Asked to Cover a Medication Round Outside Scope
You are a physiotherapist with 4 years' experience working in a busy MOH orthopaedic outpatient department in Kuwait. At 7:00 pm, after the last clinic, the nursing supervisor asks you to 'cover the medication round' on the adjacent 20-bed ward because two nurses called in sick and the evening pharmacy delivery is late. She hands you a list of eight patients and a key to the drug trolley. The patients include a 70-year-old man on intravenous antibiotics, a 45-year-old woman on warfarin with an INR of 4.8, and a 30-year-old man awaiting discharge who needs his regular metformin. You have never been trained in medication administration and your MOH professional registration lists physiotherapy only. The supervisor says, 'Just sign the chart; everyone helps out.' The ward has no pharmacist on site until 8:00 am.
1. What should you do, and what is the reasoning?
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- I would decline to administer medications or sign the drug chart. My MOH registration and scope of practice are physiotherapy only. Medication administration requires training, competency assessment, and legal authorisation; being physically present on the ward does not create that authority.
- Signing a chart for medication I did not administer would be a false record and a serious professional and legal breach. It could also hide a staffing failure rather than solve it.
- I would explain briefly and respectfully that I am not trained or registered to give medicines, and that patient safety would be at risk. I would offer help within my scope, such as assisting with safe positioning, mobility, or non-medication observations if delegated and competent.
- I would immediately escalate to the nurse manager, on-call hospital administrator, and pharmacy manager so that authorised staff can cover the round. The concern is not insubordination; it is preventing avoidable harm.
2. What patient-safety risks arise from this request, and what alternatives should be pursued?
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- The warfarin patient with an INR of 4.8 is at high bleeding risk; an untrained person could give the wrong dose, miss a hold order, or fail to recognise a deteriorating patient. The IV antibiotic patient may need correct timing and monitoring for reactions. The metformin patient may need hypoglycaemia checks and correct withholding before procedures.
- Delayed doses are also a risk, so the solution cannot be simply 'do nothing'. The supervisor should call the on-call nursing team, the hospital bed manager, or the pharmacy manager. If the situation is unsafe, the nurse in charge should activate the hospital escalation policy.
- A registered nurse from another ward or an on-call pharmacist should be contacted. Critical medicines should be prioritised by an authorised clinician. The incident should be logged as a staffing/medication-safety risk so that it is reviewed, not normalised.
- I would stay available for physiotherapy-related safety tasks but not accept the drug trolley key or the medication list as my responsibility.
3. What professional and documentation steps should follow?
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- Document the request, the time, who made it, and my refusal, in a factual ward communication note or hospital incident report. Avoid personal criticism; state that the task was outside my scope and that I escalated to named persons.
- Notify the nurse manager or on-call administrator in writing if possible, and ask for confirmation that authorised cover has been arranged. This creates a clear record that the risk was raised.
- If a patient is harmed because of the delay, the usual incident-reporting process should be followed; I should provide a statement about what I observed and did, not alter records.
- Reflect on the event with my supervisor. The key professional duty is to work within MOH scope of practice while actively helping the system find a safe alternative.