Management of Medication Policy within Residential Child Care Establishments across Forth Valley

Management of Medication Policy within Residential Child Care Establishments across Forth Valley Date of First Issue 01/11/2008 Approved 01/11/2008 Current Issue Date 09/09/2013 Review Date 09/09/2016 Version 1.1 EQIA Yes 04/11/2008 Author / Contact Group Committee Final Approval Kathy Pickles/Carole Smith LAC Health of Looked After Children This document can, on request, be made available in alternative formats Version 1.1 9thSeptember 2013 Page 1 of 21

Management of Policies Procedure control sheet (Non clinical documents only) Name of document to be loaded Area to be added to From front cover * see areas available on the policy web-page Type of document Priority Policy Guidance Protocol Other (specify) Default setting Immediate 2 days 7 days 30 days Default setting Questions Understanding Yes No Default setting Options Where to be published External and Internal Internal only Default setting Target audience NHSFV wide Default setting Specific Area / service Consultation and Change Record Contributing Authors: Consultation Process: Kathy Pickles Team Leader for LAC Nursing Service Carole Smith Community Pharmacy Champion. Senior Local Authority Residential Care Staff from: Stirling Residential Units, Clackmannanshire Residential Units and Falkirk Residential Units Distribution: NHSFV Intranet, Clackmannanshire Council Intranet, Falkirk Council Intranet, Stirling Council Intranet etc. Change Record Date Author Nature of Change Reference 01/11/08 KP Policy approved by Local Authorities Oct 08 1.0 09/09/13 KP Policy updated by Community Pharmacy Champion 1.1 Version 1.1 9thSeptember 2013 Page 2 of 21

Contents List Introduction... 4 1. The Management of Medication in Residential Units... 5 2. Duties of Staff... 6 3. Self Administered Medicines... 7 4. Source of Supplies of Medication... 9 4.1 Role of Community Pharmacy... 9 4.2 Choice of Pharmacy... 9 4.3 General Practitioners... 10 4.4 Ordering Repeat Prescriptions... 11 5. Checking In Medicines to the Establishment... 11 6. Storage of Medicines... 12 7. System for Distributing Medicines... 13 8. Household Remedies... 14 9. Disposal of Medicines... 15 10. Respite Care / Assessment Admissions... 15 11. Visitors to the Unit... 16 12. Transfer or Discharge of Young People... 16 Appendix 1:... 17 Appendix 2:... 18 Appendix 3:... 19 Appendix 4:... 20 Appendix 5:... 21 Version 1.1 9thSeptember 2013 Page 3 of 21

INTRODUCTION Following consultation with the individual local authority residential units in Forth Valley, it became apparent that there lacked a clear, consistent, comprehensive document for the administration and management of medication to the young people living there. Subsequently, a medication working group was formed, consisting of Senior Residential Care Staff, the Public Health Nurse for Looked After and Accommodated Children and a Forth Valley Primary Care Pharmacist. This group met monthly over the course of one year and have drawn up this document to guide the residential care staff in the management of prescription and nonprescription medication in the local authority Residential Units in Forth Valley. Health Rights Information Scotland (HRIS) produce a range of leaflets / booklets which are widely available. There are two which would be of assistance to you / staff / children in the wider role of the residential units. These are Confidentiality and Consent. Supplies are through NHS Forth Valley Information Governance Dept. 1. THE MANAGEMENT OF MEDICATION IN RESIDENTIAL UNITS 1.1 The way in which medication is managed and administered in residential childcare establishments reflects the underlying philosophy. This fosters an environment in which children and young people are treated as individuals, retain their dignity, have their rights respected and are able to develop knowledge and skills which allow them to take responsibility for themselves regardless of age, disability, gender, race/ethnicity, religion/beliefs or sexual orientation. 1.2 It is of paramount importance that young people s right to confidentiality is upheld at all times. Any records relating to medicines should be kept securely and away from public view and all issues relating to the handling of medicines should be carried out sensitively and in a manner which minimises the possibility of young people feeling embarrassed or stigmatised in any way. 1.3 In this context when young people are capable (refer to section 3), they should be positively encouraged to manage their own medication. For those who need help to do so, how that is offered should be consistent with allowing them a central role in all decision making that affects their lives. 1.4 In most residential child care establishments there will be a limited quantity of medicines held within the establishment at any one time. There will be numerous instances when individual young people are prescribed short courses of medication for everyday illnesses and conditions. Some young people will require to hold (or have held on their behalf) a supply of medicines which have to be administered on a regular and ongoing basis. 1.5 Young people s parents and family will have a view as to how capable (refer to section 3) that person is of managing his or her own medication and indeed whether any particular treatment is appropriate. Care staff must involve Version 1.1 9thSeptember 2013 Page 4 of 21

parents and carers in thinking through the general philosophy of administering medication and the impact these will have on individual young people. 1.6 At times the rights of the individual will conflict with the rights, needs and safety of other young people and staff. Making balanced decisions regarding a course of action can only be carried out with effective supervision, training and support, both from within the unit and from external management. 1.7 It is important that both management and residential staff develop good working relationships with colleagues in health, particularly the primary health care team. Effective co-operation with Health Services is essential if the medication system is to work for the good of young people. 1.8 The application of this policy will positively affect staff s ability to assist young people to manage this important aspect of their own life. 1.9 Residential Units working predominantly with young people aged 16 years and over will generally have an ethos of encouraging these young people to take responsibility for themselves. This responsibility will include the management and self administration of medicines. 2. DUTIES OF STAFF 2.1 The Residential Unit manager is responsible for:- a) All matters relating to the management of medication within the unit b) Ensuring that all staff are aware of these procedures c) Establishing a system of recording when staff have become familiar with the procedures d) Ensuring that the system is operating efficiently e) Maintaining effective working relationships with Medical Practitioners and Pharmacy Services f) Keeping all medicines secure when appropriate 2.2 Delegation of any of these responsibilities may only be with the agreement of the external line management. It will be usual for all staff to take responsibility for the day- to- day management of medications within the unit. 2.3 All members of staff will be responsible for following the correct procedures for checking medicines in and out of the establishment. 2.4 All care staff can, as part of their normal duties, issue medicines to young people, subject to the approval of the Residential Unit Manager. Senior Unit Managers, will ensure that, as part of the induction process, staff are aware of the medication policy and procedures. Version 1.1 9thSeptember 2013 Page 5 of 21

2.5 It is the duty of the Residential Unit Manager, in consultation with the external line manager, to ensure that further training needs are identified and that new or temporary staff are provided with information on the medication system. 2.6 The contents of this document must be made available to every new member of staff, whether permanent or temporary, on taking up post. 2.7 Any suspected irregularities in the manner in which staff manage and distribute medication prescribed to young people within a residential unit must be reported immediately to the Residential Unit Manager by the duty staff. This does not preclude the initiation of disciplinary proceedings or other investigations when appropriate. The staff on duty must prepare an internal incident report on any serious incidents relating to medication to The Service Manager. It is also a duty of staff to report any errors in the distribution of medication to all involved in the care of the young person and, where appropriate, the young person s parent or guardian. 2.8 Certain medicines e.g. methadone and other opioids are governed by The Misuse of Drugs Act 1971. Unauthorised or inappropriate possession or use of such medicines can be a criminal offence. If staff have concerns about illegal drug use within the Residential Unit, then the police should be informed and consulted. Similarly, if illegal substances are being brought into the Residential Unit or if young people are misusing controlled drugs, this matter must be reported to the police. 3. SELF ADMINISTERED MEDICINES 3.1 The Age of Legal Capacity (Scotland) Act, 1991, states that: A person under the age of 18 years shall have legal capacity to consent on his own behalf to any surgical, medical, or dental procedure or any treatment where in the opinion of a qualified medical practitioner attending him, he is capable of understanding the nature and possible consequences of the procedure or treatment. 3.2 Young people have a right to consult with their General Practitioner in confidence and without reference to residential staff. The General Practitioner may then prescribe medicines if he/she considers a young person competent in terms of 3.1. A pharmacist may then dispense these to young people. Both residential staff and young people should be made aware of this right. 3.3 Where young people are not deemed competent (in terms of 3.1) to consent to medical treatment, Social Services must obtain parental consent for the distribution of medicines. 3.4 When young people are admitted it is essential that the arrangements for primary medical care are clearly established. If a child is to be seen by a General Practitioner on a temporary basis then social work staff must ensure that the doctor is provided with details of the child s medical history. 3.5 Young people may have the right to administer their own medication. However, a Medical Practitioner, the Residential Unit Manager (and other nominated staff where appropriate), in consultation with young people and their families, need to consider Version 1.1 9thSeptember 2013 Page 6 of 21

whether they are capable of administering their own medication. That decision should be based on: a) Whether a young person is able to take the medication in the correct dosage and at the specified time. b) Whether a young person is able to keep it safe in a locked cupboard or cabinet and look after the key. c) Whether s/he is able to request or review a prescription or advise staff when the medication needs replenishing. d) Whether a young person is able to understand/agree that medication must not under any circumstances be given to other young people and is able to resist pressure and intimidation from other residents to abuse this medication in any way. In some instances a young person s right to be kept safe (or the right of other young people or staff) will take precedence over the right to self administer medication. Staff may decide to reduce a young person s right to administer his/her medication as a result of a discussion involving all relevant parties, based on the above criteria. 3.6 Arrangements for the self-administration of medicines should be included in young people s care plans where appropriate. 3.7 Prescribed drugs and household remedies (such as Paracetamol) can be misused. Residential staff should therefore be vigilant about young people s possession of medicines. The misuse of medicines and household remedies by young people should be fully addressed in their care plans. 3.8 Should a Medical Practitioner prescribe medicine to a young person who residential staff do not consider competent in terms of 3.2, they should discuss this with the prescribing Medical Practitioner. 3.9 During the admission process, it should be established whether young people manage their own medication at home. If they do so, the way in which this is carried out should be looked into and consideration given to continuing self administration. Care should be taken with those who, when living at home, have not been able to manage their medication themselves. Appropriate support and encouragement from staff, can make a considerable difference as to whether someone is able to manage, or partially manage, their own medication. 3.10 Young people must be advised that all medicines, including those that are selfadministered, should be entered into the residential unit s medicines log. However, staff should be aware that young people might be unwilling to cooperate with this for many justifiable reasons e.g. embarrassment. While staff must respect young people s right to confidential medical treatment they should be alert to the possibility of young people attempting to conceal the misuse of medications. 3.11 While respecting young people s right to privacy, staff (ideally a nominated worker) should regularly, but sensitively, check that self-administered medicines are being Version 1.1 9thSeptember 2013 Page 7 of 21

taken at the correct time and in the correct dosage. 3.12 All staff must be alert to any change, be that improvement or deterioration, in the condition of young people who they know to be administering their own medicines. 3.13 Ideally, a locked cupboard or cabinet, in their own rooms, should be provided for the safe keeping of young people s own medicines. 3.14 All staff must advise young people of the dangers of giving their medicines to other young people and must actively discourage them from doing so. 3.15 The subject of medication and self-management of medication must be discussed and monitored regularly as part of the young people s overall progress. 4. SOURCE OF SUPPLIES OF MEDICATION 4.1 Role of Community Pharmacy Individual units should have a good relationship with the Community Pharmacy who will offer them advice on all aspects of the management of medicines. Community pharmacies now provide a service called the Minor Ailments Service. This service allows pharmacists to provide advice, and where appropriate medicines, for the treatment and relief of minor ailments such as head lice. This service is free to all children under 16 and those under 19 in full time education. Residential units are encouraged to register the young people in their care with their local community pharmacy for the minor ailments service and seek advice from their pharmacist when required for the treatment of minor health ailments (see flow diagram Appendix 2). 4.2 Choice of Pharmacy Although medication can be purchased at the Community Pharmacy, there will be a number of other methods whereby medicine will be obtained and brought into the Unit; a) Directly from a General Practitioner or hospital; b) Directly from other Medical Practitioners e.g. Family Planning Clinics; c) By a member of staff from a local pharmacy; d) Young people who are capable of taking on responsibility for their own medication can and will make their own choice of pharmacist and obtain their own supplies of medication. e) Young people obtaining medicines without the knowledge of residential staff. Version 1.1 9thSeptember 2013 Page 8 of 21

4.3 General Practitioners a) When young people are admitted, the duty staff will check that any medicines are fit for use, are in date, have a legible pharmacy label attached and any storage requirements. b) If the General Practitioner/Out of hours Practitioner leaves medicines for overnight or weekend treatments, these must be dealt with according to the checking-in procedures (see section 5). c) Medicines must not be used for young people other than those for whom they are prescribed. d) Dosages must not be varied or amended except in the specific instances set out below. e) Individual general practices establish arrangements for reviewing repeat prescriptions. Residential Units should discuss these local arrangements with each child s practice to ensure that units are aware of the arrangements for reviewing the child s medication. f) When prescriptions are made or changed the General Practitioner should be asked about possible side effects or reactions and the advisability of stopping the treatment should these occur. All appropriate staff should then be informed of such. Young people should be involved in discussions as to reasons why this information needs to be shared. g) All staff have an important role in monitoring the effects of medication on young people at all times. All staff on duty must assess the significance of any change and take appropriate action, e.g. notifying the General Practitioner. While common sense should prevail, residential staff should always err on the side of caution. If an individual experiences an adverse reaction to a medicine, consideration should be given to suspending treatment in the context of the advice given by the General Practitioner. Subject to these comments, young people s prescribed treatment should not be stopped without prior consultation with the appropriate Medical Practitioner. h) Any change in a young person s condition must be recorded. In an emergency, should Health personnel be unavailable, advice should be sought from NHS 24, then inform the Residential Unit Manager or duty senior. i) The details of any change in medication must be entered on the Medicines Log and the individual s Recording Sheet with the minimum delay. Version 1.1 9thSeptember 2013 Page 9 of 21

4.4 Ordering Repeat Prescriptions a) On a weekly basis ensure that medication in stock is checked against an individual s Recording Sheet. Young people who manage their own medication must also be asked if they require a repeat prescription, if they have not already requested it. b) Should there be insufficient medicine in stock to last the following week, order a repeat prescription from the surgery or Health Centre. c) Refer to Medicines Log for re-ordering. Use the Repeat Prescription Ordering System in place at the particular health centre. 5. CHECKING IN MEDICINES TO THE ESTABLISHMENT 5.1 The Medicine s Log is the central reference document of medication within the unit. It should record all medicines (prescribed and household remedies) which are taken into the establishment. It should detail: a) date brought into the unit, by whom and whom it is for; b) the name and quantity of the medicine; c) batch number; d) signature of the person making the entry into the log. 5.2 It is likely that some young people will obtain medicines without reference to staff and their right to confidentiality regarding medical treatment must be given proper regard. However, the recording system may therefore be incomplete. Staff should not assume that young people are only taking medicines that are recorded in the Log or Recording Sheet. 5.3 Administration of Medicine Recording Sheet There should be a Recording Sheet for each young person on which all their medication is clearly printed. When a sheet is complete, continuing medication should be transferred to a new Recording Sheet and the completed sheet retained with the young person s records for a minimum of three years. The Recording Sheet should include the following details: a) the young person s full name and date of birth; b) the name of the young person s General Practitioner; c) details of any drug allergies or sensitivities; d) the original date of prescribing (NB This is not the date of re-writing the prescription); e) the drug name, dose, route and frequency of administration. The Recording Sheet should be signed at the actual time of drug administration by the person administering the medicine. Where necessary a colleague should countersign. If a General Practitioner issues verbal instructions for altering a resident s medicine dose or the giving of non prescribed medication e.g. paracetamol, Version 1.1 9thSeptember 2013 Page 10 of 21

without writing a new prescription, staff on duty must log the call detailing who was spoken to and what advice was given as soon as possible. The administration of all household remedies to young people should be noted on a Recording Sheet by staff. The Recording Sheet should also detail when medicines are refused, household remedies are requested, or as required medicines given. This should also be detailed in the young person s case notes. A record of administration is not normally kept for residents who are selfadministering. 5.4 All staff are responsible for recording information immediately and accurately in the Medicines Log and in the individual Recording Sheets. The Unit Manager is responsible for checking that this procedure is strictly adhered to. 5.5 The prescription details on the label must be checked to ensure that they are clear and precise. Staff should not accept medicines from the Pharmacist if the labels are not clear. If they are not, the medicines should not be entered into the Medicines Log or Recording Sheet nor be used until clarification has been obtained from the Pharmacist or General Practitioner. Clear details of the clarification should be entered into both the Log and Sheet. 5.6 Staff must not alter the instruction on the medicine bottle or packet. If this is necessary, the item should be returned to the Pharmacy and recorded in the Medicines Log. 6. STORAGE OF MEDICINES 6.1 Prescribed medicines and Household remedies (see section 9) not managed by young people themselves, must be stored in a lock fast cupboard or cabinet in the Unit. This will usually be located centrally, but in certain larger establishments may be decentralised. When installing medicine cupboards, either wall or floor mounted, they must be securely fixed to the walls or floor in accordance with the manufacturer s instructions. Wall mounted cupboards should be affixed to walls that are made of brick, stone or concrete. Walls constructed of stud partitions or breeze blocks do not offer adequate security. It is also important that medicine cupboards are sited so that they are not readily visible through external windows. The cupboard or cabinet used to store medicines must be used exclusively for this purpose and should be kept locked except when medicines are being checked in and out, or being issued. The cupboard or cabinet should be located in a cool area i.e. temperature below 20 degrees Celsius. 6.2 The number of duplicate keys should be restricted, usually to one set kept for emergencies and one spare in the Residential Unit. Procedures for handing over keys should be explicit written down and understood by all staff concerned. 6.3 Medicines must always be kept in their original containers. 6.4 Medicines for internal consumption must be kept separate from medication to be used externally. Version 1.1 9thSeptember 2013 Page 11 of 21

6.5 Prescribed medicines not yet issued to young people must be locked up at all times. 6.6 Medicines with special storage requirements must be properly and securely stored. Insulin, for example, should be stored in a refrigerator at all times because if it is stored at a temperature of more than 20 degrees Celsius it begins to deteriorate. 6.7 The Community Pharmacy will give advice on storage requirements for particular medicines. 6.8 A refrigerator for medication is not necessary when there is only an occasional need to refrigerate medicines. However, if medicines need to be kept in a refrigerator, they must be stored separate from food at all times and the fridge should be secure. 6.9 Medicines will not be allowed to accumulate unnecessarily and the medicines cupboard should be checked monthly. Any medicines no longer in use should be returned to the Pharmacy. Household remedies of uncertain age should be referred to the Pharmacy for disposal. 6.10 Should prescription labels become detached or illegible, the containers should be returned to the Pharmacy. 6.11 If medicines have been allowed to accumulate, the supplying Pharmacy will advise on review and disposal. 7. SYSTEM FOR DISTRIBUTING MEDICINES 7.1 Staff administering medicines should fully understand how a medicine should be given before being allowed to offer anything to anyone. 7.2 Staff must ensure that they know the identity of the young person to whom they are giving medication, and that they are giving the right medication to the right person. Check that the name on the label corresponds with that of the young person. Seek medical advice immediately if it is thought that wrong medicine or dosage has been issued by mistake. 7.3 When administering medicine ensure that the individual needs of each young person are met and allow self-medication if appropriate. 7.4 All medicines, including liquids, must be offered to the young person from the original container. In general, only one member of staff need be involved in the administration of medicines. However, current advice would be that two staff should be involved in the process when medicines are being administered to babies and pre-school children. 7.5 All medicines must be replaced in the lockable store/cabinet after use. 7.6 Any special advice about changes of medication, dosage, side effects, time of taking medicines etc. should be given to care staff changeover meetings. 7.7 If medicine is being sent on a home visit / to school all the same labelling Version 1.1 9thSeptember 2013 Page 12 of 21

requirements will still apply. Advice can be obtained from the pharmacy. The Residential Unit Manager (or nominated worker) will ensure that steps are taken to ensure that the young person receives their medication. The Recording Sheet will be completed to indicate medicines which have been given to family members and/or the young person s school to administer to them. Young people should be fully consulted about these arrangements. School policy on the administration of medicines will differ between council areas, please see individual council policies. Where such arrangements are made they should be reviewed frequently and regularly to ensure their effectiveness. 8. HOUSEHOLD REMEDIES 8.1 Household remedies are those medicines available over the counter. This also includes natural remedies that might be obtained from shops or by mail order. In these procedures, the term household remedies is used to describe all such medicines. 8.2 Young people have the right, and the opportunity, to purchase household remedies. If staff are aware of young people obtaining medicines such as these, then the guidelines in 3.5 should be referred to when deciding whether it is safe for them to keep and use such household remedies. Young people are not obliged to inform residential staff about their use of such remedies and staff should be vigilant about this possibility. 8.3 Residential staff must be alert to young people or their families taking household remedies into the unit, as many of these can be extremely dangerous if not taken according to instructions e.g. Paracetamol, iron tablets. In some instances particular young people will need to have household remedies removed from their possession where they may place themselves or others at risk through their misuse. In these circumstances, their views should be sought and the reasons for the decision to remove the household remedy made clear to them. This should be recorded in the daily contact record. 8.4 It may be appropriate to store a small supply of household remedies in the Residential Units storage cupboard or cabinet e.g. Paracetamol tablets. These household remedies which are held for general use should be clearly defined; (appendix 1 provides suggestions of which household remedies could be stocked on the unit, along with situations in which each remedy could be used). Each Residential Unit Manager should compile a list of household remedies that are to be stocked along with clear indications as to when they may be used. (Appendix 1 for guidance). Any household remedy given/administered must be recorded in the medicines log to ensure repeated doses are not given inadvertently. Certain remedies are not suitable for all young people, e.g. those that have other medical conditions or take other medicines, in these cases advice should be taken from the local pharmacist or GP if a certain household remedy is suitable for use. 8.5 Such household remedies as are held for general use must be checked into the Medicines Log. 8.6 Household remedies must only be given for immediate relief. Young people must Version 1.1 9thSeptember 2013 Page 13 of 21

consult their General Practitioner if the symptoms persist. 9. DISPOSAL OF MEDICINES 9.1 Medicines must be disposed of immediately if;- a) they become time expired; b) the course of treatment is completed; c) the course of treatment is discontinued by the General Practitioner; d) the label has been dislodged or becomes illegible. 9.2 Arrangements should be made for unused medicines to be returned to the supplying Pharmacy for disposal. 9.3 The return of such medicines for disposal must be recorded in the Medicines Log. The member of staff responsible for carrying out the task should sign the appropriate section. 9.4 Syringes and needles used by the General Practitioner or Community Nurses must be safely disposed of by the person using them. 10. RESPITE CARE / ASSESSMENT ADMISSIONS 10.1 The Residential Unit Manager should try to ensure that all details of medication are obtained prior to admission, that all medicines are brought to the Unit on admission and that all medicines are properly entered into the Medicines Log and correspondingly an individual Recording Sheet is made up. However, young people and their carers have a right to refuse to disclose such information. 10.2 When young people are discharged, the Residential Unit manager must ensure that details of medication and treatment, and the medicines themselves, are returned to their carers and that the Medicines Log and Recording Sheet are amended accordingly. 10.3 Any change in medication should be pointed out to a young person and their carers. They should be referred to the prescribing General Practitioner for advice and information. 11. VISITORS TO THE UNIT. 11.1 If family members or friends stay overnight in the Residential Unit, then staff should determine (from the parents in the case of anyone aged under 16) whether they are bringing any medicines into the Unit. If they are, then Unit staff should discuss with visitors how their medicines can be kept safely for the duration of their stay. Version 1.1 9thSeptember 2013 Page 14 of 21

12. TRANSFER OR DISCHARGE OF YOUNG PEOPLE. 12.1 When young people leave the Unit, following consultation with the General practitioner, medicines belonging to them and held by the Unit should be handed over to carers or disposed of as outlined in section 9. 12.2 When young people are transferred to another council residential unit, copies of the appropriate records should be sent direct to the residential unit along with the appropriate medication. Young people should be fully consulted regarding this process and their views taken account of. Version 1.1 9thSeptember 2013 Page 15 of 21

Appendix 1 Suggested Household Remedies A Unit may choose to hold a stock of household remedies for occasional use when a resident has a minor common ailment. The use of household remedies should be discussed with the young person s GP and their use recorded on the Recording Sheet. If the condition persists or worsens for more than 48 hours the advice of the GP should be sought. The advice of the Pharmacist should be sought regarding the expiry dates of such remedies. If in doubt about giving a household remedy to an individual resident, the GP or Pharmacist should be contacted. This list is merely a suggestion and the advice of a Pharmacist should be sought when compiling a list of household remedies for an individual Unit. a. Analgesics e.g. paracetamol for the relief of toothache, earache. b. Cough Bottles e.g. simple linctus for soothing an irritant cough. c. Throat Lozenges e.g. Soothers for the relief of a sore throat. d. Rehydration salts e.g. Diorylate for the prevention of dehydration in those suffering from diarrhoea. Always study the ingredients of household remedies to ensure their suitability for children and young people. Many remedies may contain Paracetamol or Aspirin and great care should be taken to avoid exceeding recommended doses of such medicines. Aspirin should not be given to under 16 s. Only Paediatric medicines should be administered to children under the age of twelve. The exception to this would be where the unit accommodates adolescents, and in their case, the use of the adult version of the medication can be considered. Always follow dosage instructions. Aspirin, or any product containing it, must never be given to young people under sixteen years. Version 1.1 9thSeptember 2013 Page 16 of 21

Appendix 2 Flow Chart on Seeking Medical Advice Version 1.00 4 th November 2008 Page 18 of 21 Version 1.1 9thSeptember 2013 Page 17 of 21

Appendix 3 Name of Residential Unit Consent Form Name of young person: Date of Birth. On occasion it may be necessary for staff within the Residential unit to supply/administer over the counter medicines or Household Remedies e.g. paracetamol to young people to offer relief from a minor health ailment without discussion with a healthcare professional. Do you consent to such? Yes No Are there any over the counter medicines which you would NOT want supplied/administered to the client? Yes No If answered YES above please list below medicines NOT to be supplied with reason. If No medicines to be supplied then enter All Medicines in table. Medicine not to be given Reason Your Signature Dated Your Name Relationship with young person Version 1.1 9thSeptember 2013 Page 18 of 21

Name of Residential Unit Medicines Log Appendix 4 Date of entry Name of medication Who for Quantity Batch Number Date Supplied & Supplier Date and method of disposal Signature Counter Signature Sheet Number Start date End date Version 1.00 4 th November 2008 Page 20 of 21 Version 1.1 9thSeptember 2013 Page 19 of 21

Appendix 5 Administration of Medicine Recording Sheet Name of young person: Date of Birth: Name of G.P. Tel: Address: Allergies or Sensitivities to Medication/ Foodstuffs or Others: Date Given Name of medication Time Given Dose Given Comments Signature Version 1.1 9thSeptember 2013 Page 20 of 21

Publications in Alternative Formats NHS Forth Valley is happy to consider requests for publications in other languages or formats such as large print. To request another language for a patient, please contact 01786 434784. For other formats contact 01324 590886, text 07990 690605, fax 01324 590867 or e-mail - fv-uhb.nhsfv-alternativeformats@nhs.net Version 1.1 9thSeptember 2013 Page 21 of 21