Medication and Illness
While it is not our policy to care for sick children, who should be at home until they are well enough to return to Joeys, we will agree to administer medication as part of maintaining their health and well-being or when they are recovering from an illness. We promote the good health of children attending nursery and take necessary steps to prevent the spread of infection. We ensure that where medicines are necessary to maintain health of the child, they are given correctly and in accordance with legal requirements.
In many cases, it is possible for children’s GPs to prescribe medicine that can be taken at home in the morning and evening. As far as possible, administering medicines will only be done where it would be detrimental to the child’s health if not given in the setting. If a child has not had a medication before, especially a baby/child under two, it is advised that the parent keeps the child at home for the first 48 hours to ensure there are no adverse effects, as well as to give time for the medication to take effect.
Our senior practitioners and/or management are responsible for the correct administration of medication. This includes ensuring that parent consent forms have been completed, that medicines are stored correctly and that records are kept according to procedures. We notify our insurance provider of all required conditions, as laid out in our insurance policy.
§ Children taking prescribed medication must be well enough to attend the setting.
§ We only usually administer medication when it has been prescribed for a child by a doctor (or other medically qualified person). It must be in-date and prescribed for the current condition.
§ Non-prescription medication, such as pain or fever relief (e.g. Calpol) and teething gel, may be administered, but only with prior written consent of the parent and only when there is a health reason to do so, such as a high temperature. Children under the age of 16 years are never given medicines containing aspirin unless prescribed specifically for that child by a doctor. The administering of un-prescribed medication is recorded in the same way as any other medication. We may administer children’s paracetamol (un-prescribed) for children under the age of one year with the verbal consent of the parents in the case of a high temperature. This is to prevent febrile convulsion and where a parent or named person is on their way to collect the child.
§ Prescription medicine will only be given to the person named on the label for the dosage stated and medicines must be in their original containers with label clearly visible.
§ Children's prescribed medicines are stored in their original containers, are clearly labelled and are inaccessible to the children. On receiving the medication, the member of staff checks that it is in date and prescribed specifically for the current condition.
§ Parents must give prior written permission for the administration of medication. The staff member receiving the medication will ask the parent to sign a consent form stating the following information. No medication may be given without these details being provided:
- the full name of child and date of birth
- the name of medication and strength
- who prescribed it
- the dosage and times to be given in the setting
- the method of administration
- how the medication should be stored and its expiry date
- any possible side effects that may be expected
- the signature of the parent, their printed name and the date
§ The administration of medicine is recorded accurately in our medication record book each time it is given and is signed by the person administering the medication [and a witness]. Parents are shown the record at the end of the day and asked to sign the record book to acknowledge the administration of the medicine. The medication record book records the:
- name of the child
- name and strength of the medication
- name of the doctor that prescribed it
- date and time of the dose
- dose given and method
- signature of the person administering the medication and a witness who verifies that the medication has been given correctly
- Parent’s signature (at the end of the day).
§ Parents should 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 a doctor’s letter. The parent must be asked when the child had last been given the medication before coming to nursery; this information will be recorded on the medication form.
§ When the child is picked up, the parent or guardian must be given precise details of the times and dosage given throughout the day. The parent’s signature must be obtained
§ 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.
§ If the administration of prescribed medication requires medical knowledge, we obtain individual training for the relevant member of staff by a health professional.
§ If rectal diazepam is given, another member of staff must be present and co-signs the record book.
§ No child may self-administer. Where children are capable of understanding when they need medication, for example with asthma, they should be encouraged to tell an adult what they need. However, this does not replace staff vigilance in knowing and responding when a child requires medication. If a child in out of school club is more comfortable administering asthma medication a member of staff will observe and record.
§ We monitor the medication record book is monitored to look at the frequency of medication given in the setting. For example, a high incidence of antibiotics being prescribed for a number of children at similar times may indicate a need for better infection control.
Storage of medicines
§ All medication for children must have the child’s name clearly written on the original container and kept in a lockable box in the office, which is out of reach of all children and under supervision at all times or in the baby room fridge if they so require.
§ Medication MUST NOT be stored in children’s bags.
§ For some conditions, medication may be kept in the setting to be administered on a regular or as-and-when- required basis. The manager or deputy will check that any medication held in the setting, is in date and return any out-of-date medication back to the parent.
§ All medications must be in their original containers, legible and not tampered with or they will not be given. All prescription medications should have the pharmacist’s details and notes attached to show the dosage needed and the date the prescription was issued. This will all be checked, along with expiry dates, before staff agree to administer medication.
§ Medicine will only be administered to children by a first aid trained senior member of staff. Another member of staff must witness this taking place. Both staff are required to check the details on the medication form and sign the form stating the medication was administered.
§ All medication records are stored within the classroom whilst the medication is running and then filed confidentiality in the childs personal record.
§ If at any point during the course of medication staff administer the treatment incorrectly the parents will be telephoned immediately and the management will take appropriate measures, this could be either calling a local GP, NHS direct or taking the child in to hospital.
§ Staff medication on the premises must be securely stored, if the medication needs to be refrigerated then it must be stored in the baby room fridge. Staff must inform the manager if they are bringing any medicine on to the premises and ensure that it doesn’t impair their ability to work.
Children who have long term medical conditions and who may require ongoing medication
Sometimes children have long term or complex medical needs and are therefore in need of a more regular and set care routine.
Joeys will therefore meet with the parents/carers before the child starts Joeys to consider what staff training is needed and also put together a written health care plan and risk assessment in conjunction with any care workers involved in the child’s life.
§ The risk assessment includes vigorous activities and any other activity that may give cause for concern regarding an individual child’s health needs.
- Any relevant training will be given to the staff that will be primary carers within Joeys.
- All staff will be made aware of the child’s condition and who to go to if help is needed
- All medications or medical equipment will be stored out of reach of children
- The childs parent/carer will be asked what risks they can see within the environment
- The child’s contact details will be made easily accessible for staff in emergencies
- The parents/carers of the child will be required to provide all essential medical equipment and medication (prescribed), during the child’s time with Joeys. Any medication or equipment requiring disposal will be returned to the parents/carers
§ The risk assessment includes arrangements for taking medicines on outings and advice is sought from the child’s GP if necessary where there are concerns.
§ The individual health plan should include the measures to be taken in an emergency.
We will review the individual health plan every six months, or more frequently if necessary. This includes reviewing the medication, e.g. changes to the medication or the dosage, any side effects noted etc. Parents receive a copy of the individual health plan and each contributor, including the parent, signs it.
Managing medicines on trips and outings
§ If children are going on outings, a senior practitioner will accompany the children with a risk assessment, or another member of staff who is fully informed about the child’s needs and/or medication.
§ Medication for a child is taken, with the child’s name, the original pharmacist’s label and the name of the medication, a copy of the consent form and a medication form. This will be carried by a senior practitioner.
§ On returning to the setting the medicine form is signed by the parent.
§ If a child on medication has to be taken to hospital, the child’s medication is taken in a sealed plastic box clearly labelled with the child’s name and the name of the medication. Inside the box is a copy of the consent form signed by the parent.
§ This procedure should be read alongside the outings procedure.
When any child becomes unwell and is found to have a temperature, we will contact the child’s parents/carers to collect the child, or if they are unavailable the other named people on the emergency contact list. We will attempt to cool the child down by removing clothing. If we can contact a parent we will offer to give the child a dose of our ‘emergency calpol’ to reduce temperature until the parent can collect, the parent will then have to sign the medicine form. If we cannot contact anyone and we will feel the child needs medical treatment we will contact the local doctors for advice. If we feel the case becomes serious we will call both parents and emergency services. A member of staff will accompany the child to hospital with their personal details and arrange to meet the parents/carers at the emergency department.
Managing children who are sick, infectious, or with allergies
We aim to provide care for healthy children through preventing cross infection of viruses and bacterial infections and promote health through identifying allergies and preventing contact with the allergenic trigger.
Children must not be brought into nursery if they have any types of infection or illness, e.g. chicken pox, diarrhoea, conjunctivitis etc. Any child found to be unwell will be sent home (please see or Communicable diseases list).
§ A medication form will be available to log in the name of any child receiving medication, times that the medication should be administered, date and time when medication was administered, together with the signature of the person who has administered each dose.
- Parents are asked to keep their children at home if they have an infection, and to inform Joeys as to the nature of the infection so that Joeys can alert other parents, and make careful observations of any child who seems unwell.
- Parents are asked not to bring to Joeys any child who has been vomiting or had diarrhoea until at least 48hours has elapsed since the last episode. This is in accordance with the Health Protection Agency Guidance on Infection Control in Schools and other Childcare settings Dec 2006.
- If the children of Joeys’ staff are unwell, the children will not accompany their parents/carer to work at Joeys.
- Cuts or open sores, whether on adults or children, will be covered with a sterile dressing.
- For children with long term medication needs such as Asthma, a long term medication form will be filled in.
§ Joeys will ensure that the first aid equipment is kept clean and replenished as necessary. Sterile items will be kept sealed in their packages until needed.
We ask that parents notify us if their child is going to absent due to illness please make clear if the illness is a diagnosed communicable disease (please see list for details). There may be occasions when exclusion times are extended due to regional outbreaks of contagious illnesses.
We also require parents to inform us if any child attending Joeys is admitted to hospital following an accident at Joeys, the nursery must then Inform Ofsted.
If your child is sent home by the nursery staff your fees for that session are still payable. If a child is off sick for any reason fees are still payable.
Procedures for children who are sick or infectious
§ If children appear unwell during the day – for example, if they have a temperature, sickness, diarrhoea or pains, particularly in the head or stomach – our manager or a senior member of staff will call the parents and ask them to collect the child, or to send a known carer to collect the child on their behalf.
§ If a child has a temperature, they are kept cool, by removing top clothing and sponging their heads with cool water, but kept away from draughts.
§ The child's temperature is taken using a forehead thermometer, kept in the first aid box.
§ If the child’s temperature does not go down and is worryingly high, then we may give them Calpol or another similar analgesic, after first obtaining verbal consent from the parent where possible. This is to reduce the risk of febrile convulsions, particularly for babies. Parents sign the medication record when they collect their child.
§ In extreme cases of emergency, an ambulance is called and the parent informed.
§ Parents are asked to take their child to the doctor before returning them to the setting; we can refuse admittance to children who have a temperature, sickness and diarrhoea or a contagious infection or disease.
§ Where children have been prescribed antibiotics for an infectious illness or complaint, we ask parents to keep them at home for 48 hours before returning to the setting.
§ After diarrhoea, we ask parents keep children home for 48 hours following the last episode.
§ Some activities, such as sand and water play, and self-serve snacks where there is a risk of cross-contamination may be suspended for the duration of any outbreak.
Reporting of ‘notifiable diseases’
§ If a child or adult is diagnosed as suffering from a notifiable disease under the Health Protection (Notification) Regulations 2010, the GP will report this to Public Health England.
§ When we become aware, or are formally informed of the notifiable disease, our manager informs Ofsted and contacts Public Health England, and acts on any advice given.
HIV virus, like other viruses such as Hepatitis A, B and C, are spread through body fluids. Hygiene precautions for dealing with body fluids are the same for all children and adults. We:
§ Wear single-use vinyl gloves and aprons when changing children’s nappies, pants and clothing that are soiled with blood, urine, faeces or vomit.
§ Bag soiled clothing for parents to take home for cleaning.
§ Clear spills of blood, urine, faeces or vomit using mild disinfectant solution and mops; any cloths used are disposed of with the clinical waste.
§ Clean any tables and other furniture, furnishings or toys affected by blood, urine, faeces or vomit using a disinfectant.
Nits and head lice
§ Nits and head lice are not an excludable condition; although in exceptional cases we may ask a parent to keep the child away until the infestation has cleared.
§ On identifying cases of head lice, we inform all parents ask them to treat their child and all the family if they are found to have head lice.
Procedures for children with allergies
§ When children start at the setting we ask their parents if their child suffers from any known allergies. This is recorded on the Registration Form.
§ If a child has an allergy, We consider the risks and detail the following:
- The allergen (i.e. the substance, material or living creature the child is allergic to such as nuts, eggs, bee stings, cats etc.).
- The nature of the allergic reactions (e.g. anaphylactic shock reaction, including rash, reddening of skin, swelling, breathing problems etc.).
- What to do in case of allergic reactions, any medication used and how it is to be used (e.g. Epipen).
- Control measures - such as how the child can be prevented from contact with the allergen.
- If we believe it necessary we may complete a written risk assessment and display this with the child’s health care plan
§ This written risk assessment form is then kept in the child’s personal file and a copy is displayed where our staff can see it.
§ Generally, no nuts or nut products are used within the setting.
§ If a child has a severe food allergy we may notify parents that we are unable to accept certain product in lunch boxes. So that the allergen products are not accidentally brought in, for example to a party.
Insurance requirements for children with allergies and disabilities
§ If necessary, our insurance will include children with any disability or allergy, but certain procedures must be strictly adhered to as set out below. For children suffering life threatening conditions, or requiring invasive treatments; written confirmation from our insurance provider must be obtained to extend the insurance.
§ At all times we ensure that the administration of medication is compliant with the Safeguarding and Welfare Requirements of the Early Years Foundation Stage.
§ Oral medication:
- Asthma inhalers are now regarded as ‘oral medication’ by insurers and so documents do not need to be forwarded to our insurance provider. Oral medications must be prescribed by a GP or have manufacturer’s instructions clearly written on them.
- We must be provided with clear written instructions on how to administer such medication.
- We adhere to all risk assessment procedures for the correct storage and administration of the medication.
- We must have the parents or guardians prior written consent. This consent must be kept on file. It is not necessary to forward copy documents to our insurance provider.
§ Life-saving medication and invasive treatments:
These include adrenaline injections (Epipens) for anaphylactic shock reactions (caused by allergies to nuts, eggs etc.) or invasive treatments such as rectal administration of Diazepam (for epilepsy).
- We must have:
· a letter from the child's GP/consultant stating the child's condition and what medication if any is to be administered;
· written consent from the parent or guardian allowing our staff to administer medication; and
· Proof of training in the administration of such medication by the child's GP, a district nurse, children’s nurse specialist or a community paediatric nurse.
- Copies of all three documents relating to these children must first be sent to the Insurance Department for appraisal Written confirmation that the insurance has been extended will be issued by return.
§ Senior staff are responsible for supporting children requiring assistance with tubes to help them with everyday living e.g. breathing apparatus, to take nourishment, colostomy bags etc.:
- Prior written consent must be obtained from the child's parent or guardian to give treatment and/or medication prescribed by the child's GP.
- The staff must have the relevant medical training/experience, which may include receiving appropriate instructions from parents or guardians.
- Copies of all letters relating to these children may be required by our insurer. Written confirmation that the insurance has been extended will be issued by return.
Signed on behalf of
Milnthorpe Family Centre Directors
Katie Smyth, Manager Reviewed August 2018