Preparation and Administration of Injections by Medical Assistants

In the current ambulatory care environment, medical assistants are being delegated the preparation of injectable substances, as well as the administration of injections. I often receive questions about legal restrictions on medical assistants preparing injectable substances. In some states, there are specific laws that address this question. In general, it is my legal opinion that, if there is a likelihood of significant harm to a patient if an injectable substance is prepared improperly, the delegating provider must verify the identity and the dosage of the injectable substance before it is administered by the medical assistant.

About Donald A. Balasa

Donald A. Balasa, JD, MBA, chief executive officer and legal counsel for the American Association of Medical Assistants, keeps his eye on what is happening in the profession.
This entry was posted in medication administration, On the Job, Professional Identity, Scope of Practice and tagged , , . Bookmark the permalink.

49 Responses to Preparation and Administration of Injections by Medical Assistants

  1. cheryl says:

    That is a very vague answer…

  2. M. B. says:

    Seems that medical assistants need to be trained properly in pharmacology, dosage calculation and medication administration.

    • By all means! Thorough education and competence in those areas is essential to protect patients. Don

      Sent from my iPhone

    • Aristea Massey says:

      While thi stands true almost all medication injections now come in pre-filled vials. All we have to do is draw it up. As for medication administration we are taught that in school.

      • Ramie says:

        Thank you. You are soooo right
        I don’t know about the training of today’s medical assistance ,but those of us who have been in this field close to 20 years have been well ,well ,well !! taught in how to draw up administer and or calculate the dosage .
        you always ,always show your vials to you physician before drawing up and leave them on the counter until you have completely documented the folliwing lot number, NDC and expire date into the system .
        As well there are-instructions inclosed in the box . which I’ve seen nurses read (good for them) and have had to explain to nurses what it means and how to dilute them
        don’t sell the true taught CMA short on their ability and knowledge .
        True as well most things come in single vial doses and if you do need to mix it’s usually with lidocaine or sterile water

        Ramie CMA over 20 years

  3. Lura says:

    The problem we have is medical assistants that are not trained in real programs and do not hold the AAMA CMA. The employers need to stop hiring untrained and unskilled medical assistants. We have several that did not go to school and was trained on the side. No that’s scary.

    • You are absolutely correct! Don

      Sent from my iPhone

      • Jill B says:

        If they did not receive a certification how can they even be considered be a MA, let alone be hired for a MA position. Isn’t that illegal.

      • The law varies from state to state. In what state are you located? Don

        Sent from my iPhone

      • Karen Emineth says:

        I truly agree with this statement to say the least. I was a mentor in my field, and it is amazing what and how some of the different assistant programs are taught.

    • Jenah Parris says:

      Exactly! An MA is someone who put the work in and is trained! I know it varies from states to state and even by employer, but that’s the way it should be!

    • Ramie CMA says:

      I absolutely agree The hospital and physicians office around here are hiring what they call medical assistance and or “medical “tech Who come in with absolutely no medical background . Just high school diploma . They are being taught by other “tech” who has been showen (by who only knows ) how to do injections .scary ?absolutely .
      As well I feel the schools who are teaching medical assisting need to step it up once again and go back to the true training and techniques.
      I have had some who have stated they were in the medical assistant program coming out into the field that don’t even know what the word vile is nor the proper size needles and syringe . They have no knowledge on how to do the injections .
      step it up schools don’t just put a warm body in that seat so you can get your reimbursement because you need to meet your number in students and grads to get your money.

      As far as doctors offices and hospitals if you want to hire a rooming tech . Then call them room tech . Don’t give them the title of medical assistant

      • Dionysia L Downs says:

        Your comment hit the nail directly on the head!!!!! I have been a cma (AAMA) for 17 years now, and I am a cma instructor at a vocational school here in MD. I can tell you that the curriculum has been stripped drastically! There are basic lessons, which you mention above, that some schools just don’t teach and when they get into the field the student is totally lost. I teach my students as I was taught back in the day because I feel as though it’s a waste of time and money if I don’t, as well as a setup for failure.

  4. Erica Irizarry says:

    Can a medical assistant give injections under a nurse practitioner in the state of Florida.

    • Florida law permits nurse practitioners to delegate to knowledgeable and competent medical assistants working under their direct/onsite supervision in outpatient settings the administration of IM subq and ID Injections, including immunizations. I will send you documentation when I return to the office Thursday. Don

      Sent from my iPhone

      • Yesica Quinteros says:

        What about in the Commonwealth of Virginia?

      • It is my legal opinion that Virginia law permits physicians to delegate to knowledgeable and competent unlicensed professionals working under their direct/onsite supervision in outpatient settings the administration of IM, subq, and ID injections. I will send documentation to your email address.

        Donald A. Balasa, JD, MBA
        Chief Executive Officer, Legal Counsel
        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
        The CMA (AAMA): Health Care’s Most Versatile Professional®

      • nursepierson@gmail.com says:

        Can you send to me as well? I was interpreting our FL law that MAs were directly supervised by physicians, therefore all their tasks performed would fall under on the of the onsite physician licenses.

    • FL law permits nurse practitioners to delegate to knowledgeable and competent medical assistants working under their/onsite supervision in outpatient settings the administration of IM subq and ID injections. I will send you documentation Thursday. Don

      Sent from my iPhone

  5. Alicia Abbott says:

    We allow MAs to prepare and administer injections, except for Vivitrol. Vivitrol is only administered by a provider. We are located in NH, and only hire MAs that have completed an actual MA program.

    • Latasha CMA (AAMA) says:

      Hello,
      Is there a particular reason for Vivitrol? Here in Michigan, our MAs are able to do so.

      • The Michigan law does not limit the types of medications the administration of which can be delegated by a physician to a knowledgeable and competent medical assistant working under their direct/onsite supervision in outpatient settings. However, the general legal principle is applicable: If there is a likelihood of significant harm to a patient if an injectable substance is prepared improperly, the delegating provider must verify the identity and the dosage of the injectable substance before it is administered by the medical assistant.

        Donald A. Balasa, JD, MBA
        Chief Executive Officer, Legal Counsel
        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
        The CMA (AAMA): Health Care’s Most Versatile Professional®

  6. Judy Mackey says:

    I am a medical assisting program director and educator. Our students are taught the one that gives the medication is responsible for giving it safely. They are taught dosage calculations including conversions and how to use a drug reference to check a
    providers order to make sure it is safe. Some employers here in the state of Indiana give medical assistants a dosage calculations placement test during the hiring process. Our students don’t have difficulty passing these tests, and it’s a great way to prove competence post graduation.

  7. Paula Purdy says:

    There are still many states that hire people and train them as medical assistant and I believe that is the issue as they are trained not by a professional trainer but by someone in clinic. The individual does not receive the proper technique of injections or immunizations or understands the logistics. There is a lot of risk management in hiring that way but then an employer can pay less too.

  8. Denise Plummer says:

    I just want to know why I went to college for 2 years and take certification test every 5 years if a hospital or doctors office hires someone out of high school with no degree for a CMA position. They sign reports as a CMA but they do not have a degree. And the sad thing is they make as much as a CMA, which isn’t much. I don’t understand how prominent hospitals get a way with this practice. If I knew than what I know now I would never became a CMA. I would go for nursing.

  9. Matt says:

    Hi Don, any insight on the MA laws around this?

  10. Paula Purdy, CMA (AAMA) says:

    Denise, I think it’s up to all of us to promote ourselves and show our employer the difference between a MA with the CMA (AAMA) credential and a MA with any other credential. First, AAMA is the only credentialing organization that requires the medical assistant to have graduated from a post-secondary CAAHEP/ABHES medical assisting program. Secondly, college level medical assisting education has standardized competencies. Third, the exam is administered by the NBME (National Board of Medical Examiners) which has physician-quality exam standards and for those who have taken the CMA (AAMA) test we know first hand the exam tests our knowledge not our ability to recall. Last, but certainly not least, the CMA (AAMA) and the title of Certified Medical Assistant are trademarked meaning only those medical assistants who have past the AAMA CMA examination can use this credential and the title. As an employer who hires medical assistants, I look for medical assistants who have the CMA (AAMA) credential. I know what it took to obtain that credential and I understand the continuing education it takes to keep the credential current. I don’t think employers have to or need to hire just anyone and train them to do medical assisting anymore.

  11. Cheryl Corbin says:

    May I have information pertaining to the laws in Maryland as well?

  12. Cheryl Startzell says:

    Don – It sounds as though the members would like to see a posted list of links to the pertinent state laws regarding medication administration for all states. Would this be too arduous of a task? Thanks,

    • Thank you, Cheryl. Opinion letters for many states are already posted. I hope to have all states posted by the end of this calendar year.

      Thank you again, Cheryl!

      Don

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  13. Vickie A says:

    I would like to know the laws in CT regarding an MA giving injections.

    • I will email them to you. Connecticut law does not permit medical assistants to be delegated any type of medication administration. The Connecticut Society of Medical Assistants has been working very hard for many years to get this changed. I am confident legislation will be enacted in the next few years.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  14. Roberta Coulson says:

    Don what is the current Indiana law on medical assistants giving injections when a provider is not in the office. It has been that no medication administration or venipuncure is to be performed without a provider in the office. Is this still the case?

    • Thank you for your questions, Roberta. Indiana law continues to require that a licensed health care provider be on the premises and immediately available whenever a medical assistant is administering an IM, subq, or ID injection.

      It is my legal opinion that IN law requires a licensed health care professional to be on the premises and immediately available whenever a medical assistant is performing venipuncture/phlebotomy.

      I hope this is helpful, Roberta.

      Don

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  15. Jeri says:

    Can I see the laws in the state of NH for Certified medical assistance. I feel that some there is some gray areas in what a person can and cannot do as a CMA. I do give some injections but most are prefilled or a one use vial. I am interested in getting more knowledge of the scope of practice for an CMA.

  16. Yesica Quinteros says:

    Could you please provide me information regarding CMA giving injections in the Commonwealth of VA?

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