Medication Administration in Day Care Centers
Objective: To determine the frequency with which children attending day care centers (DCCs) receive medications, what types of medications are administered, whether standardized procedures are used in the dispensing of medications, and whether any self-reported errors occur.
Design: Cross-sectional descriptive survey.
Setting: DCCs in eastern Iowa licensed by the Iowa Department of Health and Human Services.
Participants: Day care supervisors at DCCs.
Interventions: Not applicable.
Main Outcome Measures: Descriptive, self-reported information, including frequency of medication administration on-site, types of medications administered, procedures for storing and dispensing medications, record keeping, and training of staff.
Results: Response rate was 38.9% (82 of 227 mailed surveys were returned completed). On average, 5.5% of children received medications while attending a DCC during a 2-week period. DCCs administered the following medications during the year preceding the survey: antibiotics (86.5% of DCCs reporting having administered), cold medications (85.0%), analgesics (78.0%), and attention-deficit/hyperactivity disorder medications (67.0%). The two most common errors reported were missed dose (55.6% of DCCs reporting having happened) and medication not available for administration (50.6%). All DCCs surveyed reported having written policies for medication administration, but staff at only 50.0% of DCCs received special training on medication administration.
Conclusion: Medications are often administered in DCCs, and the types of medications administered in this setting have the potential to pose significant risks if their use is not monitored properly. DCC staff receive little, if any, education regarding proper storage, handling, and administration of medications. Pharmacists should take an active role in providing education to this poorly served group to help reduce risks of medication misadventures.

On a typical day, millions of children in the United States receive care in licensed day care centers (DCCs). As providers for these children, licensed DCCs play an important role in their development, nurturing, health, and safety.

Children with chronic health conditions often require medication as part of their treatment, and these medications are frequently administered during the hours the children attend DCCs. Little information is available about the types of medications being administered outside the home, especially in places such as DCCs and schools. Kogan et al. found that 54% of 3 year olds in the United States had been given at least one over-the-counter (OTC) medication in the previous 30 days. These researchers found that among those children receiving OTC medications, the most commonly reported OTC products were Tylenol (acetaminophen -- McNeil) (66.7%) and cough or cold medications (66.7%). About 40% of the OTC medication users received two medications during the past 30 days. Slack-Smith et al. observed that 73% of children attending DCCs in Australia were being given OTC medications and 11% were using prescription medications on a regular basis.

Although little information exists about medication administration in DCCs, the issue has been examined in schools. In the largest and most relevant of these studies, McCarthy et al. surveyed 1,000 school nurses nationwide. When asked whether any medication errors had occurred in the past year, almost 80% of the responding nurses reported that doses had been missed, 30% reported doses being given without documentation, 23% reported overdosing, 21% reported administering a medication without authorization, and 20% reported that the wrong medication had been given to a child. The researchers also found that the number of medication errors was directly related to the number of students cared for and to the use of nonhealth care professionals to dispense medications. Since high child-to-provider ratios are also common in DCCs, and since it is likely that individuals without health care training dispense medications in this setting, children who attend these centers are potentially at risk for experiencing medication errors.

The purpose of this study was to determine the frequency with which children attending DCCs receive medications, what types of medications are given to children in DCCs, whether guidelines are used in the distribution of medications, and whether self-reported errors occur.