Administration of Medication Child Health & Safety Policy We regard the health, safety and security of children in our care as a matter of paramount priority. For this reason we will only administer medication under the specific direction and written instruction of the parent/guardian. No non-prescribed medication will be administered, unless stated otherwise within this policy. Procedures for the administration of medication: Staff will not give the first dose of a new medicine to the child. Parents should have already given at least one dose to ensure the child does not have an adverse reaction to the medication e.g. allergic to an antibiotic. The information leaflet should accompany the medication. Staff should always read the information leaflet. Staff should check dosage with the parent and against the label. All medication should be clearly labelled or marked with the identity of the child and should be in the original container. Staff should check expiry dates and dispensed date. Medication should only be used for the current condition. I.e. if a medicine has not been dispensed recently is it still appropriate for use - eg. liquid antibiotics usually only have a 7 to 10 day shelf-life, eye drops should be discarded 28 days after opening etc. Something prescribed for a condition 6 months ago might not be appropriate now. If children self medicate staff should be aware of this and supervise where necessary. If appropriate the child should be offered a drink with the medication No communal stock will be kept in the Nursery Calpol, tubes of Savlon etc Staff should not administer medication if you do not know what it is or what it is for. Staff Training In some circumstances staff may require to have training appropriate to the administration of specific medication e.g. the use of epipens, how to use inhalers, injecting insulin via a pen or rectal diazepam etc. Training will usually be sourced through the child s health visitor. A number of staff is also trained in Paediatric First Aid and first Aid at Work. Infection control Infection control issues in terms of applying creams, eye drops etc. need to be considered at all times gloves should be worn where appropriate and discarded along with any other objects within the clinical waste bin. Staff should always wash hands before and after the administration of any medication. Non- prescribed medication This part of the policy refers to non-prescribed medication e.g. bought over the counter. We will only administer the following: teething powders Teething gels Colic treatments creams Reviewed June12 Page 1 of 8
General guidance for non-prescribed / prescribed medicines Staff may have concerns over the instructions given by the parent s e.g. Parents ask to give 2 x 5mls but the leaflet suggests maximum of 1 x 5ml dose at any time. We will only administer what is on the label. Or: The leaflet suggests it is not suitable for the reason the parent wants to give it. This should be queried by the staff with the parents, or checked with a pharmacist or NHS 24. Written permission from parents will also apply to all non prescribed medication see Information and consent below. Information and Consent A Medical Consent Form must be completed and signed by the parent/guardian giving authority and specific instructions on how the medication should be administered. The instructions must accord with information stated on the medication. The consent must include the following: Who the medication is being prescribed for (child s name) all medication should be clearly labelled or marked with the identity of the child. What is being prescribed (name of medication) Why it is being prescribed (what is being treated) The dosage The date from which the treatment is to commence The likely anticipated duration for the treatment The Medical Consent Form must have the time of administration recorded, dated and signed by the person administrating the medicine. This must be crosschecked and signed by a second member of staff. All areas will have two designated members of staff to carry out and check all administration of medication. If medication has to be given on a when required basis, It is important that staff have recorded the judgement made as to why the medication has been given e.g. child has high temperature, is wheezing, eyes running or itchy, sneezing etc. The parent/guardian must sign the Medical Consent Form at the end of each day to confirm the medication has been administered correctly and that it has been returned. Before administration the Early Years Worker will conduct a final check and confirm that the instructions on the medication label accords with the information provided by the parent/guardian. The Early Years Worker will decide on the appropriate location for storing the medication in accordance with the information provided on the medication label i.e. fridge/cupboard. Review In the case of prolonged medical treatment a review will be required after every 4 weeks. The parent/guardian will be required to complete another form, issue new instructions or Medication should be returned if necessary after 28 days. The Early Years Worker will be responsible for recording the start date for the medication in a diary. Reviewed June12 Page 2 of 8
Storage of Medication Medication will be stored in a fridge or a designated locked cupboard in an area that is below 25 C. If the medication requires storage in a fridge, this should be clearly labelled with the childs name. Where children can access the fridge a lock will be required. All medication must be signed in and out. The Early Years Worker will carry out a daily audit of medication. I.e. records of medication brought in from home, medication administered and medication sent home. This should be recorded and stored within the medication cupboard within the area. Each child s medication will be placed in an individual separate container with his/her name on it. Medical consent forms are kept within the medication storage cupboard on a clip board for confidential use. All spoons, syringes, spacers for inhalers etc are labelled and cleaned appropriately Time or course expired medication will be returned to the parents. Records While the Medical Consent Form is in use, it will be stored in the playroom. When the form is no longer current, it will be filed in the child s central record folder in the office along with all medical letters. At the end of each year all medical records will be archived and stored for 15 years What to do if too much medication is given or given to the wrong child. Should too much medication be administered to a child or accidentally given to the wrong child the senior / manger will contact NHS 24 or the children s GP for further advice and follow instructions accordingly. The first aider will monitor the situation, should any reaction become apparent immediately call 999 for an ambulance. What to do if the child spits out or refuses medication. Under no circumstances will we force any child to take medication should they spit this out or refuse to allow staff to administer medication. Parents and carers will be contacted immediately should this arise to make further arrangements. Allergy and Dietary Requirements We acknowledge that individual children may suffer from allergies or have special dietary needs. We recognise these needs and will work with parents/carers in order to accommodate them while respecting their dignity and individual circumstances. In the case of special dietary requirements, it is our policy to supply the child s food through our kitchen using the information given to us by the parent/carer. The child will be served the food at the same time as all the others to avoid the feeling of appearing to be different. The only obvious difference is that the food will be plated separately with the child s name on it for safety reasons. However as an alternative to food prepared in the nursery, parents/guardians have the option of choosing to provide their children with their own packed lunch if they consider it best for their individual needs. Reviewed June12 Page 3 of 8
Information and Consent When an initial enquiry for a nursery place is made, the parent/guardian will be provided with an application pack. This contains an Allergy/Dietary form, which must be completed by the parent/guardian if their child is subject to any of these conditions. This form provides all the relevant information for the Nursery to effectively manage the child s allergy/dietary requirements and must accompany the application form. On receipt, the Senior Early Years Worker/ Manager will check the details with the parent/guardian and identify any further information, which may be relevant. This will be recorded on the back of the form. The form must now be signed and dated by both the parent/guardian and the Senior Early Years Worker/Manager. It provides the Nursery with clear instructions about the child s condition and ALL foods and substances etc. that they must avoid and what action our staff must take. Any further subsequent instructions from the parent/guardian MUST be entered on the form and signed. We will not act on information given verbally alone. All staff coming into contact with a child who has an allergy or special dietary requirements must be fully aware of any individual needs. If a child is to spend some time in another nursery area, the Early Years Worker MUST ensure that all information is transferred to the responsible Early Years Worker and staff in the new area. This includes a copy of all relevant written instructions from the parent/guardian. Procedure Dietary Allergy Medical (D.A.M.) Summary Sheet Information from the original requirements form will be summarised on the Area Dietary / Allergy / Medical Summary sheet. (D.A.M sheet) It is the responsibility of The Senior Early Years Worker to complete the D.A.M sheet The D.A.M sheet will be displayed within the Area. A copy will be given to the kitchen Allergy Dietary Requirements form Copy to Area Copy to kitchen Original to child file Nursery Area The Front Summary sheet (D.A.M.) will be displayed on a clipboard in each area. The Senior Early Years Worker is responsible for communicating the clipboard information to their staff team. Area staff will be responsible for ensuring that all specially prepared food plates for children with special dietary requirements supplied by the kitchen are clearly labelled. Only labelled food is permitted to be given to child with special dietary requirements. If in ANY DOUBT, staff must phone the kitchen to confirm. When nursery areas supply food for activities, parties, etc, children with individual dietary needs will require ALL their food to be plated and labelled separately. This must be checked and confirmed with the kitchen before the child receives it. Reviewed June12 Page 4 of 8
Kitchen The DAM Summary sheet will be displayed on a clipboard in the kitchen The clipboard will be displayed beside the kitchen notice board Kitchen staff will coordinate the information and supply the food as specified All specially prepared food will be covered and labelled with the child s name, including am/pm snacks and lunches. Specially printed labels will be prepared by the admin staff for this purpose and supplied for use within the kitchen. IMPORTANT Always check and double-check If in doubt Leave it out!! Storage of Records While the Dietary Allergy Information Sheets are in use, they will be stored in the playroom and kitchen. When the sheets are no longer current, they will be put in the child s personal File. At the end of each year all allergy/dietary records will be scanned and achieved for 15 years. Procedure for Recording Accidents / Incidents There are Accident and Incident forms, which are completed by a member of staff and signed by the parents / Carer. These are kept in locked area cupboards and at the first aid posts around the building. ALL accidents/ incidents are recorded by the member of staff who witnessed the accident. Staff should record the child s name, area attended, date and time. The ratio of staff and children should also be recorded. This is dated and, in every case, signed by any other staff present. Staff must give a clear accurate account of the summary of the incident / accident including how the child reacted and how they were treated. The summary should also include the place where the accident / incident occurred as well as the type of accident / incident which has taken place. There is an, Action, section for the purpose of recording any action, which has been taken by the staff including if a child requires any medical attention. If a child receives medical treatment the Nursery Manager should be informed and the outcome should be recorded on the accident / incident form. Parents are shown the form and asked to sign that they have read the recorded incident. Anyone who refuses to sign this form should be directed to speak with senior staff or the Nursery Manager Senior staff as well as the Nursery Manager will review the forms and take action where necessary to avoid the accident / incident recurring. Hazards Hazards such as frayed carpets, splintered wood, broken furniture etc must be reported to management staff and appropriate action will be taken. Take out put in risk assessments procedures Reviewed June12 Page 5 of 8
Child Illness and Exclusion The Nursery and Out of School has clear guidelines in excluding children to prevent and control infection, as well as the spread of potentially infectious diseases. The guidance we adhere to is the NHS Board Communicable Diseases guidance for teachers. This provides information on illness, set incubation periods and a list of exclusions for children attending the Nursery and Out Of School services. Children who are already ill should not be taken to Nursery / Out Of School due to the risk of passing on infections to others. If a child has any of the following signs or symptoms, they should stay at home: Fever, irritability, lethargy, persistent crying or difficulty breathing; Upper respiratory tract (the nose, throat and lungs) illness such as bronchitis, tonsillitis; Gastrointestinal tract (the stomach and bowel) illness with diarrhoea or vomiting; A rash that s linked to an infection; Bacterial conjunctivitis. Exclusion / procedures Some more common diseases and infections found within the Nursery Environment which parents must be aware of are: Diarrhoea (This is defined as three or more very loose or liquid bowel movements within 24 hrs) A clear period of 48 hours until their symptoms have ceased should be allowed before the child is able to return to Nursery again, except in cases where a medical note is provided to state otherwise. Vomiting Depending on the severity and other obvious symptoms then the child will be sent home at the area senior s discretion. A clear period of 24 hours until their symptoms have ceased should be allowed before the child is able to return to Nursery again, except in cases where a medical note is provided to state otherwise. Temperature If the child has a temperature of above 37 degrees then the staff will follow procedures in order to cool them down. If this is unsuccessful then the parent or emergency contact will be phoned to collect them. High temperatures have serious implications, in the result of a fever convulsion an ambulance will be contacted immediately and the parent notified. Staff will accompany the child in an ambulance in the absence of the parent who will then meet them at the hospital. Bumps A first aider, in a designated area, will treat small cuts, grazes an everyday bumps. Any more serious injuries, and all head bumps will result in the parent being contacted to have the child checked over. All incidents and accidents will be clearly recorded following tight guidelines already in place for this. The parent must be notified of any injuries and sign the relevant form. Again in the result of any emergency, staff will go on forward to the hospital with the child and meet the parent or emergency contact there. Eyes Any noticeable eye infections such as conjunctivitis discharge, swelling and redness etc is an exclusion from the Nursery and must be adequately treated before the child can return to Nursery. This is usually 24 hours of antibiotics. Reviewed June12 Page 6 of 8
The Nursery has in place a wide variety of procedures, policies and contracts, which relate to the prevention of infection. All practices within the nursery take account of Health and Safety issues. Child Supervision Throughout the Nursery and Out of School areas, staff should know at all times how many children are in their care. Procedures in Place Each area / and playroom has a white board and marker to record numbers of children as they enter and leave the area. Regular head counts take place throughout the day. Registers / sign-in & out sheets are in place to confirm number of children within each area. Outdoor play. Regular head counts of children will take place during outdoor play. Staff will then record the number of children within the area once again inside. A list of names accompanying the group of children when moving areas / area meeting should be written and passed to the relevant staff. Doors, exits and gates should always be closed for the safety of the children children are instinctively curious and will wander. Double-check all areas and outdoors as well as toilets etc before leaving the room or the area having been used at that time. Failure to supervise children adequately will be deemed as Gross Misconduct Disciplinary Procedures will apply. Use of Restraint While AMCOL respects the dignity of individual children by not subjecting them to any physical restraint during normal nursery activities, in certain potentially hazardous situations we may have to use some restraint in a caring and sensitive manner to safeguard them from possible harm. Use of Restraint in the Nursery: In the interest of child safety, we will use certain levels of restraint within particular areas of the Nursery or within certain situations. This will always be measured and consistent with the perceived level of risk apparent at that time. The emphasis will always be to safeguard the safety of the individual child. We will use safety harnesses to restrain very young children when they are placed in the following situations: Sitting on low chairs Sitting on bouncing chairs/rockers Riding in prams Riding in buggies Use of Restraints during Outings We recognise that when children are on outings, out-with the confines of the Nursery, they may be exposed to a variety of hazards, placing an onerous responsibility on accompanying nursery staff. In these circumstances we may use a number of restraining measures as follows: Reviewed June12 Page 7 of 8
Safety harnesses when required Wrist links if warranted by a risk assessment Holding hands where staff have a concern about the safety of an individual child Use of Physical Restraint While physical restraint will not be used under normal circumstances, staff accompanying children on outings will use their professional judgement to assess any given situations and take appropriate action to safeguard the safety of individual children, e.g. if a child runs towards a road, the member of staff will use physical restraint to protect the child from imminent danger. Recording of Incidents For the protection of children and nursery staff, all incidents involving the use of exceptional restraint for safety reasons will be recorded. Sleep Procedures In lines with the Scottish Cot Death Trust our service will follow their guidelines to keep babies safe in the nursery setting. Positioning. All babies should be placed to sleep in a cot on their back with their feet towards the bottom end of the cot If the baby is less than six months old and you discover that it has turned onto its tummy you should gently turn the baby over onto its back Ensure the bedclothes are firmly tucked in and no higher than the babies shoulders so that they can t wriggle down under the covers The cot should not be placed close to windows or radiators Do not place a hat on a baby s head when putting them down to sleep unless it has specifically been recommended for medical reasons Bedding. All babies should be placed in a cot for sleeping ( beanbags, chairs and sofas increase the risks of cot death and are not as safe as a well maintained cot) Each child should have their own bedding and the mattress should be checked and disinfected between infant sleeps. Babies under 1 year old should not have pillows or duvets in their cot. Instead use one or more layers of light blankets ( depending on the room temp) Mattresses should be regularly inspected for any signs of damage to the waterproof fabric and if it is punctured, cracked or torn it should be replaced. Envornment Babies do not need the room to be very warm. The ideal room temp is 16-20c To check if a baby is too hot, feel the back of its tummy or neck, and if these areas feel too hot you should remove some bedding. Don t worry if the hands or feet feel cool this is normal. Keep the room well ventilated. In the nursery environment, sleeping babies should be closely supervised Scottish Cot Death Trust www.scottishcotdeathtrust.org contact@scottishcotdeathtrust.org Reviewed June12 Page 8 of 8