Administration of Medication

in the Child Care Setting

Catholic Charities-Diocese of JolietECSD Pre-service Conference

August 29, 2014

Deborah Fears, LPN BALinda Paschall, LPN BHA

Health Consultants

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Introduction and GoalsDispensing medicine properly to children is very

important in the child care setting. Given incorrectly, medications may be ineffective or harmful to the child.

Administering medication requires knowledge of proper dosage, attention to time, and careful observation of the child for the effects of the medication after it is given.

Goals:1. Staff are trained and designated to safely receive,

store, handle, administer, and document medication use in the child care setting

2. Staff will be familiar with and demonstrate use of dosing devices, medication measurement, and common medications given in the child care setting.

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Objectives and Agenda: Staff will be able to:

1. Implement policies and procedures for the administration of medication in the child care setting.

2. State the “5 Rights” that must be identified before giving medication to a child.

3. Demonstrate correct use of different dosing devices and correct measurement of medications.

4. Observe for signs of anaphylaxis, adverse reactions or life threatening conditions

5. Correctly complete the agencies written documentation for receiving and giving medicines.

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When medicine is given in the child care setting:All staff members designated to

administer medication must receive training by a health care professional annually.

Staff designated to administer medications are familiar with the actions of medications, their administration, dosages, measurement, documentation and specific policies and procedures of the program.

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When medicine is given in the child care setting:Medicines are given for acute(sudden or

short term) conditions like antibiotic therapy or

for chronic (ongoing) conditions like asthma.

Medications given at the child care setting must be prescribed by a physician or

OTC (over the counter) medication given by permission of the parent with prior approval of the physician.

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When medicine is given in the child care setting:The Americans with Disabilities Act (ADA)

requires child care programs to make “reasonable accommodations” for people with disabilities and special medical needs. Giving medicine is an accommodation made in the child care setting.

When talking with the parent or prescribing health provider, determine if the medication can be given before or after the child is at the program, eliminating the need for giving medication at the child care setting.

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When medicine is given in the child care setting: Written Authorization

Staff must have a written authorization signed by the parent/guardian for medication prescribed by the child’s health care provider.

Staff must have a written authorization signed by the parent/guardian for OTC (over the counter) medication and prior approval (standing order) by a health care provider designating the intended use of the medication.

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When medicine is given in the child care setting: Receiving Medications

Both prescription and OTC medication shall be accepted only in its original container

Prescription medications shall be labeled with the full pharmacy label and clearly readable.

OTC medication shall be clearly labeled with the child’s name. The container must be in a condition that the name of the medication and the directions can be read.

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When medicine is given in the child care setting: Protect the safety of the child.

A designated, trained staff person shall administer and document giving the medication.

Prescription medication shall require a signed authorization by the health care provider and the parent and shall be kept on file and updated regularly.

OTC medications may be dispensed in accordance with the manufactures' instructions with written permission by the parent. However, a standing order for the medication should be obtained from the health care provider.

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How to give medicine in the child care setting: Receiving Medications

Check the label of the original container before accepting the medication from the parent/guardian.

Always use the right technique:◦Note the expiration date. (Do not accept

and/or discard expired medications.)◦Make sure the medication is in a child-

proof container.◦Make sure the administration of

medication consent is completed properly, is current and on file.

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How to give medicine in the child care setting: The “5 Rights”1. Right child (Child’s first and last

name).2. Right medicine (generic or brand

name).3. Right dose (teaspoons: tsp, cubic

centimeters: cc)4. Right route (mouth, nose, eye, ear

drops).5. Right time (before meals, after

meals) and frequency (per day) or intervals (every 4 hours)

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How to give medicine in the child care setting: Follow-up1. Administer medication and document

immediately!2. Observe child and monitor periodically

for side effects and allergic reactions.3. Observe for the most dangerous type

of allergic reaction, Anaphylaxis.4. An emergency care plan is posted in

each classroom and someone trained in first aid and CPR should be on duty.

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How to give medicine in the child care setting: AnaphylaxisThis is a severe allergic reaction

which is life-threatening. Anaphylaxis occurs after the administration of a drug, eating a particular food, or sting of an insect to which the person is allergic.

If you observe or think a child is having an anaphylactic reaction:◦ Instruct someone to call 911 STAY WITH THE

CHILD◦Administer medication for allergic reaction if

prescribed.

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When medicine is given in the child care setting: Anaphylaxis cont’d

Signs and symptoms of anaphylaxis may include:

Hives/itchingDizziness/weaknessNausea/ vomitingAbdominal crampsSwelling of the face, hands, feet, and mucous

membranesWheezingShortness of breathDifficulty breathingSense of impending doom/fearLoss of consciousness

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When medicine is given in the child care setting: Allergic ReactionsThese reactions are related to the action

of the medication. It is difficult to predict if someone will be allergic to a particular drug even if they have taken the prescribed drug before.

When an allergic reaction to a drug occurs, the body’s immune system reacts to a drug by producing histamines. Histamines produce symptoms of an allergic reaction and the severity of the symptoms can change quickly.

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When medicine is given in the child care setting: Allergic Reactions cont’d

If you suspect a child is exhibiting allergic symptoms, withhold the next scheduled dose.

Document and report observations immediately to the parent, inform them to contact the physician and have them pick up their child and go the nearest emergency room.

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When medicine is given in the child care setting: Allergic Reactions cont’dSigns of allergic reactions (not inclusive)

◦ Mouth- itching, swelling of the lips, tongue or mouth

◦ Throat: itching/sense of tightness in the throat, hoarseness and hacking cough

◦ Skin: hives, itchy rash, redness and swelling of the face and extremities

◦ Abdomen: nausea, abdominal cramps, vomiting, diarrhea

◦ Lungs: shortness of breath, repetitive coughing, wheezing

◦ Heart: thready pulse, fainting, loss of consciousness

§§ All above symptoms can potentially progress to a life threatening situation.

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When medicine is given in the child care

setting: Common Dosing InstrumentsThe following are tips for using common

dosing instruments:Syringes: Syringes are convenient for

infants who can’t drink from a cup.◦Draw up the correct dose at eye level and

squirt the medicine in the back of the child’s mouth where it is less likely to spill out.

◦Syringes can be measured out and caped for later use. However these caps can be a choking hazard if not removed before administering the medication.

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When medicine is given in the child care setting: Common Dosing Instruments cont’d.

The cap should be discarded or placed where the child can not get it.

There are two kinds of syringes:◦Oral syringes for administering

medications by mouth◦Hypodermic syringes (for injections),

which can be used for oral medication when the needle are removed. Parents should remove the needle from the hypodermic syringe.

Always remove the cap before administering by mouth.

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When medicine is given in the child care setting: Common Dosing Instruments cont’d.Droppers: Safe and easy to use

for infants and children. Always measure at eye level and administer quickly because dropper tend to drip,

Cylindrical dosing spoons: The spoon looks like a test tube with a spoon at the end. Small children can hold the handle and the spoon fits easily into their mouth.

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When medicine is given in the child care setting: Common Dosing Instruments cont’d.

Dosage cups: These are used for children who can drink from a cup without spilling. Be sure to check the measurements on the side of the cups for the correct number. Measure liquid doses at eye level.

Medication pacifiers: These are used for infants. The medication is measured and poured into the medication holder and the infants sucks the medication through the pacifier.

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When medicine is given in the child care setting: Common Dosing Measurements

Whether they measure teaspoons, ounces or milliliters, dosing devices must be used. Regular tableware must never be used because it is not an accurate measure. One type of teaspoon may be twice the size of another.

If a product comes with a particular device, it should be used. Do not use a device from another product.

Read the measuring instruments carefully, the numbers on the side are small and sometimes difficult to read.

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Four Ways To Help Preschoolers Take Medicine.

1. Mix it up or Chase it dawnWhen approved by the pharmacist or doctor: mix foul tasting meds with yogurt, applesauce, chocolate syrup. Or the treat can be used as a reward and an aftertaste chaser.

2. The Cold MethodIf the child likes frozen treats, have her lick one before giving her a teaspoon or syringe of medicine. Use a strong flavor like orange or grape. The cold also dullest the taste buds.

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Four Ways To Help Preschoolers Take Medicine cont’d.

3. Take your medicine first.Pretend to take your medicine first. Make a big to-do about it. Have the child agree to take his medicine too when you have finished.

4. Give the child choices.Being forced to swallow

something is disgusting. Let her decide between a spoon or syringe, popsicle flavor, etc. Give as much choice as possible.

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Procedures for giving topical medications: Skin Creams/Ointments Wash hands, identify child, read medication consent. Check expiration date. Remember “5 Rights”. Explain the procedure to the child, provide privacy. (If child

needs to undress another caregiver should have clear view of the adult and child.)

Put on disposable gloves Remove any dressings if necessary. Place in a plastic bag. Remove previously applied medication with a gauze pad using

a circular motion from the center to the outside of the affected area. Discard each pad.

Change contaminated gloves. Apply medication using a clean glove or applicator. Apply dressing as instructed. Remove gloves, discard equipment in plastic bag and wash

hands. Document on medication log that medicine was given.

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Procedures for giving Metered Dose Inhalers:Wash hands, identify child, read medication

consent.Check expiration date. Remember “5 Rights”.Explain the procedure to the child, provide privacy.Have child stand up or sit erect.Shake inhaler for about two (2) seconds,Hold mouthpiece 1-2 inches from lips (or as

instructed), open mouth wide(if using a spacer, place mouthpiece in mouth).

Breathe out normally, open mouth and begin to inhale slowly, as the canister is squeezed.

Have child hold his breath for about 10 seconds to allow medicine to settle into air passages.

Wait 1 or 2 minutes before the second puff.Document and observe child for effects of the

medication.

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Most Frequently Prescribed Medications in Child Care

Antibiotics(given by mouth) –used to treat infections.

Acetaminophen( e.g.Tylenol) Used to treat fever and pain.

Antihistamines (e.g. Benadryl)- used to treat allergic reactions, such as runny nose or hives.

Bronchodilators-used to treat asthma attacks. Special equipment such as inhalers and nebulizers are needed.

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Most Frequently Prescribed Medications in Child Care

Decongestants(e.g. Dimetapp) used to reduce stuffiness in ears, nose, and chest.

Eye medication (liquid or ointment administered directly into/or on the eye) used to treat eye infections.

Iron (by mouth) used to treat anemiaCough medicine (suppressant for a dry

cough or expectorant for a wet cough)Topical medications-used to treat skin

conditions such as diaper rash, infections.

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Most Frequently Prescribed Medications in Child CareMedications for chronic

conditions-used to treat seizure disorder, cystic fibrosis, and other chronic illnesses.

Psychotropic medications: used to threat ADHD and other mental or behavioral issues.

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ResourcesAdministering Inhaled medicines and

NebulizersProcedures for administering Auto-

injectors (Epi-Pen©) www.ucsfchildcarehealth.org www.fda.gov/ForConsumers/ConsumerUpdates/ucm164427

.html

Review of Agency PolicyDemonstration: Dosing and

MeasurementsQuiz: Administration of MedicationEvaluations

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Agency PolicyThe medication will be measured by Staff and, if the child is

able, given to the child who will self-administer medication (with parental and physician consent) in the presence of Staff.

 The date, time given, dosage, amount of medication

administered, and the signature of the Staff person giving the medication will be recorded in a log, and kept in a locked file. The log will be kept with the medication in the same locked box.

 The Teachers and other Staff will be responsible for routine

observations of any child receiving medication for adverse effects. Any side effects will be shared with the Site Supervisor or designee. The Site Supervisor or designee will then contact the child’s parent and the child’s doctor documenting the observations.

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Physician’s Signature Physician’s name printed   Name of Medication     Date to Begin Medication     Date to Stop Medication     Dosage     Time(s) to Give Medication