Policy vs practice: Inconsistencies in medication storage and administration in child care centers in Philadelphia

Background: With the increased prevalence of health conditions among children and the increased number of children cared for outside of the home, there is an increasing chance for medical errors to occur among children in child care centers (CCC). Aim: Using in-depth interviews, we explored the practices and policies surrounding the storage and administration of medications in 12 CCC in Philadelphia. Methods: The CCC were purposely selected from a population of 120 CCC from the 12 planning analysis sections of Philadelphia. One administrator and one teacher from each CCC participated in separate face-to-face interviews. Questions were adapted from surveys used to investigate medication administration in schools. Interviews were audio-recorded, transcribed, and coded by four reviewers. Results: Through content analysis, 88% (21 of 24) of the interviews had at least one inconsistency between the CCC practices and policies; multiple inconsistencies were found in three (13%) of the interviews. Inconsistencies were found in the areas of medication storage (office vs. classroom), medications administered [no over-the-counter (OTC) medications allowed vs. OTC medications given], who administers medications (teacher vs. administrator), training (1 vs. 5 years), sick children (fever not allowed vs. allowed), medication log (sign daily vs. sign as needed). Conclusions: The practices and policies surrounding the storage and administration of medications are inconsistent within these CCC. The policies and practices need to be reexamined and further defined in order to assist childcare providers in standardizing medication storage and administration. Administrators and teachers may benefit from additional communication and training.