Administrating Medication

Who is permitted to administer medications

• Only Westside LIPs, nurses, medical assistants, and dental hygienists administer medications.

What medications can be administered

• Providers:
  • Any stocked medications

• Nurses:
  • Any stocked medications

WHICH ARE ALSO

• 
  
  • Properly ordered by a provider

• Medical Assistants and Dental Hygienists
  • Pre-dosed/single-use medications ordered by an LIP and for which they have been specifically trained and have demonstrated competency.
  • See Table below for specific medications

Note: The Chief Medical Officer or his/her designee is responsible for authorizing the use of medical assistants and dental hygienists for medication administration as per State of Delaware law and regulations.

Approved:

• Vaccines – Adult and Pediatric
• Vitamins – Prenatal and Multivitamins
• Medroxyprogesterone acetate (Depo-Provera) injection
• Albuterol sulfate; ipratropium bromide, and budesonide (Pulmicort) inhalants for use with nebulizer treatments
• Vitamin B12 single dose vials

Not approved:

Medications requiring dosage calculation or adjustment for patient weight or clinical condition.

What medications are not permitted to be administered

Administering or dispensing the following medications is not included in the scope of Westside clinical staff:

• Controlled substances
• Intravenous medications
• Experimental or investigational drugs
• Medications other than those approved by Westside policy

Ordering

• Providers must place an order in the EMR prior to preparation of medication for administration (or follow downtime procedures when appropriate).
  • Before ordering a medication to be administered, the provider informs the patient of any potential clinically-significant adverse drug reactions or other concerns regarding administration of the medication.

Preparation of medication

• Use clean technique
• Maintain a clean, uncluttered, and functionally separate area for preparation to avoid contamination
• Prepare medication on a medication tray
  • Use a new tray liner with each new medication preparation, OR
• Disinfect tray with disinfectant wipe after each use

Labeling medication

• Medications are labeled whenever they are prepared but not immediately administered, including when medications are dispensed.

Note: An immediately-administered medication is one that an authorized staff member prepares or obtains, takes directly to a patient, and administers to that patient without any break in the process.

• All medications prepared for administration which are not immediately administered are to be labeled with:
  • Medication name
  • Strength

Review

Before administration, the individual administering the medication verifies the following:

• Correct medication (verifies that the medication selected matches the medication order and product label).
• Visual inspection normal (visually inspects the medication for particulates, discoloration, or other loss of integrity).
• Not expired (verifies that the medication has not expired).
• No contraindications/allergies (verifies that no contraindications exist, including allergies).
• Proper time, dose, and route (verifies that the medication is being administered at the proper time, in the prescribed dose, and by the correct route).
• Concerns addressed (discusses any unresolved concerns about the medication with an LIP, preferably the ordering prescriber if available).
• Verifies patient (identifies the patient by verifying their name and date of birth).

Documentation

The staff member preparing and administering the medication is to document in the electronic medical record:

• Date
• Time
• Route
• Lot number
• Expiration date

Administration

• Medication is only to be administered by the clinical person by whom it was prepared, except for vaccines prepared for mass vaccination events.
• Clinical staff will not prepare multiple doses of medication for administration to multiple patients and will only prepare medication for a single patient at a time, except for mass vaccination events.

Monitoring

• Injections (including subcutaneous, intramuscular, and joint injections)
  • Patients are required to remain in the office for 20 minutes after administration
  • The patient should be notified of the expected timeframe and may be directed to wait in the waiting area
• Oral medications
  • There is no waiting time required