the dose has already been administered; and
• there is no discrepancy, uncertainty, change in the child’s condition or other reason that makes administration unsafe.

Where there is a discrepancy or uncertainty, staff must not guess or make an independent alteration to the medicine directions. Appropriate advice or clarification must be obtained before administration.

Staff must explain the medicines support to the child in a manner appropriate to the child’s age, understanding and communication needs and must respect the child’s rights in relation to involvement and consent.

5.2 Recording Medication Administration

Every medicine administered or supported by staff must be recorded as soon as practicable after the medicines activity has taken place and must not be signed or recorded as administered in advance.

The record must identify, as applicable:

• the child’s name;
• the medicine;
• the strength and dose;
• the route of administration;
• the date and time;
• the member of staff responsible for the administration or medicines support; and
• any additional information required by the medicine-specific instructions or personal plan.

Where a medicine is not administered, the record must clearly identify that the dose was not given and the reason, where known. This includes refusal, omission, unavailability of the medicine, the child being absent, a clinical concern or another relevant circumstance.

Appropriate action must be taken following a refusal or omitted dose in accordance with the child’s personal plan and any medicine-specific instructions. Healthcare advice must be sought where required.

A refusal must not automatically result in the medicine being administered covertly.

Any medicine-related concern, discrepancy, adverse reaction, error or significant refusal must be escalated and recorded in accordance with this policy and the child’s personal plan.

6. Storage and Security of Medicines

6.1 Safe Storage

Medicines in a domiciliary support service are normally stored in the home in which the child lives. Storage arrangements must be safe and appropriate to the individual medicine, the manufacturer’s instructions, the child’s assessed needs, the child’s ability to access and manage medicines, household circumstances and identified safeguarding risks.

The service must not apply a blanket requirement for every child’s medicine to be kept in a locked medicines cabinet. The need for locked or otherwise restricted storage must be determined through assessment of the risks and circumstances of the individual child and household.

Medicines must:

• be stored in accordance with the manufacturer’s and dispensing instructions;
• be protected from unauthorised or unsafe access where this is an identified risk;
• remain identifiable and attributable to the child;
• be stored so as to minimise the risk of deterioration, contamination, misuse or accidental ingestion; and
• be kept at the required temperature.

Where medicines require refrigeration, they must be stored at the temperature specified for the medicine and arrangements must enable the service to be satisfied that the medicine has been stored safely where staff are responsible for that storage.

Controlled drugs must be stored and managed safely in accordance with applicable controlled-drug legislation, the child’s individual circumstances and the assessed risks. The service must not impose institutional controlled-drug storage arrangements in a person’s private home unless those arrangements are necessary and appropriate to make storage safe.

6.2 Access to Medicines

Only persons who are authorised under the child’s agreed medicines arrangements may access medicines on behalf of the service.

Where the service controls access to medicines, keys, access codes or other security arrangements must be managed so that unauthorised persons cannot gain access.

The child’s right to independence must be balanced with the need for safe storage. Restrictions on a child’s access to their own medicines must have a clear assessed reason and must be recorded in the child’s personal plan.

Staff must not administer or support medicines outside their assessed competence or outside the medicines support agreed in the child’s personal plan.

7. Emergency Medicines, Adverse Reactions and Medication Errors

7.1 Emergency Medicines

Where a child has been prescribed emergency or rescue medication, including medicines for anaphylaxis, asthma, seizures or another identified emergency condition, the child’s personal plan must contain clear individual-specific instructions for its use.

Staff responsible for administering emergency medication must:

• have received appropriate medicine-specific training;
• have been assessed as competent before undertaking the activity;
• know where the emergency medicine is stored and how it can be accessed without avoidable delay;
• follow the child’s current emergency or healthcare plan and authorised instructions;
• administer the medicine only within their training and competence;
• contact emergency services by telephoning 999 where required by the child’s emergency plan or clinical circumstances;
• seek appropriate healthcare advice following administration where required;
• record the administration and the circumstances surrounding it; and
• ensure that the child and the appropriate person with parental responsibility, representative or healthcare professional are informed in accordance with the child’s circumstances, consent arrangements and emergency plan.

Emergency medicines must remain available, in date and accessible when required.

7.2 Medication Errors and Adverse Reactions

A medication error includes an incorrect medicine, incorrect child, incorrect dose, incorrect route, incorrect time where clinically significant, omitted medicine, duplicate dose or other failure to administer or manage a medicine in accordance with the authorised instructions.

Where a medication error or suspected adverse reaction occurs, staff must:

• take immediate action to protect the child from harm;
• obtain appropriate medical, pharmaceutical or emergency advice according to the circumstances;
• follow the advice received;
• immediately inform the Registered Manager or designated senior person;
• accurately record what happened, including the medicine involved, the circumstances, action taken and advice received;
• inform the child and the appropriate parent, person with parental responsibility or representative, subject to the child’s legal rights, competence, confidentiality and safeguarding considerations;
• complete the service’s incident reporting procedure;
• preserve relevant records and evidence;
• make any necessary safeguarding referral;
• review the child’s personal plan, risk assessment and medicines arrangements where required; and
• take appropriate action to reduce the likelihood of recurrence.

Staff must not conceal, alter or retrospectively falsify medicines records following an error.

The service provider must determine whether the incident meets a statutory notification requirement. Where a medicine-related incident constitutes an event specified in Schedule 3 to the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, the required notification must be made to Care Inspectorate Wales and/or another specified authority without delay and in writing unless the Regulations specify another timescale.

This includes, where applicable:

• abuse or an allegation of abuse involving the service provider, a member of staff or volunteer;
• an allegation of misconduct by a member of staff;
• a serious accident or injury to a child;
• an incident reported to the police; or
• another event specified by Schedule 3.

Medication errors must therefore not automatically be notified to Care Inspectorate Wales solely because an error has occurred. Notification is required where the circumstances or consequences meet a statutory notification category.

8. Disposal of Medications

• Expired or unused medications must be returned to a pharmacy for safe disposal.
• Medication disposal must be documented to ensure compliance.
• Staff must not dispose of medications in household waste.

9. Consent, Confidentiality and Safeguarding Considerations

9.1 Consent and Children’s Participation

Valid consent or another lawful basis must be established for medicines support and administration.

The service must not operate a blanket rule that written parental consent is required for every medicine administered to every person under the age of 18.

For a young person aged 16 or 17 who has the capacity to make the relevant decision, their consent to medical treatment is legally effective and additional parental consent is not required merely because the young person is under 18.

A child under the age of 16 may be able to consent to treatment where they have sufficient maturity, intelligence and understanding to comprehend the nature, purpose, likely consequences, risks and relevant alternatives associated with the decision. Where this applies, the child’s competence must be considered by the appropriate healthcare professional in accordance with the applicable legal framework.

Where a child under 16 is not competent to make the relevant decision, consent must be obtained from a person who has parental responsibility or another person or authority with lawful decision-making power.

For a young person aged 16 or 17 who lacks capacity to make the relevant decision, the requirements of the Mental Capacity Act 2005 and other applicable legal provisions must be followed.

Staff must not make clinical assessments of Gillick competence or mental capacity outside their role and competence. Where the legal authority for treatment or medicines administration is unclear, the Registered Manager must obtain appropriate advice before staff administer the medicine, except where immediate emergency action is lawfully necessary to protect life or prevent serious deterioration.

The child’s views, wishes and feelings must be sought and taken into account in a manner appropriate to their age, understanding and communication needs.

The relevant consent arrangements and any restrictions or specific decisions relating to medicines support must be clearly recorded and kept under review.

9.2 Confidentiality and Data Protection

Medicines information and records constitute personal information and, where they contain health information, special category personal data.

Medicines records must be created, accessed, shared, retained and disposed of securely in accordance with the UK General Data Protection Regulation, the Data Protection Act 2018 and the organisation’s confidentiality and data protection arrangements.

Staff must only access or share medicines information where they have a legitimate need to do so.

Information may be shared without consent where there is a lawful basis for doing so, including where sharing is necessary to safeguard a child, protect life, comply with a legal obligation or enable appropriate healthcare to be provided.

Any information shared must be relevant and proportionate to the purpose for which it is shared.

9.3 Safeguarding and Medicines

Medication-related abuse, neglect or improper treatment may include:

• deliberately withholding necessary medication;
• deliberately administering an excessive or insufficient dose;
• inappropriate use of medicines to control behaviour;
• unauthorised or inappropriate covert administration;
• misuse, theft or diversion of a child’s medicines;
• repeated unexplained medication omissions or errors;
• failure to obtain required medicines resulting in a risk of harm;
• administering medicines contrary to lawful instructions; or
• any other medicines practice that places a child at risk of abuse, neglect, harm or improper treatment.

Where a member of staff identifies or suspects a medication-related safeguarding concern, they must:

• take immediate action to protect the child from further harm;
• report the concern without delay to the Safeguarding Lead, {{org_field_safeguarding_lead_name}}, or another designated senior person;
• act in accordance with the Safeguarding Adults and Children Policy (DCW13) and the Wales Safeguarding Procedures;
• ensure that an appropriate referral is made to the local authority and any other relevant agency where required;
• preserve medicines records and other relevant evidence;
• ensure that the concern and actions taken are accurately recorded; and
• ensure that Care Inspectorate Wales, the police, Disclosure and Barring Service, Social Care Wales or another professional regulator is notified where the applicable legal notification or referral requirements are met.

Concerns must not be withheld from safeguarding authorities merely because a parent, representative or member of staff does not consent to the referral where there is a lawful safeguarding requirement to share the information.

10. Staff Training and Competency

Any member of staff who manages medicines, administers medicines or supports a child to manage their own medicines must receive appropriate training and must be assessed as competent before undertaking the medicines activity without direct supervision.

Training and competency assessment must be appropriate to the staff member’s role and to the medicines activities they are expected to undertake.

Where relevant to their duties, this must include:

• the service’s medicines policy and procedures;
• safe medicines administration;
• medicines records and MAR documentation;
• medicine storage and security;
• ordering, re-ordering, receipt and reconciliation where these are staff responsibilities;
• disposal of medicines;
• recognising and responding to medication errors, adverse reactions and safeguarding concerns;
• emergency medicines;
• supporting children to manage their own medicines;
• consent, confidentiality and the rights of children and young people;
• controlled drugs where relevant;
• covert administration where relevant; and
• any specialist or delegated medicines activity that the member of staff is expected to undertake.

Staff undertaking specialist or delegated medicines activities must receive activity-specific or child-specific training and must be assessed as competent before undertaking the activity.

Competency must be reviewed where there is reason to question a staff member’s competence, following a relevant medication incident where indicated, when there is a significant change in the medicines activity undertaken, or where retraining or reassessment is otherwise necessary to ensure that the staff member remains competent.

Training and competency assessments must be documented.

Staff must recognise the limits of their competence and must not undertake a medicines activity for which they have not been trained, assessed as competent and authorised.

11. Monitoring and Compliance

The Registered Manager must ensure that medicines-management arrangements are monitored and audited regularly.

Auditing must be sufficient to provide assurance that medicines are being managed safely and in accordance with this policy, the child’s personal plan and applicable regulatory requirements.

The audit arrangements must include, where relevant:

• medicines administration records;
• omissions, refusals and reasons recorded;
• storage arrangements;
• medicines requiring temperature-controlled storage;
• controlled drugs arrangements where applicable;
• ordering and re-ordering arrangements where these are the service’s responsibility;
• sufficient supply of medicines where this is the service’s responsibility;
• receipt and reconciliation of medicines;
• medicines discrepancies;
• disposal arrangements;
• medication errors, adverse reactions and related incidents;
• staff training and competency;
• emergency medicines;
• covert administration arrangements where applicable;
• delegated medicines activities where applicable; and
• whether medicines support remains consistent with each child’s current personal plan.

Identified shortfalls or unsafe practices must be acted upon promptly and proportionately to the level of risk.

The Registered Manager must ensure that themes, trends and recurring medicines incidents are identified and that appropriate corrective action is taken.

Where monitoring identifies a change in a child’s medicines support needs, the child’s personal plan, medicines arrangements and relevant risk assessments must be reviewed and revised as necessary.

Records of medicines audits, findings, actions and follow-up must be maintained so that the service can demonstrate effective oversight and improvement.

12. Medicines Governance, Supply, Ordering, Re-Ordering and Reconciliation

12.1 Responsibility for Medicines

Responsibility for obtaining, ordering, re-ordering, collecting, receiving, storing and disposing of each child’s medicines must be clearly established during assessment and recorded in the child’s personal plan.

The service must not assume responsibility for any part of medicines management unless this has been assessed, agreed and recorded.

Where responsibility is shared between the child, a parent or person with parental responsibility, healthcare professionals and the service, the respective responsibilities must be sufficiently clear to minimise the risk of missed, duplicated or incorrect medicines.

12.2 Maintaining a Sufficient Supply

Where {{org_field_name}} has accepted responsibility for obtaining, ordering or re-ordering a child’s medicines, arrangements must be in place to maintain a sufficient supply so that prescribed treatment is not interrupted because of avoidable failure to obtain the medicine.

Staff responsible for this activity must have sufficient information and time to identify which medicines are required and to act on any discrepancy or supply problem.

Urgent action must be taken where there is insufficient medicine to provide the next required dose or where interruption of treatment may place the child at risk.

12.3 Ordering and Re-Ordering

Where staff order or re-order medicines on behalf of a child, an accurate record must be maintained showing what was requested and any relevant subsequent supply information.

Staff must not independently order a medicine that is not supported by a current prescription or other lawful supply arrangement.

Any discrepancy, unexpected change, missing medicine or uncertainty arising during ordering or re-ordering must be clarified with the appropriate pharmacy, prescriber or healthcare professional.

12.4 Receipt and Reconciliation

Where {{org_field_name}} is responsible for receiving medicines, staff must check the medicines supplied against the available current medicines information.

Checks must identify, as applicable:

• the correct child’s name;
• the medicine name;
• strength;
• formulation;
• directions;
• quantity; and
• any unexpected addition, omission or change.

Any discrepancy must be resolved before the medicine is administered where the discrepancy affects the safety or accuracy of administration.

Medicines reconciliation must also take place where necessary following a significant transition or change in medicines information, including discharge from hospital or another setting, so that staff have an accurate and current understanding of the medicines they are expected to support.

Staff must not make assumptions about discontinued, newly prescribed or changed medicines where the available information is inconsistent. Appropriate clarification must be obtained from the relevant healthcare professional or pharmacy and the child’s medicines records and personal plan must then be updated.

12.5 Changes to Medicines

Changes to a child’s medicines must be communicated promptly to staff responsible for medicines support.

The service must have reliable arrangements for ensuring that obsolete or superseded instructions are not followed after a confirmed medicine change.

The child’s medicines records and, where necessary, personal plan must be updated following confirmed changes.

Verbal instructions concerning medicine changes must only be accepted where this is permitted by the service’s medicines procedure and there is a safe method for confirming, recording and communicating the instruction.

13. Related Policies

This policy should be read alongside:

• Safeguarding Adults and Children Policy (DCW13);
• Confidentiality and Data Protection Policy (DCW34);
• Risk Management and Assessment Policy (DCW18); and
• Incident Reporting and Investigation Policy (DCW37).

14. Policy Review

This policy will be reviewed at least annually and sooner where necessary following:

• a change in applicable legislation, regulations or statutory guidance;
• a relevant change in Care Inspectorate Wales requirements;
• a significant medication incident or safeguarding concern which identifies a need to revise the policy;
• changes to the service’s Statement of Purpose which affect medicines management; or
• audit, monitoring or quality assurance findings which demonstrate that amendment is required.

The Registered Manager is responsible for ensuring that the policy remains current and that staff are informed of and operate in accordance with any changes.

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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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