2010 Legislative changes

On 1 July 2010, the Health Practitioner Regulation National Law – a new national registration and accreditation scheme – was implemented. The new scheme includes new national boards and required the Victorian legislation to be changed.

Previously

In May 2006 provisions were introduced to the Drugs Poisons and Controlled Substances Act 1981 requiring approved providers of residential aged care to ensure that administration of medicine to all high care residents is managed by a Registered nurse, division 1.

The legislation required nurses to have regard to guidelines (a 'code') issued by the Nurses Board of Victoria (NBV) when managing the administration of medicine.

Issues

The introduction of the national registration and accreditation scheme on 1 July 2010, including new national boards, required consequent amendment to Victorian legislation.

An important amendment was to Section 36F of the Drugs Poisons and Controlled Substances Act 1981. This has been changed to read:

A registered nurse who manages the administration of any drug of dependence, Schedule 9 poison, Schedule 8 poison or Schedule 4 poison to a resident in an aged care service in accordance with this Division must do so in accordance with the relevant code or guideline (if any) issued by the Nursing and Midwifery Board of Australia under the Health Practitioner Regulation National Law.

The code issued by the NBV was repealed on 31 May 2010. The Nursing and Midwifery Board of Australia has not issued a replacement code.

Currently

The Drugs Poisons and Controlled Substances Act 1981 continues the key role and responsibility of registered nurses in making supervision and delegation decisions in the administration of medicine and requires that aged care providers ensure this occurs.

Similarly, staff delegated responsibility to administer medicine (including enrolled nurses and personal care workers/assistants) will continue to be responsible to the managing registered nurse, who remains responsible for ensuring the staff are appropriately trained and competent to undertake the delegated duties.

To assist residential aged care providers and nurses managing the administration of medicine, the Department of Health and Human Services has published two updated guidance notes on this website:

• Residential aged care: medication storage and record keeping
• Nurses in residential care facilities - legal requirements

The guidance notes aim to give confidence to providers and to nurses that if they follow the general professional practice principles set out in the guidelines, they will be acting within the law.

Additional governance mechanisms apply to the management of medicine within residential aged care. Mechanisms include the Aged Care Act 1997, Australian Government Department of Health and Ageing guiding principles for medication management in residential aged care facilities 2012 and organisational policies and procedures. Clinical risk management principles are recommended as the basis for the development and review of medicine administration policies.

Frequently asked questions

What are changes were made in 2010?

Two changes were made:

• The wording of Section 36F of the Drugs Poisons and Controlled Substances Act 1981 was changed to refer to the Nursing and Midwifery Board of Australia instead of the Nurses Board of Victoria
• The former Code for Guidance - Management of the Administration of Medications to High Care Residents in an Aged Care Facility (The Code) was repealed.

Registered Nurses continue to be responsible for managing the administration of medicine to residents receiving high-level care. Management includes making delegation and supervision decisions in accordance with professional practice guidelines and ensuring that appropriate supervision and monitoring arrangements are put in place and followed.

When did the 2010 changes come into effect?

The legislative amendments came into effect on 1 July 2010. The former Code for Guidance – Management of the Administration of Medications to High Care Residents in an Aged Care Facility (The Code) was repealed by the Nurses Board of Victoria on 31 May 2010.

What medicine is covered by the legislation?

The legislation applies to all medicine for which a prescription is required or instruction from an authorised prescriber is required, It applies to Schedule 4, 8 and 9 medicine that has been prescribed or provided under an instruction from a medical practitioner (or other authorised prescriber) and dispensed by a pharmacist (or the prescriber).

This is medicine that most adults outside of a residential aged care service would usually administer themselves. For all aged care residents receiving high-level care, a Registered Nurse must manage the administration of these medicines.

The residential aged care service should have quality and safety systems and protocols in place to assure quality and safety in administration of all medicines including over-the-counter and complementary medicines.

Who can administer medicine to residents receiving high-level care?

Registered Nurses are required to manage the administration of dispensed medicine to aged care residents receiving high-level care. Administration of dispensed medicine may be delegated to another nurse or personal care worker appropriately qualified to administer medicine. Registered Nurses will use their professional judgement about whether to administer the medicine themselves or delegate the administration to someone with appropriate qualifications.

Can personal care workers administer medicine to residents receiving high-level care?

Personal care workers with appropriate medication administration training may be competent to administer dispensed medicine under supervision arrangements determined by the managing Registered Nurse. If a nurse judges that a personal care worker is not appropriately qualified to administer to a resident receiving high-level care they would administer the medicines themselves.

Can an Enrolled nurse manage the administration of medicine?

The legislation does not allow Enrolled nurses to manage the administration of medication.

Can an Enrolled nurse supervise the work of another worker who is administering medicine?

Yes, the Registered Nurse who is managing the administration of medication to residents could delegate the routine supervision of other workers to an Enrolled Nurse, within the medication management plan that they have determined.

What are the minimum supervision requirements?

The legislation does not require any particular supervision arrangement. Decisions about the supervision of delegated tasks within the medicine administration process must be made by the nurse managing the process, in accordance with professional guidelines for supervision and delegation.

The Nursing and Midwifery Board of Australia published Guidelines July 2015 Supervision guidelines for nursing and midwifery.

Who will be held accountable if a nurse delegates a medicine administration task to a non-nurse and something goes wrong?

A nurse is accountable for their professional decisions and actions. A nurse must demonstrate that delegation decisions have been properly made in accordance with professional practice guidelines and that appropriate supervision and monitoring arrangements have been put in place and followed. The worker to whom a task is delegated is also held accountable to the extent of their training and for following the systems and procedures required