Medication Policy and Procedures Policy Number: 2009/10 Approved by: Heritage Management Committee 10 November 2009 Last reviewed: October 2009 Next review due: November 2011 Policy Statement Studies of children in care have found that in any one day 5% are on medication for an illness, mostly for asthma, respiratory or ear infections, or allergies, and in a month, half will have been on over-the-counter medications for colds or allergies (School of Public Health & Community Medicine, University of New South Wales, 2003). In addition, many children have chronic health problems such as asthma, diabetes, epilepsy and allergies and may be at risk of a medical emergency while in care and require emergency treatment or medication. The administration of medication is considered a high risk practice and as such carries obligations for both staff and parents/guardians. The administering of medication requires attention to detail, meticulous record keeping, teamwork and common sense as incorrect administration has potential health and litigation risks (National Health Medical Research Council 2006). Staff must be trained in the safe and hygienic administering of medications as part of their professional development, in addition to first aid qualifications, to ensure safe and hygienic practices and so adverse reaction to medication can be dealt with quickly and responsibly. While families place a high level of trust and responsibility on staff when administering medication to children and must feel confident that the process is carried out responsibly, staff must also feel they are protected against any possibility that instructions have been misunderstood. Thus parents are expected to properly document their requirements and staff must ensure this has been done before any medication is administered. It is imperative that staff are told about any medication being administered while the child is not attending Heritage. Refer to: Illness Policy. Policy Aim The Heritage Medication Policy and related procedures has been developed to ensure the appropriate administering of medication to children. Rationale Heritage recognises it has a duty of care to take all reasonable practicable steps to provide the Heritage community with a safe and healthy environment (Occupational Health and Safety Act 1989). In addition the Heritage Medication Policy and Procedures have been developed to comply with: ACT Childcare Services Standards 2009 (required by The Children & Young Persons Act, 2008). National Childcare Accreditation Council s Quality Improvement and Accreditation System (QIAS), Quality Practices Guide, Principles 4.3, 6.4 and 5.5. National Health and Medical Research Council guidelines October 2009 Page 1 of 8
Scope It is understood that there is a shared responsibility and accountability between staff and parents/guardians to implement the Heritage Medication Policy and Procedures as a matter of high priority due to the potential health and litigation risks of incorrect administration. Definitions Medication may be prescribed or non-prescribed. For the purpose of the policy, prescribed is defined as, Authorised by a health care professional and dispensed by a pharmacist with a printed label, which includes the child s name, dosage and expiry date. Examples include antibiotics and Ventolin. All medication that does not meet this criteria is defined as non-prescribed and includes eczema cream, paracetamol, antihistamine and teething gel. Summary of Principles The Heritage Medication Policy reflects the following principles: safe principles and practices to administer medication; hygiene practices; an acute attention to detail; the maintenance of accurate records; up to date professional development knowledge of administering techniques; first aid qualifications; licensing and/or legislative requirements; recommended advice and practices from a medical source; open communication between staff/carers, families and children; and the accountability of staff/carers when administering medication. The basic principles of medication administration will be adhered to at all times. The five principles are the right: child; medication; dose; method; date and time; and expiry date of the medication. Medication can only be administered when the Heritage Medication Book has been completed and signed by the child s parent or legal guardian. Heritage reserves the right to contact a health care professional if staff are unsure about administering medication to a child, even if the parent or legal guardian has requested the medication to be administered. Ultimately the safety and welfare of children is given first priority by Heritage staff, when administering medication. October 2009 Page 2 of 8
Summary of Responsibilities R Director The Director (or nominated member of staff in their absence) is responsible for: Clearly explaining during enrolment, the Heritage Medication Policy. Ensuring all parents complete all relevant Medical Condition Management Plans. Checking every six months that the forms are up to date. Room Leaders Room leaders (or nominated members of staff with a first aid certificate, in their absence) are responsible for: Administering all medications appropriately at the prescribed intervals; Advising parents that for prescribed medicines, only the child on the label may be administered the medication and only the dosage on the medication will be followed; Ensuring parents complete in full the Medication Book; Resolving any difficulty before medication is administered by contacting the parents. If they cannot be contacted, and information is required urgently, staff will call a doctor, pharmacist or Health First. Health First Number is 6207 7777. If there is any doubt about the instructions, medication is not administered. Ensuring out-of-date medicines are not administered; Cross checking with another member of staff before administering medication; Signing the Medication Book and ensuring the witness signs as well; Contacting the Emergency Services in an emergency. All Staff All staff are responsible for: Ensuring parents deliver medication to a qualified member of staff so it can be stored securely (out of children s reach and in a sealed, labelled container) and at the recommended temperature (eg in fridge) or authorised medical cabinet. Monitoring children following the administration of medication for any adverse reactions. Parents Parents are responsible for: Signing, on enrolment, written permission to allow Heritage staff to administer first aid remedies such as Panadol, antihistamines, Ventolin, insect spray etc. These will only be administered at the discretion of the Room Leader. Notifying the Director on enrolment of any long term medical conditions such as allergies, asthma, diabetes or epilepsy where medication is required, either intermittently or on a continuous basis, and completing the relevant Medical Condition Management Plan forms. Completing and signing the Medication Book (see form at end of document), located in each room, as required. Staff cannot administer medication without the written permission and signature of the parent. Ensuring all medications are handed to a member of staff for safe storage. It is vital that medication is NOT stored in children s bags. Ensuring child s medication is clearly labelled with prescribed information (dosage etc), is in its original packaging, and includes the child s name and date of issue. Prescribed medication that does not bear the child s name will not be given. Providing written advice from a GP or registered complimentary practitioner if herbal preparations are to be administered. Informing staff of any medications (including Paracetamol) being administered to the child outside Heritage hours, such as in the morning before arriving or the night before. Refer to: Illness Policy. Excluding their children from Heritage for the first 24 hours after commencing a course of antibiotics. If a repeat course of antibiotics, including a different antibiotic, the child is not excluded, providing they are coping with the daily routine. Refer to: Illness Policy Ensuring the full course of medication is completed even when symptoms disappear, eg antibiotics or eye cream/drops. October 2009 Page 3 of 8
Strategies and Practices Assessing the Need for Administering A Medication Before administering medication staff must assess: Is the medication suitable or recommended for children? Is the medication suitable for the child s age / weight? Is the medication appropriate for the symptoms? Is the expiry date current? When was the last dose administered to the child? Is the child taking a safe combination of medicines? If staff have any doubt regarding these questions or the interpretation of parental instructions, they should ask the parents to get a written authorisation from the child s GP. If they cannot be contacted, and information is required urgently, staff will call a doctor, pharmacist or Health First. Health First Number is 6207 7777. If there is any doubt about the instructions, medication is not administered. Non-Prescribed Medication / First Aid remedies For non-prescribed medication or first aid remedies, the medication must be appropriate for the symptoms. For example, a coughing child does not need paracetamol if there is no fever or pain observed. A decongestant may be more suitable. Prescribed Medication For prescribed medicine for an infectious illness or disease, staff will need to assess whether the child should be excluded from Heritage. If parents insist a child should stay at Heritage on medication, staff must respectfully communicate with the parent and refer to the exclusion guidelines in the Illness Policy. A child will be excluded from Heritage while on antidiarrhoea medication. Medical Condition Management Where a child has asthma or other on-going medical condition with requires emergency, intermittent or on-going medication, staff will follow the instructions given on the child s Asthma, Anaphylactic or other Medical Condition Management Plan. Infectious Diseases In some cases children can return to Heritage after an infectious disease or illness where medication is still being administered. For example, a child can attend care with impetigo as long as the sores are not weeping and an antibiotic has been administered for more than 24 hours. Refer to: Illness Policy. Rising Temperature In the event of a rising temperature, staff will follow the medication administration guidelines given in the Illness Policy. If requested by a parent or emergency contact person, Room Leaders may administer Paracetamol. The child s temperature, time, medication, dosage and the staff member s name will be recorded in the Medication Book, and the parent asked to sign the Book on arrival. (According to Staying Healthy in Childcare (2005), there is evidence to suggest that reducing a fever slows the immune system s response to fighting an infection). Immunisations Heritage recommends that parents have children immunised at the end of the day or keep children, particularly babies, at home following immunisations early in the day as side effects are common. If parents insist they return to Heritage on medication, staff must respectfully communicate with parents and refer to the guidelines in the Illness Policy if the child is not coping in the care setting. October 2009 Page 4 of 8
Multiple Medications If children are being given multiple medications, such as for an ear infection, a cold and paracetamol, and staff are concerned, they must respectfully communicate with the parents and ask for a written letter from their GP. If a parent says, this is what we always give them, staff must strictly adhere to the Guidelines for Administering Medication, given above. Authorisation to Give Medications Staff must always have parental/guardianship authority to administer medication to a child. This is given on the day via the signed entry in the Medication Book, or on enrolment for specific medical conditions such as asthma. Authorisation to administer first aid remedies is also sought on enrolment. If consent is not received, then staff need to refer to the Director who will consider the risks of administering medication without consent. Medication Authorisation Form The Medication Book form (at the end of this document) includes the following details: Child s name who requires the medication Child s parent / guardian signature Name of medication Dose required Method of administration eg oral, eye, ear, inhaled Date and time of administration Expiry date of medication Special instructions eg an hour before a meal Allergy information Administering Medication to a Child Parents are to hand medication to a staff member for safe storage. Parents are to record details of the medication in the Medication Book and sign the entry. The Room Leader is to verify the entry has been completed and resolve any discrepancy before medication is administered. The Room Leader is to administer medication, ensuring the five principles of medication administration are adhered to at all times (National Childcare Accreditation Council (2007). They are the correct: Child Medication Dose Method Date and time Use of the expiry date of the medication Staff are to be witnessed by another staff member or parent /carer when administering medication to children, and that the witness signs the Medication Book. Hygiene Practices Staff must wash their hands before administering medication, and maintain a clean and hygienic environment before and after medication is administered. Refer to: Hygiene Policy. The Heritage First Aid Asthma puffer and spacer is to be cleaned after use. Refer to: First Aid Policy. Monitoring after the Administration of Medication Children should be monitored after the administration of medication and if they have an adverse reaction to medication follow the First Aid action plan for allergic reactions. Refer to: First Aid Policy; Allergy and Anaphylaxis Policy. October 2009 Page 5 of 8
Storage and Disposal of Medication Parents must deliver medication to a qualified member of staff so it can be stored securely (out of children s reach and in a sealed, labelled container) and at the recommended temperature (eg in the fridge in each room) or the allocated medical cabinet, out of reach in the kitchen areas of each room. All prescribed medicine must have the child s name clearly on the label and be in its original packaging. For non-prescribed medicine, parents must attach a label and print the child s name clearly (stickers can be found in the medicine cupboard in each room), Heritage will dispose of any medications by returning them to a Pharmacist. Communicating with Staff and Families Heritage staff will communicate with families and each other about the administration of medication children through the Medication Book. In addition they will exchange information verbally and on the phone and this information must be documented on the form. Any spill, reaction or refusal to take medication will be recorded. All documentation regarding children s health is filed in the Main Office. Prolonged Use of Medication For non-prescribed medication, parents will, after 5 days, be asked to seek further advice from their GP to confirm the medication needs to be continued. For example, there is little evidence that decongestants or cough medicines help children with colds, and that they can in fact be harmful and cause irritability and drowsiness. If staff are concerned that a child is over-using using medication, parents will be asked to get written confirmation from their GP that the medicine is necessary. For example, in recent years there has been much concern about the overuse and inappropriate use of antibiotics to treat colds and viruses. Training Heritage maintains and develops the skills of staff in relation to administering medication to children as part of their Professional Development Program. Children learn through the Program about healthy and safe living. For example, they are taught not to touch medications and to tell an adult if they find some. They also learn about conditions such as asthma and to tell and adult if they see a child is hurt or ill or having difficulty breathing. Excursions Staff will adhere to the Medication Policy principles on excursions so medication is administered in a safe and hygienic way. A portable first aid kit is taken on excursions and will be used to store medications and medical equipment. A cooler bag is used for medications which need to be stored in a fridge. Emergency contact and medical information is taken. Refer to: First Aid Policy; Excursions Policy. October 2009 Page 6 of 8
Related Material Name Location Allergy and Anaphylaxis (including Nut Free) Policy Asthma Policy First Aid Policy Emergency Policy Enrolment Policy Hygiene Policy Illness Policy Immunisation Policy Occupational Health and Safety Policy Privacy Policy References and Further Reading ANU Preschool and Childcare Centre. [2006]. Policy Handbook 2006. Retrieved 31 July 2009, from http://www.anu.edu.au/childcare/preschool/upccc-policy-handbook-2006.pdf Centre for Community Child Health. (2005). Medication Management in Children s Services. Childcare and Children s Health, vol. 8, N0.2, April 2005. Frith, j., Kambouris, N., & O Grady, O. (2003). Health & Safety in Children s Centres Model Policies & Practices, 2nd edition. School of Public Health & Community Medicine, University of New South Wales. Retrieved 31 July 2009, from http://www.ccccnsw.org.au/resource/health/ccmodelpoliciesfinal.pdf National Childcare Accreditation Council. (2007). Sample Medication Policy Template. Retrieved 31 July 2009, from http://www.ncac.gov.au/policy_development/medication_policy_template.doc National Health Medical Research Council. (2006). Staying Healthy in Child Care - Preventing Infectious Diseases in Child Care, 4 th Edition. Retrieved 31 July 2009, from http://www.nhmrc.gov.au/publications/synopses/_files/ch43.pdf Somerville Community Services Inc. (1997). Practical Policies and Procedures for Child Care Services. Casuarina, NT: Somerville Community Services Inc. Useful Websites Anaphylaxis Australia www.allergyfacts.org.au/foodalerts.asp Asthma Foundations Australia www.asthmaaustralia.org.au Centre for Community Child Health - www.rch.org.au HealthInsite - www.healthinsite.gov.au National Health and Medical Research Council - www.nhmrc.gov.au National Prescribing Service- www.nps.org.au Raising Children Network www.raisingchildren.net.au Useful Fact Sheets for Parents Illness in Child Care Fact Sheet http://www.ncac.gov.au/factsheets/illness.pdf Staying Healthy in Child Care http://www.nhmrc.gov.au/publications/synopses/ch43syn.htm October 2009 Page 7 of 8
Version Control and Change History Version Number Approval Date Approved by Amendment 1 September 2001 HECC Management Committee 2 January 2007 HECC Management Committee 3 November 2009 HECC Management Committee Complete rewrite of Heritage Medication Policy based on National Childcare Accreditation Council s Medication Policy Template and other references above. Revised Medication Book form. October 2009 Page 8 of 8