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NSHA, IWK Drug Reference

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Guidelines

Safe medication administration is essential to providing patients with quality care. This involves following established guidelines and best practices to ensure that medications are given correctly and safely to patients. It includes accurate dosage, proper administration routes, understanding potential drug interactions, and monitoring for side effects.

Engaging patients and families in their care can involve providing education on their medication dose, intended use and side effects. These interactions give patients and their families an opportunity to ask questions and may identify knowledge gaps. Educating patients and their families about their medications contributes to them having an active role in their care with can prevent medication errors.

Medication Management - Accreditation Canada

Key Practice Points

Hand hygiene is performed before preparing medications, and also before and after contact with patients.
Confirm the patient’s identity using two identifiers before administering any medication.
Medication reconciliation is completed at admission, discharge, and during patient transfers to help prevent drug interactions, duplications, or omissions.
Safe medication administration involves following a structured process to prevent errors and applying the medication rights: right patient, medication, route, time, dose, reason, response, education, and documentation.
Verify medication orders to ensure they are clear, accurate, and up-to-date.
Prior to medication administration complete three checks of the medication label:
- before removing from an automated dispensing cabinet or supply drawer,
- when preparing the medication, and,
- before administering to the patient.
Provide patient education about the medication, including its purpose, potential side effects, and instructions for use.
Monitor the patient for therapeutic effects and any adverse effects or allergies.
Provide patient education about the medication, including its purpose, potential side effects, and instructions for use.
Document the medication administration process, including the time, dose, route, and any patient responses or reactions.
Make Waste NOW a priority - The preparation and administration of controlled medications requires an extra layer of responsibility for the health care professional, Health Canada's Controlled Drugs and Substances Act mandates strict accountability for all controlled substances. Immediate waste ensures legal compliance and prevents diversion.

Policies, Care Directives and Related Guides

CL-SR-025 Patient Identification
IPC-RP-020 Hand Hygiene Policy & Procedure
MM-MA-005 Medication Independent Double Checks
MM-SR-005 “Do Not Use” Abbreviations, Symbols and Dose Designations Policy
MM-SR-010 High Alert Medications
MM-SR-020 Transcribing Medication Orders
MM-SR-030 Medication Reconciliation Policy and Procedure
Includes links to related policies for Medication Reconciliation in:
Acute Care Services - NSHA MM-SR-030.01
Long Term Care - NSHA MM-SR-030.02
Continuing Care - NSHA MM-SR-030.03
Outpatient Care and Community Based Settings - NSHA MM-SR-030.04
PHC-SR-001 Allergy Identification and Documentation Policy and Procedure

Medication Administration, Reconciliation and Transcription - Skills and Procedures

Medication Delivery Method - Skills and Procedures

Adult - Skills and Procedures

Adults

Infants, Pediatrics, Adolescents - Skills and Procedures

Related Learning Modules

Nova Scotia Health eLearning (LMS - Medworxx)
You must sign in to search for the courses listed below. To sign in, enter your domain\username (e.g. cdha\doej) and password. Once signed in, select the Catalogue tab. Copy the course title or code, paste it in the Keywords search box and select Search.
NOTE Microsoft Edge is the optimal browser for LMS. For more information, go to The Compass: Learning Management System

Course Title or Series	Code(s)
Do Not Use Abbreviations	0148
Agilia Syringe Pump Declaration of Competence	0812
Agilia Syringe Pump Training Module	0703
CVAD Series: 1-6	0127 - 0132
Drug Information System: 1-3	0143 - 0145
High Alert Medications	0191
Intravenous Series: Intravenous 1-6	0223 - 0571
Medication Reconciliation Series: 1-2	1114 - 1115
Patient Identification	0349
Pyxis Training for Nursing Staff	0436
Sharps Injury Prevention	0495

What is "Waste Now"?

When preparing a controlled medication from the automated dispensing cabinet (ADC), you may be required to waste unused portions of the dose. It is recommended that waste be done immediately, however, there may be circumstances where this isn’t able to be completed (i.e., no one is available to witness, emergency situations).

The ADC will display the following options:

Waste Now: The user wastes the medication during the Remove workflow.
Waste Later: The medication removal generated undocumented waste, which will be flagged with an alert. The undocumented waste needs to be resolved by the user at some point after the Remove transaction. Undocumented waste needs to be accounted for. It is the responsibility of the healthcare professional who has prepared the medication to ensure this has been done.

Why is ‘Waste Now’ Important When Preparing Controlled Medications?

Prevention of Diversion

Controlled substances are high-risk for misuse or theft. Immediately witnessed waste reduces the risk of staff or patient access to leftover narcotics or sedatives.

Patient Safety

Leftover portions of medications (e.g., partial vials or syringes) pose a significant risk if administered incorrectly or without a documented dose. Immediate waste eliminates confusion and ensures the correct dose is the only one available.

Professional Accountability

Witnessed waste supports transparency and shared responsibility in medication management. It protects both the administering and witnessing clinicians in case of audits or investigations.

Documentation Integrity

Delayed waste increases the risk of discrepancies in narcotic counts or medication administration records (MARs). Real-time waste ensures accurate, timely documentation.

Inventory Accuracy

Waste events impact narcotic and controlled substance inventory logs. Immediate recording ensures counts are accurate, and inventory reports remain reliable for pharmacy reconciliation.

Audit Readiness

Whether internal or by external regulators (e.g., Health Canada, College of Nurses/Pharmacists), facilities must demonstrate strict controls over controlled substances. Documented, witnessed waste supports audit readiness and system trust.

Cultural Reinforcement of Best Practice

Building a culture where immediate waste is expected reinforces other high-risk safety behaviors and fosters collective vigilance around medication security.