Connecticut Licensing Standards for Day Care Centers

Licensing Standards for DayCare Centers

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Administration of Medications

Child day care centers and group day care homes are not required by this section to administer medications to children. If the program accepts responsibility for the administration of medications of any kind, the program shall comply with all requirements of this section and shall have a written policy and procedures at the facility governing the administration of medications which shall include, but not be limited to, the types of medication that shall be administered, parental responsibilities, staff responsibilities, proper storage of medication and record keeping. Said policies and procedures shall be available for review by the Commissioner during site inspections or upon demand and shall reflect best practice.

(a) Administration of Nonprescription Topical Medications Only

(1) Description

For the purposes of this section nonprescription topical medications shall include:

(A) Diaper changing ointments free of antibiotic, antifungal, or steroidal components;

(B) Medicated powders; and

(2) Nonprescription Topical Medications Administration/Parent Permission Records. The written permission of the parent shall be required prior to the administration of the nonprescription topical medication and a medication administration record shall be written in ink and kept on file at the facility for each child administered a nonprescription topical medication. The medication administration record and parent permission shall become part of the child's health record when the course of medication has ended. The parent shall be notified of any medication administration errors immediately in writing and the error shall be documented in the record. The following information shall be included on a form as part of the medication administration record:

(A) The name, address, and date of birth of the child;

(B) The name of the medication;

(D) A statement indicating that the medication has been previously administered to the child without adverse effect;

(E) The signature in ink of the director, head teacher, program staff or group day care home provider receiving the parent permission form and the medication;

(F) The name, address, telephone number, signature and relationship to the child of the parent(s) authorizing the administration of the medication;

(G) The date and time the medication is started and ended;

(H) Medication administration errors; and

(I) The name of the person who administered the nonprescription topical medication.

(3) Nonprescription Topical Medications/Labeling and Storage

(A) The medication shall be stored in the original container and shall contain the following information on the container or packaging indicating:

(i) the individual child's name;

(ii) the name of the medication; and

(iii) directions for the medication's administration.

(B) The medication shall be stored away from food and inaccessible to children.

(b) Administration of medications other than nonprescription topical medications.

(1) Training Requirements

(A) Prior to the administration of any medication, the director(s), head teacher(s), program staff, or group day care home provider(s) who are responsible for administering the medications shall first be trained by a physician, physician assistant, advanced practice registered nurse or registered nurse in the methods of administration of medications and shall receive written approval from the trainer which indicates that the trainee has successfully completed a training program as required herein. A director, head teacher, program staff, or group day care home provider trained and approved to administer medication shall also be present whenever a child who has orders to receive medication is enrolled and present at the facility.

(B) The training in the administration of medications shall be documented and shall include, but not be limited to, the following :

(i) objectives;

(ii) a description of methods of administration including principles and techniques, application, and installation of oral, topical, and inhalant medication, including the use of nebulization machines, with respect to age groups;

(iii) administering medication to an uncooperative child;

(iv) demonstration of techniques by the trainer and return demonstration by participants, assuring that the trainee can accurately understand and interpret orders and carry them out correctly;

(v) recognition of side effects and appropriate follow up action;

(vi) avoidance of medication errors and the action to take if an error occurs;

(vii) abbreviations commonly used;

(viii) documentation including parent permission, written orders from physicians, and the record of administration;

(ix) safe handling including receiving medication from a parent, safe disposal, and universal precautions; and

(x) proper storage including controlled substances, in accordance with Section 21a-262-10 of the Regulations of Connecticut State Agencies.

In addition to the above training, before a director, head teacher, program staff, or group day care home provider may administer injectable medications, he shall have successfully completed a training program on the administration of injectable medications by a premeasured, commercially prepared syringe. The trainer who shall be a physician, physician assistant, advanced practice registered nurse or registered nurse, shall assure that the director, head teacher, program staff, or group day care home provider understands the indications, side effects, handling and methods of administration for injectable medication. Thereafter, on a yearly basis, the director, head teacher, program staff, or group day care home provider shall have their skills and competency in the administration of injectable medication validated by a physician, physician assistant, advanced practice registered nurse or registered nurse. Injectable medications shall only be given in emergency situations, by a premeasured commercially prepared syringe, unless a petition for special medication authorization is granted by the department.

(2) Training Approval Documents/Training Outline

(A) Upon completion of the required training program, the physician, physician assistant, advanced practice registered nurse or registered nurse who conducted the training shall issue a written approval to each director, head teacher, program staff, or group day care home provider who has demonstrated successful completion of the required training. Approval for the administration of oral, topical, and inhalant medications shall remain valid for three (3) years. Approval for the administration of injectable medications shall be valid for one (1) year. A copy of the approval shall be on file at the facility where the director, head teacher, program staff, or group day care home provider is employed and shall be available to department staff upon request.

(B) The written approval shall include:

(i) the full name, signature, title, license number, address and telephone number of the physician, physician assistant, advanced practice registered nurse or registered nurse who gave the training;

(ii) the location and date(s) the training was given;

(iii) a statement that the required curriculum areas listed in Sec. 19a-79-9a(b)(1)(B) and Sec. 19a-79-9a(b)(1)(C) when applicable were successfully mastered, and indicating the route(s) of administration the trainee has been approved to administer;

(iv) the name, address and telephone number of the director, head teacher, program staff, or group day care home provider who completed the training successfully; and

(v) the expiration date of the approval.

(C) The trainer shall provide the trainee with an outline of the curriculum content which verifies that all mandated requirements have been included in the training program. A copy of said outline shall be on file at the facility where the trainee is employed for department review. The department may require at any time that the operator obtain the full curriculum from the trainer for review by the department.

(3) Order from an Authorized Prescriber/Parent's Permission

(A) Except for nonprescription topical medications described in Section 19a-79-9a(a)(1), no medication, prescription or nonprescription, shall be administered to a child without the written order of an authorized prescriber and the written permission of the child(s) parent which shall be on file at the facility. Such medications may include:

(i) oral medications;

(ii) topical medications;

(iii) inhalant medications; or

(iv) injectable medications, by a premeasured, commercially prepared syringe, to a child with a medically diagnosed condition who may require emergency treatment.

(B) The written order from an authorized prescriber shall be on one form which shall indicate that the medication is for a specific child and shall contain the following information:

(i) the name, address, and date of birth of the child;

(ii) the date the medication order was written;

(iii) the medication or drug name, dose and method of administration;

(iv) the time the medication is to be administered;

(v) the date(s) the medication is to be started and ended;

(vi) relevant side effects and the authorized prescriber's plan for management if they occur;

(vii) notation if the medication is a controlled drug;

(viii) a listing of any allergies, reactions to, or negative interactions with foods or drugs;

(ix) specific instructions from the authorized prescriber who orders the medication regarding how the medication is to be given;

(x) the name, address and telephone number of the authorized prescriber ordering the drug;

(xi) the authorized prescriber's signature; and

(xii) the name, address, telephone number, signature and relationship to the child of the parent(s) giving permission for the administration of the drug by the director, head teacher, program staff, or group day care home provider.

(C) If the authorized prescriber determines that the training of the director, head teacher, program staff, or group day care home provider is inadequate to safely administer medication to a particular child, or that the means of administration of medication is not permitted under these regulations, that authorized prescriber may order that such administration be performed by licensed medical personnel with the statutory authority to administer medications.

(D) The director, head teacher, program staff, or group day care home provider shall administer medication only in accordance with the written order of the authorized prescriber and shall not administer the first dose of any medication, except in an emergency. The parent shall be notified of any medication administration errors immediately in writing and the error shall be documented in the record.

(E) Investigational drugs shall not be administered.

(4) Required Records

(A) Except for nonprescription topical medications described in Section 19a-79-9a(a)(1), individual written medication administration records for each child shall be written in ink, reviewed prior to administering each dose of medication and kept on file at the facility. The medication administration record shall become part of the child's health record when the course of medication has ended.

(B) The individual written administration record for each child shall include:

(i) the name, address, and date of birth of the child;

(ii) the name of the medication or drug;

(iii) the dosage ordered and method of administration;

(iv) the pharmacy and prescription number if applicable;

(v) the name of the authorized prescriber ordering the drug;

(vi) the date, time, and dosage at each administration;

(vii) the signature in ink of the director, head teacher, program staff or group day care home provider giving the medication;

(viii) food and medication allergies;

(ix) level of cooperation from the child in accepting the medication;

(x) the date and time the medication is started and ended; and

(xi) medication administration errors.

(5) Storage and Labeling

(A) Medication shall be stored in the original child-resistant safety container. The container or packaging shall have a label which includes the following information:

(i) the child's name;

(ii) the name of the medication;

(iii) directions for the medication's administration; and

(iv) the date of the prescription.

(B) Except for nonprescription topical medications described in Section 19a-79-9a(a)(1), medication shall be stored in a locked area or a locked container in a refrigerator in keeping with the label directions away from food and inaccessible to children. Keys to the locked area or container shall be accessible only to personnel authorized to administer medication. Controlled drugs shall be stored in accordance with Section 21a-262-10 of the Regulations of Connecticut State Agencies.

(C) All unused medication shall be returned to the parent or destroyed if it is not picked up within one (1) week following the termination of the order, by flushing into sewerage or a septic system in the presence of at least one witness. The facility shall keep a written record of the medications destroyed which shall be signed by both parties.

(6) Petition For Special Medication Authorization

(A) The operator of a child day care center or group day care home may petition the department to administer medications to a child cared for at the child day care center or group day care home by a modality which is not specifically permitted under these regulations by submitting a written application to the department including the following information:

(i) a written order from an authorized prescriber containing the information for the specific child set forth in subsection b)(3)(B) and a statement that the administration by the requested modality is the only reasonable means of providing medication and that the administration must occur during hours of the child's attendance at the facility;

(ii) a written training plan including the full name, signature, title, license number, address and telephone number of the physician, advanced practice registered nurse, physician assistant or registered nurse who shall provide the training, a detailed outline of the curriculum areas to be covered in training, and a written statement by the authorized prescriber that the proposed training is adequate to assure that the medication shall be administered safely and appropriately to the particular child;

(iii) the name, address and telephone number of the person(s) who shall participate in the training;

(iv) written permission from the child's parent; and

(v) such other information that the department deems necessary to evaluate the petition request.

(B) After reviewing the submitted information, if the department determines that the proposed administration of medication for the particular child can be provided in a manner to assure the health, welfare and safety of the child, it may grant the petition. The department may grant the petition with any conditions or corrective measures which the department deems necessary to assure the health, safety and welfare of the child. The department shall specify the curriculum that the training program shall cover and the expiration date of the authorization provided in granting the petition. If the department grants the petition, no medication may be administered until after the proposed training program has been successfully completed and a written certification from the physician, advanced practice registered nurse, physician assistant or registered nurse who provided the training is submitted to the department. The certification shall include:

(i) the full name, signature, title, license number, address and telephone number of the physician, advanced practice registered nurse, physician assistant or registered nurse who provided the training;

(ii) the location and date(s) the training was given;

(iii) a statement that the curriculum approved by the department was successfully mastered and stating the modality of administration of medication that the trainee has been approved to administer; and

(iv) the name, address and telephone number of the person(s) who successfully completed the training.

(C) Copies of all documentation required under this subsection shall be maintained at the facility. The requirements of subsection (b)(4) and (b)(5) shall apply to the administration of medication authorized by petition.

(1) Cease and Desist Orders

(A) If the department determines that the health, safety or welfare of a child in the child day care center or group day care home imperatively requires emergency action to halt the administration of medications by a director, head teacher, program staff or group day care home provider in a child day care center or group day care home, the department may issue a cease and desist order requiring the immediate cessation of the administration of medications by a director, head teacher, program staff or group day care home provider in the facility. The department shall provide an opportunity for a hearing regarding the order within 10 business days of date the order is issued. Upon receipt of the order, the operator shall cease the administration of all medications and provide immediate notification to the parents of all children under his care that no medications may be administered at the child day care center or group day care home until such time as the cease and desist order is terminated.

(2) Other Action

In accord with the procedures set forth in Connecticut General Statutes Section 19a-84, if the department finds that the operator, director, head teacher, program staff or group day care home provider fails to substantially comply with the regulations in this section or fails to administer medications in compliance with policies or procedures adopted for the child day care center or group day care home, or administers medications in a manner which endangers the health, welfare or safety of the children cared for in the facility, the department may take any of the following actions singly or in combination against the license of the operator:

(A) Revocation of the license;

(B) Suspension of the license for a specific time period or until regulatory compliance is secured or conditions deemed necessary to protect the health, safety and welfare of the children cared for in the child day care center or group day care home are met;

(D) Place the licensee on probationary status and impose such conditions or corrective measures which the department deems necessary to assure the health, safety and welfare of the children cared for in the child day care center or group day care home including but not limited to:

(i) reporting regularly to the department upon the matters which are the basis of probation;

(ii) placement of restrictions upon the operation of the child day care center or group day care home deemed necessary to protect the health, safety and welfare of the children cared for in the facility; and

(iii) continue or renew professional education until a satisfactory degree of skill has been attained in those areas which are the basis for the probation.

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