1. (1) The registered nurse or licensed practical nurse shall have applied knowledge of medication administration and safety, including but not limited to:

   1. (a) Drug action.
   2. (b) Classifications.
   3. (c) Expected therapeutic benefit of medication.
   4. (d) Expected monitoring.
   5. (e) Indications based on existing patient illness or injury processes.
   6. (f) Contraindications based on presence of additional known patient illnesses, disease processes, or pre-existing conditions.
   7. (g) Possible side effects and interventions for same.
   8. (h) Adverse reactions and interventions for same.
   9. (i) Emergency interventions for anaphylactic reactions.

   10. (j) Safety precautions, including but not limited to:

       1. 1. Right patient.
       2. 2. Right medication.
       3. 3. Right time.
       4. 4. Right dose.
       5. 5. Right route.
       6. 6. Right reason.
       7. 7. Right documentation.
   11. (k) Interactions with other drugs, foods, or complementary therapies.
   12. (l) Calculation of drug dosages.
   13. (m) Federal and state legal requirements related to storage of controlled substances.
   14. (n) Healthcare facility policy and procedure on secure storage of all medications.
   15. (o) Patient education specific to medication.

2. (2) The licensed nurse shall exercise decision-making skills when administering medications, to include but not limited to:

   1. (a) Whether medications should be administered.
   2. (b) Assessment of patient’s health status and complaint prior to and after administering medications, including as needed (PRN) medications.
   3. (c) When to contact the prescriber.
   4. (d) Education of patient, family, and caregiver regarding prescribed medication.

3. (3) The licensed nurse shall exhibit skills when administering medications, including but not limited to:

   1. (a) Physical ability to open medication packaging and access delivery systems.
   2. (b) Read, write, and comprehend English.
   3. (c) Read, write, and comprehend scientific phrases relevant to administration of medication.
   4. (d) Measuring medication dosages.
   5. (e) Math calculations.
   6. (f) Routes of administration.
   7. (g) Proper usage of technical equipment for medication administration.
4. (4) Documentation of medication administration shall comply with the principles of documentation and include safety precautions of medication administration, controlled drug records per federal and state law, and facility policy.
5. (5) Administration of medications by routes beyond basic educational preparation, including but not limited to intrathecal, intracavitary, and intraosseous, require a standardized procedure.
6. (6) The topical, intradermal, subcutaneous, or intramuscular administration of a local anesthetic agent in a specified amount designated by order of a licensed physician or dentist and in compliance with the Food and Drug Administration regulations may be performed by a licensed nurse when they meet the requirements of Rule 610-X-6-.04 or 610-X-6-.05 respectively.

7. (7) The monitoring and adjustment of local anesthetic agent(s) and analgesic agent(s) infusing via an epidural, brachial plexus, intrathecal or femoral catheter placed by a qualified certified registered nurse anesthetist or qualified licensed physician may be performed by a registered nurse, with the use of an electronic pump or infusion reservoir, as ordered by a legally authorized prescriber.

   1. (a) The registered nurse is authorized to replace and refill reservoirs with a solution prepared by a licensed registered pharmacist. The registered nurse is authorized to adjust infusion rates at the direction of a physician licensed to practice medicine or a certified registered nurse anesthetist.
   2. (b) A standardized procedure is required for monitoring and adjustment of epidural, intrathecal, brachial plexus, and femoral catheter infusions of local anesthetics and analgesics.

   3. (c) The organized program of study shall include:

      1. 1. Advanced cardiac life support or other comparable certification.
      2. 2. Review of pertinent anatomy, physiology, and pathophysiology.
      3. 3. Electronic pump/reservoir management.
      4. 4. Theory of epidural analgesia.
      5. 5. Neurological assessment.
      6. 6. Recognition and management of complications.
      7. 7. Pharmacokinetics and pharmacodynamics
      8. 8. Annual review and competency evaluation.
   4. (d) The registered nurse is not authorized to administer bolus dosages via an epidural, intrathecal, or brachial plexus catheter.

8. (8) Intravenous chemotherapeutic agents may be administered by a registered nurse, following participation in:

   1. (a) An organized program of study.
   2. (b) Supervised clinical practice.
   3. (c) Demonstrated clinical competence.
   4. (d) Annual evaluation of competence.

Author: Alabama Board of Nursing

Statutory Authority: Code of Ala. 1975, §§34-21-2(c)(21).

History: New Rule: Filed October 29, 2001; effective December 3, 2001. Repealed and New Rule: Filed November 23, 2009; effective December 28, 2009. Repealed and New Rule: Filed July 25, 2016; effective September 8, 2016. Amended (Title Only): Published September 30, 2022; effective November 14, 2022.