Enrolled Nurse Medication Policy Amendment - Upload Student ...

Enrolled nurse medication policy
amendment (2006)
Controlled S8 drugs

Enrolled nurse medication policy amendment (2006)
Controlled S8 drugs
This is an amendment to the Policy on medication administration by ENs (2005).
On 19 May 2006, the Health (Drugs & Poisons) Regulation 1996 (section 58A) was amended to enable ENs with medication endorsement, EN(Med),
to administer controlled S8 drugs under the supervision of a registered nurse or doctor.
Please incorporate into/use this amendment in conjunction with the Policy on medication administration by ENs (2005)
New policy insert as section 2.3.5 (page 6)
Administration of controlled S8 drugs by an EN(Med)
An EN(Med) is authorised to administer controlled S8 drugs when all
of the following conditions are met:
1. There is a lawful, written order for the drug that is specific to
the client or the drug will be administered under the direct 1
supervision of a doctor, dentist or registered nurse/midwife.
2. The order is written 2 by a doctor, dentist or nurse practitioner, but
is not a standing order 3 .
3. The drug is prescribed to treat pain and the client’s response to
the drug is known.
5. The delegation meets the standard of appropriate delegation 4 .
6. The client’s condition is not rapidly changing or, for other
reasons, needing frequent review by an RN/midwife.
7. The effects of the drug on the client have been observed by an
RN/midwife/doctor over time and they have determined there
is a low risk of adverse effects.
Table 1 (page 3) details ENs’ authority to administer and check
schedule 2, 3, 4 and 8 drugs.
4. Administration of the drug to the individual client is a nursing
activity that has been delegated to the EN(Med) by their
supervising RN/midwife.
1 Further information on Council’s definition of direct and indirect supervision can be found in the Scope of practice framework for nurses and midwives 2005.
2 Section 97 of the Regulation requires oral instructions to be put into writing within 24 hours.
3 Standing orders are used when a client’s condition has changed, the need for a specific drug has not previously been identified for the client and a doctor is not in attendance. In such
circumstances, the client should be assessed by an RN/midwife.
4 Refer to the information on delegation in the Scope of practice framework for nurses and midwives 2005 and in Framework information sheets on delegation and clinically-focused supervision;
and assesment of competence.
New policy insert as section 2.1.3 (page 4)
Administration of prn controlled S8 drugs by an EN(Med)
If a controlled S8 drug is ordered prn, all of the following criteria
must be met before an EN(Med) can administer the drug:
1. There is a lawful written instruction for the drug.
2. The RN, nurse practitioner, doctor or dentist has identified, and
recorded in writing, client-specific criteria for the administration
of the drug.
3. The EN(Med) administers the drug under direct supervision of an
RN/midwife, doctor or dentist.
4. The supervising RN/midwife is satisfied that the EN(Med) is
competent to comply with the detailed client-specific instructions
related to the administration of the drug, including having the
clinical skills needed to gather the relevant assessment data.
5. Procedures are followed that ensure safe administration of
the drug.
Restrictions on practice of EN(Med) – administration of a
controlled S8 drug
1. All restrictions on practice relating to intravenous therapy
as set out in the Policy on medication administration by
ENs (2005) apply to controlled S8 medications. For further
clarification, see Table 2 (page 4).
2. An EN(Med) is not authorised to administer a controlled S8
drug to a client:
whose condition is rapidly changing or needs frequent review
by an RN/midwife or
who is in acute pain such as may be experienced immediately
post-operatively 6 , or at the onset, or during the acute stages
of an illness or injury.
6 This refers to the period immediately post return to the ward during which vital signs are
not stabilised.
2

Enrolled nurse medication policy amendment (2006)
Controlled S8 drugs
Table 1: Summary details of administration and checking of medications by ENs
This table replaces the policy’s Table 1 (page 17)
Potential delegation of
nursing activity
EN EN(Med) EN operating theatre (OT) EN medication
policy section
Possession and administration of medication
1 Administration of schedule
2 or 3 drugs
Yes, if delegated by an
RN/midwife
Yes, if delegated by an RN/midwife
Yes, under the supervision of an RN/
midwife/doctor
EN and EN(Med) 2.1
EN(OT)2.2
2 Administration of restricted
S4 drugs
No
Yes, if delegated by an RN/midwife and
complies with information sheet 3 EN IV
therapy and blood transfusions
No, but may possess the drug if there is a
written order from the anaesthetist
EN(Med) 2.3
3 Administration of
regulated-restricted S4 drugs
No Yes. However, caution is recommended Not applicable EN(Med) 2.3
4 Administration of controlled
S8 drug
No
Yes, (except anaesthetics) if all of the
conditions of section 2.3.5 are met
No, but may possess the drug if there is
written order from the anaesthetist
EN (OT)2.2
2.3.5
2.1.3
Table 2
Administration of prn/as-required
5 Administration of prn/as
required S2 or S3 drug
6 Administration of prn/as
required restricted S4 drugs
Yes Yes Yes 2.1.1
No Yes No 2.1.1
7 Administration of prn/as
required controlled S8 drugs
No
Yes, but only if all conditions in 2.1.3 are
met
No 2.1.1
2.1.3
2.3.5
Administration of medication requiring dosage calculations
8 Administer S2, S3 drug No Yes No 2.3
9 Administer restricted S4 drug No Yes No 2.3
10 Administer controlled S8 drug No Yes but only if all conditions of section
2.3.5 are met
No 2.3.5
Checking of medication requiring dosage calculations
11 Checking schedule 2, 3, 4,
8 drugs
Yes Yes Yes 2.4
Practising under the carer provisions of the Health (Drugs and Poisons) Regulation 1996
12 Assist clients to take dispensed
medication using Queensland
Health career guidelines
Yes 5
conditions
apply
Yes Not applicable 2.5
5 As per circular 03/98, Administration of medication by carers, Office of Chief Health Officer, Queensland Health.
3

Enrolled nurse medication policy amendment (2006)
Controlled S8 drugs
Additional table:
Table 2: ENs and peripheral intravenous therapy containing controlled S8 drugs for pain relief
ENs(Med) can only administer S8 drugs when the client’s:
response to the drug is known and has been observed by an RN/midwife/doctor
condition is not rapidly changing or needing frequent reviewing by an RN/midwife
risk of an adverse effect is low.
Also refer to EN medication policy, section 2.3.5 and EN medication policy information sheets 2 and 3
Alert for Table 2
No EN may prime, connect/hang, adjust or reset rates of any IV fluid containing cytotoxic drugs.
Potential delegation of nursing activity
New/ initiate line
EN and
EN(OT)
EN
(Med)
RN/midwife support – indirect supervision unless otherwise stated
1 Checking of order and calculation of IV rate No Yes Order and rate must be checked with RN/midwife/doctor
2 Signing S8 register as party to checking the medication Yes Yes Co-signatory must be RN/midwife/doctor
3 Priming of line No Yes
4 Add/inject/bolus of any substance to IV fluids via bag/burette/
line/cannula
No No RN/midwife role only
5 Setting up of an administration pump and setting rate No Yes Rate must be checked with RN/midwife/doctor
6 Identifying client as part of drug administration checks Yes Yes For EN and EN(OT) the other person checking must be an RN/midwife/doctor
7 Information giving and seeking consent No Yes
8 Connection of IV line to cannula No Yes Under direct supervision
9 Dressing of site Yes Yes
10 Writing actions carried out in client record Yes Yes
11 Instructions for nursing care including general fluid balance management
in client’s care plan
No No RN/midwife role only
Established line
12 Add/inject/bolus of any substance to IV fluids via bag/burette/
line/cannula
No No RN/midwife role only
13 Monitoring patency and status of cannula site Yes Yes
14 Monitoring of flow rate by observation Yes Yes
15 Changing flow rate as per order – manually or by resetting pump No Yes Order and new rate must be checked with RN/midwife/doctor
16 Temporarily ceasing flow rate and commencing flow rate at same
prescribed rate, e.g. for clothing change
No
Yes
17 Temporarily ceasing flow rate for safety reasons such as empty bag,
excessively rapid infusion
Yes Yes Must be immediately reported to RN/midwife/doctor
18 Checking order for replacement solutions and rate calculation Yes Yes Order and rate must be checked with RN/midwife
19 Identification of client and hanging replacement bag No Yes EN(Med) under direct supervision of RN/midwife/doctor
20 Gathering information for an assessment of physical response, pain relief,
fluid status, site etc.
Yes Yes Regularly reports to RN/midwife
21 Documenting actions Yes Yes
22 Flush line for patency check No No RN/midwife role only
23 Comprehensive evaluation of physical response, pain relief and
fluid status
24 Providing nursing care instructions for fluid balance evaluation etc.
in care plan
No No RN/midwife role only, although ENs contribute to data collection
No No RN/midwife role only
7 These delegated activities are always subject to local/organisation policies
Copyright protects this publication. However, the Queensland Nursing Council has no objection to this material being reproduced except for
commercial purposes. For commercial purposes contact Council. © 2006 Queensland Nursing Council.
Queensland Nursing Council
GPO Box 2928
Brisbane Q 4001
ABN 31 518 972 839
Level 14
201 Charlotte Street
Brisbane Q 4000
General enquiries
07 3223 5111
Registration enquiries
07 3223 5110
Professional enquiries
07 3223 5100
Queensland callers outside Brisbane
1300 139 993
Facsimile
07 3223 5115
www.qnc.qld.gov.au
ST3/NUR/06