Child and youth welfare facilities However, the monitoring visits in 2020 highlighted once again structural deficits that have still not been fully eliminated despite being raised by the NPM repeatedly. The staff is often not or not regularly trained in de-escalation techniques. This criticism is also taken up in most cases. Employees are then given the opportunity to take part in de-escalation training programmes and further education on the topic of violence prevention or pedagogical conversation. Socio-pedagogical and sex education concepts as well as violence prevention concepts have since been established in most shared accommodations. However, some of these are not enough to guarantee the protection of the minors. On recommendation of the NPM, several concepts had to be revised, enhanced or changed to reflect the programmes or location. NPM commissions had to insist that fire protection issues be addressed, the protection of non-smokers guaranteed and hygiene problems and structural deficits rectified. On the recommendation of the NPM, new furniture was acquired and window bars removed. Some buildings in which shared accommodations were housed in cramped or otherwise unacceptable conditions were completely converted. If this was not possible, the residents of the shared accommodations were moved to suitable buildings. In many facilities new door locking systems were installed and lockable lockers acquired for the children’s personal belongings. In some facilities there was criticism that the proper management of medication is not given priority. In many facilities in 2020, the commissions found expired medication that had been prescribed for children and adolescents who were no longer living in the facility. Deficits in the administration of the medication are observed just as frequently. In one shared accommodation, the administration of medication prescribed by doctors was only documented with a two-week delay. In another, there was no documentation of the supplies or the administration of medication that is included in the addictive substances category and for which the documentation of supplies and the maintaining of an addictive medication book are mandatory. Flaws in medication management If a patient is to stop taking medication, there must be written instructions from a doctor to do so. If these are only given verbally, the written instructions shall be obtained as quickly as possible, which some facilities occasionally forget. Some prescriptions are flawed either because the doctors or the staff add handwritten notes or because the dose to be administered is missing. There is no prescription for some medication, or the prescribed medication is not the same as that in the medication summary and the medication list. PRN medication is sometimes prescribed without any further description of the event requiring treatment. The NPM recommends consulting the competent doctor in such cases when there is doubt or the formulation of instructions is unclear. 66