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3.7.12 Family Placement Service Medication Policy for Children using the Short Breaks Service

SCOPE OF THIS CHAPTER

This policy is intended to inform short breaks foster carers, parents/guardians, supervising fostering officers and children's social workers of their duties and responsibilities in relation to medication and medical management for children using the Family Placement Short Breaks Service. It covers all aspects of the management and administration of medication, nursing interventions, treatment and consent to treatment, for children cared for on the short breaks service. It is intended to be a tool to keep children safe from harm.

OTHER RELEVANT CHAPTERS

Summary Medication Policy for Foster Carers

Medical Treatment and Medical Policy for Children Looked After in Foster Care

Risk Assessment Guidance Notes for CSWS

RELEVANT DOCUMENTS

AMENDMENT

This chapter was updated in December 2014.


Contents

  1. Philosophy of the Service
  2. The Management of Risk
  3. When a Child is Ill on Placement 
  4. The Administration of Medication by Short Breaks Foster Carers
  5. The Administration of Non Prescription Medication
  6. When a Child/Young Person Administers their Own Medication
  7. Nursing Care Interventions (Previously Referred to as Invasive Medical Treatments)
  8. Recording of Medication and Nursing Interventions
  9. Incidents Relating to Medication
  10. Storage and Disposal of Medication
  11. The Consent of the Child/Young Person
  12. Emergency Placements
  13. Keeping Parents and Guardians Informed
  14. Implementation of this Policy: Roles and Responsibilities
  15. Appendices


1. Philosophy of the Service

  1. It is Family Placement's philosophy to work closely with parents and Family Placement carers to provide high quality care in a family setting for disabled children. Our services are based on a social model of disability;
  2. We are committed to providing safe care and the application of risk management which does not undermine a child's rights to inclusion (Dignity of Risk, 2004, Council for Disabled Children). A quote from a young disabled person in the forward;

    'The saddest words are "you can't" when you know you can - I'm like a glass vase shut up in a cupboard where nobody sees me because everyone thinks I might break if they got me out!'

    We acknowledge that including medically vulnerable youngsters in family based care means we have to take carefully managed risks in partnership with parents and Family Placement carers;
  3. Family Placement Service accepts a duty of care to ensure that any risks to the health and well being of a child in placement are assessed and minimised. We work in partnership with parents who have a duty to inform Family Placement of any changes to their child's medication or health.


2. The Management of Risk

  1. The risk assessment approach to safe care is embedded in this policy. All children will have a risk assessment when they are placed for short breaks. This will initially be completed by the child's social worker with the parents, and will be updated and amended at the Placement Agreement Meeting. The risk assessment will include any medical and medication needs of the child and how this will be managed. The risk assessment should be updated if the child's needs change;
  2. For children who require nursing interventions the carer will be trained by a qualified nurse who will complete a risk assessment as part of the Nursing Interventions: Identification of Procedure and Parental Consent form regarding the procedure;
  3. The purpose of the risk assessment will be to empower as well as to safeguard Children Looked After.


3. When a Child is Ill on Placement

  1. Following their approval, the Family Placement carer will inform their GP that they are Family Placement carers and that they will have disabled children staying with them for short stays;
  2. A parent/guardian should not send an unwell child for a Family Placement stay. If a child on placement becomes ill the Family Placement carer should immediately inform the parent/guardian of the child;
  3. Where possible and appropriate arrangements should be made for the child to return home;
  4. If the child needs immediate medical treatment this should be sought. The Placement Agreement Form (CSIR 35) gives consent for a Family Placement carer to seek medical treatment for a child. This should be taken to the hospital or GP;
  5. If the child cannot return home medical advice must be sought. Family Placement carers should contact the NHS  111 service or make an appointment to see their GP. If it is an emergency situation the Family Placement carer will take the child to the nearest Emergency Department or phone an ambulance. If a child needs to go to a particular hospital this will be detailed on the Placement Agreement Form (CSIR 35). It is not appropriate for Family Placement carers to make medical judgements in respect of short breaks children;
  6. Family Placement carers should complete a Record of Accident/Incident Form when they have needed to seek medical treatment in respect of a short breaks child in their care;
  7. In the event of a child contracting an infectious disease whilst on placement the Family Placement carer would follow the above procedures. They would inform the Family Placement Service who would inform OFSTED.


4. The Administration of Medication by Short Break Foster Carers

  1. It is agreed that Family Placement short breaks carers are authorised to administer medication to children in their care following the agreed procedures;
  2. Family Placement carers will be given information regarding the health needs of the children to whom they are matched, and specifically their prescribed medications, initially through the Essential Information and Pen Picture for the child and the Placement Agreement Form (CSIR 35);
  3. A completed Placement Agreement Form (CSIR 35) will be in place for each child before placements commence. This will give consent to administer medication and to seek medical treatment. It will list the medication and dosage prescribed in respect of the child. The Placement Agreement Form (CSIR 35) will also detail any nursing interventions required in respect of the child;
  4. Parent/guardians are responsible for ensuring that Family Placement carers have written up to date information regarding all medication that is prescribed for the child. Parent/guardians should inform Family Placement carers before each placement if the medication has changed. They should complete and sign a new Notification of and Consent to a Change in Medication (Family Placement Medical Form 6) giving relevant details;
  5. If there is ambiguity between medication brought by the child, and the medication recorded on a previous Notification of and Consent to a Change in Medication (Family Placement Medical Form 6) or Placement Agreement Form (CSIR 35) the parent or GP must be contacted. If there is a change to medication arrangements should be made for the parent/guardian to complete a Notification of and Consent to a Change in Medication (Family Placement Medical Form 6) form giving relevant details;
  6. The parent/guardian will be asked to ensure that all medication which is sent to the placement is in the bottle or packaging in which it was prescribed. It should be clearly labelled by the pharmacist with the name of the child, the name of the medication, the dosage, and the times to be taken, and any other instructions. It will not be acceptable for medication to be transferred into other bottles or containers. An altered dosage will only be accepted if this is labelled by the pharmacist or accompanied by a signature from the prescribing G.P. or consultant;

    If a child arrives with medication which is not packaged in this way the Family Placement carer will contact the parent/guardian. If the parent/guardian is not available the Family Placement Supervising Social Worker or the child's GP should be contacted. If it is out of hours for these services the Family Placement carer will contact NHS 111 service or an emergency doctor for advice. The supervising social worker will keep a record of any incidents where these issues have arisen and will be responsible for ensuring that the parent is informed of the problem and the fact that placements cannot progress without the above;
  7. The Family Placement carer will be instructed to keep a written record of all medication given, including dosage, and times given. This will be on the Family Placement Record of Medication (Family Placement Medical Form 2). The Family Placement carer will keep these records in a file confidentially with the child's papers. The supervising social worker will check these at supervisory visits. They will be given to the child's social worker when the match ends to place on the child's file;
  8. If a child has an adverse reaction to any medication whilst on placement the Family Placement carer will inform the parent/guardian and seek medical attention immediately.


5. The Administration of Non Prescription Medication

  1. If a child is to be given non-prescribed medication the name of the medication, dosage and administration should be detailed on the placement agreement and signed by parents/ guardians. The Family Placement carer is not permitted to give non prescribed medication unless it is detailed on the Placement Agreement Form (CSIR 35). Parents or guardians should be asked whether there are any counter indications to giving this medication in respect of the individual child;
  2. Non prescribed medicine should only be dispensed after careful consideration of the child's presenting problem;
  3. The dose of non-prescribed medication should never exceed the manufacturer's instructions;
  4. Treatment using a non-prescribed medication (e.g. Calpol or Paracetamol) should not be extended beyond two consecutive doses without seeking medical advice through NHS Choices 111 service or the GP;
  5. The potential risk of interaction between prescribed medicines and non-prescribed medicines, including herbal and homeopathic remedies, means that it is the policy of Family Placement not to administer herbal or homeopathic remedies to children on short breaks.


6. When a Child/Young Person Administers their Own Medication

  1. When a young person is responsible for self administering medication, or undertaking a nursing procedure this should be detailed in the Essential Information and Pen Picture and recorded on the Placement Agreement Form (CSIR 35);
  2. The Family Placement carer is responsible for supervising the young person;
  3. The Family Placement carer should record on the Record of Medication Self Administered (Family Placement Medical Form 5) when the young person has taken the prescribed medication.


7. Nursing Care Interventions (Previously Referred to as Invasive Medical Treatments)

  1. It is agreed that Family Placement short breaks carers are authorised to administer nursing care interventions to children in their care following the agreed procedures;
  2. Family Placement carers will be given information regarding the health needs of the children they are matched to, and specifically nursing interventions the child requires, initially through the Essential Information and Pen Picture and the Placement Agreement Form (CSIR 35);
  3. All nursing interventions will be subject to the Family Placement Training Agreement CSWS and NHS 2013;
  4. The following nursing care interventions required by individual children who are being cared for by a Family Placement carer may be carried out by the Family Placement carer once they have been shown to be a competent practitioner following appropriate training by a qualified nursing professional and subject to the consent of the parent/guardian of the child:
    • Gastrostomy feeding and care;
    • Naso-gastric feeding and care;
    • Basic stoma care, i.e. replacement and removal;
    • Administration of rectal Diazepam;
    • Administration of Buccal Midazolam;
    • Administration of enemas;
    • Administration of oxygen;
    • Use of nebulisers;
    • Oral suction.

      (These are hereafter referred to as approved nursing care interventions).
  5. It is accepted that there will be some children who require nursing care interventions other than those listed above and their omission may run contrary to the Family Placement philosophy of inclusion. In such circumstances, the nursing care interventions required by the individual child will be confirmed by a case discussion. An interdisciplinary decision will be made to ensure that the Family Placement carer and all agencies involved are in agreement that the nursing care intervention can be performed by the Family Placement carer. This agreement should be subject to the following:
    • That it is based on an individual need;
    • Based on an individual nursing care plan or a multi-disciplinary assessment care plan;
    • Based on agreement across the relevant professionals and organizations;
    • Based on agreement by the Family Placement carer to undertake the intervention;
    • That training is given as part of the care plan by qualified nursing professional;
    • That competency is tested by observation and/or discussion;
    • That it is limited to that procedure for that child.
  6. A Family Placement Children's Scheme Nursing Procedures: Identification of Procedure and Parental Consent (Family Placement Medical Form 1) will be completed in respect of each nursing intervention for each individual child. This will be completed prior to the Family Placement carer undertaking any nursing care intervention or placement in respect of the child;
  7. The completed form will be copied to the Family Placement carer, the parent/guardian, the field social worker, the nurse who has delivered the training and a copy will be placed on the Family Placement carer's file;
  8. The Family Placement Service supervisory social worker is responsible for ensuring the above form is completed;
  9. The training will be given by a qualified nursing professional;
  10. Where training is given in respect of an approved nursing care intervention the nursing professional will ensure the Family Placement carer is given the relevant training pack;
  11. The written consent of the parent/guardian will be recorded on the Family Placement Children's Scheme Nursing Procedures: Identification of Procedure and Parental Consent (Family Placement Medical Form 1). It will also be recorded on the Placement Agreement Form (CSIR 35) in respect of the child;
  12. No Family Placement carer will be required or compelled to undertake training or to administer nursing care procedures with which they are not completely comfortable. The Family Placement carer has the right to opt out of any procedure they do not wish to administer;
  13. The Family Placement carer will record each time they carry out a nursing intervention on the Record of Nursing Care Interventions (Family Placement Medical Form 3);
  14. Where there is a complex situation it may be necessary for a detailed health plan to be completed and made available for the Family Placement carer and family;
  15. Any current nursing care intervention undertaken by a Family Placement carer will be discussed at their review, and should also be discussed at the childcare review;
  16. It is the parent/guardian's responsibility to inform the Family Placement carer of any changes to the child's medical needs;
  17. When carrying out any nursing procedure, consideration should be given to privacy and maintaining the child's dignity as outlined in the intimate care policy;
  18. As long as the agreed procedure is followed a Family Placement carer will be indemnified in respect of any claim for personal injury which arises, subject to the terms and limitations of the liability insurance policy. This insurance applies where the Family Placement carer has no insurance of their own;
  19. Where a child can administer their own nursing intervention the Family Placement carer should record this on the Record of Nursing Interventions: For a child who administers the procedure themselves (Family Placement Medical Form 4).


8. Recording of Medication and Nursing Interventions

The Family Placement carer will keep a written record of all medication given, including dosage, date and times given, method of administration.

  1. This will be recorded on the Family Placement Record of Medication (Family Placement Medical Form 2). The Record of Medication Self Administered (Family Placement Medical Form 5) will be completed by the Family Placement carer when it is agreed the child/young person can administer their own medication;
  2. The Family Placement carer will record each time they carry out a nursing intervention on the Record of Nursing Care Interventions (Family Placement Medical Form 3). Where a child/young person administers their own nursing procedure a Record of Nursing Interventions: For a child who administers the procedure themselves (Family Placement Medical Form 4) will be completed by the Family Placement carer;
  3. The Family Placement carer will keep these records in a file confidentially with the child/young person's papers. The Family Placement supervisory social worker will check these at supervisory visits;
  4. The records will be given to the child's social worker when the match ends and placed on the child's file.


9. Incidents in Relation to Medication

  1. If an incident occurs in relation to medication (the child is given more than the prescribed dose, the medication prescribed is not given to the child, the child has an adverse reaction to medication, a child gets access to and consumes medication not prescribed for them) a Record of Accident or Incident form should be completed. A copy to be retained by the foster carer, a copy should go to the supervisory social worker to be placed on the carer's file and a copy to the social worker for the child's file. The supervisory social worker should also pass a copy to their fostering manager which will be copied to the Service delivery Manager Fostering and Adoption. NB a copy of this must be sent to the Designated doctor for Children Looked After who will report this to the Medicine Management Team NHS Leeds.


10. Storage and Disposal of Medication

  1. All medication must be kept in a safe place out of the reach of children. This should preferably be in a locked cupboard although Family Placement accepts this is not always possible in a family home;
  2. The supervisory social worker will discuss with the Family Placement carer where medications are stored as part of the supervisory process;
  3. Where medication needs to be kept at a particular temperature (e.g. in the fridge) the prescriber's instructions must be followed. Care should be taken to ensure that this is out of reach of children in a separate part of the refrigerator;
  4. No medication should be given after the use by date on the bottle/packaging;
  5. Medication should be sent with the child by the parent / guardian and returned with the child at the end of the stay;
  6. In exceptional circumstances where the Family Placement carer keeps medication for the child, this should be recorded on the Placement Agreement Form (CSIR 35);
  7. Care should be taken to ensure that medicines are disposed of safely, and that all outdated medication is disposed of.


11. The Consent of the Child/Young Person

  1. Where the child/young person is able to give consent this will be sought by the Family Placement carer in the application of all medications and nursing procedures;
  2. Issues of consent are complex. Some children's disabilities are such that they are unable to give consent. Some children may dislike procedures which are necessary for their health and well-being (e.g. taking medication or the administration of suppositories);
  3. Where a child/young person is clearly reluctant, refuses medication or the undertaking of a nursing procedure, the Family Placement carer will try to persuade the child to accept this;
  4. If a child/young person in placement refuses to take medication the Family Placement carer will contact their supervisory social worker for advice and inform the parent or guardian. An Accident/Incident Form should also be completed by the Family Placement carer. If the refusal is likely to affect the child's health and well being arrangements should be made to return the child/young person home;
  5. Where a child/young person clearly does not consent (an example is a child who refused to allow a Family Placement carer to give suppositories without which she would require hospital treatment) a risk assessment will be undertaken and a health plan made. The risk assessment will involve the child/young person, parent/guardian, health professional, Family Placement carer and Family Placement Supervisory Social Worker. The risk assessment will address whether it is safe for the placement to continue.


12. Emergency Placements

  1. In exceptional circumstances (E.g. the parent/guardian has been admitted to hospital) it may not have been possible to put into place the preceding procedures;
  2. Every effort should be made by the field social worker and Family Placement Supervisory Social Worker to ensure that there is a Placement Agreement Form(CSIR 35) in place for emergency placements. If the parent/guardian is unable to sign this (for instance if they have been admitted to hospital and are incapable of doing so) the Placement Agreement Form(CSIR 35) should be signed by a Children and Families' Services Manager as a temporary arrangement. Arrangements should be made for the parent/guardian to sign the CSIR 35 and to be involved in a Placement Agreement Meeting as soon as this is possible.


13. Keeping Parents/Guardians Informed

  1. 1. The Family Placement Supervising Social Worker will visit the parents and child when eligibility for the service is confirmed through the RADAR (Resource Allocation, Decision and Review)DCAP panel. At this meeting they will discuss the short breaks service and the responsibilities of parents/guardians in relation to medication and nursing interventions. They will leave a Parent's Pack which will have a letter explaining the policy and copies of the forms required by parents. Parents and children will be party to the Placement Agreement Meeting where medication and nursing interventions will be recorded on the CSIR 35 Placement Agreement (signed by parent/guardians). The risk assessment completed by the child's social worker and updated at the Placement Agreement Meeting will also cover issues of medication, health needs and nursing interventions. Parents will also receive an annual letter from the service reminding them of their responsibilities in relation to medication;

    If a parent does not comply with the procedures the Supervising Social Worker will make contact to see how this can be resolved and where necessary a Health Plan Meeting in relation to the child will be held.


14. Implementation of this Policy: Roles and Responsibilities

  1. It is the responsibility of the supervising social worker to fully discuss the medication policy with the short breaks foster carer as part of their induction. This policy will be reproduced in full in the Carer's Handbook;
  2. It is the responsibility of the short breaks foster carer to fully read the policy and to ensure that all medication given and nursing procedures undertaken are carried out in line with this policy;
  3. The social worker for the child and the supervising fostering officer are responsible for ensuring that any issues regarding medication form part of the risk assessment in relation to the child/young person and are fully covered in the CSIR 35 Placement Agreement;
  4. The supervising fostering officer will be responsible for ensuring that the short breaks foster carer understands and follows this policy which will be discussed in supervisory visits. The supervisory fostering officer will monitor medication given and any invasive procedures in supervisory visits;
  5. The Health Service will provide appropriately qualified nurses to provide training to foster carers in invasive nursing procedures as defined in this policy and subject to the training agreement (appendix 4). It is the responsibility of the nurse to sign that the training has been given and to complete risk assessment of the nursing procedure which now forms part of the Nursing Interventions: Identification of Procedure and Parental Consent form;
  6. Nurses from the health team for Children Looked After will be available to provide support and advice to foster carers and CYPSC staff in relation to the policy. The nurses from the health team for Children Looked After will be available to attend foster carer support groups to discuss the safe administration of medication with foster carers in relation to this policy;
  7. Staff from the acute trust, the school nursing team, the children's nursing team will attend an annual Family Placement support group to discuss invasive nursing procedures and how the training agreement is working in practice. Any foster carer undertaking nursing procedures will be invited to attend this support group.


15. Appendices

Family Placement Service Medication Policy for Children using the Short Breaks Service

  1. Placement Agreement Form (CSIR 35);
  2. Family Placement Children's Scheme Nursing Procedures: Identification of Procedure and Parental Consent;
  3. Record of Medication (Family Placement Medical Form 2);
  4. Record of Nursing Care Interventions (Family Placement Medical Form 3);
  5. Record of Nursing Interventions: For a child who administers the procedure themselves (Family Placement Medical Form 4);
  6. NOTIFICATION OF AND CONSENT TO A CHANGE IN MEDICATION form (Family Placement Medical Form 6);
  7. Accident/Incident Form;
  8. Family Placement Training Agreement, CYPSC and NHS 2013;
  9. Protocol for Guidance for Social Workers Procedure for Organising Interventions;
  10. Carer's Handbook: Medical Matters for Children's Short Breaks Carers;
  11. Notifiable Infectious Diseases;
  12. Family Placement Parents Checklist;
  13. Essential Information and Pen Picture for a Disabled Child;
  14. Risk Assessment Guidance Notes.

End