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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.
65
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
mederev © September 2011 | Medication Management Manual_V1_September 2011 67
Clinical
Indication Medication Route
Recommended
Adult Dose Max. Dose
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
mederev © September 2011 | Medication Management Manual_V1_September 2011 68
Clinical
Indication Medication Route
Recommended
Adult Dose Max. Dose
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.
mederev © September 2011 | Medication Management Manual_V1_September 2011 69
Clinical
Indication Medication Route
Recommended
Adult Dose Max. Dose
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.
mederev © September 2011 | Medication Management Manual_V1_September 2011 70
Clinical
Indication Medication Route
Recommended
Adult Dose Max. Dose
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
mederev © September 2011 | Medication Management Manual_V1_September 2011 71
Clinical
Indication Medication Route
Recommended
Adult Dose Max. Dose
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
mederev © September 2011 | Medication Management Manual_V1_September 2011 72
Clinical
Indication Medication Route
Recommended
Adult Dose Max. Dose
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
mederev © September 2011 | Medication Management Manual_V1_September 2011 73
Clinical
Indication Medication Route
Recommended
Adult Dose Max. Dose
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
mederev © September 2011 | Medication Management Manual_V1_September 2011 74
Clinical
Indication Medication Route
Recommended
Adult Dose Max. Dose
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.
mederev © September 2011 | Medication Management Manual_V1_September 2011 75
Clinical
Indication Medication Route
Recommended
Adult Dose Max. Dose
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: _______________________