Medicines

Regional State Administrative Agencies advise and enforce the administration of medicinal products in both public and private health care and social welfare sectors. We provide general guidance on the administration of medicinal products based on the legislation and guidelines issued by authorities. We enforce the administration of medicinal products both on our own initiative and based on reports submitted to us. We also handle matters transferred to us from other authorities. 

Medicines are administered by qualified health care professionals trained in medicine administration in accordance with the unit’s pharmacotherapy policy. Employers are responsible for ensuring that drug treatment is safe for patients and customers and that there are enough health care professionals working in each shift to administer medicines. Management and administration of medicines as a whole is overseen by the unit’s responsible doctor.    

We recommend that drug treatment is provided in accordance with the recommendations of the Turvallinen lääkehoito guide (Safe medicine administration) issued by the National Institute for Health and Welfare. 

Turvallinen lääkehoito guide (in Finnish)

 

Administration of medicinal products by professions

Health care professionals oversee the administration of medicinal products based on their professional qualifications and training in the administration of medicines. The section ‘Specific medicine administration and procedures’ of this page provides information about how persons who are not trained in medicine administration can be involved in it. 

Nurses oversee the administration of medicines in the unit as a whole and make sure that medicines are administered safely. 

To ensure safe administration of medicines, employers are advised to check the qualifications and skills of all employees before they are allowed to administer medications.

Employers define the content and extent of the theoretical education required from employees to ensure that the skills provided by the education correspond with the level of expertise needed to administer medications in the unit.  

Employers must proactively and in a timely manner

  • arrange further training in medicine administration for employees 
  • verify the employees’ competence and skills 
  • ensure that employees receive an adequate orientation if their role becomes wider or more demanding in terms of administration of medicines.   

For employees who have not practiced administration of medications for some time, it is also important to make sure that their skills and licences are up to date before they are given duties involving the administration of medicines. In addition, further training on the drug treatment of special groups is required from those who are involved in the administration of medications to groups with special needs, such as children and the elderly.  

Verifying skills and competence 

Theoretical skills are tested with a written or oral examination. Practical skills, on the other hand, are verified with 3–5 practical tests on every aspect of medicine administration included in the employee’s role. The practical test is supervised by a qualified senior health care professional. 

Licences to administer medications must be customised to specify who and what medicine administration tasks the certificate applies to. The written licence is granted by a doctor. 

The skills and competence required for the licence are verified every 2–5 years.

Nurses, public health nurses and midwives may perform a wide range of medicine administration tasks based on their professional education. 

Health care professionals who have a nursing degree need a separate written licence to administer specialist medications or to perform specialist procedures, which include: 

  • inserting peripheral arterial catheters 
  • administering intravenous fluids and drugs 
  • performing blood transfusions 
  • delivering drugs through special routes, such as epidural administration, and using special equipment and instruments, such as a pain pump 
  • administering injections. 

Read more about demonstrating injection administration skills on the website of the National Institute for Health and Welfare.

 

Based on their professional education, practical nurses may dispense and administer medications via natural routes (excluding narcotic and central nervous system drugs), or as tablets, capsules, solutions, eye and ear drops, topical creams, patches and suppositories.  

Practical nurses must complete further training to administer specialist drugs or to perform demanding procedures, such as 

  • administering subcutaneous (under the skin) and intramuscular (into the muscle) injections 
  • administering narcotic and central nervous system drugs 
  • replacing a subsequent infusion containing a basic solution and no drugs. 

Professional degrees similar to a practical nursing degree offered in the past (carers, aides, mental nurses, mental health nurses and childcarers) did not contain as many modules on medicine administration as modern practical nursing degrees. If an employee has a degree preceding the practical nursing degree, their employer must check their diploma for completed training modules on medicine administration to verify the employee’s skills.

Social welfare professionals, whose degree programme contains at least as many modules on medicine administration as a practical nursing programme, may administer medicine in a similar way to practical nurses. 

Nursing students 

Nursing students may temporarily perform the duties of qualified nurses and participate in the administration of medicine, if  

  • they have a valid right to study 
  • they started their studies a maximum of 10 years ago 
  • they have completed two thirds of their studies 
  • they have completed the modules on medicine administration included in their degree programme  
  • their medicine administration skills have been verified.  

Students must always work under the guidance and supervision of senior staff. The unit must appoint a mentor for a student nurse in writing. Blood transfusion may only be performed by licenced health care professionals.  

Practical nursing students  

As a general rule, practical nursing students are not involved in medicine administration. If it is appropriate for the functions of the unit, a practical nursing student may administer pre-dosed medications to customers or patients via a natural route. However, the student’s skills and knowledge must be verified before this. In any case, employers should evaluate the medicine administration skills of practical nursing students and check their completed modules on medicine administration. 

During a practical training period, students may only participate in the administration of medicines under the direct supervision of their mentor. The ways in which students may participate depend on how far in their studies the students are.

Prescribing medicines

Doctors 

Persons licenced to independently practice as a doctor are entitled to prescribe medicinal products. They may prescribe medicinal products to a person for a medical purpose and write pro auctore prescriptions for their practice.  

Medical students temporarily performing the duties of a doctor may only prescribe medicinal products to their patients. 

Dentists 

Persons licenced to independently practice as a dentist are entitled to prescribe medicinal products. They may prescribe medicinal products to a person only for the treatment of dental problems and write pro auctore prescriptions for their practice. 

Dentists are entitled to prescribe a maximum of ten dosage units of medicinal products classified as narcotic drugs at the same time. The maximum amount of central nervous system drugs dentists other than dental consultants may prescribe is the smallest package size available on the market. 

Dentistry students temporarily performing the duties of a dentist may only prescribe medicinal products to their patients. 

Nurses 

Licenced nurses with sufficient practical experience and the necessary further qualifications have a restricted right to prescribe medicinal products sold at pharmacies and used in the treatment for their patients. Nurses may prescribe medicinal products for preventative care, to continue the treatment with a drug prescribed by a doctor or to provide drug treatment for a condition determined by a nurse. 

The restricted right to prescribe medicinal products requires a written order specifying the medicinal products the nurse is entitled to prescribe and any restrictions on prescribing medicinal products. The written order is provided by the responsible doctor of the unit the nurse is serving. The restricted right to prescribe medicinal products of a nurse is only valid in the unit that granted it. 

Nurses working in the outpatient services of primary health care, specialist outpatient clinics or other outpatient health care services provided by a municipality or a joint authority may have the restricted right to prescribe medicinal products. The medicinal products, medical conditions and other restrictions subject to the restricted right to prescribe medicinal products are defined in the annex to the Decree of the Ministry of Social Affairs and Health on the Prescription of Medicinal Products.

Specialist qualifications are granted by Valvira. 

Opticians 

Opticians may write pro auctore prescriptions for medicinal products sold in pharmacies for use in their practice. Opticians may not prescribe medicinal products to patients. The medicinal products that opticians may prescribe are listed in the annex to the decree of the Ministry of Social Affairs and Health.

Dental hygienists 

Independently practicing dental hygienists may write pro auctore prescriptions for medicinal products sold in pharmacies for use in their practice. Dental hygienists may not prescribe medicinal products to patients. The medicinal products that dental hygienists may prescribe are listed in the annex to the decree of the Ministry of Social Affairs and Health.

The person prescribing a medicinal product must asses the patient’s need for drug treatment and decide on the treatment together with the patient. The prescriber must inform the patient about how the medicine is used and what it is used for. 

Medicinal products may only be prescribed to a person the prescriber has personally examined in the past year, unless the prescriber can verify the necessity for drug treatment in another reliable manner. Nurses may only prescribe medicinal products for a condition they have diagnosed in the practice, with the exception of medications for sudden urinary tract infection in women. If sudden urinary tract infection is suspected, a nurse may write a prescription based solely on a phone consultation. 

The choice of medicinal product must first and foremost be based on evidence-based research, or in the absence of such research, on the generally accepted care practice. Special caution and vigilance must be exercised when prescribing medicinal products that can be abused. Specifics such as recommended uses and any restrictions on use must also be taken into consideration in the prescription of medications. 

The prescriber must record each drug prescription in patient records.

Prescriptions must be electronic. Phone and paper prescriptions are only allowed due to a technical problem or if the prescription is needed urgently and it cannot be done online for a specific reason. In an event like this, an explanation of why the prescription was not done online must be included in the paper prescription. 

As a general rule, patient instructions must be provided in an electronic prescription. Patient instructions have a barcode that identifies the prescription and makes it faster for pharmacy staff to process the prescription. 

As a general rule, prescriptions are valid for two years. Prescriptions for medicinal products such as central nervous system and narcotic drugs are only valid for one year. 

Electronic prescriptions are saved in the prescription database of the Kanta service. With prescriptions in the database, patients can get their medications from any pharmacy in Finland. 

You can request a summary of the information about your prescriptions saved in the prescription database from your health care provider or a pharmacy. You can also access information about your prescriptions through the Omakanta service.  You can also use the Omakanta service to submit a prescription renewal request to the health care unit treating you if the unit accepts electronically submitted renewal requests. However, not all prescriptions can be renewed through the Omakanta service, and prescribers may not renew a prescription if they do not have enough information about the patient’s care and treatment. 

Specific medicine administration and procedures

Designated responsible doctors oversee the planning and implementation of vaccination services. Vaccinations may only be injected by doctors or nurses, public health nurses and midwives with the appropriate training. Nurses and midwives who administer injections must be able to consult the doctor responsible for vaccinations when necessary.  

Municipalities and joint authorities may work in a partnership with private health care service providers. Municipalities and joint authorities must draw up an agreement detailing what vaccinations included in the national vaccination programme are administered by the private service provider and how the use of vaccinations in the national vaccination programme is enforced. Fees for the vaccine, clinic visit, recording the vaccination or transfer of information cannot be charged from customers having a vaccination administered under the national vaccination programme. 

Dispensaries and hospital pharmacies may not supply vaccinations without first verifying that the vaccinations are purchased under a vaccination agreement with a municipality or joint authority. 

A municipality is in charge of vaccination activities in a situation where the service provider only administers free vaccinations under an agreement made with the municipality. In a case like this, it may not be necessary for a doctor to be the officer responsible for the service, unless other services so require. If the service provider also offers other vaccinations which the customers must pay for, the officer responsible for the service must be a doctor. 

Read more about vaccination activities and the administration of vaccinations on the National Institute for Health and Welfare website.

 

Personnel not trained in medicine administration may only participate in the administration of medicines in exceptional situations and temporarily. Before this, employees must complete separate training on medicine administration, their skills must be verified and they must obtain a written permit to administer medicine. The permit in question is specific for the patient, medicinal product and delivery route.  

After obtaining the permit to administer medicines, employees not trained in medicine administration may administer pre-dosed medicinal products via a natural route, or as tablets, capsules, solutions, ear and eye drops, topical creams, patches and suppositories. Administering injections and administering and managing narcotic and central nervous system drugs are considered demanding procedures. Practical nurses who already have a professional degree and who are trained in medicine administration must also complete further training to administer these.     

Personnel not trained in medicine administration may only administer injections or narcotic and central nervous system drugs in exceptional situations if they do not have a degree equivalent to a practical nursing degree. 

Personnel not trained in medicine administration cannot obtain a permit to dispense medicines.

Botulinum toxin treatments are always provided by health care professionals. The need for botulinum toxin therapy is always assessed by a doctor regardless of the indication for the botulinum toxin injection. Doctors also write customer- or patient-specific prescriptions for botulinum toxin products. Doctors cannot write prescriptions for medicinal products containing botulinum toxin for nurses working in beauty salons for commercial purposes or order medicinal products for a beauty salon to use.  

If the prescribing doctor delegates the administration of botulinum toxin injection to someone else, they must be within immediate reach when the injection is administered. In this context, being ‘within immediate reach’ refers to being present in the same health care unit. In other words, this requirement cannot be fulfilled with remote consultation. Administering the injection can be delegated to a nurse, public health nurse or midwife trained and licensed to administer injections and working in the same unit. 

Nurses, public health nurses and midwives may only administer botulinum toxin injections while working in a health care unit either as a direct employee of the unit or as an independent contractor under an agreement made with the unit. Injections must be able to be administered under the supervision of the prescribing doctor. They cannot be administered in a beauty salon or for example at a fair or a similar event even under the supervision of a doctor. 

Medicine prescriptions and administrations must be recorded in patient records as required by rules and regulations.

Administration of medicinal products is considered a health care procedure regardless of the nature of the unit where medicines are administered. As a general rule, medicinal products are administered by health care professionals trained in medicine administration also in social welfare units. These professionals are for example nurses and practical nurses.

Other considerations

A pharmacotherapy policy must be drawn up for all units where medicines are administered. It is part of the quality and patient safety plans and the self-regulation plan. The pharmacotherapy policy is approved and signed by the doctor in charge of administration and management of medicines in the unit. 

Each unit must have its own pharmacotherapy policy focused on the drug treatments necessary for the unit’s customers/patients and the associated key qualification requirements and risks. The pharmacotherapy policy is a tool that directs the administration and management of medicinal products in practice. Medicines are administered in accordance with the unit’s own pharmacotherapy policy also in a state of emergency, such as during a pandemic. 

The pharmacotherapy policy must contain detailed descriptions, categorised by professions, of the unit’s requirements for administering and managing medicinal products in addition to professional degrees. For more detailed requirements for the contents of pharmacotherapy policies, please refer to the Turvallinen lääkehoito guide. 

Supervisors are responsible for both introducing new employees to the pharmacotherapy policy and for keeping the policy up to date. Pharmacotherapy policies must be reviewed at least once a year and updated whenever there has been a change in the legislation, operations or conditions. Employees are responsible for observing the pharmacotherapy policy.

Medicinal products must be stored  

  • in the storage conditions specified by the manufacturer 
  • in a way that prevents the mixing of medicines 
  • so that the smallest possible amount is stored in the unit 
  • in a place where unauthorised persons cannot access them 
  • in a place where the storage temperature can be monitored and documented for medicines stored at room temperature and in refrigerators. 

Particular vigilance must be exercised in the storage of central nervous system drugs and medicines classified as narcotics as they can have serious consequences if administered incorrectly and they may be abused. These medicines must be stored in separate locked locations that can only be accessed by the personnel licenced to handle them. Such personnel must be named in the pharmacotherapy policy. Medicinal products classified as narcotics must not be pre-dosed. Instead, they are dosed right before being taken to the patients.

Expired and otherwise unusable medications and medicinal products returned to the care facility by the patients or customers are considered pharmaceutical waste. Pharmacological waste also covers medicinal products that have been suspended. 

Pharmacological waste must be stored away from other medications. Unauthorised persons must not have access to pharmacological waste.  

Health and social care settings must have instructions for the safe handling of pharmacological waste. Pharmacological waste is delivered to hospital pharmacies or dispensaries from health and social care facilities. Medicinal products supplied by retail pharmacies are returned to a retail pharmacy. A pharmacotherapy policy must include details of what loss prevention strategies are in place for when pharmacological waste is returned to a retail pharmacy. 

The storage location and conditions of medicines must be regularly checked to minimise the generation of pharmaceutical waste. Health and social care facilities are encouraged to appoint a person responsible for medications and checking the storage conditions.

Links to legal texts