MEDICATION ADMINISTRATION Practice Standard May 2013, Revised March 2016
Practice Standards set out baseline requirements for specific aspects of Registered Psychiatric Nurses’ practice. They interact with other requirements such as the Code of Ethics, the Professional Standards for Psychiatric Nursing, CRPNBC Bylaws, and relevant legislation. Under the Nurses (Registered Psychiatric) Regulation, RPNs have the authority to compound, dispense and administer medications. This document provides RPNs with the information they need to safely administer medications. It should be read in conjunction with CRPNBC’s Scope of Practice document for RPNs and the Dispensing Medications practice standard. Definition: Medication administration is defined as preparing, giving and evaluating the effectiveness of prescription and non-prescription drugs 1.
Employers are responsible for providing the organizational supports and systems necessary for safe medication administration by nurses, including medication reconciliation 2. They should support voluntary reporting of medication incidents and near misses.
PRINCIPLES 1.
RPNs are responsible for administering medications within their scope of practice.
3.
RPNs adhere to the “seven rights” of medication administration: the right medication, right client, right dose, right time, right route, right reason and right documentation.
2.
4. 5. 1 2
RPNs are knowledgeable about the effects, side effects and interactions of medications and take action as necessary.
RPNs determine that all medication orders for an individual are clear, complete, current, legible and appropriate for the client before administering any medication.
If there is no alternative, RPNs can administer a medication using the pharmacy dispensing label as an order after confirming it is still appropriate (see item g below).
Mosby’s Medical Dictionary, 2009. Elsevier.
Medication reconciliation is a structured process in which health care professionals partner with clients, families and caregivers for accurate and complete transfer of medication information at transitions of care. (Accreditation Canada). Page 1 of 4 Suite 307, 2502 St. Johns Street, Port Moody, BC, Canada V3H 2B4 Tel: 604.931.5200 • Fax: 603.931.5277 • Toll Free: 1.800.565.2505 • www.crpnbc.ca •
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MEDICATION ADMINISTRATION Practice Standard 6. 7. 8. 9.
RPNs act upon pre-printed orders when the authorized health professional 3 has made those orders client-specific by adding the client’s name, reviewing and customizing them, signing them and dating them. RPNs act upon verbal and telephone orders only when circumstances require doing so and if there are no other reasonable options. RPNs administer only medications they themselves or a pharmacist have prepared, except in an emergency. RPNs educate clients about all the client’s medications.
10. RPNs understand the human and system factors that increase medication errors and near misses and take steps to prevent them.
11. RPNs verify that medication orders, pharmacy labels and/or medication administration records are complete and include the name of the client, the name of the medication, the medication strength and the dosage, and the route and frequency with which the medication is to be administered. 12. RPNs do not pre-pour medication because it increases the likelihood of errors.
13. When a medication error or near miss occurs at any point in the process of prescribing, compounding, dispensing or administering a medication, RPNs take appropriate steps to resolve and report the error or near miss in a timely manner.
APPLYING THE PRINCIPLES TO PRACTICE a. b.
c. 3
4
Read CRPNBC’s Scope of Practice for Registered Psychiatric Nurses: Standards, Limits and Conditions to ensure you understand the standards, limits and conditions under which nurses administer medications.
Familiarize yourself with agency 4 policies on medication administration and follow them.
Read back any verbal or telephone order to the prescriber to confirm it is accurately recorded.
In B.C., the following health professionals are authorized to give an order to RPNs: medical physicians, nurse practitioners, midwives, dentists, podiatrists, naturopathic physicians, pharmacists, and certified practice registrants of CRNBC. Agency means the agency that employs the RPN.
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MEDICATION ADMINISTRATION Practice Standard d. e.
f.
g.
h. i. j. k.
Be aware of drug names that look or sound similar and develop strategies to reduce the risk of errors. See ISMP List of Confused Drug Names http://www.ismp.org/tools/confuseddrugnames.pdf Be familiar with your agency’s official list of approved abbreviations, acronyms and symbols to help eliminate one source of medication error. Be aware of abbreviations, symbols and dose designations that are frequently misinterpreted and involved in harmful medication errors. See ISMP List of Error Prone Abbreviations, Symbols, and Dose Designations: http://www.ismp.org/tools/errorproneabbreviations.pdf.
Be aware of medications that have a high risk of causing serious injury or death if not used correctly. They include various anticoagulants, oral hypoglycemics, opiate narcotics, moderate sedation agents, thrombolytics, adrenergic agonists and insulin. See ISMP List of High-Alert Medications: http://www.ismp.org/tools/highalertmedications.pdf.
If you are using the pharmacy label as an order, check with the client, pharmacist or the health professional who issued the order, depending on the circumstances, to ensure the medication is appropriate. An example might occur during a home visit, when your client has a new medication recently prescribed by an authorized health professional and dispensed by a pharmacist, but the authorized health professional has not yet provided you with an order. A client who can direct their care may be able to provide enough information for you to determine that the medication and directions on the pharmacy label are appropriate. If this is not the case, you may want to contact the pharmacist for further information. If you require further information to safely administer the medication, then contact the authorized health professional for an order. If you receive an order for an “off-label” 5 use of a medication, ensure you are well informed about the medication and that you meet the same standards for administering all other medications. If you are administering an experimental medication, ensure it is part of a formal research program and that you have an order from the principal or co-investigator.
When preparing and administering medications, take steps to reduce interruptions that may lead to error.
Participate in the development of system-wide approaches that support safe medication administration in your agency.
“Off-label” use refers to using a Health Canada-approved drug for a purpose that may benefit the client, but is not indicated on the package insert.
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MEDICATION ADMINISTRATION Practice Standard
FURTHER INFORMATION RPNs will find more detailed information related to medications in CRPNBC Scope of Practice for Registered Psychiatric Nurses: Standards, Limits and Conditions: http://www.crpnbc.ca/wp-content/uploads/2016/03/2016-03-15-Revised-Scope.pdf Other CRPNBC Practice Standards and requirements are available from the Practice Support section of the CRPNBC website: https://www.crpnbc.ca/practice-support/ For more information on this or any other practice issue, contact CRPNBC’s Practice Consultant by email at
[email protected] or call 604.931.5200 or 1.800.565.2505. Additional Resources
College of Pharmacists of British Columbia website www.bcpharmacists.org Health Canada Drug Product Database http://hc-sc.gc.ca/dhpmps/prodpharma/databasdon/index-eng.php
Institute for Safe Medication Practices Canada website www.ismp-canada.org © Copyright College of Registered Psychiatric Nurses of British Columbia 2013
Adapted with permission from the College of Registered Nurses of British Columbia, Practice Standard – Medication Administration 2010, pub 408.
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