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Volume 12 – Fluid & Medications Manual Limited Registered Nurse Administration of Nicotine Replacement Therapy 1 Limited
Registered
Administration of Nicotine
Replacement Therapy
The administration of Nicotine Replacement Therapy is appropriately carried out by Registered Nursing staff who have successfully completed the online smoking cessation package. To outline the procedures where limited Nurse administration of Nicotine Replacement Therapy is permitted within the Canterbury District Health Board. This policy applies to Registered Nurses and is limited to Nicotine Replacement Therapy. The 1990 amendment to the Medicines Act (1981) and the Misuse of
Drugs Act (1975) allow midwives, including those who are
employed by the CDHB to prescribe prescriptions medicines within
the midwifery scope of practice.
Definitions
Limited Nurse Administration of Nicotine Replacement Therapy
The administration of Nicotine Replacement Therapy – which is a non
prescription medicine (that can be freely purchased across the counter
of a pharmacy), without a doctor’s prescription, for specified patients
following stated limitations (see below).
Prescription Medicine
“A medicine which can only be sold or supplied pursuant to a
prescription by a person authorised to prescribe drugs (Registered
Medical Practitioner, Dentist, Midwife)” Medicines Act 1981.
Qualified Persons for Limited Administration
A Registered Nurse
Authorised by Authorised by Executive Director of Nursing & Chief Medical Officer, Volume 12 – Fluid & Medications Manual Limited Registered Nurse Administration of Nicotine Replacement Therapy
Precautions
Patients with a history of cardiac disease or treatment with medications whose clearance is known to be affected by smoking such as theophylline should have their need for Nicotine Replacement Therapy reviewed and prescribed for by the medical team Mental Health Patients Consideration
Smoking induces the metabolism of clozapine and olanzapine. When a patient on these medicines gives up smoking, their blood concentrations of either clozapine or olanzapine will increase over the next two to four weeks. Notify the medical team that the patient is giving up smoking and be alert to the likelihood of dose related side effects over the next two to four weeks (e.g. increased sedation, hyper salivation, postural hypotension) that may necessitate a dose decrease of the clozapine or olanzapine. If an inpatient requires NRT to manage nicotine dependence notify the medical team as soon as possible to ensure ongoing management. Midwifery consideration
Midwives need to be mindful of maternity patients requiring secondary or tertiary care who may have existing co-morbidities that may well necessitate consultation with the obstetric team. It is the professional responsibility of all midwives to ensure that they have the knowledge regarding the effects, side effects, interactions and contra-indications of every drug prescribed. Associated Documents
• Drug Treatment Sheet (QMR0004), (QMR004C) • Clinical notes (QMR0003) • ABC training for health professionals • Smokefree Quit Pack • Used in conjunction with CDHB smoking cessation form C120001 (“Pink form”). Where possible this should be completed before the time of NRT administration • CDHB “Blue” handbook (Management guidelines for common medical conditions 2009, reference 0070) Authorised by Authorised by Executive Director of Nursing & Chief Medical Officer, Volume 12 – Fluid & Medications Manual Limited Registered Nurse Administration of Nicotine Replacement Therapy
Procedure
An assessment is to be made, including any history of allergies, reactions or identified precautions to the proposed medicine: e.g. allergy to sticking plaster An assessment of nicotine dependence is to be carried out following the CDHB information on page 2 of C120001 “cigarette consumption”. A progress note is entered into the patient’s clinical notes detailing the findings of assessment outlined in no’s. 1-2 above. This progress note will be signed and dated by the Registered Nurse making the assessment. • If the patients’ smoking status fits the criteria, a Registered Nurse may administer appropriate Nicotine Replacement Therapy (The RN must have completed the online ABC training for health professionals). Only medicines listed and within the ranges shown are permitted to be administered. • All administration of Nicotine Replacement Therapy is to be accurately entered on the medication chart (QMR0004), signed by the Nurse and
with the abbreviation RN added and the surname printed in block
capitals (Patches should be entered under the regular medications and
lozenges, inhalers and gum entered under the PRN section).
• All administration is recorded in clinical notes. • The effects of medication and any adverse reaction are to be recorded • The medical officer is to be contacted if Nicotine Replacement Therapy is ineffective or an adverse reaction occurs. • Provide the patient with the Smokefree Quit Pack The following limitations are to be observed: • NRT administered and documented on the QMR0004, (When possible initial consultation with medical staff regarding administration should be considered). • Only for administration to persons aged 18 years and above, unless Authorised by Authorised by Executive Director of Nursing & Chief Medical Officer, Volume 12 – Fluid & Medications Manual Limited Registered Nurse Administration of Nicotine Replacement Therapy
1.1 List of Nicotine Replacement Therapy for ‘Limited Nurse
Administration’ (Not all NRT products may be available in all areas)
1.1.1 Smoking Management or Cessation
Patches 7, Apply 1 patch daily. Patches are left for 3 days. Rash may occur at site of placement. Time to peak concentrations: 6-12h. (initial onset ~ 1-2h) (NB: Subsidised in community via
Quitline, Aukati or PEGS)
Lozenges Suck 1 lozenge every 1-2 hours. Usual When the urge to smoke is felt suck the cheek and gum. Repeat once the taste dissipates (each lozenge should (NB: Subsidised in community via
Quitline, Aukati or PEGS)
*Chew 1 piece slowly for 30min.
and gum, chew again when taste fades; continue for 30min. Mild adverse effects include hiccups, upset stomach. (NB: Subsidised in community via
Quitline, Aukati or PEGS)
smoke. Use approx 6 cartridges for smokers of < 24 cigarettes/day and cigarettes/day. Adverse effects include mouth/throat irritation and (NB: Not funded in community)
Note: As of June 2010 the recommended maximum daily dose of
Nicotine Gum has been reduced from 25 x 2mg pieces or 15 x 4mg
pieces to 20 x 2mg or 10 x4mg pieces in line with manufacturer’s
guidelines.
Authorised by Authorised by Executive Director of Nursing & Chief Medical Officer,

Source: http://www.nursingevidence.org.nz/wp-content/uploads/2011/08/limited_registered_nurse_admin_-nicotine_replacement_therapy.pdf