Administration of Medication

Statement of Purpose

To promote the health, safety, and well being of children who require the administration of medication.

Nursery Administration of Medication and Clinical Procedures

Outcome

Parent/carers feel confident about safe practice within the nursery with regard to the administration of medication.

Staff are clear about their responsibilities for maintaining safe practice.

The Nursery complies with various statutory responsibilities and the Early Years Foundation Stage Statutory Framework.

2.1	The Nursery Manager ensures that the Nursery has written Administration of Medication policy.
2.2	The Nursery's Administration of Medication procedures are drawn up in consultation with staff, parent/carers/carers and other relevant agencies.
2.3	The Nursery’s Administration of Medication procedures form a part of the Nursery’s statutory risk assessment in line with the Health, Safety and Welfare at Work policy.
2.4	The Nursery’s Administration of Medication and Clinical Procedures include: · how the Administration of Medication and Clinical Procedures will be implemented within the context of the nursery; · how any relevant standards, guidelines, protocols, procedures of the Primary Care Trust, National Inspection Agency or Local Authority are incorporated within the standards; · how the Nursery will uphold the rights of children and young people to be treated with dignity; for their privacy to be respected; how they will be asked for their consent (where possible); and how they will be consulted about the administration of their medication · how an individual health care plan (HCP) is drawn up for children health care needs; · how First Aid is organised within the Nursery; · how and when adults, both within and outside the Nursery are informed, on a need to know basis, about a child’s or young person’s need for medication e.g. teachers, swimming pool attendants, volunteers etc. may all need to know about a child’s condition and medication. · how induction, training and authorisation is provided to staff with regard to the procedures and how the training plan ensures that staff training is kept up to date; · how the monitoring of the policy and procedures are carried out by the Nursery Manager to check that practices remain safe; · how an identified error in administration of medication is reported and the action to be taken; and, · how parent/carers are informed of the Administration of Medication and Clinical Procedures Standards and the project’s procedures.

Training for the Administration of Medication

Outcome:

Staff are confident to undertake the administration of medication and can demonstrate the knowledge and ability required.

3.1	Training is given to staff on the administration of medication, storage and disposal.
3.3	Training includes: · How medications act in the body (based on individual needs of child) · The importance of the information included on medicine labels · Side effects of common medicines · Legal issues around handling, administration, storage, record keeping and disposal · Refusal to take medication as prescribed · Health and safety responsibilities · Hygiene and infection control · Safeguarding issues arising from the procedures · Training can incorporate any other issues about medication thought to be relevant to particular risk assessments
3.4	A record is made of the training undertaken by the participants which includes the subjects covered, the date, the qualifications and name of the trainer and details of any assessment component.
3.5	Following training, the Nursery Manager employs a number of checks to ensure an individual is capable of applying their training safely and confidently e.g. being paired with a more experienced staff member; observation by a manager and supervision discussions. If the checks prove satisfactory within an agreed time scale, a record is made by the Nursery Manager authorising the person to administer medication, which is also signed by the staff member.

Training and Authorisation for the Undertaking of Clinical Procedures

Outcome

Staff understand and can demonstrate how to safely undertake a clinical procedure and feel supported in their practice.

4.1	The Nursery Manager ensures only named, trained, employees/carers undertake agreed clinical procedures for named children.
4.3	The Nursery Manager ensures that designated staff who have a responsibility for clinical procedures receive training and that it is reviewed regularly.
4.4	When trainers are providing training for a specific clinical procedure on a named child, wherever possible, they include the parent/carer/carer of the child or young person in training sessions so that any specific practices that they may do at the time of the procedure are shared with those being trained.
4.5	When carrying out a clinical procedure for a particular child where the training was delivered generically, the child’s health care plan will include any specific practices that are required when undertaking that procedure.
4.6	The Nursery Manager maintains an up to date Clinical Procedure Authorisation Register, for staff, who have received the training for an individual clinical procedure, recording the date of the training, name of clinical procedure, trainer’s name, and a review date.
4.8	For other procedures, the trainer develops assessment criteria which the Nursery Manager can use to ensure an individual is competent in applying their training safely and confidently e.g. being paired with an experienced staff member, observation by a manager and supervision discussions. If the checks prove satisfactory within an agreed timescale, a record is made by the Nursery Manager authorising the person to carry out the procedure which is also signed by the member of staff.
4.10	Staff do not undertake a clinical procedure if they do not feel confident to do so and make this clear to the Nursery Manager. (Some time may have passed since they last did the procedure).
4.11	Opportunities to discuss practice are available for staff within team/group meetings, and within personal supervision or support sessions.

Accountability

Outcome

The Nursery Manager and staff understand their personal accountability for the safety of children for whom they have a responsibility.

5.1	Staff act to safeguard and promote the health and safety of children requiring the Administration of Medication and Clinical Procedures.
5.2	Those administering a medicine and assisting in its administration, or carrying out a clinical procedure or assisting in its undertaking: · have an understanding of the care needs of the individual child;; · are able to justify any actions they take; · are prepared to be accountable for the action taken; · work in an open and co-operative manner with children, parent/carers, carers, colleagues, and medical; and · recognise and respect the uniqueness, dignity and privacy of each child, and respond to their need for care, irrespective of their ethnic origin, religious belief, personal attributes, the nature of their health problems or any other factor.
5.4	Nursery staff are responsible for keeping accurate, legible records.
5.5	The Directors and Nursery Manager maintain and improve staff knowledge and abilities.
5.6	Staff acknowledge any limitations in their knowledge and ability, and decline any duties or responsibilities unless able to perform them in a safe and confident manner.
5.7	Contingency planning is undertaken by the Nursery Manager: · for children, based on their needs; and, · for reasonable foreseeable circumstances that might arise as a result of using the Administration of Medication and Clinical Procedures policy.
5.9	Where it appears that the health and welfare of the child is at risk due to staff competency this must be reported to the Nursery Manager immediately. Where staff are concerned that these issues are not being addressed they should use the Whistle blowing procedure.
5.10	Directors arrange Public Liability insurance and Employers insurance.

Health Care Plans (HCP)

Outcome

Children can access the service by having their medical needs met in a safe and planned way.

7.1	Each child with long term health care needs and/or requiring a clinical procedure has an individual Health Care Plan which identifies the kind of support to be provided by the project, and agrees and describes the protocol for undertaking a clinical procedure. The Health Care Plan is informed by consultation with parent/carers and healthcare practitioners.
7.2	The Nursery Manager ensures that individual health care plans are made with the staff who have agreed to undertake the procedure/s and will be trained to do so; parent/carers / carers; healthcare practitioners and others those that contribute are asked to sign the plan.
7.3	Individual Health Care plans contain: · consent to medication and treatment · a description of the medical needs of the child; · the particular way medication is to be administered – (if necessary the method is risk assessed – with a specific protocol written and signed up to by parent/carers and nurse/doctor · the clinical procedure/s required and the protocol of how these are to be undertaken in relation to the named child ; · a list of reasonable foreseeable difficulties that could arise and agreed responses to these; · an agreed response to a refusal to take prescribed medication or refusal to allow a clinical procedure to be undertaken; · the procedure for dealing with an emergency which is authorised and signed by a nurse or doctor on an Emergency Procedure form · agreement to First Aid.
7.5	Health care plans have an update system to record agreed changes to the plan between formal reviews, when necessary, which maintains the plan as an accurate working document.
7.6	Staff receive training on how to complete and use a Health Care Plan, as soon as is practicable, when joining the Nursery.

Storage of Medication

Outcome:

Childs are protected from the harmful effects of taking medication that is not administered under supervision.

11.1	The Nursery ensures that prescription medication is safely stored.
11.2	Nursery only store medication for children who are currently using the Nursery.
11.3	All medication in the Nursery is stored in a separate section of the fridge to which children are prevented from having access.
11.8	All medicines in the Nursery are kept in the original containers received from the supplying pharmacist, and are properly labelled with the details of contents, dose, directions and date of dispensing. (They are not to be accepted into the Nursery without this information). Monitored dosage systems are not to be altered in any way.
11.11	Daily checks are made and recorded to ensure that the fridge temperature is within the normal range i.e. 2 to 8 degrees centigrade.
11.13	When a group of children are taken on an outing or visit away from the Nursery, the first aid box is used to store and carry the medication. Medication is returned to the designated storage area in the refrigerator immediately on return to the nursery.

Recording of the Administration of Medication and Clinical Procedures

Outcome:

There is a complete audit trail of medication received and administered by staff.

12.1	Records are properly completed, legible and current, providing a complete audit trail of medication.
12.2	The Nursery Manager delegates to staff the task of recording medication on each child record form, when they arrive or depart from the Nursery, together with any clinical equipment: · Date of receipt. · Name, strength and dosage of medicine. · Quantity received. · Child for whom medication is prescribed. · Signature of the member of staff receiving the medicines.
12.4	Each child requiring medication has a child record form. All information contained on prescription labels and sent in with medication wallets or similar systems, is recorded on this sheet. No deviation from prescription labels may be made (Parent/carers cannot authorise a variation in the prescription. Only the prescriber can change a prescription, which should be in writing) i.e.: · exact dosage, which includes strength and form of medication - tablets or liquid · times of doses · route of medication · method of administration i.e. tablets whole or crushed, liquid by spoon etc.
12.5	A clear, accurate record is made of the administration of all medicines administered and on each occasion a clinical procedure is carried out, ensuring that any written entries, and the signatures, are clear and readable. The person administering the medication signs the administration record immediately after the medicine has been given or been refused. Similarly, the person carrying out the clinical procedure immediately signs that it has been carried out or been refused.
12.8	Medication labels are checked by staff to ensure that they are not out of date and match the administration of medication record. This check is signed for on the medication sheet and countersigned by another member of staff.
12.9	Staff need sight of a script if changes are being verbally communicated by parent/carers/carers.
12.14	Refusal of medication is recorded and the reason why.
12.15	The Nursery will keep a list of staff members authorised to give medicines, which includes a record of their approved signatures and initials.
12.16	Records are regularly monitored by the Nursery.

Administration of Medication

Outcome:

Children require prescribed receive the recommended dosage at the agreed time, and are protected from the potentially harmful effects of taking medication which has not been prescribed for them.

13.1	The Nursery ensures that medication is safely administered and child’s’ rights to privacy, respect and dignity are upheld.
13.2	The time medication is administered responds to children’s needs e.g. some medicines need to be in advance of food, others have specific dosage regimes.
13.3	Those administering medication are aware of the reasons that a child is receiving the medication and the part it plays in any planned programme of health care for the child.
13.4	The information on all medicine containers is carefully scrutinised, in the interests of safety. · Child’s name. · Date of dispensing. · Name and strength of medicine. · Dose and frequency of medicine.
13.5	Staff should never alter labels on dispensed medicines. When doses are changed by the prescriber and the label on the container is not changed, this could lead to errors. In this circumstance a warning should be added to the label such as: “Dose changed check care plan/notes for correct dose to give.”
13.6	The condition of the child is assessed at the time that the medication is due. This assessment requires staff to use their knowledge of the individual’s health care plan e.g. the nature of a condition and any action required, and to apply their training. If the assessment raises concern, or staff are unsure, then a parent/carer/carer is contacted for advice, before administering medication.
13.7	Staff apply the 5 rights principles to the process of one person administering medication and one person checking: · Right child · Right medicine · Right dose · Right time · Right route To facilitate this the following procedure is always undertaken; · Medication is checked by staff when handed in by parents/carers and entered on appropriate form, which parents/carers sign · The name of each child requiring medication, along with the type of medication and time of dose is written on the ‘whiteboard’ · At specified time, a senior member of staff collects the medication and form to check details and dosage. A second member of staff repeats the check. · An entry is made on the medication form, which is signed by both members of staff · Medication is returned to storage in the refrigerator · Whiteboard wiped clean at end of day The same person ensures that they have the right child, prepares the dosage and administers the medication with the check made by the other person. A person on one shift NEVER administers medication prepared by a person on an earlier shift.
13.10	If a child refuses to take their medication, they are not forced to do so. The action agreed in the Health Care Plan is followed. A record is made of the refusal including the reason why.
13.12	No medicine prescribed should be given without written permission from the parent/carer. Medicines that are not prescribed such as Pain and fever refill or, teething gels may be administered with prior written consent from the parent, and only when there is a health reason to do so.
13.13	Medication is never administered to a child that is prescribed for another child.
13.15	Children on new prescriptions are not allowed to attend nursery for the first 48-hours to avoid any adverse drug reactions taking place at nursery. However, if parents can provide evidence from their Doctor that the child has received the medication before with no allergic reaction, then the 48-hour stipulation may be waived.
13.16	The Nursery Manager ensures that there are shift overlaps which allow enough time for the communication of individual health care information.
13.18	Any mistakes and/or concerns regarding medication are recorded and reported to the Nursery Manager immediately. These are carefully and thoroughly looked into by the Nursery Manager with dates and actions clearly indicated and recorded; actions may include implementing disciplinary or capability procedures.

Agreed Clinical Procedures which staff can undertake

Outcome:

Staff are clear about the clinical procedures that have been agreed with parent/carers/carers.

15.1	Staff only undertake those clinical procedures which have been agreed between the Nursery and the child’s parent/carers.
15.2	The Nursery Manager makes a decision as to whether any of the permitted procedures can be undertaken at any point in time within the Nursery, based on a risk assessment accounting for the level of training, staff availability and numbers, and the level of complex health care issues being provided for in the service.
15.3	Parents/carers have the right of appeal to Directors

Disposal of Medication, Syringes and Needles

Outcome:

Health risks to children, rubbish collectors and other members of the public are avoided.

17.1	Date-expired medicines, syringes and needles are disposed of safely.
17.2	Parent/carers are responsible for the disposal of date-expired medicines.
17.4	Clinical waste is disposed of in the yellow clinical waste sack, which in turn is placed in the yellow bin in the car park.

First Aid

Outcome:

Children First Aid promptly, when required, by trained First Aiders.

18.1	The Nursery has First Aid equipment that is readily accessible, and has identified staff with certified Paediatric First Aid training.
18.2	Parent/carer consent forms include consent for staff to administer First Aid.
18.3	The Nursery Manager ensures that First Aid equipment is present in appropriate location in the Nursery.
18.4	First Aid equipment is taken on outings with children.
18.5	A designated member of staff is responsible for ensuring that the First Aid Equipment is maintained and is within date and replenished on a monthly basis.
18.6	The Nursery manager ensures that all staff, students and volunteers know where the First Aid Equipment is kept, and that it is stored safely, during induction.
18.7	Medicines MUST NOT be stored in a First Aid box.
18.8	The Nursery Manager ensures that staff have certified Paediatric First Aid training and a suitable number of staff with a General First Aid Certificate.
18.9	A record is made of any First Aid treatment given to a child e.g. who provided the treatment, why it was needed, when given and where. The record is signed by the person who gave the treatment.
18.10	The Nursery has clear records about first aid training undertaken by staff and when updates are due.

Emergencies

Outcome:

Children get the medical help they need as quickly as possible.

19.1	The Nursery Manager takes action to plan for emergencies, and staff act immediately should a child suddenly become ill or has an accident.
19.2	Action is taken immediately a child or young person becomes suddenly ill or has an accident.
19.3	Staff dial 999 and request an ambulance.
19.4	First Aid is administered by a trained person who, if immediately available should be summoned. In the absence of a trained first aider, staff offer what can reasonably be done and is necessary to protect life until medical help arrives.
19.5	Parent/carers are informed.
19.9	As much information and guidance as possible is made available to staff about the medical conditions of individual children: · Background information on medical conditions. · Information on specific medical conditions concerning a child. · Guidance on how to act in particular medical circumstances in relation to an individual child, which is written into the Health Care Plan.
19.10	The Nursery Manager ensures that: · Where applicable, a child’s Health Care Plan form is quickly accessible. · All children within the Nursery have contact information in case of an emergency i.e. a minimum of two names with addresses and telephone numbers, at least one being a person having parent/carer responsibility. · Names and telephone numbers of doctors and/or nurses, who can be contacted in an emergency, are readily available to those who need them. · How to make a 999 telephone call · Training for Clinical Procedures that are required in an emergency has been undertaken in relation on named children. · Medical emergencies are rehearsed to check that responses are good enough.
19.11	Following an accident or an emergency, a record is made as soon as possible and is completed by those directly involved.
19.13	The Nursery Manager ensures that following an emergency, children and their families are supported and staff have an opportunity to reflect on any impact they experienced.

© 2010