Location: Looked after Children Ref: Services for Children and Young People Specialist Services and Safeguarding Section 1: Looked After Children Consent to Medical Treatment for Foster Carers Policy & Procedure Version: Date Agreed by CMT: 2 Sept 2009 Date for Review: Sept 2010 Contents Introduction Consent to medical treatment Routine medical treatment Specific treatment Who administers medication Procedure for administering medication Administering/taking medication outside the foster home 9 Storage, inventory and disposal of medication Medication Log Introduction Whether used to alleviate the pain of a toothache or to stabilise a serious medical
condition like diabetes, medication can be critical to the functioning and well being of
children in foster care. The proper administration of medication is always important; given
that children in foster care are placed outside their own homes, it becomes even more
crucial to manage and document the activity. Storage and disposal of medication are other
issues that must be addressed in a foster care setting.
Before any medication can be given by foster carers consent to routine or specific medical
The purpose of medication varies depending on the child‟s medical condition and needs. It
can be given to alleviate symptoms or manage medical or mental health conditions. When
foster carers know the purpose of the prescribed medication, they may find it easier to
comply fully with the health care provider‟s instructions. Children may also be more co-
operative when they understand its purpose.
This procedure provides instructions and guidance regarding medication for children in
foster care for use by health and social care professionals. Consent to medical treatment Consent to medical treatment must be sought before any medical treatment can be given.
Where a child is competent, their consent should be sought in the first instance. A
competent child is a child aged sixteen years and over or a child that has „sufficient
understanding and intelligence to enable him or her to fully understand what is proposed‟
(Gillick v West Norfolk and Wisbech AHA, 1986).
If children are not legally competent (do not „have capacity‟) to give consent for themselves
consent from someone who has parental responsibility is required except in an emergency
Legally one person with parental responsibility is required for consent to medical
treatment, although it is good practice to involve all those close to the child in the decision-
In emergency situations, where there is no one able to give valid consent, the decision can
be given by a medical professional to give immediate necessary treatment on the basis
that it is in the child‟s best interests.
Where it is appropriate parents should be asked to sign a placement agreement giving
Parents of children who are looked after and accommodated may retain parental
responsibility in relation to their children, even though in some circumstances the exercise
of that responsibility may be limited. All parents should be informed, whenever possible,
about their children's health and medical treatment.
In situations where the child's parents or the child refuse or are unable to consent to
medical treatment the process for obtaining consent will depend on the legal status of the
Those who have parental responsibility other than the child's parents include:
• the child‟s legally appointed guardian – appointed either by a court or by a parent with parental responsibility in the event of their own death; • a person in whose favour a court has made a residence order concerning the child; • a local authority designated in a care order in respect of the child (but not where the child is being looked after under Section 20 of the Children Act, also known as being „accommodated‟ or in „voluntary care‟); • a local authority or other authorised person who holds an emergency protection order in respect of the child. Foster carers only have the right to consent when this has been delegated to them in the
placement agreement and will only cover routine treatment.
The service manager of the child's social worker has delegated authority to give consent
for medical treatment on behalf of the local authority for children in the local authorities
care (see above), unless a decision has been made within the care plan to delegate or
share this aspect of parental responsibility to the parent or person holding parental
responsibility. Routine medical treatment When a child entering foster care is on medication, this should re-evaluated as part of the
If the routine medication is continued, foster carers must be provided with sufficient
information so that they can understand how to administer the medication, including the
purpose, dosage, schedule, route, duration of use, and side effects and how to respond to
The placement agreement should contain information about the routine medication that the
foster carer can provide or consent to i.e. ongoing routine medication, dental
appointments, eye tests, homely remedies and immunisations. The appropriate LAC
documents must be signed by the person with parental responsibility i.e. parents or service
manager of the child's social worker where the local authority has parental responsibility to
delegate the responsibility to foster carers.
Specific treatment Medication must only be given on the guidance of a medical practitioner. Some minor
conditions can be resolved with a homely remedy. Foster carers must be advised that all
homely remedies must not be continued beyond forty-eight hours without seeking advice
Consent must be obtained for any medical treatment that is not included in the placement
agreement as routine treatment. Consent must be obtained from the child themselves if
they are old enough (or 'Gillick competent') and/or the service manager or team manager
The service manager must be consulted in all circumstances where there are risks
involved in having or not receiving medication.
The person giving the consent must be provided with precise information about:
• the treatment being advised • who is giving the advise about treatment • what the treatment will involve • what risks or side effects are possible • expected care needed following the procedure • how long the treatment is to last • who will be providing the treatment? Foster carers are responsible for understanding and following directions given by the
prescribing practitioner; it is important to review compliance with the prescribed medication
during supervisory visits. Medication cannot be discontinued unless ordered by the
• how to prepare for medical appointments in terms of medication • if blood work or other tests have been ordered, that these are to be completed in the time frames directed by the practitioner • to bring all medications that the child has been taking, including overthe- counter items (such as vitamins), to any medical appointments. Who administers medication Who administers medication depends on several factors, such as the child‟s age, ability to
prepare and self-administer the medication, and willingness to do so. Generally, foster
carers of young children will be responsible for knowing the medication schedule, verifying
the correct dose, preparing the medication (e.g., removing a pill from a bottle, measuring
Older children may be responsible for taking medication under the supervision of the
Note: Foster carers of the same sex as the child or young person should administer certain
types of medications such as vaginal creams, rectal suppositories, and anti-fungal sprays.
Procedure for administering medication General guidelines for administering medication to children in foster care follow the “Five
• Right person • Right medication • Right amount/dosage • Right route of administration • Right time Foster carers will find these „rights‟ useful whenever they administer medication. The five
R‟s are reminders to administer medication thoughtfully and with attention (not in a hurry)
and that doing so is a serious responsibility.
Critical points in administering medication include: • Knowing how to read the label, which should specify the child‟s name, name of the drug, date, route of administration, dosage, frequency, time, directions for use, precautions, refills, and stop date • Verifying the information with the child, as appropriate • Making sure conditions are clean (e.g., hands washed, clean counter) and well lit • Observing the child take the medication and swallow it completely • Storing the medication safely and as directed • Documenting the administration of medication Side effects Foster carers need to be aware of the possible side effects of all medications. A child may
experience side effects from medication even if the desired effect occurs. Observe the
child for any physical (e.g., allergies) or behavioural side effects during the first few hours
or days following use of a new medication. If a child develops an unexpected or dangerous
side effect, medical advice should be sought immediately.
It is important to adhere to the dose and frequency prescribed for each medication. Many
medications are not effective unless a certain level is maintained in the blood; missing a
dose could have a harmful effect on the child‟s health. It is important to be consistent when
Recording medication Foster carers must use a medication log at all times – form at back of this policy.
The date, time, dosage, must be recorded and the carer and child if willing to co-operate
must both sign that they have received the medication.
Where there are any errors, or the child refuses to take the medication this must be
Any relevant comments or observations must also be recorded in the child‟s medication
log. These comments can be particularly useful in revealing patterns around the effect of
the medication and the child‟s tolerance.
Foster carers should be encouraged to keep a list of the child‟s medications to present to
any medical or mental health provider. Foster carers should be urged to keep the list with
Medication errors Situations may occasionally arise that require action, such as medication errors, refusal to
take medication, and taking medication outside the foster home or facility.
If an error in the administration of medication occurs, it is important to determine the type
of error that occurred. Was the error procedural, such as giving the medication at the
wrong time? Or was the error likely to be dangerous to the child, such as giving a
If the error is dangerous, contact the child's GP and/or accident and emergency
Examples of medication errors: • Missed medication • Wrong medication • Wrong dose of medication • Medication given at wrong time • Medication given to wrong child • Medication given via wrong route or method • Discontinued medication given • Outdated medication given • Medication contaminated (e.g., dropped on the floor). Concerning errors, advise foster carers to: • Contact the Accident & Emergency department or GP if an excess dose is suspected
• Contact the pharmacist immediately for advice • Observe the child for any possible effects • Contact the child's social worker • Document any error (e.g., missed dose) in the medication log. When buying prescription medication, ask the pharmacist what to do when a child misses
Child refusal to take medication Sometimes children express concern about taking a medication because they don‟t see
the benefit, or they‟re tired of taking it, or they feel „different‟ from their friends by having to
Side effects that change the child‟s energy level or appearance can also make a child
reluctant to comply with their medication regimen. Encourage foster carers to take these
concerns seriously and address them before they reach the stage of refusing to take the
Guidance to foster carers when a child refuses to take medication includes:
• Try to talk the child through it. Find out why he/she is refusing the medication. Stress the purpose and importance of taking the medication • Explain that the child can talk to the health care provider on the next visit • If the child still refuses, ask the mental health professional or health staff for help • If the child has a condition that requires medication (e.g., seizures, asthma), talk to a health professional to determine the appropriate course of action. Tips on taking medicine:
• Mix medicine with a small amount of food or drink, if appropriate. Crush tablets or open capsules in order to mix them. Let the child choose the food or drink. Always check with the health care provider, nurse, or pharmacist first to be sure this is OK • See if the pharmacist can change the form or flavour of the medicine to make it more palatable • Have the child take medicine at the same time the foster parent takes medicine or a vitamin • Have a contest to see who can take their medicine faster • A health care practitioner should demonstrate to foster carers the proper procedure for administering medication to babies • Don‟t ask the child whether he/she wants or will take the medicine. Be firm and say he/she needs to take it
• Some children do best when they take a deep breath and drink the medicine down fast. Others take their medicine a sip at a time with a drink of juice in between. Sometimes it helps for the caregiver to count for the child while he/she takes the medicine • Offer a reward such as a sticker or star when the child takes the medicine. Administering/taking medication outside the foster home Whenever possible, dosing schedules should be planned to minimise the administration of
medication outside the foster care setting. The use of long acting formulations may
eliminate the need to take medicine during the school day. However, there will still be
times when children in foster care need to take medication while in school, on trips, or on
Medication in schools Foster parents must communicate with the school if children are routinely expected to take
medications (e.g., Ritalin, Ventolin inhaler); schools will have their own procedures
Foster parents must bring the medication to the school in its original packaging as
dispensed from the pharmacist. It may be necessary for the pharmacist to order an
additional prescription to bring to school, or the pharmacy may provide an extra vial with a
Medication on trips, home visits and while transporting When foster carers take children on short trips, they should try to give the medication
Depending on the home situation, social workers and/or foster carers should discuss the
child‟s need for medication with birth parents when children are on home visits. The birth
parents should be given the same amount of information and education regarding their
child‟s medication as the foster carers. This supports the goal of involving parents in their
child‟s overall health and well-being and will ease the eventual move from foster care back
Birth parents should be kept informed about the child's health. When children go on home
visits, the parents should be advised about:
• The medication used, its purpose, and possible side effects • Importance of giving medication at its prescribed time and amount • Importance of safe storage of the medication • Family‟s role in administering medications to their child • Return of medications to the foster home or facility after each visit home.
Storage, inventory and disposal of medication Storage and inventory Regarding storage of medications, foster carers should follow these guidelines: • Certain medications require refrigeration; if this is the case there will be a Keep Refrigerated label on the container • A cool, dry, dark cupboard is the best storage for most medications; remember that a bathroom medicine cupboard often becomes hot and steamy and is not the best place to store medications • All medication must be kept in a locked box or cupboard and away from the reach or sight of small children • Medication must always be kept in the container in which it was received from the pharmacist. The label must not be removed. The information on the label is necessary to properly identify the patient, provider, medication, instructions for use, and date the prescription was dispensed. Disposal It is important that old, outdated, and potentially dangerous medications not be kept
Foster carers must return any unused medication to the pharmacist.
Medication Form Childs Name:
Medication Dosage Given Administered Medication Dosage Given Administered Medication Dosage Given Administered Medication Dosage Given Administered Medication Dosage Given Administered Medication Dosage Given Administered
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O riginal article Scand J Work Environ Health 2006;32(5):339–348 Do burned-out and work-engaged employees differ in the functioning of thehypothalamic-pituitary-adrenal axis?by Saar Langelaan, MSc,1, 2 Arnold B Bakker, PhD,2, 3 Wilmar B Schaufeli, PhD,1, 2 Willem van Rhenen,MSc,4 Lorenz JP van Doornen, PhD 2, 5Langelaan S, Bakker AB, Schaufeli WS, van Rhenen W, van Doornen LJP. Do burned-out