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Medication Administration

Under the Nurses (Registered) and Nurse Practitioners Regulation, nurses  have the authority to compound, dispense and administer medications.

Practice Standards set out requirements related to specific aspects of nurses' practice. They link with other standards, policies and bylaws of the College of Registered Nurses of British Columbia and all legislation relevant to nursing practice.

Under the Nurses (Registered) and Nurse Practitioners Regulation, nurses1  have the authority to compound, dispense and administer medications. This document provides nurses with the information they need to safely administer medications. It should be read in conjunction with CRNBC's Scope of Practice documents for registered nurses or nurse practitioners and the Dispensing Medications practice standard.

Employers are responsible for providing the organizational supports and systems necessary for safe medication administration by nurses, including medication reconciliation2 and supporting voluntary reporting of medication incidents and near misses.

PRINCIPLES

1.

 

Nurses are responsible for administering medications within their scope of practice.

2.

Nurses are knowledgeable about the effects, side effects and interactions of medications and take action as necessary.

3.

Nurses  adhere  to  "seven  rights"  of  medication administration: right medication, right client, right dose, right time, right route, right reason and right documentation.

4.

Nurses determine all orders for an individual are clear, complete, current, legible and appropriate for the client before administering any medication.

5.

If there is no alternative, nurses can administer a medication using the pharmacy dispensing label as an order after confirming it is still appropriate.

6.

Nurses act upon pre-printed orders when the authorized health professional3 has made those orders client-specific by reviewing them, adding the client's name, customizing them signing, and dating them.

7.

Nurses act upon verbal and telephone orders only when circumstances require doing so and if there are no other reasonable options.

8.

Nurses administer only medications they themselves or a pharmacist have prepared, except in an emergency.

9. Nurses educate clients about all the client's medications.

10.

Nurses  understand  the  human  and  system  factors  that increase medication errors and near misses and take steps to prevent them.

11.

Nurses 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, route and frequency with which the medication is to be administered.

12.

When a medication error or near miss occurs at any point in the process of prescribing, compounding, dispensing or administering a medication, nurses take appropriate steps to resolve and report it in a timely manner.

APPLYING THE PRINCIPLES TO PRACTICE

1.

Read CRNBC's Scope of Practice for Registered Nurses: Standards, Limits and Conditions to ensure you understand the standards, limits and conditions under which nurses administer medications.

2.

Read back any verbal or telephone order to the prescriber to confirm it is accurately recorded.

3.

Be familiar with your agency's official list of approved abbreviations, acronyms and symbols to help eliminate one source of medication error.

4.

Be aware that your agency's policies may restrict medication administration further than the Nurses (Registered) and Nurse Practitioners Regulation and CRNBC Standards, Limits and Conditions permit.

5.

If you receive an order for an "off-label"4 use of a medication, ensure you are well informed about the medication and that you meet all the requirements for administering it.

6.

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.

7.

Be aware of medications that have a high risk of causing serious injury or death if not used correctly. They include heparin, warfarin, insulin, chemotherapy, concentrated electrolytes, opiate narcotics, neuromuscular blocking agents, thrombolytics, and adrenergic agonists. (See http://www.ismp.org/tools/highalertmedications.pdf)

8.

When preparing and administering medications, take steps to reduce interruptions that may lead to error.

9.

Participate in the development of system-wide approaches that support safe medication administration in your agency.

FOR MORE INFORMATION

  • Registered nurses will find more detailed information related to medications in CRNBC's Scope of Practice for Registered Nurses: Standards, Limits and Conditions (pub. 433). Nurse practitioners will find specific requirements related to medications and their stream of practice in CRNBC's Scope of Practice for Nurse Practitioners: Standards, Limits and Conditions.

CRNBC Resources

Available from the Nursing Standards section


Other Resources

FOOTNOTES

1.

"Nurse" refers to the following CRNBC registrants: registered nurses, nurse practitioners, licensed graduate nurses.

2.

Medication reconciliation is a structured process in which healthcare professionals partner with clients, families and caregivers for accurate and complete transfer of medication information at transitions of care. (Accreditation Canada)

3.

In B.C., the following health professionals are authorized to give an order to registered nurses to administer medications: physicians, nurse practitioners, midwives, dentists, podiatrists, naturopaths.

4.

"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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