As of January 1, 2014, RNs and RPNs have access to the controlled act of dispensing a drug. They will need an order from an authorized provider to dispense a drug but will no longer need delegation.

The following information is for members who may have questions about dispensing.

Dispensing Process

Can an RN or RPN dispense a controlled drug or substance?

Yes. Nurses are not restricted from dispensing any particular medication, provided that they have the competence to do so safely. The Medication standard provides direction to nurses who dispense medications. Nurses must also be aware of organizational policy and legislation that impacts their practice.

If a physician orders a 12-month supply of a medication to be dispensed to a client, can a nurse dispense the medication in three-month supply intervals over the course of the year?

You should contact the prescriber to clarify the amount to dispense at one time. Nurses are accountable for ensuring that a medication order is appropriate for a client. If you feel that an order is not appropriate for a client, you should discuss your concerns with the prescriber.

When dispensing medication to a client in multiple packages (for example a three-month supply of birth control pills) does each package have to have a separate label?

The primary focus of labelling is to ensure client safety by preventing medication errors that may cause client harm or inappropriate use. Use your knowledge, skill and judgment to determine the most appropriate way to label the medication. When you label, make sure you include specific information the client needs to use the medication safely (see page 7 of the Medication practice document).

In our facility, nurses perform all the steps required in dispensing a medication except handing the medication directly to the client. Is this acceptable?

No. Nurses who dispense medication must hand the medication directly to the client or the client’s representative. If a nurse does not do this they are not upholding the expectations laid out in the Medication practice standard. All nurses are accountable for adhering to the College's standards. You should advocate for dispensing processes in your organization that are consistent with College standards.

Orders

Do RNs and RPNs need an order to provide clients with OTC (over-the-counter) medication for administration at a later time?

No. The controlled act of dispensing a drug applies to prescription drugs only. A nurse does not need an order to provide an OTC medication to a client for administration at a later time because this activity is not a controlled act.

Although an order is not required, nurses must ensure they have the knowledge, skill and judgment required to perform this activity safely and ethically. Nurses should provide client teaching and ensure that the label includes the information clients need to administer their own medication safely. Nurses should also be aware of their practice setting's organizational policies and legislation. In some practice settings, an order may be required for giving clients OTC medication; for example, the Public Hospitals Act requires all treatments to be ordered by a physician, nurse practitioner, midwife, or dentist.

From whom can nurses accept orders for dispensing?

Nurses can accept orders for dispensing from Physicians, Nurse Practitioners and Dentists.

If a client has an order for medication to be administered daily, can the nurse assume that this order allows him/her to dispense the medication in the event that this client is going on an LOA (leave of absence)?

No. An order to administer a medication does not provide a nurse with the authority to dispense the medication. If a physician or NP has written orders for medication to be administered to a client on an ongoing basis and the client later needs the medication dispensed, a nurse cannot dispense it unless there is an order to dispense the medication.

Nurses should be able to distinguish between orders for administering and those for dispensing. They should advocate for systems that support safe and ethical dispensing of medications. This may include the creation of organizational policies or specific mechanisms for communicating orders.

Can a nurse accept an order that reads “dispense medications required as per MAR for three-day LOA”?

No. An order to dispense must include all of the requirements for dispensing outlined in the Medication practice standard. These are: order date, client name, medication name, dose in units, route, frequency, purpose, quantity to dispense; and prescriber’s name, signature, and designation.

What must an order to dispense include to be considered complete?

An order to dispense must include the following elements:

• order date
• client name
• medication name
• dose in units
• route
• frequency
• purpose
• quantity to dispense
• prescriber’s name, signature and designation.

Can we continue to use directives to provide the authority to nurses to dispense medications?

Yes. A directive is an order that applies to more than one client when specific conditions are met. A directive can authorize nurses to dispense a medication if it includes all of the elements of an order to dispense (except client name). See above for the list of elements that must be included in an order to dispense. For more information about directives, see Authorizing Mechanisms.

The prescriptions that we receive from community physicians do not include the purpose of the medication. Can we use a directive to clarify the purpose of these medications?

No, you cannot use an order (e.g. a directive) from a different practitioner to supplement the incomplete dispensing order. When accepting an order for dispensing, it must include all of the elements mentioned above, including purpose. The only exception is that directives do not include client name because directives apply to more than one client.

If a client is going on a leave of absence, can a nurse use an order to administer medications to also dispense those same medications?

No. Having an order to administer a medication is not the same as having an order to dispense. If your client has orders for medications to be administered, and she or he requires these medications to be dispensed, you would need a separate order to dispense the medications. The order must include the elements that are listed above. 

Before January 1, 2014, the nurses in my organization received the authority to dispense medications through delegation. This delegation was referenced in a directive. Now that we no longer need delegation to dispense, how will this affect our process?

Since nurses no longer need delegation to dispense medications, you do not need the delegation process you have in place. You still need to have an order, which can be in the form of a directive. You could discuss this within your organization and update the wording of your directives so that delegation is no longer mentioned. The required directive needs to reflect the requirements for nurses to dispense.