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Medication Policy

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					                                                  <Service name>


                                                Medication Policy


Administering medication should be considered a high risk practice. Authority must
be obtained from a parent or legal guardian before staff/carers administer any
medication (prescribed or non-prescribed).

Families place a high level of trust and responsibility on staff/carers when they are
administering medication to children, or observing older children self-administer.
Services should ensure that their policy and practices regarding medications meet
legislative requirements and that the service seeks additional medical advice or
opinion as needed.

It is crucial that staff/carers have some form of professional development training or
knowledge of administering medications, in addition to first aid qualifications to
ensure that an adverse reaction to medication can be dealt with quickly and
responsibly.


Policy Number                          <number>

Link to CCQA Principles                Family Day Care Quality Assurance (FDCQA)
                                       Quality Practices Guide (2004) – Principle 4.3/
                                       Outside School Hours Care Quality Assurance (OSHCQA)
                                       Quality Practices Guide (2003) – Principle 6.4


Policy statement

        <Service name> has a duty of care to ensure that all persons1 are provided
         with a high level of protection during the hours of the service‟s operation.

        The service‟s Medication Policy reflects the following principles:
            o safe principles and practices to administer medication;
            o hygiene practices;
            o an acute attention to detail;
            o the maintenance of accurate records;
            o up to date professional development knowledge of administering
                techniques;
            o first aid qualifications;
            o licensing and/or legislative requirements;
            o recommended advice and practices from a medical source;
            o open communication between staff/carers, families and children; and
            o the accountability of staff/carers when administering medication.



1For the purpose of this policy, 'persons' include <children, families, staff, carers, carers' family, management,
coordination unit staff, ancillary staff (administrative staff, kitchen staff, cleaners, maintenance personnel), students,
volunteers, visitors, local community, school community, licensee, sponsor and/or service owner>.



                                                                                                             Page 1 of 10
        The basic principles of medication administration will be adhered to at all
         times in the service. The five principles are the right:
             o child;
             o medication;
             o dose;
             o method;
             o date and time; and
             o expiry date of the medication.
         These basic principles are the first steps in ensuring that medication is
         administered safely to any person, and should be documented by the parent
         or legal guardian before administering medication to a child.

        Medication can only be administered when the service‟s <medication
         authorisation form2> has been completed and signed by the child‟s parent or
         legal guardian.

        In this service, medication is administered to a child by a <staff, carer,
         manager, coordination unit staff> or in some cases, with parental or guardian
         consent, medication can be self-administered by a school age child. When
         medication is being self-administered, children are supervised by staff/carers.

        The service will endeavour to ensure that staff/carers are witnessed by
         another person when administering medication to children.3

        It is understood by staff/carers, children and families that there is a shared
         responsibility between the service and other stakeholders that the Medication
         Policy and procedures are accepted as a high priority.

        In meeting the service‟s duty of care, it is a requirement under the
         Occupational Health & Safety Act4 that management and staff/carers
         implement and endorse the service‟s Medication Policy and procedures.

     The service reserves the right to contact a health care professional5 if
      staff/carers are unsure about administering medication to a child, even if the
      parent or legal guardian has requested the medication to be administered.
Rationale

The rationale represents a statement of reasons that detail why the policy and/or
procedures have been developed and are important to the service.

Please refer to:
    National Health and Medical Research Council. (2005). Staying healthy in
      child care: Preventing infectious disease in child care (4th Ed.). Canberra:
      Author.

2 For the purpose of this policy, „medication authorisation form‟ is the term used for parents or guardians to grant
written consent for a service to administer medication to a child.
3 In family day care schemes and single staff model outside school hours care services, ensuring that a witness can

observe another staff/carer administer medication is difficult or not an option. In this situation, services may need to
develop practices or strategies that protect staff/carers and reduce the likelihood of a potential incident.
4 There are legislative Acts and regulations for each state and territory that address the issue of Occupational Health

and Safety. Services are advised to seek information that is relevant to their jurisdiction.
5 For the purpose of this policy, „health care professional‟ can include the child‟s: medical practitioner (or doctor of

medicine); allied health professional, such as a speech therapist, nutritionist or child psychologist.



                                                                                                          Page 2 of 10
Strategies and practices

These are examples. Services are encouraged to develop and adapt the following
strategies and practices as required to meet their individual circumstances and daily
best practices.

Definition of medication
    The service has the opportunity to define „medication‟ in the context of the
        policy. The term „medication‟ can be defined either as prescribed or non-
        prescribed. For the purpose of this policy, „prescribed‟ medication is:
              o authorised by a health care professional; and
              o dispensed by a pharmacist with a printed label, which includes the
                  name of the child being prescribed the medication, the medication
                  dosage and expiry date.
        All medication that does not meet the criteria for prescribed medication, can
        be considered non-prescribed. This includes over-the-counter medication;
        medication dispensed by a naturopath/homeopath; or considered
        complementary or alternative such as vitamins and cultural herbs or remedies.
    Examples of prescribed medication include antibiotics; Ventolin for asthma; or
        Ritalin for Attention-Deficit Hyperactivity Disorder.
    Examples of non-prescribed medication include topical or antifungal creams
        for nappy rash or eczema; paracetamol; ibuprofen; antihistamine for an
        allergy; or teething gel.

Handwashing and hygiene practices
   Brief and concise detail of the service‟s strategy.
   Services should consider the following reflective questions:
        o Why do staff/carers or children need to wash their hands before
           administering medication?
        o When does handwashing occur?
        o Are there situations when handwashing may not occur before
           administering medication? For example, school age children may self-
           administer asthma medication. How can the service encourage
           children to remember to wash their hands?
        o Can the service identify when staff/carers may require gloves when
           administering medication?
   Services can link this section by stating:
     Please refer to the service‟s Hygiene and Infection Control Policy.

Maintaining clean and hygienic environments
   Brief and concise detail of the service‟s strategy.
   The service can state how some environments need to be hygienically
      maintained when medication is applied or administered. For example, a baby
      who has thrush needs to have an antifungal cream applied at each nappy
      change. Staff/carers will need to follow hygiene practices to ensure that the
      nappy change mat is safe to use for other children.
   Services should consider the following reflective questions:
          o How does the service ensure that hygiene practices are maintained
             when medication needs to be applied?
          o How does the service‟s hygiene practice change when a child is
             known to have an infectious illness or condition and medication is
             required? If so, in what situation and why?


                                                                           Page 3 of 10
          o   Is there specific equipment required when administering or applying
              medication which may need to be cleaned? How is this process
              carried out?
      Services can link this section by stating:
       Please refer to the service‟s Hygiene and Infection Control Policy.

Assessing the need for administering medication
    Brief and concise detail of the service‟s strategy.
    Services should consider the following reflective questions:
          o If the medication is non-prescribed, is it appropriate for the child‟s signs
             and symptoms? For example, if the child is coughing and wheezing,
             how will a paracetamol help the child‟s condition if there is no pain or
             fever observed? Is a decongestant more appropriate? How does the
             service communicate this respectfully to the child‟s family?
          o If the child is being medicated for an infectious illness or disease, does
             the child need to continue to be excluded from the service, as per the
             exclusion guidelines?
          o How do staff/carers assess a child‟s health?
          o What strategies are in place that support staff/carers when they have
             decided a child is too ill for care but the family insist that the child
             should attend care with medication?
          o Do staff/carers feel comfortable or confident administering the
             medication?
    Services can link this section by stating:
       Please refer to the service‟s Illness Policy.

Exclusion guidelines
    Brief and concise detail of the service‟s strategy.
    The service can state when children can return to the service after an
       infectious disease or illness, where medication is still being administered. For
       example, a child can attend care after being diagnosed with impetigo as
       long as the sores are not weeping and an antibiotic has been administered
       for more than 24 hours. Services should refer to their relevant state or territory
       health authority for exclusion guidelines.
    Services can link this section by stating:
       Please refer to the service‟s Illness Policy.
       Please refer to the service‟s Immunisation and Health Related Exclusion Policy.

Assessing the need to administer fever reducing medication
    Services should consider the implications of administering fever-reducing
       medication, such as paracetamol, when children are experiencing a high
       temperature. According to Staying Healthy in Child Care (2005, p.21) there is
       evidence to suggest that reducing a fever slows the immune system‟s
       response to fighting an infection.
    There is conflicting professional opinion in the children‟s service sector relating
       to the use of paracetamol to reduce fevers in children. Services should consult
       with medical practitioners, hospitals, state/territory licensing guidelines, peak
       bodies, recommendations from recognised authorities, staff/carers‟
       professional opinion and the needs of families, when deciding on the practice
       of administering fever-reducing medications.




                                                                              Page 4 of 10
      Ultimately, the safety and welfare of children is the first priority of a service and
       all medication should be administered in accordance to the service‟s
       Medication Policy, in conjunction with parent or guardian authorisation, and
       legislative guidelines.

Authorising the administration of medication
    Brief and concise detail of the service‟s strategy.
    This is the most important step in the administration of medication. If the
      service has not received parental or guardianship authority to administer
      medication to a child, then it needs to consider the risks of administering
      medication without consent.
    It is absolutely crucial at this point to determine a number of important
      elements, especially for non-prescribed medications, that the service may
      state in the policy:
           o Who has recommended the medication? For example, a child‟s
              parent, homeopath or a pharmacist.
           o Is the medication suitable or recommended for children?
           o Is the medication appropriate for the child‟s age? For example, if the
              manufacturer‟s advice does not recommend for children under two
              years of age, will the service accept responsibility for administering that
              medication to a 12 month old (even at the request of the parent)?
           o Is the medication appropriate for the symptoms or illness?
           o What happens if the dose is different for weight or age? For example, if
              a child is heavy for their age, does the service base the dose
              requirements on the weight of the child or the child‟s age?
           o How does the service respond to a claim “but this is what we always
              give to her” or “the pharmacist said it was the right dose” when the
              manufacturer‟s recommended dose is not being adhered to?
           o Has the medication expiry date lapsed?
           o When was the last dose administered to the child? For example, the
              time between doses of paracetamol is important. If the parent or
              guardian requests a time that is not within the manufacturer‟s
              recommendations, what is the action of the service?
           o Are the recommendations or instructions written in another language?
              How does the service respond to a family‟s request to administer
              medication that staff/carers are unable to interpret?
           o Is the child taking a combination of medications? What are the
              potential risks of administering more than one medication to the same
              child? Would the service feel more confident with a letter from the
              child‟s health care professional authorising the administration of more
              than one medication? For example, a parent may state the child has
              an ear infection and a cold, and requests a paracetamol,
              decongestant and antibiotic to be administered during the day. How
              does the service respond to this scenario? Why is it important to state in
              the policy how the service will respond?

Medication authorisation form
   Brief and concise detail of the service‟s strategy.
   Services should consider the following reflective questions:
         o Does the medication authorisation form include the following details:
                Child‟s name who requires the medication;



                                                                                 Page 5 of 10
                          Child‟s parent or guardian‟s name and signature;
                          Name of the medication;
                          Dose required;
                          Method of administration, for example oral, eye, ear, inhaled;
                          Time and date of administration;
                          Expiry date of the medication;
                          Special instructions, such as medication that needs to be
                           administered an hour before a meal or before a child falls
                           asleep; and
                          Known family history to allergies involving medication. If so, what
                           are the symptoms?6

Storage and disposal of medication
     Brief and concise detail of the service‟s strategy.
     The service should state how medication is stored and disposed of, whether in
      the service or carer‟s home.
     Services should consider the following reflective questions:
          o Does the service have a lockable cupboard, out of reach from
             children, where medication can be stored?
          o How are self-administered medications stored? For example, how does
             a school age child access their asthma puffer if it is in a locked
             cupboard?
          o If medication needs to be refrigerated, is it accessible to children?
          o How does the service dispose of medication? Is there a pharmacy that
             can dispose of the medication for the service?
          o When medication is handed over to the service, does it have the
             child‟s name on it? For non-prescribed medication, is it labelled and in
             its original packaging? How does the service define „original
             packaging‟?
          o What are the potential risks for the service if it stores medication that is
             not clearly labelled and does not indicate which child requires it?

Administering medication to a child
   Brief and concise detail of the service‟s strategy.
   The service should state who is authorised to administer medication in the
     service.
   The service should detail a clear step by step procedure that identifies how
     medication is administered.
   The procedure should be sourced from either a health care professional or
     recognised health authority. This ensures that the service is meeting the
     state/territory legislative requirements and recommended best practice form
     a heath professional.

The importance of a witness
    Brief and concise detail of the service‟s strategy.
    The service may decide to state how it ensures that medication being
      administered is done so safely and with the parent or guardian‟s consent by
      ensuring that there is a witness to medication administration.


6Services should seek advice from a medical practitioner regarding allergies to medications when developing this
policy.



                                                                                                     Page 6 of 10
      Family day care carers and single model outside school hours care services,
       should consider how they ensure that medication is being administered safely
       and checked for accuracy.

Self-administration of medication
     Brief and concise detail of the service‟s strategy.
     The service can state, especially for school age children, how it supports the
       self-administration of medication.
     For example, children with asthma or diabetes may have a history at home
       and at school of self-administering their medication.
     Services should consider the following reflective questions:
           o How does the service support and supervise the practice of self-
              administering medication?
           o Can children self-administer in a safe and hygienic setting?
           o How does the service document and communicate to families when
              children have self-administered medication?
           o Is there an action plan that assists staff/carers when there is an adverse
              reaction to the medication?

Documenting the administration of medication
Maintaining records
   Brief and concise detail of the service‟s strategy.
   Documenting the administration of medication is important so that
      staff/carers can communicate to families about the child‟s health needs.
   It is important that all medication documentation is stored safely.
   There may be state or territory licensing regulations that require
      documentation to be stored for a period of time. Services should state in the
      policy those requirements.
   The person administering and the witness, should sign documentation that
      identifies that they were responsible for administering the medication.
   Services can link this section by stating:
      Please refer to the service‟s Privacy and Confidentiality Policy.

Monitoring after the administration of medication
   Brief and concise detail of the service‟s strategy.
   The service can state how it plans to monitor children after the administration
      of medication.
   It may be useful to develop a first aid action plan should the child experience
      an adverse reaction to the medication.
   Services can link this section by stating:
      Please refer to the service‟s First Aid Policy.

Communicating with staff/carers and families
   Brief and concise detail of the service‟s strategy.
   Services should consider the following reflective questions:
        o How does the service communicate to families when children have
           been administered medication?
        o How do staff/carers ensure that accurate information is being
           communicated during a shift change over?




                                                                             Page 7 of 10
Prolonged use of medication
    Brief and concise detail of the service‟s strategy.

Prescribed medication
    Brief and concise detail of the service‟s strategy.

Non-prescribed medication
   Brief and concise detail of the service‟s strategy.

Protective behaviours and practices
Staff, carers, students and volunteers as role models
    Brief and concise detail of the service‟s strategy.
    Children learn through example and modelling is an important way to teach
        children behaviours and practices.
    Staff/carers, students and volunteers must comply with the Medication Policy.

Staff/Carer professional development opportunities
    Brief and concise detail of the service‟s strategy.
    The service can describe how it aims to maintain and strengthen the skills and
       knowledge of staff/carers in relation to administering medication to children.


Experiences

      Brief and concise detail of the service‟s strategy.
      The service can state how it will develop a healthy living program that
       discusses the use of medication.
      Services should consider the following reflective questions:
           o How can play and learning experiences promote safety and
              responsibility? For example, a child finds medication in the home and
              brings it to the service.
           o How can the service discuss with children about finding an adult and
              handing the medication to them?
           o If there is a child who is asthmatic, can staff/carers discuss with children
              what to do if they observe the child having difficulty breathing? How
              can staff/carers and children discuss what to do? Is there a recognised
              plan to help the child assist their peers, such as inform an adult or find
              the child‟s inhaler?
           o What if a staff/carer has a health need that requires medication and
              they are alone with children?

Excursions
    Brief and concise detail of the service‟s strategy.
    Services should consider the following reflective questions:
          o How does the service ensure that medication can be administered
            safely and hygienically while on an excursion?
          o Should a first aid kit be taken on excursions?
          o What equipment is required while on an excursion to administer
            medication?
          o Does the staffing on the excursion include staff with relevant first aid
            qualifications?



                                                                              Page 8 of 10
          o     How will the service contact parents/guardians/emergency contact
                people should there be a medical emergency?
          o     How does the service provide the correct administration requirements
                for the excursion?

Community
   Brief and concise detail of the service‟s strategy.
   Services should consider the following reflective questions:
        o How can the service promote responsible use of medication by using
           community role models? For example, the service may decide to build
           links with community organisations, such as a doctor or nurse to visit the
           service and talk about the safe use of medications. This may be
           particularly important for children who have ADHD or who see adults
           use medications consistently in the home.
        o For services with school age children and operating in areas of high
           adult drug use, how can the service be proactive in communicating
           healthy living programs and anti-drug use messages? This may be
           particularly important if there are high incidences of children seeing
           used needles in their community.


Policy review

      The service will review the Medication Policy and procedures, and related
       documents, including behaviours and practices every <timeframe>.
      Families are encouraged to collaborate with the service to review the policy
       and procedures.
      Staff/carers are essential stakeholders in the policy review process and will be
       encouraged to be actively involved.


Procedures

The following are examples of procedures that a service may employ as part of its
daily practices.
Examples:
    Employee induction procedure.
    Policy development and review procedure.
    Procedure for non-compliance of the Medication Policy and procedures by a:
           o child;
           o staff/carer;
           o parent or family member;
           o student/volunteer; or
           o visitor.
    Student and volunteer induction procedure.


Measuring tools

The service may further specify tools that assist in measuring the effectiveness of the
policy.



                                                                              Page 9 of 10
Links to other policies

The following are a list of examples:
    Allergies
    Employment of child care professionals
    Enrolment of new children and families to the service
    First aid
    Hygiene and infection control
    Illness
    Occupational health and safety
    Privacy and confidentiality
    Staff/carers as role models
    Supporting children‟s individual needs


Sources and further reading

        Frith, J., Kambouris, N., & O‟Grady, O. (2003). Health & safety in children’s
         centres: Model policies and practices (2nd Ed.). NSW: School of Public Health
         and Community Medicine, University of New South Wales.7
        Matthews, C. (2004). Healthy children: A guide for child care (2nd ed.). NSW:
         Elsevier.
        National Health and Medical Research Council. (2005). Staying healthy in
         child care: Preventing infectious disease in child care (4th ed.). Canberra:
         Author.
        Oberklaid, F. (2004). Health in early childhood settings. NSW: Pademelon Press.
        Poisons Information Centre Listing. (n.d.). Retrieved June 28, 2007, from
         http://ausdi.hcn.net.au/poisons.html
        Therapeutic Goods Administration. (2007). Scheduling of medicines and
         poisons: National Drugs and Poisons Schedule Committee (NDPSC). Retrieved
         June 28, 2007, from http://www.tga.gov.au/ndpsc/index.htm


Useful websites

        Anaphylaxis Australia - www.allergyfacts.org.au/foodalerts.asp
        Asthma Foundations Australia – www.asthmaaustralia.org.au
        HealthInsite - www.healthinsite.gov.au
        Immunise Australia Program – www.immunise.health.gov.au
        National Health and Medical Research Council - www.nhmrc.gov.au
        National Prescribing Service - www.nps.org.au



Policy created date                <date>

Policy review date                 <date>

Signatures                         <signatures>

7This publication is produced on behalf of Early Childhood Australia New South Wales (NSW) Branch and the NSW
Children‟s Services Health and Safety Committee. Services should be aware that the publication may refer to
practices that reflect NSW licensing regulations or health department exclusion guidelines.



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