Today’s correspondent wonders if I
… have broached the subject on Victorian nurses giving naloxone in the community. For example whilst they were not working at the time, if they came across someone having an opioid overdose in public? The ANMF has a firm stance that a nurse can never give medication without a doctor’s order, and does not advise nurses to ever carry or administer naloxone. I wonder if the Good Samaritan act, which I saw you discuss in another post, regarding outreach workers, has any official or unofficial umbrella-ing of registered nurses?
Indeed I have spoken about outreach workers – see Issuing naloxone to Victorian drug outreach workers (February 9, 2018). I’m not sure why nurses would be carrying naloxone ‘just in case’ or how many opioid overdose patients you’re going to find when going about your off-duty business but I guess that is irrelevant to the question.
Schedule 3 medications
As noted naloxone is now a schedule 3 medicine. Medicines listed in schedule 3 are ‘Substances, the safe use of which requires professional advice but which should be available to the public from a pharmacist without a prescription’ (Poisons Standard February 2019 (Cth)), but that does not mean that a nurse or anyone can just buy and dispense these drugs. A schedule 3 drug is available from a pharmacist, not from someone who bought the drug from a pharmacist.
A nurse practitioner or an endorsed nurse is authorised to obtain, possess and supply schedule 3 drugs approved by the Minister (Drugs, Poisons and Controlled Substances Act 1981 (Vic) s 13(ba) and (bb)). A nurse practitioner is a nurse ‘whose registration is endorsed by the Nursing and Midwifery Board of Australia under section 95 of the Health Practitioner Regulation National Law’ (s 4). A nurse practitioner can independently supply or administer a schedule 3 medicine but only for the ‘treatment of a person under the nurse practitioner’s care’ and only where ‘the nurse practitioner has taken all reasonable steps to ensure a therapeutic need exists …’ (Drugs, Poisons and Controlled Substances Regulations 2017 (Vic) s 137).
To put all that in plain English (thank you to the Victorian Department of Health; see https://www2.health.vic.gov.au/public-health/drugs-and-poisons/nurses-and-midwives):
Registered nurses and midwives are authorised (under the regulations) to possess scheduled medicines for administration to specific patients under their care in accordance with the lawful instructions and authorisation of a registered health practitioner who is authorised to prescribe or supply the medicine.
Note: Nurses and midwives may also be authorised to assist a patient in the administration of scheduled medicines that have been lawfully supplied to that patient (e.g. on prescription) in the same manner as another agent or carer who is not a nurse or midwife.
Approved by the Secretary – additional authorisation for some nurses and midwives
The department’s Secretary has also approved the possession and administration of specific medicines, by suitably trained nurses and midwives, in specified circumstances or in accordance with the conditions of a Health Services Permit of an employer.
Nurse practitioners and other registration endorsements
Nurses and midwives, whose registration is endorsed under Health Practitioner Regulation National Law (s. 94 or s. 95), may be authorised (under the Act) to possess, supply, administer (and possibly prescribe) scheduled medicines in the lawful practice of their profession. Lists of medicines have been approved by the Minister for Health in relation to different categories and scopes of practice of nurses and midwives.
Good Samaritan legislation
The provisions of the good Samaritan legislation discussed in that earlier post (see Issuing naloxone to Victorian drug outreach workers (February 9, 2018)) do not apply in Victoria. In any event it’s not relevant, as the provision being discussed there says that a good Samaritan who is intoxicated does not lose good Samaritan protection if he or she ‘administers the drug known as naloxone, honestly and without recklessness, to a person apparently suffering from an overdose of an opioid drug for the purpose of resuscitating the person’. That’s not going to be relevant (we hope) to a nurse in the circumstances described here.
There are still relevant good Samaritan provisions in Victoria. In particular the Wrongs Act 1958 (Vic) s 31B says:
(1) A good samaritan is an individual who provides assistance, advice or care to another person in relation to an emergency or accident in circumstances in which—
(a) he or she expects no money or other financial reward for providing the assistance, advice or care; and
(b) as a result of the emergency or accident the person to whom, or in relation to whom, the assistance, advice or care is provided is at risk of death or injury, is injured, is apparently at risk of death or injury, or is apparently injured.
(2) A good samaritan is not liable in any civil proceeding for anything done, or not done, by him or her in good faith—
(a) in providing assistance, advice or care at the scene of the emergency or accident…
What all that means is that a nurse is not entitled to buy naloxone (a schedule 3 medication) and put it in their first aid kit and carry it ‘just in case’. But if a nurse does come across someone suffering an opioid overdose and if the nurse, acting in good faith, forms the view that the administration of naloxone is necessary and in the patient’s best interest they will be protected by the good Samaritan legislation if they administer naloxone, whether they are carrying it or use the drug carried by the patient or his or her friend.
The Good Samaritan legislation relates to civil liability however, not professional discipline so the nurse may find themselves in trouble if it is shown that they were carrying the drug without authority. There won’t be an issue if they are using someone else’s drug, for example if the patient has obtained naloxone ‘just in case’ and the nurse is using the patient’s drug. That is the very circumstances in which the good Samaritan legislation is intended to apply and the nursing standards are not meant to stop nurses saving people’s lives when they can – see Nursing standards and assisting in an emergency (May 22, 2014).