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.
- In our facility, we provide clients with their ordered medications when they leave on day pass. Is this dispensing? What’s our responsibility when we do this?
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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:
- Making sure the medication is labelled and packaged appropriately for the client
- Providing your client with information about the medication, including its purpose, when and how to take, 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?
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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:
- 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
Follow your workplace policies when preparing 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?
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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.
- Do I have to watch my client take/swallow the medications I administer?
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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).
- The pharmacist has substituted the medication ordered by my client’s health care provider. Are they allowed to do this?
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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):
1. Changing the dose, formulation, or regimen of a prescription;
2. Renewing a prescription for continuity of care; or
3. Making a therapeutic drug substitution within the same therapeutic class for 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.