Presentation Details: Slides: 46 Duration 3 hours Bullet Point #1 Original document included as part of Healthy Futures: Improving Health Outcomes for Young Children 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.
Slide 1 Activity 15 min. Bullet Point #1 Original document included as part of Healthy Futures: Improving Health Outcomes for Young Children 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. Notes: Welcome and Entrance Flip Chart HANDOUT 2:Welcome Activity Welcome everyone to the final medication Administration Module. Ask if everyone has completed the online modules and brought in their certificates. Mention that the content of those modules will be reviewed in some of the activities they will do today. Do a warm up activity which reviews the Flip Chart Activity as well as an opportunity to get to know people s names and where they are from (center based, family home, teacher, aide, director). Flip Chart Activity (Ask people do this do this at registration as they enter) Prepare flip chart pages with bullets from http://www.healthychildcare.org/pdf/medadmin/m1_welcomeactivity. pdf Leave space between bullets. Give participants 9 stickies when they come in and have them put initials on the stickies. Ask participants to place stickies next to activities that they do at their facility. Participants can write a question mark on the sticky if they are unsure if their facility does the activity. Slide 2 Curriculum Objectives Curriculum Objectives Administration Curriculum - Module 1 1. Demonstrate procedures for receiving, storing, preparing, and administrating medications 2. Document medication administered in a simulation activity 3. Describe symptoms of adverse reactions to medication and actions to take when they are observed 4. Identify elements of a medication administration policy mp1 Notes: Curriculum Objectives Review the objectives for this module 1. Demonstrate procedures for receiving, storing, preparing, and administrating medications 2. Document medication administered in a simulation activity 3. Describe symptoms of adverse reactions to medication and actions to take when they are observed 4. Identify elements of a medication administration policy
Slide 3 Disclaimer Disclaimer Administration Curriculum - Module 1 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 Notes: Disclaimer Review the disclaimer statement briefly you can paraphrase. Slide 4 Online Modules Review Slide 5 Module 3 Brief Discussion 5 min. Online Modules Review Module 1 Reasons to Give 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 Module 3 Administration Curriculum - Module 1 5 Rights Administration of oral medications topical, eye drops, ear drops, nose drops Emergency s : inhalers, and auto injectors Notes: On Line Module Review (1&2) Review the content covered in the on line modules In Module 1 you learned about Reasons to Give Rules and Regulations Shared responsibility of parents, caregivers, and health care providers Types of medication In Module 2 you learned about Documentation Forms Program Specific Policies and Procedures Confidentiality Receiving, storing, and disposing of medications Notes: Module 3 In Module 3 the following topics were covered 5 Rights Administration of oral medications topical, eye drops, ear drops, nose drops Emergency s: inhalers, and auto injectors Mention that some of the activities in this workshop will give them an opportunity to practice what they learned in the online modules. Ask if there are things they want you to make sure you review? Start a Newsprint Parking Lot Sheet with their questions and tell them you will address them during the class don t get into details now.
Slide 6 What Is Covered in this Workshop Administration Curriculum - Module 1 What Is Covered in this Workshop Receiving and Storing medications 5 Rights of Administration review Administration of typical and routine medications for short-term use Administration of emergency medications Notes: What is Covered in This Workshop Today you will have an opportunity to do the following Practice receiving and storing medications Review the 5 Rights of Administration Practice administering a typical and routine medication for shortterm use ( simulation) Routine short term use medications include medications like : Antibiotics Eye or ear drops Fever relievers and non-narcotic pain medications Ointments and creams used as a treatment for a skin condition Over-the-counter medications s taken on a routine basis for chronic health conditions might include: ADD/ADHD medications Oral seizure medications( maintenance not emergency) Heart medications We will also practice administering emergency medications including: Asthma inhaler s and Epi Pen s And finally you will have a chance to practice receiving, storing, and documenting medication administration Slide 7 What Is Not Covered in this Workshop What Is Not Covered in this Workshop Administration Curriculum - Module 1 Special medications like injectable or rectal medication Management for children for children with special or complex medical needs Notes: What is Not Covered in This Workshop s not covered include Injectable medications such as Insulin Insulin, glucagon, and diabetes management for a child with diabetes. The Children s Integrated Services Team and Children with Special Health Needs can assist you in planning to care for children with complex medical needs setting.
Slide 8 Communication and Care Slide 9 Receiving s Review ACTIVITY 5 min. Administration Curriculum - Module 1 Receiving s 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-thecounter medication in the original container with the manufacturer s information? Does the label have all the information needed Notes: Communication and Care When children are taking medications communication with parents and other care givers is important in preventing errors To avoid double dosing or giving doses too close together, ALWAYS ask the parent at drop-off when medication was given last and ALWAYS tell the parent at pick-up when medication was last given as well as any observations that may be related to medication administration. This direct communication between child care provider and parent is essential for safety. This is an example of the Responsibility Triangle discussed in the first on line module. Notes: Receiving Review Handout 2 Five Rights Receiving s from Packet found at http://www.healthychildcare.org/pdf/medadmin/m2_medadminpacke t.pdf Slide 10 Group Activity: Receiving Review ACTIVITY 20min. Group Activity: Receiving 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 for Nick Where should the medication be stored What questions would you ask the parents Notes: Group Activity: Receiving HANDOUT 3: NICK SCENARIO 1 http://www.healthychildcare.org/participantsmanual.html HANDOUT 4: Appendix AA http://nrckids.org/cfoc3/htmlversion/appendixaa.pdf HANDOUT 5: Instructor Notes Instructor Manual 33 http://www.healthychildcare.org/pdf/medadmin/m2_scenario1.pdf Instructor Note the scenario says needs refrigeration but the label and instructions do not write needs refrigeration on the instructions and put a refrigeration sticker on the label you can get these at the local pharmacy. (If you can t get these write it in).
Slide 11 Administration Procedure Review DISCUSSION 10min. 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 Ask pairs to work together to complete the receiving medication checklist remind them to think about communicating with parents what questions do they want to ask Then ask them to complete the checklist Permission & instruction form completed and signed? is in the original child-resistant container labeled by a pharmacist or over-the-counter medication in the original container with the manufacturer s information? Check the label for: child's first and last name name of the medication date the prescription was filled and expiration date name and telephone number of the health care provider name of medication, dosage, time(s) of day to be given method of administering storage instructions Follow up Discussion: How did that go? Questions? Ask one thing they would ask the parent examples when did he have his last dose, did he take it easily, what strategies do they use at home, side effects to watch for how would they store the medication Ask them how they would store an emergency medication? Elaborate on anything they missed. Use newsprint to record their answers as needed. Notes: Administration Procedure Review HANDOUT 3: NICK SCENARIO HANDOUT 4: Appendix AA 4http://nrckids.org/cfoc3/htmlversion/AppendixAA.pdf Follow up with Now that you have received the medication for Nick let s think about things you need to do before you can administer medication. Refer participants to HANDOUT 4 Mention that they have just checked section 1 and 2 while receiving medication reinforce that you need to do this each time you give a medication. Ask participants to take turns reading the steps in 1 and 2 then review section 3 which is on this slide
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 Slide 12 Administration Procedure: Preparing the Review Slide 13 Measuring Oral DEMONSTRATION 10min. Administration Procedure: Preparing the 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 Measuring Oral Oral Measuring Devices Dropper Syringes: ½ tsp or less is most accurately measured with syringe or similar device Dosing spoon cup No kitchen teaspoons! Notes: Administration Procedure Preparing The Review Now let s think about preparing the medication Find the medication and read the label and consent form Then find the appropriate measuring device Measure the amount on the label into the measuring device Change the form of the medication ONLY if the label states for you to do so some of the ways the medication can be changed include Crushing pills Opening capsules of sprinkles do not open other capsules Then mix these with a tablespoon of applesauce Scored tablets that need to be divided should be halved by the pharmacist or parent. Do not attempt to divide the scored tablet. Notes: Measuring Oral s HANDOUT 5: MEASURING DEVICES Measuring liquids is always done at EYE LEVEL for accuracy. Pour on a flat, even surface and read measurements at eye level. Do not over fill or under fill. If using a syringe, avoid air bubbles by keeping the tip below the level of the liquid. Turn upside down and tap syringe to allow air bubbles to rise to the top. Gently push the plunger to expel air bubbles. Practice measuring liquid using a syringe. Remember that liquids need to be measured by a calibrated device and not a kitchen spoon, plastic ware, or kitchen measuring spoons. They are not accurate and can cause an under dose or overdose Use the dispenser provided by the parent. If no dispenser is provided, locate a proper device. (Pharmacies will give out extra devices free programs can ask for these to have on hand) Wash and disinfect dispenser after use unless disposable.
Equivalents: o 1cc = 1 ml o 1 teaspoon = 5 ml Slide 14 Group Activity: Administration Using Measuring Devices Practice ACTIVITY 20min. Group Activity : Administration Using Measuring Devices Practice What about this measuring device? Notes: Group Activity: Administration Using Measuring Devices HANDOUT Instructor Manual 33 : MEASURING DEVICES ACTIVITY: Hhttp://www.healthychildcare.org/pdf/MedAdmin/M3_MeasuringDevices.pd f What s wrong with this picture? ( Teaspoon) Divide into small groups provide different types of measuring devices and clear juice for practice. Refer to the handout. Fill plastic teaspoon with colored water, and then pour it into a 1 ounce measuring cup. Pass around to participants to demonstrate the difference between using common household items and proper measuring devices. Demonstrate with a variety of spoons. Note that measuring with some teaspoons, the dose can almost be doubled and with others, it would not be sufficient. Slide 15 Administration Procedure: Preparing the Child Discussion 10min Administration Curriculum - Module 1 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 Notes: Administration Procedure: Preparing the Child HANDOUT 5A/B: HANDWASHING Now let s think about preparing the child. Recall the film you watched in module 3 about strategies to use with young children when administering medications what strategies were demonstrated what have you tried that worked? What other things can you do to help prepare the child for taking medications that may have an unpleasant taste or be uncomfortable or just require them to be still? (Write some of their examples on newsprint optional) Remember to talk to the family about what works for them when you receive medication When you are ready to give the medication communicate with the child Explain the procedure to children in words they can understand Next Wash the child s hands
And Finally Position the child if they are unable to take the medication by themselves Slide 16 Administration Procedure: Finishing Up Slide 17 Administering and Documenting s Nick ACTIVITY 20 min. 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 Log Clean the measuring device Wash your hands Observe the child for side effects Administering and Documenting s 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 Notes: Administration Procedure: Finishing Up Review the following points on finishing up After administering the medication Praise the child and reward them with a drink of juice if the medication had an unpleasant taste 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 Log Clean the measuring device Wash your hands Observation for side-effects is especially important if one staff member gives the medication and returns the child to other staff. The second caregiver needs to know that the child received medication and what signs to observe for. We will discuss side effects in more detail later Notes: Administering and Documenting s Nick HANDOUT 3: ACTIVITY: ADMINISTERING MEDICATIONS TO NICK Now let s practice giving the medication to Nick: Instructions: Refer participants to the medication packet section 3 and 4 in the Nick Scenario as a checklist. Work in groups of threes Child Care Provider Nick Observer One person demonstrates giving medication to Nick All participants in the group of three can make suggestions to assure all steps are followed including Nick. The observer uses sections 3 and 4 as a checklist.
Slide 18 Procedures for Giving with Food Slide 19 As Needed Conditions Procedures for Giving 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 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 Notes: Procedures for Giving s with Food Review the slide: Some medications can be given with small amounts of food or drink. 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 or liquid, ALL of it must be taken Give the child something to drink immediately afterward to help with the taste Notes: As needed Conditions Start by mentioning that some medications may be ordered as needed s that are frequently ordered as needed include: o Asthma medication: such as albuterol o Antihistamines: such as Benadryl or newer non-sedating antihistamines such as Claritin or Zyrtec o Fever reducers: order should list a specific temperature at which to give the medication Review the slide Some medication, such as emergency medication, only need to be given as needed As needed or prn medication orders should specify specific instructions. It is important to get as much detail as possible in an as needed order when receiving medication. 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 Slide 20 Administering Asthma DISCUSSION 10 min. Slide 21 Administering An Epinephrine Auto Injector DISCUSSION 10 min. Administering Asthma 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. 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. Notes: Administering Asthma HANDOUT 7:ASTHMA ACTION PLAN HANDOUT_8 ASTHMA POSTER HANDOUT 9:ASTHMA CHECKLIST SCENARIO DISCUSSION: In the on line Module 3 you learned about Asthma. As a review let s think about an Asthma episode and discuss what to do. Ask one person to read the scenario out loud. Then ask: What signs and symptoms make you think this child needs rescue medication? Look at the Asthma Action Plan together what does the plan tell you to do? Refer participants to the asthma poster and demonstrate the procedure Have participants work in groups and follow the asthma checklist Notes: Administering and Epinephrine Auto Injector HANDOUT 10 ALLERGY PLAN HANDOUT 11EPI_PEN POSTER SCENARIO DISCUSSION: Ask one person to read the scenario Ask what are the symptoms for anaphylaxis that you see? What do you do? Look at Jeffrey s allergy plan together Ask participants to look at the Epi Pen poster handout Demonstrate the use of the Epi Pen Ask participants to check each other off on the use of the Epi Pen. (The Auvi_Q Epi Pen narrates what to do if you have access to one this
might be a useful tool) Slide 22 Take a Break 10 minutes Take a Break Notes: Take a Break! Slide 23 Administration Challenges Administration Challenges Errors Side Effects Incidents Trouble shooting and documentation Field Trips Handling requests Notes: Administration Challenges In this next segment of this training we ll have time to explore some of the challenges that can happen when administering medications in your program these include: Errors Side Effects Incidents Trouble shooting and documentation Field Trips Handling requests
Slide 24 Introduction: Common Errors in Administration Slide 25 Most Common Errors DISCUSSION 5 min. Introduction: Common Errors in Administration 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 Most Common 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 Notes: Introduction: Common Errors Errors can at home, at school, and even in hospitals. One recent study reported that 7,000 children per year require emergency department visits for medication problems (1) Examples of Common errors include Taking medication twice Taking wrong medication Received the incorrect dose Missed dose Reasons for the errors sited were Not understanding medication label Not understanding how to give the medication Poor communication between parents/guardians and health care professional Missed doses were the most common errors as reported in a child care center survey documented that missed doses. (1)Sources American Association of Poison Control Centers, Annual Report for 2007, Clinical Toxicology. 2008; 46:10:927-1057. This study was not specific to child care centers. (2)Sinkovits HS, Kelly MW, Ernst ME. Administration in Day Care Centers for Children, Journal of American Pharmacist Association. 2003; 43:3. Iowa Notes: Most Common Errors In the online modules there was a case study about Tylenol dose error do you remember it? INSTRUCTOR NOTE THIS SLIDE SWIPES IN: Why do you think errors frequently occur with over the counter medications? (Optional) Record answers on newsprint if not covered on the slide. In fact the most commonly made errors are made with OTC analgesics such as Tylenol (acetaminophen) and Motrin (ibuprofen). These medications are usually given for fever or pain. Reasons for errors include: These medications are given frequently There are many different concentrations (infant drops, children s liquids, etc) They are often mixed with other medications in cough and cold preparations Dosing charts are unique to the type and form of the medication
Slide 26 What is a Error? Slide 27 Programs Can Prevent Future Errors What is a 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 Programs Can Prevent Future 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 Notes: What is a Error Any of the 5 rights not followed will result in a medication error 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 Potentially the most serious errors occur when giving the wrong dose (especially too much) or giving medication to the wrong child. o Giving the wrong dose of medication includes overdoses, under doses, and missed doses. o Giving the medication incorrectly can also mean not carrying out the accompanying instructions (with food, etc). o Giving the dose at the wrong time means giving the dose of medication at a time when it is not ordered or outside 30 minute window each way. o The best way to prevent the 5 Rights from going wrong is to check the 5 Rights and follow the policy and procedure. Notes: Programs Can Prevent Future Errors DISCUSSION Ask can if anyone knows if there have been errors in their program? Errors can happen.how can you learn to prevent future errors? Ask for ideas about how programs can learn from errors that have been made? THIS SLIPE SWIPES IN. Look at the pattern of errors Make changes based on the patterns seen to prevent further errors of that type A common error is forgetting to give a dose of medication Set an alarm to remind you that it is time to administer a medication If they need help give them an example: One common error is teachers forgetting to give a dose of medication Can you think of possible solutions? Set an alarm to remind you that it is time to administer a medication
Slide 28 Recognizing Side Effects of DISCUSSION 5 min. Slide 29 Side Effects of, continued Recognizing Side Effects of 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 Side Effects of, 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 Notes: Recognizing Side Effects of THIS SLIDE SWIPES Start by reviewing the definition: After giving medication to children they also should be observed for side effects. A side effect can be defined as A secondary and usually adverse effect of taking a medication. (Make sure everyone knows what that means.) An example of a common side effect is dry mouth or drowsiness after taking an antihistamine. Some children may also get sleepy after antihistamines others may become jittery or very active. The effects of an antihistamine for example (drowsiness) can affect a child s balance and coordination on playground equipment. Observation for side effects is especially important if one staff member gives the medication and returns the child to the care of other staff. The person who gave the medications needs to inform the second childcare provider what to look for. Notes: Side Effects Continues THIS SLIDE SWIPES: Review the slide Some side effects are predictable and happen frequently. Other side effects cannot be predicted, like allergic reactions. 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 Example : Fast heart rate is expected for albuterol, an asthma medication, but not for others
Slide 30 Sources of Information About Side Effects Sources of Information About Side Effects Parents Information from the pharmacy who filled the prescription Information from the prescribing health care professional Notes: Sources of Information About Side Effects This SLIDE SWIPES: Ask how are you supposed to know about side effects? Give time for their answers. Then review the slide: The best way to learn about side effects is to make sure the consent form and provider instructions lists medication side effects. The best source of information is from the health care provider...the parent should get this information from the provider If you don t feel you have enough information call the pharmacy listed on the label and ask the pharmacist what you should look for Slide 31 Observation Observation Young children can t always verbalize side effects, adverse effects, or allergic reactions, so careful observation is essential Notes: Observation Review the slide Young children can t always verbalize side effects, adverse effects, or allergic reactions, so careful observation is essential Slide 32 What To Do for Errors, Adverse Effects, or Allergic Reactions What To Do for 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 Incident Report You might also: Call Poison Control Contact the health care professional Notify state Bureau of Licensing Notes: What to Do For Errors, Adverse Effects, or Allergic Reactions ASK FOR IDEAS THEN REVIEW THE SLIDE CONTENT: THIS SLIDE SWIPES It is important to act quickly as soon as the error, side effect, or allergic reaction is recognized; failure to do so may result in harm to a child who may not have been harmed or further harm to a child who is already in jeopardy. 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 and ask the parent to call the health care professional. Call the Health Care Professional if the parent can not be reached. The health care professional may wish to examine the child, or
Slide 33 When Should You Call 911? Slide 34 Other Reasons to Call Poison Control? 1-800-222-1222 DISCUSSION 5 min. 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 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 change the medication or the dose. Fill out a Incident Report :Side effects, adverse effects, and allergic reactions must be recorded You might also: Call Poison Control Notify state Bureau of Licensing If there was an injury requiring treatment or hospitalization Emergency phone numbers should be clearly posted where medication is given in centers and in the family child care home. Ask participants if they know what their program s medication administration policy is on medication errors or side effects? Notes: When Should You Call 911 REVIEW THE SLIDE: When should you call 911 THIS SLIDE SWIPES 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 Notes: When Should You Call Poison Control WHEN SHOULD YOU CALL Poison Control (THIS SLIDE SWIPES) 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) Mention that putting the poison control number on your cell phone allows quick access The AAP no longer recommends that syrup of ipecac be used Poison Control can usually access 911/EMS services if deemed necessary It is usually not necessary to call Poison Control for o a missed dose o a dose at the wrong time
o if it has been longer than the time should have been between doses; it is probably more appropriate to call the child s health care professional Slide 35 If You Call Poison Control If You Call Poison Control Have this information ready: The medication container Child s 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) Notes: If you call 911 or Poison Control If you call Poison Control or 911 what should you have ready? ASK FOR IDEAS FIRST: THIS SLIDE SWIPES The medication container Child s 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) Slide 36 Other Incidents- Not Errors Notes: Other Incidents Not Errors REVIEW THE SLIDE There are some other medication incidents that should be documented and reported to the program director and parent. With the exception of emergency medications these include: Child refusal and spit out doses need to be documented and reported but do not require emergency action. Remember our discussion about preparing the child and think about ways to prevent future refusals. Refer back to their ideas (Information on the Authorization to Give form is specifically intended to identify any anticipated problems, but occasionally they occur.)
Slide 37 What To Do for Incidents? What To Do for Incidents? Always: Notify the center director Notify parent/guardian Fill out a 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 Notes: What to Do for Incidents REVIEW THE SLIDE: What to do for Incidents Always: Notify the center director Notify parent/guardian Fill out a 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 Slide 38 Documentation of an Error or Incident Slide 39 Incident Report Documentation of an Error or Incident Make notation on the Log for that dose Complete the Incident Report Follow up according to child care facility policy Notes: Documentation of an Error or Incident HANDOUT 4: Log Appendix AA Make notation on the Log for that dose Complete the Incident Report Follow up according to child care facility policy Your Child care program should have policies and procedures for medication errors and incidents, outlining who is notified and how, who signs off, etc. Ask how many participants know or have seen their program s policies and procedures? Notes: Incident Report HANDOUT 4: Incident Report Appendix AA Explain this is an example of a Incident report that can be found in the Caring for Our Children Appendix AA http://cfoc.nrckids.org/webfiles/appedicesupload/appendixaa.pdf Handout: Incident Report This or your program form needs to be completed for any medication incidents.
Slide 40 Scenario: Nick Document 5 min. 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. Notes: Scenario Nick HANDOUT 4: Incident Log Make duplicates for practice DOCUMENTATION PRACTICE: Ask everyone to take out the incident log and record the action they would take. Ask for examples after they are done. Remind them that they should include any follow up related to the phone call. Give some examples. You notify his parent who calls his health care professional. ( Follow up example) Nick is picked up at 1:00 and is brought to the health care professional s office where he receives Benadryl. His amoxicillin is discontinued and he is given a new antibiotic. Slide 41 Field Trips and s Outdoors Field Trips and s Outdoors Someone authorized to administer medication must be present 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 Notes: Field Trips and s Outdoors REVIEW THE SLIDE: A staff person authorized to administer medication should be present when supervising a child outside of the child care facility grounds should be properly secured and labeled _a waist pack is a good way to carry medication that doesn t need refrigeration The proper temperature and conditions for the medication should be maintained. If a medication needs refrigeration take a cooler with you. Copies of emergency contact information and the child s medical forms should be carried The dose of medication given outside of the facility must be properly logged, and any side effects should be noted Hand hygiene must be maintained( alcohol based hand sanitizer can be used when no sink is available) Emergency contact methods (such as a cell phone) must be available Obtain information about the closest emergency room on route Information about the closest hospitals along the route should be available.
Slide 42 What Would You Do? Activity 15min. Slide 43 Resources 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 labeled No one on staff has had training in the procedure. 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 Notes: What Would You Do ACTIVITY: BRAINSTORMING GROUPS: Break the group into 2 or three groups have them brain storm actions they can take in the following situations 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 labeled medication No one on staff has had training in the procedure. Ask groups to report back if you are short on time do this activity as a large group summarize Having a well-planned and written medication administration policy is important when these issues arise Inappropriate requests Non-essential medication not authorized by a health care professional Off-label use Cough and cold medications for young children There may be an occasion when you must refuse to give medication because: Special training is needed before administering medication Required authorizations or other documentation is lacking Parent makes inappropriate request It is against facility policy Notes: Resources Refer them to the slide and encourage them to use the resources that are available.
Slide 44 Credits Credits Notes: Reference the sources for this training which have been modified with permission for use in Vermont Healthy Futures Connecticut Massachusetts Slide 45 Sources Sources Administration Curriculum - Module 1 Colorado: Guidelines for Administration: An Instructional Program for Training Unlicensed Personnel to Give in Out-of- Home Child Care, Schools, and Camp Settings, Fifth Edition, 2008, developed by Healthy Child Care Colorado New Jersey: Administration in Child Care developed by Healthy Child Care New Jersey North Carolina: Administration in Child Care in North Carolina developed by the Quality Enhancement Project for Infants and Toddlers, with funding from the NC Division of Child Development to the Department of Maternal and Child Health at the University of North Carolina at Chapel Hill West Virginia: Administration: An Instructional Program for Teaching Non-Medical Personnel to Give in Child Care Centers in West Virginia developed by Healthy Child Care West Virginia and the West Virginia Department of Health and Human Services Notes: Sources Reference the sources that helped in the development of the Healthy Futures Modules. Slide 46 Wrap Up Evaluation/Post Test 15 min. Post-test Evaluation Wrap Up Notes: Wrap Up Ask participants to complete the evaluation and take the posttest if you are short of time have participants self-grade on the honor roll tell them if they get more than 2 wrong you would like to go over the answers with them they will still get a certificate but you want to make sure they understand.