1. MEDICATION SAFETY IN CHILD CARE Healthy Start in Child Care Lexington-Fayette Co. Health Dept. Presented by: Karen Jones, MS, RD, LD Thanks to: Shannon Dunn, RN, BSN

2. Justification of administering medication’s in day care When the medication must be given 3 or 4 times a day. When a child has a chronic medical problem which requires urgent treatment. When refusal to give a medication would require day care absence in a child who is otherwise well enough to attend day care.

3. Conditions necessitating the administration of medication Allergies/Asthma ADHD Illness requiring antibiotics Routine symptom control

4. Prescription Meds Should be administered to a child only with the written order of a physician that indicates the medication is for that specific child.

5. Non Prescription Meds (OTC) Need to have original Label Needs a parent/guardian signature with dosage as per label, specific frequency, and child’s name

6. No medication, whether prescription or nonprescription, will be administered to a child without written parental authorization. This authorization must be signed daily!!!

7. What medications can be safely given? Prescriptions from a licensed health professional. Medications with original prescription label. Medications which all the criteria on Kentucky Regulation have been met.

8. Labels Name of child (first and last) Name of doctor (with phone #) Name of medicine Issue date of medicine

9. Labels con’t. Dosage Frequency of dosage Route of administration Storage requirements Child proof container An expiration date

10. Guidelines Only trained staff should give medication Same provider should give the child’s medication daily Ask pharmacists for an extra labeled bottle for day care Be sure you get very specific instructions on administration (food, milk, etc.)

11. Additional Guidelines Do not allow parents to add medications to bottles of formula or milk brought in from home Learn the drugs possible side effects Keep medication log with meds Always put meds up first, before leaving room or answering phone

12. Ideas for parents Consult with doctor may be able to change number of times it’s given in day Come during lunch hours to give medicines Have medicine split into 2 bottles by pharmacist

13. Morning Health Check Signs to Observe Activity level Skin color Unusual spots or rashes Swelling or bruises Sores Severe coughing, sneezing Discharge from eyes, nose, or ears Breathing difficulty General mood/unusual behavior

14. Where should medications be given? Location that is private Where accidental ingestion by children is unlikely Where hand washing facilities are accessible In a well-lit area Close to signed consent forms

15. Storage In a refrigerator separated from food (if refrigeration is required) A cool, dry, dark, locked enclosure which is not accessible to children All unused medications should be returned to the parents In a child-proof container

16. 6 rights of drug administration Right Child Right Dose Right Medicine Right Route Right Time Right Documentation

17. Routes of administration Optic = EYE Otic = EAR Nasal = NOSE Oral = MOUTH Topical = SKIN Rectal = RECTUM

18. Tips for Giving Medications

19. Newborns Easier to give when hungry Use a syringe or dropper at side of mouth in small amounts

20. Infants Hold in a firm, but comforting manner Use a medication dropper or syringe Support the head while in your lap Give small amounts Provide physical and verbal comfort

21. Toddlers Provide a sense of autonomy (give a choice) Never tell a child medicine is candy!! Mix with applesauce or pudding (with MD approval) Give a flavored drink. PRAISE!!!!

22. Preschool Children Explain importance of med Never lie about the taste Never tell them it is candy Praise child for taking med

23. Most Common Forms of Medication Given in Child Care Centers Liquid Tablet Capsule Topical

24. Liquids Suspension Fluid substance with solid particles Must be shaken before administering Usually refrigerated Ex. Amoxicillin Syrup or Elixer Sweetened liquid which contains dissolved medicine Refrigerated to enhance taste Ex. Robitussin

25. Tablets Chewable- ex. Amoxicillin Scored- ex. Ritalin (should be split by pharmacist or parents) Uncoated and coated- ex. Advil

26. Capsules Swallow whole Do not crush Sprinkles are inside of capsule, they can be sprinkled on food when directed. *Sprinkling is only done with written authorization of health care provider

27. Topicals Eye drops and ointments Ear drops and ointments Creams- wear gloves when applying Read directions!! Don’t confuse ear drops and eye drops. Notice whether drops need to be shaken or not.

28. Dosage Amount Age Appropriate Proper Measuring Devices –Dosage Cup –Dosage Spoon –Syringe *Do not use kitchen utensils or silverware

29. Specific Medications Tylenol Ibuprofen Cold Medicines Antihistamines Anti-diarrhea

30. Missed Medication Medication is dropped on floor Child refuses to take medication Spits out the medication Any other unusual occurrence Make note on medication log Contact parent

31. F.Y.I. If medicine is spit up or vomited: 30-45 minutes medicine has been absorbed 5-10 minutes (with abx only) you may need to repeat the dose……so……. Contact parent who may consult with MD and find out what steps need to be taken.

32. Medication Errors Forgetting to give a dose of medication Giving medication to the wrong child Giving the wrong dose of medication Giving the wrong medication Giving the medication at the wrong time Giving the medication by the wrong route

33. Incident Reports Notify your director Notify the parents Fill out an incident report/error report

34. Field Trips Field trip medication sheet: –Child’s first and last name –Age, Teacher –Medication, dosage, route, time to be given –Person giving med –Date and time med was given –Parents and Doctors number

35. Emergency Medications EpiPen for severe allergic reactions Asthma rescue inhaler Use of ipecac is no longer recommended

36. Important Summary Tips Never refer to medicine as candy Be honest about the taste of medication Be aware of rules regarding mixing medicine with food or liquids Always finish a prescription