medication administration, On the Job, Professional Identity, Scope of Practice

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.

59 thoughts on “Preparation and Administration of Injections by Medical Assistants”

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

    1. 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.

      1. 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

  2. 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.

      1. 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.

      2. 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.

    1. 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!

    2. 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

      1. 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.

    1. 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

      1. 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®

      2. 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.

    2. 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

      1. Don,
        I have searched the site and the web for my answer. Maybe you can help. I would like to know what injections as CMA can give in general and Minnesota. My organization keeps flipping back and forth. I am especially wondering about Torodal, Lupron, Progesterone, Rhogam(blood product). I appreciate you assistance in advance. Rachelle

      2. Thank you for your question, Rachelle. I am heading to Philadelphia for a meeting in a few hours, so I will respond briefly and will elaborate when I return to the office Monday.

        Minnesota law does not specify which injectable substances medical assistants are or are not permitted to be delegated by a physician exercising direct supervision in in outpatient setting.

        I hope this is helpful for the time being.

        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®

  3. 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.

      1. 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®

  4. 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.

  5. 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.

  6. 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.

    1. Thank you for your question, Matt. I will email to current laws in Massachusetts. 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®

      1. This is a question as well in my practice. Could we also have information in regard to scope of practice with MAs giving injections?

  7. 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.

  8. 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,

    1. 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®

    1. 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®

  9. 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?

    1. 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®

  10. 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.

    1. Thank you for your question. Here is the relevant language from the Ohio law:

      Ohio law does not…authorize a physician to delegate the
      administration of anesthesia, controlled substances, drugs administered intravenously, or any other drug
      or category of drug the board considers to be inappropriate for delegation.

      A physician shall not delegate to an unlicensed person the administration of anesthesia, controlled substances, or
      drugs administered intravenously.

      I hope this is helpful. I will email you the relevant Ohio law.

      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®

  11. Don, may I get the scope practice laws for this in Iowa? I work in an office setting but am being told I cannot administer injections because I work in a department of a hospital. Thank you!

    1. Thank you for your question, Amber. I will email you my legal opinion letter for Iowa. The fact that you work in an outpatient clinic/medical office on the premises of a hospital does not change your legal scope of practice as long as you are functioning under direct/onsite physician supervision.

      It is my legal opinion that Iowa law permits physicians to delegate to knowledgeable and competent unlicensed professionals such as medical assistants working under their direct/onsite supervision in outpatient settings (whether on the premises of a hospital or not) the administration of IM, subq, and ID injections.

      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®

    1. Thank you for your question. Go to http://www.aama-ntl.org and go to Scope of Practice Laws on the left side of the homepage. You will be able to click on this and find the Massachusetts immunization law. Here is an excerpt:

      Chapter 234 of the Acts of 2016 creates a new law, Massachusetts General Law Chapter 112, Section 265, that allows a primary care provider (PCP) acting within his or her designated scope of practice to delegate the administration of an immunization of a patient to a CMA who meets specified qualifications. The new law also updates Massachusetts General Law Chapter 94C (Controlled Substances Act) to recognize this new provision.

      Under this section, a PCP is defined as a health care provider who is qualified to provide general medical care for common health care problems who:

      (1) supervises, coordinates, prescribes or otherwise provides or proposes health care services;

      (2) initiates referrals for specialist care; and

      (3) maintains continuity of care within the PCP’s scope of practice.

      This law permits a PCP to delegate the administration of an immunization to a [medical assistant] only while the PCP is present in the facility and immediately available to assist and direct the CMA. This oversight does not require a PCP to be present in the room when the procedure is performed.

      The PCP may delegate the administration of immunizations to a CMA who:

      (1) has graduated from a post-secondary medical assisting education program accredited by [CAAHEP] or

      the Accrediting Bureau of Health Education Schools or another certificate program that the commissioner of public health may approve;

      (2) is employed in the clinical practice of a licensed primary care provider; and

      (3) performs basic administrative, clerical, and clinical duties upon the specific authorization and under the direct supervision of a licensed primary care provider.

      I hope this is helpful.

      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®

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