First Aid and Medication

You should be clear about what decisions you can make about giving consent for medical treatment and this will be recorded in the child/young person's Placement Plan.

You should have a fully equipped first aid box in your home and in each vehicle used to carry children. Your Supervising Social Worker will make sure arrangements are in place to keep first aid boxes fully stocked. The first aid box may be looked at in an unannounced visit.

First aid boxes should be kept in a safe accessible place where the people who need to get access to them can and not within reach of small children.

First aid training is mandatory in the first 12 months and then refreshed at least every 3 years. Specialist first aid training for under 5s is also available. See your Supervising Social Worker.

If a child is at risk or requires first aid, you should apply first-aid if it is safe to do so, and then contact your Supervising Social Worker as soon as possible. You must not delay the process of getting medical help.

You should always assess the situation and in a medical emergency, send for medical help and an ambulance or the Police if this is needed.

Before help arrives:

• Do not move the person other than to remove them from immediate danger or place them into the recovery position;
• Try to find out what has happened;
• Collect any drugs or spillages (e.g. vomit) for analysis;
• Do not try and make them sick;
• Observe the child/young person; keep them calm, warm and quiet;
• If the person is unconscious:
  • Ensure they can breathe and place them in the recovery position;
  • Do not move them if they are likely to have spinal or other serious injury which may not be obvious;
  • Do not give anything by mouth;
  • Do not attempt to make them sit or stand;
  • Do not leave them on their own.

When medical help arrives, pass on any information available, including samples of vomit and any drugs.

You must have guidance on giving prescribed drugs for children and advice on if they can give drugs not on prescription. You are expected to complete records when you administer any medication or when there has been a medical incident i.e. hospital admission, consultant/GP appointments.

If you accept responsibility for giving medicines either by injections, administering rectal medication or tube feeding etc. the following criteria should be met:

• The child's parent should have given written consent;
• You should be willing to do the task;
• You should be instructed in the technique by a qualified nurse or doctor who is satisfied that the carer is competent to do it.

You should also be aware of any possible reactions to the medication and the necessary steps to correct such an occurrence.

Any health-elated issues should always be discussed in supervision meetings and recorded.

You will receive training in relation to the management and administration of medication. First aid training must be renewed every three years.

Storage areas for medication must be kept in a clean area free from dust and contamination. If drugs fridges are used these must be regularly cleaned and defrosted.

Home Remedies may only be given to a child with the consent of the parent, the child if over 16 or after consulting with the child's GP and recorded in the Placement Plan.

Home Remedies are medicines that can be bought over the counter without prescription, including Paracetamol, Aspirin, homeopathic, herbal, aromatherapy, vitamin supplements or alternative therapies.

Home Remedies must be kept in a locked cabinet that is only accessible to you, unless a child is permitted to keep their own Home Remedies, in which case the arrangements for this must be set out in the Placement Plan.

Home Remedies, other than Paracetamol, should only be given for a maximum of 48 hours. If the symptoms continue the child should see a GP before further dosages are given. Where children are not able to give Home Remedies themselves, care must be taken to make sure they take it correctly and in your presence.

The following steps must be followed for medicines:

• Check the medicine to make sure it is prescribed for the child and it is within the expiry date;
• Make sure the child's name, the name of the medication, and the dosage are correct;
• Give the medicine in accordance with the instructions;
• Record when you give the medicine including the date, time, how much, your name and signature.

A specialist allergy nurse/consultant will help develop a Health Care plan which should be shared with you and with all agencies working with the child/young person.

The Care and Placement Plan and Health Care Plan should contain the following:

• All known allergies and associated risks including spotting the signs and symptoms of an allergic reaction and anaphylaxis for the child/young person;
• Preventative measures should be detailed in the Plan - for example taking daily antihistamines for hay fever, making sure cleaning products and gloves are hypoallergenic, and washing powder is suitable for skin conditions;
• Actions to take when a young person has an allergic reaction. The plan should describe exactly what to do and who needs to be contacted in the event of an emergency. For example, when to use an Epi Pen and calling for an ambulance;
• You should be aware of the Plan and should have been trained to administer an Epi Pen by a suitable qualified health professional;
• The child or young person should be educated around their allergies and what to do in an emergency - a young person may be able to self-administer their own EpiPen or take antihistamines. If this is the case this should be recorded;
• Medication should be easily accessible so you and/or the child/young person can access their medication in an emergency situation;
• You should keep a record of each episode and any medication given.

For further information, see the NHS Website or see Allergy UK Website.

All medicines from whatever source, including medication from hospital should be recorded.

The record should show:

• Date you got the medicine;
• Name, strength and dosage of medicine;
• Quantity received;
• Expiry date;
• Name of the child for whom medication is prescribed/purchased.

A record is required to identify what happens to medication in your home. This record should show:

• Date you finished the medicine are got rid of it/return to the pharmacy;
• Name and strength of medicine;
• Quantity taken;
• Name of the child for whom the medicine was prescribed/purchase;
• Your signature if you disposed of the medicines.

First aid and records of all medicines that have been given should be recorded in the Log Book if advice is sought from a GP, NHS 111 or pharmacist, you should record details of the discussions. If an accident occurs, which results in a visit to GP/hospital, it should be recorded.

You are responsible for:

• Informing Head Teachers about known medical conditions, including allergies that affect a child in your care, along with medicines that the child/young person needs to take. You will also inform the school of any changes to the child/young person's medical condition, prescription or support needed;
• Making available the Patient Information Leaflet (P.I.L.) supplied with medicines to the child or young person as appropriate.

You require information about the child or young person's health needs and medical history, which includes:

• A record of immunisations;
• Pre-existing conditions, including allergies;
• Current medications and instructions for giving this;
• Previous medications given, including previous reactions;
• Any medications a child/young person must not be given;
• Name and contact details for the GP and any other health care professional involved;
• Abuse of prescribed medications;
• Parents view on giving medications where appropriate.

There will be occasions when children/young people will require medication outside of your home, on holiday or whilst at school. You should ensure the supply of medication to a child/ young person where they spend time in two or more places, for example, outside the home in day care, with relatives, or attending school or college. The appropriate school policy should be referred to for guidance, when giving medicines in schools.

Where a child or young person goes out of a home regularly (e.g. every lunchtime) and requires medication, the Pharmacist and/or GP should be asked to assess whether an alternative preparation is available which would avoid the need for a lunchtime dose. It may be appropriate to consider whether the medicine can be given at another time. If the medicine must be taken whilst the child or young person is absent from your home, a separate container of medicine should be requested from the Pharmacist/GP as appropriate.

For those children/young people using short break services, parents/carers should be asked to provide the relevant medication, correctly labelled and in the original containers to the various locations. In this way medication should be supplied to the short break service and to the child/ young person's school if required. Written confirmation of the medication a child/young person is taking should be obtained from either the Placement Information Record, or from the child's Social Worker or a health professional who is responsible for the information provided.

You should never put solid medication such as capsules and tablets in a container to be sent to the school or other setting. All medications should be supplied in the original packaging with the proper dose instructions and warning instructions available.

It is an individual's right to refuse medicine.

You should always record the reason for refusal of the dose so that this can be discussed at the time of a medication review with the Doctor and/or the Pharmacist.

You may find that it is worthwhile to wait for a short period before going back to the child/young person and again offering the medicine.

You must never force a child/young person to take a medicine but it may be necessary to contact a Medical Practitioner for further advice.

You should not attempt to administer another dose of medication if the dose of medication has been partially swallowed or spat out.

There may be certain circumstances in which covert administration may need to be considered to prevent a child/young person missing out on essential treatment. "Covert" is the term used when medicines are given in a disguised way without the knowledge or consent of the person receiving them, for example, in food or drink.

Any decision must be reached after assessing the care needs of the child /young person and the decision recorded in the Care Plan and a date given for reviewing the decision.

To help the child/young person taking the medication, other forms may be more acceptable for example, liquid. A medicine should only be crushed following advice from the Doctor or Pharmacist.

If any medication goes missing, it must be reported immediately to the Fostering Service.

In the event of a death of a child/young person, any medication that is held for them should be retained for seven days, in case the Coroner's Office or courts require them.

A full risk assessment must be completed by the young person's Social Worker before a decision can be made about their competence to take their own medication. This should explore whether the young person;

• Wants to take responsibility for looking after and taking medicines;
• Knows the medicines they take, what they are for, how and when to take them and what is likely to happen if they don't take them;
• Understands that it is important not to leave medicines lying around.

Your level of support and resulting responsibility should be written in the young person's Care Plan. This should also record how to monitor whether the young person is still competent to take their own medicines, without constantly invading their privacy. The assessment is a continuing process.

A record must be maintained of the medicines given to a young person responsible for their own medication in the Log Book along with your signature.

A young person responsible for taking their own medication will have to complete a Choice of Handling of Medicines form.

The young person will need a safe place for keeping the medication. It is important to emphasise that prescribed medicines are the property of the individual for whom they are prescribed. 

Young people may wish to take responsibility for their own medication and in terms of promoting independence this may be encouraged.

If a young person has the capacity to collect their own prescription and take it to a pharmacy, they have the right to choose which pharmacy. If a young person cannot present their own prescriptions at a pharmacy because of disability, this does not mean that they will be incapable of exercising some control over their medicines.

Where a child/young person has complex needs or are placed with Families Together Carers, you must always complete the Medicine Administration Record when giving medication.

Medicine records must normally be kept for at least fifteen years from the date of the last entry.

Where a child/young person brings their own medicines for respite or a short break, they should be asked to supply medicines in the original containers, supplied and labeled by the Pharmacist or dispensing GP practice.

Medication sheets should be used to alert of any change of medication or change in dosage.

If there is any confusion about what medicines or doses are to be given, you should make every effort to clarify the details with the prescriber. Advice can also be sought from a pharmacist or NHS 111, if the prescriber cannot be contacted.

There is very little published information about cultural requirements and medicine management. However:

• Vegetarians and people from some religious groups do not want gelatine capsules (made from animal products);
• Some people may prefer to have medicines given to them by people of the same sex;
• Some religious festivals include fasting which may affect the giving of medication;
• Some Muslims may be concerned about medicines containing non-halal substances.

Each child/young person should be seen as an individual and advice should be sought from the key people in order to determine the appropriate course of action regarding all of the above points.

See Foster carer Medication Administration Record (MAR) which can be accessed via Forms and Records.