1.
| Nurses perform only those medication-related activities as allowed by:
|
| a.
| Relevant provincial or federal legislation or regulations,
|
| | b.
| BCCNM’s ethics standards and practice standards including any applicable limits, and conditions on performing the activity,
|
| | c.
| Organizational/employer policies, processes, and restrictions, and
|
| | d.
| The nurse’s individual
competence.
|
2.
| Nurses follow relevant provincial or federal legislation or regulations, BCCNM’s ethics standards and practice standards including any applicable limits, and conditions on performing the activity, and organizational/employer policies, processes, and restrictions when performing any medication-related activity. |
3.
| Nurses use current evidence to support their decision-making about
medications and their medication practices.
|
4.
| Nurses follow infection prevention and control principles when performing medication-related activities.
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5.
| Before performing any medication-related activity, nurses know the medication’s:
|
| | a.
| Therapeutic use/indications,
|
| b.
| Expected effects,
|
| c.
| Dosage(s),
|
| d.
| Precautions,
|
| e.
| Contraindications,
|
| f.
| Form (e.g. tablet, liquid), and route for administration,
|
| g.
| Interactions,
|
| h.
| Side effects, and
|
| i.
| Adverse effects.
|
6.
| Nurses assess the appropriateness of the medication for the
client before administering, dispensing, or prescribing a medication.
|
7.
| Nurses assess and respect the client’s values, beliefs, personal preferences, language, learning needs, abilities, mental state, and level of understanding, to support the client (or the
client’s representative) to be an active participant in making informed decisions about the medication.
|
8.
| Nurses educate the client (or the client’s representative) about the medication they are receiving, including, as applicable:
|
| a.
| The reason the client is receiving the medication,
|
| b.
| The expected action of the medication,
|
| c.
| The duration of the medication therapy,
|
| d.
| Specific precautions or instructions for the medication,
|
| e.
| Potential side-effects and adverse effects (e.g. allergic reactions) and action to take if they occur,
|
| f.
| Potential interactions between the medication and certain foods, other medications, or substances,
|
| g.
| Handling and storage requirements,
|
| h.
| Recommended follow-up.
|
9.
| Nurses identify the effect of their own values, beliefs, and experiences on their clinical decision-making about medication related activities, recognize potential conflicts and take action for the client’s needs to be met.
|
10.
| Nurses take action when a medication does not seem:
|
| a.
| Appropriate, because the client’s condition has changed,
|
| b.
| Evidence-informed, or
|
| c.
| Reflective of the client’s individual needs, characteristics, values/beliefs, or personal preferences.
|
11.
| Nurses collaborate, communicate, and/or consult with the health-care team in making decisions about medication-related activities, including:
|
| a.
| Consideration of the broader plan of care for the client developed by the health-care team,
|
| b.
| The follow-up needed with respect to medication when the client’s care is transferred to another health professional, or when the client transfers to another clinical or care setting or to their home,
|
| c.
| When the client’s care would benefit from the expertise of other health care professionals,
|
| d.
| When the needs of the client exceed the nurse’s individual competence or scope of practice, and
|
| e.
| Documenting the plan of care.
|
12.
| When a pharmacist has not reviewed and verified a medication’s pharmaceutical and therapeutic suitability, or if it is unclear whether this has occurred, nurses take steps to ensure pharmaceutical and therapeutic suitability before administering or dispensing a medication by: |
| a.
| Reviewing the client’s best available medication history and other personal health information,
|
| b.
| Assessing the client’s known allergies and ensuring medication allergy information is documented,
|
| c.
| Considering potential medication interactions, contraindications, therapeutic duplications, side effects, adverse effects, and any other potential problems,
|
| d.
| Using current, evidence-informed resources to support their clinical decision-making, and
|
| e.
| Considering the client’s ability to follow the medication regimen.
|
13.
| Nurses administer, dispense, or prescribe medications only for clients under their care, except in an emergency.
|
Medication administration |
14.
| Before administering a medication to a client, nurses verify, at minimum, the:
|
| a.
| Client name and second client identifier,
|
| b.
| Medication,
|
| c.
| Dose,
|
| d.
| Time and frequency,
|
| e.
| Route, and
|
| f.
| Reason for administration to the client.
|
15.
| Before administering a medication, nurses ensure they have the competence to:
|
| a.
| Monitor the client’s response to the medication, and
|
| b.
| Recognize and manage intended and adverse outcomes of the medication.
|
16.
| Nurses only administer medications they themselves, a pharmacist, or a pharmacy technician have prepared, except in an emergency or during large-scale immunization efforts where organizational policies, processes, and restrictions are in place to ensure safe practices. |
17.
| Nurses record the administration of medication on an individual medication profile and/or client record each time a medication is administered.
|
Dispensing medications |
18.
| When dispensing a medication, nurses:
|
| a.
| Ensure the product has not expired,
|
| b.
| Label the medication legibly with:
|
|
| i. Client name and second client identifier, ii. Medication name, dosage, route, and strength, iii. Directions for use, iv. Quantity dispensed, v. Date dispensed, vi. Initials of the nurse dispensing the medication, vii. Name, address, and telephone number of the agency from which the medication is dispensed, viii. Name and designation of the prescribing health professional, and ix. Any other information that is appropriate and/or specific to the medication,
|
| c.
| Hand the medication directly to the client, or, if appropriate, to the client’s representative or another authorized delegate.
|
19.
| When dispensing a medication, nurses record dispensing information on an individual medication profile and/or client record that includes:
|
| a.
| Client name, address, phone number, date of birth,
|
| b.
| Allergies and adverse medication reactions, if available,
|
| c.
| Date dispensed,
|
| d.
| Name, strength, dosage of medication,
|
| e.
| Quantity of medication dispensed,
|
| f.
| Intended duration of therapy, specified in days (if applicable),
|
| g.
| Directions to client,
|
| h.
| Name of prescribing health professional, and |
| i.
| Signature and title of the person dispensing the medication.
|
20.
| In response to the opioid crisis, nurses are authorized to dispense naloxone to a person who is neither their client nor their client’s representative, but who may encounter an individual experiencing a suspected opioid overdose.
|
| a.
| In this instance, which is an exception, nurses would not be expected to follow all of the principles outlined above with respect to a potential individual recipient of the naloxone, to the extent it is not possible to do so when that individual’s identity is unknown.
|
| b. | Nurses take steps to ensure public safety by teaching the person to whom they dispense the naloxone how to respond to individuals experiencing a suspected opioid overdose.
|
| c.
| Nurses follow all applicable organizational/employer policies, processes, and restrictions, regarding naloxone.
|
Acting within autonomous scope of practice (without an order)
|
21.
| Nurses are accountable and responsible when they make a decision that a client’s physical or mental condition would benefit from the administration or dispensing of a medication within their autonomous scope of practice. |
22.
| When administering or dispensing a medication within their autonomous scope of practice, nurses:
|
| a.
| Follow organizational policies, processes, and restrictions, as applicable.
|
| b.
| Assess the client’s health status including allergies.
|
| c.
| Make or confirm a
nursing diagnosis of a condition[1],[2] that can be improved or resolved by administering or dispensing a medication
|
| d.
| Decide whether the client would benefit from the medication, having considered.
|
|
| |
| e.
| Manage, monitor, and evaluate the client’s response to the medication (as applicable) including intended and unintended outcomes.
|
| f.
| Communicate and collaborate with the client (or the client’s representative) and the health-care team and document the nursing diagnosis, decision, actions, and outcomes related to the medication administered or dispensed to the client.
|
Preventing medication errors |
23.
| Nurses identify the human and system factors that may contribute to medication errors and/or near misses, and they act to prevent or minimize them.
|
24.
| Nurses take action, including following organizational/employer policies, processes, and restrictions, and when an error or near miss occurs at any point of a medication-related activity.
|
Medication inventory management |
25.
| Nurses who have responsibility for the management of medication inventory follow organizational/employer policies and processes and, as needed, consult with, and seek guidance from expert resources and pharmacists regarding:
|
| a.
| Handling,
|
| b.
| Storage,
|
| c.
| Organizing of medication,
|
| d.
| Security,
|
| e.
| Transport,
|
| f.
| Disposal, and
|
| g.
| Recording of medications.
|