FOI 24/25- 0013 DOCUMENT 37
Support workers administering medication in Australia
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Research question: What Federal, State and Territory regulations apply to administration of medication by disability support workers?
Are there additional rules for disability support workers providing high intensity support?
Date: 30/5/24
Requestor: Theresa redacted: s22(1)(a)(ii) - irrelevant
Endorsed by: Katrin redacted: s22(1)(a)(ii) - irrelevant
Researcher: Aaron redacted: s22(1)(a)(ii) - irrelevant ma
Cleared by: Aaron redacted: s22(1)(a)(ii) - irrelevant ma
1. Contents
Support workers administering medication in Australia …………………………………………………….. 1
- Contents ………………………………………………………………………………………………………….. 1
- Summary …………………………………………………………………………………………………………. 2
- Administering medication in the context of high intensity supports …………………………… 3
- NDIS Practice Standards …………………………………………………………………………………… 4
- Delegation and supervision of care ……………………………………………………………………… 4
- Australian Community Industry Alliance Practice Guidelines …………………………………… 5
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State and territory regulations …………………………………………………………………………….. 6
7.1 Australian capital territory …………………………………………………………………………….. 6 7.2 New South Wales ……………………………………………………………………………………….. 6 7.3 Northern Territory ……………………………………………………………………………………….. 6 7.4 Queensland ……………………………………………………………………………………………….. 6 7.5 South Australia …………………………………………………………………………………………… 7 7.6 Tasmania ………………………………………………………………………………………………….. 7 7.7 Victoria ………………………………………………………………………………………………….. 7 7.8 Western Australia ……………………………………………………………………………………. 7
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Gaps in the regulatory framework ……………………………………………………………………….. 7
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References ………………………………………………………………………………………………….. 8
2. Summary
There is a lack of clarity regarding legal and policy requirements for disability support workers who administer medications to clients. Federal regulations and policies regarding training and delegation of care apply to NDIS providers and their employees. However, these regulations are variously interpreted and inconsistently implemented. In addition, providers may develop their own policies regarding minimum training standards or qualifications for staff administering medication to clients.
State and territories take different approaches to regulating the supply and administering of medication. Only New South Wales, Tasmania, Victoria and Western Australia explicitly make allowances for carers, but these do not distinguish between formal and informal carers in most instances. Only Tasmania’s legislation refers to disability support workers but this is only in the context of disability support workers who receive funding from the Tasmanian state government. Tasmania is also the only jurisdiction with a Medication Management Framework that elaborates on the requirements of the legislation.
Regulations and policy relating to delivery of high intensity supports covers minimum skills and knowledge required by disability support workers who administer medication:
- through an enteral tube
- via subcutaneous injection
- for participants requiring dysphagia supports
- for participants requiring support to prior to and after seizure.
No state or territory policy or legislation was found regulating the administering of medication by disability support workers delivering high intensity supports.
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3. Administering medication in the context of high intensity supports
High intensity supports can be provided in a participant’s NDIS plan if they require support for frequent behaviours of concern or at least one of the activities described in the High Intensity Support Skills Descriptors (NDIA, 2023a). The high intensity support skills descriptors assist NDIS providers and disability support workers to understand the skills required when supporting participants with high intensity daily personal care activities (NDIS Commission, 2022). High intensity daily personal care activities are defined in National Disability Insurance Scheme (Provider Registration and Practice Standards) Rules 2018, Schedule 2 as including:
- complex bowel care
- enteral feeding and management
- severe dysphagia management
- tracheostomy management
- urinary catheter management
- ventilator management
- subcutaneous injections
- complex wound management (NDIS Commission, 2024).
Sections 29 – 35 of National Disability Insurance Scheme (Quality Indicators for NDIS Practice Standards) Guidelines 2018 specify that in order to meet their obligations under NDIS (Provider Registration and Practice Standards) Rules 2018, providers should ensure workers are trained in the high intensity skills descriptors relevant to the activity.
Regarding the administering of medication by disability support workers, the high intensity skills descriptors describe the knowledge and skills required to administer medication:
- through an enteral tube
- via subcutaneous injection
- for participants requiring dysphagia supports
- for participants requiring support to prior to and after seizure (NDIS Commission, 2022).
These concepts (‘high intensity supports’, ‘high intensity daily personal care activities’) relate to NDIS funded supports, NDIS provider registration categories and knowledge and skills required by disability support workers to ensure NDIS providers are meeting their obligations regarding quality supports. High intensity support does not appear to be relevant outside of these contexts. No State or Territory legislation, regulations or policy was found that mandates medication of any kind be delivered by support workers meeting the high intensity skills descriptors.
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4. NDIS Practice Standards
The NDIS (Provider Registration and Practice Standards) Rules 2018 states:
Each participant requiring medication is confident that their provider administers, stores and monitors the effects of the participant’s medication and works to prevent errors and incidents (s.26(2)).
Requirements of this practice standard are elaborated in section 26 of the NDIS (Quality Indicators for NDIS Practice Standards) Guidelines 2018. To meet this practice standard, providers should ensure the relevant disability support workers:
- have access to all the information required to identify, monitor and administer medication (s26(1))
- understand the effects and side-effects of the medication (s26(2))
- are aware of the steps to take in the event of an incident involving medication (s26(2)).
These practice standards are further elaborated in the NDIS Commission’s Workforce Capability Framework.
5. Delegation and supervision of care
The Disability-Related Health Supports operational guideline describes the circumstances in which disability support workers may deliver disability-related health supports. This can include administering medication. In some circumstances, a registered nurse may delegate tasks to a disability support worker:
It is the registered nurse who must decide if a task can be delegated or not, as they remain responsible for the care being provided. A registered nurse can’t delegate a task if your health needs are inconsistent or likely to change. Also, some tasks can’t be delegated and will need to be done by a registered nurse. When a registered nurse delegates a task they retain responsibility for the tasks being provided. Before a registered nurse can delegate a task to someone else, they must make sure the person is trained and competent to do that task. They must also be available for direct and indirect supervision of the person doing the task.” (NDIA, 2023, p.13).
The Nursing and Midwifery Board of Australia (NMBA) is the regulatory body for nurses and midwives in Australia. NMBA’s practice standards and decision-making frameworks do not specify which tasks can be delegated, or which people these tasks can be to. Instead, the guidance describes the responsibilities of the registered nurse and what factors are relevant to decisions to delegate care (NMBA, 2022; 2016).
The Registered Nurse Standards for Practice describes a registered nurse’s responsibility regarding delegation and supervision of care:
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Delegations are made to meet peoples’ needs and to enable access to health care services, that is, the right person is available at the right time to provide the right service. The RN who is delegating retains accountability for the decision to delegate. They are also accountable for monitoring of the communication of the delegation to the relevant persons and for the practice outcomes. Both parties share the responsibility of making the delegation decision, which includes assessment of the risks and capabilities. In some instances delegation may be preceded by teaching and competence assessment (NMBA, 2016, p.6).
The Decision-making framework for nursing and midwifery provides some decision-making guidance related to the delegation and supervision of care. When determining whether to delegate tasks to another individual, a registered nurse should:
- have a comprehensive understanding of the patient’s health needs
- obtain consent from the patient to delegate the task and to delegate the task to the nominated person
- consider the qualifications, experience, competence, and confidence of the nominated person
- have the capacity to provide any required supervision and training to the nominated person
- understand and consider relevant legislation and policy, including organisational policies and procedures (NMBA, 2022, p.6).
6. Australian Community Industry Alliance Practice Guidelines
The Australian Community Industry Alliance (ACIA) is a peak body for community services organisations in Australia. ACIA has released a series of practice standards describing best medication administering practices. These include:
- Medication Management in the Community
- Administration of Oral Medications in Community by Support Workers
- Administration of Non-Oral and Non Injectable Medication in Community
- Subcutaneous Injections in the Community by Support Workers
- Psychotropic Medication Management in the Community
- Diabetic Management in the Community
- Cytotoxic Medication Management in the Community.
However, it is not clear whether these practice standards are widely adopted within disability services.
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7. State and territory regulations
Not all regions have frameworks in place to regulate the administering of medication by disability support workers (NDS, 2023; Duckworth & Wilson, 2022). All states and territories have legislation which allows people to administer, or assist others to self-administer, medication. New South Wales, Tasmania, Victoria and Western Australia explicitly make allowances for carers, but do not distinguish between formal and informal carers in most instances. Only Tasmania refers to disability support workers but this is only in the context of disability support workers who receive funding from the Tasmanian state government.
7.1 Australian capital territory
Section 5.2.361 of the Medicines, Poisons and Therapeutic Goods Regulation 2008 (ACT) authorises someone to administer medication to another person if the medicine was legally supplied and is administered:
- according to the instructions on the label
- with the consent of the person taking the medicine or their legal guardian.
7.2 New South Wales
Section 10.4(c1) of the Poisons and Therapeutic Goods Act 1966 (NSW) and section 59.1 of the Poisons and Therapeutic Goods Regulation 2008 (NSW) authorise a carer to administer or supply medication to another person if the medication is supplied and administered according to a valid prescription.
7.3 Northern Territory
According to the Medicines, Poisons and Therapeutic Goods Act 2012 (NT), a prescription can act as an authorisation to administer medication to a person. Provided that the instructions of a valid prescription are followed, any person may administer:
- schedule 3 drugs (s75.2)
- schedule 4 and 8 drugs (s76.3).
7.4 Queensland
Section 51.1 of the Medicines and Poisons Act 2019 (Qld) allows anyone to administer medication to another person if the medication has been lawfully supplied and is administered according to the instructions on the label. Section 34.1-2 extend this for people administering schedule 4 and schedule 8 drugs.
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7.5 South Australia
Section 18.1d(c) of the Controlled Substances Act 1984 (SA) allows a person to administer a controlled drug to another person if the drug was lawfully prescribed or supplied to that other person.
7.6 Tasmania
Sections 127 and 128 of the Poisons Regulations 2018 (Tas) explicitly allows disability support workers funded by the Tasmanian government to administer or assist with the self-administering of medications providing the person being assisted has a lawful prescription. Disability support workers must not administer schedule 8 medications unless the person they are assisting does not have the capacity to self-administer or the medication is either dexamphetamine, methylphenidate or lisdexamphetamine.
Section 135 of the Poisons Regulations 2018 extends the provisions described in sections 127 and 128 for anyone who “has the care of, and responsibility for” the person receiving the medication.
These provisions are elaborated in Tasmania’s Medication Management Framework.
7.7 Victoria
Section 103 of the Drugs, Poisons and Controlled Substances Regulations 2017 (Vic) allows those caring for someone prescribed schedule 4, 8 or 9 medications to administer that medication.
7.8 Western Australia
Section 14.4(e) of the Medicines and Poisons Act 2014 (WA) allows a person to possess schedule 4 or 8 medicines if they are a carer for someone with a lawful prescription and they intend to administer or supply the medicine to that person.
8. Gaps in the regulatory framework
There is a lack of clarity regarding legal and policy requirements for disability support workers who administer medications to clients (NDS, 2023; Disability Royal Commission, 2023; Duckworth & Wilson, 2022; O’Donovan, 2022). An analysis in the context of medication administration for people with intellectual disability notes the lack of legislative coverage:
With respect to medications, national legislation includes the Therapeutic Goods Act (1989) and the Poisons Standard (2021), but neither relate to the administration of medication. On the other hand, state and territory legislation regulate the use and possession of poisons and medications in specified settings, although most predate the NDIS, and there is considerable variability regarding relevance or reference to disabilities (Duckworth & Wilson, 2022, pp.75-76).
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The Quality Use of Medication report identifies the following difficulties with implementing existing policy:
- existing guidance is high level and lacks details
- variations in service providers’ organisational policy and interpretation of national standards
- minimal guidance to distinguish between administering medication, assisting with administering medication and assisting with self-administering medication.
The report also notes:
The intersections between disability and health; national and state governments; the rights of the patient; the role and responsibility of support staff and disability support providers; the place and availability of community, practice, and specialist nurses; and the professional responsibility of doctors are currently inadequately defined and regulated with respect to medication use, oversight, and monitoring (NDS, 2023, p.11).
9. References
Duckworth, N. J., & Wilson, N. J. (2022). Medication oversight, governance, and administration in intellectual disability services: Legislative limbo. Research and Practice in Intellectual and Developmental Disabilities, 9(1), 73-83. https://doi.org/10.1080/23297018.2021.2015424
National Disability Insurance Agency. (2023a). Pricing Arrangements and Price Limits 2023-24. https://www.ndis.gov.au/providers/pricing-arrangements
National Disability Insurance Agency. (2023). Disability-Related Health Supports. https://ourguidelines.ndis.gov.au/supports-you-can-access-menu/disability-related-health-supports
NDIS Quality and Safeguards Commission. (2024). High Intensity Daily Personal Activities. Australian Government. https://www.ndiscommission.gov.au/providers/registered-ndis-providers/provider-obligations-and-requirements/high-intensity-daily-personal-activities
NDIS Quality and Safeguards Commission. (2022). High Intensity Support Skills Descriptors. Australian Government. https://www.ndiscommission.gov.au/sites/default/files/2022-12/Revised%20High%20Intensity%20Support%20Skills%20Descriptors.pdf
Nursing and Midwifery Board of Australia. (2022). Decision-making framework for nursing and midwifery. The Australian Health Practitioner Regulation Agency. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Frameworks.aspx
Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice. The Australian Health Practitioner Regulation Agency.
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