Phase I Medication Administration in Child Day Centers: An Interim training valid June 1, 2005 until

1
Phase I - Medication Administration in Child Day
CentersAn Interim training valid June 1, 2005
until June 1, 2007

• Division of Child and Adolescent Health
• Virginia Department of Health

2
Medication ManagementWhat You Need to Know

• Licensing Requirements
• Common medication problems
• Care and Storage
• Requirements to Administer
• How to Administer
• Medication Documentation
• Emergency Procedures

3
Standards for Administering Medication

• Review Virginia Standards for Licensed Child Day
  Centers
• Review National Health and Safety Performance
  Standards

4
Virginia Social Services Licensing Standards

• Check to be sure the name of the child is on the
  medication
• Read and understand label (including dose,
  frequency and other circumstances)
• Administer medicine according to prescribed
  method and dose on label
• Observe child for side effects or adverse
  reaction
• Record of medication given
• Document administration of each dose in
  accordance with 22 VAC 15-580
  

5
Standard VAC 15-30-580 Medication

• Prescription and nonprescription medications
• Shall be given according to centers written
  medication policies
• Shall be given only with written authorization
  from parent
• Shall be given according to VAC 15-30-310D (see
  page 26 of regulations, indicating staff must be
  trained)
• Shall be given according to centers procedure
  (including any general restrictions)
• Shall be given according to manufacturers
  instructions for age, duration and dosage

6
Standard VAC 15-30-580 Medication continued

• Medication authorization forms are to include how
  long the medication is to be given
• Medications that require a course longer than 10
  days shall need a new authorization at that time.
  
• Long-term use of OTC drugs may be allowed with
  written authorization from childs physician and
  parent.
• Medication authorization shall be available to
  staff entire time it is effective
• Medication shall be labeled with childs name,
  drug name, dose amount and time(s) to be given

7
Continued

• Medication shall be in original container with
  prescription label or direction label attached
• medication shall be refrigerated when needed and
  if so, must be stored in a clearly defined
  container away from food
• all medication shall be kept in a locked place
  that prevents access by children (unless
  designated otherwise by MD)
• key (if used) shall not be accessible to children

8
continued

• Record of medication given shall include
• who received the medication
• amount and type of medication
• day and time medication given
• staff who administered medication
• any adverse reactions and any error
• staff shall inform parents immediately of any
  adverse reactions to medication administered and
  medication error (including omission)
• expired authorizations of medications must be
  picked up within 14 days, be renewed or disposed
  of by flushing down toilet or dissolving in sink

9
Disposal of Medications

• Dissolve down the sink
• Flush down the toilet
• Non soluble medications, such as expired epipens
  and used insulin syringes must be disposed of in
  a sharps container.

10
VAC 15-585 OTC skin products

• All nonprescription and OTC drugs and OTC skin
  products shall be used according to
  manufacturers recommendations and not be used or
  kept beyond expiration date of product
• If sunscreen is used, the following must be met
• written parental authorization of known reactions
• sunscreen kept in original container with childs
  name
• inaccessible to children under 5 or special needs
  program
• all sunscreen shall be hypo-allergenic and at
  least SPF15
• staff not trained in medications may administer
• children 9 and older may self apply

11
Use of Diaper ointment or Cream

• Written parental authorization noting any
  adverse effects
• labeled/original container
• inaccessible to kids
• record of name, date, frequency and any adverse
  reactions
• ok for staff not trained in medications to give,
  unless prescription

12
Insect Repellent

• Written parental authorization of any known
  adverse effects
• kept in original container with childs name
• inaccessible to children
• record kept of childs name, date, frequency and
  any adverse reactions
• follow manufacturers instructions for age, dose
  and duration
• staff not trained in medications can apply,
  unless prescription

13
National Recommendations Model Child Care Policy

• More detailed pull out all standards pertaining
  to medication administer in separate document
• Staff training
• Policy
• Requirements for authorization
• Storage
• How to administer
• How to record
• Adverse reaction
• Emergency procedures
• Section on Asthma

14
Common Medication ProblemsWhats happening in
Virginia?from VDSS reports 2001

• Using common household items to measure
• Only rinsing spoons between use
• Sharing measuring devices (pharmacy spoons)
• Parents sending medications in something other
  than the original container
• Non prescription (OTC) not labeled with specific
  childs name

15
Common Medication Problems in Virginia (contd)

• Not following dosage recommendations on OTC drugs
  
• Transporting medications in an unsafe manner
• Sharing OTCs
• Not locking up medications that must be
  refrigerated, especially in the infant/toddler
  areas where refrigerators may be smaller

16
Common Medication Problems (contd)

• Not understanding ccs and mls and the potential
  health effects of inexact measurement
• In family day homes, medications being stored in
  inappropriate places where children could reach
  them
• Lack of awareness of potential medication side
  effects (e.g., excessive drowsiness) and lack of
  parental notification

17
General Guidelines in Care and Storage of
Medications

• Prescription medication must ALWAYS be kept in
  the original labeled bottle or container.
• Over the counter medication must also be stored
  in the original container and clearly labeled
  with the childs name.
• All medications should have child resistant caps

18
General Guidelines in Care and Storage of
Medications

• Store medications and supplies in a clean, secure
  and locked area.
• Keep medications in a cool, dry, dark place.
• Return to the parent any medication containers
  with labels that cannot be read.
• The parent or guardian is responsible for
  bringing the medication to the child care
  provider. Children should not transport medicine.

19
General Guidelines in Care and Storage of
Medications

• Refrigeration
• The refrigerator in secure area, not accessible
  to children
• Medication in leak-proof container separated from
  food or in separate refrigerator
• Check temperature to assure between 3646 F

20
Requirements to Administer Medications

• Prescription and nonprescription medication shall
  be given to a child according to the centers
  written medication policies and only with written
  authorization from the parent
• Written authorization includes
• Childs name
• Name of medication
• Current date
• Dosage

21
Requirements to Administer Medications

• Written authorization includes
• Route (how to administer)
• Time medication needs to be given while in child
  care
• Medication start date and medication end date
• Side effects that need to be reported
• Special instructions or storage information

22
(No Transcript)
23
5 Rights of Medication Administration

• Right Child
• Right Medication
• Right Dose
• Right Time
• Right Route

24
Right Child

• Is this the right child?
• Check the name on the medication label
• Confirm the childs identity with another person
• Ask the child his name
• Verify the childs identity with the childs
  picture, if available

25
Right Medication

• Medication must be given from a properly labeled
  original bottle
• Compare the prescribing practitioners written
  instructions to the pharmacy label and the
  medication record
• Read the label 3 times

26
Right Dose

• Give the exact amount of medicine specified by
  the orders from the health care provider and the
  pharmacy label
• Use standard measuring devices to assure proper
  dosage. DO NOT USE KITCHEN UTENSILS

27
Right Time

• Check with parent the time when the medication
  was last given at home.
• Check the medication record for the time the
  medicine needs to be given
• Check and see if the medicine as already been
  given for the current day
• Give medication up to 30 min. before or 30
  minutes after scheduled time

28
Right Route

• Check the medication order and the pharmacy label
  for the route the medication is to given (mouth,
  inhaled, ear drops, eye drops)

29
Medication Documentation

• Record medication given on the childs medication
  record. Keep the medicine in your hand until you
  have signed the record.
• Record the time given
• Record initials of staff giving medication
• Record any pertinent observations.
• Record any medication errors.

30
(No Transcript)
31
Emergency Medication

• Any child prescribed emergency medications (such
  as albuterol, glucagon and epipen) shall be in
  the care of a provider trained in administration
  of emergency medication specific to each childs
  condition

32
Emergency Procedures for Allergic Reactions

• Get help.
• Immediately activate child care center emergency
  plan.
• CALL 911 if this is appropriate.
• Does the child have an emergency doctors order
  for an Epipen or Glucagon?
• Stay with the child with the reaction. Observe
  symptoms, note time.
• Notify parent/guardian.
• Continue observing child
• Provide emergency personnel with health
  information and summary of reaction.

33
(No Transcript)
34
(No Transcript)
35
Non Traditional Medications

• Homeopathic or non traditional medications should
  be treated as an over the counter medication
  (OTC).
• These types of medications are not FDA approved,
  and when taken internally, should be treated as
  an ingested substance only to be given with an
  MD's written approval (e.g. Tylenol).

36
Antibiotic Resistance

• Dont ask for antibiotics when you have a cold or
  the flu, they dont work!
• Always finish the medicine and take it exactly as
  prescribed.
• Never save antibiotics for the next time you are
  ill.
• Dont share your medications with others.
• Provide information to parents and staff about
  appropriate antibiotic use.

37
Summary of Medication Management

• Standards of Medication Administration
• Common medication problems
• Care and storage of medications
• Examples of requirements to administer
• 5 Rs in administering
• Documentation
• Emergency Procedures
• Antibiotic Resistance

38
Resources

• National Resource Center for Health and Safety in
  Child Care http//nrc.uchsc.edu/TIPS/medadmin.htm
  
• Healthy Child Care America www.healthychildcare.or
  g
• Caring for Our Children National Health and
  Safety Performance Standards http//nrc.uchsc.edu/
  CFOC/index.html
• Virginia Department of Social Services Division
  of Licensing http//www.dss.virginia.gov/division/
  license/district.html or call 1-(800) KIDS-LIL
  )
• Healthy Child Care Virginia Program/Virginia
  Department of Health [phone] or email
  vacchcs_at_aol.com

39
Questions
40
Acknowledgements

• Bethany Geldmaker, PhD
• Virginia Department of Health
• Claire Wood, RN, BSN
• Healthy Child Care Virginia, VDH
• Carolyn Sanford, RN, BSN
• Chesapeake Health Department, VDH
• Sue Adams, RN, MSN
• Child Care Health Consultant