Department of Health and Human Services SYSTEM PURCHASING AND PERFORMANCE - MEDICATION STRATEGY AND REFORM Authority to Prescribe Medications Policy SDMS Id Number: Effective From: June 2014 Replaces Doc. No: Custodian and Review Responsibility: Contact: Applies to: Policy Type: Policy ID (as assigned by Corporate Document and Information Services) New SPP Medication Strategy and Reform Director Medication Strategy and Reform THO-North, THO-South, THO-North West DHHS-Wide Policy Review Date: June 2016 Keywords: Routine Disclosure: Prescribe, medication, administer, initiate, supply Yes Approval Prepared by Sulfi Newbold Medicines Policy Officer 61661029 16 May 2014 Through Through Cleared by Anita Thomas Senior Specialist Pharmacist Quality Use of Medicine THO-N Medication Management and Safety Committee THO-NW Medication Safety & Improvement Committee THO-S Quality Use of Medicine Committee John Kirwan Karen Linegar Matthew Daly THO-N Chief Executive Officer THO-NW Acting Chief Executive Officer THO-S Acting Chief Executive Officer 61661086 16 May 2014 16 May 2014 6 June 2014 2 June 2014 3 June 2014 Revision History Version Approved by name Approved by title Amendment notes This Policy may be varied, withdrawn or replaced at any time. Compliance with this directive is mandatory for the Department of Health and Human Services. PLEASE DESTROY PRINTED COPIES. The electronic version of this Policy is the approved and current version and is located on the Department of Health and Human Services Strategic Document Management System. Any printed version is uncontrolled and therefore not current. Page 1 of 5
Purpose The purpose of this policy is to define the authority and legal parameters of Tasmanian Health Organisation (THO) staff to prescribe, initiate therapy with, or supply medication to THO patients. In addition to medical practitioners, a range of THO staff are authorised to prescribe or supply medications to patients. Restrictions may apply to medications that can be prescribed (or supplied or initiated) by non-medical staff, and may be specific to the scope of practice of the individual staff member. Staff members with varying prescribing authority are: authorised nurse practitioners, dentists, endorsed eligible midwives, and endorsed optometrists. This policy summarises the Poisons Act and Poisons Regulations as they apply to THO health services, and provides the operational framework for staff to prescribe safely and in accordance with the Tasmanian Medicines Formulary (Formulary). Mandatory Requirements This is a statewide policy and must not be re-interpreted so that subordinate policies exist. Should discreet operational differences exist, these should be expressed in the form of an operating procedure or protocol. Failure to comply with this policy, without providing a good reason for doing so, may lead to disciplinary action. Prescribing of medications is supported by staff who are authorised by legislation to: Administer a medication (i.e. dose a patient with medication) Supply a medication (i.e. provide a medication to a patient for their use) Initiate medication therapy (i.e. commence treatment with a medicine by prescribing, administering or supplying that medicine.) All endorsed THO policies on medication management, including Formulary restrictions and medication supply, apply for all medications that are to be dispensed through the THO Pharmacies. Supply of medications by any THO staff must comply with regulatory and policy requirements. The person prescribing, supplying, and/or administering the medication must be acting within their scope of professional practice, training, and legal status. Medical Practitioners Medical Practitioners may prescribe, supply and administer medications to THO patients provided the use of that medication is for a Therapeutic Goods Administration (TGA) registered indication or is supported by the Formulary for that indication, is within the medical practitioner s scope of practice, and complies with Tasmanian legislation. Medication administration must be suitable within that setting. For non-formulary medications see DHHS: Provision of non-formulary medications through Tasmanian public hospital pharmacies. This Policy may be varied, withdrawn or replaced at any time. Compliance with this directive is mandatory for the Department of Health and Human Services. PLEASE DESTROY PRINTED COPIES. The electronic version of this Policy is the approved and current version and is located on the Department of Health and Human Services Strategic Document Management System. Any printed version is uncontrolled and therefore not current. Page 2 of 5
Eligible Midwives An eligible midwife is a registered midwife who has a notation on their Nursing and Midwifery Board Australia (NMBA) registration, stating the midwife is competent to provide pregnancy, labour, birth and postnatal care and qualified to provide the associated services and order diagnostic investigations required for midwifery practice, in accordance with relevant State legislation. An eligible midwife may also be endorsed (Scheduled Medicine Endorsement), where they have completed a program recognised by the NMBA. A Scheduled Medicine Endorsed eligible midwife may prescribe and/or supply NMBA approved Schedule 2, 3, 4 and 8 substances, to the extent authorised under the State legislation, for the management of women and their infants in the pre-natal, intrapartum, and post-natal stages of pregnancy and birth. Midwives who are NOT classified by the NMBA as an eligible midwife, and are NOT Scheduled Medicine Endorsed, have the authority to review a patient and administer a medication in accordance with a general or standing order. These orders must comply with the requirements of the Poisons Regulations, and the administration must be in accordance with a written order, formally authorised by a medical prescriber. Nurses Nurses are not authorised to prescribe or supply medications. Registered Nurses may initiate therapy with some medications by administration only, as described in the DHHS policy: Administration of Registered Nurse and Midwife Initiated Medication [link]. Nurses may initiate therapy only in accordance with that Policy, which authorises the initiation of a specified range of TGA approved Schedule 2, Schedule 3, or unscheduled medications. Enrolled Nurses may not initiate therapy with any medications, irrespective of whether they are medication endorsed or whether the medication is unscheduled. Some nurses may be approved by the Director of Public Health to administer or supply vaccines independent of a Medical Practitioner, under an approved vaccination program. The supply of medication to a patient by a Registered Nurse under section 25A must be in conjunction with a medication order authorised by a medical practitioner. Supply must be consistent with legislative requirements. Nursing staff must administer medications in accordance with legislative requirements and DHHS; Medication Management for Nurses and Midwives [link]. Nurse Practitioners A Nurse Practitioner is a Registered Nurse whose registration has been endorsed by the NMBA as having an advanced and extended clinical role. A Nurse Practitioner who is authorised to prescribe or supply medications by the Secretary of DHHS is called an Authorised Nurse Practitioner. Authorised Nurse Practitioners have conditional prescribing and supply authority for a defined range of scheduled medicines, specific to their individual position and scope of practice, as approved by the Secretary of DHHS. [link] Page 3 of 5
Details of Authorised Nurse Practitioner medicines formularies can be accessed through Pharmaceuticals Services Branch on the DHHS intranet. [link] As Registered Nurses with additional qualifications, Nurse Practitioners retain the authority to safely and appropriately administer medication, as required, within their role and scope of practice. Optometrists In the course of their practice, registered optometrists may administer diagnostic ophthalmic medications from a defined list of medications, as approved by AHPRA [link]. In addition to this, registered optometrists whose registration has a scheduled medicine endorsement may be approved to administer, supply and prescribe a broader range of topical medications if they are suitably qualified and have received approval to do so from the Optometry Board of Australia [link]. Dentists In the course of their practice, registered dentists may administer or prescribe medications to THO patients provided the use of that medication complies with Tasmanian legislation, is suitable for administering in that setting, and is consistent with any other relevant policies (including the use of the Formulary). Pharmacists Although pharmacists are legally allowed to initiate medication therapy by supplying S2 or S3 medications to a patient (following appropriate assessment of that patient), this is not supported in THO policy. Any medication that is to be supplied by a THO Pharmacy must be documented as a prescription (or inpatient medication order) by an authorised prescriber. Pharmacists may legally amend prescriptions written by prescribers, provided the medication change is communicated with, and agreed to, by the prescriber. The prescriber must send to pharmacy a rewritten or amended prescription within 24 hours where legally required. Podiatrists Podiatrists may administer a local anaesthetic that is Schedule 2, 3, or 4 to a patient whom they are treating, provided they have the necessary skills and training [link]. Administration may be via any route that is applicable to the podiatrist s training and scope of practice. Verbal, Telephone, Facsimile and Email Medication Orders Verbal, telephone, faxed and emailed medication orders are acceptable for use in THO health services if issued by an authorised prescriber. Orders must be consistent with Tasmanian legislation and locally documented procedures. General and Standing Orders Standing orders are not currently approved under the Poisons Regulations [link]. In the event that standing orders become authorised under the Poisons Regulations, THOs using this provision must have appropriate processes and documentation in place to ensure safe and effective medication supply. Page 4 of 5
General orders are allowable for the administration of specified medications by midwives under the section 94 of the Poisons Regulations [link]. THOs utilising this provision must have appropriate processes and documentation in place to meet the requirements of the legislation. Roles and Responsibilities/Delegations Each THO is responsible for implementing this policy within their health services. All healthcare professionals must practice within their scope and within the limits outlined by this policy and state and national legislation surrounding the prescription and administration of medications. Risk Implications Medications are only to be prescribed within the limits of this policy to ensure patient safety is upheld. This policy is consistent with national and state laws surrounding the prescribing of medications. Failure to comply with this policy may have legal or professional repercussions for the staff involved. Training All staff involved in medication management must be made aware of this policy. The prescription of certain items may require additional training and documentation of credentialing. THOs should keep a record of which items are restricted and which prescribers are authorised to prescribe. Audit This policy will be included in the work program of the DHHS Internal Audit function. This work program is approved by the Audit and Risk Committee and will assess underlying systems and procedures for compliance with the requirements of this policy. The overall focus of this assessment will be one of continuous improvement to DHHS activities. THOs are responsible for auditing compliance with this policy. Attachments Related Documents/Useful Resources 1 Tasmanian Poisons Act 1971 [link] 2 Tasmanian Poisons Regulations 2008 [link] 3 Health Practitioner Regulation National Law [link] 4 DHHS: Provision of non-formulary medications through Tasmanian public hospital pharmacies. 5 NMBA Prescribing Formulary for Eligible Midwives with a Scheduled Medicines Endorsement 6 NMBA approved lists of Scheduled medicines for eligible midwives with a Scheduled Medicine Endorsement Page 5 of 5