Managing drugs in residential Aged Care services

This summary is prepared by the Drugs and Poisons Regulation Group (DPRG) to assist Approved Providers in understanding relevant provisions of the Drugs Poisons and Controlled Substances Act 1981 and Regulations 2006.  This document does not include the many and varied options that are covered by the legislation.  Instead, it focuses on the circumstances that may be applicable to the vast majority of residential aged care services.  For example, to simplify many issues, references to dentists, nurse practitioners, authorised optometrists and Schedule 9 poisons have not been included. Reference must be made to the legislation (website www.legislation.vic.gov.au) for full details of requirements.

Relevance of the Drugs & Poisons Legislation

Drugs and Poisons legislation is not generally intended to apply to medications, after the medications have been supplied on prescription, for the treatment of a specific person – regardless of whether the person resides in a private home or in a residential care service.  However the legislation is intended to apply when a resident in an aged care service becomes more dependent on others for the management and administration of prescribed medications.  

Key terms

Schedule 8 poisons (labelled Controlled Drug) are drugs with more strict legislative controls, eg. morphine (Kapanol®, MS-Contin®) and oxycodone (Oxycontin®, Oxynorm®, Endone®).

Schedule 4 poisons (labelled Prescription Only Medicine) include other drugs for which prescriptions are required, eg. cardiovascular drugs, antibiotics, sleeping tablets & many others.

 “Aged care service", "approved provider" and "high level residential care" have the same meaning as in the Aged Care Act 1997 of the Commonwealth.

The term “imprest drugs” is intended to describe Schedule 4 and Schedule 8 poisons that are not supplied on prescription for a specific person but which are obtained by an establishment under the authority of a Health Services Permit (HSP).  The vast majority of residential aged care services do not need and do not hold a HSP; those that do must refer to the Poisons Control Plan that relates to their own HSP to review the different legislative controls that apply to imprest drugs.

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High level residential care

Where a resident in an aged care service is receiving high-level residential care, the Drugs, Poisons and Controlled Substances Act 1981 (the Act) specifies that the administration of Schedule 4 or Schedule 8 poisons, supplied on prescription to that resident, must be managed by a nurse registered in Division 1, 3 or 4 under the Nurses Act 1993.

The approved provider of the aged care service is responsible under the Act for ensuring that a nurse manages the administration of medication to residents receiving high-level residential care. Penalties apply.

The Act also requires nurses to have regard to guidelines (a ‘code’) issued by the Nurses Board of Victoria (NBV) when managing the administration of medication.  It is an offence, under the Nurses Act 1993, for a person to direct or incite a nurse to do anything that would constitute unprofessional conduct.

The following requirements are applicable to a residential aged care service where a resident receiving high-level residential care has been supplied, on prescription, with Schedule 4 or Schedule 8 poisons.

Storage of Schedule 4 and Schedule 8 poisons

Approved providers of residential aged care services, where there is a resident receiving high-level residential care:

• must store all Schedule 4 poisons in a lockable storage facility.

• must store all Schedule 8 poisons in a lockable room or a lockable storage facility, which is firmly affixed to the floor or wall.
• must ensure that all Schedule 4 and Schedule 8 poisons are locked away except when they need to be administered.
• may maintain a single storage system for Schedule 4 and Schedule 8 poisons for all residents receiving these medications.
• are not obliged to maintain separate storage facilities for high care residents and other residents.

To accommodate the increased use of Dose Administration Containers, Schedule 8 poisons supplied on prescription need not be stored in the steel drug cabinet that was mandated for nursing homes under the previous regulations.  However, it is recommended that Schedule 8 drugs presented in original containers are stored in a steel drug cabinet.  Schedule 8 imprest drugs must still be stored in a steel drug cabinet.  The Department of Health may also direct the use of more secure storage.

Records of Transaction

Approved providers of residential aged care services where there is a resident receiving high-level residential care must maintain true and accurate records, for Schedule 4 and Schedule 8 poisons, in a readily retrievable form for 3 years.  See Regulation 40 for details that must be recorded.
 
Approved providers of residential aged care services must also maintain a drug register, which requires a balance of stock on hand to be maintained, for Schedule 8 poisons except when:

• the medicines are supplied on prescription for a specific person; and
• the medications are supplied in tamper evident dose administration containers, and
• the containers are labelled with administration times.

Clearly a drug register will still be required for Schedule 8 poisons that are supplied in liquid form, supplied in other than tamper-evident dose administration containers or supplied as imprest drugs.

The approved provider of the residential aged care service must also:

• investigate discrepancies in records and notify the Department of Health of any unresolved discrepancies.
• notify the Department of Health or the Victoria Police of any loss or theft of Schedule 4 or 8 poisons.
• notify the Department of Human Service of any loss, destruction or theft of records relating to Schedule 8 poisons.

Responsibilities of Nurses

Please refer to the document “Key Requirements for Nurses in Residential Aged Care Facilities”, which is available of the web at: www.health.vic.gov.au/dpu

Health Services Permit (HSP) to obtain imprest stock

Some residential aged care services choose to obtain a HSP, for which an annual fee must be paid, to enable them to obtain medications that have not been prescribed for specific patients, so that the medications are readily available in the event of an emergency.  Each HSP contains conditions that are specific to the type of health service provided and require the approval of a Poisons Control Plan (PCP) that states how such medications will be managed at the service.

All relevant application forms, details of fees, Poisons Control Plans plus instructions for how to complete them, are available on the web at: www.health.vic.gov.au/dpu

For further information

Department of Health (DHS) 
Drugs and Poisons Regulation Group,
GPO Box 4541,
Melbourne 3001

Tel: 1300 364 545    
Fax: 1300 360 830

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