FACULTY OF NURSING POLICY SUBJECT/TITLE: Medicatin Preparatin and Administratin fr Undergraduate Nursing Students (Calgary Campus and Medicine Hat Cllege Site) PAGE: 1 f 6 RELATED POLICIES: *Specialized Clinical Cmpetencies fr Undergraduate Students (Calgary Campus and Medicine Hat Cllege Site) Dcumentatin in Practice Areas AUTHORIZATION: Practice Plicy and Prcedure Cmmittee Undergraduate Prgrams Cmmittee Nursing Cuncil DATE ESTABLISHED: April 7, 2010 DATE LAST REVISED: Nvember 6, 2017 Nvember 23, 2017 December 11, 2017 This plicy applies t all undergraduate students in the Faculty f Nursing. *Fr students enrlled in Terms 7 and 8, als refer t the RELATED POLICIES referenced abve. Agency plicies supersede this plicy. Purpse T supprt the prvisin f safe and effective medicatin administratin in a variety f practice settings. T prmte a safe learning envirnment fr nursing students during preparatin and administratin f medicatins. Definitins In this plicy: A. HEALTH CARE PROFESSIONAL means a nurse r ther regulated health prfessinal wh is qualified by educatin, training, and prvincial/federal licensure/regulatin and wh practices within their prfessinal determined scpe f practice. B. UNDER DIRECT SUPERVISION means that the Nursing Instructr/ Preceptr (r a practice site Health Care Prfessinal (see definitin) at the discretin f the Nursing Instructr/Preceptr) is present in the practice setting at the pint f care and is prviding supervisin at the elbw f the nursing student fr nly that which falls within the supervising qualified Health Care Prfessinal s scpe f practice.
Page 2 f 6 C. UNDER INDIRECT SUPERVISION means that the Nursing Instructr/ Preceptr (r a practice site Health Care Prfessinal at the discretin f the Nursing Instructr/ Preceptr) is readily available n the unit r in the same lcatin fr guidance and cnsultatin but is nt directly at the elbw f the nursing student, fr nly that which falls within the supervising qualified Health Care Prfessinal s scpe f practice. D. INDEPENDENT DOUBLE-CHECK requires a qualified Health Care Prfessinal t separately check each cmpnent f the wrk prcess (ISMP, 2013a), including the 7 rights f medicatin administratin (right medicatin, dse, client, rute, time/frequency, dcumentatin and reasn [CARNA, 2015]). The persn asking fr the duble check must nt influence the individual checking the prduct in any way (ISMP, 2013a). If a practice site plicy requires tw independent qualified Health Care Prfessinal signatures fr administratin f a particular medicatin, then the student must btain signatures frm tw independent qualified Health Care Prfessinals in this case the student s signature cannt cunt as ne f the independent signatures. Plicy Statement 1. Medicatin Administratin: Nursing students will fllw the guidelines fr cmpetent medicatin administratin: Nursing students are respnsible fr functining within their level f cmpetence, recgnizing their limitatins and fr seeking cnsultatin r directin when needed (CARNA, 2015, p.28). A student may nt administer ANY medicatins until he/she has cmpleted the related thery and n-site practice, and has successfully cmpleted the medicatin calculatin exam. Students must cmplete the 7 rights f medicatin administratin (right medicatin, dse, client, rute, time/frequency, dcumentatin, and reasn, [CARNA, 2015]), and 3 checks prir t administering any and all medicatins. The 3 checks include: 1) Cmpare the medicatin label t the MAR as yu remve the drug frm the strage area, 2) Cmpare the medicatin label t the MAR as yu prepare each drug, 3) Cmpare the medicatin label t the MAR at the patient s bedside befre yu administer each drug (ATI Nursing Educatin, nd) Students will initially administer medicatin Under Direct Supervisin in all practice curses. A student wh has demnstrated safe practice during directly supervised medicatin administratin is permitted t administer medicatins via the fllwing rutes Under Indirect Supervisin at the Nursing Instructr/Preceptr s discretin (if allwed by site plicy): nasal gastric, ral gastric, nasal jejunal, buccal, intranasal, rectal, and tpical rutes. Nursing students cannt be the C-Signer fr smene else.
Page 3 f 6 2. Independent duble-checks by qualified Health Care Prfessinal(s): Nursing students administering the fllwing classes f drugs must have them Independently Duble-Checked (including c-signature) by a minimum f ne qualified Health Care Prfessinal. If a qualified Health Care Prfessinal is permitted t administer the medicatin independently, then the nursing student must have the medicatin independently dublechecked by ne qualified Health Care Prfessinal. If a qualified Health Care Prfessinal requires the medicatin t be independently dublechecked, then the nursing student must have the medicatin independently duble-checked by tw qualified Health Care Prfessinals - in this case the student s signature cannt cunt as ne f the independent signatures. Narctics (c-signature required n patient chart and narctic cunt sheet, including wastage). Students are nt permitted t administer narctics via cntinuus infusin (exceptin, see #15) Insulin (s/c) and ral antihypglycemics. Students are nt permitted t administer insulin via cntinuus infusin (exceptin, see #15) Anticagulants. Students are nt permitted t administer heparin via cntinuus infusin (exceptin, see #15) Cyttxics - ral All divided dses, e.g. breaking tablets, multi-dse vials Medicatins requiring cmpunding, which means t mix tgether tw r mre ingredients f which at least ne is a drug fr the purpses f dispensing a drug r drugs, but des nt include recnstituting a drug r drugs with nly water (Gvernment Organizatin Act. R.S.A. 2000, c. G-10, Sch. 7.1, 1(b), p. 38). Pediatric, infant, and nenatal medicatins The nursing student and qualified Health Care Prfessinal must als cnsult and adhere t any applicable practice site plicies. 3. Peripheral Intravenus (IV) Medicatin Administratin: Students in Terms 6-8 are permitted t change primary bag slutins and prepare IV medicatins via mini-bags, including recnstitutin, Under Direct Supervisin. Students may administer the same Under Indirect Supervisin nce deemed cmpetent by the Nursing Instructr/Preceptr. Nursing students must cnsult with and adhere t any applicable practice site plicies, which culd supersede r limit this practice. 4. IV Push Medicatins: Terms 3 thrugh 7 Nursing students in Terms 3 thrugh 7 are nt permitted t administer IV medicatins via IV push. Term 8 Nursing students in Term 8 are nt permitted t administer IV medicatins via IV push, unless identified as an acceptable specialized clinical cmpetency, at the discretin f unit management and
preceptr(s). Refer t Specialized Clinical Cmpetencies fr Undergraduate Students plicy. Page 4 f 6 5. Peripheral Saline Lcks: Nursing students in Terms 6-8 (fllwing cmpletin f the IV medicatin administratin n-site practice sessin) are permitted t, Under Direct Supervisin f the Nursing Instructr/Preceptr (r qualified Health Care Prfessinal at the discretin f the Nursing Instructr/Preceptr) flush a saline lck with a saline flush. The student and Nursing Instructr/Preceptr must adhere t practice agency plicy. 6. Central Venus Catheters: Terms 3 thugh 6 Nursing students in Terms 3 thrugh 6 are nt permitted t administer medicatins r change slutins via a central venus catheter, midline catheter, and PICC line under any circumstances. Terms 7 and 8 Nursing students in Terms 7 and 8 are nt permitted t administer IV medicatins (abve r belw the pump) r change slutins abve the pump via a central venus catheter, midline catheter, and PICC line, unless identified as an acceptable specialized clinical cmpetency, at the discretin f Unit Management and Preceptr(s) r Nursing Instructr. Refer t Specialized Clinical Cmpetencies fr Undergraduate Students plicy. 7. Hypdermclysis: Nursing students in Terms 7 and 8 are permitted t initiate hypdermclysis and administer medicatins via this rute after participating in the related n-site practice sessin and demnstrating knwledge f the related plicy and prcedures t their Nursing Instructr/Preceptr. These skills are t be carried ut Under Direct Supervisin f the Nursing Instructr/Preceptr (r a qualified Health Care Prfessinal). 8. Weight-Based Medicatins: Nursing students are permitted t administer weight-based medicatins (where the weight f the client is included in the calculatin f the dsage) after they have cmpleted the related n-site practice sessin and demnstrate knwledge f this prcess. If a qualified Health Care Prfessinal is permitted t administer the weight-based medicatin independently, then the nursing student must have the medicatin independently dublechecked by ne qualified Health Care Prfessinal. If a qualified Health Care Prfessinal requires the weight-based medicatin t be independently duble-checked, then the nursing student must have the medicatin independently duble-checked by tw qualified Health Care Prfessinals - in this case the student s signature cannt cunt as ne f the independent signatures. The nursing student and Nursing Instructr/Preceptr must als cnsult and adhere t any applicable practice site plicies. 9. Influenza Vaccines: Students must attend site training (r equivalent) and pass required testing as applicable. Students are permitted t administer influenza vaccines Under Indirect Supervisin at the Nursing Instructr/Preceptr s discretin (if allwed by site plicy) nce deemed cmpetent.
10. Vaccines (exceptin, influenza vaccinatin refer t #9). Students must attend site training (r equivalent) and pass required testing as applicable. Page 5 f 6 If a qualified Health Care Prfessinal is permitted t administer the vaccine independently, then the nursing student must have the vaccine independently duble-checked by ne qualified Health Care Prfessinal. If a qualified Health Care Prfessinal requires the vaccine t be independently dublechecked, then the nursing student must have the vaccine independently duble-checked by tw qualified Health Care Prfessinals - in this case the student s signature cannt cunt as ne f the independent signatures. 11. Bld and Bld Prducts: Nursing students are permitted t administer bld and bld prducts Under Direct Supervisin after they have cmpleted the related n-site practice sessin and demnstrate knwledge f the related plicy and prcedures t their Nursing Instructr/Preceptr. The nursing student and Nursing Instructr/Preceptr must als cnsult and adhere t any applicable practice site plicies. If a qualified Health Care Prfessinal is permitted t administer the bld prduct independently, then the nursing student must have the bld prduct independently dublechecked by ne qualified Health Care Prfessinal. If a qualified Health Care Prfessinal requires the bld prduct t be independently dublechecked, then the nursing student must have the bld prduct independently dublechecked by tw qualified Health Care Prfessinals - in this case the student s signature cannt cunt as ne f the independent signatures. 12. Infusin pumps: Dse errr reductin sftware shall be activated and utilized when available. Apprpriate drug prfiles frm the drug library shall be utilized where available (AHS, Infusin Pumps fr Medicatin & Parenteral Fluid Administratin, 2016). Independent duble-checking f the pump prgramming is required fr medicatins that require independent-duble checks. 13. Patient cntrlled analgesic (PCA) / Patient cntrlled epidural analgesic (PCEA): Nursing students are nt permitted t manipulate r regulate these pumps r replace cartridges r slutins. Students may check values, but they may nt clear the values. 14. Chemtherapy: Nursing students are nt permitted t administer intravenus chemtherapy (accrding t the Prvincial Cancer Cntrl Skills Certificatin dcument, 2014). Intravenus chemtherapy may nt be administered by students, even if identified as a specialized clinical cmpetency. 15. Term 8 - Directly Supervised Medicatin Administratin: Nursing students in Term 8 are permitted t give the fllwing medicatins Under Direct Supervisin, if identified as an acceptable specialized clinical cmpetency, at the discretin f Unit Management and Preceptr(s)/Nursing Instructr. Refer t
Page 6 f 6 Specialized Clinical Cmpetencies fr Undergraduate Students plicy. Nursing students in Terms 5, 6, and 7 are nt allwed t administer the fllwing: High alert medicatins (ISMP, 2014) Heparin infusins Insulin infusins Oxytcin infusins (intrapartum) Direct IV push medicatins Parenteral nutritin Narctic (piid) cntinuus infusins Medicatins abve the pump with central lines, mid-line catheters, and PICCs If a qualified Health Care Prfessinal is permitted t administer the medicatin independently, then the nursing student must have the medicatin independently dublechecked by ne qualified Health Care Prfessinal. If a qualified Health Care Prfessinal requires the medicatin t be independently dublechecked, then the nursing student must have the medicatin independently duble-checked by tw qualified Health Care Prfessinals - in this case the student s signature cannt cunt as ne f the independent signatures. The nursing student and Nursing Instructr/Preceptr must als cnsult and adhere t any applicable practice site plicies. 16. Verbal Orders/Transcriptin f Orders: Nursing students are nt permitted t receive and /r transcribe verbal rders, in persn r via telephne. References Alberta Health Services (2016). Infusin Pumps fr Medicatin & Parenteral Fluid Administratin. ATI Nursing Educatin. (n.d.). Medicatin Administratin 3. Retrieved frm http://www.atitesting.cm/ati_next_gen/skillsmdules/cntent/medicatin-administratin- 3/equipment/safety.html Cllege and Assciatin f Registered Nurses. (2015). Medicatin guidelines. Retrieved frm http://www.nurses.ab.ca/cntent/dam/carna/pdfs/dcumentlist/guidelines/medicatinguidelines_ Mar2015.pdf Gvernment Organizatin Act. Revised Statutes f Alberta. (2000). Alberta Queen s Printer. Institute fr Safe Medicatin Practices Canada. (2013a). Independent duble checks: Undervalued and misused: Selective use f this strategy can play an imprtant rle in medicatin safety. Retrieved frm https://www.ismp.rg/newsletters/acutecare/shwarticle.aspx?id=51 Institute fr Safe Medicatin Practices Canada. (2014). ISMP list f high-alert medicatins in acute care settings. Retrieved frm https://www.ismp.rg/tls/highalertmedicatins.pdf