Medicines Guideline

Medicine Administration

Scope of Practice: (A resource for students,

clinical facilitators and placement venues)

Updated May 2019

May 2019

University of South Australia Bachelor of Nursing and Bachelor of Midwifery students: a guide to supervising students in medicine administration

(a resource for students, clinical facilitators and placement venues)

Please note the following:

Supervision

• Students undertaking study to become a Registered Nurse must be supervised by a Registered Nurse when administering medications.

• Students undertaking study to become a Registered Midwife must be supervised by a Registered Midwife or Registered Nurse or Medical

Officer when administering medications.

Standing Orders

• Undergraduate nursing and midwifery students are able to administer from standing orders when: o The registered nurse/ registered midwife write up the order on the medication chart and both RN/RM and student are familiar

with the requirements of the standing order i.e. aware of dosing schedule, exclusions and or special requirements. o Once the medication order has been documented on the medication chart the student may prepare and administer the

medication under direct and continuous supervision of the registered nurse/registered midwife and counter sign following administration.

Nurse/Midwife Initiated Orders

• Undergraduate nursing and midwifery students are NOT able to administer medicines from nurse/midwife-initiated orders. Drug of Dependence Undergraduate nursing and midwifery students are unable to prepare or administer Drugs of Dependence – this includes S8 and Restricted S4 medications. Please note this restriction originates (legal obligation) from the Controlled Substances Act 1984 (SA) and applies to both public and private venues (includes anywhere medications are administered) including home visits across SA. Health Venue Site Medicine Procedures Students will always need to practice in accordance with the local health venues medication procedures.

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Nursing

Psychomotor skill/ Assessment skill Mapping

across the BN program

ELA WITHIN Current Scope OUTSIDE Current Scope

Monitoring and Observation only

Skill delivery Assessment skills Associated skills

Experiential Learning Activity: Preparation for Clinical Practice Practicum 1

NURS 1061

HHHS placement only

Students are able to observe medication administration however are not able to check or administer medications

Checking or administration of any medications

BHP:

8 'rights' Medication Safety

Oral medication calculations

BHP:

TPR, BP, SaO2

Health questionnaire

BMI

Practice and observation re 8 rights, oral medications and NIMC

ELA 1:

National Medication Inpatient Chart (NIMC)

Oral administration

Oral/parenteral Medication calculations

Priming an IV line

ELA 1:

Health questionnaire

Respiratory Assessment

BGL’s

May 2019

ELA WITHIN Current Scope OUTSIDE current Scope

Monitoring and Observation only

Skill delivery Assessment skills Associated skills

Experiential Learning Activity: Older Adults Practicum 2

NURS 2034

Aged care focus

Under direct supervision of a Registered Nurse – (NOT an Enrolled nurse or personal carer) check and administer medicines via the following routes:

Oral excluding sublingual

Enteral

Nebulised

MDI’s

Topical including eye and ear

Rectal/Vaginal

And

Oxygen

ALL High Risk medicines

Intravenous medicines or infusions

HOOA:

Oxygen delivery

Oral medication

Eye drops/ ointment

PR and PV medication

PEG/ JEG/ NGT, IMI, Sub cut injection, medication and fluid

infusions (NIKI pump)

IVT - pump/ gravity

line

MDI

Nebs

HOOA:

Respiratory assessment (limited)

Neurological assessment

Neurovascular assessment

Peak flow Blood glucose monitoring

12-lead ECG Cardiovascular assessment (limited)

Falls risk assessment

Pain assessment

Complex wounds

Practicing skills in HHHS only:

Intramuscular injections

Nasogastric, PEGs

Practice for placement:

oral medications

Sub cut fluids and non-high-risk medicine infusions

May 2019

ELA WITHIN Current Scope

OUTSIDE current Scope

Monitoring and Observation only

Skill delivery Assessment skills Associated skills

Experiential Learning Activity: Acute Care Practicum 3

NURS 2033

Acute care focus

Under direct supervision and continuous supervisions of 2 nurses (one must be RN)

In addition to those listed under ELA 2 and including the following medicines/routes:

• Sublingual

• Subcutaneous injection and fluids

• Intramuscular injection

• Intravenous fluid infusions

• Blood products via IV infusion

• The following High-Risk Medicines:

• Insulin subcutaneous ONLY

• Anticoagulants – subcutaneous ONLY

Injectable medicine infusions

The following High-Risk medicines:

• Controlled Medicines

• Potassium/High Dose Electrolyte infusions

• Cytotoxic

• Neuromuscular blockers

• Epidural infusions

Paediatric/Neonatal medicines

Patient Controlled Narcotic Infusions

HOA:

Blood administration

Parenteral Medication including PICC + CVC, IV

Mixed dose insulin (Sub cut)

Basal/Bolus insulin

Oral/enteral medication

HOA:

Physical Assessment (head toe including height, weight, vital signs)

Neurological assessment

Cardiovascular assessment

Respiratory assessment

Asthma assessment

Abdominal assessment

Pain assessment

Practice for placement:

All parental medications

May 2019

ELA WITHIN Current Scope

OUTSIDE current Scope

Monitoring and Observation only

Skill delivery Assessment skills Associated skills

Experiential Learning Activity: Extension to Practice Practicum 4

NURS 3042

Acute and high-end acute focus

All specialties including acute –

Under direct and continuous supervisions by 2 nurses (one must be RN)

As per ELA 3 and the following:

• Intravenous medicine infusions

including High Risk Anti- infectives

• Subcutaneous infusions

• Premixed potassium solution infusions

The following High-Risk Medicines:

• All Controlled medicines

• Cytotoxic medicines

• Potassium – bolus dose or preparation of potassium infusions from ampoules

• Neuromuscular Blockers

• Epidural infusions

Controlled

Medications including narcotic infusions

Cytotoxic medicines

Epidural infusions

High Dose Electrolyte infusions including potassium

Insulin Infusions

Heparin Infusions

Contexts:

IM injection medication calculations

Application of 8 R’s of medication administration IVT and infusions

Introduction of more complex orders and medication calculations likely seen in specialty settings

All within context of chosen setting/ specialty

Contexts:

Deteriorating Client

Mental Health Clozapine with extreme caution

Antipsychotics

Intramuscular Long Acting Antipsychotics

As per ELA 4 As per ELA 4 As per above

May 2019

Perioperative As per ELA 4 As per ELA 4 As per ELA 4 As per above

May 2019

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ELA WITHIN Current Scope

OUTSIDE Current

Scope

Monitoring Observation only

Skill delivery Assessment skills Associated skills

Paediatrics

ELA 3 – 2nd Year

Nursing students may undertake the role of a supernumerary third person who can check medicines for children.

Students are not able perform the role of 2nd checker where 2 nurses are required to perform a medication check for children.

With direct and continuous supervision of Registered Nurse:

• Oral

• Enteral

• Nebulised/MDI

• Subcutaneous

• Intradermal

• Intramuscular injections

• Topical

• Rectal/vaginal – with chaperone

The following high-risk medicines:

• All Controlled Drugs

• IV Potassium and concentrated electrolyte infusions

• Cytotoxics

• Heparin and anticoagulants

• Epidural /intrathecal agents

• Neuromuscular blocking drugs

All IV fluid therapy and medications

All subcutaneous fluid therapy

Blood and blood products

All controlled medicines including narcotic infusions and PCA’s

• Heparin Infusions

• Insulin Infusions

• All IV Fluid therapy and medications

• All subcutaneous fluid therapy

• Blood products and transfusions

May 2019

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ELA WITHIN Current Scope

OUTSIDE Current

Scope

Monitoring Observation only

Skill delivery Assessment skills Associated skills

Paediatrics

ELA 4 – 3rd Year

Nursing students may undertake the role of a supernumerary third person who can check medicines for children.

Students are not able perform the role of 2nd checker where 2 nurses are required to perform a medication check for children.

With direct and continuous supervision of Registered Nurse

As per ELA 3 with the addition of:

• IV fluid therapy including additives

• IV medications

• Blood and blood products

Nurse Initiated medications

The following high-risk medicines

-All Controlled Drugs

-Cytotoxics

-Heparin and anticoagulants

-Epidural /intrathecal agents

-Neuromuscular blocking drugs

All controlled medicines including infusions and PCA’s

Heparin Infusions

Insulin Infusions

May 2019

ELA WITHIN Current Scope

OUTSIDE current Scope

Monitoring and Observation only

Skill delivery Assessment skills Associated skills

PHC As per ELA 4

As per ELA 4 As per above

Palliative Care As per ELA 4

Subcutaneous narcotic and sedation infusions

As per above

Aged care As per ELA 4

Subcutaneous narcotic and sedation infusions

As per above

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ELA WITHIN Current Scope

OUTSIDE Current Scope

Monitoring and Observation only

Skill delivery Assessment skills Associated skills

Experiential Learning Activity: Transition to Practice Practicum 5

NURS 3043

Under direct and continuous supervisions by 2 nurses (one must be RN)

As per ELA 4

As per ELA 4 As per ELA 4

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Midwifery

Mapping across the IBMW program

ELA WITHIN Current Scope

OUTSIDE Current Scope

Monitoring and Observation only

Skill delivery

Experiential Learning Activity: Midwifery Foundation Practicum 1 (Year 1)

NURS 1056

Antenatal/Postnatal/Mixed Focus

Under direct supervision of a Registered Midwife and/or Registered Nurse or Medical Officer – (not an Enrolled nurse) check and administer medicines via the following routes:

• Oral

• Enteral

• Subcutaneous

• Intramuscular (IM)

ALL high-risk medicines

• Intravenous medicines or infusions

8 rights Medication Safety

Oral medication calculations

Oral medication

Intramuscular neonatal injections (Hep B and Vitamin K)

Intramuscular maternal injections

Subcutaneous maternal injections

May 2019

Mapping across the IBMW program

ELA WITHIN Current Scope

OUTSIDE Current Scope

Monitoring and Observation only

Skill delivery

Experiential Learning Activity: Midwifery Development Practicum 2 (Year 2)

NURS 2039

Antenatal/Postnatal focus

Under direct supervision of a Registered Midwife and/or Registered Nurse or Medical Officer – (not an Enrolled nurse) check and administer medicines via the following routes:

• Oral

• Intravenous (IV)

• Intramuscular (IM)

• Subcutaneous

• Epidural catheter

The following high-risk medicine

-Controlled medicines

-Potassium/ High Dose Electrolyte infusions

-Cytotoxic

-Neuro-muscular blockers

-Neonatal IV medicines

Patient Controlled Opioid Infusions

Blood administration

Parenteral Medication including IV infusions/ epidural/ PR & PV medications

Magnesium sulphate

Basal/Bolus insulin & mixed dose insulin

(Subcutaneous) Oral/enteral medication

May 2019

Mapping across the IBMW program

ELA WITHIN Current Scope

OUTSIDE Current Scope

Monitoring and Observation only

Skill delivery

Experiential Learning Activity: Midwifery Practice Development Practicum 3 (Year 2)

NURS 2036

Intrapartum/Mixed/ Nursery Focus

Under direct supervision of a Registered Midwife and/or Registered Nurse or Doctor – (not an Enrolled nurse) check and administer medicines via the following routes:

Maternal and neonatal:

• oral medications

• subcutaneous, intramuscular

• intravenous injections

Maternal and neonatal IV therapy

Maternal epidural administration/ management

• Per rectum & per vagina medications

The following high-risk medicines

-Controlled medications

Patient Controlled Opioid Infusions

Parenteral

Gentamicin

• Adrenaline

• Oral medications

• Intramuscular neonatal injections

• Intramuscular and subcutaneous maternal injection

• Intravenous therapy and injections, syringe pumps and infusions

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Mapping across the IBMW program

ELA WITHIN Current Scope

OUTSIDE Current Scope

Monitoring and Observation only

Skill delivery

Experiential Learning Activity: Midwifery Transition Practicum 4 (Year 3)

NURS 3052

Antenatal/Postnatal/ Intrapartum/Mixed/ Nursery Focus

Under direct supervision of a Registered Midwife and/or Registered Nurse or Medical officer – (not an Enrolled nurse) check and administer medicines via the following routes:

-Maternal and neonatal oral medications, subcutaneous, intramuscular and intravenous injections

-Maternal and neonatal IV therapy

- Maternal epidural administration/ management

-Per rectum & per vagina medications

The following high-risk medicines

-Controlled medications

Patient Controlled Opioid Infusions

Psycho-pharmacology

Oral medications

Intramuscular neonatal injections

Intramuscular and subcutaneous maternal injection

Intravenous therapy and injections, syringe pumps and infusions

May 2019

Mapping across the IBMW program

ELA WITHIN Current Scope

OUTSIDE Current Scope

Monitoring and Observation only

Skill delivery

Experiential Learning Activity: Midwifery Transition Practicum 5 (Year 3)

NURS 3053

Antenatal/Postnatal/ Intrapartum/Mixed/ Nursery Focus

Under direct supervision of a Registered Midwife and/or Registered Nurse or Medical Officer – (not an Enrolled nurse) check and administer medicines via the following routes:

-Maternal and neonatal oral medications, subcutaneous, intramuscular and intravenous injections

-Maternal and neonatal IV therapy

-Maternal epidural administration/ management

-Per rectum & per vagina medications

The following high-risk medicines:

-Controlled Medications

Patient Controlled Opioid Infusions

Parenteral Lignocaine and Lignocaine with Adrenaline

Maternal and neonatal:

-Oral medications,

-Subcutaneous, intramuscular and intravenous injections

-Intravenous therapy

-Maternal epidural administration/ management

-Per rectum & per vagina medications

May 2019

Glossary

Controlled Medicines

All Schedule 8(S8) AND

Restricted Schedule 4 (S4) Medicines: ALL Benzodiazepines, cannabidol containing preparations in S4, codeine containing preparations in S4, dextropropoxyphene (Di-Gesic, Doloxene), tramadol, zolpidem (Stilnox), and zopiclone.

High Risk Medicine

High risk medicines are those medicines that have a high risk of causing significant patient harm or death when used in error. Although errors may or may not be more common than with other medicines, the consequences of errors with these medicines can be more devastating. To assist in preventing errors.

Special safeguards to minimise opportunities for errors are integral to patient/woman safety – see High Risk medicines – SA Health below

BHP Being a Health Professional

Nursing

ELA (1-5)

Experiential Learning Activity:

Experiential Learning Activity: Preparation for Clinical Practice Practicum 1

Experiential Learning Activity: Older Adults Practicum 2

Experiential Learning Activity: Acute Care Practicum 3 Experiential

Learning Activity: Extension to Practice Practicum 4 Experiential Learning

Activity: Transition to Practice Practicum 5

Midwifery

ELA (1-5)

Experiential Learning Activity:

Experiential Learning Activity: Midwifery Foundation Practicum 1 (NURS 1056)

Experiential Learning Activity: Midwifery Development Practicum 2 (NURS 2039)

Experiential Learning Activity: Midwifery Development Practicum 3 (NURS 2036)

Experiential Learning Activity: Midwifery Transition Practicum 4 (NURS 3052)

Experiential Learning Activity: Midwifery Transition Practicum 5 (NURS 3053)

HOOA Health of Older Adults

HOA Health of Adults

Contexts Nursing Contexts of Practice

May 2019

Appendix 1

High Risk Medicines – SA Health High risk medicines are those medicines that have a high risk of causing significant patient harm or death when used in error. Although errors may or may not be more common than with other medicines, the consequences of errors with these medicines can be more devastating. To assist in preventing errors. Special safeguards to minimise opportunities for errors are integral to patient safety. Organisations are required to implement systems to reduce the occurrence of medication incidents and improve the safety and quality of medicines use in accordance with National Safety and Quality Health Service (NSQHS) Standard 4 – Medication Safety.

High Risk Medicines Management

To assist organisations to meet the NSQHS Standards, SA Health has developed a High Risk Medicines Management Policy Directive (PDF 493KB) (opens in a new window). This directive and its associated High Risk Medicines Management Guideline (PDF 629KB)(opens in a new window) aim to improve patient safety and reduce harm within the domains of storage, prescribing, dispensing and administration of identified high risk medicines and assist organisations achieve these goals. Compliance with this policy is mandatory and will ensure a standard approach to high risk medicines and support clinical staff in their safe management.

APINCH and high-risk medicines

The acronym APINCH is often used to classify high risk medicines however the list is not exhaustive and other individual medicines or groups can be included. The Horizon Hospital and Health Service within the Nursing and Midwifery School has extended the list to include Epidural/Intrathecal agents along with neuromuscular blocking agents.

The most common high risk medicines reported are included in the ISMP ‘High Alert Medications’ (opens in a new window) and A PINCH lists (opens in a new window).

Further Information regarding High Risk medicines can be found:

1. Australian Commission on Safety and Quality in HealthCare; High Risk medicines:

https://www.safetyandquality.gov.au/our-work/medication-safety/high-risk-medicines/

2. SA Health High Risk Medicines Website :

http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+t

opics/medicines+and+drugs/high+risk+medicines

3. NSW Clinical Excellence Commission – High Risk Medicines:

http://www.cec.health.nsw.gov.au/patient-safety-programs/medication-safety/high-risk-medicines

4. Institute for Safe Medicine Practices – USA. List of High Alert Medications

http://www.ismp.org/Tools/highAlertMedicationLists.asp

May 2019

Appendix 2: UniSA High Risk Medicines

May 2019

Version Control Review date Content changes Author Approved by

October 2018 Major review including addition of midwifery program:

Carolyn Field, Naomi Rooney, Angela Brown

Teaching & Learning group October 2018

May 2019 Addition of:

• Blood products within ELA 3 – nursing

• High Risk Anti – infectives within ELA 4 - nursing

Carolyn Field PD – BN program (ELA) May 2019