Assisted Living Med. Administration

casi, ASN, RN · Aug 16, 2005

Are the "Caregivers" (as you put it) setting up meds or passing preset meds?

I'm an aide in an AL facility. We pass meds, but everything is preset up in med strips (by the nurse) and locked in the residents apartment. For the longest time we had All of the strips and MARs in a central storage area, but that quickly changed to the amount of med errors we were having. There were a lot of residents getting the wrong persons medications.

We recently got a new DON and her current plans are to put us through her own training session that sounds like will be very simular to that of a TMA, because she realises we are working under her liscense and she doesn't want us to hurt her liscense. So many instead of having the caregivers be certified med techs (TMAs) give them simular in facility training.

Also have you tried talking to the aides and finding out why these med errors are happening? (Are they to busy, distracted by another resident, etc.) Maybe by trying to target the little problems you'll be able to decrease the number of errors.

Antikigirl, ASN, RN · Aug 16, 2005

We also have unlicensed caregivers pass meds at our assisted living facility, and basically they are in bubble pack and they follow the MAR. They are tested monthly on ability to pass meds, take classes for 8 or so hours at the beggining, have to shaddow and prove ability to administer before they get the ok, and go to inservices monthly on various issues of med pass. They also must pass a criminal history check before being able to be alone with anyone or pass meds!

If a person does not perform well, they go back to the 8 hour class and start all over. An RN teaches and reviews an entire med pass (reviews monthly).

We also have caregivers fill out med error forms as they see errors (and believe me, they do...they don't want to get in trouble for not reporting!). An RN then goes and investigates the probelms...helps the patients...informs the doctor of the error...and they are retested and perhaps (dependent on error or if this is a second or more error) have to take the med class over again.

Most of our med errors and simply not signing the MAR...but we have had some errors when caregivers are not matching the bubble pack lables to the MAR (we have locked med carts...meds are not in patient rooms because our patients have a tendancy to mess with them or take them incorrectly) and those are the dangerous errors!

Caregivers pass all meds PO, PR, topical meds (including narcotics)...RN's do all injections and diabetic care (CGB, glucagon tabs PRN, etc). Also most caregivers do most simple skin issues (monitor, change dressings, clean, etc.) whereas the RN's do complex dressing. Our caregivers also do all cath care except insertion and removal, and all ostomy care.

Goes to figure because there is only one RN on duty per shift for 150 pts! The caregivers do it all basically, and I can't believe they do it day after day and...I will toot a horn here...and do it VERY WELL! I am very proud of them, and most would pass RN school in a heartbeat with their tallents and knowledge! They really take it very very seriously, and rarely make errors! :) Lucky us!

annlet · Aug 17, 2005

Well thanks to both of you on your inputs. Generally speaking our system seems the same as yours in OR. They must past an 8 hour class and then bring them back and train them ourselves but only one time unless med errors (we do reports as well) add up to a certain points and then we must either councel or they have to take the class again. It seems we always have ongoing info. on medication administration but lately........I think maybe they are getting too distracted with care and I'd like to try med techs., just have to figure how to best incorporate them into the schedule. Anyway I appreciate all your help!

Annlet

DusktilDawn · Aug 17, 2005

Sorry, entirely disagree with unlicensed care givers providing medications.

FAIRYTALES · Aug 17, 2005

HELP!!!!
Here in our state (NV) "Caregivers" (not CNA's) are allowed to administer medications (yes even narcotics) to residents. They must pass a 8 hour medication class as their only requirement. Our facility then gives them additional training. We make it as "simple" as we can but they are continuely making BIG mistakes!!! (i.e meds to the wrong person!) Our current system has caregivers assigned to one or two halls giving meds and ADL assistance. I'm sure one answer would be to have certain caregivers become med techs just not sure how to schedule this most cost effectively! HelP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

WOW!!!!!!!!! I pass meds in a long term setting and I had to take a course that as 3 months long. yes most meds are bubble packed but you would be surprised how many med errors I personaly find. That is realy crazy to me. Good luck to all our people who depend on someone to prepare their meds.......

annlet · Aug 18, 2005

Couple of questions came to mind. Is your facility Assisted Living or LTC? What is the level of care typically? How many residents is each caregiver responsible for (care & meds). Do you also have LPN's? How many nurses total? do the caregivers work 8 or 12 hour shifts?

Thanks,

Annlet

Marie_LPN, RN, LPN, RN · Aug 18, 2005

Sorry, entirely disagree with unlicensed care givers providing medications.

I agree.

Mandylpn · Aug 27, 2005

HELP!!!!
Here in our state (NV) "Caregivers" (not CNA's) are allowed to administer medications (yes even narcotics) to residents. They must pass a 8 hour medication class as their only requirement. Our facility then gives them additional training. We make it as "simple" as we can but they are continuely making BIG mistakes!!! (i.e meds to the wrong person!) Our current system has caregivers assigned to one or two halls giving meds and ADL assistance. I'm sure one answer would be to have certain caregivers become med techs just not sure how to schedule this most cost effectively! HelP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

A post I can relate to. I had at least 10 med errors to write up this week, one caregiver had three in a row, on the same resident. I think next time I will have them call the family and the physician. :angryfire

mandykal, ADN, RN · Sep 9, 2005

Apparently, our a local Assisted living, the CNAs there are passing meds too. They too are working around the system(company). Meds are prepoured by a license nurse...ie Monday-Friday, and/or a color coding system. CNAs pour it for the residents but does not "administor it directly." That's how it works. So, the care plans would say "Aide to cue resident on meds...ie 9am, 1pm, 5pm, 9pm.

But even if its against the role of a CNA as we were taught in school, they still do it. Its part of their job, and if they want a job, that's exactly what has to be done. They all agree, and so do we all that its inappropriate. How the hell are they going to know what are the effects if there is any?

I'll tell you what, I have to call the state board of nursing today for my personal matters, but I will mention and question how a law can be in-place for "CNAs," who work for any facility or under any roof that has more then 2 residents to not have them play any role in "Cueing, assisting, prepouring meds, watching, and/or playing any role in any tasks that deals with prescription medication. I will follow through and post my results. This is frustrating.

DusktilDawn · Sep 9, 2005

You know, as a nurse in a hosptial facility, I cannot give an OTC without a doctor's order, if I do, I can lose my license or at the very least be discipline by the SBON. Nurses have actually been disciplined by SBONs or criminally charged for doing exactly this.

You think that as a RN, I would ever prepour meds for someone else to give? NOT ON YOUR LIFE.

LPNs and RNs have been subjected to disciplinary action for making the mistake of administrating another nurse's prepoured medications, by either the facility they worked for or by their SBON or both.

Sooo maybe I'm just not a very trusting soul, I would never prepour meds for anyone (who may do GOD knows what with them when I'm not around) to administer. Why would any nurse jeopardize her license by allowing anyone but themselves to administer their medications.

Originally Posted by annlet
HELP!!!!
Here in our state (NV) "Caregivers" (not CNA's) are allowed to administer medications (yes even narcotics) to residents. They must pass a 8 hour medication class as their only requirement.

I had to take a course in pharmacology, medication administration & pharmacology learning was ongoing throughout my 4+ years of nursing education, and my continuing education (through practicing as an RPN/LPN for 10 years and practicing as an RN for 3 years, in a health care setting) concerning medication administration & pharmacology still continues to be ongoing.

Gee, 8 hours in NV and you too can be qualified to pass medications. I believe I've wasted alot of time, apparently I've wasted 13 years, if it only takes 8 hours to qualify a person to administer medication (sarcasm intended).

Only licensed nurses should be handing out medication within a health care institution period. There is no argument that can be made that will EVER change my POV on this subject.

MQ Edna · Sep 9, 2005

We also have unlicensed caregivers pass meds at our assisted living facility, and basically they are in bubble pack and they follow the MAR. They are tested monthly on ability to pass meds, take classes for 8 or so hours at the beggining, have to shaddow and prove ability to administer before they get the ok, and go to inservices monthly on various issues of med pass. They also must pass a criminal history check before being able to be alone with anyone or pass meds!
If a person does not perform well, they go back to the 8 hour class and start all over. An RN teaches and reviews an entire med pass (reviews monthly).
We also have caregivers fill out med error forms as they see errors (and believe me, they do...they don't want to get in trouble for not reporting!). An RN then goes and investigates the probelms...helps the patients...informs the doctor of the error...and they are retested and perhaps (dependent on error or if this is a second or more error) have to take the med class over again.
Most of our med errors and simply not signing the MAR...but we have had some errors when caregivers are not matching the bubble pack lables to the MAR (we have locked med carts...meds are not in patient rooms because our patients have a tendancy to mess with them or take them incorrectly) and those are the dangerous errors!
Caregivers pass all meds PO, PR, topical meds (including narcotics)...RN's do all injections and diabetic care (CGB, glucagon tabs PRN, etc). Also most caregivers do most simple skin issues (monitor, change dressings, clean, etc.) whereas the RN's do complex dressing. Our caregivers also do all cath care except insertion and removal, and all ostomy care.
Goes to figure because there is only one RN on duty per shift for 150 pts! The caregivers do it all basically, and I can't believe they do it day after day and...I will toot a horn here...and do it VERY WELL! I am very proud of them, and most would pass RN school in a heartbeat with their tallents and knowledge! They really take it very very seriously, and rarely make errors! :) Lucky us!

Pass RN school in a heartbeat? There's more to nursing school than passing meds......but it's good to hear you have diligent unliscensed staff who don't rush their tasks