Administering & Dispensing Medications

NOVEMBER 2014

Administering & Dispensing Medications

P R O F E S S I O N A L P R A C T I C E G U I D E L I N E

COLLEGE OF RESPIRATORy ThERAPISTS OF ONTARIO

Administering & Dispensing Medications Professional Practice Guideline

Professional Practice Guideline

College of Respiratory Therapists of Ontario (CRTO) publications contain practice parameters and standards which should be considered by all Ontario Respiratory Therapists in the care of their patients/clients and in the practice of the profession. CRTO publications are developed in consultation with professional practice leaders and describe current professional expectations. It is important to note that these CRTO publications may be used by the CRTO or other bodies in determining whether appropriate standards of practice and professional responsibilities have been maintained. Resources and references are hyperlinked to the Internet for convenience and referenced to encourage exploration of information related to individual areas of practice and/or interests. Bolded terms are defined in the Glossary.

It is important to note that employers may have policies related to an RT's ability to accept delegation to dispense medications. If an employer's policies are more restrictive than the CRTO's expectations, the RT must abide by the employer's policies. Where an employer's policies are more permissive than the expectations of the CRTO, the RT must adhere to the expectations of the CRTO.

2nd Revision: November 2014 Originally Published: 2005

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Administering & Dispensing Medications Professional Practice Guideline

table of contents

INTRODUCTION

4

ADMINISTRATION

5

The 9 "Rights" of Competent Medication Administration

6

Medication Management Systems

6

Oral and Topical Medication

6

Over the Counter (OTC) Medication

7

DISPENSING

8

When it's Appropriate for an RT to Dispense

8

Accepting Delegation to Dispense

9

Who an RT Can Accept Delegation From

9

TABLE 1: Who can order medication and who can order dispensing medication. 10

Orders for Dispensing

10

Factors to Consider when Accepting Delegation to Dispense

10

Labeling dispensed medication

11

Safe storage and handling

11

DOCUMENTATION

12

DISPENSING PROCESS MAP

13

SPECIAL CONSIDERATIONS

14

Substitution Policies

14

Repackaging

14

Narcotics and other Controlled Substances

14

Dispensing Samples

15

Medication Errors

16

Glossary

17

References

18

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Administering & Dispensing Medications Professional Practice Guideline

Introduction

The Regulated Health Professions Act, 1991 (RHPA) identifies thirteen controlled acts that pose significant risk of harm to the public of Ontario [RHPA section 27(2)]. Dispensing medications falls under the 8th controlled act in the RHPA:

"Prescribing, dispensing, selling or compounding a drug as defined in the Drug and Pharmacies Regulation Act, or supervising the part of a pharmacy where such drugs are kept."

The Respiratory Therapy Act, 1991 (RTA) does not authorize Respiratory Therapists (RTs) to perform this controlled act, the authority to dispense medications must be delegated to an RT from another regulated health care professional that is authorized to dispense and to delegate dispensing (i.e., physicians). Therefore, RT's can only receive delegation for the dispensing portion of this controlled act. Respiratory Therapists must not prescribe, sell or compound a drug, or supervise the part of a pharmacy where such drugs are kept.

Please Note...

Other regulated health care professionals who are authorized to perform this controlled act in its entirety, or parts of it, have additional regulations and standards guiding these practices. For example, only Pharmacists and wholesalers are permitted to sell medications. Selling implies the possession of the medication. RTs cannot accept payment for medications dispensed or invoice clients on behalf of their employers.

For additional information, please see the Interpretation of Authorized Acts and Delegation of Controlled Acts Professional Practice Guidelines (PPGs).

Other legislation regulating the practices of prescribing, dispensing, selling, or compounding a drug, and supervising a pharmacy, includes but is not limited to:

Provincial Legislation: ? Pharmacy Act, 1991 ? Drug and Pharmacies Regulation Act, 1990 ? Drug Interchangeability and Dispensing Fee Act, 1990 ? Narcotics Safety and Awareness Act, 2010

Federal Legislation: ? Food and Drugs Act, 1985 ? Controlled Drugs and Substances Act, 1996 ? Narcotics Control Regulation (amended 2014)

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Administering & Dispensing Medications Professional Practice Guideline

ADMINISTRATION

RTs commonly administer medications via the authority granted to them by the Respiratory Therapy Act - "administering a substance by injection or inhalation" [s.4 (4)]. Dispensing occurs less often, and will be explained later in this PPG. RTs are responsible for administering medications within both their personal and professional scope of practice. The safe and competent administration of medication requires the RT to have the competencies (knowledge, skill and abilities) to:

? assess the appropriateness of a particular medication for the patient/client, including indications and contraindications;

Examples of administering medication:

? Obtaining, preparing and administering a narcotic for use during conscious sedation of a patient/client

? Obtaining, preparing and administering a drug from a supervised hospital or departmental "stock" of medications (e.g. sedatives kept in a bronchoscopy suite for use during an outpatient procedure)

? be aware of the actions, interactions, dose, route, side-effects and adverse effects of the drug;

? be able to calculate the correct dosage and prepare the medication correctly, when necessary; and

? to monitor the patient/client during and following administration, as well as manage any side-effects or adverse reactions to the drug, intervening when necessary.

* Prior to administering any substance, the Respiratory Therapy Act requires RTs to obtain a valid order (direct order or medical directive) from:

(a) a member of the College of Physicians and Surgeons of Ontario, the College of Midwives of Ontario or the Royal College of Dental Surgeons of Ontario;

(b) a member of the College of Nurses of Ontario who holds an extended certificate of registration under the Nursing Act, 1991; or

(c) a member of a health profession that is prescribed by regulation.

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