APNA often receives enquiries around medication administration by nurses in general practice.
The difficulty in answering these questions lies in the fact that each state and territory has its own drugs and poisons legislation, with different guidelines for rural and remote areas and for certain sectors of the healthcare worker community. APNA recommends nurses check with their local authority on questions around drug and poisons.
We’re interested in your experiences. To start the discussion, we thought it would be helpful to share a typical enquiry we receive around medication administration.
Q. What should I do when a patient brings a prescription medicine dispensed from the pharmacy (e.g. a vitamin B12 injectable supplement) in to the practice for me to administer?
A. To answer this question, our discussion would address the following:
- As with all procedures, consider what is within your individual scope of practice: what are you educated, authorised and competent to perform?
- We normally discuss the way in which the prescribing GP might document the medication order for nursing staff in the patient’s clinical notes (i.e. this might coincide with writing the prescription or the GP may prefer to see them again on the day of administration).
- We ask nurses to ensure the order is written and provides all of the required information, including authorisation for the nurse to administer the medication (i.e. dose, how often, pre and post follow up if required).
- Verbal orders can be difficult to manage when there is only one nurse in the practice and should be reserved for urgent situations – discuss with your practice team how this might be managed.
- We like to discuss the need for nurses to have a good understanding of the drugs they are administering. What are the potential side effects? Has the medication been stored appropriately prior to presentation? Is any pre-administration care required? What follow up is required? Is this a cytotoxic drug? If so, what appropriate measures need to be put in place to be able to administer this safely and within legislation in your practice?
- We always recommend you refer to the ‘6 Rights’ of medication administration (or the 8 rights, if you prefer to include right reason and right response):
- Right drug – check the order, medication and expiry date. If you don’t have another nurse to check the order and the medication, we recommend you check with the GP. Note that nursing students are NOT able to check medication with you.
- Right individual/patient – use a minimum of two identifiers. Ask the patient to identify themselves by name and date of birth. Ask them for their understanding of the medication you are about to administer, and deliver medication information. If there is an alert on the patient file that there is a person with a similar name in your practice please use normal processes to provide additional checks.
- Right dose – check the order and confirm appropriateness of the dose using a current drug reference. If necessary, calculate the dose and have another nurse or the GP calculate the dose as well.
- Right time – check the frequency of the ordered medication. Double-check you are giving the ordered dose at the correct time. Confirm when the last dose was given. Confirm whether follow up or examination is required prior to or post medication being administered. Place a recall or reminder for next dose or follow up.
- Right route – again, check the order and appropriateness of the route ordered. Confirm the patient can take or receive the medication by the ordered route.
- Right documentation – document administration AFTER giving the ordered medication. Using the clinical software, you may develop ways to consistently document the medication administration which includes information about the drug, expiry date, time, route, site of injection, and any other specific information as necessary (e.g. any pathology test or observation which needs to be checked before or after giving the drug).
Have you developed an easy process in your practice to improve medication management that you would like to share? We would love to hear from you.