Policy and Procedure 22 - Mederev€¦ · · 2012-02-06NURSE-INITIATED MEDICATIONS POLICY Nurse-initiated medication in Residential Aged Care Facilities may be administered only:

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mederev © September 2011 | Medication Management Manual_V1_September 2011

Policy and Procedure 22

NURSE-INITIATED MEDICATIONS

POLICY

Nurse-initiated medication in Residential Aged Care Facilities may be administered only:

• from a Medication Advisory Committee (MAC) defined and Medical Officer

approved list of non prescription medications;

• the defined and approved list will include indications for the drug dosage and

contraindications; and

• in line with relevant State/Territory and Commonwealth legislation and guidelines.

PROCEDURE

Nurse-initiated medication is the administration of non-prescription medication by a

registered nurse when the need arises and with the prior agreement of attending medical

officers. The MAC will develop a list of nurse-initiated medications together with the

recommended indications for use, dosage and contraindications.

The MAC meeting will formalise the Nurse-Initiated Medication List and forward it to all

medical officers for approval for all residents in their care. The list will be reviewed annually

at the MAC meeting and will be forwarded to the medical officer’s annually or more

frequently when required, for their approval.

Where a medical officer has specific requirements for a particular resident the Nurse-

Initiated Medication Form will be utilised, and will be located in the resident’s medication

chart.

If the use of a nurse-initiated medication becomes routine the resident should be reviewed

by the medical officer and if considered appropriate, a regular or PRN order formalised.

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mederev © September 2011 | Medication Management Manual_V1_September 2011

THE NURSE-INITIATED MEDICATION

AGREEMENT FORM

The following is a list of nurse-initiated medications for _____________________________

(Resident’s Name) which may be administered when required.

Any nurse-initiated medications will be documented on the appropriate area of the medication

chart.

NURSE-INITIATED MEDICATIONS

Medication

Dose and Administration

This list of medications is appropriate for my patient .......................................................(Resident’s Name)

Medical officer’s Name:

Signature:

Date:

If the use of a nurse-initiated medication becomes routine the resident should be reviewed by the medical

officer and if considered appropriate, a regular or PRN order formalised.

mederev © September 2011 | Medication Management Manual_V1_September 2011 66

Nurse Initiated Medication List

Clinical

Indication Medication Route

Recommended

Adult Dose Max. Dose

Max.

Duration Comments

Precautions/

Contraindications

Angina

Glyceryl trinitrate

tablets 600mcg

(Anginine)

Sublingual

½-1 tablet under the

tongue repeated

every 3-4 minutes

until pain is resolved

2 or 3 tablets

over 15

minutes

3 doses

Sit or lie down

before use as it may

cause dizziness. Call

an ambulance if 2 or

3 tablets over 15

mins does not

relieve the pain.

Nitrolingual Spray Sublingual

1-2 sprays under the

tongue repeated

every 3-4 minutes

until pain is resolved

2 or 3 sprays

over 15

minutes

3 doses

Sit or lie down

before use as it may

cause dizziness. Call

an ambulance if 2 or

3 sprays over 15

mins does not

relieve the pain.

Arthritis /

Muscle rubs

Methy Sal Co Liniment

/ Deep Heat / Metsal

(100g)

Topical

Apply directly to

painful joint/muscle

3-4 times a day

After 24 hours of no

improvement

contact medical

officer


Clinical


Recommended


Max.

Duration Comments

Precautions/

Contraindications

Asthma Salbutamol MDI plus

spacer Inhalation

First Aid for asthma

using spacer: 1 puff,

ten breaths repeat

until 4 puffs have

been given.

4 puffs every 4

minutes until

the ambulance

arrives

One

treatment

only

Tremor, palpitations

and headache may

occur at this dose.

Body / Hair

Lice

Banlice / Orange medic

(Pryrethrins) Topical

-Apply to dry hair

and massage

shampoo until wet.

Leave for 10 minutes

then shampoo out.

- Always comb hair

with a fine tooth

comb.

Repeat

application 8-

10 days as

necessary

Contact medical

officer after first

application and no

improvements

Bruising Lasonil (Hepariboid

5000) Cream Topical

Apply 2-3 times a

day.

Do not apply to

bleeding areas

Contact medical

officer if bruising

becomes problematic

Chesty cough Senega and ammonia

(200mlLs) Oral 10mLs every 4 hours


Clinical


Recommended


Max.

Duration Comments

Precautions/

Contraindications

Bisolvon Regular Oral 10mLs every 4 hours

Cold Fess Spray Nasal 1-2 sprays in each

nostril

Up to 8 sprays

a day Shake bottle first

Constipation Docusate sodium

(Coloxyl 50mg & 120mg) Oral

100-150mg once or

twice daily

Up to 480mg

per day in

divided doses

72 hours

Faecal softener.

Onset of action is 1-

3 days.

Docusate + Senna

(Coloxyl with Senna) Oral

1-2 once or twice

daily

3 tablets twice

a day 72 hours

Faecal softener with

a stimulant. Onset of

action is 1-3 days.

C/I – intestinal obstruction.

C/I – appendicitis.

C/I- Inflammatory bowel

condition.


Clinical


Recommended


Max.

Duration Comments

Precautions/

Contraindications

Lactulose Oral 10-20mls twice a day. Up to 60mls

daily 72 hours

Onset of action 1-3

days. This medicine

tastes very sweet. It

may help to mix it

with fruit juice,

water or milk.

C/I – intestinal obstruction.

C/I – Galactose or lactose

intolerance.

Movicol sachet Oral 1-3 sachets daily.

Take no more

than 2 sachets/

hour

For faecal impaction

– 8 sachets daily.

Movicol contains Sodium.

Monitor for hypernatraemia

with chronic use.

Use with caution with CV

disease e.g. CHF.

Precaution with use with

electrolyte disturbances.

Glycerine suppositories Rectal 1 suppository once

daily

1 suppository

daily. Single dose

Onset of action 5-30

minutes.

Sodium/magnesium

laxatives e.g. Microlax

enema

Rectal 1 enema 1 enema Single dose Onset of action 2-30

minutes.

Avoid use of sodium salts in

CV disease e.g. CHF as fluid

and electrolyte disturbances

may occur.


Clinical


Recommended


Max.

Duration Comments

Precautions/

Contraindications

Bisacodyl (Durolax)

Suppositories Rectal

Insert 1 suppository

PRN

No more

frequently

than 3 times

weekly

Should only be used when

all other alternative bowel

management has been tired

or for an acute situation

such as impaction.

NOT TO BE USED

ROUTINELY.

Consult medical officer if

constipation continues to be

problematic.

Nulax Oral One walnut sized

piece daily PRN 7 days

To be reviewed by medical

officer if constipation still

problematic.

ADEQUATE FLUID INTKE

IS ESSENTIAL

Dry Eye

Liquifilm Tears

Liquid Tears

Cellufresh (carmellose –

50 disposable)

Optical 1 – 2 drops to

affected eye

Instil drops 2

minutes apart


Clinical


Recommended


Max.

Duration Comments

Precautions/

Contraindications

Dry skin Sorbolene and

glycerine products Skin Twice daily PRN

May be used in

conjunction with

bath/shower oils

provided by resident.

Ear wax

Olive oil, or

proprietary products

eg Cerumol, Ear Clear,

Waxsol.

Otic

As per

manufacturer’s

directions.

3-7 days May require syringing

afterwards.

Gastro-

intestinal

Diarrhoea

(fluid/electrolyte

replacement) Gastroltye

sachet

Oral Dissolve 1 sachet in

200mLs of water

Repeat after

each vomit or

loose motion

Natural Fibre Anusol

/Rectinol (cream and

suppositories)

Rectal


Clinical


Recommended


Max.

Duration Comments

Precautions/

Contraindications

Mylanta Oral

10-20mLs QID PRN

1-2 tablets QID PRN

Max. 80mLs in

24 hours

Max. 8 tablets

in 24 hours

If given for relief of

indigestion/chest

pain, which is

unrelieved after 2

doses – consult

medical officer

NOT TO BE GIVEN WITH

A DOCUMENTED

DIAGNOSIS OF RENAL

IMPAIRMENT.

SPACE DOSES AWAY

FROM REGULAR

MEDICATIONS

General skin

Zinc and Castor Oil

Cream (100g)

Sorbolene Cream +/-

Glycerine

Topical

Usage of up to 100g

is allowable before

medical officer

notification

Hair /

Shampoo

Nizoral (1% and 2%)

antidandruff

Ionil T

Poly-Tar (coal Tar

preparation)

Selsun

Topical


Clinical


Recommended


Max.

Duration Comments

Precautions/

Contraindications

Indigestion Combination antacids Oral 10-20mls 3-4 times a

day.

20mLs four

times a day. 24 hours

Best taken between

meals or at bedtime.

Constipation may be

worsened by antacids

containing aluminium and

calcium.

Diarrhoea may be worsened

by antacids containing

magnesium.

Dexsal Granules Oral 0.5-1 capful QID 24 hours

Not to be given to residents

on sodium restrictions.

Ongoing complaints to be

investigated by a medical

officer.

Kidney /

Bladder

Ural Sachets or

Cranberry tablets Oral

Mouth Ulcers Kenalog and Ora-base Oral

Apply a small dab

onto the sore area in

the mouth until a

thin film develops

2-3 doses per

day Apply after meals


Clinical


Recommended


Max.

Duration Comments

Precautions/

Contraindications

Oral hygiene Chlorhexidine

gluconate mouthwash

Oral – DO

NOT

SWALLOW

As needed

Pain Paracetamol 500mg

tablets Oral

1-2 every four hours

if necessary.

Max. dose of

4g/day 48 hours

Caution to check

total paracetamol

dose with other

products which may

be being taken

concurrently.

Use rectal form if

resident unable to

swallow. Please call

medical officer if

fever persists more

than 12 hours or if

pain not controlled.

If fever, less than

36.5°C or greater

than 38.0°C, the

medical officer to be

notified immediately.

Impaired renal function –

space six hours apart.


Clinical


Recommended


Max.

Duration Comments

Precautions/

Contraindications

Scabies Lyclear (Permerthrin)

30g cream Topical

Cover entire skin

with cream and leave

for 8-24 hours (use

entire tube if needed)

Repeat in 7

days

Contact medical

officer after first

application if no

improvement

Sore throat Difflam Lozenges Oral

Suck 1 lozenge as

required every 1-2

hours

Max. 12

lozenges per

day

This list of medications is appropriate for my patients at this facility

Medical officer’s Signature: ____________________________________ Print Name: ___________________________________

Date: _______________________

Documents

Policy and Procedure 22 - Mederev€¦ · · 2012-02-06NURSE-INITIATED MEDICATIONS POLICY Nurse-initiated medication in Residential Aged Care Facilities may be administered only: