With the move to national registration, there is no longer a specific code to assist nurses to manage the administration of scheduled medications to high care residents. Despite this, it remains the law in Victoria that only a Registered Nurse (not an Enrolled Nurse) can manage the administration of schedule 4 and 8 medication to high care residents in an aged care facility. The term "manage" was addressed in detail in the now defunct Code for Guidance.
The Drugs and Poisons Regulation Group (DPRG) - part of the Victorian Department of Health - have issued substantial guidelines to assist both nurses and providers understand their obligations post July 1. These guidelines also reflect the new titles of Registered and Enrolled Nurse. The Drugs Poisons and Controlled Substances Act 1981 and Regulations 2006 determine who can "prescribe", "dispense" "possess" and "administer" certain dangerous medications.
The DPRG advise that where a resident in an aged care service is receiving high-level residential care, the Act specifies that the administration of Schedule 4 or Schedule 8 poisons, to that resident, must be managed by a "Registered Nurse". Compliance with the legal requirement to ensure each high-care resident's medication is "managed" may be met thorough compliance with the DPRG guidelines. According to the DPRG, an Enrolled Nurse, including an Authorised Enrolled Nurse (medication endorsed) cannot manage the administration of medication to high-care residents.
The Registered Nurse with overall responsibility for management of medication must be readily identifiable to nurses, personal care staff and medical staff and be able to be contacted by DPRG. It is expected that the position will be formalised in the service's organisational framework and position description and that staff are aware of that Registered Nurse's role. The Registered Nurse must also be free from coercion and have the necessary resources to carry out the management of the medication in accordance with their professional judgement and applicable professional nursing standards, for example in regard to delegation and supervision. Section 136 of the Schedule to the Health Practitioner Regulation National Law (Victoria) Act 2009 replaced a similar provision in Section 85 of the Health Professions Registration Act 2005 that "A person must not direct or incite a registered health practitioner to do anything, in the course of the practitioner's practice of the health profession, that amounts to unprofessional conduct or professional misconduct."
The DPRG confirm that a nurse must demonstrate that delegation decisions have been properly made in accordance with professional practice guidelines and appropriate supervision and monitoring arrangements have been put in place and followed. The Registered Nurse may delegate medication administration to someone appropriately qualified to administer medicines. This means that nurses will use their professional judgement about whether to administer the medicines themselves or whether to delegate the administration to someone with appropriate qualifications. If a nurse judges that a personal care worker is not appropriately qualified to administer to a ‘high-care' resident they would administer the medicines themselves. It is anticipated that a resident not requiring high-level care is more likely to be personally involved in the management and administration of his/her own medicines. Supervision is also equally important in determining delegation. In the absence of an NMBA policy on delegation and supervision, nurses should rely on the Australian Nursing and Midwifery Council document "Delegation and Supervision for Nurses and Midwives" which it is anticipated will be adopted by the NMBA.
This obviously places the Registered Nurse charged with the responsibility of managing the administration of medication (and note it is the nurse, not the facility or the proprietor) in both a very responsible but potentially conflicting situation. Registered Nurses should not conclude that a personal care worker or Enrolled Nurse (without endorsement) can administer medications simply based on those employees being the only staff available. As the DPRG state, that could place the proprietor at risk of breaching their obligation not to incite or coerce unprofessional conduct.
Further details can be found on the Victorian Department of Health website and the Australian Nursing and Midwifery Council Limited website.
