Holding Child Care Facilities Responsible for Errors in Dispensing Medication
Each person who administers prescription or non-prescription medication to a child must be trained to verify and to document that the right child receives the proper dosage of the correct medication designated for that particular child and given at the correct time(s), and by the proper method.
Each person who administers medication (other than topical medication) must demonstrate competency in the administration of medication before being authorized by the day care to administer any medication. Additionally:
- The day care must ensure that at least one staffer with training in medication administration is present at any and all times when children are in care.
- Each person who administers any medication, other than oral or topical medications and epinephrine auto-injectors, must be trained by a licensed health care practitioner and must demonstrate annually to the satisfaction of the trainer, competency in the administration of such medications. An alternative method of training approved by the Massachusetts Department of Public Health (MDPH) can be substituted with approval from MDPH.
- The day care must ensure that each staffer, including those staffers who do not administer medication, receives training in recognizing common side effects and adverse interactions among various medications, and potential side effects of specific medications being administered in the program.
Massachusetts Regulations Regarding Medication Administration in Child Care Centers
Read All Child Care Regulations (PDF)
7.11 Health and Safety
Medication Administration
(a) The day care must have a written policy regarding administration of prescription and non-prescription medication. The policy must provide for the administration of medications ordered by a child’s health care practitioner.
(b) All medication administered to a child, including but not limited to oral and topical medications of any kind, either prescription or non-prescription, must be provided by the child’s parent, unless noted in section (l), below
(c) All prescription medications must be in the containers in which they were originally dispensed and with their original labels affixed. Over-the-counter medications must be in the original manufacturer’s packaging.
(d) The staffer must not administer any medication contrary to the directions on the original container, unless so authorized in writing by the child’s licensed health care practitioner. Any medications without clear instructions on the container must be administered in accordance with a written physician or pharmacist’s descriptive order.
(e) Unless otherwise specified in a child’s individual health care plan, the staffer must store all medications out of the reach of children and under proper conditions for sanitation, preservation, security and safety during the time the children are in care and during the transportation of children.
- Those medications found in United States Drug Enforcement Administration (DEA) Schedules II-V must be kept in a secured and locked place at all times when not being accessed by an authorized individual.
- Prescription medications requiring refrigeration shall be stored in a way that is inaccessible to children in a refrigerator maintained at temperatures between 38º F and 42 º F.
(f) Notwithstanding the provisions of 606 CMR 7.11(2)(e), above, emergency medications such as epinephrine auto-injectors must be immediately available for use as needed.
(g) Each day care shall have a written policy on medication disposal.
(h) When possible, all unused, discontinued or outdated prescription medications shall be returned to the parent and such return shall be documented in the child’s record. When return to the parent is not possible or practical, such prescription medications must be destroyed and the destruction recorded by a manager or supervisor in accordance with policies of the day care and the Department of Public Health, Drug Control Program.
(I) No staffer shall administer the first dose of any medication to a child, except under extraordinary circumstances and with parental consent.
(j) Each time a medication is administered, the staffer must document in the child’s record the name of the medication, the dosage, the time and the method of administration, and who administered the medication, except as noted in (k) below.
(k) The staffer must inform the child’s parent(s) at the end of each day whenever a topical medication is applied to a diaper rash.
(l) All medications must be administered in accordance with the consent and documentation requirements specified below:
| Regulation Number and Type of Medication | Written Parental Consent Required | Health Care Practitioner Authorization Required | Logging Required |
| 7.11(2)(l)1All Prescription | Yes | Yes. Must be in original container with original label containing the name of the child affixed. | Yes, including name of child, dosage, date, time, & staff signature. Missed doses must also be noted along with the reason(s) why the dose was missed. |
| 7.11(2)(l)2Oral Non-Prescription | Yes, renewed weekly with dosage, times, days and purpose | No in FCC Yes in Large and Small Group Must be in original container with original label containing the name of the child affixed | Yes, including name of child, dosage, date, time, & staff signature. Missed doses must also be noted along with the reason(s) why the dose was missed. |
| 7.11(2)(l)3Unanticipated Non-Prescription for Mild Symptoms (e.g., acetaminophen, ibuprofen, antihistamines) | Yes, renewed annually | No in FCC Yes in Large and Small Group Must be in original container with original label containing the name of the child affixed | Yes, including name of child, dosage, date, time, & staff signature |
| 7.11(2)(l)4Topical, non-Prescription (when applied to open wounds or broken skin) | Yes, renewed annually | No in FCC Yes in Large and Small Group Must be in original container with original label containing the name of the child affixed | Yes, including name of child, dosage, date, time, & staff signature. |
| 7.11(2)(l)5Topical, non-Prescription (not applied to open wounds or broken skin) | Yes, renewed annually | No. Items not applied to open wounds or broken skin may be supplied by program with notification to parents of such, or parents may send in preferred brands of such items for their own child(ren)’s use. | No for items not applied to open wounds or broken skin. |
Parent Notification Requirements
The daycare or child care center must inform parents immediately of any injury which requires any medical care beyond minor first aid or of any emergency administration of non-prescription medication.
The day care or nursery must immediately report any medication error which occurred while the child was in their care and which:
- required hospitalization or emergency medical treatment, or
- which resulted in a child receiving the wrong medication.
Was Your Child Injured Due to a Daycare or Caregiver Medication Error?
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