Health Services Permit
Nurses providing acute care will typically possess Schedule 4 and Schedule 8 medicines in accordance with the Health Services Permit (HSP), which has been issued to an establishment (for example, hospital or day procedure centre) to authorise it to possess Schedule 4 and Schedule 8 medicines for the provision of health services.
Each HSP contains conditions that are specific to the type of health service provided – for example, the conditions for a hospital differ from those of a bush nursing centre or an ambulance service.
Nurses and midwives employed at a health service should refer to the health service permit document as well as legislative requirements in current Drugs, Poisons and Controlled Substances legislation (such as Regulation 8 of the Drugs, Poisons and Controlled Substances Regulations 2017). The director of pharmacy and/or the director of nursing commonly oversee the management of Schedule 4 and 8 medicines in health services.
Health service permits in hospitals, medical centres and day procedures centres contain a standard condition that the administration of scheduled medicines obtained via the permit is carried out only by a person authorised under Victorian Drugs, Poisons and Controlled Substances legislation in the lawful practice of his or her profession (for example, registered medical practitioners or registered nurses).
Administration versus supply
Nurses and midwives are authorised to possess Schedule 4 and Schedule 8 medicines for administration purposes but are not authorised to supply Schedule 2, 3, 4 or 8 medicines unless their registration has been endorsed to do so (for example, under a Scheduled Medicines [Rural and Isolated Practice] endorsement), and then only to the extent described or listed within the state jurisdiction.
A nurse or midwife may return or deliver a person’s own medications (for example, discharge medicines that have been lawfully supplied on prescription for that patient) if it is appropriate to do so. A nurse or midwife must not supply hospital ward stock to a patient; this may only be done by an authorised prescriber or pharmacist in the lawful practice of their profession.
Regulation 96 requires a nurse or midwife to refer to authoritative instructions before administering a Schedule 4 or Schedule 8 medicine, namely:
- written instructions of an authorised prescriber (the most common option where a nurse or midwife is employed by a HSP holder)
- oral instructions of an authorised prescriber if, in the opinion of the authorised prescriber, an emergency exists (for example, telephone orders)
- written transcription of emergency oral instructions by the nurse or midwife who received those instructions
- directions for use on a container supplied by an authorised prescriber or pharmacist (for example, when administering a person’s own lawfully supplied medicine)
- instructions in accordance with the provisions of regulation. 8 – namely in accordance with an approval issued by the Secretary of the department (for example, nurse immunisers). See this web-page for all current Secretarial Approvals.
Some establishments have documented protocols that detail when a nurse or midwife may initiate treatment with specified medicines other than Schedule 4 or Schedule 8 medicines. This is a matter of liability and policy, rather than of drugs and poisons legislation.
Schedule 8 medicines – destruction
Regulation 115 authorises a nurse or midwife to act as the witness when a Schedule 8 medicine is to be destroyed by a medical practitioner, nurse practitioner, pharmacist or dentist. Note: This does not mean that two nurses and/or midwives may destroy Schedule 8 medicines.
To clarify the situation relating to an accepted and necessary practice, regulation. 115 - specifically authorises a nurse or midwife to destroy the remaining, unused contents of a previously sterile container (for example, a partially used ampoule), provided that an appropriate record is made. Note: A witness is not mandated, although many establishments have a policy that requires a witness when another nurse or midwife is available.
The term ‘starter pack’ is commonly used to describe a limited number of doses of a Schedule 4 medicine, which has been pre-packaged by a pharmacist or licensed manufacturer, to provide medicine to enable a patient to begin taking the medicine before obtaining a larger quantity of the medicine on prescription.
Starter packs are commonly supplied to a permit holder (for example, hospital or day procedure centre) with the containers labelled in a manner that enables an authorised prescriber to insert patient-specific information at the time of supply.
Not to be supplied by nurses or midwives
Nurses and midwives are not generally authorised to supply Schedule 4 medicines. The decision to supply a starter pack or professional sample pack of a Schedule 4 medicine must be made by an authorised prescriber.
Supply by an authorised prescriber
An authorised prescriber (for example, medical practitioner or nurse practitioner) is responsible for ensuring that the container is labelled in accordance with the provisions of regulation. 72, plus Appendix L of the Standard for the Uniform Scheduling of Medicines and Poisons (see below), and that a record of supply is made. This responsibility cannot be delegated to another person. Required components of a label include:
- the name of the patient
- the date on which the transaction is recorded and/or a reference number that clearly shows the date
- the name, address and telephone number of the supplier
- the name of the medicine, or a trade name that unambiguously identifies the medicine plus its strength, form (for example, tablets) and quantity
- the words ‘KEEP OUT OF REACH OF CHILDREN’ in red on a white background
- adequate directions for use
- if the medication is intended for external use only, the word ‘POISON’ or the words ‘FOR EXTERNAL USE ONLY’ in red on a white background
- the mandatory ‘sedation warning’ for drugs listed in Appendix K of the Standard for the Uniform Scheduling of Medicines and Poisons, a link to which is located in the ‘Related sites’ section of the Drugs and Poisons Regulation website.
Containers must be impervious to the contents, sufficiently sturdy to prevent leakage and capable of being securely re-closed.
Replacing a starter pack
If an authorised prescriber provides a prescription that allows a pharmacist to supply medicine to the patient, it would be possible for the pharmacist to supply the quantity specified on the prescription, label the corresponding container in the manner described in regulation. 72 and make a record of the transaction.
It is an offence to administer medicines, obtained on prescription, to any person other than the person named on the prescription. Hence, a container of medicine obtained on prescription must not be used to replace a starter pack that was previously supplied.