Original Notice.

     Preproposal statement of inquiry was filed as WSR 09-22-012.

     Title of Rule and Other Identifying Information: Amending WAC 170-151-230 (school-age child care) What requirements must I meet for medication management?, 170-295-3060 (child care centers) Who can provide consent for me to give medication to the children in my care?, and 170-296-0870 (family home child care) How do I manage medications for children?

     Hearing Location(s): Due to state budget cuts only one public hearing will be held, on Wednesday, September 8, 2010, at 6:30 p.m. to 9:00 p.m., at the Department of Early Learning (DEL), Room 230, 649 Woodland Square Loop S.E., Lacey, WA 98503 (at the corner of College Street and Woodland Square Loop, above Harborstone Credit Union).

     Those who cannot attend in-person may join the hearing by phone or on-line anytime from 6:30 to 9:00 p.m.:

     •     By telephone toll-free by calling 1-866-441-7284. When directed by the operator, enter "PIN" number 454181 followed by the # (pound) key.

     •     At "Go to Meeting" on-line at https://www2.gotomeeting.com/register/535332531. You will need to give your name and e-mail address when registering.

     DEL encourages sending your input in writing. See the "Send written comments to" section of this notice for the comment deadline and how to send written input on-line or by e-mail, fax or postal mail. All comments are considered equally, whether received at the public hearing or in writing.

     The department will respond in writing to all comments on the proposed rules in a consolidated "concise explanatory statement" that DEL prepares for the final adoption of the rules. This statement is sent to everyone who comments on the proposal, and to anyone who asks for it. Please contact the DEL rules coordinator to request a copy of the concise explanatory statement.

     Date of Intended Adoption: After September 14, 2010.

     Submit Written Comments to: DEL Rules Coordinator, P.O. Box 40970, Olympia, WA 98504-0970, DEL on-line comment web site https://apps.del.wa.gov/PolicyProposalComment/Detail.aspx, e-mail Rules@del.wa.gov, or fax (360) 725-4939, by 11:59 p.m. on September 9, 2010.

     Assistance for Persons with Disabilities: Contact Andy Fernando, DEL rules coordinator, by September 1, 2010, (360) 725-4397 or by e-mail to andres.fernando@del.wa.gov.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rule adds "hand sanitizer gels" to the list of nonprescription medications that a licensed child care provider may administer to a child over twelve months of age, if the provider has obtained written permission from the child's parent or guardian.

     Reasons Supporting Proposal: The department is amending rules regarding the use and administration of hand sanitizer gels with children in DEL-licensed child care to help limit the spread of flu viruses (including pandemic H1N1 flu) and other diseases.

     The current rules create a potential barrier to using hand sanitizer gels. Alcohol-based hand sanitizers are regulated by the United States Food and Drug Administration as "over the counter" drugs, which under DEL rules are considered "nonprescription medications." Unless a nonprescription medication is specifically listed in the rules as allowed for administration with a parent's written permission, a physician's written authorization for each child is required. The proposed rules will help alleviate this barrier.

     Statutory Authority for Adoption: RCW 43.215.200.

     Statute Being Implemented: Chapter 43.215 RCW.

     Rule is not necessitated by federal law, federal or state court decision.

     Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: DEL filed emergency rules on the use of hand sanitizing gels in DEL-licensed child care to help limit the spread of the H1N1 "Swine flu" virus, which had reached worldwide pandemic status according to the World Health Organization and federal Centers for Disease Control. See rules filed as WSR 09-22-011, 10-05-120, and 10-13-104. DEL intends to adopt permanent rules on hand sanitizer use.

     The proposed rules do not require the use of hand sanitizer gels with children under the licensed child care provider's care, but allows their use with the required parental permission.

     The department welcomes input posted to the on-line DEL Facebook page and DEL Blog. However, to assure receipt of the department's written response (the concise explanatory statement) to public comments on this proposal, written input must be submitted as described in the "Send written comments to" section of this notice, and must include the sender's postal or e-mail address.

     Name of Proponent: DEL, governmental.

     Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Robert McLellan, Senior Assistant Director, DEL, Lacey, Washington, (360) 725-4569.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed rule is not expected to create more than minor costs for affected small businesses. Preparation of a small business economic impact statement is not required.

     A cost-benefit analysis is not required under RCW 34.05.328. DEL is not listed among the state agencies required to comply with RCW 34.05.328.

July 30, 2010

Elizabeth M. Hyde

Director

OTS-2705.1

AMENDATORY SECTION(Amending WSR 06-15-075, filed 7/13/06, effective 7/13/06)

WAC 170-151-230   What requirements must I meet for medication management?   You may have a policy of not giving medication to the child in care. If your center's health care plan includes giving medication to the child in care, you:

     (1) Must give medications, prescription and nonprescription, only on the written approval of a parent, person, or agency having authority by court order to approve medical care;

     (2) Must give prescription medications:

     (a) Only as specified on the prescription label; or

     (b) As authorized, in writing, by a physician or other person legally authorized to prescribe medication.

     (3) Must give the following classifications of nonprescription medications, with written parent authorization, only at the dose, duration, and method of administration specified on the manufacturer's label for the age or weight of the child needing the medication:

     (a) Antihistamines;

     (b) Nonaspirin fever reducers/pain relievers;

     (c) Nonnarcotic cough suppressants;

     (d) Decongestants;

     (e) Anti-itching ointments or lotions, intended specifically to relieve itching;

     (f) Diaper ointments and powders, intended specifically for use in the diaper area of the child; ((and))

     (g) Sun screen; and

     (h) Hand sanitizers.

     (4) Must give other nonprescription medication:

     (a) Not included in the categories listed in subsection (3) of this section; or

     (b) Taken differently than indicated on the manufacturer's label; or

     (c) Lacking labeled instructions, only when disbursement of the nonprescription medication is as required under subsection (4)(a), (b), and (c) of this section:

     (i) Authorized, in writing, by a physician; or

     (ii) Based on established medical policy approved, in writing, by a physician or other person legally authorized to prescribe medication.

     (5) Must accept from the child's parent, guardian, or responsible relative only medicine in the original container, labeled with:

     (a) The child's first and last names;

     (b) The date the prescription was filled; or

     (c) The medication's expiration date; and

     (d) Legible instructions for administration, such as manufacturer's instructions or prescription label.

     (6) Must keep medication, refrigerated or nonrefrigerated, in an orderly fashion and inaccessible to the child;

     (7) Must store external medication in a compartment separate from internal medication;

     (8) Must keep a record of medication disbursed;

     (9) Must return to the parent or other responsible party, or must dispose of medications no longer being taken; and

     (10) May, at your option, permit self-administration of medication by a child in care if:

     (a) The child is physically and mentally capable of properly taking medication without assistance;

     (b) You include in the child's file a parental or physician's written statement of the child's capacity to take medication without assistance; and

     (c) You have stored the child's medications and other medical supplies so the medications and medical supplies are inaccessible to other children in care.

[06-15-075, recodified as § 170-151-230, filed 7/13/06, effective 7/13/06. Statutory Authority: Chapter 74.15 RCW and RCW 34.05.395. 02-13-073, § 388-151-230, filed 6/14/02, effective 7/15/02. Statutory Authority: RCW 74.15.020. 01-02-031, § 388-151-230, filed 12/22/00, effective 1/22/01. Statutory Authority: Chapter 74.15 RCW. 93-02-020 (Order 3493), § 388-151-230, filed 12/30/92, effective 1/30/93.]

OTS-2706.1

AMENDATORY SECTION(Amending WSR 06-15-075, filed 7/13/06, effective 7/13/06)

WAC 170-295-3060   Who can provide consent for me to give medication to the children in my care?   (1) Parents must give written consent before you give any child any medication. The parent's written consent must include:

     (a) Child's first and last name;

     (b) Name of medication;

     (c) Reason for giving medication;

     (d) Amount of medication to give;

     (e) How to give the medication (route);

     (f) How often to give the medication;

     (g) Start and stop dates;

     (h) Expected side effects; and

     (i) How to store the medication consistent with directions on the medication label.

     (2) The parent consent form is good for the number of days stated on the medication bottle for prescriptions. You may not give medication past the days prescribed on the medication bottle even if there is medication left.

     (3) You may give the following medications with written parent consent if the medication bottle label tells you how much medication to give based on the child's age and weight:

     (a) Antihistamines;

     (b) Nonaspirin fever reducers/pain relievers;

     (c) Nonnarcotic cough suppressants;

     (d) Decongestants;

     (e) Ointments or lotions intended to reduce or stop itching or dry skin;

     (f) Diaper ointments and nontalc powders, intended only for use in the diaper area; ((and))

     (g) Sun screen for children over six months of age; and

     (h) Hand sanitizers for children over twelve months of age.

     (4) All other over the counter medications must have written directions from a health care provider with prescriptive authority before giving the medication.

     (5) You may not mix medications in formula or food unless you have written directions to do so from a health care provider with prescriptive authority.

     (6) You may not give the medication differently than the age and weight appropriate directions or the prescription directions on the medication label unless you have written directions from a health care provider with prescriptive authority before you give the medication.

     (7) If the medication label does not give the dosage directions for the child's age or weight, you must have written instructions from a health care provider with prescriptive authority in addition to the parent consent prior to giving the medication.

     (8) You must have written consent from a health care provider with prescriptive authority prior to providing:

     (a) Vitamins;

     (b) Herbal supplements; and

     (c) Fluoride.

[06-15-075, recodified as § 170-295-3060, filed 7/13/06, effective 7/13/06. Statutory Authority: Chapters 74.12 and 74.15 RCW. 03-14-110, § 388-295-3060, filed 6/30/03, effective 8/1/03.]

OTS-2707.1

AMENDATORY SECTION(Amending WSR 06-15-075, filed 7/13/06, effective 7/13/06)

WAC 170-296-0870   How do I manage medications for children?   You must meet specific requirements for managing prescription and nonprescription medication for children under your care. Only you or another, primary staff person may perform the functions described in this section.

     (1) You must have written approval of the child's parent or legal guardian to give the child any medication. This approval must not exceed thirty days.

     (2) You must:

     (a) Keep a written record of all medications you give a child;

     (b) Return any unused medication to the parent or legal guardian of the child;

     (c) Give certain classifications of nonprescription medications, only with the dose and directions on the manufacturer's label for the age or weight of the child needing the medication. These nonprescribed medications include but are not limited to:

     (i) Nonaspirin, fever reducers or pain relievers;

     (ii) Nonnarcotic cough suppressants;

     (iii) Decongestants;

     (iv) Anti-itching ointments or lotions intended specifically to relieve itching;

     (v) Diaper ointments and talc free powders intended specifically for use in the diaper area of children; ((and))

     (vi) Sun screen; and

     (vii) Hand sanitizers for children over twelve months of age.

     (3) You must not administer any nonprescribed medication for the purpose of sedating a child;

     (4) You must not administer any prescribed medication in an amount or frequency other than that prescribed by a physician, psychiatrist or dentist;

     (5) You must not give one child's medications to another child; and

     (6) You must not use any prescribed medication to control a child's behavior unless a physician prescribes the medication for management of the child's behavior.

[06-15-075, recodified as § 170-296-0870, filed 7/13/06, effective 7/13/06. Statutory Authority: RCW 74.08.090, 74.15.030, chapters 74.12 and 74.15 RCW. 04-18-082, § 388-296-0870, filed 8/31/04, effective 10/1/04.]

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