Medication Policy

Name of Child Care Centre: Kinder Learning Centres
Date Policy and Procedures Established: June 22, 2021
Date Policy and Procedures Updated: June 22, 2021

Purpose

The purpose of this policy and the procedures outlined within is to provide clear direction for staff,
students and volunteers to follow for administering drugs or medication to children at the child care
centre and for appropriate record-keeping.
Where the term drugs and/or medications is used in this policy, the term refers to any product with a
drug identification number (DIN), with the exception of sunscreen, lotion, lip balm, bug spray, hand
sanitizer and diaper cream that is not used for acute, symptomatic treatment. For the purpose of this
policy, drugs and medications fall into the following two categories, unless otherwise specified:

• Prescription, intended for acute, symptomatic treatment; and

• Over-the-counter, intended for acute, symptomatic treatment.

The policy and procedures support children’s health, safety and well-being by setting out measures to:

• ensure children receive only those drugs or medications deemed necessary and appropriate by
  their parents;

• reduce the potential for errors;

• ensure medications do not spoil due to improper storage;

• prevent accidental ingestion;

• administer emergency allergy and asthma drugs or medications quickly when needed; and

• safely administer drugs and medications according to established routines.

This policy is intended to fulfill the obligations set out under Ontario Regulation 137/15 for the
administration of drugs and medication in a child care centre.
Note: definitions for terms used throughout this policy are provided in a Glossary at the end of the
document.

Policy

Parental Authorization to Administer Medication:

• Whenever possible, parents will be encouraged to administer drugs or medications to their
  children at home if this can be done without affecting the child’s treatment schedule.

• Prescription medications for acute, symptomatic treatment will only be
  administered to a child where a parent of the child has given written authorization to do so by
  completing the child care centre’s Authorization for Medication Administration on the Kindertales parent app prior to arrival of their child to the child care centre.

• Staff are required to review and understand the Authorization for Medication Administration form on kindertales prior to accepting any medication.

• We do not accept administration of over-the-counter medications.

• The authorization must include a schedule that exactly sets out the specific time(s) the drug or medication is to be given and the amounts to be administered.

• Where a drug or medication is to be administered to a child on an “as needed” basis (i.e. there is
  no specific schedule or time of the day for administration), the drug or medication must be
  accompanied with a doctor’s note outlining signs and symptoms for administering the drug or
  medication and the appropriate dosage. In addition, the Authorization for Medication
  Administration Form must clearly indicate the situations under which the medication is to be given
  as outlined in the doctor’s note, including observable symptoms. Examples may include:

  • when the child has a fever of 37.8 degrees Celsius;

  • when the child has a persistent cough and/or difficulty breathing; and

  • when red hives appear on the skin, etc.

• Prescription skin products (with a DIN) that need to be administered for acute or
  symptomatic treatment will only be administered to a child where a parent of the child has given
  written authorization to do so by completing the child care Centre’s Authorization for Medication
  Administration on the Kindertales parent app prior to arrival of their child to the child care centre.

• Authorization for Medical Administration Forms will be reviewed with parents every 3 months to
  ensure the dosage continues to be accurate (e.g. based on the child’s age or weight) and the need is still there.

• As long as sunscreen, lotion, lip balm, bug spray, hand sanitizer and diaper cream are nonprescription
  and/or are not for acute (symptomatic) treatment, and due to their longer-term daily
  usage, these products:

  • must have a blanket authorization from a parent on the enrolment form;

  • can be administered without an Authorization for Medication Administration form; and

  • do not require record-keeping

Drug and Medication Requirements

All drugs and medications to be administered to children must meet the following requirements:

• All drugs and medications must be stored in their original containers as supplied by a pharmacist,
  or their original packages. Medications that have been removed from their original package or
  transferred into a different container will not be accepted or administered to children.

• All drug or medication containers must be clearly labelled with:

  • The child’s full name;

  • The name of the drug or medication;

  • The dosage of the drug or medication;

  • Instructions for storage;

  • Instructions for administration;

  • The date of purchase of the medication for prescription medications; and

  • The expiry date of the medication, if applicable.

• The information provided on the written parental authorization on Kindertales must match with all the
  requirements listed above.

• Where information is missing on a drug or medication label and/or the written parental
  authorization does not match the label on the labelled container, the child care centre will not
  accept or administer the medication until the label and/or written parental authorization accurately
  contains all the required information.

• Over-the-counter epinephrine purchased for a specific child can be administered to a child with an
  individualized plan and emergency procedures for an anaphylactic allergy as long as it is
  accompanied by a doctor’s note and is clearly labeled with the child’s name, the name of the drug
  or medication, the dosage, the date of expiration and the instructions for storage and
  administration.

• Drugs or medications purchased by staff, students or volunteers for their own use will be kept
  inaccessible (e.g. stored in locker versus left in a purse in the classroom) to children and will not
  be administered to children at any time, except where written parental authorization to administer
  has been obtained (e.g. hand sanitizer).

Drug and Medication Handling and Storage:

• All drugs or medications will be kept inaccessible to children at all times in a locked container or
  area (e.g. in a refrigerator, cabinet, cupboard or drawer). There are exceptions for emergency
  medications as outlined below:

  • Emergency medications will never be locked up and will be made easily accessible to all staff
    while being kept out of the reach of children, including during outdoor play periods and off premises
    activities.

  • Where a child has written permission to carry their emergency allergy or asthma medication,
    precautions will be taken to ensure that these medications are not accessible to other children
    (e.g., in cubbies or backpacks that are unattended).

• In case of an emergency, all staff, students and volunteers will be made aware of the location of
  children’s emergency medications at all times.

• Emergency medications will be brought on all field trips, evacuations and off-site activities.

• Any topical products or drugs/medication in the first aid kit will not be used on children to clean or
  treat wounds. Children’s cuts and wounds will be disinfected in accordance with local public health
  recommendations.

• All drugs and medications for children will be stored in accordance with the instructions for storage
  on the label. Medication requiring refrigeration will be stored in the refrigerator in a locked
  container.

• Where drugs or medications are past their expiry date, they will be returned to the parent of the
  child, where possible, and this will be documented on the Authorization for Medication
  Administration Form on Kindertales in the comments sections when returned.

• Any drugs or medications remaining after the treatment period will be returned to a parent of the
  child, where possible, and this will be documented on the Authorization for Medication
  Administration Form on Kindertales in the comments sections when returned.

• Where attempts have been made to return a drug or medication to a parent and the parent has not
  taken the medication home, the person in charge of drugs and medications will ensure that the
  efforts made to return the drug or medication have been documented on Kindertales in the appropriate staff communication book (e.g. daily written record), and the drug or medication must be returned to a
  pharmacist for proper disposal.

Drug and Medication Administration:

• Drugs or medications will be administered according to the instructions on the label and only with
  written parental authorization.

• A drug or medication will only be administered from its original container as supplied by a
  pharmacist or its original package, and where the container is clearly labelled as outlined under
  the Drug and Medication Requirements section of this policy.

• A drug or medication will only be administered using the appropriate dispenser (e.g. syringe,
  measuring spoon/cup, etc.).

• To support the prompt administration of emergency medication:

  • Emergency medications may be administered to a child by any person trained on the child’s
    individualized plan at the child care centre; and

  • Children will be allowed to carry their own asthma or emergency medication in accordance
    with this policy, the drug and medication administration procedures, and the child’s
    individualized plan, where applicable.

• Drugs or medications that are expired (including epinephrine) will not be administered at any time.

Record-Keeping:

• Records of medication administration will be completed using the Records of Medication
  Administration on Kindertales every time drugs or medications are administered. Completed records will be kept in the child’s file on Kindertales.

• Where a child’s medication administration form includes a schedule setting out specific times to
  administer the medication and the child is absent on a day medication would have been administered.
  the child’s absence will be documented on the medication administration record to account for all days
  during the treatment period (excluding weekends, holidays and planned closures).

• If a dose is missed or given late, reasons will be documented on the record of medication
  administration and a parent will be notified as soon as possible as it may impact the treatment
  schedule or the child’s health.

• Where a drug or medication is administered ‘as needed’ to treat specific symptoms outlined in a
  child’s medication administration form or individualized plan and emergency procedures for an
  anaphylactic allergy (e.g. asthma, fever, allergic reaction), the administration and the reason for
  administering will be documented in the appropriate staff communication book (e.g. daily written
  record) and in the child’s symptoms of illness record. A parent of the child will be notified.

Confidentiality

• Information about a child’s medical needs will be treated confidentially and every effort will be made to
  protect the privacy of the child, except when information must be disclosed for the purpose of
  implementing the procedures in this policy and for legal reasons (e.g. to the Ministry of Education,
  College of Early Childhood Educators, law enforcement authorities or a Children’s Aid Society).

Additional Policy Statements

• Children who have an anaphylactic allergy will not be permitted to attend day care until the
  required forms are filled out and medication is presented to the designated staff.

Drug and Medication Administration Procedures

SCENARIO: A child is authorized to carry their own emergency allergy medication.

ROLES AND RESPONSIBILITIES

Staff must:

1. ensure that written parental authorization is obtained to allow the child to carry their own
   emergency medication;

2. ensure that the medication remains on the child (e.g., fanny pack, holster) and is not kept
   or left unattended anywhere at the child care centre (e.g. in the child’s cubby or backpack);

3. ensure that appropriate supervision is maintained of the child while they are carrying their
   medication and children in their proximity so that other children do not have access to the
   medication; and

4. Where there are safety concerns relating to the child carrying his/her own medication
   (e.g. exposure to other children}, notify the centre supervisor/designate and the child’s parent of
   these concerns and discuss and implement mitigating strategies. Document the concerns and
   resulting actions in the appropriate staff communication book (e.g. daily written record).

SCENARIO: A prescription must be administered to a child.

ROLES AND RESPONSIBILITIES

Where a non-emergency medication must be administered, the person in charge must:

1. prepare the medication dosage in a well-lit area in the appropriate measuring device, where
   applicable (e.g. do not use a household spoon for liquid medications);

2. where possible, remove the child from the activity area to a quiet area with the least possible
   interruption;

3. administer the medication to the child in accordance with the instructions on the label and the
   written parental authorization;

4. document the administration of the drug or medication and any comments/observations on the
   medication administration record after it has been administered;

5. store the medication in the designated storage space in accordance with the instructions on
   the label and the parental authorization received on the medication administration form; and

6. Where the child is sent home, document any symptoms of ill health in the child’s records.

7. Where a medication is administered on an “as needed” basis, notify a parent of the child.

8. Where a child is absent, document the absence on the Record of Drug/Medication
   Administration.

Where an emergency allergy medication must be administered due to a severe allergic
reaction, the staff who becomes aware of the emergency situation must immediately:

1. administer the emergency medication to the child in accordance with the emergency
   procedures on the child’s individualized plan;

2. administer first aid to the child, where appropriate;

3. contact, or have another person contact emergency services, where appropriate; and

4. contact, or have the supervisor/designate contact a parent of the child.

After the emergency situation has ended:

1. document the administration of the drug or medication on the medication administration record;

2. document the incident in the appropriate staff communication book (e.g. daily written record}.;
   and

3. document any symptoms of ill health in the child’s records, where applicable.

Where a child is authorized to self-administer their own drug or medication, the person in
charge must:

1. supervise and observe the child self-administer the drug or medication to ensure that the
   proper dosage and procedure for administration is being followed;

2. where the child asks for help, assist the child in accordance with the parent’s written
   authorization;

3. document the administration of the drug or medication and any comments/observations on the
   medication administration record after it has been administered;

4. store the medication in the designated storage space in accordance with the instructions on
   the label and the parental authorization received on the medication administration form, unless
   the child is authorized to carry his/her own emergency allergy medication (in such cases,
   follow the steps outlined in Scenario C [a child is authorized to carry their own emergency
   allergy medication]);

5. where applicable, document any symptoms of ill health in the child’s records; and

6. where there are safety concerns relating to the child’s self-administration of drugs or
   medications, notify the centre supervisor/designate and the child’s parent of these concerns,
   and discuss and implement mitigating strategies. Document the concerns and resulting actions
   in the appropriate staff communication book (e.g. daily written record}.

SCENARIO: A child has a reaction to an administered drug or medication.

ROLES AND RESPONSIBILITIES

Where adverse symptoms appear upon medication administration, the person in charge must
immediately:

1. administer first aid to the child, where appropriate;

2. contact emergency services, where appropriate and send the drug/medication and
   administration information with the child if they are leaving the premises to seek medical
   attention;

3. notify a parent of the child;

4. notify the supervisor/designate;

5. document the incident in the appropriate staff communication book (e.g. daily written record);
   and

6. document any symptoms of ill health in the child’s records, where applicable.

Where the reaction results in a life-threatening situation for the child, call emergency services
and follow the serious occurrence policy and procedures.

SCENARIO: A drug or medication is administered incorrectly (e.g. at the
wrong time, wrong dosage given).

ROLES AND RESPONSIBILITIES

The person in charge must immediately:

1. where applicable, follow the steps outlined in Scenario D (a child has a reaction to
   administered medication); and

   1. contact the parent of the child to report the error;

   2. report the error to the supervisor/designate;

   3. document the actual administration of the drug or medication on the medication
      administration record; and

   4. document the incident in the appropriate staff communication book (e.g. daily written record).
      Where any reaction to a drug or medication results in a life-threatening situation for the child,
      call emergency services and follow the serious occurrence policy and procedures.

SCENARIO: A drug or medication is administered to the wrong child.

ROLES AND RESPONSIBILITIES

1. The person in charge must immediately:

   1. where applicable, follow the steps outlined in Scenario D (a child has a reaction to
      administered medication); and

   2. contact the parents of the children affected to report the error;

   3. report the error to the supervisor/designate;

   4. document the incident in the appropriate staff communication book (e.g. daily written record); and

   5. administer the medication to the correct child per Scenario B (a drug or medication must be
      administered to a child).

Where any reaction to a drug or medication results in a life-threatening situation for the child,
call emergency services and follow the serious occurrence policy and procedures.

SCENARIO: Surplus or expired medication is on site.

ROLES AND RESPONSIBILITIES

1. Where possible, the surplus or expired medication must be returned to a parent of the child.

2. The person in charge of drugs/medications must record the return of the drugs/medication to the parent on the Records of Medication Administration on Kindertales

3. Where attempts have been made to return a drug or medication to a parent and the parent has not
   taken the medication home, the person in charge of drugs and medications must attempt to return
   unused drugs or medications to a local pharmacist for proper disposal.

Do not flush any drugs or medications down the toilet or sink or throw them in the garbage.

Glossary

Drug Identification Number (DIN): An eight-digit number assigned by Health Canada to a drug
product prior to being marketed in Canada. It uniquely identifies all drug products sold in a dosage
form in Canada and is located on the label of prescription and over-the-counter drug products that
have been evaluated and authorized for sale in Canada.
Drug or Medication: Any product with a drug identification number (DIN), with the exception of
sunscreen, lotion, lip balm, bug spray, hand sanitizer and diaper cream that is not used for acute,
symptomatic treatment. Drugs and medications fall into the following two categories, unless
otherwise specified in this policy:

• Prescription, intended for acute, symptomatic treatment; and

• Over-the-counter, intended for acute, symptomatic treatment.

Emergency Medication: Prescription drugs or medications that are used in case of an urgent
medical reaction that requires immediate treatment. Emergency medications include medications
used to treat asthma (e.g. puffers) and anaphylactic allergies (e.g. epinephrine).
Licensee: The individual or corporation named on the licence issued by the Ministry of Education
responsible for the operation and management of the child care centre.
Parent: A person having lawful custody of a child or a person who has demonstrated a settled
intention to treat a child as a child of his or her family (all references to parent include legal
guardians, but will be referred to as “parent” in the policy).
Person who is in Charge of All Drugs and Medications (a.k.a. the ‘person in charge): The individual
at the child care centre who is responsible for administering medication to children. The person in
charge may be one designated person per program room or age group. In the absence of the
person in charge, they may temporarily delegate this responsibility to another person.
Staff (Employee): Individual employed by the licensee (e.g. program room staff, cook)

Regulatory Requirements: Ontario Regulation 137/15

ADMINISTRATION OF DRUGS OR MEDICATIONS

1. Where a licensee agrees to the administration of drugs or medications, the licensee shall ensure
   that,

   1. a written procedure is established for,

      1. the administration of any drug or medication to a child receiving child care at a child care centre
         operated by the licensee or at a premises where it oversees the provision of home child care, and

      2. the keeping of records with respect to the administration of drugs and medications

   2. all drugs and medications on the premises of a child care centre operated by the licensee or at a
      premises where it oversees the provision of home child care are,

      1. stored in accordance with the instructions for storage on the label,

      2. administered in accordance with the instructions on the label and the authorization received under
         clause (d),

      3. inaccessible at all times to children, and

      4. in the case of a child care centre, kept in a locked container;

   3. one person in each child care centre operated by the licensee and in each premises where it
      oversees the provision of home child care is in charge of all drugs and medications and that all
      drugs and medications are dealt with by that person or a person designated by that person in
      accordance with the procedures established under clause (a);

   4. a drug or medication is administered to a child only where a parent of the child gives written
      authorization for the administration of the drug or medication and that included with the
      authorization is a schedule that sets out the times the drug or medication is to be given and
      amounts to be administered; and

   5. a drug or medication is administered to a child only from the original container as supplied by a
      pharmacist or the original package and that the container or package is clearly labelled with the
      child’s name, the name of the drug or medication, the dosage of the drug or medication, the date
      of purchase and expiration, if applicable, and instructions for storage and administration.

2. Despite subclauses (1) (b) (iii) and (iv) and clause (1) (c), the licensee may permit a child to carry
   his or her own asthma medication or emergency allergy medication in accordance with the
   procedures established under clause (1) (a).