Administering Medications In Childcare MC8-1

Inevitably, some children will require medication while in the childcare setting. The process for handling and administering medications must be well structured and carefully followed in order to ensure that the interests of the children and the providers are best served. When possible, a child’s parents and physician should try to minimize the need for medications while in childcare.

Medicines ordered twice a day should normally be given before and after, rather than during, childcare hours. Medications ordered to be given three times daily also may be planned so that they are given in the morning before the child leaves for childcare, in the afternoon after the child returns home, and again during the evening. However, in some cases, administration of medications during childcare hours is unavoidable.

By clearly identifying the risks, it should be possible to set up a system that works for all involved. First, there is the risk that a medicine might be given to the wrong child, with potentially serious implications for the well-being of both the child who is given the wrong medicine and the child who should have gotten it.

Another possibility is that the dose given may not correspond to the dose ordered. Both under--and over--dosing can result in serious problems. Even when the medication is given properly, there may be side effects that the provider must be prepared to deal with. Some of these, such as drowsiness, are predictable. An unanticipated side effect--like a rash, wheezing or some type of allergic reaction--may occur, demanding a quick but carefully thought out response by the caregiver.

A Cautionary Tale

A few years ago, a 10-week-old boy named Douglas was found lifeless in his crib in the childcare facility he attended. He was taken to the hospital by the responding emergency medical personnel but never recovered consciousness. The baby had vomited repeatedly, and it was subsequently thought that the baby had choked on his vomit, causing death, although no one had reported that the baby had appeared or acted ill.

The parents persisted in requiring a more thorough forensic examination and in the vomit found on the baby’s shirt, as well as the stomach contents, there was indisputable evidence of the presence of several different medications. The parents had not signed authorization forms for any medications to be given to the infant.The source of these medications has never been identified, but administration of any medication without the parents’ permission and/or a physician’s order is forbidden by the regulations governing childcare in Douglas’ state.

Legislation known as the “Baby Douglas law” was enacted in the state making it a felony to administer medications to a child with intent to drug the child or alter the child’s behavior, beyond what is medically prescribed, or with reckless disregard for the health, safety, and welfare of the child.

No childcare provider wants a Baby Douglas situation in their program. By following a few simple guidelines, you can prevent medication errors that could harm the children in your care.

Policies and Procedures

Store medication appropriately, away from children and in childproof containers. A major hazard is the possibility of the child finding a bottle of some medication--whether his own or another child’s--and taking a large dose.

No medication should ever be given without the parents’ knowledge and permission. The administration of medicine in a childcare facility should be limited to:

Medications prescribed by a healthcare provider for a specific child.
Non-prescription, over-the-counter medications recommended by a healthcare provider for a specific child.
Non-prescription medications recommended for any child in the facility in very clearly defined situations (e.g., acetaminophen for fever).

In all cases, the provider should have written parental permission on file for each child to receive each individual medication. A general permission to give medication to any child is not adequate to protect the childcare provider from liability unless such broad permission is acknowledged by the parents in writing.

The container holding the medication must have a clearly written label that should be verified every time the medicine is administered.
Medications must always be given in the dosage specified on the label. It is not permissible to honor requests to vary from the label dosage, even when they come from the parents.
Accurate records must be kept of all parental and physician approvals and directives and of each administration of every medication. The records must be kept in a location where they are confidential, yet readily accessible. Staff should be taught to consistently utilize the records to prevent inadvertent double-administration of medication by different staff members.
Parents should always be notified at the end of the day, and in some cases sooner, of any medications their children have been given. If a fever has occurred, for instance, and acetaminophen is given in accordance with written parental approval and directions, the parents should be advised of the event.
Wash hands between each administration of medications to different children and clean any utensils used in the process.
Measurements of the dosage should be done by using measuring instruments designed for administering medication and should be exact, not approximate.
Medications must be left in their original containers and must not be transferred to other bottles. Childproof caps should always be used. Follow the pharmacy’s instructions about refrigeration and other safe storage procedures.
Be fully aware of all the information on the medication administration form. Know what the purpose of the medication is, and about how long before it takes effect. Also, be aware of any possible side effects of the medication.

Treat medication with respect and encourage children to understand the purposes of medication. Never refer to any medication as “candy.” Wash medications down with water. Give the medication before or after eating, as directed. Follow all instructions carefully such as administering antibiotics until they are gone, and do not discontinue upon the appearance of improvement.

Giving medicine to children in childcare settings is a matter of great responsibility. No shortcuts and no compromises are ever appropriate or allowable.

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