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Medication Administration

Roles of Nursing Students in Medication Administration

Nursing students must:

  • engage in safe medication practices, and contribute to a culture of safety 
  • know the limits of own knowledge, skill and judgment, and seek help
  • assess the appropriateness of the medication practice by considering the patient, the medication, and the environment 
  • adhere to SickKids expectations for direct supervision when administering medications

Nursing students need to assess:

  • patient drug allergies
  • the expected actions, dose range, side effects of the medication, and any precautions to be taken
  • the developmental stage of the infant/child/adolescent patient
  • any alterations in the patient's condition or functional status which interferes with their physical capacity to take medications (for instance not being able to swallow oral medications).
  • the child and family's level of understanding and knowledge of each medication

Competent medication administration is a continual process and goes beyond the task of simply giving a medication to a patient. It includes:

  • Preparing the medication correctly
  • Ensuring the following rights:
    • right PATIENT
    • right MEDICATION 
    • right REASON
    • right DOSE - for the patient's weight
    • right ROUTE
    • right FREQUENCY
    • right TIME
    • right SITE
  • Monitoring the patient and appropriately intervening as necessary
  • Providing the right education and information about the medication 
  • Evaluating the outcome of the medication on the patient's health status
  • Documenting the process

The nursing student must ensure that the right medication is administered to the correct patient by:

  •  verifying patient using two unique identifiers (e.g. patient name & SickKids Medical Record Number)
  •  using barcoding technology as per hospital policies

When preparing and administering medications, the nursing student should:

  • administer medications within 30 minutes of the scheduled time
  • promptly document the medication administration in the electronic health record
  • if a child vomits their medication, the prescriber or pharmacist should be consulted to determine if the dose should be repeated

Essential Tips for Safe Medication Practice

  • Know or research the medication 
  • Confirm patient information
  • Double check and verify with others when uncertain
  • Minimize distractions
  • Communicate with patients and families

Alone and Apart (A2) Check 

Alone and Apart A2 Check is a mechanism designed to reduce the risk of error in high-risk situations. A2 Check occurs when two clinicians confirm medication steps alone and apart from each other in order to reduce the risk of bias and then compare results. This process is also known as an independent double check.

An A2 Check requires two healthcare providers with appropriate knowledge, skill and judgement and must be performed for select high-alert medications.  While nursing students are not authorized to perform an A2 Check at SickKids, if  you participate in the administration of a high-alert medication as a student, you will be the third person performing the checks and calculations.

What needs to be A2 checked?

High-alert medications require an A2Check. The high-alert medication list is reviewed and updated annually. Some examples of high-alert medications are listed below

  • Specific drugs (e.g. Unfractionated Heparin greater than 100 unit/mL, Enoxaparin,  Insulin) 
  • Narcotics ( e.g. Fentanyl, Hydromorphone, Morphine) and Sedatives (Lorazepam, Midazolam)
  • Continuous infusions of inotropes / vasoactive medications (e.g. Dopamine, Epinephrine, Milrinone, Nitroglycerine, Vasopressin, etc)
  • Infusions of concentrated electrolytes (Calcium, Magnesium, Phosphate, Potassium [equal to or greater than 60 mmol/L], Sodium chloride 3%)
  • Parenteral nutrition - TPN and Lipids, TNA
  • Epidurals/ nerve blocks
  • Anestetic Agents (e.g. Propofol, Ketamine)
  • Neuromuscular Blocking Agents (e.g. Rocuronium, Succinylcholine)
  • Antineoplastic agents

Upon commencing your clinical placement at SickKids, you are required to review the following policies. Please note that these documents can only be viewed on the hospital internal Policies and Procedures website.

  • Administration of Medication
  • High-Alert Medications
  • Alone and Apart Check

Refer to the following CNO documents for additional information on medication administration:

Medication Practice Standard, College of Nurses of Ontario

College of Nurses Of Ontario Reference Document: Legislation and Regulation, RHPA: Scope of Practice, Controlled Acts Model.

References : College of Nurses of Ontario Medication Practice Standard, 2017.