The Home must have a qualified First Aider and medication trained staff member on duty at all times, this is identified on the Rota and within the Training Matrix for each home.

First Aid boxes should have a white cross with a green background and must be held in the Home and should be carried in each of the vehicles used for the transportation of children.

Each box has an inventory that must include the full quantity of each item stipulated in the box. When an item has been used, it should be replaced as soon as possible. There must be weekly checks on the First Aid boxes, and this will be documented on the Clear Care system.

Recording: Each child should have permission for staff to administer first aid and non-prescription medication from a person with Parental Responsibility for them recorded in the relevant plan. Permission should be sought and arranged by the child's social worker or person with Parental Responsibility.

The administration of First Aid must be recorded in the First Aid Log, Accident Book (if there has been an accident), the child's Daily Record and Medication Administration Record (MAR) sheet.

2. Allergies

A specialist allergy nurse/consultant will help develop a Health Care plan which should be shared 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 child/ 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 EpiPen and calling for an ambulance;
All staff should be aware of the Plan and should have been trained to administer an EpiPen by a suitable qualified health professional;
The child/young person should be educated about 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 staff and/or the child/young person can access their medication in an emergency situation;
A record should be kept of each episode and any medication given should be recorded on the Medication Administration Record (MAR) sheet;
Children’s profiles are to be visible in the medication area for the home, ensuring that children and young people are identifiable, along with their known allergies.

For further information please contact the child or young person’s health professional who deals with their allergies and check the NHS website or see Allergy UK Website.

3. Home Remedies

Home Remedies are medicines that can be bought over the counter, including Paracetamol*, aspirin, homeopathic, herbal, aromatherapy, vitamin supplements or alternative therapies.

If a young person has capacity and there are no safeguarding issues, they may be permitted to 'self-administer' Home Remedies however this should be risked assessed accordingly. This would need to be approved by their social worker / person with parental responsibility, with the agreement recorded in the Placement Plan.

Home Remedies can only be used by the child/young people in the home with the approval of relevant social workers (as set out in children's Placement Plans) and the person/s with PR, or as prescribed by a GP or from guidance from the pharmacy.

Home Remedies must be purchased from the pharmacy and advice should be sought on how to administer the Home Remedy.

Unprescribed Home Remedies can only be used once authorisation has been sought from the Home’s Manager.

Home Remedies should be purchased for a named child and booked in using a Medication Administration Record (MAR) sheet. If the Home Remedy is unprescribed, this must be booked in by the Home’s Manager or by a senior staff member following the authorisation of the Manager that has been appropriately trained in medication management.

When a Home Remedy container is opened, staff should record the date of opening to ensure it is not kept beyond its expiry date.

Home Remedies are only be given for a maximum of 48 hours. If the symptoms persist beyond that time the child should see a medical practitioner before further dosages are given. However, if Soluble Paracetamol is given for 24 hours and the symptoms persist, the child should see a medical practitioner before further dosages are given.

Each time an unprescribed Home Remedy is administered, the first dose must be reported to the manager. This is to support the monitoring and reviewing of continued use without advice from the GP.

Recording: The administration of any Home Remedies must be recorded in the child's Daily Record and Medication Administration Record (MAR) sheet. The Home Remedy advice sheet must be followed. Particular attention must be paid to the dosage and administration guidance, including how long the child/young person can continue to take the Home Remedy before a GP appointment should be made. This will differ depending on the Home Remedy.

For further advice on what a pharmacist can support with, please see: How pharmacies can help (NHS).

4. Key First Aid and Medication Records held in the Home

Each home should keep the following records:

Caption: Each home should keep the following records
Record	Purpose
First Aid Log	To record any administration of First Aid.
Accident Book (Recorded on Clear Care)	To record any accidents.
Medical Record	A record for each child, details of health-related issues, medication used, name of GP. This is documented in their support plan.
Medication Administration Record (MAR)	A record for each child to record any medication (or Home Remedies) administered etc.

For detailed information about controlled drugs (such as morphine, pethidine, methadone and methylphenidate) see CQC information on Controlled Drugs.

4.1 Ordering Ongoing Medication

Some children/young people will have prescribed medication, which is ongoing. This should be ordered on monthly basis where possible. Responsibility for ordering these medicines is that of the registered manager or a delegated person/member of staff.

When ordering, a note must be made of:

The name of the child/young person;
The name, strength, form and quantity of the medicine;
The name of the surgery/G.P;
When the prescription will be ready.

When ordering, staff should check stock levels before ordering. To minimise wastage and reduce risks of errors, stock levels should be kept to a minimum.

4.2 Collecting Prescriptions

To collect a prescription, you must first request a repeat prescription from your GP, who will issue it digitally or on paper. It can then be taken or sent electronically to the pharmacy.

A photocopy of the prescription should be made and stored until the medicine is received back from the Pharmacy. Staff should check with the Pharmacy when the prescriptions will be ready for collection. Where possible, arrangements should be made for medication to be delivered to the home.

4.3 Receiving/Collecting Medicines

Staff must take their ID when collecting medicines or controlled drugs.

When the medicines are collected, staff should check the medicine against the photocopied prescription that they have before leaving the pharmacy. Any discrepancies should be brought to the attention of the Pharmacy and rectified as soon as possible.

The Pharmacy will be able to give, and advice should be sought upon:

Potential side effects;
Advice on how the medicine should be taken;
Advice on whether the medicine may be affected by any other medicine;
Whether the medicine should be stored in the fridge;
If the medicine is a Controlled Drug.

Staff should ensure that the medicine has been properly labelled. If the medicine does not have a dispensing label on it, then it should be returned to the Pharmacy before being used. Staff should also make sure that they have received a Patient Information Leaflet from the Pharmacy which will provide instructions on medication dosage, side effects, and contraindications when the medication is unsafe to use.

The receipt of medication should be recorded on the child's Medication Administration Record (MAR) sheet, if a Controlled Drug has been prescribed, two staff members should record/sign the record. The Controlled Drugs book should also be updated accordingly.

4.4 Administration

NOTE: all staff must be familiar with the following detailed guidance on the administration of medication:

Caption: Administration
Circumstances	Relevant Guidance
For detailed guidance on the administration of medication.	Appendix 1: Administration of Medication Guidance
For guidance on specific issues, e.g. refusal to co-operate, if a child is missing/absent, covert administration.	Appendix 2: Specific Issues re Administration
For guidance on specific issues, e.g. refusal to co-operate, if a child is missing/absent, covert administration.	Appendix 3: Administration away from the home
Skilled Health Tasks, e.g. for children with Diabetes.	Appendix 4: Delegated Health Care Tasks

Medication should be administered as set out on the label or instructed by the GP/Medical Practitioner. Medicine prescribed to one child must never be administered to a different child.

Staff must be medication trained before administering medication to Children and Young People.

Medication records must provide clarity on when specific medication should not be taken in conjunction with other types of medication.

No child may be permitted to 'self-administer' unless approved by their social worker, with the arrangements outlined in the Placement Plan with appropriate risk assessments being undertaken.

Administration should be recorded on the individual child's Medication Administration Record (MAR), if a Controlled Drug has been administered, 2 staff are required to record/sign the record.

To Clarify:

One member of staff can sign as having administered medication and one must witness (This does not apply to controlled drugs);
The member of staff must count/measure the amount of medication remaining and ensure this is the same as what is recorded on the administration record, if this is not the case, they must record this as a discrepancy and report to their manager;
The member of staff administering the medication must have completed the relevant training course and competency checks and signed off as competent by the manager.

As and When Required Medication (PRN)

PRN medication is “as and when required” and will only be administered when the children and young people require them. PRN medication must only be prescribed in line with the prescriber’s direction. PRN medication is only to be used for medical conditions, not to manage behaviours.

The agreements to administer PRN, guidance must be sought from the health provider(s) and must include:

Name of the child / young person;
Name of the medication and route of administration;
Condition(s) on when the PRN Medication should be administered;
The dose to be given and the maximum dose in a 24 period;
Minimum time between doses;
Details of the prescriber.

All information for the PRN medication must be kept with the young people’s MAR sheets.

Where PRN is prescribed for managing medication specifically, there must be agreements with all health and social care professionals. All PRN medication must have their own MAR Sheets, with clear records of administration, consideration must also be given on the impact on medication already prescribed. Medial advice must be sought if this is not clear.

All PRN medication must be stored appropriately and correctly in line with policy.

When there is a prescription for PRN medication, the home must ensure that there is not requested if there is adequate stock already within the home to prevent the holding of excess medication.

Process for Medicine Administration:

Before giving medication

Inform the child/ young person that their medication is due;
Wash hands and any other utensils before use;
Follow the ‘six rights';
Use disposable gloves when appropriate;
Check for allergies;
Check verbally that the child/ young person has not already taken or been given the medication;
Check the dose has not already been administered by checking the MAR;
If there is a discrepancy, consult managers, community pharmacist or the NHS Out of hours health help line.

When Administering Medication

Only administer medication from labelled bottles, containers, and compliance aids;
Don’t give medicines from unlabelled or illegibly labelled bottles, blister packs or containers;
Don’t transfer medication from their original containers;
Don’t prepare medicines or drugs in advance of administration. Once prepared they must be used immediately or discarded;
Don’t leave medicines unattended for child/ young persons to take at a later time;
Don’t handle medications directly when administering as far as is practicable;
Don’t give discoloured solutions, disfigured tablets, substances etc. These must be stored safely and returned to the pharmacist.

When Administering Liquids

Shake the bottle by gently turning it upside down several times;
When pouring, hold the bottle with its label on top so that the liquid falls away from the label so that this doesn’t damage the label;
Pour into a measured dosage container appropriate for the volume of the drug to be given and appropriate to the requirements of the child/ young person;
Measuring devices include a graduated medicine cup, medicine spoons or an oral syringe and bottle adapter;
When using a graduated medicine cup, ensure that the cup is placed on a flat surface and the liquid is poured into the cup and observed at eye level;
If the medication is refused, the liquid medicine must never be poured back into the original bottle. It should be signed off as refused and disposed of safely.

After Administering Medication

Following any medication being administered, the relevant documentation e.g. MAR Sheets and Controlled Drugs book must be completed. This must include Name of the medication, time, date, who administered the medication and the correct MAR coding.

4.5 Storage and Expiry Dates

Medicines kept in the Home must be stored in a secure place to prevent any child from having unsupervised access to them.

All medicines must be kept in a safe/secure place, e.g. a locked cabinet that does not exceed 25°C. A key to this cabinet should be held by a senior/responsible member of staff on duty. Controlled drugs must be stored in a locked cabinet in a locked cabinet, with separate keys.

Internal medicines (those taken by mouth for example tablets, syrups, capsules) should be kept separate from external medicines (including ointments, creams, antiseptics, eye/ear drops). Liquids are best stored on the bottom shelf to prevent accidental spillage onto other medicines.

Medicines that require refrigerated storage should be kept in either a dedicated lockable fridge (in the office) or a locked box inside the food fridge.

All medicines have expiry dates, usually clearly stated on the label, upon expiry, they should be disposed of.

Where the shelf-life of a drug or medicine has expired. Special attention is required for items such as eye drops, ear drops, and ointments, which must be clearly dated when first opened. Medication that has expired must not be used under any circumstances.

The medicines that are held in the home at any given time should be appropriate to the current therapy of the young person, and any surplus or unwanted medicines should be disposed of in an appropriate manner.

Labelling of Medication:

For a member of staff to administer a medicine it must have a printed label containing the following information:

Young persons’ name;
Date of dispensing;
Name and strength of medicine;
Dose and frequency of medication;
Medication opened date and expiry date.

This information must be checked by the administering staff member to ensure the accurate dispensing of medicine. Where appropriate staff should liaise with the dispensing pharmacy with a view to using their monitored dosage systems.

4.6 Disposal

SMBC Children’s Homes is committed to ensuring the safe, timely, and hygienic disposal of surplus, expired, or unwanted prescription drugs and medicines. This policy outlines the procedures and responsibilities associated with managing the disposal of pharmaceutical products to maintain safety, comply with relevant regulations, and ensure the welfare of children and young people in our care. All drug disposal procedures must comply with relevant national and local regulations, including but not limited to:

Health and Safety regulations;
Safeguarding standards;
General Pharmaceutical Council (GPhC) guidelines.

Staff must be regularly trained in the procedures for safe handling and disposal of medications to ensure compliance with these standards. All training records are held centrally, and within the homes files.

Safe Storage of Unwanted Drugs:

All unwanted or surplus drugs/medicines should be securely stored in a locked, designated container clearly marked for disposal purposes. This ensures that no medicines are inadvertently re-used or misplaced.

When a young person leaves the home, the medicines should be returned to the young person or responsible adult unless the young person has positively consented to their safe disposal. When there is a change to medication, and a product has been discontinued, the surplus should be returned to the supplier.

All medicines have an expiry date, some of which are shortened when the product is in use, i.e. eye drops, information on which will be included with the medicine.

Documentation of Disposal:

Before disposal, a senior staff member must ensure that all drugs/medicines are properly recorded in the Drugs Disposal Book or Record Sheet, documenting the following details for each item:
- Name of the drug/medicine;
- Name of the child/young person (if applicable);
- Date of entry;
- Quantity of drugs/medicines;
- Reason for disposal (e.g., expired, discontinued treatment);
- Signature of the staff member performing the entry.

Return to Pharmacy for Disposal:

After proper documentation, a senior staff member will arrange for the drugs/medicines to be returned to the originating pharmacist. The Drugs Disposal Book or Record Sheet should accompany the returned items;
The pharmacist will verify and sign off on the returned drugs/medicines and confirm their disposal;
The signed Drugs Disposal Book or Record Sheet must then be returned to for record-keeping;
There are a few reasons why medication may be returned:
- Medication has expired;
- No longer prescribed;
- Prescription has changed / been amended;
- Excess of stock;
- Medication has been refused.

Discontinuation of Treatment:

Where a course of treatment is discontinued, resulting in excess drugs or medicines that are no longer necessary.

Return or disposal of medication should be recorded on the child's Medication Administration Record (MAR) sheet, and the receipt attached. If a Controlled Drug has been disposed of, two staff members are required to record/sign the record.

5. Appendix 1: Administration of Medication Guidance

All medicines must be administered strictly in accordance with the prescriber's instructions (or as advised on the packet in relation to Home Remedies). Only the prescriber (e.g. GP or medical practitioner) can vary the dose. Medicines must be locked away in the locked storage areas when not in use. Before administration, staff should:

Wash their hands;
Make sure they have a pen and any required record sheets;
Enough glasses for each child/ young person receiving medication;
A jug of water.

The procedure for administration is as follows:

Check the child/young person's identity (a photo is normally kept in the young person's file). Only one child/young person should have their administered medication at a time, this reduces the risk of mistakes being made;
Check the child/young person's medical profile;
Check the medication on the individual medication records corresponds with that on the child/young person's medical profile;
Check that the Individual medication record sheet to ensure that someone else has not already given the medication;
Check the expiry date and use by date (where appropriate) on the medication;
Check the amount to be given at that time;
If opening a new container, add the date;
Measure or count the dose without touching the medicine;
Place the medicine carefully into an appropriate container (such as a medicine pot) and offer the container to the child/young person so they can take the medicine;
If the medicine is a liquid, take care not to drip onto the label as it can damage important information. Use the appropriate device for measurement such as a medicine spoon, syringe, or medicine cup according to the child’s or young person’s preference;
If the medicine is a cream or ointment, then it should be squeezed directly onto the child/young person's finger or hand for them to apply. If application by staff is required, then latex/PVC gloves must be worn;
When administering a Controlled Drug, a second member of staff, must check the dose before being administered;
Watch the child/young person as they take their medicine to ensure administration is successful;
Offer the child/young person a drink of water (where appropriate);
Check that the medication is recorded in all the required records;
Print and sign your name against the date and time of each medicine administered;
Record when medicine has been refused / not taken and the reasons why;
If a child/young person is absent when medication is due- this should be recorded;
Do not sign for any medicines that you have not administered or witnessed yourself;
If a child/young person refuses to take medication, under no circumstances should they be forced to do so;
Medication must be kept in the original labelled boxes (by the Pharmacy) containers and not put into weekly/daily medical boxes unless agreed by the medical practitioner and pharmacy;
After administration the medicines should be returned to the cabinet immediately and the cabinet locked;
When administering medication, it's essential to consider the prescribed timing in relation to meals and daily routines. Incorrect timing can affect the efficacy of the medicine or increase the risk of side effects.

6. Appendix 2: Specific Issues Re Administration of Medication

Swallowing Problems

Staff may find that some young people struggle with swallowing their medicines. The child/young person's G.P or medical practitioner should be contacted for an alternative. Under no circumstances should staff take it on themselves to crush tablets without seeking advice from the G.P or Pharmacist. Any advice given should be recorded.

Medication Refusal

When an individual expresses a choice not to take a prescribed medication, the following actions should be taken:

An entry must be made on the MAR and the staff should record the circumstances and reason why the child/young person has refused the medicine (if the child/young person will give a reason), unless there is already an agreed plan of what to do when that child/young person refuses their medicines;
The manager must be informed, and they may seek further guidance from the GP, pharmacist or out of hours health help line (dependant on the medication and the number of doses refused);
Where the child/young person refuses medication, this must be identified within the Placement, Health, Care and Support Plan & any risk assessments;
If the child/young person agrees the carer should tell the prescriber about any on-going refusal and inform the supplying pharmacy to prevent further supply to the children’s home or person’s own home.

If a child/young person is Absent when the Medicine is Due

When a child/young person is absent and their medication is due, this should be recorded. When the child/young person returns, then staff must consider the time delay and seek advice if required from the Pharmacist, the G.P or NHS website (as appropriate depending on the time of day). To miss taking a medicine dose completely can be dangerous depending on the medical condition.

Omitted Medication

If a dosage of a regularly prescribed medication is intentionally omitted by the responsible person, for any reason e.g. not giving the laxative because the child/young person has developed diarrhoea, the following action must be taken:

An entry must be made on the MAR sheet;
A record must be made on the child/young person’s placement plan;
The manager must be informed. They will then make a judgement regarding whether to seek advice from the prescriber;
If a second dose is to be intentionally omitted, the advice of the prescriber must be sought prior to this decision being carried out.

Medication should never be removed from its original container in which a dispensing pharmacist or GP supplied it until the time of administration. The best way of administering medicines is directly from the container in which it was prescribed; medicines can be placed in a small pot after removing it from the dispensed container as a way of hygienically handling it to a Child or young person. Medication should never be dispensed for someone else to administer at a later time or date.

The Manager must ensure staff follow the correct procedure for the administration of medicine and ensure they are suitably trained for the procedure.

The person administering the medication should sign the administration record immediately after the medicine has been given.

Covert Administration

Covert administration is where a medicine is hidden in food and the person does not know that they are taking it. Staff must not hide any medicine in food or perform any other types of covert administration unless a best interest decision has been made.

Lone Working

On occasions staff may be required to work alone for a period of time. During such times, it may be necessary to administer medication. Staff must ensure that they double-check any medication given, and record all instances of medication administration carried out while lone working.

This can present challenges when administering Controlled Drugs. It is important that the child/young person receives their medicine at the correct time therefore the member of staff administering the medicine, must also record that they were lone working in the register. It is not acceptable for another staff member to sign the register when they come in. You cannot be a witness to something you have not seen happen.

Storage of Controlled Drugs:

The structural requirements in relation to cabinets and rooms for the safe storage of controlled drugs must be met by Regulation 3(3) Schedule 2 of The Misuse of Drugs (Safe Custody) Regulations 1973.

A cabinet meeting these requirements can be secured within a wall mounted locked cupboard or placed upon a wall of solid construction within a locked room;
The cupboard must be attached to a solid brick wall or if such a wall is not available in the storage room, it should be fitted to a wall that has a steel plate mounted behind it. It should be attached using either rawl or rag bolts;
In no circumstance must the controlled drugs cabinet remain free standing;
The controlled drugs cabinet key must be kept apart from the keys for other medicines;
The key must be kept in the possession of the designated person or their deputy and must never be left in a drawer or suspended from a hook. Alternatively, these must be locked away separate to the medication cabinet keys;
The controlled drugs cabinet must never be removed from the premises.

Administering Controlled Drugs:

All procedure for administering non-controlled drugs apply to the administration of controlled drugs; there are additional elements that are required.

Any controlled medication must be administered by the lead person; controlled drugs must be witnessed by a second person who must over-see the whole process;
Both people must sign the Controlled Drugs book and MAR sheet.

Any entries into the Controlled Drugs book must be written in ink. NB the Controlled Drugs Register must be kept for 5 years.

Controlled drugs which have been obtained on an NHS prescription, may be disposed of in the same manner as other medicines, and a receipt must be obtained from the pharmacy. Stock-controlled drugs may only be destroyed in the presence of an authorised person. In such cases a record of the destruction must be made in the controlled drug register. The person administering the medication should sign the administration record and the controlled drug book and so must the member of staff who is witness to the administering of the drugs. This should be done immediately after the medicine has been given.

Receipt of Controlled Drugs

The pharmacy will notify the staff team / the home that a controlled drug has been dispensed and supplied for the child / young person, the team will be asked to sign a controlled drugs delivery note. A copy of this will be retained by the pharmacy and the home.

The controlled drugs must be booked into the Controlled Drugs register / book, and this must be locked away along with the controlled drugs. This must always be signed by two people, and the following information will need to be recorded. Each young person may have their own Controlled Medication book.

Date when this arrived into the home;
The name of the young person;
Quantity received;
How the medication was received;
Each medication / dose must have their own page;
Two signatures required on each line.

The MAR Sheet will also indicate that the medication is a Controlled Drug.

Rescue Medication

Where a child or young person is requiring rescue medication for epilepsy, the staff team must be appropriately trained to administer any rescue medication for that young person. When a young person is in receipt of rescue medication, they must have a health care plan in place.

When rescue medication is administered this must be in line with the training that has been provided and in line with the guidance from health professionals. MAR Sheets must be updated when this has been administered.

Spilled Medicines

When medicine has been spat out then this medication must be cleared away following the correct procedures and a note must be made in the records. However, a second dose must not be offered, as staff will not know how much has been absorbed. If this persists the G.P or medical practitioner should be contacted.

Detached or Illegible labels

If a label becomes detached from a container or is illegible, then staff must seek advice from the Pharmacist. Until this advice is received the container should not be used.

Secondary Dispensing

Staff must ensure that medicines stay in the containers supplied and labelled by the Pharmacist. Medicines must not be placed in daily or weekly medicine trays dosette boxes or blister packs unless agreed by medical practitioners.

Medication Errors

In the event of an error being made in the administration of any medication, advice must be sought from the young person's G.P. or another medical practitioner/ help line (e.g. NHS Choices) immediately or as soon as the error is discovered. Staff must record the advice that they have been given.

The medication error document must be completed on Clear Care and submitted to the management team for review and action.

Verbal Alterations

There may be times when it is necessary to stop or change the dose of a child/young person's medication without receiving a new prescription. Verbal requests to change medication by the G.P. or another medical practitioner must be confirmed in writing before any changes are permitted. These changes must be recorded on all relevant medication records including the Medication Record sheet in the child/ young person's file. Staff must note the change, the name of the Doctor, the time the confirmation of alteration was received and the date. Staff must not alter the dispensing labels. A note may be added saying 'Refer to record for new instructions'. Staff should check the next prescription to make sure these new changes have been implemented.

Adverse Drug Reaction

Any adverse drug reaction or suspected adverse drug reaction should be reported to the G.P or another medical practitioner before further administration is considered. Advice should be sought on whether the medicine should be stopped, or the treatment continued. Staff must record the advice that they have been given indicating the date and time and authorising Practitioner.

Drug Recalls

All healthcare professionals, including pharmacies and GP surgeries, are responsible for alerting patients if a medicine is subject to a recall.

When stock is found that is listed on a drug recall, then staff must follow the directions given.

The 6 Rights of Medication

All staff must ensure when they are administering medication, the following practice is in place, Medication must not be administered if one of these rights is not correct.

Right Child / Young Person

Check the child’s name against the MAR Sheet, medication box and the picture of the young person;
A picture of the young person will be displayed on the medication cabinet(s) to ensure identity;
Medication for a child must only be administered to the child it is prescribed for.

Right Medication

Check that the young person’s name against the medication label, packaging, and MAR Sheet in addition to the young person picture labels;
Check that the dosage and strength is correct, and that this matches on the labels and MAR Sheet;
Check there have been no changes to the medication;
Check they have not expired;
Check that there is enough medication (Quantity);
Check the warnings, make sure that there are no concerns with the young person taking the medication.

Right Route

Check how the medication should be administered;
Medication should be administered orally or topically, where there is an alternative method due to the needs of the child / young person (i.e. via PEG) medical training must be received.

Right Dose

Check that the dose matches the labels and the MAR chart;
Check that the dosage has not been administered already – Checking the MAR Chart;
Check for any changes to the dose, and if the child / young person is on a varied dose, that the correct dose is given at the right time;
Utilise the correct measuring equipment.

Right Time

Check that the time is correct to administer the medication, this will be identified within the MAR Sheet;
Check for additional labels i.e. “before food” or “after food”.

Right of the Child / Young Person

The young person has the right to refuse the medication, this must be clearly documented within the MAR Sheet and medical advice from 111 must be gained.

7. Appendix 3: Administration away from the Home

8. Appendix 4: Delegated Health Care Tasks

Delegated health care tasks refers to a clinical activity that are normally carried out by a registered health professional (such as a nurse, or doctor), but which can be delegated to another suitably trained person under specific conditions.

Medication-related tasks for example administration of epilepsy medication such as Buccal diazepam or administrating an epi- pen for allergic reaction can be delegated, but only under strict conditions such as clear policies, appropriate training for the staff member, competency checks, and ongoing accountability by the registered medical professional.

9. Appendix 5: Guidance: Intentional Overdose

If an overdose is suspected, hospital treatment should be sought without delay. Staff should try to find out what the child/young person has taken and if possible, take a sample to give to a medical practitioner.

Possible signs of an overdose:

Nausea/vomiting;
Cool clammy skin;
Blue lips or fingernails;
Not waking up or reacting to a loud noise;
Shallow or disrupted breathing or not breathing at all;
Gurgling, snorting or snoring/choking sounds;
Slow or very faint pulse.

It is important to stay calm, take it seriously and seek NHS support immediately.

What to do if someone is reacting to an overdose

Lie them on the floor;
Put them in the recovery position and ensure their airway remains open;
Call the ambulance - 999 - inform the operator of the overdose;
Do not leave the child/young person alone, make sure they don't roll onto their back;
Inform the ambulance team what the child/young person has taken; try to gather all the packaging you can find;
Get some help, keep other children and young people away (but don't dismiss any valuable information that they may be trying to pass on to you).

Recording and Review

10. Further Information

Legislation, Statutory Guidance and Government Non-Statutory Guidance

Promoting the Health and Well-being of Looked-after Children

Good Practice Guidance

Managing Medicines in Care Homes NICE Guidelines

Useful Websites

Health and Safety Executive Website

CQC information on Controlled Drugs

Last Updated: March 4, 2026

v48