Medication Safety in the Childcare Setting

Diane Covel, RN

As a nurse you may encounter parents of young pediatric patients in a doctor’s office, school or Med-Surg unit to name a few. You’ve probably educated the child’s parents on medication safety in their home. They’ve baby-proofed all the cabinets and locked up all the medications. Even the sitter and the grandparents are all on board. But, have you educated the parents on medication safety at their child’s daycare center or preschool?

Child care and preschool centers are special in that they do not typically have a ‘school nurse’ on site when school is in session. As nurses we can fill this gap by taking the opportunity to teach parents how to ensure their child is safely receiving medications in a childcare center. Some young children may need to have multi-dose inhalers, oral diphenhydramine, or injectable medications by a premeasured commercially prepared syringe at their childcare or preschool for asthma or allergies. So what should parents be looking for in medication safety in a daycare or preschool?

Child Care Center Should Be Licensed In The State It Operates

When choosing a daycare or preschool parents can ask if the center is licensed. Holding a license from the state means a center will be held to a higher standard. If a center is licensed parents can ask to see the center’s license. The license certificate should have a license number which can then be researched most likely online through a government website by searching for ‘Child Care Licensing Program’ for that state. This can let prospective parents know if a center's license is in good standing or if there are any problems or issues with a particular child care center.

Child Care Center Should Follow State Statutes And Regulations

Once the parent chooses a child care center, they should ask the director how the center follows the statutes and regulations of their particular state. Parents can ask what the policy is for giving medications, how the staff are trained to safely give medicine and how the parents will be involved in the process.

Child Care Center Should Have Current Medication Policy On Site

The medication policy provides a framework under which staff should operate. It will say who can give meds, what types of medicine the center is prepared to give your child (I.e. only emergency meds), what the parents’ responsibilities are (providing meds, submitting pediatrician medication authorization and care plan, measuring spoons or spacers) and the staff responsibilities for safely giving medications.

Child Care Center Should Only Have Trained Staff To Administer Medications

Parents will want to ask if staff are trained to give medications, by whom they are trained (doctor, PA, APRN or nurse) and how often. How often staff are trained will be based on a particular state's regulations. Training curriculum and staff certificates should be kept on site and available upon request. The center’s policy should clearly state that untrained staff are never allowed to administer medication.

Child Care Center Should Have Plan For Storage Of Medications

Proper storage of medications at a child care or preschool center can significantly reduce medication errors. Parents should ask how their child’s medication will be stored. Each child’s medication should be stored separately from other children’s medications. This could be in something as simple as a clear gallon zipper storage bag. The bag could then be labeled with the child's name and classroom. A recent color headshot photo of the child should be attached to the bag. Once the child's medication is stored in a separate bag, it can be stored together in a central location with other children’s meds. Having a designated area in the classroom where meds are stored is helpful for staff to respond in a timely manner. Medication should also be stored out of reach of children, out of direct sunlight, and in a designated private space for HIPPA regulations. The state regulations will advise centers on which medications must be locked up or left unlocked for faster access.

As nurses we always strive to avoid medication errors and keep our patients safe. We typically remember home safety for medications but we should not forget medication safety in the child care or preschool setting. Following some basic guidelines will go a long way to ensuring young children are safely administered medication in childcare.

Remind parents to look for centers that:

are state-licensed
follow state regulations for administering medications to children
have a current medication policy on site
only allow trained staff to administer medications
have a plan for the safe storage of medications

Helping parents of young children find a childcare or preschool program where they feel confident their child’s medication will be safely administered is another important nursing role.

References

Chronic Conditions and School

NCDHHS - Be On the Safe Side: Medication & Administration

Statutes and Regulations: Child Care Centers and Group Child Care Homes