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Medication -
Foundation
Handbook

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 Contents

Learning Objectives................................................................................................................................. 3
Seeking Advice About Medication .......................................................................................................... 3
General Types of Medication .................................................................................................................. 3
The Medication Name............................................................................................................................. 4
Categories of Medication ........................................................................................................................ 4
Forms of Medication ............................................................................................................................... 4
Routes of Administration ........................................................................................................................ 5
Homely Remedies ................................................................................................................................... 5
Controlled Drugs ..................................................................................................................................... 5
Infection Control ..................................................................................................................................... 6
Infection Control – Good Guidelines .................................................................................................. 6
The Six Rights of Medication Administration.......................................................................................... 6
Reviewing Medication Labels ................................................................................................................. 7
Oral Medication ...................................................................................................................................... 8
Measuring Medication ............................................................................................................................ 8
Instructions ......................................................................................................................................... 8
Supervision.............................................................................................................................................. 9
Medication When Away from Home ...................................................................................................... 9
Medication Scheduling and Recording ................................................................................................... 9
Medication Errors ................................................................................................................................. 10
Accidents to Young people ................................................................................................................... 10
Where do young people accidentally find medication? ................................................................... 11
Safe Storage and Disposal ..................................................................................................................... 11
Receiving Medication ............................................................................................................................ 12
Labelling Medication ............................................................................................................................. 12
Administering Medication .................................................................................................................... 13
Prescriptions ......................................................................................................................................... 13
Computer-Issued Prescriptions......................................................................................................... 13
Side Effects ............................................................................................................................................ 14
Common Side Effects ........................................................................................................................ 14
Less Common Side Effects ................................................................................................................ 14
A Severe Reaction ............................................................................................................................. 15
Medication and Consent ....................................................................................................................... 15

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 Gillick Competent.................................................................................................................................. 15
How is Gillick Competency Assessed? .............................................................................................. 16
Fraser Guidelines (Gillick v West Norfolk, 1985) .............................................................................. 16
When Consent Can Be Overruled ..................................................................................................... 17
Reasons for Refusal ........................................................................................................................... 17
Covert Medication ................................................................................................................................ 17
Managing a Refusal ............................................................................................................................... 18

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 Learning Objectives

• To know how to comply with good practice to safely administer medication

• To be aware of a range of medications, their form, and route of administration
• To be able to identify the six rights of medication
• To review a label for an over the counter medication
• To know how to safely administer and store medication
• To understand the common side effects
• To understand the action to be taken if a severe reaction is suspected
• To understand consent
• To be able to complete a Medication Administered Record (MAR)

Seeking Advice About Medication

It is the responsibility of the person administering the medication to understand the

following aspects of the medication:

• Therapeutic use
• Normal dose
• Side effects
• Precautions
• Contra-indications
To aid them in this, they can use the British National Formulary (BNF) which includes
information relevant to all medication prescribed throughout the UK.

General Types of Medication

It’s important that you have an understanding of the different types of medication.
1. Prescription Medication – Medication that requires a written prescription for a
specific illness/reason for a specific person; should not be shared with anyone else.
2. OTC (Over-The-Counter) Medications – Medications that can be purchased without
a prescription.
3. Psychiatric Medication – Medication prescribed for the treatment of mental illness
or mental illness symptoms.
4. Herbal or Homeopathic Remedies – Variety of different substances following
traditional practices. Should only be used under the advice of a healthcare provider.

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 5. PRN Medications – Medication given only when needed to relieve symptoms; not
given on a routine basis.

The Medication Name

The medication name is important too – is it a generic name or a brand name?

• A Generic Name – A simplified version of the chemical name. Generic medications
are usually less expensive than their trade name (brand name) counterparts.
Example: paracetamol, loratadine.
• A Trade Name (Brand Name) – A name chosen by and owned by the manufacturer.
The same medication may have different brand names. Example: Calpol, Claritin.

Categories of Medication

Medication is split into the following categories.

• POM – Prescription-Only Medicines
• P – Pharmacy-Only Medicines
• CD – Controlled Drugs
• GSL – General Sales List (Over the Counter)

Forms of Medication

1. Tablets or Caplets – These come in different sizes, shapes, and colours.

2. Capsules
3. Lozenges
4. Liquid – Suspensions, syrups, and elixirs must be carefully measured. Some must be
shaken well before use. Some contain alcohol.
5. Inhalants – These are designed to be inhaled into the lungs. Most frequently, they
are prescribed for young people with asthma. When properly used, they should take
effect immediately.
6. Injections
7. Suppositories – These are designed for absorption from rectum or vagina.

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 8. Other – Creams, ointments, sprays, powders, patches, lotions, and medicated
shampoos.

Routes of Administration

Depending on the form of a medication, the medication will be administered in a variety of

different ways.
1. Orally – Tablets and liquid medication taken by mouth.
2. Topically – Lotions, creams, and ointments applied directly to the skin.
3. Inhalation – Medications inhaled through the nose or mouth.
4. Sublingual – Medication placed under the tongue.
5. Rectal – For treating local infections or for medications that cannot be taken orally.
6. Injections – Generally, only nurses give injections. In some instances the carer might
be trained, or the young person may self-administer with appropriate training and
supervision.

Homely Remedies

1. Non-prescription medicines and over-the-counter products are known as “homely

remedies”. These can be bought without a prescription from a pharmacy or
supermarket.
2. Examples include mild painkillers or cough medicine.
3. Homely remedies should be written down for each young person. The list should be
sent to the GP to ensure it does not interact with other medication the young person
is taking.
4. This list should be reviewed every six months.
5. If there’s no list, there’s no medication.

Controlled Drugs

• Controlled drugs (like morphine) are stored, administered, and destroyed in a certain
way. These types of drugs are treated in law as dangerous and therefore have strict
governance concerning them.

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 • The administration of controlled drugs must be completed by authorised trained
carers only and should be witnessed by another trained carer.
• The recording of controlled drugs administration should be in a bound book/register
with numbered pages. The register must show the quantity of drugs remaining and
this must be checked every time a controlled drug is issued.
• Should the young person refuse to take the controlled drug, it must be returned to
the pharmacy as soon as possible and not left in a communal pot with other
standard medication. Upon receipt by the pharmacy, a signature must be obtained
from the carer returning the drug and the pharmacist receiving it.

Infection Control

• Contaminated (dirty) hands are a prime cause of cross-infection (spread of

infection). Hand washing is the most important and most basic technique in
preventing and controlling the transmission of germs.
• Good practice suggests that to minimise coming into contact with bodily secretions
you are advised to wear gloves during some administration of medication.

Infection Control – Good Guidelines

DO
• Wash hands before preparing medications.
• Discard medication that has been accidentally dropped on dirty surfaces.
• Administer medication straight from the packet/bottle into a pot and then give to
the young person to.
• Minimise handling medications with your hands – wear gloves when needed.

DON’T
• Administer medication that has been contaminated.

The Six Rights of Medication Administration

It is vital that you know the six rights of medication administration.

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 1. The right child
2. The right medication
3. The right dose (amount)
4. The right time (the two-hour window of administration)
5. The right route
6. The right documentation

Reviewing Medication Labels

A carer should become familiar with the proper procedure for medication administration.
Part of this responsibility involves knowing how to read the medication label.
Always remember that:
• The medication is only for the young person whose name is on the label.
• You should never give medication to another young person, even if the young person
has similar symptoms or prescription.

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 Oral Medication

1. With tablets and capsules, do not cut or crush any tablet or capsule without checking
with the healthcare professional or pharmacist first.
2. When directed by the healthcare professional to do so, crushed medication can be
mixed with a small amount of yoghurt, or applesauce, for example.
3. Do not open capsules unless you have been directed by the healthcare provider or
pharmacist.
4. Check expiry dates, especially on over-the-counter medications.
5. Liquid medications must be carefully measured – only use calibrated measuring
spoons, droppers, syringes, or medicine cups.
6. Always use the measuring spoons or cups provided with the medication. Never use a
household teaspoon or tablespoon to measure medication!

Measuring Medication

Check the dose before giving to the young person, as some medicines are available in
different strengths.
Some syringes are marked in millilitres (ml) and some in milligrams (mg).
Here are some useful measurement conversions to remember.
• Half a teaspoon = 2.5ml
• 1 teaspoon = 5ml
• 1000 milligram = 1ml

Instructions

The following are three common instructions found on medication and an explanation of
what each means.
• Take full course – This means the young person should finish the entire contents of
the prescription, even if the young person is feeling better.
• Take with food – This means the medication should be given to a young person after
a meal.

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 • Take on an empty stomach – This means that the medication should be given one
hour before a meal or two hours after a meal.

Supervision

You may be supervising the young person as they take their medication. Follow this process.
• When appropriate, a young person might be trained in self-administration.
• Always monitor self-administration for proper technique and compliance.
• Observe the young person and make sure that the medication was swallowed
completely.
• Always give fluids with all medications. Water is usually the best option.

Medication When Away from Home

• If possible, the administration of medication should be planned to minimise the need

for administration outside of the home.
• If medication is needed during the school day, consult with the young person’s social
worker, healthcare professional, or the school staff to arrange for medication
administration at school.
• It is best to give medication before and/or after short trips or, if needed during a trip,
take only the required amount and keep it safe and properly stored.

Medication Scheduling and Recording

• It is important to adhere to the dose and frequency prescribed for each medication.
• It is important to be consistent when giving medication – the carers are responsible
for following the orders of the healthcare providers.
• A medication log/MAR is a helpful tool, especially for young people with a
complicated medication schedule. You can see a MAR pictured here.
• Correct recording on the MAR is a responsibility for everyone administering
medication. It involves recording the date, time, dosage, and any relevant comments
or observations.
• Keep a list of all the young person’s medication and take it with you to all medical
appointments.

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 Medication Errors

A medication error could include administering an incorrect dose or the incorrect

medication, or administering medication at the wrong time etc.
If there is an error, remember the following:
• Identify the precise error
• Have any paperwork to hand
• Contact pharmacy and/or doctor
• Observe and monitor the young person
• Follow instructions given by medical staff
• Record the incident
• Inform social worker/family as appropriate
• Complete requested paperwork

Accidents to Young People

1. According to the Royal Society for the Prevention of Accidents (RoSPA) more than
two million young people under the age of 15 experience accidents in and around
the home every year, for which they are taken to accident and emergency units.
Many more are treated by GPs and by parents and carers.
2. On average, 62 young people under the age of five died as a result of an accident
and over 76,000 under the age of 14 are admitted for treatment, of which 40% are
under the age of 5 years.
3. Most poisoning accidents involve medicines, household products, and cosmetics.
More than 28,000 young people receive treatment for poisoning or suspected
poisoning accidents every year.

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 Where do young people accidentally find medication?

Medicines and vitamins help families feel well and stay well, but young people are curious.
Always keep medicines stored up and away and out of sight.

Safe Storage and Disposal

Just as important as administering the medication, correct storage and disposal are vital.
• You should ensure that medication is stored safely – out of reach of young people
and secured, locked if necessary.
• Always store medication in the container in which it was dispensed by the pharmacy.
• Certain medications require refrigeration – the label will say “Keep Refrigerated”.
They are best put in a plastic box on the top shelf or in a locked refrigerator if
necessary.
• A cool, dry area is best for medication storage. For example, a bathroom cabinet
often becomes hot and steamy and is not a good location to store medications.
• Every medication has a shelf life. Observe shelf life and use-by dates.
• Do not remove the label until the medication is finished.
• Do not flush medication down the sink or toilet.

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 • Take advantage of your pharmacy by taking unused medication promptly back to
them for proper disposal. This gives you a clear audit trail of evidence relating to safe
disposal.

Receiving Medication

When you receive medication, and before it can be administered, the following must be
checked.
• The young person’s name
• The name of the drug
• The dosage of the medication
• The time the medication is to be given
• The route the medication is to be given
• Any special instructions
• Any warnings, side effects, and reactions
• The use-by date of the medication
The ‘double-checking’ method, where two individuals count and then compare, is thought
to be the most effective method.

Labelling Medication

For you to administer a medicine, it must have a printed label containing the following
information:
1. Young person’s name
2. Name and strength of medication
3. Dose and frequency of medication
4. Route
5. Date of dispensing

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 Administering Medication

• Never administer medication if there is any discrepancy in the prescription or supply.

• Never leave medication unattended, the drugs cabinet unlocked or with keys left in
it.
• Never give the key to the medication cabinet to an unauthorised person.
• Never give out medication for someone else to administer or for the young person
to take at a later time – it is illegal and negligent.

Prescriptions

• Ideally, all prescriptions should be filled and refilled at one pharmacy so that all medications
are listed in one place.

• Keep track of how much medication you have:

How many pills?

How much liquid?

How many puffs left in the inhaler?

• Carers must ensure there is a sufficient amount of medication. To prevent treatment

disruption, order/reorder the young person’s medications in a timely manner.

Computer-Issued Prescriptions

• If any alterations must be made it should be in the prescriber’s own handwriting and
countersigned.
• They are valid for six months from the date they were signed.
• Controlled drugs prescriptions are only valid for 28 days from the date signed, for a
total of 30 days’ treatment by instalment.
• Best practice suggests that phone alterations should be witnessed by another person
over loudspeaker, or a fax should be sought.

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 Side Effects

Every medication has the power to help and the power to harm.
Some side effects are mild and will go away after the young person takes the medication for
a while. Other side effects are serious and the medication must not be administered again,
following the advice from the young person’s GP.
Ask the young person’s healthcare provider or pharmacist about possible side effects – what
to watch for and what must be reported immediately.

Common Side Effects

Common side effects include:

• Nausea
• Vomiting
• Diarrhoea
• Constipation
• Swelling
• Headache
• Dry mouth
• Rash
• Anxiety
• Drowsiness
These should subside within a few days but seek medical advice if you are concerned.

Less Common Side Effects

Less common side effects include:

• Any unusual behaviour (increased agitation, hyperactivity, aggression or sedation)
• Any unusual body movements, drooling, difficulty swallowing
• Fever might also be a sign of a serious side effect to some psychotropic medications

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 These side effects are uncommon – you should seek medical advice immediately. However,
do not discontinue the medication without instructions from the young person’s healthcare
provider or pharmacist.

A Severe Reaction

If a severe reaction is suspected, check if there is:

• Difficulty in breathing
• A tingling sensation in the lips
• Swelling to lips, eyes, hand, face, and body
• Reddening of skin or blotching
If so, you should:
• Dial 999 – Get help quickly
• Reassure – Keep the young person calm
• Epi-pen – Do they have one?

Medication and Consent

The laws around medication and consent differ depending on the age of the young person
or young person.
• 16 and Over – People aged 16 or over are entitled to consent to their own
treatment, and this can only be overruled in exceptional circumstances. Like adults,
young people (aged 16 or 17) are presumed to have sufficient capacity to decide on
their own medical treatment, unless there's significant evidence to suggest
otherwise.
• Under 16 – Young people under the age of 16 can consent to their own treatment if
they're believed to have enough intelligence, competence, and understanding to
fully appreciate what's involved in their treatment. This is known as being Gillick
competent.

Gillick Competent

People often talk about whether a young person is 'Gillick competent' when they are trying
to decide whether the young person is mature enough to make decisions.
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 The Gillick competency helps us all to balance young people’s rights and wishes with our
responsibility to keep young people safe from harm.
They originated from a legal case which looked specifically at whether doctors should be
able to give contraceptive advice or treatment to under 16-year-olds without parental
consent. But since then, they have been more widely used to help assess whether a young
person has the maturity to make their own decisions and to understand the implications of
those decisions.

How is Gillick Competency Assessed?

Lord Scarman’s comment in his judgement of the Gillick case is often referred to as the test
of “Gillick competency”.
"...it is not enough that she should understand the nature of the advice which is
being given: she must also have a sufficient maturity to understand what is involved.”
He also commented more generally on parents’ versus young people’s rights:
“Parental right yields to the young person’s right to make his own decisions when he
reaches a sufficient understanding and intelligence to be capable of making up
his own mind on the matter requiring decision.“
Professionals working with young people need to consider how to balance young people’s
rights and wishes with their responsibility to keep young people safe from harm.

Fraser Guidelines (Gillick v West Norfolk, 1985)

The Fraser guidelines refer to the guidelines set out by Lord Fraser in his judgment of the
Gillick case in the House of Lords (1985), which apply specifically to contraceptive
advice. Lord Fraser stated that a doctor could proceed to give advice and treatment
“provided he is satisfied in the following criteria:
• That the girl (although under the age of 16 years of age) will understand his advice
• That he cannot persuade her to inform her parents or to allow him to inform the
parents that she is seeking contraceptive advice
• That she is very likely to continue having sexual intercourse with or without
contraceptive treatment
• That unless she receives contraceptive advice or treatment her physical or mental
health or both are likely to suffer
• That her best interests require him to give her contraceptive advice, treatment or
both without the parental consent."
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 When Consent Can Be Overruled

If a young person refuses treatment, which may lead to their death or a severe permanent
injury, their decision can be overruled by the Court of Protection. This is the legal body that
oversees the operation of the Mental Capacity Act (2005).
The parents/guardians of a young person who has refused treatment may consent for them,
but it's usually thought best to go through the courts in this situation.

Reasons for Refusal

• Do they have difficulty swallowing?

• Is the medication too big?
• Have they had a previous allergic response or reaction to medication?
• Are there side effects?
• Is there behaviour or psychiatric reasons?
• Are they in pain?
• Do they have gum problems or mouth ulcers?
• What are their religious beliefs?
• How does the medication taste?

Covert Medication

Covert medication is the administration of any form of medication in a disguised form and
usually involves disguising medication by administering it in food and drink. This is not the
administration of medication against a competent person’s wishes which would constitute a
tort or civil wrong of trespass to the person.
Under exceptional circumstances, your GP may consent to this in the best interests of the
young person.

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 Managing a Refusal

If a young person or young person refuses medication we cannot force them to take it.
Here are some techniques to help you manage a refusal.
• Just try again later on
• Get someone else to try
• Explain what will happen to them if they don’t take it – the possible medical issues
• Ring the GP for advice
• Record the refusal on the MAR
• Contact their Social Worker as soon as possible

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