MEDICATION ADMINISTRATION

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MEDICATION ADMINISTRATION

• Topic 1A
• Drug Schedules

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Identify the schedules of drugs relevant to
nursing practice

• It is the Poisons and Therapeutic Goods Act 1966
  ( NSW ) who impose some limitation on the use of
  many potent drugs by restricting their
  distribution to certain groups or persons trained
  in handling them and permitting their
  administration only on medical authority.

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It is the Poisons and Therapeutic Goods Act
provides for the establishment of a Poisons List,
which consists of eight schedules.
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SCHEDULED DRUGS

• ( DANGEROUS POISONS )
• Extreme danger to life. Only available from
  Medical Practioners
• e.g. Atropine, Arsenic

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2. Medicinal Poisons Poisons for therapeutic use
which are available to the public only from
pharmacies. Dangerous to life if misused or
carelessly handled. e.g. Panadol, Aspirin,
Codeine
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3. Potent Substances

• Poisons for therapeutic use, which are dangerous
  or liable to abuse. Their availability to the
  public is restricted to supply by pharmacists and
  medical practioners/ dentists/ vets.
• e.g. Insulin

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4. Restricted Drugs

• Substances which in the public interest should
  be supplied only on the written prescription of a
  medical practitioner, dentist or veterinary
  surgeon.
• e.g. Oral hypoglycaemic agents, Cortisone
• Barbiturates.

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4D. Prescribed Restricted Substances

• Substances which are also only available to the
  public on the prescription of an authorised
  person. These substances are treated differently
  because of their potential for misuse and abuse.
• e.g. Diazepam, Midazolam

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5. Domestic Poisons

• Poisons of a hazardous nature, which are readily
  available to the public but require caution in
  handling storage and use.
• e.g. Bleach, Hydrogen peroxide

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6. Industrial and Agriculture

• Substances which should be readily available to
  the public for agricultural, pastoral,
  horticultural, veterinary, photographic or
  industrial purposes or for the destruction of
  pests.
• e.g.Phenol

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7. Special Poisons

• Poisons which require special precautions in
  manufacture, handling, storage or use or special
  individual regulations regarding labelling or
  availability.
• e.g. Insecticides

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8. Drugs of Addiction

• Substances which produce addiction or have such
  potential. A drug register must be kept.
• e.g. Morphine, Pethidine

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STORAGE

• Nurse in charge of the ward is responsible for
  the storage of all drugs. Must met legal
  requirements that is security, temperature and
  stock rotation.
• Storage should be such a way that it minimises
  errors

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GENERAL SCHEDULE 4 MEDICATIONS

• Must be stored out of patient and public access.
  ( locked cupboard, locked room or locked
  medication trolley ).
• Keys kept by the nurse in charge of the ward or
  their delegate who must be a registered
  /authorised enrolled nurse.
• Emergency or anaesthesia trolleys are exempt for
  locked storage

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DRUG KEYS
Please note that Drug keys must be kept from
ward keys.
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SCHEDULE 4 APPENDIX D

• Liable to abuse
• Stored separate from all other drugs except S8
• No other goods should be stored in the same
  place ( e.g. cash, keys )
• S4D Drug key and S8 keys can be kept together
  but with no other ward keys and carried by an RN.
  

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SELF MEDICATIONS
Stored in a secure bedside storage that is
inaccessible to other patients or visitors e.g.
locked bedside drawer to which the patient may
hold the key.
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STORAGE IN ORIGINAL PACKS

• All drugs should be stored in their original
  packs or containers as received from Pharmacy

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MEDICATION INCIDENT REPORTING

• Part of quality improvement programs, should
  have a system in place.
• All disciplines should be encouraged to report
  incidents even near miss incidents
• Drug committee for review.
• Circular Incidents Reportable to the
  Department 97/58.

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MEDICATION ORDERS
What do you think should be included on the
medication order ?
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Medication Order

• Must use a patient medication chart ( area
  health logo )
• Allergies/ adverse drug reactions
• Clear, legible and unambiguous
• Patient full name, DOB,MRN and or address.
• age, weight of a paediatric patient

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Medication Order

• Name of medication ( what name trade chemical or
  generic ?? )
• Strength of medication
• Form of medication
• Dose, route, and frequency
• Date of cessation, total number of doses or
  finite time period of administration.

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Medication Orders

• Signature and date. Each individual medication
  order must be written in a separate box and each
  medication order must be signed.
• To cease a medication order the MO must draw a
  line across the area of the chart where
  administration is recorded ( after the last entry
  ) and sign and date adjacent to this line.

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Medication Orders

• If a drug is not to be given on certain days,
  the prescriber must cross out those days on the
  medication chart, to prevent errors.
• Medication orders must not be duplicated so the
  drug is not administered twice in error/

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Medication Orders

• A MO should confirm their intention to order any
  dose that could be considered to be unusually
  high by underlining and initialling the dose.