Administration and Dispensing of drugs

Dispensing can only occur once. After a drug is labeled and dispensed to a patient/client via an automated
medication dispensing unit, physically giving the medication to the patient/client is administration, not
dispensing. medication administration systems: their occurrences, causes, and threats to patient safety.

ADMINISTRATION
RTs commonly administer medications via the
authority granted to them by the Respiratory
therapy Act - “administering a substance by
injection or inhalation” [s.4 (4)]. Dispensing occurs
less often, and will be explained later in this PPG.
RTs are responsible for administering medications
within both their personal and professional scope of
practice. The safe and competent administration of
medication requires the RT to have the
competencies (knowledge, skill and abilities) to:
• assess the appropriateness of a particular
medication for the patient/client, including
indications and contraindications;
• be aware of the actions, interactions, dose, route, side-effects
and adverse effects of the drug;
• be able to calculate the correct dosage and prepare the
medication correctly, when necessary; and
• to monitor the patient/client during and following
administration, as well as manage any side-effects or adverse

reactions to the drug, intervening when necessary.

Examples of administering
medication: • Obtaining, preparing and administering a
narcotic for use during conscious sedation
of a patient/client
• Obtaining, preparing and administering a
drug from a supervised hospital or
departmental “stock” of medications (e.g.
sedatives kept in a bronchoscopy suite for
use during an outpatient procedure)

The 9 “Rights” of Competent Medication Administration

1. right PATIENT/CLIENT –should be at least two unique identifiers (not room number);
2. right MEDICATION to be given - compare Medication Administration
Record (MAR) with order;
3. right ROUTE– includes site (e.g., IV, IM);
4. right TIME/ DAY – includes frequency;
5. right DOSE – check calculation and label;
6. right DOCUMENTATION – i.e. after medication is administered;
7. right FORM – e.g. liquid, tablet, etc.;
8. right REASON – to treat the appropriate condition; and
9. right RESPONSE - monitor to ensure that the medication has the desired
Medication Management Systems

Most facilities now use some form of medication management system, which
usually includes an automated medication dispensing unit. The purpose of
implementing this type of delivery system is to avoid preventable medication
errors and improve patient safety. The pharmacy receives the medication order
electronically from the physician and dispenses the medication into the unit. The
medication can then be accessed by staff to be administered when needed.
Oral and Topical Medication
Administration of a substance orally or topically is not a controlled act under the
RHPA and is not considered dispensing unless a supply was given to the
patient/client to take at another time. An RT may assist a patient/client in taking
their prescribed tablets at the time they are due; however, an RT may not leave
extra tablets from a stock at the bedside for the patient/client to take. As with all
other medications, to administer oral (e.g., Prednisone) and topical medications
(e.g., Lidocaine) the RT needs to know the indications, contraindications, proper
dosages and potential side-effects. The prescription and medication container
must be checked, along with the patient/client’s identity and any potential
allergies/drug sensitivities, as with any other medication. Oral medications in a
tablet form should be given to the patient in a disposable container, and liquid
preparations should be measured using syringes specifically designed for that
purpose. The RT must ensure that the medication was taken by the patient/client
as directed, and document accordingly.

Over the Counter (OTC) Medication

OTC refers to medications that can be obtained in the community without a prescription from
an authorized regulated health care professional. However, in a hospital setting an order is still
required to administer an OTC medication. Many facilities also have policies requiring that any
OTC medication brought in from home by a patient/client must be sent to the pharmacy for
labelling, and then approved by the most responsible physician before returning it to the
patient/client.
DISPENSING
Dispensing is a controlled act that authorizes an RT to select,
prepare and provide stock medication that has been prescribed to a
patient/client (or his or her representative) for administration at a
later time.
The process of dispensing has both technical and cognitive
components. The technical component includes tasks such as
receiving and reading the prescription, selecting the drug to
dispense, checking the expiry date, labeling the product, and record
keeping.
The cognitive component of dispensing involves assessing the
therapeutic appropriateness of the prescription, applying approved
substitution policies, being able to make recommendations to the
prescriber and advising the patient/client.
Orders for Dispensing

An order to dispense must include the following:

• order date,
• client name,
• medication name,
• dose in units,
• route,
• frequency,
• purpose, quantity to dispense; and
• prescriber’s name, signature, and designation.

Factors to Consider when Accepting Delegation to Dispense

1. Is your certificate clear of any terms, conditions or limitations that

prevent you from dispensing or accepting delegation to dispense?
2. Do you reasonably believe that the person who delegated
dispensing to you has the authority and the competence to do so?
3. Do you have the competence to dispense medication?
4. Is it appropriate and in the best interest of the patient/client that
you accept delegation to dispense medication, given the known
risks and benefits?
5. Are there other controlled acts involved and are you authorized to
perform them?

Labelling Dispensed Medication

If medication is being dispensed based on a prescription, the label must meet all the
requirements outlined in the Drugs and Pharmacies Regulation Act (s.156 (3) –
Identification Markings), which means that the container in which the drug is
dispensed shall be marked with:
(a) the identification number that is on the prescription;
(b) the name, address and telephone number of the pharmacy in which the
prescription is dispensed (if applicable);
(c) the identification of the drug as to its name (preferably both generic and
trade name), its strength (where applicable) and its manufacturer, unless
directed otherwise by the prescriber;
(d) the quantity where the drug dispensed is in solid oral dosage form;
(e) the name of the owner of the pharmacy (if applicable);
(f) the date the prescription is dispensed;
(g) the name of the prescriber (along with professional designation (e.g., MD);
(h) the name of the person for whom it is prescribed;
(i) the directions for use as prescribed.
Professional Requirement

The industry requires pharmacologists to have an advanced degree, such as a Ph. D., Pharm. D. or M.D., to
find practice in the field. Those interested in practicing clinical pharmacology may find it beneficial to earn an
M.D. or Ph.

Admission and Selection requirements

an MBChB or equivalent degree;
a four-year professional bachelor's degree in a health-related discipline;
a BScHons degree of this University or another recognised university; or.
an equivalent qualification as approved by Senate.

A midwife is a highly trained clinical professional who obtains rigorous education in health care and has
significant experience in providing holistic care to women. For those looking for a position in the health care
industry that positively impacts women's lives, a career as a midwife may be a suitable option.
In medical professions, education requirements are usually dictated by the legal requirements for the field.
Midwives are not regulated in many states, and they aren't held to the same requirements as nurse-midwives,
who are advanced practice nurses typically holding master's degrees. Some states have mandatory licensing for
midwives, while, in other states, licensing is voluntary or does not exist at all. Among states that do require or
offer voluntary licensing or certification, education requirements vary.

Civil Liability

Our law states that every person criminally liable for a felony is also civilly liable. This civil liability ex delicto
may be recovered through a civil action which, under our Rules of Court, is deemed instituted with the
criminal action.
Civil liability is a legal obligation that requires a party to pay for damages or to follow other court-
enforcements in a lawsuit.
The legal responsibility to make restitution for loss or damage. In health care, a provider is legally responsible
for actions that fail to meet the standards of care or are grossly negligent, thereby causing harm to the patient.