Healthcare Support Workers Administration of Medicines For Specified Children with Complex Needs in the Community Author: Children s Community Nursing Team Child Health This document in principle matches the Protocol for Medicines Management and Administration by Health Care Support Workers for the Adult Continuing Health Care Team which ratified 2013. Date Approved: 10 th July 2013 Approved by: W&CH Quality & Safety Board Date for Review: July 2016
Table of Contents Children s Community Nursing Team Child Health Draft 1.1 Introduction... 3 1.2 Accountability... 3 1.3 Legal Framework, Duty... 3 1.4 Scope... 4 1.5 Objectives of the Protocol... 4 1.6 Key Principles for Practice... 4 1.7 Underpinning Principles... 5 1.8 Risk Management... 5 1.9 Training... 6 1.10 Administering Medicines... 6 1.11 The Use of Prescription Charts... 7 1.12 Alterations and Errors to Prescription charts... 7 1.13 Administration of Oxygen... 6 1.14 Records... 7 1.15 Children Vomiting/refusing medicines... 7 1.16 Dispoasl of medicines.... 8 1.17 Mistakes or Incidents... 8 1.18 Ordering Prescriptions...8 1.19 Storage of Medicines.......8 1.20 HCSWs Responsibilities.... 9 1.21 Role and Responsibilities of Team Leader... 10 1.22 References..... 11 1.23 Other resources...10
1.1 Introduction The Children s Community Nursing (CCN) Team provide intensive nursing care to children and young people with complex health needs, children who have been assessed as eligible for NHS Continuing Care. Without such a community service which provides complex health care (and includes medicines management), families would not have support at home. Past experience has shown, without community support, families depend more on the acute hospital in patient services. This leads to an increase in the number of hospital consultations/admissions and creates more disruption for the child and family. The long term effects, of increased admissions to hospital are known to be detrimental to the holistic well being of children with complex needs. It is essential therefore, that there are clear, processes that support the children remaining within the community for care. These processes must reflect ABMU protocols/policy and will maintain/advance the quality of care provided in the community setting. This document outlines the roles, responsibilities and procedures for the Childrens Community Team to support the children and families with administering prescribed medication. This support includes the handling and administration of medicines by identified Health Care Support Workers (HCSW) for specific children with complex needs. The aim is to provide standards to be adhered to when administering medication and this will form part of a child patient s Care Plan. 1.2 Accountability NHS Wales has adopted the following interpretation of accountability as per All Wales Guidance For Delegation (NLIAH 2010). Accountability is the principle that individuals and organisations are responsible and answerable for their actions. The delegator is accountable for ensuring that the treatment or care is appropriately delegated to competent individual/s. The delegatee is accountable for accepting appropriately delegated task/s and for the performance of the task/s. All regulated professionals should accurately interpret and consistently apply the standards and requirements of their respective Codes of Conduct and Practice. All staff and those whose practice is not regulated by a statutory body should refer to organisational policies and procedures. Accountability can take the form of criminal, civil, contractual and/or regulatory/professional accountabilities. In the context of these Guidelines, accountability specifically relates to the following: When delegating work to others, the delegator has a responsibility to have determined the knowledge and skill level required to perform the delegated task. The delegator is accountable for delegating the task. The individual accepting the task is accountable and responsible for their actions in carrying out the task. When tasks are delegated, account must be taken of the guidelines and protocols pertinent to the relevant workplace/s and steps must be taken to ensure that the level of supervision and feedback is appropriate (NLIAH 2010) 1.3 Legal Framework, Duty The legal and ethical responsibilities for nurses are outlined by the NMC (NMC 2008). The code provides a legal and ethical framework to work within. This framework has become integral and fundamental to practice and influences the aspirations of team in achieving the highest standards of care for children (NMC 2008, Griffiths and Tengnah 2010, Corkin et. al 2012). The CCN service therefore aims to safeguard,
protect and promote the health and well being of the children with complex needs in the community setting. All tasks involving medicines are regulated by the Medicines Act 1968 and subsidiary regulations made under that Act. The protocol and procedures for HCSWs in the CCN Team are in accordance with the guidance laid down in legislation and national standards which include the ABMU Medicines Management Policy, NMC Standards for Medicines Management (2007), the HCSW Code of Conduct, and Equality Act (2010). 1.4 Scope The aim of this protocol is to define the Health Care Support Workers who can safely administer medicines to the identified children with complex needs. It also provides a safe framework for the Children s Community team staff to work within when supporting families. It outlines the documentation which is to be used and records which are to be kept. 1.5 Objectives of the Protocol To ensure that all staff are aware of this protocol for Health Care Support Workers (HCSW) in the administration of medication to children with complex needs in the community Ensure clear standards and best practice are adhered to, in accordance with Clinical Governance requirements Ensure the children as patients receive prescribed medications safely and appropriately Ensure HCSWs are administering medicines in line with a local and national policy Ensure that there is a framework in place so that staff receive the appropriate training for identified methods of administration of medication Improve risk management & safety regarding medicines management in the community such as reporting prescribing errors and consistent and appropriate action in the event of an error or near miss Promote a safe, holistic approach to care for children at home Improve child and family satisfaction 1.6 Key Principles for Practice To provide child and family centred care To support children with complex needs remaining or returning to their family home To promote family independence wherever possible To accommodate personal and cultural preferences To prevent avoidable admissions to hospital To improve the quality of the service provided to children and families by continually monitoring the service provided To define roles and responsibilities of Health Care Support Workers To ensure that any assistance given by HCSWs adheres to protocol. To ensure that care is defined in the Care Plan. To ensure that the HCSWs have received the appropriate training and been approved as competent Whilst the mechanical tasks of administering medicines is undertaken by HCSWs, accountability for this remains with the registrant (as per All Wales Delegation Guidance 2010, NMC guidelines). 1.7 Underpinning Principles Medicines prescribed by a Doctor/Nurse/Pharmacist prescriber and dispensed by a Pharmacist become the property of the child and carer/s with parental responsibility. Whoever administers medication must make sure that it is administered according to the prescriber s written instructions and recorded. Administration of
medication will be delivered in a way that respects the dignity, privacy, cultural and religious beliefs of the child and family. HCSWs will administer medication, with the informed consent of the carer with parental responsibility. Consent will be recorded on the Care Plan Nominated HCSW s will administer medication when it is requested by the Team Leader and this is documented on the Care Plan; and only when the HCSW is trained and it is within their competence. 1.8 Risk Management HCSW administration of medication will only be provided when there is no other means of the family managing their child s medication. It has been established that a child requires medicine management as part of a package of care, but in order to minimise the risk: At the outset of service provision a risk assessment will be carried out by the Team leader/registered Nurse who will identify the level of HCSW support required. The Team Leader/Registered Nurse will liaise with the community pharmacist/gp/community paediatrician as necessary to undertake a medicines review where appropriate. Thereafter, the Registered Nurse will monitor the support required. Medication training and competency training will be provided to the identified HCSW s The Health and Safety at Work Act 1974 imposes a general duty on employers to ensure, as far as is reasonably practicable, the health, safety and welfare of employees and others which includes patients and any others affected by what is done. HCSWs must not carry out any invasive or clinical procedures which fall beyond the limitations of their role, such as administering injections The Child Patient Care Plan must be accessible in the home. Any incidents, near misses or administration errors relating to medicines in the home must be reported as per ABMUHB incident reporting and risk management policy. 1.9 Training All HCSWs must be suitably trained and competent for the tasks they are to perform and must feel confident to carry out these tasks correctly and safely. HCSWs must always adhere to the protocol, procedure and Health Care Support Workers Code Of Conduct (WAG 2010) and must not carry out any tasks that have not been authorised by the Registered Nurse and stated in the child s Care Plan. HCSW will be encouraged to undertake a QCF qualification, this is the new regulated framework for creating and accrediting qualifications and replaces National Vocational Qualifications from January 2011. All HCSW will undertake Child Health community skills training days twice per year. A record of training and competency for each staff member will be maintained by the CCN Team Leader, in accordance with ABMUHB policy.
In addition the Registered Nurse will be trained to fulfil their role in undertaking medicines management competency assessments with the HCSWs who are involved with supporting patients with their medicines. All Registered Nurses will update as mentors and identified Registered Nurses will train as QCF assessors. 1.10 Administering Medicines HCSWs can administer a patient s medication, provided they have been appropriately trained, that the medicine has been prescribed and the written directions of the prescriber are followed. These directions will be on the medicine label and the prescription chart. Each time a HCSW administers a medicine to the patient the procedure for administration of medications must be followed. HCSWs can only administer medicines if the tasks have been written into the Care Plan, a copy of which will be kept in the child s home. Medication can only be given to the patient if it has been written onto the prescription chart Where this is not available the HCSW will inform the Team Leader/Registered Nurse on duty immediately so that appropriate arrangements can be made for safe administration. 1.11 The Use of Prescription Charts The Registered Nurse who assesses the need for HCSW administration of medicines is responsible for ensuring the prescription chart is fully completed and the community pharmacist informed. The chart will be kept safely, in the child s home with the medicines and must state the name and dose of the medicines to be given to the patient and all HCSWs must be aware of these details. All HCSWs must complete the prescription chart when administering medication The charts will be audited by the Registered Nurse on a regular basis and new charts will be obtained through the Registered Nurse 1.12 Alterations and errors to Prescription Charts Any alterations to prescription charts can only be made by a registered health professional and must be dated and signed. Errors must not be obliterated by correction fluid/tape or biro. Any errors made when signing the chart are to be crossed through with an X and details recorded on the Medicines Administration: Additional Information Record Where a HCSW finds that this has occurred and they are therefore unable to place their initials in the appropriate box when administering the medication, they will instead document and sign that they have administered the medication on the Medicines Administration: Additional Information Record. In some circumstances a new chart may need to be arranged and the Registered nurse informed 1.13 Administration of Oxygen Where possible, family support will be sought and facilitated, but where this is not possible, HCSWs may provide limited support to services users with oxygen where this has been assessed as appropriate.
All patients requiring support from HCSWs with oxygen must be referred to the Team Leader/Specialist Nurse and or Consultant Paediatrician who will undertake a risk assessment and assessment of the level of support actually required. Additional training will be provided to the HCSWs by an appropriate registered health professional when oxygen is necessary. Details of the support required will be recorded on the Care Plan and reviewed by the Team Leader. 1.14 Records A record of the printed names, signatures and initials of all HCSWs must be kept by the Team Leader. 1.15 Children Vomiting/refusing medicines If a child vomits/refuses the medication the HCSW must make a note on the prescription chart. The health of the child may be affected so the carer with parental responsibility must be informed. This will be recorded. It is recommended that the HCSW seeks advice from the Team Leader/Registered Nurse. Any advice given will be recorded. This does not apply to medicines which are taken only when required. 1.16 Disposal of medicines If medicine has been prepared for giving to the child by removal from the container and then the prescription is changed (change to therapy/altered dose often due to weight increase) then this medicine is to be returned to the pharmacy for disposal. The replacement medicine will be obtained. This will be recorded. 1.17 Mistakes or incidents Errors can occur in the prescribing, dispensing or administration of medicines. It is important that errors are recorded and the cause investigated so that we can learn from the incident and prevent a similar error happening in the future. Examples of administration errors are: Wrong dose is given, too much, too little Medication is not given Medication is given to the wrong patient Medication given at the wrong time HCSWs must report any error or near miss in the administration of medicines to their Team Leader/registered Nurse on duty, who will then contact the relevant Health professional as appropriate. Where an error occurs and the Team Leader/Registered Nurse cannot be contacted the HCSW will contact the Children s Ward directly for advise and details of the advice given must be recorded on the Medicines Administration: Additional Information Record sheet.
An on-line incident form will be completed, submitted. All reports will be investigated to decide whether additional training or a review of existing procedures needs to be undertaken. Repeated errors by a HCSW despite receiving additional support will lead to a review of duties. 1.18 Ordering Prescriptions Only medicines listed on the prescription chart are to be ordered. The family, carers with parental responsibility will be responsible for monitoring stock and ordering repeat prescriptions. 1.19 Storage of Medicines HCSWs administering medicines must ensure that medicines are stored in a suitable safe, place, within a lidded box to allow safe administration of medicines in accordance with the procedure. For some homes, it will be appropriate to store medicines in a place where the child or siblings cannot get access them. This could take the form of a lockable box to be provided by the family. In this situation the location of the medicines will be documented in the Care Plan and written consent gained from the carer with parental responsibility. It is also important to note that certain as required medications must not be stored to enable easy access but away from the child 1.20 HCSWs Responsibilities HCSWs must: Be child centred in all aspects of care and enhance the quality of care by supporting the family at home Monitor level of development/capability and be create a simulative care environment Inform Team Leader/Registered Nurse of requests for additional help with medication that is not documented in Care Plan Administer medication using Prescription Chart as per policy and procedure Document administration of medicines on chart and record any other information on the Additional Information Record sheet Ensure safe storage of medication Seek advice when the child is unable to take or refuses any medication Report mistakes/errors/near misses immediately Notify their Team Leader/registered Nurse where they are being asked to provide assistance with medication which deviates from this guidance Only undertake tasks that they feel adequately competent to undertake Assist with administration of Oxygen as stated in the Care Plan Dispose of medicines appropriately through the pharmacist. Adhere to HCSW Code of Conduct Administer medicines in a way that respects the dignity, privacy, cultural and religious beliefs of the patient Have received appropriate training, and been assessed as competent, before assisting in the administration of medicines Not provide advice regarding medication. They must seek clarification and guidance from the Registered Nurse
Not work beyond the limitations of their role with regards to medicines management set out in the protocol If in doubt medication must not be given and advice sought HCSWs must NOT: Assist in any way that is not clearly documented in the Care Plan and written consent obtained Administer injections/pessaries/enemas Offer advice or recommendations regarding medication Force or coerce the child to take medications Undertake any drug calculations, however simple Crush tablets or open capsules Replace refused medication into its original container Undertake any medication task that they do not feel adequately competent to undertake Leave out medicines for the patient to take later Administer medicines prepared by another Give any medication that is not recorded on the prescription chart including over the counter Amend/alter the prescription chart in any way Assist with oxygen where no assessment/care plan has been completed Make any adjustment to the dose set when assisting with the administration of oxygen 1.21 Role & Responsibilities of the Team Leader The Team Leader must ensure that: All children and families are subject to an assessment of their ability to manage their own medication, and a review of their medicines in conjunction with Paediatrician/ GP/Community Pharmacist as appropriate A specific risk assessment is completed on all children who require support with Oxygen Accurate information must be available regarding the level of assistance required and included in the assessment. As part of arranging a package of care, the Team leader is responsible for the provision of a prescription chart Community Children Nursing team staff act in ways which are within the law and consistent with the policy and procedure HCSWs are provided with information, instructions and training which enables them to competently carry out their duties as described in these guidelines. Training must be updated regularly to ensure competency HCSWs are competent to carry out tasks as specified in the child patients personal care plan through supervision and monitoring HCSWs are not undertaking inappropriate tasks The child patient s Care Plan accurately describes the support the HCSW is being asked to provide The quality of completed prescription charts are monitored and any appropriate actions required are taken with immediate effect.
1.22 References ABMUHB (2009) Policy on prescribing, supply, ordering, storing, security & disposal of medicines HMSO (1968) Medicines Act HMSO (2005) Mental Capacity Act HMSO (2010) Equality Act NLIAH (Sep 2010) All Wales Guidelines for Delegation NLIAH (governance paper), National Framework for the educational and training of Healthcare support workers: http://www.wales.nhs.uk/sitesplus/829/opendoc/117062/ accessed on 03/03/2011 NMC (2007) Standards for medicines management NMC (2008) The code: Standards of conduct, performance and ethics for nurses and midwives WAG (Jan 2011) Code of Practice for NHS Wales Employers WAG (2010) Setting the Direction Primary and Community Services Strategic Delivery Programme WAG (2010) Code of Conduct for Health Care Support Workers 1.23 Other resources: Homerton University Hospital NHS Foundation Trust (2011) Policy for administration of medication by HCA in the Continuing Care at Home Team Neath Port Talbot County Borough Council (2009) Medication Policy for Domiciliary Care Royal Pharmaceutical Society of GB (October 2007) The Handling of Medicines in Social Care WAG (2006) National Service Framework for Older People in Wales WAG (2010) Doing Well, Doing Better: Standards for Health Services in Wales
TOPIC: ADMINISTRATION OF MEDICATIONS WITHIN THE COMMUNITY CHILDREN S NURSING SERVICE STANDARD STATEMENT: The Administration of medications within the Community Children s Nursing Service will be administered safely. Structure Process Outcome The Community Children s Nursing Service will administer medication that is consented and signed for by a parent/guardian, on appropriate Drug Record Charts. All medications will be administered safely and effectively. Consent to administer any medication will be obtained in writing from the parents/guardian. The Community Children s Nurses will adhere to ABMU HB Policy and NMC guidelines for the administration of medication. The child will receive the medication they require. All children will receive the correct medication, and dose at the correct time, via the correct route. Reference: NMC (2010) Standards for Medicines Management.
Directorate of Women & Child Health Checklist for Clinical Guidelines being Submitted for Approval by Quality & Safety Group Title of Guideline: Name(s) of Author: Chair of Group or Committee supporting submission: Childrens Community Nursing Team, Child Health. Health care Support Workers Administration of Medication for specified children with complex needs in the community Sharon Littlehales and Louise Hughes Sian Passey, Eirlys Thomas, Sian Townsend Issue / Version No: 1 Next Review / Guideline Expiry: 2015 Details of persons included in consultation process: Brief outline giving reasons for document being submitted for ratification Helen Griffiths Lead for Professionals Standards Lynne Jones, Lead for Education and Workforce Planning Eirlys Thomas, Ass Head of Nursing Sian Passey, Head of Nursing Sian Townsend, Lead Nurse Sheila Evans, Community Manager As per NMC guidance, Band 4 non Registered staff can administer identified routine medicines to specific children as a delegated task. Name of Pharmacist (mandatory if drugs involved): Please list any policies/guidelines this document will supercede: Keywords linked to document: Previous competency medicines administration competency document 2010 Competence, safety, risk assessment, accountability, responsibility protocol Date approved by Directorate Quality & Safety Group: File Name: Used to locate where file is stores on hard drive * To be completed by Author and submitted with document for ratification to Clinical Governance Facilitator