Administer medication within
guidelines
Administer medication according to
organisation policies and legislative
requirements
Precautions to take when administering
medication
Medicines are given to children for many reasons. The most common medicines that are given
in childcare services are:
•
•
antibiotics, used to fight infections
paracetamol (Panadol), used to reduce fever or pain.
Other medicines that may have to be given are ear or eye drops and asthma inhalers.
Guidelines
When you give any medication always:
1
2
3
4
5
Check the label. This will ensure that you are giving the correct medicine.
Medicines will often have a brand name and a generic name. It is the generic name
that is written on prescriptions that should match the label
Check the expiry date. Medicines cannot be used after the stated expiry date.
Check the dose.
Know what you are giving. If you have any doubt about the medicine you are
giving do not give it until you check.
Know how frequently you can give the medicine.
All childcare centres must comply with the medication policy as set out by the NSW
government, in the Children’s Services Regulations 2004. The safety precautions that follow
are based on these regulations.
1
© NSW DET 2007
Check medication for name, dosage and use-by-date
cli
Precautions with non-prescription medications
In childcare services this is principally paracetamol (Panadol). Paracetamol liquid comes in
different strengths so it is important to always read the label. The label of any medicine must
show the concentration of that medicine, the dose instructions and the expiry date. The dose
instruction on a Paracetamol bottle is in the form of a table, with the estimated weight of the
child and the dose required for each age of child. It is easy using the table, to work out the
correct dose. The label must be easy to read, so always wipe the bottle after use to remove
any spills. Remember to read the warnings on the bottle.
Activity 1
Precautions with homeopathic medication
The same precautions should be taken when administering homeopathic medication as are
taken when giving any other non-prescription medication. Homeopathic or herbal
preparations must be labelled in the same, safe manner and written permission from the
parents is again mandatory.
Precautions with prescription medicines
The most common prescribed medicines seen in childcare services are antibiotics. Antibiotics
are used to fight bacterial infections such as a throat or ear infection. They must be taken as
instructed and the whole course finished. The labels on all prescription medicine bottles must
have the name of the medicine, the name of the child and the dose (in both mls and mgs)
written clearly. The frequency you give the medicine and whether it has to be taken with, or
before, food should be included. The expiry date must be clear and the prescribing doctor and
the dispensing chemist included in case of queries.
2
© NSW DET 2007
Centre policy on administering medication
There are certain safety measures which must be followed when giving medicine and these
will be written in the medication policy in each service.
You must read the policy, be familiar with it and follow the safety guidelines in every service
you work.
1
The parent (or guardian) must have completed the Centre’s medication register, with
the following:
•
•
•
•
the child’s name
name of medicine
dosage and time intervals of doses
parent’s signature (and date of signature).
The parent (or guardian) would have informed a staff member about the request and ensured
that the medicine was stored and labelled appropriately.
2
Two staff members should check the medicine permission form and the dose of the
medicine.
3
The medicine is removed from the locked cupboard and the cupboard relocked.
4
The medicine label is checked against the permission form.
5
The dose is measured accurately.
6
The medicine is replaced in the locked cupboard.
7
Check it is the correct child for the medication.
8
Give the medication according to instructions, ensuring all is taken.
9
Both staff members sign in the child’s personal file that the specific medicine and dose
had been given. Date and time need to be recorded as well.
Precautions
Before giving medicine to a child, check that the dose has not been given the by any other staff
member. Check by both asking other staff and look at the child’s medication records.
In the case of Panadol make sure the child has not had a dose in the last four hours. If you
need to give Panadol to a child and he has not been in the childcare service for the last four
hours you will need to ring his parents/carer to check he has not had Panadol at home. This
will prevent any errors and overdoses.
You should also check the Centre’s policy regarding administering Panadol.
3
© NSW DET 2007
If the medicine dose, or even medicine itself, appears to be strange or unusual do not give it,
first check with the director or whoever is in charge. You may have to ring the parents or
chemist with your query.
Measuring the dose
When you are measuring a dose of medication special precautions should be taken to prevent
errors. When measuring use a correctly marked measuring cup, syringe or dropper. Do not
measure by teaspoon as it is not accurate, however you can use a teaspoon to give the
medicine. The measuring cup should remain on a level surface when pouring and measuring.
Do not lift to eye level to measure as it will not be an accurate measurement. Once two staff
members have checked the dose and the amount the medicine can be given.
Always use measuring devices to measure the correct dose - don't guess. cli
Giving medicine
A baby will only receive the smallest volume of medicine so the easiest way is to give the
medicine with a dropper or a syringe. Give the medicine in small amounts at a time so less is
lost if the baby spits out a mouthful. Try to make sure the child has the whole dose, spoon in
what is spat out where possible. Older children can take medicine from a spoon or the
measuring cup. Again give in small sips and try to make sure that they take the whole dose.
Most children’s medicines are sweet and flavoured so they are not so unpleasant.
Here are five guidelines:
1
2
3
4
5
Check the label. This will ensure that you are giving the correct medicine.
Medicines will often have a brand name and a generic name. It is the generic name
that is written on prescriptions that should match the label
Check the expiry date. Medicines cannot be used after the stated expiry date.
Check the dose.
Know what you are giving. If you have any doubt about the medicine you are
giving do not give it until you check.
Know how frequently you can give the medicine.
4
© NSW DET 2007
Activity 2
Here are a few more guidelines for safe medicine administration:
•
•
•
•
•
Measure the medicine accurately.
Do not mix the medicine in the baby’s bottle.
Do not give medicine in a bottle, a feeding cup or regular drink cup.
Supervise all children when taking medicine, even if they are older.
If a child vomits or spits the medicine, do not repeat a dose of medicine without
senior staff approval.
Problems in giving medications
Sometimes you will find that children will either spit or vomit the dose of medicine. Seek
Director’s or parents’ advice if this happens.
In some cases if the child vomits the entire dose of either antibiotics or Paracetamol within five
minutes of taking it, you will be able to give the medicine again but you MUST seek the advice
of parents and/or the Centre Director.
If the child has kept the medicine down for any longer than five minutes some of it will be
absorbed, so it should not be repeated. If a child spits out some of the dose it is often difficult
to tell how much and therefore, you should not repeat the dose. If you have a child who is
resistant to taking medicines enlist the help of an experienced staff member. This will make
sure the dose is given and the trauma to the child is minimal.
Different types of medication
Ear drops
The easiest way to put ear drops in a baby or toddler is to swaddle them well in a blanket,
making sure their arms are well wrapped. All eardrops should be given with the child lying on
his side comfortably, with the ear to be treated upmost. When the drops are in, the child
should try to lie still for five minutes. A tissue is usually required to wipe away any excess.
Eye drops
Putting eye drops in your own eyes is tricky enough, so imagine how tricky it is to put them in a
small child’s eyes. Children generally will not cooperate and will screw their eyes tight, again
swaddling the baby and the toddler is a good idea. Lie the child down and have tissues to wipe
away excess. Ask the child to open his eyes or gently open their eyes. If the child is struggling
or their eyes are tightly shut do not attempt to prise their eyes open. Drop the measured
amounts of drops into the eye at the side nearest the nose. Once the drops are in, encourage
the child to open their eyes and blink.
5
© NSW DET 2007
Asthma inhalers
In Australia asthma is a serious illness and needs to be treated quickly and effectively. Asthma
is an allergic reaction which causes the air passages to swell and narrow making breathing
difficult. There are some indicators that an asthma attack is developing but sometimes the
asthma attack can happen very suddenly, with little warning. Triggers such as dust, animal hair,
exercise, or stress can bring on attack. Sometimes it happens if a child has had a cough or cold
virus or even when the weather changes suddenly.
Each child with asthma should have an asthma management plan which is updated regularly.
You should be familiar with the plan. The treatment for asthma is medication breathed into
the lungs from a puffer or inhaler. A child who suffers from asthma will have to carry his
inhalers with him at all times. There are a few different types of inhalers that are taken for
asthma and a senior staff or director must ensure you are competent in their use. The most
common inhaler you will see is called Ventolin. Very young children will require a machine
which blows the medication into their air passages via a mask.
Some children will also regularly use nebulizers. These quite complex looking machines are
relatively simple to operate. They disperse asthma medication in a vapour form.
Again you will need instruction on its operation. You will need to become familiar and
confident in their use if working in a Centre where children who routinely use nebulizers
attend.
Inhalers should be given as soon as a child has a wheezing sound when he breathes or has a
persistent cough and wheeze. Use of inhalers should be in accordance with the child’s asthma
management plan, a format you can obtain from Asthma Council.
Asthma can have a rapid and frightening onset so vigilance and fast, effective action is
required. The parents/carer should be informed and the child given quiet activities and
watched carefully.
Ensure the child is sitting so that his or her chest is elevated. Lying down aggravates asthma.
If the child’s breathing becomes nosier or he seems to be breathing with more difficulty he
must be seen by a doctor and his parents informed.
Do not hesitate to ring an ambulance.
Poisoning
If a wrong dose of medication is given where the child receives too much or if he takes the
medicine himself, contact the Poisons Information Centre or your local casualty to give you
advice. If there is any change in the child’s behaviour or any change in conscious level,
telephone for an ambulance immediately. The director must know of any incidents, an
accident report must be filled out and the parents informed. .
The Poisons Information Centre number is 13 11 26
6
© NSW DET 2007
Activity 3
Store medication according to
requirements
Before you store a medication it is important to read the storage instruction on the label, as
there are differences in storage requirements. Some medicines must be stored at low
temperatures in the fridge and some need stored at room temperature. There are
preparations that require storage in dark areas or they will deteriorate. These medicines
usually come in dark bottles to reduce light infiltration. As a general rule, liquid antibiotics and
eye drops must be stored in the fridge and all other medicines must be in a cool environment.
Whatever the temperature the medicine is stored at, it must always be stored securely.
Medicines must be stored in either an adult height, locked cupboard or a locked box in the
refrigerator (preferably with a fridge lock). The storage facilities must be kept locked all the
time. When you take a medicine out to measure for a child, always lock the medicine
cupboard/box immediately after. This may be a little more trouble but if you are distracted
when measuring there is no chance that a child might get into the medicine cupboard. All
medicine containers should have child safety locks which can only be operated by adults. Do
not store medicine in anything other than its original container.
Check medication for name,
instructions and use by date
When you last had a headache and reached for some Paracetamol did you check if it was in
date? Did you check the foil packet against what came out of the box? Did you check you were
taking the right dose? Did you read the warnings?
When you give medicine to others you must be extremely careful particularly with children.
Imagine what would happen if you gave too much, too little or the wrong medicine.
Remember children are never given tablets and never take adult medicine.
7
© NSW DET 2007
Medicines are not routinely given in childcare services; therefore staff are much less practised
in this skill. The dose or amount of medicine the child receives is carefully calculated according
to the child’s weight and age. Adult medicine usually comes in tablet form, where one tablet
will suit a range of adults. Children’s medicines come in a liquid form and have to be measured
carefully according to instructions. The doses that children receive are small and the
measurements have to be accurate. A child has a small body; any inaccuracy in the dose has a
magnified effect on the child.
Activity 4
Document all medication
administration in accordance with
requirements
Thaya’s father arrives with a bottle of amoxicillin, an antibiotic for Thaya’s ear infection. He is
in a hurry and hands you the bottle saying Thaya has to have 5mls of the amoxicillin at
lunchtime.
What must Thaya’s father do before he leaves?
Before you can give any medicine you must get signed permission from the parents/carer. All
children require an up to date medication permission form before you can give any medication
in a childcare centre, even Panadol. The form must be clear, legible, dated, signed. The
permission form for a prescription medicine may look something like this:
Administration of medication permission form
Date
Child’s name
Name of medication
Prescribing doctor
Medication to be given for
Dose of medication to be given
Route of administration
Day to be given on Monday / Tuesday / Wednesday / Thursday / Friday
8
© NSW DET 2007
Time medication to given by staff
I
………………………………………………………….give my permission for the staff to administer the above
prescribed medication according to the above guidelines to………………………………..
I understand the staff cannot be held responsible for any complications resulting from this medication
being given according to the directions.
Signed\Date…………………………………………………………………
Staff signature\Date…………………………………………………………
No medication can be given without permission.
A modified form like the above may be given to all parents to sign, for the administration of
Paracetamol and any long-term medication. Check with the centre where you are working.
These permission forms will be updated every year while the child is at the service. The details
on the form must be easy to read and understand and must be dated and signed.
When a parent/carer hands the medication and the permission form over, you must check all
the details and the medicine itself before the parent/carer leaves to save problems or
misunderstandings occurring. What is on the medication form must tally with what is on the
label of the medicine. Expired medicine forms must be kept in the child’s personal file.
Activity 5a
Activity 5b
Activity 5c
Activity 5d
Activity 5e
9
© NSW DET 2007
Recording medication
Once medication has been successfully given it must be recorded on that child’s medication
form. The date, time, dosage and who administered the medication should be included. This is
necessary both for legal purposes and to prevent another staff member repeating the dose. If
the child refused the medicine, spat it out or the dose was missed this must also be recorded.
If a dose was given which was incorrect an incident form must be filled out and the
appropriate staff and carers informed.
Summary





Medication is not routinely given in child care services and so carers are less practised
at this skill. Extra care and diligence must be taken when administering medication to
minimise risk and hazards to children.
Precautions for the safe administration of medications apply to prescription as well as
non prescription (over the counter) medications and homeopathic medications.
Accurate measurement and checking procedures are critically important.
All medications must be stored securely and appropriately as per individual medication
requirements to ensure their safety and to prevent access by children.
All medications given must be documented appropriately and stored with
confidentiality in mind.
Additional Resources
Staying Healthy in Child Care (Fourth Edition):
http://www.nhmrc.gov.au/PUBLICATIONS/synopses/ch43syn.htm
10
© NSW DET 2007