HLTENN007 - Enrolled Nurse: Medication, Legalities & Risk Management

This assignment solution for HLTENN007 Diploma of Nursing focuses on the responsibilities and legal frameworks relevant to enrolled nurses in Australia. It addresses key areas such as the meaning of supervision in nursing practice, legal and regulatory frameworks that enrolled nurses must comply with, the influence of risk management on prevention and control according to National Safety and Quality Health Service (NSQHS) Standard 3, and the rights of medication administration. The assignment delves into the enrolled nurse's role in providing care under the supervision of a registered nurse, emphasizing the importance of adhering to organizational policies, legal obligations, and professional standards. It also highlights the significance of understanding relevant legislation and guidelines from bodies such as the Nursing and Midwifery Board of Australia (NMBA) and the Australian Commission on Safety and Quality in Health Care. This document is available on Desklib, a platform offering a range of study tools and resources for students.

HLT54115 Diploma of Nursing
HLTENN007 - Administer and monitor medicines and intravenous therapy
Written Assessment Student Copy
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Instructions to Students
Welcome to the written assessment. To successfully complete the assessment requirements,
you need to follow the following instructions.
Step 1
Read the study guide and the related resources.
Step 2
Read this assessment to gain an understanding of what you need to do to complete the unit.
Talk to your trainer or supervisor and ask for help if you need to.
Step 3
Complete all questions in this assessment. Please write clearly in pen (not pencil). You may
attach printed answers. Do not remove any pages from this assessment.
Step 4
Complete the cover sheet and attach to this assessment. We recommend you make and keep
a copy of your assessments.
Step 5
Submit for assessment.
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Part A
Question 1
The following website may assist with this question
http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/FAQ/Enrolled-nurses-
and-medicine-administration.aspx
The Enrolled Nurse practices with and under the direction and supervision of the Registered
Nurse, and assists in the provision of nursing care. At all times the Enrolled Nurse retains
responsibility for his/her own actions and remains accountable to the Registered Nurse for all
delegated functions. Enrolled Nurses will be required to function only within the limits of their
education and competence.
What is meant by supervision?
Answer:
In the field of healthcare, supervision is used in psychotherapy, counselling and other disciplines
of mental health. Even in somatic disciplines supervision is used on practitioners on their
preparatory work for the patients and also their bond with the patients. Instead of being a formal
backdated investigation, supervision is rather a replacement. Supervision contains the meeting
of the practitioner with another professional on a regular basis, one who usually possesses
training in supervision skills and is not necessarily a senior (Butterworth and Faugier, 2013).
Such meetings are done for the discussion of professional issues and caseworks in a structured
manner. It is sometimes known as counselling or clinical supervision. The primary purpose of
supervision is helping the practitioners for learning from his progress and experience in
expertise and also for ensuring better quality services to the patients and the clients
(Butterworth and Faugier, 2013). The learnings of the practitioner would be applied to the
planning, diagnostic as well as therapeutic work. In the British National Health Service, several
disciplines have the usage of clinical supervision. It is now mandatory for having regular and
proper clinical supervision for the federal and registered health professionals like
physiotherapists, occupational therapists, dieticians, drama, music and art therapists. The
supervision skills that are focused on the solution are used in clinical super work as counselling
others. There is a compulsion of having supervision for a minimum of 1.5 hours a month’s time
period for the British Association of Counselling and Psychotherapy’s practicing members.
Supervision is a formal procedure of professional learning and support that helps in allowing
midwifes(supervisee) and nurses for developing the significant competence, knowledge and the
responsibility for their practices and enhancing public safety and protection as well (Butterworth
and Faugier, 2013). Supervision can be direct or indirect in accordance with the context’s nature
under which the supervision of practice takes place. In the practice plan of a supervision’s
context, a supervisor is responsible for providing reports to the territory board, state or the
committee of registration at intended intervals. A written agreement between the supervisee and
the supervisor which is submitted to the significant Nursing and Midwifery Board of Australia’s
(NMBA’s) registration committee, territory board or the state is known as the agreement of
Supervision. Such an agreement helps in identifying the supervisee and the supervisor, the two
party’s agreed responsibilities and the place of practice. A supervision report is a formal
document which is submitted in a format that is approved by NMBA and is given during the
relevant intervals and is agreed in the practiced plan of the supervision (Severinsson and Sand,
2010). The report details and shows the progress of the practice plan of the supervision. An
additional report of supervision might be submitted by a supervisor during any point of time.
Such a report is prepared when there is any mandatory requirement or proposal of changes to
the practice plan of the supervision or in case of the supervisee’s concerns.
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A Supervisor is a properly experienced and qualified registered or enrolled nurse or/and midwife
who is responsible for supervising an individual who undertakes a supervision practice period
that is approves by the NMBA (Severinsson and Sand, 2010). The supervisor is responsible for
assessing, monitoring, providing significant feedback and reporting to the necessary territory
board, state or committee of registration of the NMBA regarding the nurse’s or midwife’s
performance under the supervision. An ideal supervisor should have more than two years of
experience as a midwife or nurse and should have completed a course of a supervisor or
preceptorship. A nurse or midwife who holds registration with undertakings or conditions or a
provisional registration, or enters into a supervision requiring undertaking is known as a
Supervisee (Severinsson and Sand, 2010). They practice under the guidance, direction and
oversight of a supervisor for meeting their objectives and goals of a supervised plan of practice.
Question 2
The following websites may assist with this question
http://www.health.nsw.gov.au/pharmaceutical/pages/legislation.aspx
http://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-
2012.pdf
The Registered Nurse retains overall accountability and responsibility for the nursing care
provided to his/her allocated consumers whether performed directly, in collaboration with, or
delegated to an Enrolled Nurse.
The Enrolled Nurse working in conjunction with and under the supervision of the Registered
Nurse will assist in the planning, the implementation and delivery of nursing care to consumers.
The Enrolled Nurse will implement medical/treatment orders under the direction and as
delegated by the Registered Nurse with reference to the Enrolled Nurses scope of education
and practice The Enrolled Nurse will practice in accordance with organisational policy within
their level of training and legal obligations. Discuss the legal and regulatory frameworks that
Enrolled nurses need to comply with.
Answer:
An enrolled nurse has several responsibilities and liabilities, and need to comply with certain
legal and regulatory frameworks. An enrolled nurse needs to demonstrate the in-depth
understanding and knowledge the state and territory legislation, commonwealth and the
common law that is relevant to the nursing practice (Eagar, Cowin, Gregory and Firtko, 2010).
During the undertaking of the enrolled nurse’s practice, they need to fulfill all the duties of care.
It is their duty to manifest and exhibit the thorough knowledge and implications of all the
standards, work policies, procedures and codes and guidelines of the Nursing and Midwifery
Board of Australia (NMBA) which are applicable on the nursing practice. In accordance with the
agreed care plan, policies of the workplace, guidelines of the procedures and the professional
standards, the enrolled nurse should provide nursing care. It is a must for them to identify and
clarify their own responsibilities for the particulars of entrusted care in order to work in
collaboration with the registered nurse and the healthcare team. The enrolled nurse should
recognize and identify their own limitations and liabilities in the competence and practice and
should seek supervision from the registered nurse and assist them as and when needed (Eagar,
Cowin, Gregory and Firtko, 2010). They are required to withhold from undertaking any acts
where there is no significant education, experience, training and demonstration regarding
competence or has not been undertaken. During any sorts of occurrence of incidents related to
unsafe practice, the enrolled nurse should immediately report to the registered nurse and other
individuals in authority or people in-charge, and should explores ways of preventing such
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incidents from taking place again in the future. The registered nurse should also negotiate and
cooperate with the all the appropriate personnel as well as the registered nurse for ensuring the
rights and needs of people and patients in care receipt are upheld and addressed.
The nurses should have significant knowledge about certain legal acts and frameworks. these
include the Poison and Therapeutic Goods Regulation Act 2008, the NSW Poisons List,
Standard for the Uniform Scheduling of Medicines and Poisons (SUSMP), the Trafficking and
Drug Misuse Act and Regulations, Dangerous Goods legislation, NSW and Commonwealth
Food regulations, National Industrial Chemicals Notification and Assessment Scheme
(NICNAS), Commonwealth Therapeutic Goods Act, Competition and Consumer legislation,
SafeWork Australia national code for labelling workplace substances, import and exports
regulations that are customs prohibited, Therapeutic Goods Administration (TGA), Australian
Pesticides and Veterinary Medicines Authority (APVMA) etc.
Question 3
The following website may assist with this question
http://www.safetyandquality.gov.au/wp-content/uploads/2012/10/
Standard3_Oct_2012_WEB.pdf
The Australian Commission on Safety and Quality in Health Care developed the National Safety
and Quality Health Service (NSQHS) Standards to improve the quality of health service
provision in Australia. The NSQHS Standards provide a nationally consistent statement of the
level of care consumers should be able to expect from health service organisations. How does
risk management influence prevention and control for Standard 3?
Answer:
For the Standard 3, risk management is related to the risk of transmission or acquisition of an
infectious agent or an infection for patients, visitors and the workforce within a healthcare
organization. The implementation and the usage of an approach of risk management helps in
allowing the healthcare provider to determine the specific areas where there is low or high risk
and focus on how it should be responded to accordingly. The senior managers of a healthcare
organization and clinical leaders implement certain systems for preventing and managing the
healthcare related infections and convey the same to the staff or the workforce for the
achievement of significant results. The clinicians and other representatives of the organization’s
workplace use and implement the systems for control and prevention of the healthcare related
infections. These infections are very common difficulties that affect the patients of a hospital. In
Australia, every year, patients contract with nearly 200,000 healthcare infections (NHMRC,
2010). Almost half of these healthcare infections can be prevented. In order to control infections
successfully and for minimizing the transmission risks, a certain range of strategies is required
across all the levels of the system of healthcare. It also requires a collective approach for the
implementation to be successful. Such a standard’s objective is the prevention of the patients
from acquiring the healthcare related infections that are preventable and management of the
infections effectively as and when they occur by using strategies which are based on evidences.
There are certain requirements of the Standard 3. Effective management and governance
systems should be implemented and maintained for the healthcare related infections.
Appropriate strategies should be developed, used and maintained for controlling and preventing
these healthcare related infections. Patients that are brought into the hospital carrying an
infection or colonialization, or acquire the same during the period of care should be taken proper
care of, their complications should be determined promptly and should receive the appropriate
treatment and management. A strategic aim of the system of clinical governance is the
significant and safe prescription of antimicrobials. The environment of the healthcare and the
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related facilities should be hygienic and clean. The reprocessing of the instrumentation and
equipment helps in meeting the guidelines of practice that are the best. The patients,
caretakers, service providers and the consumers are provided with relevant information and
knowledge on healthcare related infections.
Question 4
The following website may assist with this question
http://www.newhealthadvisor.com/10-Rights-of-Medication-Administration.html
Discuss the rights of medication administration.
Answer:
Whether it is a nurse providing medications or a patient receiving the same, it is very crucial to
understand the medication administration rights. While consuming medication by oneself, or
while giving it to a family member, safety should be considered at the very first place. There are
always chances and risk of wrong medications or improper dose or the medications of the wrong
person being provided. Such incidents can result in bringing dangerous, harmful and even life-
taking consequences. It is very critical for everyone to have prior knowledge and understanding
of rules of safety for medications even though protocol for the medications have always been
there. The various medication administration rights are as follows.
Right Patient
It should be ensured that the right medications are being given to the right patient (Elliott and
Liu, 2010). If a person is at home and is providing medication to their family member, the bottle
of medication should be checked and it should be ensured that it is being given to the right
person in accordance with the appropriate prescription.
Right Medication
When certain medication is prescribed by a doctor, the medication container would include a
prescription label. Often, mistakes and blunders are made by pharmacies and clinicians as well.
The medication should be checked against the prescription label and a person should be aware of
the names of medications that sound alike.
Right Dosage
One of the most vital administration rights is the right dosage. One should always be careful
about the appropriate proportion of dosage of the medicine to be given to a patient (Elliott and
Liu, 2010). Until and unless surety is obtained regarding the dosage amount, the medications
should not be given to a patient. Different dosages such as pediatric, adult, pregnant, elderly, etc.
should be kept in mind.
Right Route
The right route of medication is important to be considered as well. If a patient is unable to
swallow a pill form medicine, he should be given liquid form of the same. Appropriateness of
medications should be focused on such as whether they can be given by suppositories, cream or
lotions form, syrup form or in form of pills (Macdonald, 2010).
Right Time
The appropriate timing of taking a medication should be given prior consideration to. Whether
the medicines should be given to the patient during the daytime, in the morning or before bed,
before or after meals, all are crucial to be considered (Macdonald, 2010).
The other five rights of medication administration are the Right Documentation, Right Client
Education, Right to Refuse, Right Assessment and the Right Evaluation (Elliott and Liu, 2010).
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Question 5
The following website may assist with this question
http://www.safetyandquality.gov.au/our-work/medication-safety/medication-chart/
Medication charts are legal documents and must be completed accurately and unambiguously
in order to ensure that clients receive safe and optimal drug therapy. What constitutes a legal
medication order?
Answer:
An order for any kind of medication, compound or nutritional agent of a policy which is defined
by the institutional policy during an order requirement from a prescriber. A legal medication
order is constituted by the policy purposes, scope of policy and the various policy statements.
The policy purpose is related with providing a base for safe communication of nutritional and
medication orders. Hence, they reduce the possibility of preventable adverse events or errors
and also establish the continuity of prescriptions. Its foundation is related to a set of common
guidelines of practice that are developed for the health authorities and are applied on the
ambulatory, residential and impatient services. There are various policy statements which
compose the legal medication order. These are namely, Medication order writing, Medication
order legibility, Medication order forms, Core Medication order components, Verbal (Medication)
orders, Telephone (Medication) orders, Medication order dosage format, Medication order
dosage formula, Medication order disallowed, Suggested Medication orders, Standing
Medication orders, Safety validation of Medication orders: Practitioner responsibilities,
Prescriber or practitioner compliance reviews.
Question 6
The following website may assist with this question
http://medical-dictionary.thefreedictionary.com/
The nurse is responsible for ensuring that they have the knowledge to ensure the correct
administration of drugs. This includes pharmacology, anatomy and physiology, and legal issues.
Another responsibility of the nurse is to monitor the effect of the drugs that are administered to a
client, i.e.
- whether the drug had the required effect
- little or no effect or
- if any adverse reactions occurred.
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Complete the following table.
Define pharmacology The science which deals with the nature,
origin, effects, chemistry and the usage of
drugs and medications is known as
Pharmacology (Lesko, Zineh and Huang,
2010). It also includes
the science that deals with the origin, nature, c
hemistry, effects, and uses of drugs; it includes
pharmacokinetics, pharmacognosy, toxicology,
pharmacotherapeutics and
pharmacodynamics.
Define pharmacodynamics. It is the study of the physiological and
biochemical effects of medicines and their
action mechanisms, including their actions’
correlation effects with the chemical
composition of the drugs (van der Graaf and
Benson, 2011).
Define pharmacokinetics. It is the study which is related to the
movements of medicines and drugs inside the
human body, including the different processes
of
the study of the movement of drugs in the body
, including the processes of distribution,
absorption, biotransformation, tissue
localization and excretion (Bergen, et. al.,
2012).
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Define pharmacotherapeutics. It is the study of medical science that deals
with the therapeutic effects and usage of
medicines and drugs. It identifies the adverse
and beneficial effects of medicines.
Define toxicology. Toxicology is basically the study or science of
poisons (Elsaesser and Howard, 2012).
Developmental toxicology is another popular
and close related terms which is related to the
study of the toxin effects that are caused on
the development of embryos.
Define adverse reactions The serious and unexpected symptoms with
coincide with a drug’s or medicine’s
administration are known as adverse reactions.
In other words, they are the unfavorable
reactions which are caused due to the usage
of local anesthetic. The factors that are
responsible include the concentration of drug,
its usage and usage route.
What are contraindications? The indication of inadvisability of a medical
treatment is known as contraindication (Ryoo,
et. al., 2013).
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What are side effects? In medicines or drugs, an effect whether
adverse or therapeutic, which is secondary to
the intended one, is known as side effect of
those medicines or drugs. The term can be
applied for unintended yet beneficial results of
a drug.
What are precautions? In medicines and drugs, the practice of avoidance
of making any sorts of contact with the bodily fluids
of patients, by the usage of or wearing nonporous
objects like face shield, goggle and medical gloves.
What are Drug Interactions? Drug interaction is a physiological or chemical
reaction which can take place if two distinct
drugs or medicines are taken with each other
at the same other. In other words, it is the
conversion of the effects of one drug by
reaction with some other drug, with medical
condition that is already existing or with foods
or consumables.
What is anaphylaxis? It is a life-threatening and rapidly progressing
allergic reaction, where the non-harmful
substances of the environment are responded
by the immune system (Simons, et. al., 2011).
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Question 7
The following websites my assist with this question
http://nursing.flinders.edu.au/students/studyaids/drugcalculations/page.php?id=1
http://www.safetyandquality.gov.au/wp-content/uploads/2014/02/Literature-Review-Medication-
Safety-in-Australia-2013.pdf
https://www.nursingcenter.com/ncblog/may-2011/8-rights-of-medication-administration
Part A
Administration of medications is a major component of the enrolled nurse’s role within clinical
settings. Medication administration is a high risk activity which requires a consistently accurate
approach by the enrolled nurse in any workplace. List the factors you need to consider when
calculating medication dosages.
Answer:
The factors that should be considered for calculating the medication dosages are age, weight,
sex, race, genetic make-up, occupation, habitual use, administration time and frequency.
Part B
Paediatric medication calculations have high risks due to
- Immature organ function to metabolise drugs
- Mg/kg doses require calculations
- Small doses required: a small change may make a big difference clinically
- Dosage forms are usually in adult sizes
- Liquid formulations need to be measured and/or diluted
Emily is a 4 year old girl who has Cystic Fibrosis. Emily has been admitted into hospital for the
treatment of a chest infection. Emily has been ordered IV antibiotics. What factors do you need
to consider when calculating her medication?
Answer:
The factors that are needed to be considered while calculating Emily’s medication are her
Weight, Formula of calculation, Dosage calculation, Flow rate drops per minute, Flow rate
milliliters per hour.
Part C
Prescribing for older patients presents unique challenges. Many medications need to be used
with special caution because of age-related changes in pharmacokinetics (ie, absorption,
distribution, metabolism, and excretion) and pharmacodynamics (the physiologic effects of the
drug).
Particular care must be taken in determining drug dosages when prescribing for older adults. An
increased volume of distribution may result from the proportional increase in body fat relative to
skeletal muscle with aging. Decreased drug clearance may result from the natural decline in
renal function with age, even in the absence of renal disease. Larger drug storage reservoirs
and decreased clearance prolong drug half-lives and lead to increased plasma drug
concentrations in older people.
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Mr Howard King, 93 year old frail man, has been prescribed paracetamol prn. Discuss safe
paracetamol use in the elderly.
Answer:
For the usage of paracetamol in elderly people, calculations of geriatric dosage should be taken
into consideration, the body weight of the person should be considered, along with the surface
area and his age.
Part D
Mr Howard King has been admitted to hospital. He has a dose administration aid that he has
brought with him, however, he is not sure of the contents. What would you do in this
circumstance? How would you explain to Mr King how medication is administered in the hospital
if you are to use hospital stock?
Answer:
An explanation to Mr. King would be that the administration of medication in hospitals and the
usage of the hospital stocks would require the policies and procedures of the organization to be
followed and proper and significant reporting and documenting of the medications would be
needed.
Question 8
The following website may assist with this question
http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/
Peripheral_Intravenous_IV_Device_Management/
https://www2.health.vic.gov.au/about/publications/policiesandguidelines/Intravenous%20therapy
(Download Intravenous therapy PDF)
While medical staff are responsible for IV fluid orders, you need to be aware of the indications,
techniques and problems associated with IV fluid administration
Part A
List six indications for IV fluid therapy
The major indications for IV fluid therapy are:
1. Dehydration: This refers to the fluid which is lost from the interstitial space. This is either
due to intake of less fluid in diet or due to the loss of excess fluid through vomiting,
polyuria, diarrhoea, etc.
2. Hypovolemia: In this case the fluid is lost from intravascular space. This is also caused
due to intake of less amount of fluids in the daily diet or from haemorrhage. This is also
caused by loss of fluid from the body during vomiting, diarrhoea, etc.
3. Distributive shock: This can be caused due to transfusion reactions which are severe,
tissue hypoxia, tissue perfusion reduction, vasodilation, etc (Hoste, et.al, 2014).
4. Kidney failure: The patients who suffer from kidney failure are those who face from
isotonic crystalloid fluids administration.
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