Common questions about changes to medication administration provisions

When will these changes come into force?

The amendments come into effect on 30 May 2006.

What medications are covered by this legislation?

The provisions apply to Schedule 4, 8 and 9 medications only. Only drugs prescribed by a doctor and dispensed by a pharmacist may be administered. These are drugs that most adults outside of a residential aged care service would usually administer themselves. For all ‘high care’ aged care residents, nurses will be required to manage the administration of these drugs.

Who can administer drugs to ‘high care’ residents?

Nurses will be required to manage the administration of drugs to ‘high care’ aged care residents. Under the Code for guidance issued by the Nurses Board of Victoria they may only delegate the administration to someone appropriately qualified to administer drugs. The new provisions will require that nurses ‘manage’ rather than ‘administer’ drugs to high care residents in residential aged care services. This means that nurses will use their professional judgement about whether to administer the drugs themselves or whether to delegate the administration to someone with appropriate qualifications. In many instances nurses will continue to administer drugs themselves.

Will personal care workers be able to administer drugs to high care residents?

Personal care workers with appropriate drug administration training may in some circumstances be competent to administer drugs under the supervision of a nurse. These are drugs that are prescribed by a doctor and dispensed by a pharmacist. If a nurse judges that a personal care worker is not appropriately qualified to administer to a ‘high care’ resident they would administer the drugs themselves. Personal care workers are already administering drugs to residents in hostels. Now for the first time when administering drugs to high care residents in hostels personal care workers will require the supervision of a nurse who may if necessary take over administration themselves.

Why can’t a Registered Nurse Division 2 (endorsed) manage the administration of medication?

Registered nurses Division 2 (endorsed) may administer medication under the direction of an RN Division 1,3 or 4. However, their scope of practice does not allow them to administer medication by all routes or to manage administration of medication.

Can a Division 2 nurse (endorsed) supervise the work of another worker who is administering medication?

Yes, the RN1, 3 or 4 who is managing the administration of medication to residents could delegate the routine supervision of other workers to an endorsed Division 2 nurse, within the medication management plan that they have determined. A non-endorsed Division 2 nurse could not be delegated this supervision as they do not have training in medication administration.

Are there plans to broaden the scope of practice of Registered Nurses Division 2 (endorsed)?

Yes. Work is in progress within the profession to extend the educational preparation of RN2s (endorsed) so that they may be recognised by the Nurses Board of Victoria as also being able to administer medication by intramuscular and sub-cutaneous routes.

Does this mean that Division 2 nurses (endorsed could also manage the administration of medication in the future?

Further change to the scope of practice of RN2s may pave the way for such a change in the future, but it would also require a change to the Drugs Poisons and Controlled Substances Act.

If a personal care worker can administer routine medications under supervision, why can’t a Division 2 nurse without endorsement do something as simple as applying an anti-fungal cream?

This is a professional practice matter rather than a legal matter. A Division 2 nurse without medication endorsement currently has no training in medication administration. Accordingly, their current scope of practice does not allow them to administer medications of any kind. The law does not preclude anyone from administering a medication other than a Schedule 4, 8 or 9 medication. However, good practice dictates that such a task should only be delegated to someone with the training and competence to do so.

Who will be held accountable if a nurse delegates a medication administration task to a non-nurse and something goes wrong?

As in all other aspects of their professional activity, a nurse is accountable for their professional decisions and actions. If a nurse demonstrates that delegation decisions have been properly made in accordance with professional practice guidelines (including especially the Code for guidance issues by the NBV) and appropriate supervision and monitoring arrangements have been put in place and followed, they need not be concerned about being held responsible for an adverse incident. The worker to whom the task is delegated would also be held accountable to the extent of their training and for following the systems and procedures required of them.

Is there still a requirement that two people check and ‘sign out’ Schedule 8 or 9 drugs?

Please see the storage and records page. There is no specific legal requirement for checking (and was not under the ‘old’ regulations either). Procedures in each aged care service should be determined in accordance with good practice.

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