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INJECTABLE METHOTREXATE
Methotrexate is an anti-neoplastic or chemotherapeutic agent used primarily in the treatment of cancer. Methotrexate has immunosuppressive properties and is often used to treat a number on non-cancer related disorders. It is important to note that regardless of the indication for Methotrexate, it is still considered to be a chemotherapeutic agent, and must be regarded as such. Basic pharmacology and medication administration courses offered in or post graduate LPN programs have little chemotherapy content. The resulting lack of chemotherapy
education means that administration of this drug, in its injectable form, is considered
to be beyond the entry level practice of the LPN.
LPNs with the necessary competency (knowledge, skill and judgment) may administer
oral Methotrexate or other oral chemotherapy.
Can LPNs administer Methotrexate by injection?
In appropriate contexts, LPNs may administer Methotrexate by injection* to clients who
have established care plans, and where (as a part of the plan of care), the patient’s
response to the Methotrexate is both known and reasonably anticipated. LPNs may
engage in this skill following the completion of an employer based Formal Shared
Competency. The purpose of the formal shared competency is to provide the practical
nurse with the necessary education and background information so they can competently administer and care for patients receiving Methotrexate. All nurses are accountable for safe and competent medication administration. Safe administration of this medication will require knowledge of pertinent drug and client information including action, duration, dose, frequency, purpose, side effects, and all nursing implications. LPNs are expected to follow a medication protocol regarding the proper client assessment, medication administration, handling, storage or disposal as outlined in an agency policy. Competence (via the formal shared competency process) must be
achieved and documented before administration of this medication.
* Subcutaneous or intramuscular ONLY. IV administration of Methotrexate (intermittent
or IV push) is beyond the scope of practice of the LPN and is not subject to a formal
shared competency at this time (See LPNs and Administration of IV Medications).
Can LPNs administer injectable Methotrexate? Page 1
I was planning to go to a client’s home to have someone show me how to
administer Methotrexate and “sign me off”. Would this be enough to satisfy a
formal shared competency?
No. Shared Competencies are advanced skills gained through additional and
specialty education or clinical practice. LPNs have the necessary general or
background education and knowledge to support learning a shared competency, but not
the specific education and knowledge to enact the competency. A Formal Shared
Competency, such as the administration of Methotrexate, is a new technical skill built
on advanced (or new) PN knowledge and education. Formal shared competencies
require a structured educational program/session made up of a:
1. Learning module
2. Clinical learning opportunity and 3. Policy to support the LPN to enact the competency. A policy outlines the process of achieving, maintaining and documenting the competency. Formal shared competencies represent a specific practice, and as such require ongoing or regular (annually, for example) recertification beyond the initial competency process. It is not the responsibility of CLPNNS to create these programs. The nurse and the employer share the accountability to develop, implement, sustain and document this program and process.
LPNs are not be permitted to administer Methotrexate until all three components of the
formal shared competency are successfully completed or in place. It is particularly important for nurses and employers to understand that work-place policy, which permit the LPN to engage in the skill and outlines the processes in place to support achieving competency, must be official and approved by the organization. Polices in “draft” or “under development” are not sufficient to support the advanced practice of the LPN.
Successfully completing the required elements of a shared competency permits the LPN
to add that particular skill to their practice, in appropriate contexts. Shared
competencies are not transferable and apply to one practice setting at a time. This means that an LPN competent to perform a skill in one clinical area may not be supported to perform it in another. For example, an LPN has become competent and is supported by policy to administer Methotrexate in an outpatient clinic may be limited in administering Methotrexate in a home care setting, if there is no policy supporting the
practice in the home care context.

I work in a pharmacy with a registered pharmacist. I have been asked to mix
and prepare Methotrexate. Is this within my scope of practice?
LPNs can work in a variety of practice settings, including the pharmacy. In this practice
context, (the pharmacy) the LPN works in collaboration with or under the guidance/ Can LPNs administer injectable Methotrexate? Page 2
direction of the pharmacist. LPNs have basic pharmacology and medication administration knowledge. In the clinical setting, this knowledge is used to perform the necessary patient assessments before, during and after the administration of medications. Mixing or preparing Methotrexate, or any chemotherapy (regardless of their use) is not a part of the basic pharmacology and medication administration course (in-program or post-graduate) and therefore, like the administration of Methotrexate, is considered to be a beyond entry level competency for LPNs. If a nurse and employer wish to have an LPN mix and prepare Methotrexate, a formal shared competency process (learning module specific to the preparation of Methotrexate, clinical learning opportunity to demonstrate technical competence and an official policy supporting LPN
practice in this tasks) is required.
Please Note: It is important to recognize the practice differences between medication
administration and medication mixing/preparing in the pharmacy context. A shared
competency focused only on the practice of administering Methotrexate, will not satisfy
the competency requirements for the practice of mixing or preparing Methotrexate. The
learning module of the shared competency must be specific to all the practices it is to
support.
Could I or my employer be asked to provide the content of a shared
competency to CLPNNS?
Typically no. CLPNNS provides counsel and guidance to nurses and employers as
requested but generally does not review, approve or deny the content of any employer
based shared competency. This said, nurses and employers hold the accountability of
providing shared competency content if required. (See Guide to Continuing Competence
Program)
References
College of Licensed Practical Nurses of Alberta. (2011). Ask a Practice Consultant: Can LPNs Administer Methotrexate? Care: Exploring the Emotional and Practical realities of Healthcare. 25(1), 34. College of Licensed Practical Nurses of Nova Scotia, (2009). Administrative Policy: Request for Shared Competencies, Halifax, Author. College of Licensed Practical Nurses of Nova Scotia, (2011). ELC and SC: Practice Update: March 2011, Halifax, Author. College of Licensed Practical Nurses of Nova Scotia. (2011) Practice Guidelines: LPNs and Administration of IV Medications. Halifax: Author. Wilson, B,. Shannon, M., Stang, C. (Eds.). (2002). Nurses Drug Guide. Upper Saddle Can LPNs administer injectable Methotrexate? Page 3

Source: http://www.clpnns.ca/youaskedus/June11Methtrexate.pdf