Medication Management and Regulation 23 in Children's Homes

What Regulation 23 requires

Regulation 23 requires the registered person to ensure that medicines are given to children only as prescribed, and that the administration of medicines is properly recorded. The home must have a clear policy on the management of medicines, including storage, administration, recording and disposal.

The requirement covers all medicines: prescribed medicines, over-the-counter medicines, controlled drugs, and homely remedies. Each type has different requirements, but the underlying principle is the same: medicines must be managed safely, administered correctly, and recorded accurately.

The medication policy

Every home must have a medication policy. The policy should set out: how medicines are obtained, how they are stored, who can administer them, how administration is recorded, how errors are managed, how medicines are disposed of, and how children are supported to self-administer.

The policy should be clear enough that staff know what to do in every situation. A policy that says 'medication will be managed safely' is not a policy. A policy that says 'prescribed medicines are stored in the locked medication cabinet in the office, administered by staff who are trained, and recorded on the MAR chart within 30 minutes' is a policy.

Storage of medicines

Medicines must be stored safely. Prescribed medicines should be stored in a locked cabinet or cupboard. Controlled drugs have additional storage requirements under the Misuse of Drugs Regulations, including a locked cabinet that is fixed to the wall or floor.

Medicines that require refrigeration should be stored in a locked fridge or a fridge in a locked room. The storage temperature should be monitored and recorded. Medicines should be stored in their original packaging with the pharmacy label intact.

Administration and recording

Medication must be administered as prescribed. The person administering should check the prescription, the child's identity, the medicine, the dose, the route, and the time before administering. This is often described as the 'six rights': right child, right medicine, right dose, right route, right time, right documentation.

Every administration must be recorded on the Medication Administration Record (MAR chart). The record should show what was given, when, by whom, and any refusal or error. A medication that is refused should be recorded, not just left blank. An error should be recorded and reported, not hidden.

Controlled drugs

Controlled drugs have additional requirements under the Misuse of Drugs Regulations 2001. They must be stored in a locked cabinet that is fixed to the wall or floor. They should be subject to additional recording, including a controlled drug register that records each supply, administration and disposal.

The home should have a clear process for managing controlled drugs, including who holds the keys, how the register is maintained, and what to do if a controlled drug is missing. The process should be followed consistently, not just when an inspection is expected.

Supporting children to self-administer

Regulation 23 requires the home to support children to self-administer medication where appropriate. Self-administration supports children's independence and prepares them for managing their own medication when they leave care. However, it must be safe and appropriate for the child and the medication.

The decision about self-administration should be made on a case-by-case basis, considering the child's age, understanding, the medication, and any risks. A child who self-administers should have a clear agreement about what they can manage, how it will be stored, and how it will be monitored. Self-administration is not an all-or-nothing decision: a child may self-administer some medicines but not others.

Child-centred question

If a child in this home was learning to manage their own medication, would they feel supported and trusted, or would they feel that the adults did not believe they could do it?

PRN medication and homely remedies

PRN (pro re nata, or 'as needed') medication is prescribed to be given when a child needs it, rather than at a fixed time. The home should have clear guidance for each PRN medication: when it should be given, how much, how often, and what to record. PRN medication should not be given without clear guidance from the prescriber.

Homely remedies are over-the-counter medicines that the home may give for minor ailments. The home should have a policy on homely remedies, including what can be given, in what circumstances, and with whose consent. Homely remedies should not be given without parental consent (or the child's consent, if they are competent), and should be recorded.

Managing medication errors

Medication errors happen. What matters is how the home responds. An error should be recorded, reported to the manager, and assessed for harm. If the error may have caused harm, medical advice should be sought immediately. The error should be reported to the prescriber and, if it is a serious incident, to Ofsted under Regulation 40.

The home should learn from errors. A pattern of errors suggests a problem with the system, not just the individual. The home should review medication practice after errors and make changes to prevent recurrence. A home that hides errors or blames individuals without looking at the system is not managing medication safely.

Staff training and competence

Staff who administer medication must be trained and competent. The training should cover the medications children in the home are taking, the administration routes, the storage requirements, the recording requirements, and what to do if something goes wrong.

Competence should be assessed, not just assumed. A staff member who has attended a training course may not be competent to administer a specific medication. The home should assess competence through observation and supervision, and should provide refresher training regularly.

What Ofsted looks at

Ofsted inspects medication management as part of the SCCIF. Inspectors may look at MAR charts, storage arrangements, controlled drug registers, medication policies, staff training records, and how errors have been managed. Inspectors will be interested in whether the system works in practice, not just whether the policy exists on paper.

Inspectors may explore how children experience medication: whether they understand what they are taking, whether they are involved in decisions about their medication, and whether they are supported to self-administer. A home that manages medication well will not be penalised for having children who take medication. A home that manages it poorly will be.

Common medication management mistakes

• Not recording refusals or errors, only successful administrations
• Not storing controlled drugs in a separately secured, fixed cabinet
• Not monitoring fridge temperatures for medicines that need refrigeration
• Giving PRN medication without clear prescriber guidance
• Giving homely remedies without consent or recording
• Assuming staff are competent after a single training course, without assessment
• Not supporting children to self-administer where it is safe and appropriate
• Hiding medication errors instead of reporting and learning from them
• Not notifying Ofsted of serious medication errors under Regulation 40
• Not reviewing medication practice after errors to identify system problems