RACF List of Nurse Initiated Medications

							                                                       Reference Card: RACF List of Nurse Initiated Medications


                                                        RACF List of Nurse Initiated Medications
Suggested list of medications that may be considered by Medication Advisory Committees for inclusion as nurse initiated medications (NIM).
Recommended dose, duration and specific administration comments must be stated. Maximum duration applies to the maximum length of time the medication may be given or used
without contacting a medical prescriber.

Source: Bouchner F (Chairman Ed Advisory Board). Australian Medicines Handbook 2004 Australian Medicines Handbook Pty Ltd, Hyde Park Press Richmond SA, 2004


Clinical            Medication            Route            Recommended Adult                 Maximum dose                 Maximum              Comments
Indication                                                 dose                                                           Duration
Angina              Glyceryl trinitrate   Sublingual       ½ -1 tablet under the             2 or 3 tablets over          3 doses              Sit or lie down before use as it may cause dizziness
                    tablets 600mcg                         tongue repeated every             15 minutes                                        Call an ambulance if 2 or 3 tablets over 15 minutes
                    (Anginine)                            3-4 minutes until pain is                                                           do not relieve pain.
                                                           resolved
Asthma              Salbutamol MDI        Inhalation       First Aid for asthma.             4 puffs every 4              One
                    plus spacer                            Using spacer: 1 puff              minutes until                treatment only
                                                           four breaths, repeat              ambulance arrives
                                                           until 4 puffs have been
                                                           given
Constipation        Docusate sodium       Oral             100 – 150mg once or               3 tablets twice a            72 hours             Faecal softener. Onset of action is 1-3 days
                    (Coloxyl 50mg)                        twice daily                       day
                    Docusate sodium,      Oral             100 – 150mg once or               3 tablets twice a            72 hours             Faecal softener with peristaltic stimulant.
                    sennosides a & b                       twice daily                       day                                               Onset of action is 1-3 days
                    (Coloxyl &
                    Senna)
                    Lactulose             Oral             10 – 20mL twice a day             20mL twice a day             72 hours             Onset of action is 1-3 days
                    Movicol sachet       Oral             1 sachet until result             Take no more than                                 Useful for impaction Cardiovascular disease (eg
                                                                                             2 sachets/hour is                                 heart failure) may be exacerbated; use with caution
                                                                                             there is                                          as fluid and electrolyte disturbances may occur
                                                                                             cardiovascular
                                                                                             disease
                    Glycerine             Rectal           1 suppository                     1 suppository                Single dose
                    suppositories
                    Sodium/magnesium      Rectal           1 enema                           1 enema                      Single dose          Avoid use of sodium salts in cardiovascular disease
                    laxatives eg                                                                                                               eg heart failure as fluid and electrolyte disturbances
                    Microlax enema                                                                                                            may occur



                                                                      For details see Clinical Information Sheet: Medication Management
                                                   Produced by North West Melbourne Division of General Practice, December 2004r reviewed November 2006
                                               Reference Card: RACF List of Nurse Initiated Medications

Ear wax        Olive oil, or        Otic             As per manufacturers                                           3-7 days             2-3 days (may require syringing after)
               proprietary products                  directions
               eg Cerumol,
               EarClear,
               Waxsol
Indigestion    Combination          Oral             10 – 20mL 3-4 times a             20mL 4 times a day           24 hours             Antacids should not be taken at the same time as
               antacids liquid                       day between meals and             between meals &                                   other orally administered drugs; most drug
               product                               at night                          at night                                          interactions can be avoided by having an interval of
                                                                                                                                         at least 2 hours between an antacid and another
                                                                                                                                         drug.
                                                                                                                                         Be aware of the differential diagnosis between heart
                                                                                                                                         conditions and indigestion
Oral hygiene   Chlorhexidine        Oral - do not    As needed
               gluconate            swallow
               mouthwash
Dry skin       Sorbolene and        Skin             Twice daily                       prn                                               May be used in conjunction with bath/shower oils
               glycerine products                                                                                                        provided by resident
Pain           Paracetamol          Oral             1-2 every three to six             Maximum dose                48 hours             Caution to check total paracetamol dose form other
               500mg tablets                         hours if necessary                4g/24 hours                                       products




                                                                For details see Clinical Information Sheet: Medication Management
                                             Produced by North West Melbourne Division of General Practice, December 2004r reviewed November 2006