medicines guideline...parenteral medication including picc + cvc, iv mixed dose insulin (sub cut)...
TRANSCRIPT
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
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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
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