Current through September 9, 2024
(a)
Water
supply. A water supply of sanitary quality shall be provided for each
youth camp in ample quantity to meet all requirements of the maximum number of
persons using such a camp at any time. Whenever water is obtained from other
than an approved public water supply, it shall be of safe, sanitary quality
approved by the state department of health. Any well shall conform with the
requirements of sections
19-13-B51a to
19-13-B51
l, inclusive. Such water supply shall be easily obtainable
from its source or from a distributing system within a distance of not more
than three hundred feet of any camping spot within such tract. In cases where
it can be shown that the approved water supply is not adequate to satisfy all
demands of the camp, chlorinated lake water may be used for toilets and showers
but shall not be supplied to the kitchen or to any sinks.
(b)
Drinking facilities.
Drinking fountains shall be sanitary as prescribed in section
19-13-B35
and no common drinking utensils shall be provided or used.
(c)
Toilet facilities. Chemical
toilets, fly tight privy pits or water flushed toilets shall be provided and
shall be maintained in a clean and sanitary condition. Separate toilets for men
and women shall be provided. In a residential camp at least one toilet seat for
each fifteen persons or fraction thereof shall be provided. At least one toilet
seat for each twenty persons or fraction thereof shall be provided in each day
camp. Urinals may be substituted for not more than one-half of the total
requirement for male campers. No unit site within a camp shall be at a greater
distance than three hundred feet from the toilets. The location of all toilets
shall be plainly indicated by signs. Privies shall be located at least two
hundred feet from a kitchen or food service area.
(d)
Disposal of sewage and
refuse. The method of final sewage or refuse disposal utilized in
connection with the operation of a camp shall be such as to create no nuisance
and shall conform with the requirements of sections 19-13-B20a to 19-13-B20r,
inclusive, and plans for such disposal shall be approved by the state
department of health.
(e)
Plumbing. The plumbing facilities within each camp shall conform
with requirements of section
19-13-B45.
(f)
Washing facilities. Adequate
hand washing facilities shall be provided with at least one facility for each
twenty persons or fraction thereof. Wash basins and water shall be readily
accessible to the toilet rooms. In a residential camp at least one shower house
shall be provided with one shower head for each twenty persons or fraction
thereof.
(g)
Control of
refuse litter. Supervision and equipment sufficient to prevent littering
of the grounds with rubbish, garbage or other refuse shall be provided and
maintained. Fly tight depositories for such material shall be provided and
conspicuously located. Each unit site within a camp shall be within a distance
of not over two hundred feet of such depository. Such depositories shall not be
permitted to become foul smelling or unsightly or a breeding place for
flies.
(h)
Facilities for
dispensing foods or beverages. Facilities for dispensing foods or
beverages shall meet the requirements of section
19-13-B42.
Day camps shall collect and store potentially hazardous food in appropriate
refrigeration facilities.
(i)
Public swimming pools and public swimming areas. Public swimming
pools and public swimming areas, when provided, shall comply with the
provisions of sections
19-13-B33b and
19a-36-B61 of the Regulations of Connecticut State Agencies.
(j)
Health care. A physician
shall be on call and responsible for all health care including first aid.
Annually the physician shall sign and date standing orders to be carried out in
his absence by the camp nurse or by a person over age twenty-one having
American Red Cross Standard First Aid and Personal Safety Training
certification, or the equivalent. Physicians and nurses employed in camps shall
hold current Connecticut licenses and registrations. Additional aides under age
twenty-one may be employed if they possess American Red Cross Standard First
Aid and Personal Safety Training certification or its equivalent but shall not
be in charge of health care. All camp health care personnel shall present
current proficiency certification in cardiopulmonary resuscitation as evidenced
by examination by the American Red Cross or American Heart Association. For
residential camps having two hundred fifty or more campers or staff in
residence a registered nurse shall be required to be in charge of first aid and
emergency medical care activities. First aid equipment and supplies shall be
specified by the camp physician in his standing orders. Only nonprescription
drugs shall be available in stock containers in camps. Prescription drugs shall
be available only on individual prescription unless locked and in the sole
custody of a physician. Proof of use records as required under section 19-461
of the general statutes shall be kept by the physician.
(k)
Communicable disease control
requirements. Communicable disease control shall meet the requirements
of sections 19-13-A2 to 19-13-A24, inclusive.
(l)
Records. Records of both
staff and campers shall be kept on file at camp and shall include the personal
data concerning each member of the staff and camper kept in any reasonable form
the camp director may choose, including therein the name, age and address of
the individual, the name, address and telephone number including the business
telephone number of the parent, guardian, or in the case of an adult next of
kin, who shall be notified in an emergency, the date of first attendance at
camp and the date of leaving camp permanently in the case of residence camps,
or the last date of attendance at camp in the case of day camps, and a physical
examination or health status certification by a physician, an advanced practice
registered nurse or registered nurse licensed pursuant to chapter 378 or a
physician assistant licensed pursuant to chapter 370 dated within thirty-six
months prior to the date of arrival at camp. A physical examination, including
a complete immunization history, that is required for school purposes may also
be used to satisfy this requirement provided it is dated within thirty-six
months prior to the date the camper arrives at camp. The physical examination
requirement may be waived where such procedure is contrary to the religious
beliefs of the camper. A statement requesting such exemption shall be submitted
annually and shall be kept on file at the camp. This statement shall be signed
by a parent or guardian, shall include affirmation of church membership by an
appropriate church authority, and shall grant permission to camp authorities to
authorize physical examination or other appropriate measures when medical
emergencies occur. The parent or guardian shall certify that he/she accepts
complete responsibility for the health of the camper and that to the best of
his/her knowledge the camper is in good health. All staff and campers shall be
adequately immunized as specified in Sections
10-204a-1
-4 of the Regulations of Connecticut State agencies against diphtheria,
tetanus, pertussis, polio, measles, rubella, and any other diseases specified
in Section
10-204a.
The physical examination or health status certification shall include a
complete immunization history. Where the individual because of medical or
religious reasons does not have such immunizations these reasons shall be so
specified in writing in accordance with Section
10-204a(a)
of the General Statutes.
(m)
Emergency medical care.
(1) For
resident camps there shall be on file a memorandum of understanding between the
camp director and the nearest hospital with regard to arrangements for
emergency medical care.
(2) There
shall be on file a memorandum of understanding with the on-call or resident
physician concerning the provision of medical care for emergencies and of
routine care to be carried out at camp, including standing orders for the
nurse, if there is one, and instructions for the director of first aid in lieu
of a resident physician or nurse, for both day and residential camps.
(3) There shall be a telephone
line available to the first aid area for the use of the first aid staff, with
posting of the telephone numbers of the camp physician, camp director, camp
nurse, nearest hospital, local director of health in whose jurisdiction the
camp falls, local fire department in whose jurisdiction the camp falls, local
police department in whose jurisdiction the camp falls, the poison control
center, the nearest state police barracks which is the source of snake
anti-venom or other emergency assistance, and of ambulance services.
(4) An abstract record of all cases treated
at camp shall be kept in a bound volume noting the date, the condition, the
disposal and the persons responsible for the care. At least once a week these
cases shall be reviewed by the camp physician who shall sign and date the bound
volume indicating his review of cases.
(5) There shall be available a defined area
where ill or injured individuals may rest and receive care until they are
either removed to their homes or recovered. This area shall be adequate to
provide for the temporary isolation of any suspected communicable diseases and
shall have its own toilet facilities not used for other purposes within the
camp.
(n)
Qualifications of management and staff.
(1) No person shall establish, conduct or
maintain a youth camp without adequate and competent staff.
(2) The camp director shall be over the age
of twenty-one and of good character, shall not have been convicted of any
offense involving moral turpitude, shall be certified as mentally competent by
a physician, shall not use improperly any narcotic or controlled drug, and
shall uphold and maintain the standards required under the Youth Camping Act.
Except for those persons who have already served at least one summer as a camp
director, a camp director shall have had at least sixteen weeks administrative
or supervisory experience, in an organized camp or in lieu thereof equivalent
training or experience in camping satisfactory to the commissioner.
(3)
(a) The
director of each individual waterfront or swimming area, including areas
devoted to the practice of aquatics, shall be over age twenty and shall possess
an American Red Cross Lifeguard Training current rating or its
equivalent.
(b) The director of each
small craft waterfront area shall possess current certification in American Red
Cross Lifeguard Training or its equivalent and current certification in the
small craft safety program of the American Red Cross or its equivalent for the
type of small craft used in the camp. Each such director shall comply with the
provisions of the Connecticut boating safety laws and laws relating to scuba
diving.
(4) the director
of the Rifle Range shall be at least twenty-one years of age and shall possess
a current National Rifle Association Instructor's card or equivalent.
(5) The director of the archery
range shall be over age eighteen and possess evidence satisfactory to the State
Department of Public Health of appropriate training and experience in archery.
(6) The director of horseback
riding activities shall be over age eighteen and possess evidence satisfactory
to the State Department of Public Health of appropriate training and
experience.
(7) The camp director
provided he meets the requirement Section 1, subsection (n) (5) and (n) (6) may
serve as director of archery or horseback riding activities in addition to his
duties as camp director. Counselors shall be over age sixteen. Counselors in
training shall be over age fourteen.
(8) In resident camps the ratio of staff,
exclusive of cooks, clerical and maintenance personnel, to campers shall be at
least one person over age sixteen to six campers under age eight and to eight
campers eight years and older. In day camps the ratio shall be at least one
person age sixteen or older to each nine children under age six, and to each
twelve children over six years.
(o)
Safety of grounds and program
practices.
(1) Fields intended for
athletic activities or use shall be maintained free of hazards.
(2) The waterfront and aquatic activities
shall be laid out and conducted in accordance with the American Red Cross Water
Safety Aquatics and Small Craft Activities Standards or equivalent.
(3) The rifle range shall be laid out and
operated in accordance with standards of the National Rifle Association or its
equivalent.
(4) Vehicles used for
the transport of campers both on and off the camping premises shall have a
motor vehicles safety sticker for the current year and shall be licensed
including, if necessary, licensure for their specific use.
(5) Boats and small crafts shall be licensed
or registered under the boating laws, if so required, and this information
shall be available upon request to agents of the state department of health.
Water safety equipment shall meet United States Coast Guard standards where
applicable.
(6) When any out of
camp outings or trips are planned, advance information shall be kept on file
which will include permission of the campers to participate, signed by the
parent or guardian, the purpose of the trip and the itinerary, the names of the
campers, trip director and staff. The trip director shall be an adult who shall
have had experience or hold certification in the activity in which the trip is
being conducted, if this is applicable, e.g. Maine Guide's license, Red Cross
Water Safety Instructor, etc.
(p)
Arrangements for camp
inspection. The camp director shall make arrangements either personally
or through one of the members of the senior camp staff to conduct the state
inspector around the camp premises and to supply him with any information,
documents or materials necessary in order to comply with the inspection
process.
(q)
General
sanitation requirements. The camp site shall be owned by the operator or
the operator shall have a written lease giving permission to use the site for a
youth camp. The location of the camp shall be such as to provide for adequate
drainage of all areas occupied by campers, the food preparation and service
area and other activity areas. Buildings shall be maintained in a safe and
sanitary condition. When the state department of health or the local director
of health so directs, a certificate of approval shall be obtained from the
local or state fire marshal. All hot water and space heaters shall be properly
located and vented.
(r)
Trailer coaches. In every camp where space for trailer coaches is
rented or offered for rent or on which free occupancy or camping of trailers is
permitted to trailer owners or users, sanitary facilities shall be provided for
the disposal of wastes from trailer sinks and toilets. Trailer facilities and
parking shall comply with the provisions of section 19-14-B44.
(s)
Responsibility of
management. The camp director shall be responsible at all times for the
health, comfort and safety of campers and staff and shall have responsibility
for maintaining in good repair all sanitary appliances on the camp ground. He
shall promptly prosecute or cause to be ejected from such ground any person who
willfully or maliciously damages such appliances.
(t)
Exceptions. Exceptions to
the requirements of subsection (a), (c) and (f) may be made by the commissioner
of health at his discretion in the case of primitive or pioneer camps.
Exceptions to the requirements of subsection (l) may be made
by the commissioner of health at his discretion in the case of day camps where
the requirements of a physical examination or health memorandum for campers
would impose a hardship on the administration of such a camp. Application for
such exemptions shall be made in writing by the camp director thirty days
before the opening of camp.
(u)
Accident or illness. Any fatality which occurs at camp or which
results from camping activities or any injury or illness which occurs at camp
or which results from camping activities and which is attended by a physician,
nurse, or person in charge of health care at the camp, and as a result of which
the person (1) is sent home, or (2) is admitted to a hospital, or (3) has a
clinical report, laboratory analysis, or x-rays performed which result in a
positive diagnosis, shall be reported to the state department of health
services within twenty-four hours by telephone by the camp director. This
verbal report shall be confirmed in writing within seventy-two hours of the
verbal report on a form provided by the state department of health services.
The original report form shall be maintained at the camp or sponsoring
organization for a minimum of two years. A copy shall be forwarded to the state
department of health services upon completion of the form. For day camps, such
reports are not required for any injury or illness where the individual as a
result of such injury or illness is sent home and for which there is no
hospital admission or positive diagnosis by clinical report, laboratory
analysis, or x-ray.
(v)
Administration of Medications and the Monitoring of Diabetes in Youth
Camps
(1) Definitions as used in this
subsection:
(A) "Administration of medication"
means the direct application of a medication by inhalation, ingestion or any
other means to the body of a person;
(B) "Advanced practice registered nurse"
means an individual licensed pursuant to section
20-94a
of the Connecticut General Statutes;
(C) "Authorized prescriber" means a
physician, dentist, advanced practice registered nurse, physician assistant,
optometrist, or podiatrist;
(D)
"Commissioner" means the Commissioner of Public Health or the commissioner's
designated representative;
(E)
"Department" means the Connecticut Department of Public Health or any duly
authorized representative thereof;
(F) "Medication" means any medicinal
preparation including controlled substances, as defined in section
21a-240
of the Connecticut General Statutes;
(G) "Medication error" means failure to
administer medication to a child, or failure to administer medication within
one (1) hour of the time designated by the authorized prescriber, or failure to
administer the specific medication prescribed for a child, or failure to
administer the medication by the correct route, or failure to administer the
medication according to generally accepted standards of practice, or failure to
administer the correct dosage of medication;
(H) "Optometrist" means an individual
licensed pursuant to section
20-127
of the Connecticut General Statutes;
(I) "Parent(s)" means the person(s)
responsible for the child and may include the legally designated guardian(s) of
such child;
(J) "Pharmacist" means
a person with a license to practice as a pharmacist in Connecticut in
accordance with section
20-590
of the Connecticut General Statutes;
(K) "Physician" means a doctor of medicine or
osteopathy licensed to practice medicine in this or another state;
(L) "Physician assistant" means an individual
who has two (2) years of pediatric experience and functions under the direction
of the consulting physician for the youth camp and meets the requirements of
sections
20-12b
of the Connecticut General Statutes;
(M) "Podiatrist" means an individual licensed
pursuant to chapter 375 of the Connecticut General Statutes;
(N) "Program staff" means those persons
responsible for the direct care of children;
(O) "Registered nurse" means a person with a
license to practice as a registered nurse in Connecticut in accordance with
chapter 378 of the Connecticut General Statutes;
(P) "Self administration of medication" means
that the child is able to identify and select the appropriate medication by
size, color, amount, or other label identification; knows the frequency and
time of day for which the medication is ordered; and consumes the medication
appropriately;
(Q) "Significant
medication error" means a medication error, which is potentially serious or has
serious consequences for a child, such as, but not limited to, the
administration of medication by the wrong route; for which the resident has a
known allergy; which was given in a lethal or toxic dosage; or which causes
serious medical problems resulting from the error. Refusal of a medication is
not considered a significant medication error if appropriate follow up action
is taken; and
(R) "Staff" means
personnel, including volunteers, who provide a service to a youth
camp.
(2) Administration
of Medications
Youth camps are not required by this subsection to
administer medications to children. If a youth camp permits the administration
of medications of any kind by unlicensed program staff, the youth camp shall
comply with all requirements of this subsection and shall have a written policy
and procedures at the youth camp governing the administration of medications
which shall include, but not be limited to, the types of medication that will
be administered, parental responsibilities, staff responsibilities, proper
storage of medication and record keeping. Said policies and procedures shall be
available for review by the department during inspections or upon demand and
shall reflect current best practice. No program staff member under eighteen
(18) years of age shall administer any medication at a youth camp.
Children enrolled at youth camps may self administer
medications with documented parental and authorized prescriber's permission.
Children may request and receive assistance from staff in opening containers or
packages or replacing lids.
(A)
Administration of Nonprescription Topical Medications Only
(i) Description
For the purposes of this subparagraph, nonprescription
topical medications shall include:
(I)
diaper changing or other ointments free of antibiotic, antifungal, or steroidal
components;
(II) medicated powders;
and
(III) gum or lip medications
available without a prescription;
(ii) Nonprescription Topical Medications
Administration/Parent Permission Records
The written permission of the parent shall be required
prior to the administration of the nonprescription topical medication and a
medication administration record shall be written in ink and kept on file at
the youth camp for each child administered a nonprescription topical
medication. The medication administration record and parent permission shall
become part of the child's health record when the course of medication has
ended. Any medication error shall be documented in the record. This information
shall include:
(I) the name, address,
and date of birth of the child;
(II) the name of the medication;
(III) the schedule and site of administration
of the medication, as applicable, according to the manufacturer's
directions;
(IV) the name, address,
telephone number, signature and relationship to the child of the parent(s)
authorizing the administration of the medication;
(V) the date and time the medication is
started and ended;
(VI) the name of
the person who administered the nonprescription topical medication;
and
(VII) the signature of the camp
director or the camp director's designee receiving the parent permission
form.
(iii)
Nonprescription Topical Medications, Labeling and Storage
(I) The medication shall be stored in the
original container and shall contain the following information on the container
or packaging indicating:
(a) the individual
child's name;
(b) the name of the
medication; and
(c) directions for
the medication's administration.
(II) The medication shall be stored away from
food and inaccessible to children and unauthorized persons. External and
internal medications shall be stored separately from each other.
(III) Any unused portion of the medication
shall be returned to the parent. Any expired medication shall be destroyed by
the program staff member in a safe manner or returned to the parent.
(B) Administration of
Medications Other Than Nonprescription Topical Medications
(i) Training Requirements
(I) Prior to the administration of any
medication by program staff members, the program staff members who are
responsible for administering the medications shall first be trained by a
pharmacist, physician, physician assistant, advanced practice registered nurse
or registered nurse in the methods of administration of medications and shall
receive written approval from the trainer indicating that the trainee has
successfully completed a training program as required herein. A program staff
member trained and approved to administer medication shall be present whenever
a child who has orders to receive medication is enrolled and present at the
youth camp, and the youth camp permits the administration of medication by
unlicensed program staff.
(II) The
training in the administration of medications shall be documented and shall
include, but not be limited to, the following:
(a) statement of objectives;
(b) a description of methods of
administration including principles and techniques, application and
installation of oral, topical, and inhalant medication, including the use of
nebulization machines, with respect to specific age groups;
(c) techniques to encourage children who are
reluctant or noncompliant to take their medication and the importance of
communicating the noncompliance to the child's parent and to the authorized
prescriber;
(d) demonstration of
techniques by the trainer and return demonstration by participants, assuring
that the trainee can accurately understand and interpret orders and carry them
out correctly;
(e) recognition of
side effects and appropriate follow up action;
(f) avoidance of medication errors and the
action to take if a medication error or a significant medication error occurs,
or if a dosage is missed or refused;
(g) abbreviations commonly used;
(h) required documentation including parent
permission, written orders from the authorized prescriber, and the record of
administration;
(i) safe handling,
including receiving medication from a parent, safe disposal, and universal
precautions; and
(j) proper storage
including controlled substances, in accordance with Section
21a-262-10
of the Regulations of Connecticut State Agencies.
(III) Injectable Medications
In addition to the above training, before program staff
members may administer injectable medications, they shall have successfully
completed a training program on the administration of injectable medications by
a premeasured, commercially prepared syringe. The certifying trainer who shall
be a pharmacist, physician, physician assistant, advanced practice registered
nurse or registered nurse, shall assure that the program staff member
understands the indications, side effects, handling and methods of
administration for injectable medication. Thereafter, on a yearly basis, the
program staff members shall have their skills and competency in the
administration of injectable medication validated by a pharmacist, physician,
physician assistant, advanced practice registered nurse or registered nurse.
Injectable medications shall only be given in emergency situations, by a
premeasured commercially prepared syringe, unless a petition for special
medication authorization is granted by the department as specified in section
19-13-B27a(v)(2)(B)(vi).
(IV) A program staff member
currently certified by the State of Connecticut Department of Mental
Retardation to administer medications shall be considered qualified to
administer medications at youth camps.
(ii) Training Approval Documents and Training
Outline
(I) Upon completion of the required
training program, the pharmacist, physician, physician assistant, advanced
practice registered nurse or registered nurse who conducted the training shall
issue a written approval to each program staff member who has demonstrated
successful completion of the required training. Approval for the administration
of oral, topical, inhalant medications shall remain valid for three (3) years.
Approval for the administration of injectable medications
shall be valid for one (1) year. A copy of the approval shall be on file at the
youth camp where the program staff member is employed and shall be available to
the department upon request.
(II) The written approval shall include:
(a) the full name, signature, title, license
number, address and telephone number of the pharmacist, physician, physician
assistant, advanced practice registered nurse or registered nurse who gave the
training;
(b) the location and
date(s) the training was given;
(c)
a statement that the required curriculum areas listed in Sec.19-13-B27a(v)(2)
(B)(i)(II) and Sec.
19-13-B27a(v)(2)(B)(i)
(III) when applicable were successfully mastered, and indicating the route(s)
of administration the trainee has been approved to administer;
(d) the name, date of birth, address and
telephone number of the program staff member who completed the training
successfully; and
(e) the
expiration date of the approval.
(III) The trainer shall provide the trainee
with an outline of the curriculum content which verifies that all mandated
requirements have been included in the training program. A copy of said outline
shall be on file at the youth camp where the trainee is employed for department
review. The department may require at any time that the youth camp licensee
obtain the full curriculum from the trainer for review by the
department.
(iii) Order
From An Authorized Prescriber and Parent's Permission
(I) Except for nonprescription topical
medications described in Section
19-13-B27a(v)(2)(A)(i),
no medication, prescription or nonprescription, shall be administered to a
child without the written order of an authorized prescriber and the written
permission of the child's parent which shall be on file at the youth camp. Such
medications may include:
(a) oral
medications;
(b) topical
medications, including eye and ear preparations;
(c) inhalant medications; and
(d) injectable medications, by a premeasured,
commercially prepared syringe, to a child with a medically diagnosed condition
who may require emergency treatment.
(II) The written order from an authorized
prescriber shall contain the following information which may be on the
prescription label or on supplemental information provided by the authorized
prescriber or pharmacist;
(a) the name,
address and date of birth of the child;
(b) the date the medication order was
written;
(c) the medication or drug
name, dose and method of administration;
(d) the time of the day the medication is to
be administered;
(e) the date(s)
the medication is to be started and ended as applicable;
(f) relevant side effects and the authorized
prescriber's plan for management should they occur;
(g) notation if the medication is a
controlled drug;
(h) a listing of
any allergies, reactions to, or negative interactions with foods or
drugs;
(i) specific instructions
from the authorized prescriber who orders the medication regarding how the
medication is to be given;
(j) the
name, address and telephone number of the parent;
(k) the name, address and telephone number of
the authorized prescriber ordering the drug; and
(l) the authorized prescriber's
signature.
(III) If the
authorized prescriber determines that the training of the program staff member
is inadequate to safely administer medication to a particular child, or that
the means of administration of medication is not permitted under this
subsection, that authorized prescriber may order that such administration be
performed by licensed medical staff with the statutory authority to administer
medications.
(IV) The program staff
member shall administer medication only in accordance with the written order of
the authorized prescriber. The parent shall be notified of any medication
errors immediately by telephone and in writing within seventy-two (72) hours,
and the error shall be documented in the medication administration
record.
(iv) Required
Records
(I) Except for nonprescription topical
medications described in Section
19-13-B27a(v)(2)(A)(i),
individual written medication administration records for each child shall be
written in ink, reviewed prior to administering each dose of medication and
kept on file at the youth camp. The medication administration record shall
become part of the child's health record when the course of medication has
ended.
(II) The individual written
medication administration record for each child shall include:
(a) the name, address, and date of birth of
the child;
(b) the name, address,
telephone number, signature and relationship to the child of the parent(s)
giving permission for the administration of the drug by the program staff
member;
(c) the name of the
medication or drug;
(d) the dosage
ordered and method of administration;
(e) the date, time, and dosage at each
administration;
(f) the signature
in ink of the program staff member giving the medication at the time of each
administration; and
(g) any refusal
by the child in accepting the medication, and any follow-up action taken as a
result of the refusal.
(III) Medication errors shall be logged and
recorded in the individual written medication administration record of the
child. Significant medication errors, identified by the camp director or the
camp director's designee, shall be reported in writing within seventy-two hours
to the department, by the camp director or the camp director's designee. The
camp physician shall review all logs of medication errors on a weekly basis,
and a record of the review shall be kept on file at the youth camp.
(v) Storage and Labeling
(I) Medication shall be stored in the
original child-resistant safety container. The container or packaging shall
have a label which includes the following information:
(a) the child's name;
(b) the name of the medication;
(c) directions for the medication's
administration; and
(d) the date of
the prescription.
(II)
Except for nonprescription topical medications described in Section
19-13-B27a(v)(2)(A)(i),
medication shall be stored in a locked area or a locked container, in a
refrigerator in keeping with the label or manufacturer's directions, away from
food and inaccessible to children and unauthorized personnel. External and
internal medications shall be stored separately from each other. Keys to the
locked area or container shall be accessible only to personnel authorized to
administer medication. Controlled drugs shall be stored in accordance with
Section
21a-262-10
of the Regulations of Connecticut State Agencies.
(III) All unused or expired medication,
except for controlled drugs, shall be returned to the parent or destroyed by
the camp director or the camp director's designee if it is not picked up within
one (1) week following the camper's departure at the end of camp. Medications
that need to be destroyed shall be flushed into sewerage or a septic system in
the presence of at least one witness. The youth camp shall contact the CT
Department of Consumer Protection for direction on the proper method of
disposing of a controlled drug, and shall carry out the direction as required.
The youth camp shall keep a written record of the medications destroyed which
shall be signed by the person destroying the medication and the witness to the
destruction.
(vi)
Petition For Special Medication Authorization
(I) The youth camp licensee may petition the
department to administer medications to a child cared for at the youth camp by
a modality that is not specifically permitted under this subsection by
submitting a written application to the department including the following
information:
(a) a written order from an
authorized prescriber containing the information for the specific child set
forth in Section
19-13-B27a(v)(2)(B)
(iii) and a statement that the administration by the requested modality is the
only reasonable means of providing medication and that the administration must
occur during hours of the child's attendance at the youth camp;
(b) a written training plan including the
full name, signature, title, license number, address and telephone number of
the physician, advanced practice registered nurse, physician assistant,
registered nurse, or pharmacist who will provide the training, a detailed
outline of the curriculum areas to be covered in training, and a written
statement by the authorized prescriber that the proposed training is adequate
to assure that the medication will be administered safely and appropriately to
the particular child;
(c) the name,
date of birth, address and telephone number of the person(s) who shall
participate in the training;
(d)
written permission from the child's parent; and
(e) such other information that the
department deems necessary to evaluate the petition request.
(II) After reviewing the submitted
information, if the department determines that the proposed administration of
medication for the particular child can be provided in a manner to assure the
health, welfare and safety of the child, it may grant the petition. The
department may grant the petition with any conditions or corrective measures
the department deems necessary to assure the health, safety and welfare of the
child. The department will specify the curriculum that the training program
shall cover and the expiration date of the authorization provided in granting
the petition. If the department grants the petition, no medication may be
administered until after the proposed training program has been successfully
completed and a written approval from the physician, advanced practice
registered nurse, physician assistant, registered nurse or pharmacist who
provided the training is submitted to the department. The approval shall
include:
(a) the full name, signature, title,
license number, address and telephone number of the physician, advanced
practice registered nurse, physician assistant, registered nurse or pharmacist
who provided the training;
(b) the
location and date(s) the training was given;
(c) a statement that the curriculum approved
by the department was successfully mastered by the participant. The statement
shall also include the modality of administration of medication that the
participant has been approved to administer; and
(d) the name, date of birth, address and
telephone number of the person(s) who successfully completed the
training.
(III) Copies
of all documentation required under this subsection shall be maintained at the
facility. The requirements of Sections
19-13-B27a(v)(2)(B)(iv)
and
19-13-B27a(v)(2)(B)(v)
shall apply to the administration of medication authorized by
petition.
(3) The Monitoring of Diabetes in Youth
Camps.
(A) Policy and Procedures
(i) All youth camps at which designated
program staff members will be administering finger stick blood glucose tests
shall have written policies and procedures governing the administration of
finger stick blood glucose tests to children diagnosed with diabetes mellitus.
The policies and procedures shall address at least the following areas:
(I) parental responsibilities;
(II) staff training and
responsibilities;
(III) proper
storage, maintenance, and disposal of test materials and supplies;
(IV) record keeping;
(V) reporting test results, incidents, and
emergencies to the child's parent and the child's physician, physician
assistant, or advanced practice registered nurse; and
(VI) a location where the tests occur that is
respectful of the child's privacy and safety needs.
(ii) Said policies and procedures shall be
available for review by the department during inspections or upon
demand.
(B) Training
(i) Prior to the administration of finger
stick blood glucose tests, the program staff member(s) shall have completed the
following training requirements:
(I) a course
approved by the department in first aid, as verified by a valid first aid
certificate on file at the youth camp; and
(II) additional training given by a
physician, physician assistant, advanced practice registered nurse, registered
nurse, certified emergency medical technician, or the child's parent according
to written guidelines provided by the child's physician, physician assistant,
or advanced practice registered nurse. The additional training shall include,
but not be limited to:
(a) the proper use,
storage and maintenance of the child's individual monitoring
equipment;
(b) reading and
correctly interpreting test results; and
(c) appropriate actions to take when test
results fail to fall within specified ranges indicated in the written order
from the child's physician, physician assistant, or advanced practice
registered nurse.
(ii) The training shall be updated at least
every three years when a child with diabetes mellitus who requires finger stick
blood glucose testing is present at the youth camp.
(iii) Documentation that program staff
member(s) have been trained to administer finger stick blood glucose tests
shall be in writing and kept at the facility for review by the department. Such
documentation shall indicate:
(I) the subjects
covered in training;
(II) the
signature and title of the instructor;
(III) the signature and title of the trainee;
and
(IV) the date the training was
given.
(C)
Administration of Finger Stick Blood Glucose Test
(i) Except as provided in subclause (iii) of
this subparagraph, only program staff members trained in accordance with
subparagraph (B) of this subdivision may administer the finger stick blood
glucose test in youth camps. No program staff member under eighteen (18) years
of age shall administer finger stick blood glucose tests to another person at a
youth camp.
(ii) Whenever a child
diagnosed with diabetes mellitus who has orders to receive finger stick blood
glucose monitoring is enrolled and present at the facility, a program staff
member designated and trained to administer finger stick blood glucose tests
shall be present at the youth camp.
(iii) Upon the written authorization of the
child's physician, physician assistant or advanced practice registered nurse,
and the child's parent, a child may self administer the finger stick blood
glucose test under the direct supervision of the designated staff member who
has met the training requirements in subparagraph (B) of this
subdivision.
(iv) Only those staff
trained to administer injectable medications as described in section
19-13-B27a(v)(2)(B)(i)
(III) of the Regulations of Connecticut State Agencies and authorized to do so
in writing by the child's parent and physician, physician assistant, or
advanced practice registered nurse may administer glucagon in a pre-filled
syringe in emergency situations only.
(D) Equipment
(i) The child's parent shall supply the youth
camp licensee with the necessary equipment and supplies to meet the child's
individual needs. Such equipment and supplies shall include at least the
following items:
(I) the child's blood glucose
meter and strips;
(II) an
appropriate retracting lancing device used in accordance with infection control
procedures;
(III) tissues or cotton
balls; and
(IV) fast acting
carbohydrates to be given to the child as indicated in the written order from
the child's physician, physician assistant, or advanced practice registered
nurse for hypoglycemia.
(ii) Such equipment and supplies shall be
labeled with the child's name and shall remain in a locked storage area when
not in use.
(iii) The youth camp
licensee shall obtain a signed agreement from the child's parent that the
parent agrees to check and maintain the child's equipment in accordance with
manufacturer's instructions, restock supplies, and remove material to be
discarded from the facility. All materials to be discarded shall be kept locked
until it is given to the child's parent for disposal. The youth camp may
dispose of medical waste if it has a contract with a medical waste disposal
contractor, in accordance with local, state, and federal laws.
(E) Record Keeping
The youth camp licensee shall keep the following records at
the facility as part of the child's medical record, and shall update them
annually or when there is any change in the information:
(i) A current, written order signed and dated
by the child's physician, physician assistant, or advanced practice registered
nurse indicating:
(I) the child's
name;
(II) the diagnosis of
diabetes mellitus;
(III) the type
of blood glucose monitoring test required;
(IV) the test schedule;
(V) the target ranges for test
results;
(VI) specific actions to
be taken and carbohydrates to be given when test results fall outside specified
ranges;
(VII) diet requirements and
restrictions;
(VIII) any
requirements for monitoring the child's recreational activities; and
(IX) conditions requiring immediate
notification of the child's parent, emergency contact, the child's physician,
physician assistant, or advanced practice registered nurse.
(ii) An authorization form signed
by the child's parent which includes the following information:
(I) the child's name;
(II) the parent's name;
(III) the parent's address;
(IV) the parent's telephone numbers at home
and at work;
(V) two adult,
emergency contact people including names, addresses and telephone
numbers;
(VI) the names of the
program staff member(s) designated to administer finger stick blood glucose
tests and provide care to the child during testing;
(VII) additional comments relative to the
care of the child, as needed;
(VIII) the signature of the parent;
(IX) the date the authorization is signed;
and
(X) the name, address and
telephone number of the child's physician, physician assistant or advanced
practice registered nurse.
(iii) The youth camp director or the youth
camp director's designee shall notify the child's parent in writing of the
results of all blood glucose tests and any action taken based on the test
results, and shall document the test results and any action taken in the
child's medical record.
(w)
Emergency Distribution of Potassium
Iodide. Notwithstanding any other provisions of the Regulations of
Connecticut State Agencies, during a public health emergency declared by the
Governor pursuant to section 2 of public act 03-236 and if authorized by the
Commissioner of Public Health via the emergency alert system or other
communication system, a youth camp licensed in accordance with section
19a-421
of the Connecticut General Statutes and located within a 10-mile radius of the
Millstone Power Station in Waterford, Connecticut shall permit designated staff
members to distribute and administer potassium iodide tablets to adults present
or to a child in attendance at the youth camp during such emergency, provided
that:
(1) Prior written consent has been
obtained by the youth camp for such provision. Written consent forms shall be
provided by the youth camp to the parent(s) or guardian(s) of each child
currently enrolled or employees currently employed at the youth camp promptly
upon the effective date of this subdivision. Thereafter, written consent forms
shall be provided by the youth camp to the parent(s) or guardian(s) of each
minor child upon enrollment and to each new employee upon hire. Such
documentation shall be kept at the facility;
(2) Each person providing consent has been
advised in writing by the youth camp that the ingestion of potassium iodide is
voluntary;
(3) Each person
providing consent has been advised in writing by the youth camp about the
contraindications and the potential side effects of taking potassium iodide,
which include:
(A) persons who are allergic to
iodine should not take potassium iodide;
(B) persons with chronic hives, lupus, or
other conditions with hypocomplementemic vasculitis should not take potassium
iodide;
(C) persons with Graves
disease or people taking certain heart medications should talk to their
physician before there is an emergency to decide whether or not to take
potassium iodide; and,
(D) side
effects may include minor upset stomach or rash.
(4) Youth camps shall have designated staff
members to distribute and administer potassium iodide to those individuals and
minor children for whom prior written consent has been obtained. Such
designated staff members shall be eighteen (18) years of age or older and shall
have been instructed by the youth camp in the administration of potassium
iodide. Such instruction shall include, but not be limited to the following:
(A) the proper use and storage of potassium
iodide;
(B) the recommended dosages
of potassium iodide to be administered to children and adults as prescribed by
the Food and Drug Administration.
(5) Potassium iodide tablets shall be stored
in a locked storage area or container, inaccessible to children.
