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.
I have a client who was recently admitted to the unit. Their admission assessments and associated documentation has been completed but the primary healthcare provider won't be in for another couple of hours to write medication orders. The client is complaining of moderate pain due to a headache. Can I treat this client's pain within my autonomous scope of practice (i.e., give pain medication without an order)?
The controls on practice and the Medication practice standard can guide you in your decision-making. Your first step is to determine whether this is an activity you are:
Start by thinking about the activity and the controls on practice by asking these questions:
According to the Nurses Regulation, nurses are authorized to: administer/dispense Schedule II & III medications and a limited number of Schedule I medications within their autonomous scope of practice.
BCCNM's standards, limits and conditions outline the requirements you need to meet when acting within autonomous scope of practice. Nurses are authorized to act within their autonomous scope of practice if they meet the principles outlined in applicable standards.
Check relevant policies and protocols at your workplace for carrying out a medication-related activity without a client-specific order. Specifically, does the organization allow it? What policies need to be followed when carrying out the activity? Can you meet all these requirements?
Evaluate your individual competence in carrying out the activity. Do you have the required knowledge, skills and abilities to do so safely?
If you determine that you are authorized to carry out the activity, review the Medication practice standard to see what additional requirements you need to meet related to medication-related activities and acting within your autonomous scope of practice. Remember, when acting within autonomous scope of practice nurses are the most accountable and responsible provider when administering or dispensing a medication without an order. Being the sole decision-maker increases risks to the client.
Additional Medication practice standard requirements:
Acting within Autonomous Scope of Practice thinking tool can help you.
After reviewing the controls on practice, the Acting within Autonomous Scope of Practice standard and the Medication practice standard, you determine that you are authorized and competent to treat your client's condition within your autonomous scope of practice.
Following your workplace's protocol for autonomously treating mild to moderate pain, and consulting your client about their wishes, you administer pain medication and document your care in the client's medical record. You communicate your intervention to the client's care team.