<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 13A.17.11.04" title_num="13A" subtitle_num="17" chapter_num="11" heading="Medication Administration and Storage.">
  <paragraph num="A.">
    <text>Medication Administration.</text>
    <paragraph num="(1)">
      <text>Medication, whether prescription or nonprescription, may not be administered to a child in care unless:</text>
      <paragraph num="(a)">
        <text>Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form, provided by the office, that is received at the center before the medication is administered; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A licensed health practitioner has approved the administration of the medication and the medication dosage.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A prescription medication may not be administered to a child unless at least one dose of the medication has been given to the child at home.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>If medication is by prescription, it shall be labeled by the pharmacy or physician with:</text>
      <paragraph num="(a)">
        <text>The child's name;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The date of the prescription;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The name of the medication;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The medication dosage;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>The administration schedule;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>The administration route;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>If applicable, special instructions, such as “take with food”;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>The duration of the prescription; and</text>
      </paragraph>
      <paragraph num="(i)">
        <text>An expiration date that states when the medication is no longer useable.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Topical Applications. A diaper rash product, sunscreen, or insect repellent supplied by a child's parent may be applied without prior approval of a licensed health practitioner.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Medication shall be administered according to the instructions on the label of the medication container or a licensed health practitioner's written instructions, whichever are more recently dated.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Recording Requirements.</text>
    <paragraph num="(1)">
      <text>Each administration of a prescription or nonprescription medication to a child, including self-administration of a medication by the child, shall be noted in the child's record.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Application of a diaper rash product, sunscreen, or insect repellent supplied by a child's parent shall be noted in the child's record.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Medication Storage.</text>
    <paragraph num="(1)">
      <text>Each medication shall be:</text>
      <paragraph num="(a)">
        <text>Labeled with the child's name, the dosage, and the expiration date;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Stored as directed by the manufacturer, the dispensing pharmacy, or the prescribing physician; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Discarded according to guidelines of the Office of National Drug Control Policy or the U.S. Environmental Protection Agency, or returned to the child's parent upon expiration or discontinuation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>All medications shall be stored to make them inaccessible to children in care but readily accessible to each employee designated by the operator to administer medication.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Medication Administration Training.</text>
    <paragraph num="(1)">
      <text>Whenever children in care are present, there shall be at least one center employee present who has completed medication administration training approved by the office.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Medication may be administered to a child in care only by an employee who has completed approved medication administration training.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Section F of this regulation does not apply if:</text>
    <paragraph num="(1)">
      <text>The center employs a registered nurse, licensed practical nurse, or medication technician certified by the Maryland Board of Nursing to administer medication to children in care; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Responsibility for administering medication to children in care is delegated to a center employee by a delegating nurse in accordance with COMAR 10.27.11.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Self-Administration of Medication.</text>
    <paragraph num="(1)">
      <text>Before a child may self-administer medication while in care, the operator shall:</text>
      <paragraph num="(a)">
        <text>Have a written order from the child's physician and the written request of the child's parent for the child's self-administration of medication;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>In consultation with the child's parent, establish a written procedure for self-administration of medication by the child based on the physician's written order; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Authorize the child to self-administer medication.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Revocation of Authorization to Self-Administer.</text>
      <paragraph num="(a)">
        <text>An operator may revoke a child's authorization to self-administer medication if the child fails to follow the written procedure required by §H(1)(b) of this regulation.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Immediately upon revoking the child's authorization to self-administer medication, the operator shall notify the child's parent of that revocation.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The operator shall document the revocation of authorization to self-administer and the notification to the child's parent in the child's record.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>Medical Cannabis.</text>
    <paragraph num="(1)">
      <text>The administration of medical cannabis by a caregiver to a child who is a qualifying medical cannabis patient is governed by COMAR 10.62.01—10.62.37.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The administration of medical cannabis that includes smoking or vaping is prohibited.</text>
    </paragraph>
  </paragraph>
</regulation>