Today’s correspondent has:

… a question regarding Schedule 4 and 8 medications and who is to administer them in NSW Aged Care Facilities.

If you are not aware the Aged Care Royal Commission made recommendations for aged care facilities to have a Registered Nurse on shift 24/7.

As the facility I work at is under 30 beds (28) we are exempt until October 2024. Our senior management has decided to have an RN 24/7 even if it is agency based. Currently, the permanent nurses we have are x2 Registered Nurses and x1 Endorsed Enrolled Nurse (me).

The company has spent over $100 thousand on agency Registered Nurses in three months.

Recently we had an afternoon shift in that we didn’t have a Registered Nurse or Endorsed Enrolled Nurse. The Facility Manager (Registered Nurse) made a direction that the Personal Care Workers are to hold the Schedule 8 Safe keys and to administer Schedule 4 and Schedule 8.

I would like to know the legal requirements for who is allowed to administer these scheduled drugs in NSW. Our Medication Policy currently states it has to be a Registered Nurse. I have searched the Poisons and Therapeutic Goods Act 1966 but was unable to find anything.

I think the critical issue is the nature of the drugs that are held. Hospital wards will have a supply of schedule 4 and 8 drugs so that they can be prescribed and administered. There are specific provisions for who can have access to those drugs in a hospital ward – Poisons And Therapeutic Goods Regulation 2008 (NSW) rr 30 (Sch 4) and 74 (Sch 8); but a residential aged care facility is not a hospital.

There is no offence to be in possession of, supply and administer a drug to a person for whom the drugs have been prescribed – Poisons and Therapeutic Goods Act 1966 (NSW) s 16(d1) and Poisons and Therapeutic Goods Regulation 2008 (NSW) r 59 (with respect to sch 4); Poisons and Therapeutic Goods Act 1966 (NSW) s 23 (with respect to sch 8).

It therefore makes a difference if you are talking about a supply of non-allocated drugs in which case the person with access to the drugs and supplying them does, generally speaking, have to be a nurse (see Poisons and Therapeutic Goods Regulation 2008 (NSW) r 62, 101, 103, 117(2)).  So, if for example, a doctor says ‘give this patient drug ‘x’’ and someone has to go to a bulk store, locate the drugs and supply them that has to be a nurse.

If on the other hand you are talking about drugs that have been prescribed and supplied for an individual patient – eg drugs in their Webster pack, it would appear that anyone who has the care of that person which could include a ‘personal care worker’ can administer those drugs in accordance with the prescription.

That conclusion makes sense. Good practice may suggest that access to drugs is restricted to registered health professionals but as my correspondent has noted ‘the Aged Care Royal Commission made recommendations for aged care facilities to have a Registered Nurse on shift 24/7’ and some facilities are exempt that requirement so it is not yet the law that there has to be a nurse on duty at every facility, but drugs have to be given by someone.

Conclusion

I cannot of course speak to the specifics at a particular facility but generally speaking it is the case that anyone who is involved in a person’s care can be in possession of, supply and administer a drug to a person for whom the drugs have been prescribed. It is up to the facility management to determine how they manage that with respect to potential risks to patient’s and the facility.

This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.