Medicine Administration Policy

^{Rationale and Policy Considerations}

The early years’ service must take appropriate actions to ensure the health, safety and welfare of children in their care, including the administration of medication where required, especially in an emergency situation. This policy sets out the procedures to ensure that the administration of medication is carried out in a safe way. It also needs to ensure that no child’s care is compromised and no child will have to leave the service because medication is refused or delayed. A clear policy and procedures that are understood and accepted by staff members and parents/guardians provides a sound basis for ensuring that children requiring medication receive proper and appropriate care and can attend the service regularly. The purpose of this policy is to ensure:

The provision of a clear, structured procedure for staff members to help deal with any need to administer medication to a child

That any medications required are administered safely and appropriately to children
That medications are stored appropriately
That the appropriate procedure is followed by parents/guardians and by staff members
That there is thorough documentation and recording of any medication administered

^{Legislation and regulatory requirements}

Having a clear, written policy and procedure to ensure the safe storage of medication and the safe administration of medication to a child attending the service is a requirement under Regulation 10 of the Child Care Act 1991 (Early Years Services) Regulations 2016.
Parent/guardian consent for the administration of medication is required under Regulation 16 (1) (j) of the Child Care Act 1991 (Early Years Services) Regulations 2016 .
Under the Safety Health and Welfare at Work Acts 2005 and 2010 and the Safety, Health and Welfare at Work (General Application) Regulations 2007, employers have a duty to ensure the employees’ safety, health and welfare at work as far as is reasonably practicable and to carry out risk assessments and provide safety statements

^{Children’s needs}

Children need:

This policy to ensure that staff responsible for their care have the information and guidance required for the safe storage and administration of medication.
Their parents to be kept fully informed of any administration of medication to them and any issues relating to it.

Parents/Families’ needs

Parents and families need:

To be confident that procedures are in place in the service that ensure that the service is a safe place for their child and their child’s medication needs will be properly met.
To clearly understand the service’s role and responsibilities regarding administration and storage of medication including the need for sharing information.
To clearly understand their own role and responsibilities in relation to the administration of medication for their child, including the need for sharing information.
To know that should any incident relating to the administration of medication involving their child occur in the service, they will be contacted at the earliest possible time and appropriate action will be taken by staff to ensure their child’s wellbeing, for example calling the emergency services if required.
To know that, following any investigation, all relevant information will be shared with them.

Staff needs

The staff members need:

Absolute clarity on the service’s approach to dealing with the administration and storage of any medications
To be competent (have the knowledge, skills, experience) to administer and safely store medication.
To know that they will receive appropriate training if required. This may be from a professional (nurse, doctor, pharmacist) if necessary to ensure their confidence and ability to store and administer medications safely,
To be clear on:
what consent must be obtained;
the information to be recorded;
how this information is to be recorded (in what format); and
who must be informed/notified of any matter relating to administration of medication, what information must be notified, when and in what way.

^{Management needs}

Management needs:

To know that this policy provides the information and clarity that both staff members and parents/guardians need in order to ensure that medication is stored and administered correctly thereby maintaining the safety, health and welfare of the children while in the care of the service.
To ensure that any safety issues and/or notifications of any incidents related to the storage or administration of any medications are brought to their attention, that all required reporting and notifications are carried out appropriately and efficiently.

^{National Quality Frameworks}

Definitions/Glossary

Medication (or medicine)	A medication is a substance that is taken into or placed on the body to cure or treat a disease or condition, to relieve symptoms of an illness or to prevent diseases.
Anti-febrile Medication	Medication used to reduce a raised body temperature. The most common anti-febrile medications used are Paracetamol and Ibuprofen.
Health Care Professional	Can include the child’s general practitioner (GP), dentist, Public Health Nurse (PHN) or an allied health professional such as a pharmacist.

Policy Statement

Parents have the prime responsibility for their child’s health and should provide the service with information about their child’s medical needs including information on medicines their child needs as well as contact information for their child’s GP. In general (name of service) advises parents/guardians to ensure medicines are administered to children before arrival at the centre and after they have left. The service manager will discuss and agree with the parents/guardians on what is to be the service’s role in relation to meeting the child’s medication needs, in accordance with this policy.

The written consent of the parent(s)/guardian(s) must be obtained in all cases using only the medical consent form book . The consent form must be completed in full. Both prescription and non-prescription medicines (such as Paracetamol) can only be administered where specific written consent has been obtained from the child’s parent/guardian.

Only medications suitable for children will be given to a child. Where a parent requests any other medication, the service will seek written confirmation from a registered medical practitioner.

All medications will be administered by a staff member competent and authorised to do so.

All medications will be stored safely away from children’s reach and according to manufacturer’s instructions including refrigeration if required.

All medication received from parents/guardians, administered to children and/or returned to parents/guardians will be fully and accurately recorded

. In respect of those children who have long-term medical needs such as chronic conditions (e.g. asthma, epilepsy, diabetes, severe allergic reactions), written consent of parents/guardians must be renewed when any change to the administration of the medication is made.

Any child who may require emergency medication will always be in the care of a staff member who has received the required specific training.

Parents remain responsible for ensuring that the service has adequate supplies of the medication their child needs (prescription and non-prescription) and renewing any medication for chronic conditions.

In some cases an Individual Care Plan may have been developed and the service ensures that the medication required in the plan is given as detailed. The Individual Care Plan may be drawn up by the relevant health care professional in conjunction with the service if appropriate. Such a plan will include details of any chronic diseases or health issues the child is currently receiving treatment and care for, such as allergies or asthma. The plan documents current medications, medical treatments and other therapeutic interventions and specifies how the service will meet the child’s needs.

The service will only accept prescribed medicines that have been provided in the original container marked with the date, name of the dispensing pharmacist, expiry date and clear directions.

The service will only administer medications as prescribed and will not change this at the request of parents without a registered medical practitioner’s written direction. The service reserves the right to contact a health care professional if authorised staff members are unsure about administering medication to a child, even if the parent/guardian has requested the medication to be administered.

Procedures & Practices

Parents’/Guardians’ role and responsibilities

The parent/guardian must provide the following details on the child’s enrolment to the service:
Details of any medical condition
Emergency contact numbers
GP details – name, address and phone number
Written details of any medication required (instructions on dosage and times and written consent for staff to administer the medication – see below for further details)
Information on any allergies
Special dietary needs
Parents/guardians must make every possible effort to ensure that the child’s medication needs are met before arriving at the service and after returning home.
Parents/guardians must complete in full the Consent Form for Administration of Medication and provide all of the information the service will need to:
safely store medicines
administer the necessary medication to their child
deal with any issues or incidents arising relating to their child’s condition or the administration of the medication

Medication must be provided by parents/guardians in its original labelled container as dispensed by a pharmacist including the child’s full name, prescriber’s instructions for administration, clear storage instructions, the date it was dispensed and the expiry date. Medicines must never be transferred from their original container as dispensed by a pharmacist which includes the prescriber’s instructions for administration. Where a recipient needs two or more prescribed medicines, each should be in its own separate container and clearly labelled as above Parents must sign the completed medication administration form to acknowledge notification for each day that medication is required.

Staff members’ responsibilities

Parents must be informed of the policy and procedures on the administration of medications in the service. Where informed consent has been obtained for the administration of medicines from at least one of the child’s parents/guardians then the following will apply:

The child must have received the medication for at least 24 hours prior to it being given in the service.
All medications will be administered by a staff member competent to do so.

[Staff members should receive training where required about the purpose, expected response, contra-indications and possible side effects of medications they are expected to administer. They must be made aware of how the medication reacts with food, fluids or other medications, e.g. some medications cannot be given with milk, or when taking another medication. They need to know what adverse reactions are possible and what to do should they occur. Training must also be provided on the proper use of equipment such as inhalers or nebulisers.]

All medications will be stored safely away from children’s reach and according to manufacturer’s instructions.
Staff members can only administer medication to a child that has been prescribed for that particular child.

A list of those staff members authorised to administer medications is kept in the office.

Administering Medication General points of note:

Only staff members authorised by the manager to do so, and appropriately trained for the specific medications, are to administer medication. Medication must not be added to the child’s bottle or food unless the registered prescriber has directed that this is how it should be administered. The staff members may administer non-prescription medicines (including non-prescription ointments for rashes) according to the written directions but only with prior written informed parental/guardian consent, and supply of the medication. No anti-febrile medications are given without the daily approval and notification of the child’s parent/guardian unless not doing so would put the child’s health at risk.

When a child’s body temperature rises beyond a safe limit (38°C or higher[1]) it is important that appropriate measures are taken to reduce the child’s temperature. This may include the administration of an anti-febrile medication. Staff members involved must keep records each time they administer medication using the Record of Medication Administration Form

Prescription ointments for nappy rash are not applied unless for specific treatment purposes and where a health care professional has directed their use for the child on whom they are being used. The ointment must be supplied by the parent. Instructions which state that a prescribed medication may be used whenever needed must be reviewed with the parent at least at the beginning of each term. ‘As needed’ medications for example an inhaler must be labelled with the child’s name and in their original container labelled with the required information (see below for Storage of Medications). Prescription or non-prescription medications are accepted for use only when they are within date. Medication must not be used beyond the date of expiration on the container or beyond any expiration of the instructions provided by the health care professional. All staff members should follow hygiene procedures for example hand washing and drying.

Before administration of medication

A second staff member must be present when medications are administered.

Both staff members must confirm:
That appropriate consent has been given
That the child’s identification is in accordance with the medication to be administered
The date and time the medication was last given
Recipient’s name
Prescribed dose
Expiry date
Written instructions provided by the prescriber on the label/container as dispensed by the pharmacist
Any possible side effects

If there is any doubt about any of the procedures, the authorised member of staff should check with parents/guardians and/or a health professional before taking further action. It must be checked that the medicine has previously been administered without adverse effect to the child and that parents have confirmed this is the case – a note to this effect should be recorded in the written parental agreement for the setting to administer medicine.

On administration of medication

Both staff members must confirm: The correct medication Medication is given to the correct child. The medication is given at the correct time and date. The correct dose is given. The correct route of administration. Appropriate equipment is used to administer the medication dose – for liquids the correct measuring tool provided with the medication. The dignity and privacy of the child is ensured as appropriate – for example when medication is required to be administered by a route other than the oral route.

After administration of medication

Observe child for any possible side effects.
Where appropriate observe their response to medication – for example where an anti-febrile agent is administered.
Medication returned to appropriate storage.
Appropriate management or disposal of any equipment used in administration.

Accidents and Incidents Involving Medications

Where a child refuses to take the medication prescribed for them, they must not be forced to do so but parents/guardians must be informed as a matter of urgency. If the child not taking the medication leads to an emergency situation, the emergency services and the parents must be called.
Failure to administer medication at the time prescribed as requested by a health care professional or parent/guardian should be noted on the Medication Administration Form (Appendix B) with a written explanation of why the medication was not given.
If a child is mistakenly given another child’s medication, a doctor must be called immediately and the advice given must be followed. The parents of the child who mistakenly received the medication must be called as soon as possible.
The poisons information line number, GP, Pharmacist and other emergency numbers must be readily available at all times.

Dealing with Emergencies

Where medication is administered in the case of an anaphylaxis or asthma emergency, both the emergency services and the child’s parents/guardians must be notified as soon as possible.

All relevant staff members need to know where to obtain First Aid and how to summon the emergency services. Where a child is taken to hospital by ambulance they must be accompanied by a member of staff who is to remain with them until a parent/guardian arrives (See Accidents and Incidents Policy and Procedures). All required information is shared with the emergency services and the child’s parents/guardians. Staff support is essential following any such incident.

Medications Records

Staff members involved must keep records each time they administer medication in the Record of Medication Administration Form .

A medication record must be created and kept for each child to whom medication is, or is to be, administered.

The record for both prescription and non-prescription medications must include:
The name of the child
A consent signed by the parent(s)/guardian(s) to administer each medication
A medication administration log detailing the checks completed prior to administration of medication to the child including:
Check of the child’s identification
Whether consent was received
When the medication was last administered (either at home or in the service)
Check of the administration instructions, including the name of the medication, the method and times for administration and the required dose
Check to ensure the medication is within expiry date
The time and date the medication was administered
The route and dose of medication administrated
The signature of the person who administered the medication and the signature of the witness
The time and date, or the circumstances under which, the medication is scheduled to be next administered
Any side-effects noted after the medication was given or if the dose was not retained because of the child vomiting or spitting out the medication.
The number of attempts to give medications that were refused by the child is also documented

Storage of Medications

All medications brought into the setting are stored according to the manufacturers’ instructions paying particular note to temperature, sources of moisture, light and sources of contamination and safely out of the reach of children. Medicines are stored safely in a secure container, accessible to authorised persons. Emergency medication such as asthma inhalers and adrenaline pens must be readily accessible to authorised staff members in case of an emergency when time is of the essence. A copy of the consent form for administration of medication and clear, precise details of the action to be taken should be immediately accessible. Sunscreen, special soaps, lotion and nappy creams do not need to be in a locked container but must not be accessible to children. Medications requiring refrigeration should be clearly marked and separated from food in an airtight container marked ‘Medications’. Access to the fridge should be restricted. Medications that are applied to skin should be kept separate from medications that are injected into the body or taken by mouth. Medicines must never be transferred from their original container as dispensed by a pharmacist which includes the prescriber’s instructions for administration. Non-prescription medications should be labelled with the child’s full name and the expiry date must be visible and monitored.

Staff members should only bring their own medication to work when it is absolutely necessary (either prescribed or over the counter). They must ensure that these medications are stored securely so that others (including children and adult service users) do not have access to these medications. This includes for example medications held on the person, held at desks, in their bags, coats or in vehicles.

Disposal of Medications

Medication should be returned to the child's parents whenever:

The course of treatment is complete
Labels become detached or unreadable
Instructions are changed by a health care professional
The expiry date has been reached
When the child ceases to attend in the service
To ensure a complete record all medication returned, even empty bottles, should be recorded.
If a parent has not picked up unused medication by 14 days after the required use or it is not possible to return a medicine to the parent, then it should be taken to a community pharmacy for disposal. No medicine should be disposed of into the sewerage system or in the refuse.

Sunscreen Application

The time and frequency of application of sunscreen is to be recorded. Written consent is not required to apply sun protection creams supplied by the parent/guardians for their own child as the supplying of the sunscreen gives implied consent for that specific cream. Written consent is required from parents/guardians to apply sun protection creams supplied by the service in order that the parent can advise if a previous adverse reaction may have occurred with the cream supplied by the service. As part of the planning process and risk assessment for outings, the medication needs of children are taken into account. Specific measures may be necessary to support those who need to take medication and to ensure sufficient medical supplies are available. All staff members participating in the outing must be aware of the medication needs of the children and any agreed medical emergency procedures. A member of staff who has been trained to administer the required medication must be present. All staff must know there role in the event of a medical emergency. A copy of any individual care plans should be taken on outings as the information may be needed in the event of an emergency.

^{Communication Plan}^{[For staff & families]}

All parents/guardians are informed of the policy and procedures regarding the administration of medication on enrolment. Staff members will check with parents that they have read and understood the policy and provide any assistance needed. A summary of this policy will be included in the parent handbook. This policy will also be reviewed with staff members at induction and annual staff training. A copy of all policies will be available during all hours of operation to staff members and parents in the Policy Folder located in the office. Parents/guardians may receive a copy of the full policy and procedures at any time upon request. Parents/guardians and all relevant staff members will receive written notification of any updates to this policy.