LPN News

Important information on LPN scope of practice and client safety

It has come to the attention of the College of Licensed Practical Nurses of Alberta (CLPNA) that Licensed Practical Nurses (LPNs) providing infusion therapy in some private settings are practicing outside of the LPN scope of practice.

LPNs providing this therapy should read the following information and consider whether adjustments are needed to ensure safe and competent practice within the requirements of the Health Professions Act, regulations, standards, and other relevant documents.

What Is Infusion Therapy?

In this context, infusion therapy is a treatment, usually for healthy individuals, seeking to boost hydration, energy levels, and immunity. It is vitamins, minerals, and other nutrients that are infused directly into the bloodstream.

Concerns with Infusion Therapy

LPNs providing infusion therapy outside the guidance of a provincial authority should ensure that they are practicing within scope of practice. Practicing outside of scope is grounds for a complaint of unprofessional conduct.

Potential areas of concern include:

• Compounding medications,
• Use of standing orders,
• Manufacturing and menu ordering, and
• Advertising.

Outside of Scope: Compounding

Compounding is not within LPN scope of practice, and the advertisement of compounded drugs to the public is prohibited. Recent audits by Health Canada have identified that some LPNs are compounding drugs for the purpose of infusion therapy and advertising them to the general public.

Compounding is the combining or mixing of two or more ingredients (of which at least one is a drug or pharmacologically active component) to create a final product in an appropriate form for dosing and administering. Compounding does not include mixing or reconstituting, which is performed following the directions for use on a drug’s labelling material.

Most vitamins procured for infusion therapy are compounded at licensed pharmacies at the request of healthcare professionals for their use in the treatment of their clients. These vitamins are considered compounded, and they do not have a drug identifier number (DIN) or an accompanying product monograph. LPNs are not authorized to mix, dilute, or reconstitute these compounded products.

Use of Standing Orders

Orders are required before administering infusion therapy. These orders should be client-specific and based on an assessment and diagnosis from an authorized prescriber such as a nurse practitioner or physician.

The use of standing orders in this context isn’t an authorized practice. A standing order is a prewritten medical directive that allows a provider to administer medication without a client-specific order for each instance.

LPNs need a complete, client-specific medical order from an authorized prescriber when administering all drugs, including scheduled and unscheduled. Acceptable medication orders are clear, complete, current, legible, and clinically relevant.

Manufacturing and Menu Ordering

LPNs are not authorized to manufacture drug products. Manufacturing occurs when drugs are mixed or compounded without an existing practitioner-client relationship.

In infusion therapy settings, the mixing/compounding of drugs based on menu ordering is considered manufacturing because the client is receiving an infusion based on preference instead of a therapeutic need that is determined through an assessment and diagnosis from authorized professionals.

Advertising

When advertising professional services such as those offered in infusion therapy, LPNs should only advertise professional services that they are authorized and competent to perform. In addition, LPNs should always avoid exaggerating or misleading claims.

For more information on LPN responsibilities related to advertising, see our guideline on Self-Employed Practice.

What Is in an LPN’s Scope of Practice?

Administering Medication

LPNs are authorized to administer medication, with the following considerations.

• The LPN has a complete, client-specific order from an authorized prescriber.
• The LPN has the education, knowledge, and competence to accept, record, and process medication orders.
• The LPN has the education, knowledge, and competence to safely prepare, initiate, administer, monitor, titrate, and discontinue medications.
• The LPN adheres to the core rights and checks of medication administration to ensure client safety.
• The LPN has the competence and environmental resources in the practice area to ensure safe medication administration.

See the Medication Management policy for more information.

Parenteral Administration

Vitamin infusion therapy is administered through parenteral means. LPNs are authorized to administer medication through these means, provided they have the knowledge, skills, and abilities to do so and that they:

• follow an authorized, client-specific prescriber order, and
• adhere to all rights and checks of medication administration.

Mixing and Reconstituting Medications

LPNs are authorized to mix or reconstitute medications, in accordance with the directions for use on an authorized drug’s labelling material. LPNs are required to follow the product monograph and/or the manufacturer’s instructions. Product monographs provide essential information that may be required for the safe and effective use of a drug.

The Drug Product Database (DPD) may be searched to find drugs authorized for sale by Health Canada. Drugs in the DPD can be identified by a DIN. The DPD is updated nightly and includes the availability of the drug in Canada and the product monograph for human drugs.