The Medication practice standard outlines nurses' accountabilities and responsibilities when performing activities involving medication. The practice standard is principle-based, which means that it uses general statements. Nurses need to use critical thinking and knowledge, skill and judgment when making decisions about medication activities.
Yes. You are dispensing when you package and give medication to a client (or their delegate) for later use. If a pharmacist has already dispensed your client's medications to your unit or workplace, you’re responsible for taking steps to ensure proper use. This includes:
Medication Practice Standard provides clear direction for labelling, packaging, client education, and documentation.
Preparing medications is part of the medication administration process. Preparation includes selecting, calculating, crushing, breaking, mixing, labelling, drawing up, popping out, etc. Prepare medications as close as possible to the time you administer them.
Pre-pouring medications is not safe medication practice. Pre-pouring medications is preparing medications in well in advance of administration and storing them until you administer them. Pre-pouring medications blurs the accountability for ensuring the medication rights are met and it increases the risk of errors and risk to the client.
Examples of pre-pouring include:
Follow your workplace policies when preparing medications.
There are limited situations where you may share the responsibility for preparing and administering medications. Examples include:
You’ll find more information and guidance in the
Medication Practice Standard.
Yes, nurses can dispense medications, including narcotics, to clients under their care with a client-specific order from an authorized health professional. Nurses must meet the requirements set out in the
Medication Practice Standard and follow workplace policy.
It is not always possible or practical to watch your clients take the medications you administer; however, one of your responsibilities when administering medications is to verify that medications you administer are taken. Verification can take the form of watching the client take the medication or asking the client (or delegate) if they have taken the medication. Verification is an important step in the process.
Medications assumed to have been taken but not, or those left with the client to be taken, can create potential safety issues. For example, your client may tell you that they have taken the medication when in fact they are saving several doses to take at one time.
Each client and practice setting is unique so you will need to use your nursing judgment to decide the best way to verify medication administration. Some medications may be subject to workplace policies where you must observe the client taking it (i.e., methadone).
Yes, they can. Pharmacists are authorized through the
Health Professions Act and their regulatory college's
Professional Practice Policy-58 (PPP-58) Medication Management (Adapting a Prescription):
(Note, policy (PPP-58)
does not apply to controlled drug substances and cancer chemotherapy agents.)
For example, a pharmacist is authorized to substitute a generically equivalent drug or interchange drugs to the closest manufactured dose—if the medication order is for a 300 mg tablet but the standard dose available is 325 mg, the pharmacist may dispense a 325mg tablet.
Pharmacists are not authorized to interchange or substitute medications if the prescriber indicates that no substitutions are allowed or that a specific drug manufacturer's product be dispensed.
Selena is new to rural nursing practice. For the last three months she’s been working at a small community hospital. Tonight, she is working in the Emergency department.
While Selena is reviewing her client’s lab results at the nursing station, she hears footsteps. She looks up to see a man who hands her a paper and says, “My doctor sent me to get this filled.” Selena sees it’s a prescription from a local physician.
Selena asks him to take a seat and tells him she needs to assess him. He says that he doesn’t have time for that, “I’ve already seen my doctor. Can’t you just give me the pills so I can go?”
Selena considers her options. She knows the hospital has the medication in stock. There isn’t a pharmacist on site, but she knows nurses can dispense medications to clients with a physician’s/NP’s client-specific order.
That’s not correct. If Selena dispenses the medication, she would not be meeting the
Medications Practice Standard. While she has an order for the medication, the man is not her client. Without knowing anything about him, she’s not able to determine if the order is appropriate for him.
What are potential consequences of dispensing to someone who is not your client?
Correct. Selena doesn’t dispense the medication because the man is not her client, and she can’t determine whether the medication ordered is appropriate. Selena lets the man know he must either be assessed or take the prescription to a pharmacy to be filled.
Nurses dispense medications
only for clients under their care and when it is in the best interest of the client. When nurses dispense medications, without a pharmacist’s involvement, they need to ensure its proper use, and the pharmaceutical and therapeutic suitability. Before dispensing, nurses:
Medication Practice Standard provides nurses with the information to dispense medications safely.
You are working in a small community hospital. One of your clients has been discharged with a prescription for antibiotics. The local pharmacy is closed. The unit has a stock of this medication.
Correct. Nurses can dispense medications to a client under their care when it is in the client’s best interest, the medication has been ordered by an authorized health professional, and where organizational policy allows.
That’s not correct. Under the Regulations, nurses can dispense a medication when a pharmacist is not available if the medication has been ordered by an authorized health professional and where organizational policy allows.
That’s not correct. Sometimes it may be more appropriate for another nurse or a physician to dispense the medication. If you think you are not the most appropriate person to dispense the medication, consult the health professional who gave the medication order to determine the best course of action.
During the morning medication administration round, you notice a new medication on a client’s MAR that you are unfamiliar with.
That’s not correct. Nurses adhere to the ‘rights’ and checks of medication administration: Right medication, Right client, Right dose, Right time, Right route, Right reason and Right documentation. Nurses understand how medication errors and near misses can occur and take steps to prevent them.Refer to the
Medication Practice Standard.
That's not correct. Nurses determine all orders for a client are clear, complete, current, legible and appropriate for the client before administering any medication. (See the Medication Practice Standard).
Correct! Nurses are responsible for administering medications and adhering to the ‘rights’ and checks of medication administration: Right medication, Right client, Right dose, Right time, Right route, Right reason and Right documentation. (See the
Medication Practice Standard).
That’s not correct. Before administering any medication, nurses are knowledgeable about the effects, side effects and interactions and take action as necessary. Refer to the
Medication Practice Standard.
Workplace policies may place restrictions on medication administration over and above that of the nursing Regulations and BCCNM standards, limits and conditions. Organizations are responsible for providing the supports and systems necessary for safe medication administration by nurses, including medication reconciliation and reporting of medication incidents and near misses.