Passing medications without being an LPN or RN

Originally posted by Ayasweetz
I work a private residential school wherein an LPN is responsible to putting meds into pillkeepers and the childcare workers pass out the meds to the residents. However, she is now using the pills that come in the plastic bubble packages. Thus, the childcare workers are now responsible for punching the pills directly from the bubble packs, is this legal? Is this safe--as there are some residents that take six to seven different types of meds all at the same time? Any information that would address this issue would be appreciated. I am really concerned about the dangers, the legality of this situation.

Nursing Practice Related to Medication Administration by Certified Program Staff in Community Residences - Departments of Mental Health and Retardation

This Advisory ruling is issued to guide the practice of Registered Nurses and Licensed Practical Nurses employed in, or employed as nurse consultants to, community residences under the auspices of the Massachusetts Department of Mental Health and/or Department of Mental Retardation.

The areas of nursing practice covered in the Board’s Advisory Ruling include:

teaching the curriculum for the certification of program staff in medication administration;
accountability for medication administration to clients for whose care the nurse is responsible;
the role of nurses who provide episodic care to clients, but who are not responsible for the client’s overall care;
the requirement for a valid order from an authorized prescriber prior to administering medication;
the duty to report observed, inappropriate medication administration by certified staff;
providing technical assistance and advice, as in regulations at 115 CMR 6.06 (6) (f), and 104 CMR 15.03 (6) (h) (9); and
the role of the nurse consultant under the Medication Occurrence Reporting System, implemented 12/01/96.
Teaching the Curriculum for Medication Administration Certification

Nurses deemed qualified by the Departments of Mental Health (DMH) or Mental Retardation (DMR) to teach the established program of instruction for medication administration may instruct unlicensed program staff in the didactic and practical components of the program leading to certification in medication administration.
The nurse instructor does not bear on-going accountability for the practice of the staff person who is certified under the standards established by DMR and/or DMH.
Nurses who have not been trained as instructors for the DMR/DMH medication administration program should not participate in supervising or monitoring the initial administration of medications to clients by newly certified staff.
Monitoring of initial medication administration is not a formal part of the DMR or DMH training program. However, the Board strongly supports such supervision by qualified nurse instructors. This does not constitute delegation of medication administration by the nurse instructor.
Accountability for Medication Administration to Clients for Whose Care the Nurse is Responsible

Nurses shall not delegate, assign or allow unlicensed, certified staff to administer medications to clients for whose direct care the nurse is responsible. When a licensed nurse is responsible for a client’s direct care, such responsibility shall include administration of all medications.
In residences where program staff are responsible for direct care provided to certain clients, and licensed nurses are responsible for direct care provided to other clients, the nurse shall only be accountable for administration of medications to clients for whom he/she has direct responsibility or for medications the nurse personally administers to any other client.
Administration of medications by certified program staff to clients for whom the certified staff person has direct care responsibility, is not considered delegation and/or supervision, as defined in 244 CMR 3.05, by a nurse who is providing care to other clients in the same residence.
A licensed nurse is only accountable for the medications he/she administers. A nurse is not accountable for medications administered by certified direct care staff.
Medication Administration and the Nurse Who Provides Episodic Care

Nurses who provide episodic care to clients in DMR and/or DMH community residences include nurses employed by Visiting Nurse Associations or home health agencies, as well as nurses employed by DMH and/or DMR for the purposes of intermittent or episodic health assessment and nursing intervention. For the purposes of this Advisory, the nurse functioning in this role is not the care provider responsible for managing or supervising overall client care, and is not accountable for medication administration by certified program staff.
Providing Technical Assistance and Advice
115 CMR 6.06 (6) (f) and 104 CMR 15.03 (6) (h) (9)

Nurses who are employed by DMR and/or DMH to provide or arrange for technical assistance and advice, as described in the regulations noted above, shall provide assistance about systems related to medication administration issues as required. Examples of systems include, but are not limited to transcribing, ordering, procuring, documenting; destroying and storing of medications.
Questions about client care problems related to medications shall be directed or referred to the appropriate licensed practitioner (MD/NP/PC) either via telephone, office visit, clinic visit, or emergency room visit, or the appropriate emergency response system, per Department of Public Health policies.