Medication management in aged care - Queensland Nurses Union

Masonic Care QNU members 16 July 2012
Medication management
in aged care
QNU CONNECT
3099 3210
www.qnu.org.au
Medication management in aged care is regulated by the Health (Drugs and Poisons)
Regulation 1996 (the Regulation), the Aged Care Act 1997, the Quality of Care Principles
and the National Law. To determine their relevance to medication management, we need
to look at each legislative component individually.
1. The Regulation prescribes that:
a. carers may assist a person to take their dispensed medication, but only if
the person has requested that assistance (dispensed medication is that
supplied and labelled by the Pharmacy for that specific person)
b. the term Administer means ‘to give a person a single treatment dose of a
drug, to be taken immediately’
c. registered nurses and authorised enrolled nurses have endorsement to
administer a drug, carers do not
d. administering a drug without endorsement under the Regulation carries a
penalty of up to $8000 (for each instance)
e. a carer has no authority under the Regulation to possess another person’s
drug, possession of which also attract a substantial fine.
From the provisions of the Regulation, simple logic dictates that for the carer to lawfully
assist a person to take their medication, the person must already have the drug in their
possession and then ask for the carer’s assistance to take it. Conversely, if the carer gives
a drug to a person in their care, the carer could be deemed to be administering it and
becomes liable to the penalty.
2. The Aged Care Act 1997 prescribes that every aged care facility in Australia
must comply with the Quality of Care Principles in order to maintain
accreditation and funding.
3. The Quality of Care Principles prescribes that every facility must comply with all
legislation, regulation, professional standards and guidelines relevant to
health care.
4. The National Law prescribes that, through the Board’s codes and guidelines, every
nurse must ensure their practice complies with professional standards and best
practice guidelines.
The Royal College of Nursing Australia, the Australian Nursing Federation and
Geriaction—all being professional nursing organisations—jointly developed nursing
guidelines for medication management in aged care settings (for both residential and
community). The guidelines can be found at Appendix K of the Department of Health and
Ageing’s Guidelines for Medication Management in Residential Aged Care.
These guidelines constitute best practice in aged care medication management in both
residential and community aged care and form a professional standard as defined by the
Board and a practice guideline as defined by the Quality of Care Principles.
The guidelines state that, with respect to medication management in aged care, a carer
may only assist those aged care recipients who are self-medicating.
Authorised by B. Mohle, Secretary, Queensland Nurses’ Union, July 2012.

How do we relate the above nursing codes and guidelines and medication
management guidelines to the AIN level 3 position description at Masonic Care
The numbered statements below are direct quotes from the AIN level 3 PD. Each
statement is followed by lettered responses from the QNU:
1. “Reporting to Registered Nurse (RN) or Endorsed Enrolled Nurse (EEN)…”
a. There is no such nursing title as Endorsed Enrolled Nurse. The correct
title is Enrolled Nurse.
2. “Assist in the provision of… under direct supervision of a Registered Nurse or
Endorsed Enrolled Nurse…”
a. An Enrolled Nurse is not permitted to supervise nursing care activities.
Any EN who does so is acting outside their scope of practice and could be
subject to disciplinary action by the Board.
b. Direct supervision means there must be a Registered Nurse by the AIN’s
side at all times providing support, direction and guidance.
3. “Supervise and support staff in the delivery of resident care.”
a. Only a Registered Nurse can supervise any nursing care activities on the
care plan.
4. “Assist residents, who have requested help, with the management of medication
prescribed by Medical Officers.”
a. The professional standard is that only those residents who self-medicate
may receive assistance from a carer.
b. The carer may only help the self-medicating resident to take the
medication, not manage the medication.
c. The carer can only assist the self-medicating resident to take medication
that has been dispensed by the Pharmacy, this does not include every
medication prescribed by the Medical Officer.
5. “Successful completion of an approved Medication Assistance Program.”
a. There are no such programs approved by the Nursing and Midwifery
Board of Australia or the Department of Health and Ageing.
6. “Demonstrates an ability to competently perform clinical nursing cares under the
direct or indirect supervision of a Registered Nurse or Endorsed Enrolled Nurse.”
a. As above, an Enrolled Nurse cannot supervise nursing activities.
7. “Demonstrates an ability to develop, implement, monitor and review care for noncomplex
residents…”
a. The development and review of nursing care for any resident is the role of
the Registered Nurse alone and cannot be delegated to any other category
of staff.
8. “Demonstrates an ability to provide on the job training to lower level staff.”
a. Only a Registered Nurse is authorised to train staff in the provision of
nursing care.
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