Nursery medication policy

At The University of Dundee Nursery, we promote the good health of children attending the 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 and will ensure this information is kept up to date.

We follow the Care Inspectorate guidance on the management of medication in day care of children and childminding services when dealing with medication of any kind in the nursery and this is set out below.

Medication prescribed by a doctor, dentist, nurse, or pharmacist

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

• Prescription medicine will only be given to the person named on the bottle for the dosage stated
• Early learning and childcare practitioners should not give the first dose of a new medication to a child. Parents should have already given at least one dose to ensure that the child does not have an adverse reaction
• Medicines must be in their original containers and where possible early learning and childcare practitioners should always read and retain the information which is supplied with the medicine
• Those with parental responsibility for any child requiring prescription medication should hand over the medication to the most appropriate member of staff who will then note the details of the administration on the appropriate form and another member of staff will check these details
• Those with parental responsibility must give prior written permission for the administration of each and every medication. However, we will accept written permission once for a whole course of medication or for the ongoing use of a particular medication under the following circumstances:
  1. The written permission is only acceptable for that brand name of medication and cannot be used for similar types of medication, e.g. if the course of antibiotics changes, a new form will need to be completed
  2. The dosage on the written permission is the only dosage that will be administered. We will not give a different dose unless a new form is completed
  3. Parents must notify us 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
• The nursery will not administer a dosage that exceeds the recommended dose on the instructions unless accompanied by written instructions from a relevant health professional such as a letter from a doctor or dentist
• The parent must be asked when the child has last been given the medication before coming to nursery; and the staff member must record this information on the medication form. Similarly, when the child is picked up, the parent or guardian must be given precise details in writing of the times and dosage given throughout the day. The parent’s signature must be obtained at both times
• 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. (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 or spits it out, then a note will be made on the form and parents told
• Where medication is ‘essential’ or may have side effects, discussion with the parent will take place to establish the appropriate response.

Non-prescription medication

(these will not usually be administrated)

• The nursery will not administer any non-prescription medication containing aspirin
• The nursery will not administer non prescribed medication unless it is or pain relief from teething or to administer teething gel. These must be in original packages with instructions written in English.
• Nursery will apply non prescribed barrier creams to children at required only after cream consent form is completed properly.
• If the nursery feels the child would benefit from medical attention rather than non-prescription medication, we reserve the right to refuse nursery care until the child is seen by a medical practitioner such as pharmacist or GP
• If a child needs liquid paracetamol or similar medication during their time at nursery, such medication will be treated as prescription medication with the *onus being on the parent to provide the medicine/*nursery providing one specific type of medication should parents wish to use this
• We keep an emergency supply of paracetamol for pain relief and reduction of fevers and antihistamines on site (following Care Inspectorate guidance). If a child exhibits any of the symptoms that require non-prescription medication during the day, e.g. a high temperature or a reaction (e.g. bee sting) the nursery will make every attempt to contact the child’s parents. Where parents cannot be contacted then the nursery manager will help to reduce the child’s temperature, contact the child’s emergency contact and seek further medical advice if the child is:
  • under three months old and a temperature of 38 degrees or above
  • between three to six months and has a temperature of 39 degrees or above
  • over six months and shows other signs of being unwell – for example, they are floppy and drowsy, or you are concerned about them.
• For any non-prescription cream for skin conditions prior written permission must be obtained from the parent and the onus is on the parent to provide the cream which should be clearly labelled with the child’s name
• 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. If the child is staying, the parent must be asked if any kind of medication has already been given, at what time and in what dosage and this must be stated on the medication form
• As with any kind of medication, staff will ensure that the parent is informed both verbally and in writing of any non-prescription medicines given to the child whilst at the nursery, together with the times and dosage given
• The nursery DOES NOT administer any medication unless prior written consent is given for each medicine, unless it is an emergency as described above.

When assessing children, staff must take into account the usual condition/personality of an individual, their medical needs, and factors that may affect them (lack of sleep, teething, temperature of the room, what they have been eaten or what they have been doing etc.).

 A child’s key person with Room Senior is best placed to assess the condition of a child and will make the judgment on the health of an individual. However Senior Nursery Manager or Junior Nursery Manger reserve the right to adjust the following guidance at times of a particular outbreak of sickness.

A child has a temperature of 37,5˚ Celsius +

Parent/ carer will be called to advise them of the situation so that they can collect if they wish.

Temperature monitored and record every 10 minutes whilst cooling the child by adjusting clothing, sips of water offered.

A child has a temperature of 38˚ Celsius +

• Parent/ carer will be called to collect their child.
• Temperature monitored and record every 10 minutes whilst cooling the child by adjusting clothing, sips of water offered.
• Child excluded for 24hours after temperature returns to normal.

A child has a temperature of 38˚ Celsius + for a period of 30 min

• Parent/carer will be called again to advise them of the situation. Child needs to be collected by parent/carer as soon as possible.
• Temperature monitored and recorded every 10 minutes whilst cooling the child by adjusting clothing, sips of water offered.
• Child excluded until 24 hours after temperature returns to normal and the child is clinically well.

A child has a temperature of 39˚ Celsius +

• Parent/carer will be called to give permission for administration of an emergency paracetamol.
• Senior Nursery Manager or Junior Nursery Manager will administrate appropriate dose of paracetamol.
• Temperature monitored and recorded every 10 minutes whilst cooling the child by adjusting clothing, sips of water offered.
• Child excluded until 24 hours after temperature returns to normal and the child is clinically well.

A child has a temperature of 39˚ Celsius +

• For a period of 1 hour
• Parent/carer will be called again to advise them of the situation. If child’s condition deteriorates an ambulance may be called.

All staff and parents/carers must be aware that if a child needs to be given paracetamol, they are too ill to be at nursery.

Please be aware that child must be collected by parent/carer within an hour and 30 minutes of the first phone call.

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 the child requiring the procedure. This training is specific for individual children 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 such medication. 

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 where they are infectious or too unwell to meet children’s needs. This includes circumstances where any medication taken affects their ability to care for children, for example, where it makes a person drowsy. If any staff member believes that their condition, including any condition caused by taking medication, is affecting their ability to work, they must inform their line manager and seek medical advice. *The senior 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 home room where staff may need easy access to the medication such as an asthma inhaler. In all cases it must be stored out of reach of the children. It must not be kept in the first aid box and should be labelled with the name of the member of staff.

Storage

Most medication should be stored in a locked cupboard or locked container which is out of reach of children in an area that is below 25oC. A few medicines, such as asthma inhalers, may need to be readily available and in this circumstance must not be locked away.

The medication’s packaging and accompanying patient information leaflet will include instructions about how to store the medicine. These should be stored with the medication.

Services should not store large volumes of medication. Parents/carers should be asked to supply weekly or monthly supplies of the doses to be taken at the service in their original container with the name of the child, the name of the drug, the dosage frequency and expiry date.

Medication for each child should be kept separate (including devices such as inhalers). This can be in a plastic box or zip lock type plastic bag. These should be labelled with the child’s name, photo and date of birth and date service received it. Where a pupil needs two or more prescribed medicines, each should be in a separate original container.

Medicine spoons and oral syringes should be cleaned and stored with the child’s medication. Devices such as inhaler ‘spacers’ should be cleaned as directed in the product information and stored with the child’s medication.

Some medication will need to be stored in a fridge. The medical fridge should be lockable and be kept at a temperature between 2oC - 5oC. The temperature should be checked each day using a maximum and minimum thermometer. Record both the maximum and minimum temperature. Where a medical fridge is not available medication requiring refrigerated storage can be kept in a clearly labelled airtight container in a domestic fridge.

Administration

Medication must not be administered by care staff unless there is clear, explicit written consent given by parents/carers.

Only medication provided in the original container with the information leaflet will be administered. Staff should be aware of the recommended dosage as per the information leaflet which is supplied when a medicine is dispensed or bought over the counter and this should be stored with the medication.

If medication is provided from different country and original leaflet does not have English translation, then parent MUST contact GP or Pharmacy for translation.

All medication and associated ‘devices’ such as inhalers, must be clearly labelled with the child’s name and date of birth and date received by the service. All administration will be recorded clearly and accurately.

Where children have complex medical needs a Health Plan should be developed in conjunction with specialist services supporting the child. See Appendix 1 for sample ‘Individual Child Health Care Plan’.

Individual Child Health Care Plan is document design for a child with ongoing medical needs, if may be or a longer term or on a continual basis. The aim is to ensure that nursery know how to support child with medical needs effectively and to provide clarity about needs to be done, when, and by whom. Individual Child Health Care Plan are developed in partnership between nursery and parents/carers, and relevant health professional who can advise on child’s case.

If in doubt about any of the procedures the member of staff should check with the parents or a health professional before taking further action.

Staff should complete and sign record sheets each time they give medication to a child.

See Appendix 2 for sample ‘Prescribed Medication Form.

First Dose

Care service staff is not allowed to give the first dose of a NEW medicine to a child. Parents should have already given at least one dose to ensure that the child does not have an adverse reaction to the medication. The date of first administration must be recorded along with consent to administer.

Any fully qualified member of staff giving medicine to a baby/ young child must check:

• The child’s name
• Written instruction provided by parents/carer and doctor
• Prescribed dose
• Dose frequency
• Expiry date
• Any additional or cautionary labels

Emergency medication (e.g. inhalers and Epipen)

If medication must be given on a ‘when required’ basis, it is important that care staff ask if any medication has been given to the child prior to arriving at the service.

Parents should be informed when medication was administered and in what circumstances when the child is collected from the service, or sooner if that is required by parents.

The first dose ‘rule’ does not include emergency medication such as an adrenaline pen where the risk of not giving it could outweigh any adverse reaction. This should be explicit in the consent given.

If the service locks away medication that a child might need in an emergency, all staff should know where to obtain keys to the medicine cabinet. Where medication is required in an emergency there should be a Individual Child Health Care Plan (in addition to the permissions) setting out the procedure for administration and follow up required. This is likely to come from a medical professional such as an epilepsy nurse.

Medication management during trips and outings

Agreement should be made between the service and parents/carers before a trip or outing.

A record will be made about how medication will be stored and administered. A note of this should be kept in the child’s file.

Refusal to take medication

No child or young person should be forced to take medication. If a child refuses parents/carer should be contacted.

Collection/returning medication to parents/carer

To minimise any spread of COVID -19 at setting, nursery has strict regulation of collecting and returning medication to parents. Parents and a member of staff collecting or returning medication to parents/carer must try to minimise any unnecessary contact of medication with any surface at nursery. A member of staff must wear gloves when collecting medication and place medication straight away into child’s individual well labelled box. When administration of medication required a member of staff must wear gloves and PPE on, open medication box, put medication box lid on unit. During administration medication cannot be placed on any nursery unit.

Parental Responsibility

Parents/carers MUST give written information and permission for all administration of medication.

Parents/carers must be made aware that it is their responsibility to ensure that medicines are “in date”.

Parents/carers are responsible for ensuring that there is sufficient medication to be administered as required.

Parents/carers must give explicit written information when medication is required as symptom relief, about the circumstances/signs/symptoms of the need for administration.

Staff Training

All staff should know and understand the administration of medication policy and

procedures. Staff asked to administer medication should ask for clarification from their Room Senior/Junior Manager/Senior Manager/ child’s parents if they are unclear.

Staff administering medication should attend training to understand their roles and responsibilities. Managers of services should understand the legal requirements and undertake to ensure that best practice guidance is always followed by all staff.

Staff required to administer ‘life saving’ treatments (such as an Epipen) should only do so having had ‘specialist’ training from a health practitioner specifically relating to the child.

Document information