Policy: Medication

In this article, we look at our approach to medication, how we keep it, where we keep it, and what procedures we have to ensure effective handovers are in place of the dosage logs and use directions between parent and practitioner

Medication

At Hatching Dragons we promote the good health of children attending nursery and take necessary steps to prevent the spread of infection (see sickness and illness policy). If a child requires medicine we will:

obtain information about the child’s needs for this,
ensure this information is kept up to date via updating the Medication log on EY Log, being sure to log and follow the instructions for dosage and refrigeration if required
update the expiration dates on the medication log in EY Log if required
Require parents to handover any / all medication during morning handover / evening collection with instructions as to the latest dosage provided

We follow strict guidelines when dealing with medication of any kind in the nursery and these are set out below. The nursery WILL NOT administer any medication unless prior written consent is given for each and every medicine on the permissions provided during registration

Illness

If any child is brought to the nursery in a condition in which he/she may require medication sometime during the day, the Nursery Manager will decide if the child is fit to be left at the nursery.
For information on infection control and infectious diseases visit the Public Health England website and view their document titled ‘Health protection in schools and other childcare facilities’.
If the child is deemed well enough to stay at the setting, the parent/ carer must be asked if any kind of medication has already been given, at what time and in what dosage and this will be recorded in the medication logs on EY Log

Medication in the Nursery Setting - General Guidance

Before administering medication to any child we will require written agreement from the parents in a signed medication form, which in standard practice, is provided via EY Log's medication form (the school has a pdf template - Medication Form -as a back up)
This agreement (usually a Medication Form) should include;

the child’s name
the name of the medication
the required dose and agreed time of administration
Clearly stated whether the medication is on-going or to be taken up until a particular date
Possible side effects, and/or the information leaflet that is normally supplied by the manufacturer made available

Medication is only accepted in its original labelled container
Where the medication is an adrenaline pen or inhaler (where there may be only occasional emergency use), it will have the expiry date of the medication recorded on the appropriate form
For non-prescription medication the nursery reserve the right to determine the number of days the medication will be given before requesting parents/ carers further input or the advice of a healthcare professional. This will be based upon the individual child and condition
If at any time there is any doubt regarding the administration of medication to a child, practitioners will stop and check with the Nursery Manager before continuing.

Parents Will:

Ensure the medication provided has not passed its expiry
Ensure that it is in its original container with doctor's original prescription advice clearly available
Ensure that all medication is handed over with clear instructions upon hand over so that it can be safely stowed in the medication cabinets

Staff Will

Fill out the medication forms on EY Log accordingly
Notify the manager of the medication and its expiry / dosage requirements
Hand over the medication to the manager for storage in the medication cabinets and / or retain in their own
In either event, the manager must be informed

Storage

All medication will;

Be stored in accordance with the manufacturer’s instructions on the container (e.g. cool dark place, refrigerated)
Be stored in a closed box (the medication cabinets located throughout the school, unless refrigeration is required)
Be kept out of the reach of children
Be in their original containers
Have labels which are legible and in English
Be clearly marked with child’s name and date of birth

Emergency medication, such as inhalers and Adrenaline (EpiPens), will be within easy reach of staff in case of an immediate need in the room based medication cabinets, but will remain out of children’s reach
Any ‘stored’ medication such as Nursery stock of Paracetamol or a child’s inhaler, will be regularly checked to ensure the product is still within its expiry and therefore suitable for use.

Medication Prescribed by a Doctor, Dentist, Nurse or Pharmacist

(Medicines containing aspirin will only be given if prescribed by a doctor)

Prescription only medicine will be given when prescribed by the above and only for the person named on the dispensing label on the bottle/container for the dosage stated
Medicines must be in their original containers
For all medication the parent/carer must give prior written permission for the administration of each and every medication. Written permission will be accepted once for a whole course of medication or for the ongoing use of a particular medication required for long term use
The parent/ carer will complete the relevant form to enable the nursery to administer the medication(s) required. The form will include;

Child’s name, date of birth
Name and strength of medication
Dose
Any additional requirements (such as to be taken with food)
Expiry date whenever possible
Dispensing date

The written permission is only acceptable for the medication listed and cannot be used for similar types of medication, e.g. if the course of antibiotics changes
Parents must notify the nursery IMMEDIATELY if the child’s circumstances change, e.g. a dose has been given at home, or a change in strength/dose needs to be given
Any change in the details listed above must be recorded on a new form with counter signature from parent / carer

The nursery will only administer as per the information listed on the form
At each visit the child’s parent/ carer will be asked if there have been any changes to the requirements stated on the form. If there have been changes, a new form must be completed and counter signed by parent/ carer
When the child is picked up from the setting, the parent/ carer must be given an update as to the times and dosage given throughout the day. The parent’s signature must be obtained confirming this information has been given
At the time of administering the medicine, a senior member of staff will ask the child to take the medicine, or offer it in a manner acceptable to the child at the prescribed time and in the prescribed form N.B. It is important to note that staff working with children are not legally obliged to administer medication
If the child refuses to take the appropriate medication a note will be made on the form. Where medication is “essential” or may have side effects, discussion with the parent will take place to establish the appropriate response. This will be documented on the form accordingly.

Non-prescription Medication (also known as over the counter medicine)

If any child is brought to the nursery in a condition in which he/she may require medication sometime during the day, the manager will decide if the child is fit to be left at the nursery
The nursery will not administer any non-prescription medication containing aspirin
The nursery will only administer non-prescribed medication for a short initial period and only if necessary. After this time parents / carers will be advised to seek medical advice
The nursery reserve their right to refuse to administer medication if they feel that the child does not need the medication or deem further medical attention is required

For all medication the parent/carer must give prior written permission for the administration of each and every medication
Medicines must be in their original containers
This also applies to non-prescription creams or ointments for skin conditions e.g. Sudocrem
The parent / carer will complete the relevant form to enable the nursery to administer the medication(s) required. The form will include:

Child’s name and date of birth
Name and strength of medication
Dose
Any additional requirements (such as to be taken with food)
Expiry date whenever possible
Length of treatment (will not be exceeded)

The written permission is only acceptable for the medication listed and cannot be used for similar types of medication
Parents must notify the nursery IMMEDIATELY if the child’s circumstances change, e.g. a dose has been given at home, or a change in strength/dose needs to be given
Any significant changes in the details listed above must be recorded on a new form and countersigned by the parent/ carer

The nursery will only administer as per the information listed on the form
At each visit the child’s parent/carer will be asked if there have been any changes to the requirements stated on the form. If there have been changes, a new form must be completed and counter-signed by the parent/carer
When the child is picked up from the setting, the parent / carer must be given an update as to the times and dosage given throughout the day. The parent’s signature must be obtained confirming this information has been given

At the time of administering the medicine, a senior member of staff will ask the child to take the medicine, or offer it in a manner acceptable to the child at the prescribed time and in the prescribed form.
Calpol will not be administered unless the child has a fever of 38 degrees celsius or more and only after a temperature has been monitored using the the temperature / child symptoms log
Calpol will also not be administered at parental instruction / direction - child has to be symptomatic

Emergency Medication

At new registration of a child to the setting, parents will be asked if they are happy to give consent to ‘emergency’ treatment being given. This would be only deemed necessary for specific circumstances. Parents/ carers will be asked to complete a form to give consent. This form will include:

The circumstances in which ‘emergency’ medication will be given e.g. High temperature (above 37.8˚c)
The specific medication (drug name) e.g. Paracetamol
Dose to be administered will follow the guidance on the original container e.g. following age / dosage instructions
Statement that medication will only be given if the nursery is unable to contact the parent

An ‘emergency’ nursery stock of medication may be kept on site
Stock medication will be kept in accordance with manufacturer’s instructions on the container (e.g. cool dark place, out of the reach of children)
Stock will be checked at regular intervals by the designated trained first aider to ensure there is ample supply and is still within its expiry date
If a child experiences symptoms of illness, attempts will be made to contact the child’s parents before administering ‘emergency’ medication
Where parents cannot be contacted the Nursery Manager will take the decision as to whether the child is suitable to receive the ‘emergency’ medication based on the symptoms and medical history of the child given at registration
Administering ‘emergency’ non-prescription medication will be a last resort and the nursery staff will use other methods first to try and alleviate the symptoms. The child will be closely monitored until the parents collect the child.

Injections, Pessaries, Suppositories

As the administration of injections, pessaries and suppositories represents intrusive nursing, we will not administer these without appropriate medical training for every member of staff caring for this child. This training is specific for every child and not generic. The nursery will do all it can to make any reasonable adjustments including working with parents and other professionals to arrange for appropriate health officials to train staff in administering the medication.

Administration

As a general guideline before administering medication to a child the staff member should:

Wash their hands
Ensure a drink is available if appropriate (some medication can irritate and damage the throat and oesophagus if administered without a drink)
Check the label on the medication: name of child, dose, route of administration (e.g. by mouth, into ear/eye, rubbed on the skin), any special instructions and expiry date and ensure this is the same information on the Medication Form

If there is any doubt about any procedure staff should not administer, but seek advice from parent/ carer or health professional
If a child refuses the medication, they must not be forced. Staff can try to encourage them or perhaps get someone else to try. Under no circumstances should staff attempt to hide the medicine in food or drink, unless there in express written permission from parents to do so
It is normally considered poor practice to give medicines covertly, although in rare cases where the health professionals judge that it is in the child’s interests to do so, this is acceptable. Some children do find tablets difficult to swallow so may be given them, with their full knowledge, in, for example, a spoonful of jam. Even in these circumstances parents must give written instructions as some medicines can react with certain foods it is advisable they have sought advice from their pharmacist before doing this.

Staff Fitness to Work & Staff Medication

All nursery staff have a responsibility to work with children only where they are fit to do so
Staff must not work with children if they are infectious or too unwell to meet children’s needs. This includes circumstances where medication taken by staff affects their ability to care for children, for example, where it makes a person drowsy
If staff members believe their condition, including any condition caused by taking medication, is affecting their ability to care for children they must inform their line manager immediately
The nursery manager / person’s line manager/registered provider will decide if a staff member is fit to work, including circumstances where other staff members notice changes in behaviour suggesting a person may be under the influence of medication. This decision will include any medical advice obtained by the individual or from an occupational health assessment
Where staff may occasionally or regularly need medication, any such medication must be kept in the person’s locker/separate locked container in the staff room or nursery room. If the medication is required to be accessed in an emergency, such as an asthma inhaler, this should be easily accessible but safe from children
In all cases medication must be stored out of reach of children. It must not be kept in the first aid box. It will be clearly labelled with the name of the member of staff.

Medication Errors

Occasionally mistakes may happen. In most cases, whether it is a missed dose or a medicine given in error there will be no harm done. It is important to be open and honest if errors occur
Parents should be contacted and the mistake explained to them:
In the case of a missed dose, the dose may be able to given at a later time. The parent may be able to advise
Where a dose has been given in error, it is important the child is monitored for any reactions and medical advice sought if there are concerns. It is important to inform the parent/ carer as this may happen after the child leaves the setting
The Nursery Manager will investigate all medication errors and put in preventative actions to ensure future errors do not occur.

Disposal of Medication

Tablets and capsules are occasionally dropped on the floor or spat out. In this case we will place the tablet in a labelled envelope and hand to the parents to be disposed of later
In no circumstances should it be flushed down the toilet or thrown in the bin
When a child leaves the setting, ceases to need medication or if a medicine has passed its expiry date, we will return any unused quantity to the parents. If this is not possible then we will take it to a local pharmacist for safe disposal.