Mary Mahoney examines our responsibilities when asked to give medicine to children.
The increasing and extended use of provision such as childminders, day care including ‘wrap around care’, children’s centres, pre-schools, nursery schools, breakfast clubs, extended schools and holiday clubs increases the number of occasions where medicines have to be given to children by those to whose care parents1 have entrusted them. Those of us who work in the child care and education ‘industry’ must therefore seriously consider the implications that this responsibility has on the services we offer.
All children should have the same admission rights to a setting, as long as they are well enough to do so, whether they have medical needs or not. There is a need to ensure that children with short, long-term or specific medical conditions can continue to attend if they are well enough to do so. By accommodating the needs of children who require medication, settings can ensure that outcomes for children are met – they can be healthy, stay safe, enjoy and achieve, as well as making a positive contribution to the setting. Due consideration therefore needs to be given as to how medical needs can best be accommodated – not just to provide for children’s individual requirements but also to ensure that all regulatory and health and safety aspects for both the child and the staff are met. All settings are required to comply with health and safety regulations2.
Policies and procedures
To ensure that every aspect of administering medication is appropriate, it is the responsibility of each setting to develop polices and procedures around the management of medicines. Consideration needs to be given to:
- assessing what is needed locally, which resources are available and examples of good practice
- meeting statutory and regulatory responsibilities
- ensuring appropriate employer and public liability insurance is in place.
An effective medicine policy should cover children who require short-term medical treatment, for example to finish a course of antibiotics as well as catering for children who have ongoing medical needs. It should also cover emergency medical treatment for conditions such as allergies. In deciding on the content of any policy, attention needs to be given to complying with SEN and Disability Act (SENDA) 2001 and Part III of the Disability Discrimination Act 1995. These acts state that early years settings are required to take ‘reasonable steps’ to meet the needs of disabled children. In addition, settings must not treat a disabled child any ‘less favourably’ than another child, if that reason relates to their disability. Occasionally, there may be an objective justification for less favourable treatment; in such a scenario management must be able to demonstrate that they made every effort to accommodate any special needs requirement.
It is important to ensure that you include provision to ensure that pre-enrolment discussions are undertaken with parents, and other health professionals if appropriate, to identify, assess and agree how the child’s needs can be safely met. This may result in the development of an individual health care plan and/or a specific risk assessment3.
Where a health care plan is required it should include:
- child, family and health professional details
- details of the condition
- any special requirements, for example, dietary needs
- medication needs and any potential side effects of medication
- what constitutes an emergency
- what to do in an emergency situation
- who to contact in an emergency
- the role of staff.
Prescribed or not prescribed?
Ofsted standards4 for the under eights (Standard 7) states that ‘medicines are not usually administered unless they have been prescribed for that child by a doctor’. Whilst this suggests that only prescribed drugs may be administered, there is a degree of flexibility around the administration of non-prescribed medication such as cough preparations and teething gel. With so many parents now dependent on setting support to allow them to enter and remain in the work place, such an option may have to be considered in the policy development. However, any policy should give due regard to the Misuse of Drugs Act 1971 (this refers to the administration of controlled drugs) and the Medicines Act 1968.
Whatever the child’s needs, it is important to ensure that appropriate authorisation has been gained prior to administration of any medication. This is a mandatory requirement in Standard 7 – ‘the parent gives prior written permission to administer any medication’. In addition, all medicine must be administered in line with the prescriber’s instructions5. Therefore, it is important to ensure that your procedures contain an effective record keeping system. Authorisation information should include:
- details of the date of instruction
- name of child, name of medication
- condition being treated
- date course of medication commenced
- prescribed dosage and frequency
- time of dose and duration of treatment
- method of administering dose (in some cases there may be a possibility for self-administration) and storage instructions
- any possible side effects
- expiry date of medication and any other valid details.
Staff should check that any details provided by parents are consistent with the instructions on the medicine’s container. Authorisations must be signed by the parent. It could also be signed by the setting as confirmation that they understand and agree to the authorisation – blanket authorisations for all medicines cannot be given.
There is also a regulatory requirement (Standard 7) that written records must be kept of all medicines administered to children. Although not a requirement, it is good practice to encourage parents to sign the records to acknowledge the information. Thought should be given to the procedures required around the administration of the medication, for example:
- who will take responsibility for doing this
- who will witness the process
- what steps will be taken to ensure the medication is checked – expiry dates, child’s name, dosage, written instruction provided on the label
- how and what will be recorded – as a minimum date, details of dosage given and when it was given but this could also include the signatures of the person administering the dose and the witness
- how will hygiene standards (Standard 7) be maintained.
If a child refuses to take some or all of the medicine, they should not be forced to do so. However, this should be noted on the records. It would be wise to include in the procedure any action to be taken should this occur.
Where a setting agrees to administer any medicines they must ensure that the risks to the health of others are properly controlled6. Criteria under the Standard 7 require medicines to be stored in their original containers and clearly labelled. Any policy should state that failure to meet this requirement will result in refusal to administer. Medicines should be stored in strict accordance with the product instructions. Some medicines need to be refrigerated; where this is the case, they can be kept in a fridge storing food but should be in an airtight container that is clearly labelled. Medicines which do not require refrigeration should be kept in a secure place, not accessible to children. Special arrangements will need to be made for immediate access to medicines such as asthma inhalers and adrenaline pens. Account should be taken for this in any policy and procedure to ensure that medicines are only accessible to those for whom they are prescribed. Staff must not dispose of unused medicine – parents should be responsible for returning these to the pharmacy for safe disposal.
Links with other policies
When creating a policy and procedure for the management of medicines there are links with other policies that should be considered:
- admissions – providing clarity over rights of admission to the setting for all children
- outings and visits – taking medicines on trips and outings
- hygiene – good hygiene practices are in place
- food management – covering specific dietary requirements and food allergies
- exclusion and sick children – providing clarity over when children are too unwell to attend and what will be done if a child becomes ill whilst at the setting
- emergency and contingency – what emergency steps will be taken if an emergency medical problem affects a child at the setting
- premises – privacy for children with special needs who may require intimate care
- first aid – if any child requires immediate attention.
It is the setting’s responsibility to make sure that there are appropriate and effective systems for sharing information about a child’s medical needs. Therefore, it is crucial that the policy and procedure clarify the responsibilities of individuals involved with a child, particularly those of the parent and staff. ‘Outside’ health professionals may also contribute to this exercise. Consideration should be given to how information is shared about a child who may spend time with various adults, in different areas of the premises or who attend more than one setting. Where details of a child’s medical condition are shared such information must be treated as confidential by all involved.
The setting is accountable for ensuring that staff are provided with appropriate training in the content and day-to-day application of the medicine policy and procedures. Where technical or medical knowledge is needed, training specific to the individual child should be given by a qualified health professional7 and written confirmation of staff competence gained from them. Settings must be satisfied that the relevant training has provided staff sufficient understanding, confidence and expertise in the administration of medication and that arrangements are in place to update such training regularly.
The Medicine policy and procedure should be robust and as a minimum should cover:
- procedures for managing prescription medicines
- circumstances in which children may take any non-prescription medicines
- procedures for dealing with long-term or complex needs, for example, developing a health care plan or undertaking a risk assessment
- the roles and responsibilities of staff in regard to the administration of medicines
- the role and responsibility of parents in respect of their child’s medical needs
- the need for prior written agreement from parents for any medicine to be administered
- procedures for the safe storage of medicines
- procedures for record keeping and how long records will be kept
- procedures for managing medicines on trips and outings
- the provision for staff training and support.
Most importantly, where appropriate policies and procedures have been produced, it is crucial that they are clearly understood, by staff and parents alike and scrupulously applied by all in practice. The proper administration of medicine to children within the childcare environment fosters greater inclusion, which can have a positive contribution to the setting as well as the child in question. However maladministration of the medicine policy can have serious consequences. Ignorance by staff members is not a defence in the eyes of the law if there is a failure to correctly administer a medicine. An incorrectly administered medicine/drug may not afford us the luxury of a second chance – never assume, check!
- Throughout this article parents should be taken to include all those with parental responsibility, including parents and carers.
- Health and Safety at Work Act 1974; Management of Health and Safety at Work Regulations 1999
- Management of Health and Safety at Work Regulations 1999; National Standards for Under 8s, (Standard 6 – Risk Assessment)
- National Standards for Under 8s Day Care and Childminding: Childminding (DFES/0649/2003); Creches (DFES/0650/2003); Full Day Care (DFES/0651/3003); Out of school care (DFES/0652/2003); Sessional care (DFES/0653/2003).
- Medicines Act 1968
- Control of Substances Hazardous to Health Regulations 2002 (COSHH)
- Medicines Act 1968
- DFES, (March 2005) Managing Medicines in Schools and Early Years Settings,
- DfES, National Standards for Under 8s (Day Care and Childminding, Sessional Care, Creches, Out of School Care)
- DfES, Guidance to the National Standards for Under 8s (Day Care and Childminding, Sessional Care, Creches, Out of School Care)
All available from www.dfes.gov.uk
Mary Mahoney who is a QTS, has spent a number of years working as a regional, and then national, manager for a large child care company.