Question:
I have a question about the legality of surgeons, anesthesiologists, and CRNAs in the OR verbally requesting the administration or dispensing of medication without writing an order. Many times a request for medication is given to the RN to "get a medication" to give to anesthesia. My understanding is that an order must be written for any medication to be administered by a RN. RNs are not to dispense medication as it is out of their realm and scope of practice. My head nurse does not supporting me in my thinking and feels that this is a major change in hospital policy and procedure. I disagree and wish to protect my license and hold my peers accountable for their actions. Would you please clarify what the correct procedure is? Signed,Michelle
I have a question about the legality of surgeons, anesthesiologists, and CRNAs in the OR verbally requesting the administration or dispensing of medication without writing an order. Many times a request for medication is given to the RN to "get a medication" to give to anesthesia. My understanding is that an order must be written for any medication to be administered by a RN. RNs are not to dispense medication as it is out of their realm and scope of practice. My head nurse does not supporting me in my thinking and feels that this is a major change in hospital policy and procedure. I disagree and wish to protect my license and hold my peers accountable for their actions. Would you please clarify what the correct procedure is? Signed,Michelle
Answer:
Dear Michelle,I think it best to respond to your questions by defining terms. First, "dispensing" is usually defined in a state pharmacy act, and generally means the delivery of drugs and medical devices to a patient by a pharmacist or other healthcare provider who is given this role as part of his or her scope of practice. Dispensing is not a linear activity. It involves the packaging of the medication or device as well as compounding it, labeling it, and providing any recommendations as to its use. "Administering" medications, in contrast, involves the management of medications and treatments and all that is included in that management. Administration of medications or treatments is not a linear activity either. It includes the assessment of the patient, the actual administration of the medication or treatment, and the evaluation of the patient's response to the regimen. Medication or treatment administration is ordered by a licensed healthcare practitioner (e.g., physician, advanced practice nurse, dentist) whose scope of practice allows this role. The situation in your question does not appear to fit the definition of "dispensing" medications. Rather, it appears that based upon an order from someone else on the perioperative team, one who is able to physically get a medication (without compromising the sterile field) does so and brings it to the surgical team member(s). Such an order, whether written or oral, fulfills the requirement that medications can only be administered upon the order of a licensed healthcare provider given that role as part of his or her scope of practice. Obviously, any order for medications or treatments must conform to standards of practice and the institution's policy governing oral, written, or standing orders. It might be helpful for you to review your state Nurse Practice Act and its rules and regulations to obtain a clear picture of the nurse's role and responsibilities in medication administration. In addition, standards of practice for the perioperative nurse, and information about perioperative nursing generally, can be reviewed by contacting The Association of Perioperative Registered Nurses (AORN). Their website is http://www.aorn.org">www.aorn.org. Best wishes,Nancy
Dear Michelle,I think it best to respond to your questions by defining terms. First, "dispensing" is usually defined in a state pharmacy act, and generally means the delivery of drugs and medical devices to a patient by a pharmacist or other healthcare provider who is given this role as part of his or her scope of practice. Dispensing is not a linear activity. It involves the packaging of the medication or device as well as compounding it, labeling it, and providing any recommendations as to its use. "Administering" medications, in contrast, involves the management of medications and treatments and all that is included in that management. Administration of medications or treatments is not a linear activity either. It includes the assessment of the patient, the actual administration of the medication or treatment, and the evaluation of the patient's response to the regimen. Medication or treatment administration is ordered by a licensed healthcare practitioner (e.g., physician, advanced practice nurse, dentist) whose scope of practice allows this role. The situation in your question does not appear to fit the definition of "dispensing" medications. Rather, it appears that based upon an order from someone else on the perioperative team, one who is able to physically get a medication (without compromising the sterile field) does so and brings it to the surgical team member(s). Such an order, whether written or oral, fulfills the requirement that medications can only be administered upon the order of a licensed healthcare provider given that role as part of his or her scope of practice. Obviously, any order for medications or treatments must conform to standards of practice and the institution's policy governing oral, written, or standing orders. It might be helpful for you to review your state Nurse Practice Act and its rules and regulations to obtain a clear picture of the nurse's role and responsibilities in medication administration. In addition, standards of practice for the perioperative nurse, and information about perioperative nursing generally, can be reviewed by contacting The Association of Perioperative Registered Nurses (AORN). Their website is http://www.aorn.org">www.aorn.org. Best wishes,Nancy
