TITLE 8. EDUCATION

STATE BOARD OF EDUCATION

Fast-Track Regulation

Title of Regulation: 8VAC20-780. Standards for Licensed Child Day Centers (amending 8VAC20-780-40, 8VAC20-780-245, 8VAC20-780-510).

Statutory Authority: §§ 22.1-16 and 22.1-289.046 of the Code of Virginia.

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: December 17, 2025.

Effective Date: January 1, 2026.

Agency Contact: Tatanishia Armstrong, Legislative Consultant, Department of Education, Office of Child Care Health and Safety, 101 North 14th Street, Richmond, VA 23219, telephone (804) 382-5047, or email tatanishia.armstrong@doe.virginia.gov.

Basis: Section 22.1-16 of the Code of Virginia authorizes the State Board of Education to promulgate regulations necessary to carry out its powers and duties and the provisions of Title 22.1 of the Code of Virginia. Section 22.1-289.046 of the Code of Virginia requires the board to adopt regulations for the activities, services, and facilities to be employed by persons and agencies required to be licensed under Chapter 14.1 (§ 22.1-289.02 et seq.) of Title 22.1 of the Code of Virginia, which shall be designed to ensure that such activities, services, and facilities are conducive to the welfare of the children under the control of such persons or agencies.

Purpose: This action is essential to enhancing the health, safety, and welfare of children in care because it protects children with undiagnosed allergies in cases where exposure to the allergen may result in anaphylaxis that could be deadly. The action is required to comply with the provisions of Chapters 122 and 123 of the 2023 Acts of Assembly.

Rationale for Using Fast-Track Rulemaking Process: This action is expected to be noncontroversial and therefore appropriate for the fast-track rulemaking process because it is required by Chapters 122 and 123 of the 2023 Acts of Assembly.

Substance: The amendments (i) require each child day center to implement policies for the possession and administration of epinephrine to be administered by any nurse at the center, employee at the center, or employee of a local health department who is authorized by a prescriber and trained in the administration of epinephrine to any child believed to be having an anaphylactic reaction and (ii) require that at least one nurse at each child day center, employee at the center, or employee of a local health department who is authorized by a prescriber and trained in the administration of epinephrine has the means to access, at all times during regular facility hours, any appropriate weight-based dosage of epinephrine that is stored in a locked or otherwise generally inaccessible container or area.

Issues: The advantage of this action to the public and the Commonwealth is that the requirement for stock epinephrine to be available in centers increases protections for children and could potentially save the life of a child who experiences anaphylactic shock as a result of an allergic reaction. There are no disadvantages to this action.

Department of Planning and Budget Economic Impact Analysis:

The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Code of Virginia and Executive Order 19. The analysis presented represents DPB's best estimate of the potential economic impacts as of the date of this analysis.¹

Summary of the Proposed Amendments to Regulation. Pursuant to Chapter 122 and Chapter 123 of the 2023 Acts of Assembly (legislation), which amended § 22.1-289.059 of the Code of Virginia, the Board of Education (board) proposes several amendments to the regulation concerning the possession and administration of epinephrine at child day centers.

Background. Consistent with § 22.1-289.02 of the Code of Virginia, the regulation defines child day center as a child day program² offered to (i) two or more children younger than 13 years of age in a facility that is not the residence of the provider or of any of the children in care or (ii) 13 or more children at any location. Pursuant to the legislation, the board proposes to require in the regulation that (i) child day centers possess and store weight-based dosages of undesignated or stock epinephrine in a locked or inaccessible container or area in the center; (ii) the undesignated or stock epinephrine is only administered by a nurse at the center, an employee of a local health department who is authorized by a prescriber and trained in the administration of epinephrine, or staff at the center authorized by a prescriber and trained in the administration of epinephrine, and (iii) at least one of the above individuals has the means to access the epinephrine at all times during regular facility hours. If the person administering the epinephrine is neither a nurse nor an employee of a local health department, the Board proposes to require that their training be from (i) a program for this purpose developed by the Board of Nursing and taught by a registered nurse, licensed practical nurse, nurse practitioner, physician assistant, doctor of medicine or osteopathic medicine, or pharmacist, (ii) a course on this topic developed or approved by DOE in consultation with the Department of Health (VDH), or (iii) a course taught by a registered nurse, licensed practical nurse, nurse practitioner, physician assistant, doctor of medicine or osteopathic medicine, or pharmacist that includes the following: (a) recognizing signs and symptoms of anaphylaxis, (b) emergency procedures for responding to anaphylaxis, and (c) instructions and procedures for administering epinephrine. The proposed regulation expands upon the legislation, which only requires that the employee be trained in the administration of epinephrine.

Estimated Benefits and Costs. Anaphylaxis is a severe, life-threatening allergic reaction. It can happen seconds or minutes after a person has been exposed to an allergen.³ Immediate use of an epinephrine autoinjector can keep anaphylaxis from worsening and can be lifesaving.⁴ Thus, the proposed requirements that child day centers possess and store appropriate weight-based dosages of undesignated or stock epinephrine, and that at least one person qualified to administer epinephrine has access to the epinephrine at all times during regular facility hours, has the potential to save the lives of children with undiagnosed allergies in cases when exposure to the allergen may result in anaphylaxis. An EpiPen package comes with two auto-injectors of 0.3 mg and is approved for adults and children who weigh 66 lbs or more. The EpiPen JR package comes with two auto-injectors of 0.15 mg and is approved for children who weigh 33 lbs to 66 lbs.⁵ There are now also Food and Drug Administration (FDA) approved epinephrine auto-injectors of 0.1 mg for infants and toddlers.⁶ Retail prices for a package of two brand name epinephrine auto-injectors range from $650 to $750 without insurance.⁷ FDA-authorized generic epinephrine is available from CVS at $109.99 per two-pack.⁸ Epinephrine autoinjectors have a shelf life of 12 to 18 months from the date of manufacture.⁹ For a child day center with children that fall into all three weight groups, and uses the FDA-authorized generic epinephrine from CVS, it would cost approximately $330 annually to maintain non-expired epinephrine on hand.¹⁰ DOE reports that it is already under contract with an outside entity that provides training in medication administration, including epinephrine administration. DOE is proposing a training program for staff at child day centers on the administration of epinephrine by this entity. If the training proposal is approved by VDH, the undesignated or stock epinephrine training would be developed. DOE's plan is for the training to be offered at no cost to the child day centers.

Businesses and Other Entities Affected. The proposed amendments would affect the 2,663 licensed child day centers.¹¹ DOE believes all would qualify as small businesses. The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.¹² An adverse impact is indicated if there is any increase in net cost or reduction in net benefit for any entity, even if the benefits exceed the costs for all entities combined.¹³ The costs from requiring that child day centers possess and store appropriate weight-based dosages of undesignated or stock epinephrine stem from the legislation. Requiring training for the administration of epinephrine is also in the legislation, but the proposed text on training requires more than the legislation. Nevertheless, it appears that the training may be offered for free to the child day centers. Thus, no adverse impact is indicated.

Small Businesses¹⁴ Affected.¹⁵ As noted above, all child day centers appear to be small businesses. The proposed regulation does not appear to introduce costs beyond those already required by the legislation.

Localities¹⁶ Affected.¹⁷ The proposed amendments neither appear to disproportionally affect particular localities nor affect costs for local governments.

Projected Impact on Employment. The proposed amendments do not appear to substantively affect total employment.

Effects on the Use and Value of Private Property. The increase in costs, which are due to the legislation, may moderately reduce the value of some child day programs. The proposed amendments do not affect real estate development costs.

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¹ Section 2.2-4007.04 of the Code of Virginia requires that such economic impact analyses determine the public benefits and costs of the proposed amendments. Further the analysis should include but not be limited to: (1) the projected number of businesses or other entities to whom the proposed regulatory action would apply, (2) the identity of any localities and types of businesses or other entities particularly affected, (3) the projected number of persons and employment positions to be affected, (4) the projected costs to affected businesses or entities to implement or comply with the regulation, and (5) the impact on the use and value of private property.

² Child day program is defined in the regulation as a regularly operating service arrangement for children where, during the absence of a parent or guardian, a person or organization has agreed to assume responsibility for the supervision, protection, and well-being of a child younger than 13 years of age for less than a 24-hour period. Child day program does not include programs such as drop-in playgrounds or clubs for children when there is no service arrangement with the child's parent.

³ Source: Mayo Clinic https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468.

⁴ Source: Mayo Clinic https://www.mayoclinic.org/diseases-conditions/anaphylaxis/diagnosis-treatment/drc-20351474.

⁵ See https://www.goodrx.com/epinephrine-epipen/how-to-save-cost.

⁶ See https://www.fda.gov/media/127806/download.

⁷ Supra, note 5.

⁸ See https://www.cvs.com/content/epipen-alternative.

⁹ See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720482/.

¹⁰ Average of $110 per epinephrine auto-injector package, and three separate packages for the three different weight groups.

¹¹ Data source: DOE.

¹² Pursuant to § 2.2-4007.04 D: In the event this economic impact analysis reveals that the proposed regulation would have an adverse economic impact on businesses or would impose a significant adverse economic impact on a locality, business, or entity particularly affected, the Department of Planning and Budget shall advise the Joint Commission on Administrative Rules, the House Committee on Appropriations, and the Senate Committee on Finance. Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation.

¹³ Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation. As a result, DPB has adopted a definition of adverse impact that assesses changes in net costs and benefits for each affected Virginia entity that directly results from discretionary changes to the regulation.

¹⁴ Pursuant to § 2.2-4007.04, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

¹⁵ If the proposed regulatory action may have an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include: (1) an identification and estimate of the number of small businesses subject to the proposed regulation, (2) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the proposed regulation, including the type of professional skills necessary for preparing required reports and other documents, (3) a statement of the probable effect of the proposed regulation on affected small businesses, and (4) a description of any less intrusive or less costly alternative methods of achieving the purpose of the proposed regulation. Additionally, pursuant to § 2.2-4007.1 of the Code of Virginia, if there is a finding that a proposed regulation may have an adverse impact on small business, the Joint Commission on Administrative Rules shall be notified.

¹⁶ "Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

¹⁷ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency Response to the Economic Impact Analysis: The State Board of Education thanks the Department of Planning and Budget for its thorough economic impact analysis.

Summary:

Pursuant to Chapters 122 and 123 of the 2023 Acts of Assembly, the amendments (i) require each child day center to implement policies for the possession and administration of epinephrine to be administered by certain authorized and trained individuals to any child believed to be having an anaphylactic reaction and (ii) require that at least one authorized and trained individual at each child day center has the means to access at all times during regular facility hours any appropriate weight-based dosage of epinephrine that is stored in a locked or otherwise generally inaccessible container or area.

8VAC20-780-40. Operational responsibilities.

A. Applications for licensure shall conform with Article 3 (§ 22.1-289.010 et seq.) and Article 4 (§ 22.1-289.030 et seq.) of Chapter 14.1, of Title 22.1 of the Code of Virginia and the regulation entitled General Procedures and Information for Licensure, (8VAC20-820).

B. Pursuant to § 22.1-289.034 of the Code of Virginia and the regulation entitled Background Checks for Child Day Programs and Family Day Systems, (8VAC20-770), the applicant and any agent at the time of application who is or will be involved in the day-to-day operations of the center or who is or will be alone with, in control of, or supervising one or more of the children, shall be of good character and reputation; shall not have been convicted of a barrier crime as defined in § 19.2-392.02 of the Code of Virginia; and is shall not be the subject of a founded complaint of child neglect or abuse within or outside the Commonwealth.

C. The sponsor shall afford the superintendent or his the superintendent's agents the right at all reasonable times to inspect facilities and to interview his the sponsor's agents, employees, and any child or other person within his the sponsor's custody or control, provided that no private interviews may be conducted with any child without prior notice to the parent of such the child.

D. The license shall be posted in a place conspicuous to the public (§ 22.1-289.011 of the Code of Virginia).

E. The operational responsibilities of the licensee shall include ensuring that the center's activities, services, and facilities are maintained in compliance with these standards, the center's own policies and procedures that are required by these standards, and the terms of the current license issued by the department.

F. Every center shall ensure that advertising is not misleading or deceptive as required by § 22.1-289.027 of the Code of Virginia.

G. The center shall meet the proof of child identity and age requirements as stated in § 22.1-289.049 of the Code of Virginia.

H. The sponsor shall maintain public liability insurance for bodily injury for each center site with a minimum limit of at least $500,000 each occurrence and with a minimum limit of $500,000 aggregate.

1. A public sponsor may have equivalent self-insurance that is in compliance with the Code of Virginia.

2. Evidence of insurance coverage shall be made available to the department's representative upon request.

I. The center shall develop written procedures for injury prevention.

J. Injury prevention procedures shall be updated at least annually based on documentation of injuries and a review of the activities and services.

K. The center shall develop written procedures for prevention of shaken baby syndrome or abusive head trauma, including coping with crying babies, safe sleeping practices, and sudden infant death syndrome awareness.

L. The center shall inform all staff who work with children of children's allergies, sensitivities, and dietary restrictions.

M. The center shall maintain, in a way that is accessible to all staff who work with children, a current written list of all children's allergies, sensitivities, and dietary restrictions documented in the allergy plan required in 8VAC20-780-60 A 8. This list shall be dated and kept confidential in each room or area where children are present.

N. The center shall develop written playground safety procedures that shall include:

1. Provision for active supervision by staff to include positioning of staff in strategic locations, scanning play activities, and circulating among children; and

2. Method of maintaining resilient surface.

O. Hospital-operated centers may temporarily exceed their licensed capacity during a natural disaster or other catastrophe or emergency situation and shall develop a written plan for emergency operations, for submission to and approval by the Department of Education.

P. When children 13 years of age or older are enrolled in the program and receive supervision in the licensed program, they those children shall be counted in the number of children receiving care and the center shall comply with the standards for these those children.

Q. The center shall implement policies for the possession and administration of undesignated or stock epinephrine pursuant to § 22.1-289.059 of the Code of Virginia that ensure:

1. Undesignated or stock epinephrine is only administered by a nurse at the center, an employee of a local health department who is authorized by a prescriber and trained in the administration of epinephrine, or staff at the center authorized by a prescriber and trained in the administration of epinephrine pursuant to 8VAC20-780-245 M to a child believed to be having an anaphylactic reaction;

2. At least one nurse at the center or an employee of a local health department who is authorized by a prescriber and trained in the administration of epinephrine, or staff at the center authorized by a prescriber and trained in the administration of epinephrine pursuant to 8VAC20-780-245 M has the means to access at all times during regular facility hours appropriate weight-based dosages of undesignated or stock epinephrine based on the children in care at the center; and

3. Undesignated or stock epinephrine is stored in a locked or inaccessible container or area in the center.

8VAC20-780-245. Ongoing training.

A. Staff shall complete annually a minimum of 16 hours of training appropriate to the age of children in care.

B. Training completed to meet the requirements of this section shall be in addition to completing orientation requirements in 8VAC20-780-240.

C. Staff who do not work with a group of children at the center shall only be required to complete annual training on emergency preparedness and response, child abuse and neglect, and mandated reporter requirements.

D. Staff who work with a group of children at the center and are employed at a short-term program shall only be required to obtain a minimum of 10 hours of staff training per year.

E. In a cooperative preschool center that is organized, administered, and maintained by parents of children in care, parent volunteers, or other persons who participate and volunteer in a cooperative preschool center on behalf of a child attending such cooperative preschool center, including such volunteers who are counted in the staff-to-child ratios required in 8VAC20-780-340, shall complete four hours of training per year and shall be exempt from training requirements applicable to staff of child day programs. This training exemption shall not apply to any parent volunteer or other person as referred to in this subsection if the cooperative preschool center has entered into a contract with the department or a local department to provide child care services funded by the Child Care and Development Block Grant.

F. Volunteers who work more than six hours per week shall be required to complete annual training on the center's emergency procedures.

G. For therapeutic child day programs and special needs child day programs, staff who work directly with children shall annually complete four additional hours of training. At least eight hours of annual training shall be on topics related to the care of children with special needs.

H. Annual training shall be relevant to staff's job responsibilities and the care of children, and include topics such as:

1. Child development, including physical, cognitive, social, and emotional development;

2. Behavior management and positive guidance techniques;

3. Prevention and control of infectious diseases;

4. Prevention of sudden infant death syndrome and use of safe sleep practices;

5. Prevention of and response to emergencies due to food and other allergic reactions, including:

a. Recognizing the symptoms of an allergic reaction;

b. Responding to allergic reactions;

c. Preventing exposure to the specific food and other substances to which the child is allergic; and

d. Preventing cross contamination;

6. The center's policies and procedures on the administration of medication;

7. Building and physical premises safety, including identification of and protection from hazards that can cause bodily injury, such as electrical hazards, bodies of water, and vehicular traffic;

8. Prevention of shaken baby syndrome and abusive head trauma, including procedures to cope with crying babies or distraught children;

9. Signs and symptoms of child abuse and neglect and requirements for mandated reporters;

10. Emergency preparedness and response planning for emergencies resulting from a natural disaster or a human-caused event such as violence at a child care facility and the center's specific emergency preparedness plan as required 8VAC20-780-550 A through K;

11. Handling and storage of hazardous materials and the appropriate disposal of diapers and other items contaminated by body fluids;

12. CPR and first aid;

13. Precautions in transporting children if applicable; and

14. If applicable, the recommended care requirements related to the care and development of children with special needs.

I. Training on the center's emergency preparedness plan shall be completed annually and each time the plan is updated.

J. Medication administration:

1. To safely perform medication administration practices listed in 8VAC20-780-510, whenever the center has agreed to administer prescribed medications, the administration shall be performed by a staff member or independent contractor who has satisfactorily completed a training program for this purpose approved by the Board of Nursing and taught by a registered nurse, licensed practical nurse, nurse practitioner, physician assistant, doctor of medicine or osteopathic medicine, or pharmacist pursuant to § 54.1-3408 of the Code of Virginia; or the administration shall be performed by a staff member or independent contractor who is licensed by the Commonwealth of Virginia to administer medications.

a. The approved training curriculum and materials shall be reviewed by the department at least every three years and revised as necessary.

b. Staff required to have the training specified in subdivision 1 of this subsection and subsection M of this section shall be retrained at three-year intervals.

2. To safely perform medication administration practices listed in 8VAC20-780-510, whenever the center has agreed to administer over-the-counter medications other than topical skin gel, cream, or ointment, the administration must be performed by a staff member or independent contractor who has satisfactorily completed a training course developed or approved by the Department of Education in consultation with the Virginia Department of Health and the Board of Nursing and taught by a registered nurse, licensed practical nurse, nurse practitioner, physician assistant, doctor of medicine or osteopathic medicine, or pharmacist; or the administration shall be performed by a staff member or independent contractor who is licensed by the Commonwealth of Virginia to administer medications.

a. The course, which shall include competency guidelines, shall reflect currently accepted safe medication administration practices, including instruction and practice in topics such as reading and following manufacturer's instructions; observing relevant laws, policies, and regulations; and demonstrating knowledge of safe practices for medication storage and disposal, recording and reporting responsibilities, and side effects and emergency recognition and response.

b. The approved training curriculum and materials shall be reviewed by the department at least every three years and revised as necessary.

c. Staff required to have the training shall be retrained at three-year intervals.

3. Any child for whom emergency medications (such as albuterol, glucagon, and epinephrine auto injector) have been prescribed shall always be in the care of a staff member or independent contractor who meets the requirements in subdivision 1 of this subsection.

K. Daily health observation training shall include the following:

1. Components of daily health check for children;

2. Inclusion and exclusion of the child from the class when the child is exhibiting physical symptoms that indicate possible illness;

3. Descriptions of how diseases are spread and the procedures or methods for reducing the spread of disease;

4. Information concerning the Virginia Department of Health Notification of Reportable Diseases pursuant to 12VAC5-90-80 and 12VAC5-90-90, also available from the local health department and the website of the Virginia Department of Health; and

5. Staff occupational health and safety practices in accordance with Occupational Safety and Health Administration's bloodborne pathogens regulation (29 CFR 1910.1030).

L. There shall always be at least one staff member on duty who has obtained, within the last three years, instruction in performing the daily health observation of children.

M. The administration of undesignated or stock epinephrine shall be performed by:

1. A nurse at the center or employee of a local health department authorized by a prescriber and trained in the administration of epinephrine;

2. A staff member at the center who is authorized by a prescriber and meets the requirements of subsection J of this section;

3. A staff member who has satisfactorily completed a training course developed or approved by the Department of Education in consultation with the Virginia Department of Health; or

4. A staff member who has satisfactorily completed a course taught by a registered nurse, licensed practical nurse, nurse practitioner, physician assistant, doctor of medicine or osteopathic medicine, or pharmacist that includes the following:

a. Recognizing signs and symptoms of anaphylaxis.

b. Emergency procedures for responding to anaphylaxis; and

c. Instructions and procedures for administering epinephrine.

N. Documentation of training shall be kept by the center in a manner that allows for identification by individual staff member, is considered part of the staff member's record, and shall include:

1. Name of staff;

2. Training topic;

3. Evidence that training on each topic required in this section has been completed;

4. Training delivery method;

5. The entity or individual providing training;

6. The number of training hours or credit hours received; and

7. The date of training.

N. O. Medication administration training required in subsection J of this section and daily health observation training required in subsection K of this section may count toward the annual training hours required in this section.

8VAC20-780-510. Medication.

A. The decision to administer medicines at a facility may be limited by center policy to administer:

1. Prescribed medications;

2. Over-the-counter or nonprescription medications; or

3. No medications except those required for emergencies or by law.

B. Prescription and nonprescription medication shall be given to a child:

1. According to the center's written medication policies; and

2. Only with written authorization from the parent.

C. Medication shall be administered by a staff member who is 18 years of age or older.

D. Nonprescription medication shall be administered by a staff member or independent contractor who meets the requirements in 8VAC20-780-245 J 1 or J 2.

E. The center's procedures for administering medication shall:

1. Include any general restrictions of the center.

2. For nonprescription medication, be consistent with the manufacturer's instructions for age, duration, and dosage.

3. Include duration of the parent's authorization for medication, provided that it shall expire or be renewed after 10 work days. Long-term prescription drug use and over-the-counter medication may be allowed with written authorization from the child's physician and parent.

4. Include methods to prevent use of outdated medication.

F. The medication authorization shall be available to staff during the entire time it is effective.

G. Medication shall be labeled with the child's name, the name of the medication, the dosage amount, and the time or times to be given. Undesignated or stock epinephrine kept at the center pursuant to § 22.1-289.059 of the Code of Virginia shall be labeled with the name of the medication and the dosage amount.

H. Nonprescription medication shall be in the original container with the direction label attached.

I. The center may administer prescription medication that would normally be administered by a parent or guardian to a child, provided:

1. The medication is administered by a staff member or an independent contractor who meets the requirements in 8VAC20-780-245 J;

2. The center has obtained written authorization from a parent or guardian;

3. The center administers only those drugs that were dispensed from a pharmacy and maintained in the original, labeled container; and

4. The center administers drugs only to the child identified on the prescription label in accordance with the prescriber's instructions pertaining to dosage, frequency, and manner of administration.

J. When needed, medication shall be refrigerated.

K. When medication is stored in a refrigerator used for food, the medications shall be stored together in a container or in a clearly defined area away from food.

L. Medication, except for those prescriptions designated otherwise by written physician's order, including refrigerated medication and staff's personal medication, shall be kept in a locked place using a safe locking method that prevents access by children.

M. If a key is used, the key shall not be accessible to the children.

N. Centers shall keep a record of medication given children, which shall include the following:

1. Child to whom the medication was administered;

2. Amount and type of medication administered to the child;

3. The day and time the medication was administered to the child;

4. Staff member administering the medication;

5. Any adverse reactions; and

6. Any medication error.

O. Staff shall inform parents immediately of any adverse reactions to medication administered and any medication error.

P. When an authorization for medication expires, the parent shall be notified that the medication needs to be picked up within 14 days or the parent must renew the authorization. Medications that are not picked up by the parent within 14 days will be disposed of by the center by either dissolving the medication down the sink or flushing it down the toilet.