Child Day Care Centers Could Reduce Medication Risks

Preschoolers who need to take medications while at day care centers in Iowa generally are getting the right drugs on schedule, but more could be done to reduce the risk of medication errors, according to a University of Iowa study.

Almost all day care centers in the study have written policies about giving medication to their charges, but only half of all centers train their staff in administering medications. In addition, the study suggests that pharmacists may be able to aid parents and day care staff in better dispensing practices. The findings appear in the May/June issue of the Journal of the American Pharmacists Association.

The issue of dispensing medication in schools for grades K-12 has been previously studied. However, this investigation is believed to be the first to look at the issue in day care settings in the United States, said Michael Kelly, Pharm.D., associate professor (clinical) in the UI College of Pharmacy and of family medicine in the UI Roy J. and Lucille A. Carver College of Medicine and one of the study's authors.

"We used the same approach that we used when we first started studying this issue in schools," Kelly said. "The medication errors were not anything you would consider too serious, but there is room for improvement, and as researchers, we want to learn more about this issue in day care centers."

The investigators sent surveys to 227 day care centers in eastern Iowa. Nearly 39 percent of the surveys were completed and returned (82 of the 227). An average 5.5 percent of children at any one center were taking medications during any given two-week period.

"The results mirrored quite closely those we found in schools," Kelly said, referring to the finding that the problem most commonly reported by day care centers was a missed dose, with 56.5 percent of all respondents saying it had happened at least once in the past year. The most common prescription drugs given to children in day care centers were antibiotics, cold medications, allergy medications and analgesics (pain/fever relievers such as Tylenol).

The second most commonly reported problem was medication not being available for a baby or youngster, occurring at least once in half of all centers. Kelly said pharmacists may be able to help address this problem by providing parents two containers, one that can be taken to the center and one that can remain at home.

Schools, unlike day care centers, generally have a nurse who gives out medications, or schools provide training for individuals who are not health care workers -- such as secretaries or aides -- but who may need to give medications to students. However, the UI investigators found that half of all day care centers do not even provide simple training about the appropriate ways to administer medications, including storage and handling issues.

"We think those who give drugs to children should have some training so that they can identify adverse drug reactions, for example, or know how to help a young child use a multidose inhaler for asthma," Kelly said.

"Providing medications to their charges is a minor aspect of day care staff's responsibilities. Pharmacists should do more to make the process as simple and safe as possible," he added.

The study used a small sample, so the investigators now are reviewing guidelines related to the medication dispensing in day care centers in all 50 states.

Other investigators on the team included Michael Ernst, Pharm.D., assistant professor (clinical) of family medicine in the Carver College of Medicine and clinical and administrative pharmacy in the UI College of Pharmacy; and Heidi Sinkovits, Pharm.D., who completed a primary care pharmacy residency at the UI and now is a clinical pharmacist with Group Health of the Puget Sound in Seattle, Wash.