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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.

Practice Standard

Resources

FAQs

In our facility, we provide clients with medications when they leave on day pass. Is this dispensing? What’s our responsibility when we do this?

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 organization, you’re responsible for taking steps to ensure proper use. This includes:

  • Making sure the medication is labelled and packaged appropriately for the client
  • Providing your client with information about the medication, including its purpose, possible side effects, and when and how to take it
  • Documenting on the client’s record that you dispensed the medications

The Medication Practice Standard provides clear direction for labelling, packaging, client education and documentation.

What is the difference between preparing and pre-pouring medications? Can I pre-pour medications?

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 preparing medications in advance and storing them until you or others administer them. For example:

  • Drawing up and labelling an IV medication to administer later in the day
  • Removing client medications from a blister pack and placing them in labelled medication cups to administer throughout your shift
  • Preparing a PRN medication in a syringe, labelling it and administering it throughout your shift

Do not pre-pour medications as it blurs the accountability for ensuring the medication rights are met and it increases the risk of errors.
If you can’t administer medications right after preparing them, make sure they are securely stored. Follow your organizational policies and use your professional judgment when deciding how far in advance to prepare your medications.

There are limited situations where you may share the responsibility for preparing and administering medications. Examples include:

  • In a life threatening situation, when the client’s need for medications is urgent, you draw up and label medications and another nurse gives them
  • You start an IV infusion that other nurses will be responsible for maintaining

You’ll find more information and guidance in the  Medication Practice Standard.

Can nurses dispense narcotics?

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 organizational policy.

Do I have to watch my client take/swallow the medications I administer?

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 are 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 organizational/employer policies where you must observe the client taking it (i.e. methadone).

Mini case studies

Scenario 1

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 medication order 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 order. 

What should Selena do?

Dispense the medication

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?

  • Inability to check pharmaceutical and therapeutic suitability of the medication for the client
  • Cannot document dispensing as there is no client record
  • Cannot obtain the best possible medication history and review the client’s PharmaNet profile and medical record
  • Unable to review allergies or past adverse reactions, contraindications, therapeutic duplications or potential drug interactions, alcohol or drug use and other health issues
Not dispense the medication

Correct. Selena doesn’t dispense the medication because the man is not her client and she can’t determine whether the medication order 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:

  • Review the order for completeness and appropriateness (e.g., dosage, route, frequency)
  • Review the client’s medication history and other health information
  • Consider potential drug interactions, allergies, contraindications (e.g., adverse side effects)

The Medication Practice Standard provides nurses with the information to dispense medications safely.


Scenario 2

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.

What should you do?

After ensuring pharmaceutical and therapeutic suitability, dispense the medication following organizational policy.

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.

Do not dispense the medication because there is no pharmacist on site.

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.

Dispense the medication even though you are not familiar with its use.

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.


Scenario 3

During the morning medication administration round, you notice a new medication on a client’s MAR that you are unfamiliar with.

What do you do?

Do not administer it because you are not familiar with it. Leave the new medication for the next shift.

That’s not correct. Nurses adhere to the ‘rights’ 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.

B: Consult with the charge nurse before giving the medication then look up the medication in an organization-recognized drug guide following the completion of the morning medication administration round.

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).

Look up the new medication in an organization-recognized drug guide before administering it. If you still have concerns, discuss the medication with the dispensing pharmacist.

Correct! Nurses are responsible for administering medications and adhering to the ‘rights’ of medication administration: Right medication, Right client, Right dose, Right time, Right route, Right reason and Right documentation. (See the Medication Practice Standard).

Administer the new medication. After administration, call the pharmacist to discuss possible interactions with current medications.

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.

Organizational 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. ​​