Sec.19a-87b-17. Administration of Medication

For purposes of the administration of medication at a family child care home, the provider shall comply with all requirements of this section and shall have written policies and procedures at the family child care home governing the administration of medication 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. Such policies and procedures shall be available for review by the Office during any inspection or upon demand and shall reflect best practice.

(a) Administration of Nonprescription Topical Medication Only

(1) Description

For the purposes of this section nonprescription topical medication shall include, but not be limited to:

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

(B) Medicated powders; and

(C) Teething, gum or lip medication.

(2) Administration of Nonprescription Topical Medication and Parent Permission Records

The written permission of the parent(s) shall be required prior to the administration of the nonprescription topical medication and shall be kept on file at the family child care home for each child administered a nonprescription topical medication. The administration of medication shall be only in accordance with the written permission of the parent(s). The parent(s) shall be notified immediately of any medication error. Written notice of such medication error shall be sent thereafter to the parent(s) not more than seventy two hours after the medication error occurred, and such medication error shall be documented in the child’s health record.

(3) Nonprescription Topical Medication; 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.

(C) Any unused portion of the medication shall be returned to the parent(s). An expired medication shall be destroyed in a safe manner or returned to the parent(s).

(b) Administration of Medication Other Than Nonprescription Topical Medication

(1) Training Requirements

(A) Prior to the administration of medication, the provider and any substitute(s) who are responsible for the administration of medication shall first be trained by a pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse in the methods of administration of medication and shall receive written approval from the trainer which indicates that the trainee has successfully completed a training program as required by this subsection. A provider or substitute trained and approved for the administration of medication shall also be present whenever a child who has orders to receive medication is enrolled and present at the family child care home.

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

(i) Objectives;

(ii) A description of methods of the administration of medication including principles and techniques;

(iii) Administration of 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 authorized prescribers and the administration of medication record;

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

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

(C) Oral, Topical and Inhalant Medication

In addition to the training requirements in subparagraphs (A) and (B) of this subdivision, before a provider or substitute may administer oral, topical or inhalant medication, the provider or substitute shall have successfully completed a training program on the administration of oral, topical and inhalant medication. The trainer, who shall be a pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse, shall assure that the provider or substitute understands the indications, side effects, handling and the methods of administration for oral, topical and inhalant medication. After completing such training, the provider or substitute shall have his or her skills and competency in the administration of oral, topical and inhalant medication reviewed and validated by a pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse every three years. A provider or substitute trained in the administration of oral, topical and inhalant medication shall be present whenever a child who has a prescription for an oral, topical or inhalant medication is enrolled and present at the family child care home.

(D) Injectable Medication by a Premeasured Commercially Prepared Auto-Injector

In addition to the training requirements in subparagraphs (A) and (B) of this subdivision, before a provider or substitute may administer injectable medication, the provider or substitute shall have successfully completed a training program on the administration of injectable medication by a premeasured commercially prepared auto-injector. The trainer who shall be a pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse, shall assure that the provider or substitute understands the indications, side effects, handling and methods of administration for such injectable medication. After completing such training, the provider or substitute shall annually have his or her skills and competency in the administration of injectable medication reviewed and validated by a pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse. Injectable medication by a premeasured commercially prepared auto-injector shall only be given in emergency situations. A provider or substitute trained in the use of a premeasured commercially prepared auto-injector used to treat an allergic reaction shall be present whenever a child who has a prescription for a premeasured commercially prepared auto-injector used to treat an allergic reaction is enrolled and present at the family child care home.

(E) Rectal Medication

In addition to the training requirements in subparagraphs (A) and (B) of this subdivision, before a provider or substitute may administer rectal medication, the provider or substitute shall have successfully completed a training program on the administration of rectal medication. The trainer, who shall be pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse, shall assure that the provider or substitute understands the indications, side effects, handling and the methods of administration for rectal medication. After completing such training, the provider or substitute shall have his or her skills and competency in the administration of rectal medication reviewed and validated by a pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse every three years. A provider or substitute trained in the administration of rectal medication shall be present whenever a child who has a prescription for a rectal medication is enrolled and present at the family child care home.

(F) Injectable Medication Other than by a Premeasured Commercially Prepared Auto-Injector

In addition to the training requirements in subparagraphs (A) and (B) of this subdivision, before the provider or substitute may administer injectable medication other than by a premeasured commercially prepared auto-injector, the provider or substitute shall have successfully completed a training program on the administration of injectable medication other than by a premeasured commercially prepared auto-injector. The trainer, who shall be a pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse, shall assure that the provider or substitute understands the indications, side effects, handling and the methods of administration for injectable medication. After completing such training, the provider or substitute shall have his or her skills and competency in the administration of injectable medication other than by a premeasured commercially prepared auto-injector reviewed and validated by a pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse every three years. A provider or substitute trained in the administration of injectable medication other than by a premeasured commercially prepared auto-injector shall be present whenever a child who has a prescription for injectable medication other than by a premeasured commercially prepared auto-injector is enrolled and present at the family child care home.

(G) A provider or substitute currently certified by the Department of Developmental Services or the Department of Children and Families for the administration of medication shall be considered qualified for the administration of medication for the modalities in which they have been trained at a family child care home.

(2) Training Approval Documents and Training Outline

(A) Upon completion of the required training program or the review and validation of the required training, the pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse who conducted the training shall issue a written approval to each provider or substitute who has demonstrated successful completion of the required training. Approval for the administration of oral, topical, inhalant medication, rectal medication and injectable medication other than by a premeasured commercially prepared auto-injector shall remain valid for three years. Approval for the administration of injectable medication by a premeasured commercially prepared auto-injector shall be valid for one year. A copy of the approval shall be on file at the family child care home where the provider or substitute is employed and shall be available to Office staff upon request.

(B) The written approval shall include:

(i) The full name, signature, title, license number, address and telephone number of the pharmacist, 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 subdivision (1) of subsection (a) of this section 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 provider or substitute 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 family child care home where the trainee is employed for Office review. The Office may require at any time that the provider obtain the full curriculum from the trainer for review by the Office.

(3) Order From An Authorized Prescriber and Parent’s Permission

(A) Except for nonprescription topical medication described in subdivision (1) of subsection (a) of this section, 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(s) which shall be on file at the family child care home. Such medication may include:

(i) Oral medication;

(ii) Topical medication;

(iii) Inhalant medication;

(iv) Injectable medication, by a premeasured commercially prepared auto-injector, to a child with a medically diagnosed condition who may require emergency treatment;

(v) Rectal medication; and

(vi) Injectable medication other than by a premeasured commercially prepared auto-injector.

(B) The written order from an authorized prescriber shall be on a form or forms 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 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 substance, as defined in section 14-1 of the Connecticut General Statutes;

(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 medication;

(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 medication by the provider or substitute.

(C) If the authorized prescriber determines that the training of the provider or substitute is inadequate for the safe administration of medication to a particular child, or that the means of administration of medication is not permitted under this section, that authorized prescriber may order that such administration be performed by licensed medical personnel with the statutory authority for the administration of medication.

(D) The administration of medication by the provider or substitute shall be 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 immediately of a significant medication error or a medication error, and notified in writing not later than seventy-two hours after the significant medication error or medication error occurred, and the error shall be documented in the medication administration record. Significant medication errors shall also be reported immediately to the Office by telephone and in writing no later than the next business day.

(E) Investigational drugs shall not be administered.

(4) Required Records

(A) Except for nonprescription topical medication described in section subparagraph (1) of subsection (a) of this section, individual written medication administration records for each child shall be maintained, reviewed prior to administering each dose of medication and kept on file at the family child care home. 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;

(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 medication;

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

(vii) The signature in ink of the provider or substitute 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) Significant medication errors and medication 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 administration of medication; and

(iv) The date of the prescription.

(B) Except for nonprescription topical medication described in subparagraph (1) of this subsection (a) of this section, and medication described in subparagraph (C) of this subdivision, 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. Only staff trained for the administration of medication pursuant to this section shall be permitted to access such area or container. Controlled substances, as defined in section 14-1 of the Connecticut General Statutes shall be stored in accordance with section 21a-262-10 of the Regulations of Connecticut State Agencies.

(C) Equipment and medication prescribed to treat asthma, administer glucagon, control seizures, or as an emergent first line of defense medication against an allergic response or a diabetic reaction shall be stored in a safe manner, inaccessible to children, to allow for quick access in an emergency.

(D) All unused or expired medication, except for controlled substances, as defined in section 14-1 of the Connecticut General Statutes, shall be returned to the parent(s) or disposed of if it is not picked up within one week following the termination of the order, in the presence of at least one witness. The family child care home shall keep a written record of the medication disposed of for three years which shall be signed by both parties.

(E) The provider shall require the parent(s) of a child who has a prescription for a premeasured commercially prepared auto-injector used to treat an allergic reaction or injectable equipment used to administer glucagon or other injectable medication or rectal medication or inhalant medication to treat asthma, to provide the injector or equipment labeled with the information from the authorized prescriber upon enrollment and attendance of such child at the family child care home, and replace such medication and equipment prior to its expiration date.

(6) Children enrolled at the family child care home may self-administer medication with documented permission from the parent(s) and authorized prescriber. Children may request and receive assistance from the provider or substitute in opening containers or packages or replacing lids. Medication to be self-administered shall be stored in accordance with subdivision (5) of this subsection).

(7) Petition For Special Medication Authorization

(A) A provider may petition the Office for the administration of medication to a child cared for at the family child care home by a modality which is not specifically permitted under this section by submitting a written application to the Office including the following information:

(i) A written order from an authorized prescriber containing the information for the specific child set forth in subparagraph (B) of subdivision (3) of this subsection and a statement that the administration of medication by the requested modality is the only reasonable means of providing medication and that the administration of medication is necessary during hours of the child’s attendance at the family child care home;

(ii) A written training plan including the full name, signature, title, license number, address and telephone number of the pharmacist, 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(s); and

(v) Such other information that the Office deems necessary to evaluate the petition request.

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

(i) The full name, signature, title, license number, address and telephone number of the pharmacist, 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 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 for a period of two years at the family child care home. The requirements of subdivisions (4) and (5) of this subsection shall apply to the administration of medication authorized by petition.

(c) Cease and Desist Orders

If the Office determines that the health, safety or welfare of a child in the family child care home imperatively requires emergency action to halt the administration of medication by a provider or substitute in a family child care home, the Office may issue a cease and desist order requiring the immediate cessation of the administration of medication by a provider or substitute in the family child care home. The Office shall provide an opportunity for a hearing regarding the order no later than ten business days after of the date the order is issued. Upon receipt of the order, the provider or substitute shall cease the administration of all medication and provide immediate notification to the parents of all children under the provider’s care that the administration of medication shall not be allowed at the family child care home until such time as the cease and desist order is terminated.

(d) Emergency Distribution of Potassium Iodide. Notwithstanding any other provisions of the Regulations of Connecticut State Agencies, during a public health emergency declared by the Governor pursuant to section 2 of public act 03-236 and, if authorized by the Commissioner of Public Health via the emergency alert system or other communication system, a family day care home provider licensed in accordance with section 19a-87b of the Connecticut General Statutes, or a substitute or an assistant approved in accordance with section 19a-87b-8 of the Regulations of Connecticut State Agencies and located at a family day care home, within a 10-mile radius of the Millstone Power Station in Waterford, Connecticut, shall be permitted to distribute and administer potassium iodide tablets to adults present or to a child in attendance at the family day care home during such emergency, provided that:

(1) Prior written consent has been obtained by the family day care home provider for such provision. Written consent forms shall be provided by the family day care home provider to the parent(s) or guardian(s) each child currently enrolled or employees currently employed by the family day care home provider promptly upon the effective date of this subdivision. Thereafter, written consent forms shall be provided by the family day care home provider to the parent(s) or guardian(s) of each minor child upon enrollment and to each new employee upon hire. Such documentation shall be kept at the facility;

(2) Each person providing consent has been advised in writing by the family day care home provider that the ingestion of potassium iodide is voluntary;

(3) Each person providing consent has been advised in writing by the family day care home provider about the contraindications and the potential side effects of taking potassium iodide, which include:

(A) persons who are allergic to iodine should not take potassium iodide;

(B) persons with chronic hives, lupus, or other conditions with hypocomplementemic vasculitis should not take potassium iodide;

(C) persons with Graves disease or people taking certain heart medications should talk to their physician before there is an emergency to decide whether or not to take potassium iodide; and,

(D) side effects including minor upset stomach or rash.

(4) Only family day care home providers who have read the regulations pertaining to the administration of potassium iodide and approved substitutes and approved assistants who have been instructed by the family day care home provider in the administration of potassium iodide may distribute and administer potassium iodide to adults or minors for whom written consent has been obtained. Such instruction shall include, but not be limited to the following:

(A) the proper use and storage of potassium iodide;

(B) the recommended dosages of potassium iodide to be administered to children and adults as prescribed by the Food and Drug Administration.

(5) Potassium iodide tablets shall be stored in a locked storage area or container, inaccessible to children.

(Adopted effective November 3, 1997; Amended January 4, 2005; Amended March 19, 2021)

Notation

Notes: Subsection (d) was inadvertantly omitted from the version published on 3-19-2021 and has been restored. (April 22, 2021)