Today’s question comes from a Queensland paramedic and demonstrates some of the difficulties in getting the language right around drugs. They say:

I’m a QAS paramedic that’s recently started working at a Urgent Care Centre (private but Medicare funded) as a Paramedic. In my induction I was informed that (in Queensland) I am unable to administer any Scheduled medications under state legislation, and it has to be performed by a nurse. 

I’ve since briefly looked up the State Medicines and Poisons Act and found very little information outside of QAS specific drug administration. It essentially looks like when working in QAS capacity I am able to administer set medications under set criteria. However, outside of QAS, it appears I have no authority and am only qualified when administering “Emergency First Aid.”

This is further complicated when, for the exact same private company, if I worked in NSW, I would fully legally be able to administer all medications that the company provides under their company policy and NSW’s State Legislation. 

Nurses, however, do not seem to fall under the same state-by-state stipulations that paramedics do. Is this something that you’ve come across in your travels or is this only really becoming an issue now that Paramedics are being utilised outside of state services and policy/legislation has not caught up?

I’ve read through 2 of your previous similar posts regarding Ambulance vs Private authority to carry, but in a Clinic setting do the rules alter? If a Doctor asks me to administer ‘XYZ’ am i actually able to administer said medication?

First nurses and paramedics are both regulated by the Health Practitioner National Law as it applies in each state (recognising that although it is described as a ‘national’ law it is, in fact, different in each jurisdiction).  They are also both regulated by each jurisdiction’s drug laws even though they too are giving effect to the national poisons schedule. 

I think the real issue in this question is the use of the term ‘administer’.  The Medicine and Poisons Act 2019 (Qld) s 26 says that the term ‘administer’ means:

(a)            introduce a dose of the medicine into the body of a person or animal by any means; or

(b)           give a dose of the medicine to a person to be taken immediately.

The Medicines and Poisons (Medicines) Regulation 2021 (Qld) sch 5 says that a person who is an ambulance officer (ie an employee of QAS rather than a paramedic) may possess and administer a drug in accordance with ‘the extended practice authority’.  Does that mean a paramedic cannot administer a drug in the clinic setting? No it does not.

The point of schedule 5 is to authorise QAS paramedics to ‘possess’ and ‘administer’ drugs on their own initiative. That is they can carry their drug box and they decide that the patient’s condition calls for the administration of a drug and they determine the appropriate dose where that depends on the patient’s age, or size or whatever, and they administer the drug. 

In a clinic setting where a ‘Doctor asks me to administer ‘XYZ’’ then the only question is do you have the skill set to deliver the drug via the correct route – ie do you know how to administer an IM or IV injection or whatever other route is called for.   The Medicine and Poisons Act 2019 (Qld) s 51(1) says:

 A person does not commit an offence against this Act if the person—

(a) supplies a medicine by giving it to someone else (a “patient”) if the medicine has been lawfully supplied for the therapeutic treatment of the patient; or

(b) for lawfully helping a patient, administers a medicine in accordance with the approved label of the medicine;

If, in a clinic, a medical practitioner has examined the patient, determined that the patient requires drug xyz and effectively prescribes the drug for that patient then anyone can administer the medication.  I personally have had experience of family members undergoing treatment where I have administered s 8 drugs and I’m not a health practitioner but of course I’m committing no offence.  So if the doctor prescribes or dispenses the drug for the use by a particular patient, assisting the patient by administering that drug is fine whether the person administering the drug is a nurse, a paramedic or anyone else.

Nurses are no different. The Medicines and Poisons (Medicines) Regulation 2021 (Qld) sch 7 gives authority to ‘nurse practitioners’ to possess and administer various drugs, but a nurse practitioner is a ‘a registered nurse and endorsed under the Health Practitioner Regulation National Law as being qualified to practise as a nurse practitioner’, not any registered nurse. 

The situation is no different in NSW – see Poisons and Therapeutic Goods Act 1966 (NSW) s 23 with respect to s 8 drugs; and Poisons and Therapeutic Goods Regulation 2008 (NSW) r 59 with respect to schedule 2, 3 and 4 drugs.

Conclusion

There is nothing in Queensland legislation that says a paramedic cannot administer a drug to a patient where that drug has been ‘lawfully supplied for the therapeutic treatment of the patient’, in this context supplied by a medical practitioner practising at the clinic.  I have no idea why anyone thinks the legislation draws any distinction between nurses and paramedics in this context. 

This blog is a general discussion of legal principles only.  It is not legal advice. Do not rely on the information here to make decisions regarding your legal position or to make decisions that affect your legal rights or responsibilities. For advice on your particular circumstances always consult an admitted legal practitioner in your state or territory.