DISPENSING BY REGISTERED NURSES

Transcription

1 1999 DISPENSING BY REGISTERED NURSES

2 This Interpretive Document was approved by ARNNL Council in 1999.

3 Dispensing By Registered Nurses Dispensing is a practice of pharmacy in the province of Newfoundland and Labrador. Dispensing, however, has traditionally been a practice requirement for registered nurses in geographical areas of our province with no access or limited access to a pharmacist. In such communities, dispensing will continue to be a necessary part of the nurse s scope of practice and a valuable service for the people they serve. As a means of ensuring public safety, the Association of Registered Nurses of Newfoundland (ARNNL) developed this document to guide the practice of registered nurses who are given the authority to dispense prescribed medications. Dispensing Defined The Newfoundland Pharmaceutical Association Act (1994) identifies dispensing as a practice of pharmacy and defines dispense as to provide a substance or item ordered by prescribing but does not include the administration of that substance or item to a person or animal (p. 3). The Act further describes the practice of pharmacy to include: subdividing or breaking up a manufacturer s original package of a drug for the purpose of repackaging the drug in larger or smaller quantities for re-distribution or retail sale (p. 4). Legal Authority for Dispensing by Registered Nurses The legal authority for dispensing by registered nurses is found in Section 3(2) of the Pharmaceutical Act, which reads as follows: This Act shall not extend to or interfere with the dispensing of necessary drugs or medicines by registered nurses in the course of duty when practicing with the approval and under the general supervision of a hospital board (p. 5). There are two common types of situations where registered nurses are required to dispense medications in their course of duty and in the best interest of patient care. In emergency areas, the registered nurse may dispense a portion of prescribed medications for a patient when the community pharmacist and the hospital pharmacist are not available and there is an urgency to dispense a small portion of the prescribed medications. Examples of such situations include, for example, preventing excessive hardship for the patient, initiating a course of antibiotic therapy, and controlling the spread of a communicable disease. This practice has a long-standing history for registered nurses and is commonly referred to as accessing the night cupboard or accessing tide over medications. This practice also applies to infrequently occurring situations where nurses on general duty units may need to dispense from an emergency stock supply established by the pharmacist, enough prescribed medications to cover a patient s unexpected short leave of absence period or a pass from a health care facility. The second commonly occurring situation is a practice expectation for registered nurses working in communities with no access to a community pharmacy to dispense all prescribed medication and over the counter medications on a routine basis. In such communities, the registered nurse may be the only health care provider available to assume the responsibility for dispensing on an ongoing basis Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca ARNNL.CA

4 Association of Registered Nurses of Newfoundland and Labrador Criteria to be Met Before the Registered Nurse Dispenses Medication The decision about whether the registered nurse s scope of practice will include dispensing is a responsibility of the Hospital Board for whom the nurse is employed. The Board must consider a number of factors and give approval to dispensing prior to the registered nurse incorporating this role into practice. The following criteria should exist before a registered nurse is given the responsibility to dispense: 1. Dispensing by the registered nurse does not compromise nursing care requirements. 2. The pharmacy department deems that it is appropriate and necessary for another health care professional to dispense in the particular situation(s) under review. 3. An in-house pharmacist is not available (note: some Boards may also require that the physician who is responsible for dispensing in absence of the pharmacist, is not available), 4. There is no immediate access to a community pharmacy, and 5. In emergency departments, there is an urgency to dispense the medication. It is the responsibility of the Hospital Board to provide registered nurses with the appropriate education and supervision to ensure medications are dispensed safely and in accordance with accepted standards. In addition, agency policies, procedures and quality assurance mechanisms must be in place to monitor dispensing practices and all aspects of management of the pharmacy. All policies, procedures, and quality assurance initiatives must be developed by the pharmacy department and in collaboration with nursing, where appropriate. The Board must also ensure that registered nurses have access to relevant and current reference material. Professional Expectations for Dispensing The registered nurse s primary duty is to the patient and to the delivery of safe, competent, and ethical nursing care as described in the ARNNL (1995) Standards for Registered Nurses in Newfoundland and Labrador. In respect to dispensing, the registered nurse is also held accountable to practice according to accepted standards governing this practice. Accepted standards governing dispensing are found in Part 111 Standards of the (1998) Pharmaceutical Association Regulations. Standards applicable to registered nurses are identified in this document. There is considerable similarity between the standards governing the administration of medications and dispensing medications. In addition, there is considerable overlap in the knowledge and the competencies required for both practices. For example, practice expectations for both include: ensuring the prescription order is appropriate, identification of possible drug interactions and known allergies, seeking clarification of orders as necessary, and providing appropriate health and drug information to the patient. Significant areas of overlap will not be addressed in this document. Rather, select sections of the Pharmaceutical Regulations unique to dispensing practices will be identified. Nurses and their employers are referred to the Regulations for more detailed information. 2 ARNNL.CA 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca

5 Dispensing By Registered Nurses When Dispensing From the Night Cup Board It is the responsibility of the Board to ensure policies and procedures are developed collaboratively with the Pharmacy Department to govern the partial filling of a prescription by the registered nurse and the preparation of drugs to cover a patient s leave of absence. These policies should ensure dispensing remains the primary responsibility of the pharmacist and should address all aspects of documentation and/or communication required between the dispensing nurse and the Pharmacy Department. They should also identify any areas where exceptions occur to the standards identified in the Regulations, for example, the use of properly labeled envelops to hold a 24 hour portion of a prescription rather than the use of a child resistant container as required by the Pharmaceutical Association Regulations. When small amounts of a medication are dispensed in an envelope, the following information must be clearly visible on the envelope: Patient s name dispensing date; brand name of the drug, or generic name of the drug and name of manufacturer; quantity and strength of the drug; directions to the patient; identification of practitioner prescribing the medication; the initials of the registered nurse dispensing the prescription. It is important to note that providing a patient with a small supply of medications from the night cupboard which have been previously dispensed by a pharmacist in a child proof container, a blister package or a vial does not constitute dispensing. This is an accepted practice. When nurses provide patients with this type of previously dispensed medication, attention must be given to ensuring labels are properly completed. When Dispensing is a Routine Part of the Nurse s Scope of Practice In keeping with the Regulations, the registered nurse is expected to: 1. Maintain patient medication profiles on all patients. The profiles should be reviewed before dispensing to identify problems and take appropriate action where applicable. The profiles should include the following patient information: surname and given names; address; telephone number; sex; date of birth; chronic medical conditions; notations of allergies and drug reactions; and any other notations of importance (these notations would be at the professional judgment of the registered nurse, for example, the results of a request for clarification of the order). 2. Include the following prescription information on patient medication profiles and labels: dispensing date; prescription number; brand name of the drug, or generic name of the drug and name of manufacturer; quantity and strength of the drug; directions to the patient; identification of practitioner prescribing the medication; number of authorized refills; and the initials of the registered nurse dispensing the prescription Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca ARNNL.CA

6 Association of Registered Nurses of Newfoundland and Labrador 3. Dispense solid medications in child resistant containers as designated by the Canadian Standards Association. Exemptions to this, as Identified in the Pharmaceutical Association Regulations, include: The prescriber, the patient or his or her agents directs otherwise, In the professional judgment of the registered nurse, in each instance, it is advisable not to use the child resistant containers; and A child resistant container is not suitable because of the physical nature of the drug. 4 Not fill prescriptions beyond one year from the date on which the prescription was originally written. 5. Retain prescription information recorded on a patient s medication profile for 2 years from the date of entry. 6. Retain every original prescription on file for 2 years from the date of prescription. It is recognized that in some Boards, the original prescription is retained on the client s health record rather than on file in the Pharmacy Department. 7. Destroy all superfluous confidential records or labels concerning patients and prescriptions by Shredding or by incineration. Examples of superfluous information may need to be identified in Boards specific policies. Summary In summary, this document has been developed to guide safe dispensing practices of registered nurses. It describes the standards governing the dispensing of medications as identified in the Newfoundland Pharmaceutical Regulations. Nurses and their employers are referred to the Regulations for more detailed information. References Association of Registered Nurses of Newfoundland. (1994). Standards of Practice for Registered Nurses in Newfoundland and Labrador. St. John s: Author. Newfoundland and Labrador. (1998). Pharmacy Association Regulations. St. John s: Queens Printer. Newfoundland and Labrador. (1994). Newfoundland Pharmaceutical Association Act. St. John s: Queen s Printer. 4 ARNNL.CA 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca

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8 55 Military Road St. John's NL Canada A1C 2C5 Tel (709) (800) (NL only) Fax (709) info@arnnl.ca arnnl.ca