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

Each box must have an inventory that includes the full quantity of each item stipulated in the box. When an item has been used, it should be replaced as soon as possible.

Homes staff are to complete weekly stock checks of first aid supplies and replaced used stock as and when necessary.

Homes staff are to ensure they are aware of the location of first aid boxes in the Home.

Homes staff are to ensure that any vehicle used to transport children has a fully stocked first-aid box.

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 their Health Care plan. Permission should be sought and arranged by the child's social worker.

See Consents and Delegated Authority Procedure.

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

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 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 around their allergies and what to do in an emergency - a young person may be able to self-administer their own EpiPen or take antihistamines. If this is the case, this should be recorded.
Medication should be easily accessible so staff and/or the child/young person can access their medication in an emergency;
A record should be kept of each episode, and any medication given should be recorded on the Medication Administration Record (MAR) sheet.

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

3. Home Remedies

Home Remedies are medicines that can be bought over the counter, including Paracetamol*, aspirin, homoeopathic remedies, herbal remedies, 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. This would need to be approved by their social worker, with the agreement recorded in the Placement Plan.

Home Remedies can only be used by the child/young person 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 as guided by the pharmacy.

Home Remedies must be purchased from the pharmacy. Advice should be sought from the pharmacist when purchasing an unprescribed 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 individual child and booked in using a Medication Administration Record (MAR) sheet. If the Home Remedy is unprescribed, it must be booked in by the Home’s Manager or a senior staff member following the Manager's authorisation.

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

Homes staff should seek advice from a GP or Pharmacist.

Recording: The administration of any Home Remedies must be recorded in the individual child's Daily Record and Medication Administration Record (MAR). 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 taking the Home Remedy before a GP appointment should be made. This will differ depending on the Home Remedy.

Homes staff are to complete stock checks of any medication held in the home for each child and report any discrepancies to the Homes Mangers.

*_{Paracetamol must not be given for more than} _{three consecutive days without the advice and guidance being sought from a GP/Medical Practitioner/Pharmacist.}

For further advice on what a pharmacist can support with, please see: www.nhs.uk

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	To record any accidents.
Medical Record	Individual record for each child: details of health-related issues, medication used, and GP name.
Medication Administration Record (MAR)	Individual 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 Ritalin), see CQC information on Controlled Drugs.

4.1 Ordering Ongoing Medication

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

When ordering, a note must be made of:

The name of the 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 waste and reduce the risk of errors, stock levels should be kept to a minimum.

4.2 Collecting Prescriptions

Staff should collect prescriptions from the GP/surgery and check that they have received all the prescriptions they have ordered and that the quantities are correct before taking them to the Pharmacy. If a medicine has directions of 'as directed' or 'as before', then the surgery should be asked to amend the prescription. 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 as to when the prescriptions will be ready for collection.

4.3 Receiving/Collecting Medicines

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

When the medicines are collected, staff should check them against the photocopied prescriptions they have. 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 the medicine is properly labelled. If the medicine does not have a dispensing label, it should be returned to the Pharmacy. Staff should also ensure they have received a Patient Information Leaflet from the Pharmacy.

The receipt of medication should be recorded on the individual child's Medication Administration Record (MAR). If a Controlled Drug has been prescribed, 2 staff members should record/sign the record.

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: Skilled Health Tasks

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

Medication records must clearly state when certain medications should not be taken with other medicines.

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

If a Controlled Drug has been administered, the 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.

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, at a temperature not exceeding 25°C. A key to this cabinet should be held by a senior/responsible member of staff on duty.

Medicines taken internally should be stored separately from those used externally in the medicine cabinet, with liquids preferably on the bottom shelf.

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

Homes staff should record the temperature of fridges used to store medication a.m. and p.m.

All medicines have expiry dates, usually clearly stated on the label. Upon expiry, they should be disposed of; see below.

4.6 Disposal

Medication should be disposed of when:

The expiry date has been reached;
The course of treatment is completed;
The medication has been discontinued.

Unless instructed by a GP/Pharmacy, unused/expired medicines should be returned to the Pharmacy, and a receipt obtained.

The return or disposal of medication should be recorded on the individual child's Medication Administration Record (MAR), and the receipt attached. If a Controlled Drug has been disposed of, 2 staff 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 for Homely Remedies). Only the prescriber (e.g. GP) 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 young person receiving medication;
A jug of water.

The procedure for administration is as follows:

Check the young person's identity (a photo is normally kept in the young person's file). Only one young person should be administered medication at a time, reducing the risk of mistakes.
Check the young person's medical profile;
Check the medication on the individual medication records corresponds with that on the young person's medical profile;
Check 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;
If the medicine is a solid (such as a tablet), then carefully place it into an appropriate container and offer it to the young person. They may wish to put it in their hand or swallow it straight from the container.
If the medicine is a liquid, take care not to drip onto the label. If the amount to be measured is less than 5ml, then use a medicine syringe; otherwise, use a medicine spoon or measure as preferred by the young person.
If the medicine is a cream or ointment, then it should be squeezed directly onto the young person's finger for them to apply. If required to be applied by staff, then latex/PVC gloves must be worn.
When administering a Controlled Drug, a second member of staff must check the dose prior to it being administered;
Watch the young person as they take their medicine to ensure administration is successful;
Offer the 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 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 young person refuses to take medication, under no circumstances should they be forced to do so;
Medication must be kept in the original labelled (by the Pharmacy) containers and not put into weekly/daily medical boxes;
After administration, the medicines should be returned to the cabinet immediately and the cabinet locked.
Each time you give medication, remember that it is important to consider the time of administration. Care should be taken to ensure that, if the medicine is required to be taken before food, it is taken before food. Similarly, the administration of some medicines, such as eye drops or inhalers, may not be suitable to be given at mealtimes. Not all medicine administration times will fall in line with mealtimes.

6. Appendix 2: Specific Issues Re Administration of Medication

Swallowing Problems

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

Medication Refusal

When a child/young person refuses to take their medicine, then the G.P. or medical practitioner should be contacted for advice. This information must be recorded and followed. The child/young person cannot be forced to take their medicines.

If a Young Person is Absent when the Medicine is Due

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

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 conceal any medicine in food or perform any other types of covert administration.

Lone Working

On occasions, staff may be required to work on their own for a period of time. It may be necessary to administer a medicine during this period. Staff should ensure they double-check for themselves and make a record of any medical administration required during the period when they were lone working.

This can be a problem when administering Controlled Drugs. The young person must receive 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.

Spilled Medicines

When a medicine has been dropped on the floor or spilt, it must be safely disposed of, and a note must be made in the records. A second dose should be offered to the young person (where a medication has been spilt, leaving the remainder short of the prescribed dose, advice should be sought from the G.P. as to how to make up for the lost dose).

When medicine has been spat out, it 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. 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.

Medication Errors

In the event of an error 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., the NHS website) immediately, or as soon as the error has been discovered. Staff must record the advice that they have been given.

Medication errors should also be reported to the Homes Manager, who should investigate to ascertain how the error occurred.

Verbal Alterations

There may be times when it is necessary to stop or change the dose of a young person's medication without receiving a new prescription. Verbal requests from the G.P. to change medication must be confirmed in writing before any changes are permitted. These changes must be recorded on all relevant medication records, including the Individual Medication Record in the 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 ensure these changes have been implemented.

Adverse Drug Reaction

Any adverse drug reaction or suspected adverse drug reaction should be reported to the G.P. 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 they have been given, indicating the date and time, and the authorising Practitioner.

Drug Recalls

When a Drug Recall Notification is received, staff should check the medication to see if the Home holds any stock. If none are in stock, the notification should be signed, dated, and filed for reference.

When stock is found to be listed on the drug recall, staff must follow the directions given after isolating the stock.

7. Appendix 3: Administration away from the Home

If a child spends time away from the Home, whether on home visits, holidays, or at school, any medication due to be taken must be kept in the original, labelled container.

Any medication taken away from the Home should be appropriately recorded on the individual child's Medication Administration Record (MAR), showing which medication has been taken away/handed over to parents/carers. The person receiving the medication should countersign the record.

If the parent/carers wish, a copy of the MAR should be handed over to them so that a record of administration can be kept; this may be returned to the Home when the child returns.

If the person responsible for the child is a member of staff, they must complete the documents for administration while they are away as normal.

The medication should always be handed over to someone responsible for the child.

Any medication returned to the home should be counted by the Home's staff and accounted for on the medication audit record.

8. Appendix 4: Skilled Health Tasks

This applies to specialist or skilled healthcare tasks, for example:

For diabetic children;
Physiotherapy programme;
For the use of Buccal Midazolam;
For the use of Rectal Diazepam.

If a child requires a skilled health task to be undertaken, this will only be carried out by trained staff with the written authorisation of the prescribing Doctor for the child concerned, as set out in a Placement Plan or other written Health Care Plan.

Appropriate training will be provided, together with written guidance, on how the skilled tasks will be performed and recorded.

9. Appendix 5: Guidance: 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:

Mild nausea/vomiting;
Paler skin;
Blue lips or fingernails;
Not waking up or reacting to a loud noise;
Shallow or disrupted breathing;
Gurgling, snorting or snoring/choking sounds;
Slow or very faint pulse.

It can take a long time between taking the substance and the first signs of an overdose; children/young people may verbally 'boast' about having taken an overdose, even when there are no signs, but staff must consider that there is a chance an overdose has been taken. They must act with caution and seek medical attention.

What to do if someone is reacting to an overdose:

Lie them on the floor;
Put them in the recovery position;
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 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).

DON'T

Walk the child/young person around;
Put the child/young person in a cold bath/layer them up to heavily to generate warmth;
Give them a drink.

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: January 9, 2026

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