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The exceptions to this broad authorization(outlined below) include administration ofmedication for the purposes of medicalassistance in dying and administeringmedications for the purpose of performing renaldialysis and immunization.NOTE: Please refer to the Competency Profile forLPNs regarding the LPN scope of practice specificto medication administration.Medical Assistance in Dying (MAID)In June 2016 the federal government enactedlegislation that allows for the provision of medicalassistance in dying under certain circumstances. InCanada, the Criminal Code allows nurses to assist aphysician or nurse practitioner (NP) in theprovision of MAID as per the direction of theirrespective regulatory bodies. A nurse who isassisting a physician or NP must also be under thedirection of the physician or NP, otherwise theycannot assist. Only a physician or NP can assesseligibility for MAID and only the physician or NPcan administer the substance(s) that causes death.It is essential for the LPN to understand that LPNswill have a limited role in MAID.The CLPNA recommends that: all LPNs review the Medical Assistance inDying: Guideline for Nurses in Albertadocument available on the CLPNA websiteto better understand the associatedrights, responsibilities and obligations;andany LPN who has been asked toparticipate in MAID contact a PracticeConsultant at CLPNA for advice.Renal Dialysis & ImmunizationIn accordance with the LPN Profession Regulation,the CLPNA considers Renal Dialysis andImmunization to be areas of Specialized Practice.In order for LPNs to provide immunizations orpractice dialysis nursing they must completeeducation approved by CLPNA and receiveauthorization from the CLPNA Registrar.LPNs can inform their nursing practice byunderstanding that drugs are regulated at bothfederal and provincial levels, with drugmanagement and responsibilities identified in thelegislation. The following describes legislation thatis relevant to LPN practice in Alberta.FederalDrugs in Canada are controlled at a federallevel by the Food and Drug Act, theControlled Drugs and Substances Act, and theregulations associated with those acts, includingNatural Health Products Regulations. HealthCanada is responsible for regulating food anddrugs to establish safety standards and qualitythrough Canada’s Food and Drug Act. 10 The Foodand Drug Act regulates the advertising, selling,and importing of foods, drugs, cosmetics, andmedical devices.The Controlled Drugs and Substances Act 11explains several drug-related offenses thatinclude exporting or importing, trafficking,growing, and possessing drugs. The act alsodefines activities related to prescriptionshopping—seeking prescriptions from multipledoctors and pharmacies for drug abuse—ascriminal activity. 12In Canada, drugs are categorized into threeschedules, or four categories: 131. Schedule 1 drugs require a prescription asa condition of sale.2. Schedule 2 drugs are available without aprescription but must be obtained from apharmacist.3. Schedule 3 drugs are available without aprescription from the self-selection areaof a pharmacy.4. Unscheduled drugs are not listed in anational or provincial schedule and maybe sold from any retail outlet.CLPNA Medications Administration – Page 3

The Province of Alberta, in conjunction with theNational Drug Scheduling Advisory Committee,decides how drugs are scheduled (Scheduled DrugRegulation) through an online database of thenational drug schedules. 15 The regulationorganizes drugs into categories according to thelevel of risk of taking medications with or withoutthe advice of a health care professional. Forexample, higher-risk medications are placed inSchedule 1, and lower-risk medications are placedin Schedule 3. For information regarding theScheduled Drugs Regulation, see the Pharmacyand Drug Act: Scheduled Drugs Regulation. 16ProvincialThe Province of Alberta has establishedlegislation to govern the management ofmedications in the province. In 2000 thePharmacy and Drug Act was passed. Thislegislation serves to regulate the delivery ofpharmacy services to maintain the integrity of thedrug distribution system and ensure thatpharmacy services are provided safely, effectively,and with accountability. 14Alberta’s provincial drug schedules are generallyaligned with the national drug schedules. To viewa list of exceptions, visit the Alberta College ofPharmacists’ website ’s drug schedules, with some examples,are provided in Table 1.CLPNA Medications Administration – Page 4

Table 1. Alberta’s Drug SchedulesAlberta’s Drug Schedules 17Schedule 1Schedule 2The drugs included in Schedule 1require a prescription as a condition ofsale and must be stored and sold onlyin the dispensary in a pharmacy. Drugsin this schedule include all federallyscheduled drugs and certain others,some of which are specific to Alberta.The latter may appear to be nonprescription drugs (as there will be nosymbol directly on the drug productlabel). Pharmacists must be aware ofthese products to prevent possiblesale without a prescription.Drugs listed in Schedule 1 of theScheduled Drugs Regulation aresubject to all the same considerationsas drugs listed in the Prescription DrugList of the Food and Drug Regulations(Canada).The standards of practice that apply todrugs in this schedule are the samestandards that apply to all prescriptionmedications.The drugs listed in Schedule 2 donot require a prescription as acondition of sale. These drugsmay be sold only from a licensedpharmacy or an institutionpharmacy by a pharmacist orunder the direct supervision of apharmacist. Schedule 2 drugsmust be stored and sold only inthe dispensary. Standards ofpractice for assessment oftherapy (standards 3 and 4), clientcounselling (standard 8), anddocumentation (standard 18)apply to Schedule 2 drugs.Examples in Schedule 1 includeamlodipine, Altace, citalopram,Lipitor, metoprolol, penicillin, andTylenol #3Examples in Schedule 2 includesilver nitrate, Gravol, Tylenol #1,codeine, nitroglycerin, andiron 30 mg.Schedule 3The drugs listed in Schedule 3 donot require a prescription as acondition of sale. These drugs maybe sold only from a licensedpharmacy or an institutionpharmacy. Schedule 3 drugs mustbe stored and sold only in theclient services area of thepharmacy. A pharmacist must takereasonable steps to aid a clientwho wishes to purchase aSchedule 3 drug (standard 9).Examples in Schedule 3 includefluoride and its salts, lactulose,acetaminophen in sustainedrelease formulations, and vaginalyeast infection products.Note: Unscheduled drugs not listed in Schedules 1, 2 or 3 (e.g., Tylenol, Bayer Aspirin, ibuprofen) may besold from any retail outlet. More examples are available in the full drug schedules, available from theNational Association of Pharmacy Regulatory Authorities (NAPRA). 18Over-the-Counter MedicationsOver-the-counter medications are Schedule 2, 3,and Unscheduled drugs outlined in the AlbertaPharmacy and Drug Act and the supportingScheduled Drugs Regulation. These medicationscan be acquired without a prescription.The LPN Profession Regulation does not authorizeLPNs to prescribe medications; having adiscussion with a client or family member andmaking recommendations about over-the-countermedications may be viewed as pseudoprescribing. Therefore, LPNs should advise theirclients to seek advice about over-the-countermedication from a health care professional who isauthorized to provide such information (e.g., anauthorized prescriber).In the event a client has an existing order (e.g.,postoperative) for over-the-counter medicationfrom an authorized prescriber, the LPN maydiscuss and provide education on this over-thecounter medication and suggest that the client orCLPNA Medications Administration – Page 5

family pick some up to have on hand upondischarge, only if this advice is consistent with theorder in place. This advice would be consideredappropriate as there is a covering order from anauthorized prescriber in place. To provide thiseducation, the LPN needs to be aware of theclient’s specific health information andmedication history.LPN Profession-SpecificDocumentsInall aspects of medication administration,the LPN is expected to follow the Standardsof Practice, Code of Ethics, MedicationManagement Practice Guideline, and the mostcurrent Competency Profile for LPNs, wherecompetencies specific to medicationadministration are outlined.The Medication Management Practice Guideline isto provide guidance to LPNs by enhancing theunderstanding of LPNs’ roles and expectedpractices in medication management. Guidelinesare not intended to be exhaustive but are toprovide guidance in making informed decisions.The guideline is based on federal and provinciallegislation, the Standards of Practice and Code ofEthics adopted by the CLPNA, and theCompetency Profile for LPNs. It is also informed byAccreditation Canada’s Medication ManagementStandards, guidelines provided by the Institute forSafe Medication Practices and the CanadianPatient Safety Institute, and the work of othernurse regulators across Canada. 19The Competency Profile for LPNs, 3rd edition,broadly defines the legislated scope of practicefor LPNs in Alberta and competencies specific topharmacological principles of medicationadministration. 20 As autonomous nurses, LPNshave responsibility for their own nursing practicesand, depending on their individual knowledge,experience, and workplace settings, will havetheir own levels of proficiency in applicablecompetencies in medication administration.The LPN’s Role in MedicationManagementMedication administration must be performed inaccordance with legislation, regulatory standardsand policy documents, and employer policy. TheLPN may administer medication under thefollowing conditions: The LPN must have the education,knowledge, and competence to acceptand transcribe medication ordersaccording to best practice; The LPN must have the education,knowledge, and competence to safelyprepare, initiate, administer, monitor,titrate, and discontinue medications; The LPN must adhere to the core rightsand checks of medication administrationto ensure client safety; and The LPN’s decision to administermedications must always include theclient’s individual needs determinedthrough health assessment, the LPN’scompetence, and the availability ofsupports in the practice environment toensure safe medication administration.Decision-Making for SafeMedication ManagementMedication management is defined as clientcentred care that optimizes safe, effective,and appropriate drug therapy provided incollaboration with the client and their health careteam. 21It is important to consider a number of factors infull utilization of LPN competencies, including anassessment of the client, the nurse, and theenvironment. These factors are derived from theevidence informed Decision-Making Frameworkfor Quality Nursing Care, established by acollaborative working group of representativesfrom the Canadian Council for Practical NurseRegulators, the Canadian Nurses Association, andthe Registered Psychiatric Nurses of Canada. 22CLPNA Medications Administration – Page 6

The ClientThe LPN’s assessment of the client should begrounded in evidence-based data. This datainforms the LPN of the appropriateness of themedication for the client. Some of the assessmentfactors include, but are not limited to, the client’s continuity of care; and current and anticipated state of acuityand complexity of care needs, based onthe client’so age (infants, children, older adults);o previous medication history;o historical and anticipated response tocare; ando challenges and barriers.In some circumstances, information about theclient may not be readily available or attainable.For example, the client may not be able tocommunicate information to the nurse due toconfusion or cognitive impairment. In thissituation, family members can assist withidentification, or there may be a previous healthrecord available with a unique identifier. Inemergency situations, life-saving medications maybe provided, and the client’s identity should beobtained as soon as possible afterward. In themeantime, it is common practice to assign atemporary unique identifier to the client. 23Individual Competence of the NurseAs members of a regulated health profession,LPNs have the responsibility and accountabilityfor autonomous nursing practice. This means theLPN is responsible for his or her own level ofcompetence. Maintaining competence inmedication administration should be evaluatedannually. Nursing competency represents theintegrated knowledge, skills, behaviours,attitudes, critical thinking, inquiry, and clinicaljudgments required by LPNs to provide safe,competent, and ethical nursing care.The expected competencies of an LPN formedication management can be found in thecurrent Competency Profile for LPNs. LPNcompetencies specifically related to medicationmanagement include understanding of thepharmacokinetics and pharmacodynamicsassociated with medication administration,relative assessments, safe preparation andadministration of medications, monitoring andmanaging any adverse effect or reaction, teachingclients, and evaluating anddocumenting/communicating the client’sresponse to medication.The core importance with the administration ofany medication is that the LPN is knowledgeableabout the medication, safe recommended dosage,appropriate route, indications, contraindications,side effects, interactions, precautions, onset,duration, excretion, related-lab values,appropriate evaluation and documentation. 24The Environment (Employer Policies)While the CLPNA has the regulatoryauthority to define the scope of practicefor LPNs in Alberta, employer organizations definethe roles of LPNs specific to the practiceenvironment(s). This may vary depending on thespecific care requirements, care delivery model,and staff mix in the practice area. LPNs must workwithin the role articulated by employer jobdescription and policy.With respect to medication administration,legislation does not specify what medications canbe administered by which provider. This allowsflexibility for employers to determine whatmedications are appropriate for certain providersto administer based on client needs, providercompetencies, and the resources available in thatspecific care environment. LPNs must followemployer policy around the medicationsconsidered appropriate for them to administerwithin a given care environment. In certain areasof practice, employers may require LPNs to obtainsite-specific education before performing certainactivities within their facility.CLPNA Medications Administration – Page 7

There are several environmental factors for LPNsto consider, including legislation and regulations; employer policy and procedures; decision-making guidelines; care-delivery model; evidence-informed practice; leadership support; staff mix; orga

practice dialysis nursing they must complete education approved by CLPNA and receive authorization from the CLPNA Registrar. LPNs can inform their nursing practice by understanding that drugs are regulated at both federal and provincial levels, with drug manag