MEDICATION ADMINISTRATION Topic 1A Drug Schedules

Identify the schedules of drugs relevant to nursing practice It is the Poisons and Therapeutic Goods Act 1966 ( NSW ) who impose some limitation on the use of many potent drugs by restricting their distribution to certain groups or persons trained in handling them and permitting their administration only on medical authority.

It is the Poisons and Therapeutic Goods Act provides for the establishment of a Poisons List, which consists of eight schedules.

1.( DANGEROUS POISONS ) Extreme danger to life. Only available from Medical Practioners e.g. Atropine, Arsenic

2. Medicinal Poisons Poisons for therapeutic use which are available to the public only from pharmacies. Dangerous to life if misused or carelessly handled. e.g. Panadol, Aspirin, Codeine

3. Potent Substances Poisons for therapeutic use, which are dangerous or liable to abuse. Their availability to the public is restricted to supply by pharmacists and medical practioners/ dentists/ vets. e.g. Insulin

4. Restricted Drugs Substances which in the public interest should be supplied only on the written prescription of a medical practitioner, dentist or veterinary surgeon. e.g. Oral hypoglycaemic agents, Cortisone Barbiturates.

4D. Prescribed Restricted Substances Substances which are also only available to the public on the prescription of an authorised person. These substances are treated differently because of their potential for misuse and abuse. e.g. Diazepam, Midazolam

5. Domestic Poisons Poisons of a hazardous nature, which are readily available to the public but require caution in handling storage and use. e.g. Bleach, Hydrogen peroxide

6. Industrial and Agriculture Substances which should be readily available to the public for agricultural, pastoral, horticultural, veterinary, photographic or industrial purposes or for the destruction of pests. e.g.Phenol

7. Special Poisons Poisons which require special precautions in manufacture, handling, storage or use or special individual regulations regarding labelling or availability. e.g. Insecticides

8. Drugs of Addiction Substances which produce addiction or have such potential. A drug register must be kept. e.g. Morphine, Pethidine

STORAGE Nurse in charge of the ward is responsible for the storage of all drugs. Must met legal requirements that is security, temperature and stock rotation. Storage should be such a way that it minimises errors

GENERAL SCHEDULE 4 MEDICATIONS  Must be stored out of patient and public access. ( locked cupboard, locked room or locked medication trolley ).  Keys kept by the nurse in charge of the ward or their delegate who must be a registered /authorised enrolled nurse.  Emergency or anaesthesia trolleys are exempt for locked storage

Please note that Drug keys must be kept from ward keys.

SCHEDULE 4 APPENDIX D Liable to abuse Stored separate from all other drugs except S8 No other goods should be stored in the same place ( e.g. cash, keys ) S4D Drug key and S8 keys can be kept together but with no other ward keys and carried by an RN.

Stored in a secure bedside storage that is inaccessible to other patients or visitors e.g. locked bedside drawer to which the patient may hold the key.

STORAGE IN ORIGINAL PACKS All drugs should be stored in their original packs or containers as received from Pharmacy

MEDICATION INCIDENT REPORTING  Part of quality improvement programs, should have a system in place.  All disciplines should be encouraged to report incidents even near miss incidents  Drug committee for review.  Circular – Incidents Reportable to the Department 97/58.

What do you think should be included on the medication order ?

Medication Order  Must use a patient medication chart ( area health logo )  Allergies/ adverse drug reactions  Clear, legible and unambiguous  Patient full name, DOB,MRN and or address.  age, weight of a paediatric patient

Medication Order  Name of medication ( what name trade chemical or generic ?? )  Strength of medication  Form of medication  Dose, route, and frequency  Date of cessation, total number of doses or finite time period of administration.

Medication Orders  Signature and date. Each individual medication order must be written in a separate box and each medication order must be signed.  To cease a medication order the MO must draw a line across the area of the chart where administration is recorded ( after the last entry ) and sign and date adjacent to this line.

Medication Orders  If a drug is not to be given on certain days, the prescriber must cross out those days on the medication chart, to prevent errors.  Medication orders must not be duplicated so the drug is not administered twice in error/

Medication Orders  A MO should confirm their intention to order any dose that could be considered to be unusually high by underlining and initialling the dose.