Conn. Agencies Regs. § 19a-79-9a

Current through October 16, 2024

Section 19a-79-9a - Administration of medications

Group child care homes and child care centers that administer medications of any kind shall comply with all requirements of this section and shall have written policies 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, program staff responsibilities, proper storage of medication and record keeping. Such policies and procedures shall be available for review by the Office during inspections or upon demand and shall reflect best practice. A group child care home or child care center shall not deny services to a child on the basis of a child's known or suspected allergy or because a child has a prescription for a premeasured, commercially prepared auto-injector used to treat an allergic reaction or for injectable equipment used to administer glucagon. A group child care home or child care center shall not deny services to a child on the basis of a child's diagnosis of asthma or because a child has a prescription for an inhalant medication to treat asthma.

(a)Administration of Nonprescription Topical Medications Only

(1) For the purposes of this section nonprescription topical medications 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 medications.

(2) Nonprescription Topical Medications Administration/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 facility for each child administered a nonprescription topical medication. The medication shall be administered only in accordance with the written permission of the parent(s). The parent(s) shall be immediately notified of any medication error, and notified of such error in writing not more than seventy two hours after the medication error occurred, and such medication error shall be documented in the child's record.

(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.

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

(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 care home provider(s) who are responsible for administering the medications shall first be trained by a pharmacist, 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 child 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;

(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 authorized prescribers and the record of administration;

(ix) Safe handling including receiving medication from the parent(s), 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 Medications.

In addition to the training requirements set forth in subparagraphs (A) and (B) of this subdivision, before a director, head teacher, program staff or group child care home provider may administer oral, topical or inhalant medications, he or she shall have successfully completed a training program on the administration of oral, topical and inhalant medications. The trainer, who shall be a pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse, shall ensure that the director, head teacher, program staff or group child care home provider understands the indications, side effects, handling and the methods of administration for oral, topical and inhalant medication. After completing such training, the director, head teacher, program staff or group child care home provider shall have his or her skills and competency in the administration of oral, topical and inhalant medications reviewed and validated by a pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse every three years. The facility shall have program staff trained in the administration of oral, topical and inhalant medication on site during all hours when a child with a prescription for oral, topical or inhalant medication is on-site.

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

In addition to the training requirements set forth in subparagraphs (A) and (B) of this subdivision, before a director, head teacher, program staff or group child care home provider may administer injectable medications, he or she shall have successfully completed a training program on the administration of injectable medications 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 ensure that the director, head teacher, program staff or group child care home provider understands the indications, side effects, handling and methods of administration for injectable medication. After completing such training, the director, head teacher, program staff or group child care home provider shall annually have his or her skills and competency in the administration of injectable medication validated by a pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse. Injectable medications by a premeasured commercially prepared auto-injector shall only be given in emergency situations. The facility shall have program staff trained in the use of a premeasured, commercially prepared auto-injector used to treat an allergic reaction on site during all hours when a child with a prescription for an automatic prefilled cartridge injector or similar automatic injectable equipment used to treat an allergic reaction is on-site.

(E) Rectal Medications

In addition to the training requirements set forth in subparagraphs (A) and (B) of this subdivision, before a director, head teacher, program staff or group child care home provider may administer rectal medications, he or she shall have successfully completed a training program on the administration of rectal medications. The trainer, who shall be a pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse, shall ensure that the director, head teacher, program staff or group child care home provider understands the indications, side effects, handling and the methods of administration for rectal medication. After completing such training, the director, head teacher, program staff or group child care home provider shall have his or her skills and competency in the administration of rectal medications reviewed and validated by a pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse every three years. The facility shall have program staff trained in the administration of rectal medication on site during all hours when a child with a prescription for rectal medication is on-site.

(F) Injectable Medications Other than by a Premeasured Commercially Prepared Auto-Injector In addition to the training requirements set forth in subparagraphs (A) and (B) of this subdivision, before a director, head teacher, program staff or group child care home provider may administer injectable medications other than by a premeasured commercially prepared auto-injector, he or she shall have successfully completed a training program on the administration of injectable medications 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 ensure that the director, head teacher, program staff or group child care home provider understands the indications, side effects, handling and the methods of administration for injectable medication. After completing the training, the director, head teacher, program staff or group child care home provider shall have his or her skills and competency in the administration of injectable medications 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. The facility shall have program staff trained in the administration of injectable medication other than by a premeasured commercially prepared auto-injector, on site during all hours when a child with a prescription for injectable medication other than by a premeasured commercially prepared auto-injector is on-site.

(G) A program staff member currently certified by the Department of Developmental Services, or the Department of Children and Families, to administer medications shall be considered qualified to administer medications for the modalities in which they have been trained at child care centers or group child care homes.

(2) Training Approval Documents/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 director, head teacher, program staff or group child care home provider who has demonstrated successful completion of the required training. Approval for the administration of oral, topical, inhalant medications, rectal medications and injectable medications other than by a premeasured commercially prepared auto-injector shall remain valid for three years. Approval for the administration of injectable medications by a premeasured commercially prepared auto-injector shall be valid for one year. A copy of the approval shall be on file at the facility for a period of three years 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 this subsection 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 child 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 for a period of three years for Office review. The Office may require at any time that the operator obtain the full curriculum from the trainer for review by the Office.

(3) Order From An Authorized Prescriber/Parent's Permission

(A) Except for nonprescription topical medications described in subsection (a)(1) 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 facility for at least two years after the child is no longer attending the program. Such medications may include:

(i) Oral medications;

(ii) Topical medications;

(iii) Inhalant medications;

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

(v) Rectal medications; or

(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 that indicates that the medication is for a specific child and that contains 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 child care home provider.

(C) If the authorized prescriber determines that the training of the director, head teacher, program staff or group child 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 child 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(s) shall be notified immediately of a significant medication error or a medication error, and notified of such error 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 medications described in subsection (a)(1) 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 facility for at least two years after the child is no longer attending the program. 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, or in another manner that prevents alteration of the information, of the director, head teacher, program staff or group 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 subdivision (1) of subsection (a) of this section, and medication described in subsection (b)(5)(C) of this section, 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 personnel authorized to administer medication may be provided with the means to access such medication. 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 medications 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 other 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 facility shall keep a written record of the medications destroyed for three years which shall be signed by both parties.

(E) The facility 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 prescriber upon enrollment and attendance of such child at the facility, and replace such medication and equipment prior to its expiration date.

(6) Children enrolled at the facility may self-administer medications with documented parental and authorized prescriber's permission. Children may request and receive assistance from program staff 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) The operator of a child care center or group child care home may petition the Office to administer medications to a child cared for at the child care center or group child care home by a modality which is not specifically permitted under these regulations 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 subdivision (3)(B) of this subsection 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 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) 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, it 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, physician assistant, advanced practice registered nurse 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, physician assistant, advanced practice registered nurse 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 subdivision shall be maintained for a period of two years at the facility. The requirements of subsection (b) (4) and (b) (5) of this section 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 child care center or group child care home imperatively requires emergency action to halt the administration of medications by a director, head teacher, program staff or group child care home provider in a child care center or group child care home, the Office 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 child care home provider in the facility. The Office shall provide an opportunity for a hearing regarding the order within ten 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 parent(s) of all children under his or her care that no medications may be administered at the child care center or group 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 19a-131a of the Connecticut General Statutes and if authorized by the Commissioner of Public Health pursuant to section 19a-131k of the Connecticut General Statutes via the emergency alert system or other communication system, a child care center or group child care home licensed in accordance with section 19a-80 of the Connecticut General Statutes and located within a ten mile radius of the Millstone Power Station in Waterford, Connecticut shall notify parents and guardians of enrolled minors, program staff and other persons present of the statutory requirement to provide potassium iodide, and shall designate program staff members to distribute and administer potassium iodide to adults present or to a child in attendance at the child care center or group child care home during such emergency. Such distribution of potassium iodide shall comply with the following:

(1) Prior to distribution, each child care center or group child care home shall notify parents and guardians of minors currently enrolled, and program staff currently employed, of the requirement to distribute and administer potassium iodide. Such notification shall also be made upon enrolling a new minor or hiring a new program staff member;

(2) Upon notification made pursuant to subdivision (1) of this subsection, and prior to distribution, the child care center or group child care home shall obtain written permission or written objection for such administration. Written documentation of such notification and permission or objection shall be kept at the child care center or group child care home;

(3) Prior to obtaining written permission or written objection, each child care center and group child care home shall advise each such person, in writing, that the ingestion of potassium iodide is voluntary;

(4) Prior to obtaining written permission or written objection, each child care center and group child care home shall advise each such person about the contraindications and the potential side effects of taking potassium iodide, according to current guidelines on exposure, dosage, contraindications and side effects issued by the Food and Drug Administration;

(5) Child care centers and group child care homes shall designate program staff members to distribute and administer potassium iodide to minors, program staff, and other persons present at the child care center or group child care home when directed by the Commissioner during a public health emergency. Such designated program staff members shall be eighteen years of age or older and shall have been instructed by the child care center or group child care home in the administration of potassium iodide. 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; and

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

Conn. Agencies Regs. § 19a-79-9a

Adopted effective November 3, 1997; Amended March 8, 2004; Amended January 4, 2005; Amended November 6, 2008; amended 8/10/2023; amended 10/16/2024