Practice Standards set out requirements related to specific aspects of nurses’ practice. They link with other standards, policies and bylaws of the BC College of Nurses and Midwives and all legislation relevant to nursing practice.
This Medication practice standard outlines
nurses'1accountabilities for providing safe nursing care to clients when performing activities involving medication.
“Medication” refers to Schedule I, IA, II, III, and unscheduled drugs as defined in the provincial
Drug Schedules Regulation under the
Pharmacy Operations and Drug Scheduling Act (PODSA).
Nurses have the authority to
compound certain medications under the
Nurses (Licensed Practical) Regulation, the
Nurses (Registered) and Nurse Practitioners Regulation, and
the Nurses (Registered Psychiatric) Regulation, Nurses may administer, dispense, or compound medications to or for a
Nurse practitioners, registered nurses, and registered psychiatric nurses also have the authority to
prescribe certain medications within their autonomous scope of practice under the
Nurses (Registered) and Nurse Practitioners Regulation, and the
Nurses (Registered Psychiatric) Regulation.
For specific scope of practice standards, limits and conditions related to administering, dispensing, compounding and/or prescribing medications, refer to BCCNM’s:
Employers provide the organizational supports and systems necessary for nurses to meet the Standards of Practice.
Nurses perform only those medication-related activities as allowed by:
Relevant provincial or federal legislation or regulations,
BCCNM standards, limits, and conditions,
Organizational/employer policies and processes, and
The nurse’s individual competence.
Nurses follow relevant provincial or federal legislation or regulations, organizational/employer policies and processes, and BCCNM standards, limits, and conditions when performing any medication related activity2 medication related activity
Nurses use current evidence to support their decision-making about medications and their medication practices.
Nurses follow infection prevention and control principles when performing medication-related activities.
Before performing any medication-related activity, nurses know the medication’s:
Form (e.g. tablet, liquid), and route for administration,
Side effects, and
Nurses assess the appropriateness of the medication for the client before administering, dispensing, or prescribing a medication.
Nurses assess and respect the client’s values, beliefs, personal preferences, language, learning needs, abilities, mental state, and level of understanding, to support the client (or their substitute decision-maker) to be an active participant in making informed decisions about the medication.
Nurses educate the client (or their substitute decision-maker) about the medication they are receiving, including, as applicable:
The reason the client is receiving the medication,
The expected action of the medication,
The duration of the medication therapy,
Specific precautions or instructions for the medication,
Potential side-effects and adverse effects (e.g. allergic reactions) and action to take if they occur,
Potential interactions between the medication and certain foods, other medications, or substances,
Handling and storage requirements,
Nurses identify the effect of their own values, beliefs, and experiences on their clinical decision-making about medication-related activities; recognize potential conflicts and take action for the client’s needs to be met.
Nurses take action when a medication does not seem:
Appropriate, because the client’s condition, needs, or wishes have changed,
Reflective of the client’s individual needs, characteristics, values/beliefs, or personal preferences.
Nurses collaborate, communicate, and/or consult with the health care team in making decisions about medication-related activities, including:
Consideration of the broader plan of care for the client developed by the health care team,
The follow-up needed with respect to medication when the client’s care is transferred to another health professional, or when the client transfers to another clinical or care setting or to their home,
When the client’s care would benefit from the expertise of other health care professionals,
When the needs of the client exceed the nurse’s individual competence or scope of practice, and
Documenting the plan of care.
When a pharmacist has not reviewed and verified a medication’s pharmaceutical and therapeutic suitability, or if it is unclear whether this has occurred, nurses take steps to ensure pharmaceutical and therapeutic suitability before administering or dispensing a medication by:
Reviewing the client’s best available medication history and other personal health information,
Assessing the client’s known allergies and ensuring medication allergy information is documented,
Considering potential medication interactions, contraindications, therapeutic duplications, side effects, adverse effects, and any other potential problems,
Using current, evidence-informed resources to support their clinical decision-making, and
Considering the client’s ability to follow the medication regimen.
Nurses administer, dispense, or prescribe medications only for clients under their care, except in an emergency.
Before administering a medication to a client, nurses verify, at minimum, the:
Client name and second client identifier,
Time and frequency,
Reason for administration to the client.
Before administering a medication, nurses ensure they have the competence to:
Monitor the client’s response to the medication, and
Recognize and manage intended and adverse outcomes of the medication.
Nurses only administer medications they themselves or a pharmacist have prepared, except in an emergency.
Nurses record the administration of medication on an individual medication profile and/or client record each time a medication is administered.
When dispensing a medication, nurses:
Ensure the product has not expired,
Label the medication legibly with:
Client name and second client identifier,
Medication name, dosage, route, and strength,
Directions for use,
Initials of the nurse dispensing the medication,
Name, address, and telephone number of the agency from which the medication is dispensed,
Name and designation of the prescribing practitioner, and
Any other information that is appropriate and/or specific to the medication,
Hand the medication directly to the client, or, if appropriate, to the client’s substitute decision-maker or other authorized delegate.
When dispensing a medication, nurses record dispensing information on an individual medication profile and/or client record that includes:
Allergies and adverse medication reactions, if available,
Name, strength, dosage of medication,
Quantity of medication dispensed,
Intended duration of therapy, specified in days (if applicable),
Directions to client,
Name of prescribing practitioner, and
Signature and title of the person dispensing the medication.
In response to the opioid crisis, nurses are authorized to dispense naloxone to a person who is neither their client nor their client’s substitute decision-maker or delegate, but who may encounter an individual experiencing a suspected opioid overdose.
In this instance, which is an exception, nurses would not be expected to follow all of the principles outlined above with respect to a potential individual recipient of the naloxone, to the extent it is not possible to do so when that individual’s identity is unknown.
Nurses take steps to ensure public safety by teaching the person to whom they dispense the naloxone how to respond to individuals experiencing a suspected opioid overdose.
Nurses follow all applicable organizational/employer policies and processes regarding naloxone.
Nurses identify the human and system factors that may contribute to medication errors and/or near misses, and they act to prevent or minimize them.
Nurses take action, including following organizational/employer policies and processes, when an error or near miss occurs at any point of a medication-related activity.
Nurses who have responsibility for the management of medication inventory follow organizational/employer policies and processes and, as needed, consult with, and seek guidance from expert resources and pharmacists regarding:
Organization of medication,
Recording of medications.
Examples of dispensing include when:
For more information on this or any other practice issue, contact BCCNM’s Practice Support Services by email at
email@example.com or call 604.742.6200 or toll-free (Canada only) 1.866.880.7101.
'Nurses' refers to all BCCNM registrants who are nursing professionals, including licensed practical nurses, nurse practitioners, registered nurses, registered psychiatric nurses, licensed graduate nurses, employed student nurses, and employed student psychiatric nurses. It does not include midwives.
In this standard ‘client’ means the person being treated by the nurse, as well as any substitute decision-maker, if applicable, who is authorized under applicable legislation (e.g. a temporary substitute decision maker for an adult client under the
Health Care (Consent) and Care Facility (Admission) Act, R.S.B.C. 1996, c. 181; the client’s parent or guardian, if the client is under 19 years of age, or another person authorized to exercise parental responsibilities under Part 4 of the
Family Law Act, S.B.C. 2011, c. 25, subject to the client’s right to consent to their own treatment under section 17 of
Infants Act, R.S.B.C. 1996, c. 223; a representative authorized by a representation agreement under the
Representation Agreement Act, R.S.B.C. 1996, c. 405; or a “committee of the patient” appointed under the
Patients Property Act, R.S.B.C. 1996, c. 349).
Medication related activities include, but are not limited to: administering, dispensing, compounding, prescribing, preparing, handling, storing, securing, disposing of, and transporting medication.
Other examples of standards that may be applicable depending on the context of the client’s needs and the setting are given in the ‘For More Information’ section at the end of this standard.