1. Bullet Point #1 Original document included as part of Healthy Futures: Improving Health Outcomes for Young Children Medication Administration Curriculum. Copyright © 2009 American Academy of Pediatrics. All Rights Reserved. The American Academy of Pediatrics does not review or endorse any modifications made to this document and in no event shall the AAP be liable for any such changes.

2. Medication Administration Curriculum - Module 1 Curriculum Objectives At the completion of this workshop participants will be able to: 1.Demonstrate procedures for receiving, storing, preparing, and administrating medications in a practice activity 2.Document medication administered in a simulation activity 3.Describe actions to take in emergency situations in a scenario based activity 4.Identify elements of a medication administration policy

3. Medication Administration Curriculum - Module 1 Disclaimer This curriculum provides education for personnel in the child care setting who give medication to children but are not licensed health care professionals It is not a substitute for written policy and professional medical guidance It is not certification of competency Actual care must be based on the child’s clinical presentation, the health care professional’s orders, parental guidance, personnel experience and training, and facility policy Each program must review the current licensing regulations and comply with the requirements

4. Online Modules Review Module 1 Reasons to Give Medication Rules and Regulations Shared responsibility of parents, caregivers, and health care providers Types of medication Module 2 Documentation Forms Program Specific Policies and Procedures Confidentiality Receiving, storing, and disposing of medications

5. Medication Administration Curriculum - Module 1 Module 3 5 Rights Administration of oral medications topical, eye drops, ear drops, nose drops Emergency Medications : inhalers, and auto injectors

6. Medication Administration Curriculum - Module 1 What Is Covered in this Workshop Receiving and Storing medications 5 Rights of Medication Administration review Administration of typical and routine medications for short-term use Administration of emergency medications

7. Medication Administration Curriculum - Module 1 What Is Not Covered in this Workshop Special medications like injectable or rectal medication Medication Management for children for children with special or complex medical needs

8. Medication Administration Curriculum - Module 3 Communication and Care When Children need to take medication in the child care program good communication at drop-off and pick-up will help prevent errors

9. Medication Administration Curriculum - Module 1 Receiving Medications Review Communicate with Parents : What questions do you need to ask ? Are consent forms with instructions completed and signed? Is the medication in the original child-resistant container labeled by a pharmacist or over-the- counter medication in the original container with the manufacturer’s information? Does the label have all the information needed

10. Medication Administration Curriculum - Module 3 Group Activity: Receiving Medication Review Nick is 15-months-old and has an ear infection. Nick needs a noon time dose of amoxicillin suspension for this week and part of next week. Receive Medication for Nick Where should the medication be stored What questions would you ask the parents

11. Medication Administration Curriculum - Module 3 Medication Administration Procedure Review Prepare the area Wash Hands Check 5 rights: child, medication, dose, time, and route Take the medication from the container Prepare the medication Never give more or less, accuracy is very important Check the label again Prepare the Child Give the medication

12. Medication Administration Curriculum - Module 3 Medication Administration Procedure: Preparing the Medication Review Find the medication - read label and consent form Find appropriate measuring device Measure the amount on the label Change the form of the medication ONLY if the label states for you to do so: –Crushing medication –Opening capsule of Sprinkles

13. Medication Administration Curriculum - Module 3 Measuring Oral Medication Oral Measuring Devices –Dropper –Syringes: ½ tsp or less is most accurately measured with syringe or similar device –Dosing spoon –Medication cup No kitchen teaspoons!

14. Medication Administration Curriculum - Module 3 Group Activity :Medication Administration Using Measuring Devices Practice What about this measuring device ?

15. Medication Administration Curriculum - Module 1 Medication Administration Procedure: Preparing the Child Strategies to prepare the child –Communicate with the child –Explain the procedure to the child Wash the child’s hands, if appropriate Position the child

16. Medication Administration Curriculum - Module 3 Medication Administration Procedure: Finishing Up Praise the child Check the label again Return the medication to storage immediately –Never leave medication unattended Record the medication, date, time, dose, route, and your signature on the Medication Log Clean the measuring device Wash your hands Observe the child for side effects

17. Medication Administration Curriculum - Module 3 Administering and Documenting Medications Nick Work in groups of threes –Child Care Provider –Nick –Observer Practice giving medication to Nick All members of your group can make suggestions can make suggestions to assure all steps are followed including “Nick”

18. Medication Administration Curriculum - Module 3 Procedures for Giving Medication with Food Mix medication with food only when necessary Assure that the prescriber or pharmacist have approved mixing medication with food or liquid If medication is mixed with food use a –small amount (1 tablespoon) of applesauce, jello, jelly, pudding, baby cereal or liquid use –a small amount of formula, water, or juice. The child should take the entire amount of fluid. Do not mix medication in a whole baby bottle. Give the child something to drink immediately afterward to help with the taste

19. Medication Administration Curriculum - Module 3 “As Needed” Conditions Some medication, such as emergency medication, only need to be given “as needed” “As needed” or “prn” medication orders should specify specific instructions. –Example of acceptable, specific instructions: albuterol – 2 puffs as needed for wheezing, increased cough, or breathing difficulty OTC medication for pain and fever should be kept to a minimum and should be as specific as possible The order should state the maximum number of times the dose can be repeated before seeking further medical care

20. Medication Administration Curriculum - Module 3 Administering Asthma Medication Susie is 4 years old. She recently was diagnosed with asthma which is often triggered by a cold. You notice that she is sitting quietly on the platform of the climbing gym and is not participating with the other children ( she is usually very active). She has an intermittent cough and you think you hear a slight wheeze.

21. Medication Administration Curriculum - Module 3 Administering An Epinephrine Auto Injector Jeffrey is 2. He is allergic to peanuts. You have a peanut free classroom and all parents have signed the peanut free classroom agreement. Today is Mary’s Birthday. Mary’s grandmother who is visiting from out of town brought in a special snack. After eating the snack Jeffrey starts pointing to and scratching at his tongue.

22. Medication Administration Curriculum - Module 3 Take a Break

23. Medication Administration Curriculum - Module 3 Medication Administration Challenges Medication Errors Side Effects Medication Incidents Trouble shooting and documentation Field Trips Handling requests

24. Medication Administration Curriculum - Module 3 Introduction: Common Errors in Medication Administration Medication Errors Can Happen! Common errors –Took medication twice –Wrong medication –Incorrect dose –Missed dose Common causes –Not understanding medication label –Not understanding how to give medication –Poor communication between parents/guardians and health care professional –Child Care Survey-missed doses

25. Medication Administration Curriculum - Module 3 Most Common Medication Errors Errors are most commonly made with OTC analgesics, which include medications like Tylenol ® (acetaminophen) and Motrin ® (ibuprofen) Reasons for errors include: –Given frequently –Many different concentrations (infant drops, children’s liquids, etc) –May be mixed with other medications in cough and cold preparations –Dosing charts are unique to the type and form of the medication

26. Medication Administration Curriculum - Module 3 What is a Medication Error? Any of the “5 Rights” gone wrong… Giving the medication to the wrong child Giving the wrong medication Giving the wrong dose Giving the medication at the wrong time Giving the medication by the wrong route

27. Medication Administration Curriculum - Module 3 Programs Can Prevent Future Medication Errors Can you think of ways to prevent future errors? Look at the pattern of errors Make changes based on the patterns seen to prevent further errors of that type

28. Medication Administration Curriculum - Module 3 Recognizing Side Effects of Medication A secondary and usually adverse effect of taking a medication Common side effects include: –Upset stomach –Diarrhea or loose stools –Dry mouth –Drowsiness –Change in activity or mood –Dizziness –Flushing, sweating –Rashes –Rapid heartbeat –Nausea

29. Medication Administration Curriculum - Module 3 Side Effects of Medication, continued Effects of medication can vary from child to child –The same antihistamine (diphenhydramine/Benadryl ® ) can make one child sleepy while another becomes jittery and hyperactive Side effects that could be normal for 1 medication might be abnormal for another –Fast heart rate is expected for albuterol, an asthma medication, but not for a fever reducing medication

30. Medication Administration Curriculum - Module 3 Sources of Information About Medication Side Effects Parents Information from the pharmacy who filled the prescription Information from the prescribing health care professional

31. Medication Administration Curriculum - Module 3 Observation Young children can’t always verbalize side effects, adverse effects, or allergic reactions, so careful observation is essential

32. Medication Administration Curriculum - Module 3 What To Do for Medication Errors, Adverse Effects, or Allergic Reactions Act Quickly: If the child is in distress, call 911 Notify the center director (if this is a serious error, do not delay the 911 call) Notify parent or guardian Fill out a Medication Incident Report You might also: Call Poison Control Contact the health care professional Notify state Bureau of Licensing

33. Medication Administration Curriculum - Module 3 When Should You Call 911? When you see signs of distress When there is a loss of (or change in) consciousness Blue color or difficulty breathing Difficulty swallowing Swelling of lips, tongue, or face, or drooling Seizure activity Rapidly spreading rash or hives Impaired speech or mobility Getting worse quickly When in doubt

34. Medication Administration Curriculum - Module 3 Other Reasons to Call Poison Control? 1-800-222-1222 When medication is given to the wrong child When the wrong medication is given to a child When the wrong dose is given (overdose) When a medication is given by the wrong route When a medication is given at the wrong time (and it results in an extra dose) The AAP no longer recommends that syrup of ipecac be used

35. Medication Administration Curriculum - Module 3 If You Call 911 or Poison Control Have this information ready: The medication container Child’s Medication Administration Packet Child’s Emergency Contact Form Child’s current weight or the most recent weight known ( recording a child’s weight on the medication log is a good way to assure that it is available for any reason)

36. Medication Administration Curriculum - Module 3 Other Medication Incidents- Not Errors Child refusal Spit out doses Vomited doses Spilled medication

37. Medication Administration Curriculum - Module 3 What To Do for Medication Incidents? Always: Notify the center director Notify parent/guardian Fill out a Medication Incident Report Develop and document a follow-up plan Never: Repeat a dose that the child does not keep down without specific instructions from a health care professional

38. Medication Administration Curriculum - Module 3 Documentation of an Error or Incident Make notation on the Medication Log for that dose Complete the Medication Incident Report Follow up according to child care facility policy

39. Medication Administration Curriculum - Module 3 Medication Incident Report To be completed by the person who administered the medication or his or her supervisor

40. Medication Administration Curriculum - Module 3 Scenario: Nick You gave Nick his dose of amoxicillin at noon and recorded it. At 12:30, you note that Nick is scratching his arms and he is developing a rash on his arms. He is happy and playful and is not having any breathing difficulties. What do you do? Document the outcome.

41. Medication Administration Curriculum - Module 3 Field Trips and Medications Outdoors Someone authorized to administer medication must be present Medication is secured and labeled Maintain the proper temperature and conditions for the medication Carry copies of emergency contact information and the child’s medical forms Document medication administration given outside of the program Use good hand hygiene Access to a telephone ( cell phones are ok ) Know where the closest emergency room is

42. Medication Administration Curriculum - Module 3 What Would You Do ? A parent asks you to give the morning dose of a medication that is ordered three times a day A parent asks you to give a medication but the medication is incorrectly labeled A child has had three seizures and has been prescribed emergency medication. The parent brings in a correctly completed consent form and label. No one on staff has had training in the procedure.

43. Medication Administration Curriculum - Module 3 Resources Child Care Health Consultants National Resource Center for Health and Safety in Child Care –Caring for Our Children Standards –1-800-598-kids –http://nrckids.org Local pharmacist Child’s health care professional Local children’s hospitals Other health educators

44. Medication Administration Curriculum - Module 3 Credits Healthy Futures: Medication Administration in Early Education and Child Care http://www.healthychildcare.org/healthyfutures.html http://www.healthychildcare.org/healthyfutures.html Massachusetts Department of Health and EEC( Department of Early Education and Care: Medication Administration in Child Care Training (MACC) http://www.eec.state.ma.us/docs1/20110504_macc_eitc_fly er.pdf http://www.eec.state.ma.us/docs1/20110504_macc_eitc_fly er.pdf Connecticut Department of Social Services and Connecticut Department of Health and Education: Connecticut Medication Administration in Early Education and Child Care Settings: http://www.ctcharts.org/index.cfm?module=118 http://www.ctcharts.org/index.cfm?module=118

45. Medication Administration Curriculum - Module 3 Special Thanks Kim Akre, MD ( reviewer ) Kary Towne, RN (reviewer) Nancy Coleman, RN ( reviewer )

46. Medication Administration Curriculum - Module 3 Wrap Up Post-test Evaluation