Appendix 1: Administratin f Medicatin Guidance Checklist: If yu wish, yu may print ut this Appendix, Click here dwnlad a PDF versin, then print it ff. All medicines must be administered strictly in accrdance with the prescribers (r as advised n the packet in relatin t hmely Remedies) instructins. Only the prescriber (e.g. G.P.) can vary the dse. Medicines must be lcked away in the lcked strage areas when nt in use and the keys fr these areas must be kept in a secure lcatin signed fr by the senir member f staff n duty. The Five Rights f Administratin 1. Right persn 2. Right medicine 3. Right dse 4. Right time 5. Right rute Befre administratin, staff shuld be prepared: Wash yur hands; Have the MARR sheets t hand; Have a pen; Water is prvided fr the child; A supply f clean dry medicine tts; Ensure the medicine preparatin area is clean. The prcedure fr administratin is as fllws: Check the medicatin recrd t see what medicine is due at that time; Duble check n the MARR sheet that the medicine has nt already been administered; Find the medicine and check the pharmacy label with the instructins n the MARR sheet, ensuring the expiry date and use by date (where apprpriate);
Pay particular attentin t any special instructins r any recent changes in therapy. If there is any difference, check with the pharmacist befre administering the medicine; Measure the dse withut handling it: pp ut the tablet int a clean, dry measure, r pur ut the required dse frm the bttle int a clean, dry measure, after shaking the bttle. Shake the bttle means shaking the bttle vigrusly s that the cntents are well mixed. (If nt mixed prperly, sme dses may cntain n medicine at all and thers will cntain an excessive amunt, which culd lead t verdse and pssibly serius side effects.) When measuring liquids, ensure the liquid des nt drip nt the label and hld the measure at eye level. Yu will see a curve under the surface f the liquid. Measure frm the bttm f this curve. If the amunt t be measured is less than 5ml, use a syringe r spn; If pening a new cntainer, add the date; Check the label again; Take the medicine t the child; Check the child s identity by asking their name and / r checking their phtgraph (a pht is nrmally kept in the child s file and can be kept with the MARR). Only ne child shuld be administered medicatin at a time, this reduces the risk f mistakes being made; Tell the child that their medicine is ready and ask them if they want it. The child has a right t refuse medicines; Make sure the child is standing r sitting in an upright psitin t prevent tablets frm sticking in the thrat and causing prblems; If the medicine is a cream r intment, then it shuld be squeezed directly nt the yung persn's finger t apply them. If necessary t be applied by staff, then latex/pvc glves must be wrn. Apply sparingly is an instructin fund n sme creams and intments. This means that a small amunt f the medicatin is applied t the area in questin and massaged int the skin. A fingertip unit is used t shw the amunt yu need t apply t each area. It is the amunt f cream squeezed ut f a standard tube frm the very tip f yur finger t yur first crease; Give the medicine; When administering a Cntrlled Drug, anther member f staff prir t it being given must check the dse; Watch the yung persn as they take their medicine- sme are knwn nt t swallw the dse;
Offer the yung persn a drink f water (where apprpriate); Check that the medicatin is recrded in all the apprpriate recrds immediately; Initial yur name against each medicine administered; Recrd n the MARR sheet when medicine has been refused / nt taken and the reasns why using the fllwing MARR chart cdes: A = Refused (Used if a medicine is refused befre it is remved frm its bx r bttle). A nte shuld be made n the reverse f the MARR sheet under Carers Medicatin Ntes t clarify the circumstances; B = Nausea r Vmiting (Used if the medicine was nt ffered because they were unwell); C = Hspitalised (Used if a child has been hspitalised and whether r nt their medicine has been sent t the hspital, this cde shuld be entered n the MARR sheet fr each administratin time indicated thrughut the child s stay in hspital); D = Scial Leave (Used fr all situatins where medicine is made available fr the child t take whilst away frm the hme. Fr example, ut fr the day with relatives r ther carers nt wrking in the hme, away n hliday, ging hme fr the weekend). A cpy f the MARR sheet can be sent with the child and this cpy shuld be attached t the riginal MARR sheet at the end f the cycle t cnfirm ttal accuntability and cmpliance. When a supply f medicine is made t a relative r carer, the cmplete bx r bttle shuld be supplied t the relative r carer. A risk assessment shuld be carried ut befre this takes place; E = Refused and Destryed (Used when a medicine is refused after it has been remved frm its bx r bttle). Under n circumstances shuld the medicine be pured back int the bttle r put back int the bx. A nte shuld be made n the reverse f the MARR sheet under Carers Medicatin Ntes t clarify the circumstances; F = Other (Used when clarificatin is needed fr ther situatins). Fr example, if the child is asleep at the time r if the medicine is nt needed. The reasn shuld be defined n the dtted line beside the F at the bttm f the tp cpy f the MARR. Once the cde F has been defined, then the reasn remains the same until the end f the cycle. If there is a secnd reasn where clarificatin is needed, use cde G belw; G = See Ntes Overleaf (Used fr several different reasns including):
1. When a full explanatin needs t be given n the reverse f the MARR sheet under carers medicatin ntes; 2. Any eventuality that culd nt be cvered by the cdes A t F r M t P; 3. Additinal dses required at time ther than thse given n the frnt f the MARR sheet; 4. As required medicine; 5. Medicine prescribed with a variable dse; 6. Hmely remedies; 7. Dcument any discrepancies n the MARR and/r running balance; 8. Dcument when medicine is nt available t give t the child and the steps taken t address this. M = Make Available (Used when a child wants t self-administer but requires assistance frm the carer t select the crrect medicine the M can be used t indicate that full administratin has nt taken place); N = Offered PRN nt required (Used t indicate that a child has chsen nt t take the as required medicine); P = Prmpt (Used when a child self-medicates but needs a prmpt frm staff at the crrect administratin time). D nt sign fr any medicines that yu have nt administered r witnessed yurself; If a child refuses t take medicatin, under n circumstances shuld they be frced t d s; Medicatin must be kept in the riginal labelled (by the pharmacy) cntainers and nt put int weekly/daily medical bxes; After administratin the medicines shuld be returned t the cabinet immediately and the cabinet lcked; Each time yu give medicatin, remember that it is imprtant t cnsider the time f administratin. Care shuld be taken t ensure that if the medicine is required t be taken befre fd, that this ccurs. Similarly the administratin f sme medicines such as eye drps r inhalers may nt be suitable t be given at meal times. Nt all medicine administratin times will fall in line with meal times. The determining factr has t be dctr s instructins n the prescriptin:
1 daily /.d. the medicine can be given in the mrning r at night, depending n the type f medicine. It is imprtant t administer the medicine at the same time every day s that each dse is separated by a 24-hur interval; 1 twice daily / b.d. the medicine shuld usually be given every 12 hurs, althugh there are exceptins; 1 three times daily / t.d.s. this usually means ne every eight hurs. Side effects can smetimes be caused by changes in the amunt f drug in the bld. Uneven timings might cause these changes s even gaps between dses can be imprtant; 1 fur times daily / q.d.s. this means ne every six hurs but this des nt mean waking up the child administer the last dse as clse t bedtime as pssible and spread ut the ther dses during the day; 1.m. / 1 mane ne t be taken in the mrning but the patient infrmatin leaflet r dctr s instructins shuld be fllwed fr example, t be taken befre breakfast r after breakfast; 1.n. / 1 ncte ne t be taken at night. Sleeping tablets are best administered half an hur befre bedtime. Mst sleeping tablets will have an effect within 15 t 30 minutes. Tablets shuld be given with the child sitting upright and with half a glass f water, nt ne r tw sips. If the child wuld prefer anther drink t take their medicatin, check if this is k by referring t the patient infrmatin leaflet r ask the pharmacist; 1 r 2 p.r.n. ne r tw t be taken when required. The dctr r pharmacist will give guidance n hw many and when t be given. Staff shuld knw what the medicine is fr s that it can be ffered apprpriately. At the last administratin f the day, the stck fr each medicine can be checked and recrded in the Running Balance bx n the MARR sheet (this may say R r RB). Remember t include stck that is stred in the medicine cupbards, fridges and CD cabinets; If whilst cmpleting the running balance there is a discrepancy between the cunt f medicines and the MARR sheet, the actual stck shuld be entered n the MARR sheet and circled. A G cde shuld als be entered n the MARR sheet. On the back f the MARR sheet, the discrepancy and the actins taken shuld be recrded. Tpical Medicines Applicatin The Hme Manager r a delegated persn/member f staff shuld cmplete a Tpical Medicines Applicatin Recrd (TMAR) and bdy map, shwing where the medicine shuld be applied, fr each
tpical medicine prescribed. It is a handwritten dcument and therefre it shuld then be cuntersigned. At the end f the 28 day cycle, the MAR shuld be attached t the crrespnding MARR sheet, t prvide a full recrd f administratin.