Nurse initiated or once only drugs

[greatshakes]

hello everyone

i am wondering if someone can tell me, when a patient has heart complaint or angina and needs anginine, apparently a nurse can initiate anginine as a nurse initiated or once only drug. is this considered a standing order or verbal order? it has to be written up as a prn by the doctor. i was told to give it as a student by a nurse who supervised me when i had a patient with chest pain. i am currently writing assessment criteria for a position and want to know how best to describe this incident. this is what i have so far. can i improve upon this. thanks

as a new rn i am aware of the need to work within my scope of practice and am aware of the anci competencies relating to practice. the following is an example of my treatment as student with a patient experiencing chest pain.

- gathering information about intensity, location and rating of pain, charted on chest pain chart

- raised head of bed and sat patient upright to facilitate air entry

- delivery of oxygen at 6l/min via hudson mask

- advised cn2 and patient's dr of patient status and commenced twelve lead ecg

- administered anginine per verbal order ( nurse initiated drug under direction of rn as student)

- stayed with dr while he performed examination as learning strategy

- measured and re- charted vital signs following anginine

- repeated ecg and evaluated the results. checked patient for improvement in condition.

- attended to patient documentation in inpatient progress notes. ensured that the anginine was written up on medical chart as prn by doctor. i then returned to patient to check status.

[gwenith, BSN, RN]

Okay we need to clear up a little semantics here first. A standing order is one which has been ratified by the policies and proceure committees of the hospital and is part of the policy and procedure manual for that hospital. That way, even if the drug is not normally one that a nurse may initiate without a medical order. (i.e. ALS drugs) he/she is legally covered to do so under the hospitals administration act (or so I understand).

Now the question becomes, since it was a registered nurse and not a doctor who gave you the verbal order - did the nurse have the right to do so if there was no documented standing order as described above in that facility?

For an answer to THAT you need to reference the various drug acts in Queensland.

This link is invaluable

http://www.health.qld.gov.au/legislation/reviews/legislation_list.asp

So the first act to check is the Health (Drugs and Poisons) Regulation 1996. It is the main act regulating dispensing and adminstration of medications.

What classification or schedule does Anginine come into? Is it a restricted or a controlled drug under that act?

Here is a list of drug schedules giving an outline of which drugs fit into which classification.

http://www.tga.health.gov.au/ndpsc/gazette/g980800.htm#2

Schedule 2 - Drugs or preparations for which pharmacist advice on use may be required by the consumer, which should be available to the public, without a prescription, from a pharmacy or, where a pharmacy service is not available, from a licensed person.

Schedule 3 - Drugs or preparations that require professional advice on use, which should be available to the public from a pharmacist without a prescription.

Schedule 4 - Drugs and preparations, the use, supply and prescribing of which should be by registered medical, veterinary and dental practitioners, or the supply of which by a pharmacist should be on prescription.

Now, I am teacher enough not to go past this point and let you find some of the rest of the answers. They are there but you might have to put them together. But to be fair I will say that Anginine is not in the schedule you might initially think.

See how you go;)

[greatshakes]

Thanks for that Grace. I was given the info that it was a standing order by a doctor at the time as an emergency measure but will certainly be checking out those sites. Don't want to leave anything to chance.