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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.

On Thursday 1 October I appeared at the House of Representatives Standing Committee on Health’s Inquiry into Chronic Disease Prevention and Management in Primary Health Care, representing the primary health care nursing profession.

As the peak body for primary health care nurses, it was a pleasure to work with a group of our colleague nursing organisations (CATSINaM, ACMHN, MCaFHNA and ACN).

General practitioners continue to advocate their role as gatekeepers for real reform. It is time to challenge the role all healthcare professionals provide as part of a multidisciplinary team.

At APNA, our vision is to support the views of our membership to contribute to a healthier Australia and healthier communities.

Nurses at the frontline are well qualified to take an active role in primary health care as we are active in all areas of the community, the cities, the country and our islands, and we continue to develop long term relationships with the people in our care.

In my address to the Inquiry I highlighted the need to support:
–  recruitment and retention of primary health care nurses in the workforce
–  nurses transitioning into primary health care nursing
–  the nurse clinic model as a successful method of dealing with chronic and complex diseases and the coordination of care.

As your president and also an independent representative of the Primary Health Care Advisory Group, I felt well qualified and well positioned to speak on behalf of nurses in our sector and our members.

APNA is commencing work to deliver significant projects including:

>  Transition to Practice Program – which will directly support the recruitment and retention of nurses in all areas of primary health care

>  Nurse Demonstration Projects – established in multiple regions directly informed by health population needs

>  Education and Career Framework – to support the career trajectory available to primary health care nurses

>  Chronic Disease and Healthy Ageing Workshops – innovative face to face professional development for nurses in primary health care.

These important long term projects will be run in collaboration with the Department of Health to directly benefit recruitment and retention of nurses in primary health care and to support the Government’s initiative of population health driven chronic disease management and healthy ageing.

Our APNA projects promote a broader model of healthcare, providing the right care at the right time, keeping people out of hospital and caring for them on their return to their homes and communities.

The current environmental and political focus is well and truly focused on health reform. This is a time of change, challenge, and considered action and responsiveness from your peak body. APNA will be flexible and dynamic and continue to drive the agenda on your behalf. It is vital your voice is heard so we can best represent your position. Please continue to communicate your views with us at policy@apna.asn.au.

Our role has been recognised as the peak body for nurses in primary health care nurses and we are confident the Federal Government is listening and will make changes based on our submissions and direct feedback.

Kind regards,

Karen Booth

Read our full submission here.

Read the transcript of the Parliamentary Inquiry hearing here.

Of the more than 5500 Medicare items, 70% of them have remained unchanged and unassessed since they were introduced.

The purpose of the Medicare Benefits Schedule (MBS) Review is to align the list of services funded by the Australian government with contemporary clinical practice. The Review will focus on whether patients are being offered the right service at the right time for the right reason, and whether it will provide them with a health benefit. And yes, it is aimed at enabling Medicare and our health system to sustain itself in the future, for a future population.

A broad consultation of clinicians, consumers and stakeholders has been promised, and individuals can have a say through the online consultation hub.

At APNA we believe this is a priority for the primary health care sector, our members and the Australian public. Primary health care nurses are in the perfect position to ensure we are supporting the delivery of modern, patient-focused care.

As your President, I encourage you to stay active and engaged in the ongoing review of the MBS.

The increase in public health spending is in proportion the rising costs of chronic disease and an ageing population – two areas APNA is heavily focused on – and this will continue to swell if we fail to review regularly to test the response against the demand of the Australian population health needs.

Investing in primary health care and prevention is the smart fiscal move, to keep people well and out of hospital.

Hear the reasoning behind the Review from Chair Professor Bruce Robinson.

And Health Minister Sussan Ley writes It’s time to fix our healthcare system for doctors and patients.

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