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HCS75-Childrens Medication Management and Administration Policy

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Childrens Medication Management and Administration Policy

Introduction and Purpose

This policy outlines how our domiciliary care service in Scotland manages and administers medication for children and young people from infancy through 18 years of age. The purpose is to ensure that any medication support we provide is safe, effective, and centered on the child’s best interests in compliance with Care Inspectorate requirements and the Health and Social Care Standards. In line with these standards, “any treatment or intervention that a child experiences is safe and effective” and “based on relevant evidence, guidance, and best practice”. By adhering to this policy, our staff will maintain high-quality care and uphold each child’s rights, dignity, and well-being when supporting their medication needs.

{{org_field_name}} is registered with the Care Inspectorate as a provider of children’s care at home services. We administer medications directly to children, and where appropriate we support or prompt children to self-administer, according to their age, development, and care plan. This policy will be used by all care staff and managers and will be available to families and Care Inspectorate inspectors. It provides detailed guidance on roles and responsibilities, procedures for safe medication handling (including controlled drugs, PRN (as-needed) medications, and emergency medications), what to do if a child refuses medication, record-keeping on paper and electronic Medication Administration Records (MAR), communication with families and health professionals, and how we ensure the child’s voice and best interests are central in all decisions.

Scope

This policy applies to all staff involved in the handling of medications for children in our care service, including care/support workers, supervisors, and managers. It covers all aspects of medication management for children aged 0–18, whether the medication is prescribed or over-the-counter, short-term (e.g. antibiotics) or long-term (e.g. for chronic conditions), and whether administration is done by staff or by the child with staff support. It encompasses medication given in the child’s own home or any setting where our domiciliary care service is provided.

All forms of medication are within scope, including oral medicines (tablets, capsules, liquids), topical medicines (creams, ointments), inhalers and nebulisers, eye/ear drops, injections (when part of the care plan), as well as controlled drugs (medications regulated under the Misuse of Drugs Act, such as certain pain medications or ADHD treatments) and emergency rescue medications (like Epinephrine auto-injectors for allergies, or rescue anticonvulsants for epilepsy).

The policy addresses: obtaining consent and authorisation to administer medicines; safe storage, transport, and disposal of medications in a home environment; detailed administration procedures; supporting self-administration and prompts for children who are able to participate in their own care; documentation and MAR chart usage (both electronic MAR systems and paper MAR charts); staff training and competency requirements (with attention to paediatric medication management and child safeguarding); and communication protocols with parents/guardians and healthcare professionals.

Legal and Regulatory Framework

This policy is developed in accordance with current legislation and guidance to ensure our practices meet the required standards for children’s services in Scotland:

Principles of Safe and Child-Centered Medication Management

We adhere to the following key principles in all medication management for children:

With these principles in mind, the following sections detail how we operationalise safe medication management for children in our service.

Roles and Responsibilities

Safe medication management is a team effort. This section clarifies the responsibilities of different roles within {{org_field_name}}, as well as expectations from families and healthcare professionals we liaise with.

Management (Registered Manager or Service Manager): {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}.

The Manager has overall accountability for implementation of this medication policy. Management ensures that:

Care Staff (Care Support Workers / Carers): These are the frontline staff delivering care in the child’s home. Their responsibilities include:

Parents/Guardians: While this is an internal policy, it is important to note the expectations we have of parents and guardians, as medication management is a shared responsibility in a home setting. We request that parents:

Healthcare Professionals (Pharmacists, Doct​ors etc)

We coordinate with the child’s healthcare providers for safe medication management. While not “responsible” under this policy, it’s worth noting how we work with them:

By clearly delineating these roles and responsibilities, we ensure everyone involved understands their part in safely managing the child’s medications. The following sections will describe the procedures we follow to fulfil these responsibilities.

Consent and Authorisation for Medication

Before administering any medication to a child, it is essential that we have proper consent and authorisation. We recognise both the legal requirement for consent and the ethical importance of involving families and children in decisions about health interventions.

Parental Consent: We require written consent from a person with parental responsibility for the child for each medication that we will be administering. This is usually obtained during the initial development of the child’s care plan and whenever a new medication is introduced. The consent form (or section of the care plan) will specify the name of the medication, the dose and timing, and under what circumstances it is to be given (for example, regularly each day, or only when needed for a certain symptom). Consent is typically time-limited – for instance, a consent might be given to administer an antibiotic for a 7-day course, or to use an emergency inhaler up until the review date just before it expires. We use time-limited consents to ensure regular review. As a matter of good practice, all consents will be reviewed with the parent/guardian at least every three months, or sooner if the child’s medication regimen changes. This regular review checks that the medication is still needed and appropriate, that dosages haven’t changed, and that the medication remains in date.

Consent may be ob​tained through signed forms: by signing our consent form document, or in certain situations via an email or text from the parent authorizing administration (the Care Inspectorate guidance notes that services can receive consent by text or email as appropriate). For our service, initial consent will always involve a signed form (physical or electronic signature). Minor updates (like a one-off dose change instructed by a doctor) might be accepted via text/email from the parent as a temporary measure, but will need follow-up documentation.

Child/Young Person’s Assent or Consent: In addition to parental consent, we seek to involve the child in consenting or assenting to medication where they are able. For young people aged 16 or 17 who are deemed to have capacity, their own consent will be sought as primary (though we still involve the parents in most cases for transparency unless the young person objects). For children under 16, if a child is mature enough to understand their medication (for example, a 15-year-old who has been on asthma inhalers for years), we will explain what we are doing and get their agreement, even though legally we still need the parent’s consent in our service context. We never force medication on a child against their will; if a capable child refuses, we respect that (following the refusal procedure outlined later). The law in Scotland allows competent under-16s to consent to treatment, but since our staff are not prescribers or doctors, in practice we use that principle to guide how much we involve the child and respect their wishes. If a child says “I don’t want to take this,” we consider their reasons and try to work with them and the parent to find a solution, rather than overriding them. Ultimately, decisions will be made in the child’s best interest, so if a life-sustaining medication is refused, we would involve medical professionals promptly to advise on the best course of action (which may include not forcing but maybe administering in a different way or at a different time as advised).

Verification of Parental Responsibility: We understand that the person giving consent must have parental responsibility for the child. We cannot assume that whoever signs a form (e.g., a step-parent or grandparent) actually has the legal authority. Therefore, when obtaining consent, we ask for confirmation of the r​epresentative or the signer to the child and, if needed, we will check that they have parental rights (for example, if the parents are divorced, or if someone else holds guardianship). If in doubt, we note it in the care record and may ask for clarification or additional proof of authority. Generally, the child’s mother (unless removed by court order) and father (if named on birth certificate or married to mother, etc.) have parental responsibility, as well as legally appointed guardians or others by court order. We have this knowledge in mind per the guidance, and will politely require proper consent from the right individual to protect the child and ourselves. In foster care or local authority care situations, we will liaise with social workers to identify who can sign medical consents (e.g., the local authority or a delegated foster carer, depending on legal arrangements).

Scope of Consent: Our consent forms make it clear for what situations the consent is valid. We do not ask parents to sign blanket permissions for “any medication if needed,” because best practice is that “parents should not be asked to give general permission for services to administer at any other time” outside of specific illnesses or incidents. Instead, we obtain consent per medication and per known condition. For example, a consent might say: “Paracetamol 120mg/5ml suspension – 5ml to be given every 6 hours as needed for fever above 38°C or pain, up to 4 times a day, for the duration of teething period (review date X).”

This way, the parent knows exactly what they are authorizing and we know the limits.

If a child no longer needs a medication (e.g., the course is finished or the doctor stopped it), we will consider that consent expired and not administer that medication unless re-prescribed. We also require new consent if a dosage changes significantly or a new medication is added.

Emergency Situations: In an emergency where a medication is needed to save the child’s life or prevent serious harm (for example, using an Epipen during an anaphylactic shock), our staff will act immediately according to the child’s emergency care plan and training, even if it’s not possible to get verbal consent in that moment. Typically, consent for emergency treatment is obtained in advance: our care plan process will include asking parents to con​sent for emergency interventions such as an Epipen, rescue inhaler, or seizure medication if those are relevant to the child. So in practice, the consent is on file. If an emergency arises for which we have no prior consent (say a child has a first-time allergic reaction unexpectedly), we will act in the child’s best interest (e.g., call emergency services and follow their guidance, which might include administering something under their direction) and inform parents as soon as possible. The law and care standards support that withholding an emergency treatment like an adrenaline pen could pose greater risk than any potential adverse reaction, so emergency meds are an understood exception to the “first dose given by parent” rule.

When Required (PRN) Medications: Special attention is given to obtaining consent for “when required” (PRN) medicines. Because these are not given on a fixed schedule, our staff must use some judgment as to when to give them, it’s important that parents clearly agree to when and why we would administer them. We document the specific indications for each PRN medication in the care plan (e.g., “give 5ml paracetamol if temperature over 38°C or if child is in pain (crying, not settling) and last dose was at least 6 hours ago”). We will also have a mechanism to inform the parent each time a PRN dose is given, since they may not be present. Some families prefer to be contacted by phone or text for confirmation before a PRN is given, and we respect that if it’s feasible (for instance, calling a parent at work to ask permission to give a nebuliser treatment for wheezing). Our consent form can include whether the parent wants to be contacted every time or if they give standing permission within the defined guidelines. If we cannot reach a parent in a scenario where a PRN medication is clearly needed for the child’s well-being (e.g., the child is in significant pain), staff will use their judgement within the agreed parameters to proceed and inform the parent as soon as possible after. The key is that parents will always be told whenever PRN medication is administered (either immediately or at the soonest appropriate time).

Documentation of Consent: All consent forms and correspondence about consent are kept in the child’s file. The care plan will have a section summarizing the consent (e.g., “Consent for medication obtained from [Name], mother, on [Date] for the following medications…”). If consent is withdrawn or changed at any time, we update the records and inform all relevant staff immediately.

By ensuring robust consent processes, we respect the family’s authority and the child’s rights, and we provide medication only in situations that have been agreed upon and authorised. This protects everyone involved and aligns with the regulatory expectation that medication should only be given at the parent’s request for a specific illness or incident (except where part of an ongoing treatment plan).

Medication Planning and Documentation (Personal Plan and MAR Charts)

Every child receiving our service will have a section in their Personal Plan (Care Plan) that details their medication regimen and how it will be managed. This medication plan is developed in consultation with the parents (and the child if ap​ropriate) and with input from healthcare providers as needed. It ensures that staff have clear, child-sp​ecific training to follow, and it aligns with Health and Social Care Standard 1.15 about the personal plan setting out how needs will be met.

Content of the Medication Plan: For each medication a child is on, the care plan will typically include:

This medication section of the care plan is shared with all staff who work with the child. Staff are required to familiarise themselves with it prior to administering any medication for the first time, and whenever it is updated.

Medication Administration Records (MARs): In addition to the care plan narrative, we use Medication Administration Record (MAR) charts to log each administration. We utilise both paper MAR charts and a secure electronic MAR system, depending on t​he  service delivery:

Regardless of format, all MAR entries must be legible, accurate, and complete. If using paper, staff sign with a full signature at least once and initials on the chart, with an initial signature log. If an error is made in writing (e.g., signed in wrong box), staff should strike a single line through the error, write “error” and their initials – no erasing or using correction fluid on MARs, as records must be transparent. If using electronic records, staff ensure they select the correct medication and time when recording.

The MAR chart, together with the care plan, provides a full audit trail of the child’s med​ication administration. We keep completed MAR charts as part of the child’s record. Paper MARs are collected and returned to the office for filing and audit. Electronic MAR data is stored and backed up on our system, with access controlled and retained according to data protection and record retention policies (typically medication records are kept for a certain number of years as required by regulation).

Record of Medicines Received and Disposed: Alongside administration records, we maintain records of medications coming in to and going out from the service for each child. When a parent or pharmacy delivers a new medication for the child, staff will record on a Medicines Receipt form or the MAR chart the date, name and quantity received (for instance, “Received 1 bottle (150ml) of Amoxicillin on 12/03/2025”). This ensures we know what stock we should have. Similarly, if a medication is finished or discontinued, any remaining should be returned to the parents or pharmacy for disposal, and we note that (e.g., “Returned 5 unused doses to parent to dispose at pharmacy on 20/03/2025”). The Care Inspectorate expects services to log medicines received, returned, or disposed, and we follow this closely to avoid any medication being unaccounted for.

Personal Plan Review: The medication parts of the care plan are reviewed in regular care plan reviews (at least every six months formally, and more frequently if needed). Additionally, any time there’s a change in medication (new drug, dose change, etc.), we update the care plan and MAR immediately rather than waiting for a scheduled review. The Health and Social Care Standards emphasise that care and support (including medicine support) should be right for the person and adapt to their needs, so we keep the plan current with the child’s medical needs. We involve the parent and, where appropriate, the child in these updates. For example, if a teenager has demonstrated they can now handle their inhaler without supervision, we might update the plan to reflect that increased independence.

In summary, our documentation system – combining a detailed care plan and meticulous MAR chart records – ensures continuity of care and provides evidence of safe practice. It gives confidence to everyone (family, staff, and regulators) that medications are being managed appropriately, as one can audit and see that “accurate, up-to-date records of all medicines… taken or not taken, and disposed of” are kept and that staff monitor the medication and the condition for which it’s taken, seeking medical advice if needed. These records and plans are a cornerstone of delivering safe medication support.

Safe Storage and Handling of Medicines

Proper storage of medication in a home environment is crucial to ensure that medicines remain effective (potency can be lost if stored incorrectly), to prevent accidental ingestion or misuse by others (particularly important with children in the home), and to comply with leg​islation. Our service guides and assists families in setting up safe medication storage, and our staff strictly follow procedures for handling medication during visits.

General Safe Storage Principles:

Checking Expiry and Condition: Each time before administering, staff check the expiry date on the medicine. When a medicine is first brought into use, staff note the date opened if it has a limited shelf-life once opened (common for eye drops, some liquid antibiotics, etc.). For example, many eye drops expire 28 days after opening. We note that on the MAR or bottle (e.g., “opened 1 Apr, discard after 29 Apr”). If a medication is found to be expired or looks abnormal (change in color, texture, etc.), staff will not use it and will inform the parent/manager so a replacement can be obtained. We also periodically do an inventory check, especially for emergency or infrequently used PRN meds, to ensure they have not expired unnoticed. The guidance reminds us to check that medicines are for a current condition and not something that was prescribed long ago which may no longer be appropriate. So if a parent presents a medicine that was prescribed six months ago for something, staff should flag this to the manager or suggest the parent confirm with a doctor if it’s still okay to use. As a policy, we don’t administer another person’s “leftover” medicines without clear medical direction.

Transporting Medication: In domiciliary care, most medication stays at the child’s home. If staff ever need to transport medication (say, picking up a prescription from the pharmacy on behalf of the family, or accompanying the child on an outing where a dose will be needed), they must carry it securely (in a closed bag, ideally a locked bag for controlled drugs) a​lways with them – never leaving it in a car in view or in extreme temperatures. If transporting controlled drugs, the staff should go directly to the destination without unnecessary stops. We also document the handover, e.g., “Staff collected X medication from pharmacy, delivered to home – parent received it.” This ensures chain of custody.

Safe Disposal of Medications: Medications that are no longer needed or are expired must be disposed of safely. Our policy is that we do not throw medication into general waste or down the toilet. Instead, any unused meds are given to a pharmacy for safe disposal (most pharmacies in the UK will accept unwanted medicines). Typically, we advise parents to handle disposal by returning items to the pharmacy, as technically the medicines belong to them/the child. Our staff will assist if needed – for example, we might take the medicines to a pharmacy with the parent’s permission. We will record what was disposed and when for accountability. Sharps (like used Epipen injectors or needles, if applicable) are handled using appropriate sharps boxes and returned via healthcare services. If a child passes away or leaves the service, we make sure no medication is left unsecured; everything would be returned to the family or pharmacy for disposal, with documentation.

Environmental Considerations: We remind families that medicines should be kept away from direct sunlight, moisture, and extreme heat. If a family lives in an especially warm home, we might request a fan for the medication area or similar precautions. Conversely, freezing can ruin some meds, so not in a garage in winter, etc. These are usually common sense, but we do make a note during the home risk assessment if anything stands out.

By maintaining strict storage protocols, we aim to prevent accidental poisonings and ensure medications remain effective. A locked storage approach also reduces risk of misuse – for instance, an older child or visitor being tempted to experiment with medication. The controlled drug storage and recording is especially important if any medicines have potential for abuse. Our staff are trained to treat medication security as a priority – this is part of keeping the child and others safe, and is also a visible sign of good practice that inspectors expect to see (e.g., they might ask “show me where medications are stored” during a visit; we should be able to demonstrate it meets the standards).

During each visit, one of the responsibilities of staff is to ensure that after giving meds, all containers are properly closed and put away, and that no tablets have fallen on the floor etc. This housekeeping aspect is critical when working around children.

Overall, these measures reflect best practice guidance – for example, “Most medication should be stored in a locked cupboard or container out of reach of children below 25°C” and * “Each child’s medication should be kept separate and l​abelled. By following them, we maintain a safe environment around medication in the home.

Administration of Medication Procedure

Administration of medicine to children must be carried out carefully and consistently to avoid errors and to make the experience as stress-free as possible for the child. Below is our step-by-step procedure that staff follow for each medication administration, whether it’s a regularly scheduled dose or a PRN dose. These steps incorporate the “six rights” check and other precautions:

  1. Preparation and Hygiene: Before handling any medication, the staff will wash their hands thoroughly. If appropriate, they may also wear disposable gloves (usually for applying creams or giving injections, or if there’s a risk of contact with bodily fluids; for oral meds gloves are not usually needed with proper handwashing). They gather the necessary supplies – the medication itself, any administration tools (spoon, oral syringe, glass of water, inhaler spacer, etc.), the MAR chart (or device for eMAR), and perhaps a towel or tissue if needed (for spills or drips, especially with kids). Ensuring everything is ready prevents leaving a child unattended or interrupting the process mid-way.
  2. Verify the “Six Rights”: The staff will systematically verify:
    • Right Child: Confirm the child’s identity – in a home setting, usually the staff knows the child by name and face, but if there’s any potential confusion (say twins, or multiple kids in a group setting), double-check by asking the child (if verbal) or the parent. In solo care this is straightforward, but we state it to instil the habit.
    • Right Medication: Check the name and label on the medication against the MAR chart. The MAR entry and the pharmacy label must match (same drug name, form, strength). For example, confirm “am I holding the correct inhaler for this child, not a sibling’s inhaler.” This is critical in homes with multiple medications around. Staff also look at the appearance – if anything looks different (like pills are a different colour than usual), pause and verify that it’s not a pharmacy dispensing change or error.
    • Right Dose: Check the dose on the MAR and label (e.g., “5ml” or “half a tablet”). Make sure to measure accurately. Use proper measuring devices – for liquids, use an oral syringe or medicine cup at eye level, not a household spoon. For tablets, ensure the correct number of tablets or the correct splitting if needed.

Double-check any dose calculations (especially in children’s meds, doses might be by weight, but those should be pre-calculated by phar​macy

  1. Right Time: Confirm when the last dose was and when the next is due. Check the MAR to ensure the medicine hasn’t already been given by someone else (to avoid double dosing). We​ give the medication within the appropriate window (usually 30 minutes before or after scheduled time is acceptable unless a specific timing is required.

If PRN, ensure enough time has passed since last dose and that the need is present (e.g., child does have pain now). Also consider if the child is about to do some​ activities

or a nap – some meds might need the child to remain upright, etc., but typically that’s minor). Our staff also ensure that if a medication is meant for a certain relation to meals (before/after food), the timing respects that.

  1. Right Route: Confirm how the medication is to be given – orally (swallowed, chewed, under tongue?), inhaled (with correct device technique), applied on skin (on the correct site), eye drop (which eye? how many drops?), etc. Staff should be trained in the proper administration technique for each route. For example, for eye drops, we know to pull down the lower eyelid and drop into the pocket, not directly onto the eyeball, and use separate drops if both eyes as needed. For inhalers, ensure the spacer is used if prescribed, and count the puff and ensure the child inhales correctly. We only administer via routes we’re authorised and trained for.
  2. Right to Refuse: Be mindful of the child’s willingness. Before administering, staff often will say, “It’s time for your medicine now, okay?” to gauge if the child is cooperative. If the child says no or is upset, we don’t ignore that – we attempt encouragement (like “I know it tastes yucky, but it will help your tummy feel better; maybe we can have a drink of juice after?”). The child’s right to refuse is always respected, meaning we do not force or sneak medication without consent. If a child initially resists, we may pause and try again in a few minutes, or use a different approach (like have the parent try, or offer a reward/sticker after taking it). Details on refusal handling are below, but the key is the child should not be coerced beyond gentle encouragement.
  3. Administer the Medication:
    • If oral: Give the medicine in the form appropriate. For infants, this might mean using an oral syringe to gently dispense liquid into the cheek pocket, a little at a time, allowing them to swallow. For toddlers, it might involve a spoon or syringe – sometimes with them sitting upright on a parent’s lap. For older children, hand them the tablet or medicine cup and a drink, and supervise to ensure it’s swallowed (some kids hide pills in their cheek, so staff may ask to “open your mouth, let me see” if there’s any doubt, in a friendly way). We avoid mixing medicine into a full meal (risk they won’t finish it all), but a small known quantity of food or drink can be used if it helps (and if it’s compatible – e.g., no grapefruit juice if contraindicated). Always check with pharmacist about any medicine-food interactions or if it’s okay to mix with something sweet.
    • If via inhaler: Assist as needed – younger kids might need the staff to hold the spacer. We ensure the child exhales, then put spacer to face, puff, then child inhales deeply. Give praise for doing it right. Wait appropriate time between multiple puffs.
    • If topical: Don gloves (to avoid absorbing it ourselves or any contamination). Apply cream/ointment to the correct area in the amount prescribed. Only to that child’s personal supplies (never share creams between children to avoid cross-infection). Cover or not cover as directed.
    • If feeding tube (gastrostomy): Follow specific training procedure – checking tube placement if needed, flushing before and after with water, etc. Only staff specifically trained on the child’s enteral feeding/medication are assigned to do this.
    • If injection: Only nurses or trained, authorised staff will do injections in this domiciliary context (except emergency autoinjectors like Epipen which all trained staff can do in an emergency). Routine injections (like insulin) might be administered by staff if they have been trained by a nurse and deemed competent, and the care plan supports it. They will follow the exact technique (site rotation, use of insulin pen, dosage verification by second check if required).
    • If eye/ear/nose drops: Gently administer the drops as instructed, trying to keep it comfortable (distractions for kids help, like a toy or something to look at on the ceiling). We ensure the child actually takes the medicine. For oral meds, we check the mouth if unsure. For patches, we date/time them when applied and remove old ones per schedule (making sure old patch is disposed safely out of child’s reach).
  4. Support and Observe the Child: As we administer, we pay attention to the child’s condition. If the child coughs or spits up, we handle that. After giving, we stay for a moment to ensure the child doesn’t have an immediate adverse reaction or choke. If the medication is known to sometimes cause immediate side effects (like inhaler causing slight jitteriness), we reassure the child if they feel anything unusual.
    • If a child spits out a medication or vomits shortly after, our staff will note that effectively the dose may not have been fully taken. We will not re-administer a full dose without advice (because it’s hard to judge how much was absorbed). Instead, we will document it and inform the parent/manager. Depending on the drug and importance of dose, the parent might contact a doctor to see if another dose should be given. The Care Inspectorate guidance specifically states staff should know what to do if a child spits out or refuses, and always inform the parents in such cases – our procedure aligns with this: inform and seek advice, rather than making a unilateral decision to repeat a dose.
    • If the child refuses before even taking, see Refusal section below for the steps to follow (essentially, don’t force, inform parent/manager/doctor as needed).
    • We give positive reinforcement to the child (“Well done, you took your medicine!” or a sticker for younger ones, etc.) to make future administrations easier.
    • For medications that may require follow-up action, we do that. Example: if giving an asthma reliever inhaler, check in 5-10 minutes if breathing improved. If giving a PRN pain med, check later if pain seems better.
  5. Immediately Record the Dose: Right after administering (never before), the staff member documents it on the MAR chart (paper: initial or sign in the correct date box; electronic: tick/enter the details on the device). We record the exact time given if it wasn’t exactly on scheduled time (e.g., PRN given at 2:30pm). If it’s a PRN, we will also write in the notes section the reason (“child had 38.5°C fever” or “complained of headache”). Our MAR format has a code or space for “reason PRN given” which we fill. If the medication was refused or not given, we circle or mark the dose as missed and state why (“R” for refused, etc.). We also note if a child only took partial dose or vomited it – typically as a comment like “maybe only half ingested, vomited rest”.
    • If an error happened (e.g., spilled dose and had to pour again), we note the occurrence if it affects the record (like if tablet fell and wasted, we account for it in stock, etc.).
    • For controlled drugs, we have an extra step: besides the MAR, we update the Controlled Drug stock log (if we maintain a separate CD register as good practice even though not legally required in child services). For example, “10am – gave 5ml (5mg) of morphine, remaining balance in bottle ~45ml” and sign it. If two staff are present, both sign the controlled drug administration (one as giver, one as witness).
    • The staff should also communicate to the parent what was done if the parent is present or when they return (verbal reporting as courtesy, in addition to the written MAR). This ensures real-time sharing of information.
  6. Monitor After Administration: Some medications have effects that need monitoring – our staff will keep an eye on the child for a suitable period. For instance, after giving a first dose of an antibiotic, allergic reactions typically would occur within an hour, so we stay vigilant in that timeframe. If the child is active and fine, great. If any adverse sign arises, we act accordingly (minor rash – inform parent and monitor; severe reaction – call emergency services).
    • If the medication was PRN for a symptom, we check whether the symptom subsides. We might record outcome in daily notes (like “Calpol given at 2pm, by 3pm temp down to 37.5°C, child more comfortable”). This is not necessarily on MAR but in narrative notes.
    • We ensure that any special post-medicine routines are followed (e.g., “keep child upright for 30 minutes after giving” – would do so if instructed).
  7. Conclude and Clean Up: We put away all supplies. Sharps if any go into a sharps container. Spoons/syringes are rinsed. Gloves removed and disposed if used. We then wash hands again. Basically, leave the environment safe (no stray meds or equipment around).

These steps are taught to all care staff and are practiced until routine. They cover normal administration. In edge cases or special scenarios (like a child asleep at dose time), the plan might allow slight adjustments (we wouldn’t wake a sleeping child for a non-critical med without prior agreement – we’d discuss with parent if we can give slightly later).

We emphasise that staff should never administer a medication if they are unsure about any aspect of it – for example, if a parent says “give him 1.5 tablets because the doctor said so on phone” but the label still says 1 tablet, the staff must hold off and get clarification from a manager or doctor with proper documentation. Also, if a staff hasn’t been trained for a certain procedure (say an injection), they must not attempt it – instead, escalate so a nurse or trained person does it.

Our procedure also forbids staff from altering how a medication is given without guidance – e.g., not crushing a tablet unless it’s confirmed safe (some meds are extended-release and must not be crushed).

Another rule: Staff should not prepare medicines for later use except in specific safe instances (like setting up a dosette box if part of care plan and trained for it). Generally, the person who prepares (e.g., puts tablets in a cup) should be the one who directly gives it to the child and charts it – to maintain clear responsibility. If there’s a need to transfer responsibility (like during a staff shift change at a dose time), they should do it together or clearly hand over saying “I have not given the 2pm med yet, can you do it and sign?”.

By following this robust procedure every time, we aim to eliminate medication errors and ensure the child receives their medication correctly. This satisfies the requirement that “any treatment is safe and effective” by embedding safety checks into each administration.

Supporting Self-Administration and Prompts

We recognise that as children grow and develop, they may take on some responsibility for their own medications. Encouraging appropriate self-management can build independence and confidence, and for older youths it is a crucial life skill. Our service supports children and young people to be as involved as possible in managing their medications, while ensuring safety. The level of self-administration or prompting versus full administration by staff will be determined on an individual basis through risk assessment and agreement with the child (if appropriate) and parents.

Assessment for Self-Administration: When a young person (typically this might be considered around age 12 and up, but it depends on the individual’s maturity and the medication) is a candidate to manage some or all of their medication, the manager or senior staff, in consultation with the family and possibly the healthcare professional, will do a risk assessment. We consider factors such as:

If the assessment is favourable, we then outline in the care plan which medications the child will self-administer, under what supervision (if any), and what the staff’s role is.

Consent for Self-Administration: We obtain consent from the parent (and assent from the child) for this arrangement, clarifying responsibilities. For instance, a parent might consent that their 14-year-old can keep their asthma inhaler in their pocket and use it as needed without asking staff each time, whereas for other meds they want staff to still handle it. We respect the comfort level of the family while also advocating for independence where appropriate.

Prompts vs. Administration: There’s a distinction:

We clarify in the plan whether a medicine is to be given by staff, self-administered, or prompted.

Storage for Self-Admins: If a child is managing a medication (like keeping their eczema cream in their room to apply themselves, or a teen carrying their inhaler), we evaluate safety. If it’s safe for them to have access (and no risk to others), we allow it. Otherwise, even if self-admin, the medication might stay locked and the child asks staff or parent for it when needed. A common example: a responsible teen might have their daily acne antibiotic in their room to take each night and just tell staff they took it – but a controlled drug like ADHD medication we would not leave out for them due to potential misuse or diversion; staff would still secure it and hand the dose to the teen to self-administer in front of staff.

Staff Role in Self-Administration: Even when a child self-administers, our staff have important roles:

Gradual Approach: We often encourage a gradual approach to self-administration. For example, maybe initially the child takes charge of one medication (like their inhaler) while we continue to … continue (Completion of the policy document) …

Gradual Approach: We often implement a gradual approach to self-medication. For example, initially a child might self-administer only a simple medication (like using their inhaler under observation), while staff continue to fully administer more complex or critical medications. As the child demonstrates reliability and understanding, we can increase their responsibility. This stepwise method keeps safety first while promoting the child’s confidence. At each stage, we reassess to ensure the arrangement is working well. If a child who is self-medicating begins to struggle (for instance, they start forgetting doses or misusing the medication), staff will step back in to a more active role and the care plan will be adjusted.

Documentation: Even when children self-administer, all medication intake must be recorded on the MAR. If the child took it independently (say, a teenager took their morning dose before staff arrived), the staff member, once informed, will document it as “taken (self-administered) – by report”. We rely on honesty and communication; if unsure whether a dose was taken, staff should verify with the child and parent and, if in doubt, treat as missed and notify the parent/doctor for guidance. The MAR needs to reflect reality – who took what, when – so that there is no ambiguity in the records.

Promoting Responsibility: Our care staff educate and encourage children who are self-managing. For instance, they might teach a 10-year-old how to use a sticker chart to remember each dose, or help a teenager set reminders on their phone for pill times. We also ensure the child knows they can ask for help anytime. Just because a child is self-administering, we do not leave them without support – we strike a balance, being there if needed but giving them space to do it themselves.

Risk Mitigation: To mitigate risks of self-administration, we may use tools like lockable medication boxes that only the child and staff have access to (ensuring younger siblings cannot get to it), daily check-ins (“Show me you took your tablet, let’s mark it off”), and continued oversight in MAR auditing. If a controlled drug is self-administered by a mature youth, it will still be kept locked and issued per dose rather than giving them full supply at once, due to legal responsibilities and potential risks.

By supporting self-administration appropriately, we uphold the principle of inclusion and respect for the child’s abilities, aligning with Standard 2 (which emphasises involvement in decisions and care) and ensuring the child feels competent and involved. At the same time, our duty of care means we always have safeguards so the child does not come to harm through this independence.

Controlled Drugs Management

Some children in our care may be prescribed controlled drugs (CDs) – medications regulated under the Misuse of Drugs legislation due to their potential for dependence or misuse (examples include stimulants for ADHD like Methylphenidate/Ritalin, strong painkillers, or certain anxiety/seizure medications). We recognise the heightened responsibility around controlled drugs and have special measures in place:

By treating controlled drugs with this level of care, we ensure compliance with legal requirements and protect the child and others from potential harm. Our practices follow good practice guidance, for instance locking up Ritalin (a Schedule 2 CD) with access only by those allowed, and maintaining records even if not strictly required because it’s simply safer.

“PRN” (As-Needed) Medications

PRN (pro re nata) medications are those given only when certain symptoms or conditions arise, rather than on a fixed schedule. Examples include pain relief for headaches, inhalers for asthma symptoms, or medication for agitation to be used only if needed. Managing PRNs appropriately is important to ensure they are effective and used safely.

Our approach to PRNs:

Proper PRN management ensures that children get relief and timely treatment for intermittent issues, without overusing medications or keeping parents in the dark. It also aligns with a responsive care model – we respond to the child’s needs in the moment but within a safe framework.

Emergency Medications and Medical Emergencies

Children with certain health conditions may have emergency rescue medications as part of their care plan – for instance, an epinephrine auto-injector (Epipen) for severe allergies, buccal Midazolam or rectal Diazepam for prolonged epileptic seizures, or a fast-acting inhaler/nebuliser for acute asthma attacks. Managing these emergency medications is critically important; while we hope they are rarely needed, our staff must be prepared to act swiftly and correctly when they are.

Specialised Training: All staff who may care for a child with an emergency medication will receive training from a qualified health professional in how and when to administer it. For example, if a child has an Epipen, we arrange for a medical professional (doctor, nurse, or certified first aid trainer) to train our staff in recognizing anaphylaxis and the use of the Epipen. Likewise, for seizure rescue meds, we involve an epilepsy specialist nurse or similar to ensure staff are competent and confident. We document that training and ensure it’s refreshed before expiry (Epipen training might be yearly, for instance). We also require that training is completed and documented before the child is left in the sole care of staff without the parent for those specific needs. This echoes best practice that staff must know what to do in an emergency rather than facing it unprepared.

Emergency Protocols: The child’s care plan will include a clear step-by-step emergency protocol, often provided by their doctor. For example, for anaphylaxis: “Signs of anaphylaxis include difficulty breathing, swelling of lips/face, hives. If these occur or the child is known to have had allergen exposure and shows any reaction: administer Epipen into outer thigh immediately, call 999 for an ambulance stating ‘anaphylaxis’, then call parents. If no improvement in 5 minutes and ambulance not arrived, a second Epipen (if available) may be given.” Staff will follow the prescribed steps exactly. Similarly, for seizures: “If seizure lasts >5 minutes, administer buccal midazolam as trained; call ambulance if seizure not stopping within 5 min after med or per epilepsy care plan instructions; monitor breathing; inform parents.”

We keep a printed emergency action plan in the home (with the MAR or care file) and highlight it so any caregiver can refer quickly under stress.

Accessibility: As noted, emergency meds are kept readily accessible (not locked away behind too many barriers). Staff must know the location. For a child who goes out often (e.g., to school or park), the emergency meds often travel with them in a kit. If our staff accompany them outside the home, the staff ensures they have that kit (for example, carrying the Epipen in a waistpack). We never leave the home without the child’s emergency medication if the child has a known risk requiring one, because an emergency can happen anywhere.

Administration: When an emergency med needs to be given, there is no time for the usual checks to the same extent – but having only one child to treat, the risk of misidentification is low. Still, if more than one medication is in the kit, ensure to grab the correct one (e.g., Epipen vs. asthma inhaler; the situations are usually distinct). Administer with the method taught:

We focus on the child’s immediate survival and comfort. This may include basic first aid alongside the medication (like keeping airway open, loosening tight clothing, reassuring the child if conscious).

Post-Administration Actions: After giving any emergency medication, call emergency services (999) if that is part of the protocol (for anaphylaxis and severe seizures, it usually is, even if the medication seems to have worked, because further medical evaluation is needed). Even if an ambulance might not be deemed necessary (for example, one dose of rescue inhaler relieves asthma symptoms fully), we will at least inform the parents and likely the GP about the incident, as it could indicate needing a review of the child’s condition. We also ensure the used medication device is disposed of safely (used Epipen or empty syringe should be given to paramedics or taken to pharmacy for disposal later, not left where someone might touch the needle).

Emotional Support: Such incidents can be scary. Our staff will also comfort and calm the child (and others present) as much as possible, and continue to monitor vital signs until help arrives or the child stabilizes. We stay with the child at all times during an emergency and do not, for example, leave them alone to fetch items (hence we carry phones and have emergency numbers pre-set, so we can call for help while still with the child).

Reporting: Every emergency medication administration is treated as a critical incident. Staff must inform management immediately after the situation is under control (often the manager will be on the phone with staff as events unfold if possible). We then conduct an incident debrief, ensuring the event is documented in detail, the Care Inspectorate is notified if required (likely yes for significant incidents requiring medical intervention), and the care plan is reviewed to see if anything could be adjusted to prevent future emergencies (e.g., does the allergy care plan need updating?).

Where to report:

1) Verbally to the Registered Manager or Safeguarding Lead

2) Inform the Registered Manager by email: {{org_field_registered_manager_email}}

3) Call the office and inform the Registered Manager or Safeguarding Lead: {{org_field_phone_no}}

4) Out of hours phone number: {{out_of_hours}}

5) Online via our website: {{org_field_website}}

Parental Involvement: Parents are notified as a top priority once the child is safe. Often, parents want to be involved in decision-making for emergencies, but practically, staff have standing permission via consent forms to act because in life-threatening situations there may not be time to call the parent first. After the fact, we provide full information to the parent about what happened and what actions were taken (for instance, “John had a seizure at 2:05pm that lasted 6 minutes, we administered Midazolam at 5 minutes and it stopped one minute later. He slept afterwards, and ambulance arrived at 2:20pm to check him. He’s doing okay now, and we’re with him. We have informed your neurologist as well.”).

By handling emergency medications with readiness and precision, we aim to prevent worst-case outcomes. Our staff are mindful that not giving an emergency medicine when needed could be far more dangerous than any side effect of the medicine, so we err on the side of action when criteria are met. At the same time, we do not give such powerful medications in non-emergencies – they are strictly reserved for the conditions defined.

Refusal of Medication

Children, like adults, have the right to refuse medication. A child might refuse for many reasons: bad taste, fear of swallowing pills, not understanding why they need it, assertion of independence, or side effects making them feel unwell. Our policy is to handle refusals with sensitivity, never forcing medication in a way that infringes on the child’s rights or could cause trauma. That said, if a child refuses a critical medication, we must balance respecting their wishes with safeguarding their health by involving appropriate people to address the situation.

When a Child Refuses:

In summary, our handling of refusals ensures the child’s voice is heard and that we respond in a supportive, not punitive, manner. We involve parents and professionals to address the underlying issue. The Care Inspectorate expects that “staff should know what to do if the child spits out or refuses the medication” and that parents are always told in such cases – our policy meets this expectation by providing clear guidance and communication. We treat refusals seriously especially if health could be compromised, but we always approach it from a care and welfare perspective, not blame.

Medication Errors and Incidents

Despite strict procedures, there is always a risk of human error. A “medication error” refers to any deviation from the prescribed medication regimen or administration protocol – for example, giving the wrong medication or dose, missing a dose, giving it at the wrong time, administering to the wrong child, or not following special instructions. Our goal is zero errors, but if an error occurs, we respond immediately to ensure the child’s safety and learn from the incident to prevent reoccurrence.

Types of Errors: Common examples include:

Immediate Actions if an Error is Discovered:

  1. Ensure Child’s Safety: This is top priority. If the child has received something they shouldn’t have or missed something important, assess their condition. Many errors might not cause immediate harm (like one missed dose of antibiotic will usually be okay if made up), but some can be serious (giving a double dose of insulin, for example). Depending on the situation, staff may need to call emergency services or seek immediate medical advice. For instance, if a child was given another child’s medication or an overdose, the staff should call NHS 24 or 999 for guidance on potential antidotes or interventions. If a critical dose was missed (like seizure meds), the risk of a seizure may rise, so increased monitoring or preventative measures might be needed.
  2. Inform the Parent/Guardian: We do not hide medication errors. As soon as the child is safe, or concurrently if another staff can call, we notify the parent about what happened and what is being done. Transparency is key. For example: “I need to let you know that I accidentally gave Jamie a double dose of his pain medicine at 1pm. I have consulted with the GP who said it should be okay but might make him drowsy. We are monitoring him closely.” Parents understandably may be upset, but it is their right to know and be involved in the next steps.
  3. Follow Medical Advice: Often with medication errors, after initial first aid or safety steps, the protocol is to call a doctor or poison control for advice. We’ll provide accurate information (what drug, how much, when) and follow their instructions (which could be to observe at home, give some remedy, or take the child to A&E). According to best practice, “if too much medication is given or given to the wrong child, staff should seek further advice/instructions from a doctor immediately”– we incorporate this by always involving appropriate medical professionals at once.
  4. Monitor and Support the Child: Keep checking the child’s vital signs, behaviour, and comfort. Even after advice is followed, continue to observe for a period as recommended. Comfort the child if they’re aware of something wrong (we don’t alarm them; e.g., we don’t need to tell a young child “I gave you the wrong medicine” but rather “we are going to check you and make sure you’re okay, you might feel sleepy, but we’re here with you” in a soothing way).
  5. Do not attempt to correct by additional errors: For example, if a dose was missed, do not double dose next time unless a physician explicitly says to. If wrong medication given, do not give another med to counteract unless told. Just manage as per professional guidance.

Reporting and Documentation of Errors:

Investigation and Follow-Up:

Support for the Child and Family: We acknowledge that even a small error can erode trust. We apologise to the child and family openly (this is part of our Duty of Candour) and reassure them of what will be done to prevent future incidents. If the child was physically harmed (even mildly, like extra drowsiness or an upset stomach from an error), we follow up until they’re fully recovered. If needed, we may involve the family doctor to do a check or provide follow-up care.

Disciplinary Action: Our primary aim is learning, not punishment. However, if an error was the result of negligence or serious breach of protocol (e.g., a staff knowingly ignored the policy or was impaired at work), it will be handled under our disciplinary procedures, as that is a safety issue. Also repeated errors by the same individual will be taken seriously. We owe it to the children to have competent caregivers.

By handling errors in this transparent and proactive manner, we ensure that each incident leads to safer practice in the future. We also align with regulatory expectations that providers “make proper provision for health, welfare and safety” by not only trying to avoid errors but managing them properly if they occur. This approach ultimately fosters trust, as families and inspectors see that we respond responsibly even when things go wrong.

Communication and Collaboration

Effective communication is a thread that runs through every aspect of medication management. We emphasise open, honest, and timely communication with families, healthcare professionals, and within our staff team to ensure everyone has the information they need to keep the child safe.

Communication with Parents/Guardians:

Communication with Healthcare Professionals:

Internal Communication and Handover:

Multidisciplinary Collaboration:

Consent and Confidentiality in Communication: We always respect confidentiality – we will share information with healthcare providers under the basis of providing care (which is allowed under data protection as necessary information sharing). With schools or other agencies, we typically do so with consent from the parent, unless there’s an emergency or risk that warrants sharing without (rare in medication context). For example, if a social worker is involved, we might share medication compliance info if relevant to the child’s welfare, as part of joined-up care.

Documentation of Communication: Important communications (like “parent informed GP will review asthma meds next week” or “pharmacist said label was misprinted, correct dose is…” ) are written in the care notes or handover notes, so that there is a record and everyone is kept in the loop. For significant changes, we update the care plan formally so the written info stays current.

In essence, we aim for a no-surprise environment – families and professionals should not be surprised by something medication-related because we strive to keep everyone informed. This collaborative approach ensures continuity of care, and it instills confidence, aligning with Standard 4.11 that care is based on best practice and good communication between all parties.

Staff Training and Competency

Safe medication management for children depends on the knowledge and skill of the staff administering or overseeing it. Therefore, we invest significantly in training our staff and assessing their competency, in line with Health and Social Care Standard 3.14 (people have confidence in staff because they are trained, competent and follow codes).

Induction Training: Every new care staff member, regardless of prior experience, undergoes an induction that includes our medication management procedures. They are required to read this Medication Policy in full and discuss any questions with a trainer or mentor. We provide training modules on general medication handling (covering the 6 R’s, use of MAR charts, infection control, etc.), and specifically on paediatric considerations (such as weight-based dosing concepts, how medication affects children differently than adults, safeguarding aspects unique to children, and child-friendly communication techniques). We also cover the legal responsibilities and expectations from the Care Inspectorate at induction, so staff understand the gravity of their role in administering medicines correctly.

Paediatric-Specific Training: Staff receive training that focuses on caring for children and young people. For example:

Formal Qualifications: We encourage and support staff to pursue formal qualifications in medication management. For instance, the Professional Development Award (PDA) in Health and Social Care: Administration of Medicine at SCQF Level 7 is a recognised qualification tailored to social service workers who administer medication. This PDA covers practical and theoretical knowledge and is a form of Continuing Professional Development. Staff who complete such programs bring back enhanced expertise. While not mandatory for all, we aim to have at least senior staff or those frequently handling complex meds achieve this qualification. We also keep them updated on any changes in guidelines or best practices from resources such as the Care Inspectorate’s Hub or NHS Education for Scotland.

Competency Assessment: Training is not considered complete until the staff’s competency is verified. We use methods such as:

Staff must demonstrate competence before being allowed to handle medication unsupervised. If a staff member is not yet confident or has language barriers in reading labels, etc., we continue training and pair them with others until they reach the required level.

Ongoing Training and Refresher: Medication practice and guidelines evolve, so we provide refreshers at least annually. This might be a workshop revisiting key points of the policy, updates from new guidance, or learning from any incidents that occurred. For instance, if there’s a new formulation of a drug or a change in the Health and Social Care Standards, we brief the team. Additionally, if a child with a very specific medical technology (like a pump or a new type of inhaler) joins our service, we arrange specialist training for that as needed.

We also include medication topics frequently in team meetings or newsletters – like a “topic of the month” such as safe disposal or avoiding antibiotic resistance – just to keep knowledge fresh.

Training in Documentation: We ensure staff know how to correctly fill MAR charts (paper and electronic). Poor record-keeping can be as dangerous as poor administration. We share examples of good practice and common mistakes to avoid (the Care Inspectorate often finds issues with MAR chart recording so we emphasise accuracy).

Emergency Drills: For those with emergency meds in their caseload, we run through mock scenarios (“what would you do if…”) to keep them on their toes. This builds muscle memory so that in a real emergency, the training kicks in despite stress.

Safeguarding Training: All staff must pass our safeguarding training which includes how medication mis-management can be a form of harm. They are taught that if they see signs of deliberate harm (for example, a caregiver administering something unnecessary or a youth overdosing intentionally), it must be reported. This intersects with med training as well.

Code of Conduct and Professional Standards: We remind staff of their obligations under professional codes, such as those of the Scottish Social Services Council (SSSC) for social care workers, where applicable. Administering medication improperly is a breach of those codes. They are expected to “follow their professional and organisational codes”, meaning this policy and the ethical guidelines provided.

Records of Training: We maintain a training log for each staff member indicating what medication training they have received and when refreshers are due. The Manager reviews these to ensure compliance. Inspectors often ask about staff training, and we can readily provide evidence.

Through comprehensive training and rigorous competency checks, we make sure our staff have the skills and confidence to manage children’s medications safely. This fulfills the standard that families can have confidence in the people supporting their child (HSCS 3.14) because those people are well-prepared and qualified. Our commitment to training is continuous – as new challenges arise, we address them proactively with education.

Safeguarding, Confidentiality, and Child-Centred Ethics

Medication management does not happen in isolation from broader childcare responsibilities. We integrate safeguarding and ethical considerations into our medication practices:

In summary, safeguarding and ethics are woven through everything from how we talk to a child about their medicine to how we report concerns. Our aim is that children feel safe, respected, and heard in their care, and that parents trust that we are not just doing a task but caring for their child’s overall well-being.

Audit and Quality Assurance

To ensure that this policy is not just words on paper but truly guiding practice, we have systems for auditing and quality assurance:

Through these efforts, we strive to ensure that “care and support is based on relevant evidence and best practice”. Inspectors will find that our paperwork and actual practice align, and that we are proactive in maintaining high standards.

Policy Review and Implementation

This Medication Management and Administration Policy is approved by the management of our service and is distributed to all staff. A copy is readily available for reference in the staff handbook and digitally on our care management system. Key points from the policy are included in quick-reference guides (like a one-page flowchart for medication administration steps) to support staff in day-to-day operations.

Training on Policy: All staff are trained on this policy upon induction and whenever updates are made. They sign to confirm they have read and understood it. We may test understanding through scenarios to ensure it’s fully embedded.

Review Schedule: The policy will be formally reviewed at least annually (next review due by [Month, Year] – one year from its last revision) or earlier if:

During review, we consult various sources: current laws, Care Inspectorate standards, staff experiences, and perhaps parent feedback. We then update the policy, have it approved by the service manager (and the board or owner if applicable), and then we retrain staff on the changes.

Version Control: Each iteration of the policy is version-controlled (e.g., version date in footer) to avoid confusion. Old versions are archived.

Compliance Monitoring: Adherence to this policy is a condition of employment for our staff. The manager will monitor compliance via the audits and supervision as described. Non-compliance can lead to corrective action.

In implementing this policy, we ultimately aim to create a safe system where children receive their medications correctly and comfortably, parents and professionals collaborate effectively, and staff are confident and accountable in their practice. By following this policy, our service will meet and exceed the Care Inspectorate’s requirements and, most importantly, ensure the children in our care remain healthy and safe when it comes to their medications.

Sources:

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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