Protect Your Practice

Risk Management

printer

Medicine and vaccine storage

As a practice manager, you are responsible for protecting your patients and ensuring that systems are in place to ensure that the correct medication or vaccination will be administered to the correct patient, at the correct time, in the correct dose and by the correct route as ordered. To ensure this occurs, it is essential to provide staff with guidelines on minimum requirements for correct medication management, including ordering, storing, checking and administration.

 

Improve your practice

  1. Only authorised registered nurses (RNs), appropriately endorsed enrolled nurses (ENs) under the supervision of an RN or a GP and medical practitioners are authorised to check and administer medications. Some states may have different and specific drug therapy protocols e.g. Queensland Health has specific protocol details for isolated practice areas and rural hospitals, nurse practitioners, midwives and orthoptists.
  2. Registered nurses should only administer medications as prescribed by a medical practitioner. Unless an emergency, all medication orders should be documented prior to administration. In an emergency situation, medication may be administered by an RN on the advice of a telephone order from the medical practitioner (preferably confirmed by a second RN if available). The telephone order should be confirmed in writing as soon as possible after the event and within 24 hours.
  3. The RN should not alter any medication order. Any changes to a medication order should be confirmed with the relevant medical practitioner, the order cancelled and if the medical practitioner is unavailable, written in progress notes in the patient’s medical record.
  4. Once the medication has been administered, it should be documented in the appropriate section of the patient’s clinical notes and on the patient’s medication chart if available. Vaccinations should also be recorded in the patient’s medical summary (electronic or otherwise).
  5. All medications should be checked before administration.
  6. The following classifications of medication and patient identity should always be checked by two registered nurses (Division 1) or one registered nurse (Division 1) and a medical practitioner:
    1. all drugs of addiction (S8 drugs), regardless of route.
    2. the oral medication warfarin.
    3. all injections, regardless of route
    4. all infusions
    5. all parenteral medications.
  7. The protocol for administering any medication involves checking:
    1. the doctor’s orders before administering the correct medication is given to the right patient
    2. the correct dose is given.
    3. it is given via the correct route
    4. it is given at the correct time
    5. the expiry date of the medication is checked.
    6. that any cold chain requirements have been met (vaccines, particularly if not stored appropriately, can become ineffective).
  8. If a medical practitioner is administering a medication – and especially if a parenteral medication – and an RN is not available to check the medication, then (unless an emergency) at the minimum, the patient (or their nominated carer/parent) should check, as they have a vested interest in ensuring they will be receiving the correct medication/dose.
  9. The person administering the medication is responsible for knowing:
    1. the clinical status of the patient receiving the medication
    2. the storage characteristics of the medication they are administering
    3. the indications and contraindications of the medication to be administered
    4. the action and normal general dosage of the medication to be administered
    5. the medication’s side effects and potential complications
    6. how to recognise any reaction to the medication
    7. how to recognise as early as possible serious or life-threatening reactions to the medication
    8. the practice protocols for reactions to medications
    9. how to institute first line support to the patient while awaiting the doctor
    10. the location of emergency drugs for treating severe medication reactions and that those drugs are available and in-date.
    10. Practice managers should be aware that a medication should not be administered until all these factors are clarified. When in doubt, the medical practitioner or pharmacist should be contacted for advice. Additional information may be gained from current pharmacological reference, e.g. MIMS or from the manufacturer’s information line and often, poisons information lines are able to provide such information.
  10. Before administering a medication to a patient, the patient’s identity should be confirmed by checking.
    1. name
    2. ID number
    3. date of birth on the medication chart
    4. details on the patient’s identification band.
  11. The RN or medical practitioner responsible for the administration of a medication should always check the patient’s allergy and sensitivity status prior to a medication being administered. The medication should be withheld if the patient has had any previous reaction to the medication or if the patient’s allergy/sensitivity status is not able to be determined.
  12. Medications should be kept in a locked cupboard if they are in areas where non-authorised people/patients might have unsupervised access.
  13. Vaccines should be kept in an appropriate temperature controlled environment in line with the manufacturer’s recommendations. Appropriately trained practice staff must regularly monitor the temperature of vaccine storage to ensure vaccine viability.
  14. An unlocked cupboard containing medications should not be left unattended.
  15. The RN/medical practitioner administering a medication should only sign that a medication has been administered after it has been administered.
  16. The RN/medical practitioner responsible for the administration of a medication is also responsible for monitoring the patient for side effects and complications, after the medication has been administered, and ensuring the patient remains under observation for an appropriate time (dependent upon the medication).
  17. If a drug is withheld or contraindicated for any reason, the reason should be documented in the patient care plan/progress notes stating the date, time and the reason the medication was withheld. The relevant medical practitioner should be informed.
  18. The RN/medical practitioner should monitor for any adverse reactions from an administered medication and report any complications. In the event of an adverse drug reaction, the following should occur:
    1. Promptly inform the relevant medical practitioner concerned about the reaction.
    2. Administer emergency treatment as necessary according to practice protocols.
    3. Place drug alert labels/warnings on the medication chart and medical record (electronic or otherwise).
    4. Document the incident in the patient’s clinical notes and complete an adverse event form.
  19. Medications should be returned to their boxes/cartons where possible, as these may contain information such as storage, use by dates, etc.
  20. Medications should preferably never be transferred from their original container to another container (unless a parenteral medication is being drawn up into a syringe), but if the medication/syringe is not to be used immediately then it must be clearly labeled as to its contents and date and appropriately stored. Unlabeled medications must never be given unless the practitioner themselves has transferred the medication and the medication has not been put down whilst awaiting administration.

Next page

Tracking tests
  • Setting up your practice support systems
  • Computer systems
  • Manual systems
  • Central register

Icon TemplatesTemplates

Icon linksLinks

This publication is proudly brought to you by Avant Mutual Group. The content was authored by Brett McPherson, reviewed by Colleen Sullivan and Avant Mutual Group.

This publication is not comprehensive and does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practice proper clinical decision making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgment or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss suffered in connection with the use of this information. Information is only current at the date initially published. © Avant Mutual Group Limited 2014.

IMPORTANT: Professional indemnity insurance products and Avant’s Practice Medical Indemnity Policy are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and consider the policy wording and PDS, which is available at www.avant.org.au or by contacting us on 1800 128 268. Practices need to consider other forms of insurance including directors’ and officers’ liability, public and products liability, property and business interruption insurance, and workers compensation and you should contact your insurance broker for more information. Cover is subject to the terms, conditions and exclusions of the policy. Any advice here does not take into account your objectives, financial situation or needs. You should consider whether the product is appropriate for you before deciding to purchase or continuing to hold a policy with us.