The following information is provided in response to member questions pertaining to medication administration.

PREPOURING OR PRE-FILLING MEDICATIONS*

Q.: “I am a nurse working in a nursing home. Can I pre-pour medications into a ‘day’ container or medication box for the resident who may be going out on pass?”

A: The NYS Boards for Nursing and Pharmacy recommended that nurses not pre-pour medications to be administered by the patient/client or another individual, except for self directing:

• nursing home residents who leave the nursing home for several days;
• persons receiving home care - Up to 8 days of medications can be prepared (pre-poured) for self-administration by such individuals. The nurse is responsible for determining the degree to which an individual is self-directive.

*NYS Education Department, Office of the Professions, Nursing: under Practice Information: RN & LPN Practice Issues, “Prefilling Medication Boxes in Home Care Settings.”

Q.: “As a school health nurse, I’m faced with how to handle a student requiring medication while on a field trip.”

A.: Same as pre-pouring or pre-filling medications above. School children are included in the answer.

Q.: “As a nurse in an OMRDD certified setting, I have been asked to pre-pour medications into a medication box for unlicensed assistive personnel (UAP) to administer. Is this acceptable?”

A.: Unlicensed attendants in institutions under the jurisdiction of OPWDD may, if adequate medical and nursing supervision is provided, administer medications after they complete a medication administration course and have demonstrated their competence to the satisfaction of the RN.

*NYS Education Department, Office of the Professions, Nursing: under Practice Information: RN & LPN Practice Issues, OMRDD (the former name for OPWDD).

RE-LABELING MEDICATIONS

Q.: “I received an order to change the dosage of one of the medications for a home care patient. The patient recently had this prescription refilled and cannot afford to discard the existing medication. Since the tablets are scored, is it acceptable for me to make a change on the label of the existing bottle to reflect to new orders?”

A.: RNs are not legally allowed to “label medication bottles”, except in very limited situations. An RN may change the dosage on one medication for a home care patient if the patient had the prescription refilled at a lower dose and could not afford to discard the existing scored medication. In this instance the Board requested the nurse to change the dosage on the existing bottle and to document the change in the patient’s progress record.

Source: 2002 Nursing Practice Alert

TREATMENT OF ANAPHYLAXIS WITHOUT A PATIENT SPECIFIC ORDER

Q.: “Many students report allergies and, as such, epi-pens are now available in the school. What will happen if I am unavailable to administer?”

A.: RNs may administer emergency treatment for anaphylaxis pursuant to a non-patient specific order/protocol prescribed or ordered by a physician or NP. LPNs may assist an RN with anaphylaxis treatment (i.e., record-keeping, administer anaphylaxis agents). 

AUTHORITY OF NURSES TO POSSESS ANAPHYLACTIC TREATMENT AGENTS*

RNs and LPNs are legally allowed to possess anaphylaxis agents and devices that are not ordered and labeled for a specific patient – pursuant to a non-patient specific order.

USE OF EPINEPHRINE AUTO-INJECTOR DEVICES IN THE SCHOOL SETTING

LPNs and unlicensed trained school staff, when responding to an emergency, may administer epinephrine to a student with a known severe allergy needing anaphylactic treatment as prescribed for the student by a licensed prescriber. An RN may train unlicensed persons to administer an epi-pen in an emergency where a nurse or other licensed individual is not available.

Source: 6/2002 memo by Duncan-Poitier and Kadamus

*NYS Education Department, Office of the Professions, Nursing: under Practice Information: RN & LPN Practice Issues, Epinephrine Auto injector Devices in School Settings.

AVAILABILITY OF MEDICATIONS WHEN THE PHARMACY IS CLOSED

Q.: “I work the night shift in an Emergency Department. Occasionally, it is necessary to provide a patient with medication upon discharge, until they can get a prescription filled at the Pharmacy. Is this an acceptable practice?”

A.: Healthcare facilities may maintain a “night” or “emergency medication” that permits nurses to administer medications ordered after the pharmacy is closed (making available medications ordered for newly admitted patients and for situations where the supply of medications for a patient does not meet the demand). The facility should have a protocol covering the medication cart and it should require that a “log” be kept of all medications, the person distributing them, and the name of the client receiving them.

Source: 1990 letter by Megel

In ERs, RNs may provide patients with an emergency supply of medications until a pharmacy is open and the prescription can be filled. The patient’s medical record must identify the drugs prescribed and the drugs given to the patient. Controlled substances provided to the patient must be accounted for in ER department administration records.

Source: Boards of Nursing and Pharmacy

DISPENSING MEDICATIONS

Q.: “I'm a nurse who works part-time in a planned parenthood clinic. Many of our clients return to pick up oral contraceptive packs when a prescriber is not onsite. Can I provide or is this considered dispensing?”

A.: NPs may dispense or compound medications for their own patients.

RNs and LPNs may, at the direction of an authorized prescriber, package and label a drug and give it to the authorized prescriber who must check it for accuracy and dispense it to the client.

Generally, RNs, LPNs and non-licensed personnel may “hand-over” to patients a supply of medications (that was dispensed by a pharmacist or physician) in college health facilities, family planning clinics, etc. A pharmacist or physician must be available at least by phone to provide required counseling should the client so request.

Source: 2002 letter by Zittel; comment by Mokhiber

COUNSELING FOR PRESCRIBED DRUGS

Pharmacists who dispense a drug must be available, if only by telephone, to provide drug counseling to patient who request this service — even when the medication that has been dispensed by a pharmacist, is “handed-over” to a patient by an RN, LPN, or unlicensed person in the absence of the pharmacist. 

For questions related to this alert, contact Nursing Education and Nursing Practice: 518.782.9400, ext. 282