Medicine and vaccine storage

Improving your practice

1. Only authorised registered nurses (RNs), appropriately endorsed enrolled nurses (ENs) under the supervision of a RN and medical practitioners are authorised to check and administer medications.
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 the "verbal orders only" section of the chart.
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: 
   - All drugs of addiction (S8 drugs), regardless of route
   - The oral medication warfarin
   - All injections, regardless of route
   - All infusions
   - All parenteral medications.
7. The checking of a medication involves checking the following:
   - The doctor's orders before administering
   - The correct medication is given to the right patient
   - The correct dose is given
   - It is given via the correct route
   - It is given at the correct time The expiry date of the medication is checked
   - 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:
   - The clinical status of the patient receiving the medication
   - The storage characteristics of the medication they are administering
   - The indications and contraindications of the medication to be administered
   - The action and normal general dosage of the medication to be administered
   - The medication's side effects and potential complications
   - How to recognise any reaction to the medication
   - How to recognise as early as possible serious or life-threatening reactions to the medication
   - The practice protocols for reactions to medications
   - How to institute first line support to the patient whilst awaiting the doctor
   - The location of emergency drugs for treating severe medication reactions and that those drugs are available and in-date.
   
   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 the patient's:
    - Name
    - ID number
    - Date of birth on the medication chart
    - 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. An unlocked cupboard containing medications should not be left unattended.
14. The RN/medical practitioner administering a medication should only sign that a medication has been administered after it has been administered.
15. 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).
16. 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.
17. 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:
    - Promptly inform the relevant medical practitioner concerned about the reaction.
    - Administer emergency treatment as necessary according to practice protocols.
    - Place drug alert labels/warnings on the medication chart and medical record (electronic or otherwise).
    - Document the incident in the patient's clinical notes and complete an adverse event form. Medications should be returned to their boxes/cartons where possible, as these may contain information such as storage, use by dates, etc.
18. 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 labelled as to its contents and date and appropriately stored. Unlabelled medications must never be given unless the practitioner themself has transferred the medication and the medication has not been put down whilst awaiting administration.