CNA's passing meds in ALF. What's your opinion?

Specialties Geriatric

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I have a big problem. I have been observing CNA techs passing meds in ALF's this year with huge med errors. Like not knowing the doses, side effects, checking with Doctor's for old orders.meds not in the drawers and pts. not get their meds for 10 days.What about a pt getting 17 PO meds at 8am!!!! Not one single nurse in the ALFs.

We as nurses go years to school to learn meds and general nursing tasks.

What is your opinion on this?

Thanks.

You seem to forget that med techs work directly under an RN or LPN. They are not out there doing their own stuff.

From the Missouri State Auditor:

"Our review of these incident reports showed a substantial number of medication errors, including 903 medication errors over 18 months at one facility. Such errors included failing to dispense medications or dispensing them late. Since we could only track medication errors through incident or injury reports, it is unknown how understated or widespread the error really is."

These CMTs worked under supervisors with human service' degrees... not under nurses.

Their supervisor had a degree in human services.

Since the state wants ALF to be as homelike an environment as possible, they say "you don't have nurses giving meds to you at your home, do you?" so...the only requirement is to have an RN consult.

Specializes in ER, PACU.
You seem to forget that med techs work directly under an RN or LPN. They are not out there doing their own stuff.

So what? Is the nurse right there when they are administering medications? No they are not, so they are still passing meds on thier own, so they ARE out there doing thier own stuff. Even if the med techs are "working directly" under a nurse, it still doesnt make them competent to administer meds. What role does the nurse play anyway in this situation? Explain this to me..

I would like to know what nurse (who values thier license) would accept responsibility for an unlicensed person to give medication? :uhoh21:

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

I wouldn't accept the responsibility, nor would i expect a nurse to accept it for me.

Specializes in ER, ICU, Nursing Education, LTC, and HHC.

There are alot of great points here. In florida the med tech class is only a 4 hour medication administraton course for unlicensed staff in Assisited living facilities.

It is actually refered to as "self administration" of medication under florida statue 400.4256

It is for unlicensed staff in ACLF's

This law reads as follows:

"Unlicensed staff who meet training requirements may ASSIST with self administration of medications. Assistance includes taking previously dispensed, properly labeled containers from where they are stored, and bringing them to the resident.

reading the label, opening the bottle, removing the dose, handing to resident who may be assisted to lift their hand to their mouth, and keeping an accurate record fof administration. Licensed staff may administer medications."

Most ALF's use regulated printed MAR's from pharmacies. Most are bubble packed.

SO I wonder where on crosses the line from Assisting a resident with self administration vs. actually administering. I know for sure thay are administring, and most residents cannot self administer.

I am authorized to teach this class, and have.. but refuse to teach it any longer as I feel no unlicensed person can learn to accept responsibilty to pass meds ( or assist..as the state puts it) and do it safely due to lack of assessment skills and multitude of side effects that can arise. Four hours is nothing, compared to four years many of us have... not to mention all the years we have practiced as nurses... we are still prone to error, and these individuals do not even have to be a CNA.. they are not trained medically or professionally to accept such a big responsibility for 10-50 residents. Just My Opinion. :)

This can be found on the florida health care association web site

at http://www.fhca.org

Specializes in Home care, assisted living.

I work as a med tech in one of these facilities. What irritates me is that I only got a 2-hour course from some lady who came in from the local pharmacy (and most of the training consisted of learning how their packaging system works). Some of our med techs aren't even certified, whereas I am. Personally I wish they would do more thorough training with med techs. I would also have loved to have a class teaching us how to handle an emergency, take vital signs, etc. Med techs at my facility have to rotate as shift supervisors and that means we have to take charge in an emergency. Another thing that really bothers me is that according to personal care home regulations, we are supposed to "double-lock" our narcotics in the cart. They must be in a locked compartment in the cart. This has never been done, but at one point they were kept together and the offgoing med tech was required to counts narcs with the med tech for the oncoming shift and we documented counts in a narcotics book. Now the narcs are packaged with the other meds, and only one of them is counted. :confused:

One thing we are NOT allowed to do is stick anyone with a needle. My boss had another nurse come in and teach us how to prepare an insulin needle. One of the med techs took that as a "green light" to actually GIVE insulin. :eek: She couldn't understand why the rest of us were uncomfortable giving injections when we were NOT TRAINED TO DO SO. Um, we're working under our boss' LPN license, of course we're uncomfortable!! It's illegal! If the resident is unable to inject themselves, home health sends a nurse to do it. We're not supposed to stick people!

Assisted-living facilities are not tightly regulated, as nursing homes are, but I've heard that this will change. Hopefully this means better training for med techs, and only letting actual CERTIFIED med techs touch the meds.

I work as a med tech in one of these facilities. What irritates me is that I only got a 2-hour course from some lady who came in from the local pharmacy (and most of the training consisted of learning how their packaging system works). Some of our med techs aren't even certified, whereas I am. Personally I wish they would do more thorough training with med techs. I would also have loved to have a class teaching us how to handle an emergency, take vital signs, etc. Med techs at my facility have to rotate as shift supervisors and that means we have to take charge in an emergency. Another thing that really bothers me is that according to personal care home regulations, we are supposed to "double-lock" our narcotics in the cart. They must be in a locked compartment in the cart. This has never been done, but at one point they were kept together and the offgoing med tech was required to counts narcs with the med tech for the oncoming shift and we documented counts in a narcotics book. Now the narcs are packaged with the other meds, and only one of them is counted. :confused:

One thing we are NOT allowed to do is stick anyone with a needle. My boss had another nurse come in and teach us how to prepare an insulin needle. One of the med techs took that as a "green light" to actually GIVE insulin. :eek: She couldn't understand why the rest of us were uncomfortable giving injections when we were NOT TRAINED TO DO SO. Um, we're working under our boss' LPN license, of course we're uncomfortable!! It's illegal! If the resident is unable to inject themselves, home health sends a nurse to do it. We're not supposed to stick people!

Assisted-living facilities are not tightly regulated, as nursing homes are, but I've heard that this will change. Hopefully this means better training for med techs, and only letting actual CERTIFIED med techs touch the meds.

this is a scary situation to be in! :uhoh21: you are supposed to "take charge" in emergency situations and you weren't even taught how to take vital signs? Some times these are the things that would tip you off that a negative reaction to the medication is happening! I would try to find a different job with less risk of unfortunate outcomes

I was offered a scary position in ALF. I was a CNA with about 2 months of experience in LTC. This facility wanted to train me on 7-3 shift and then have me take a med tech class (two 8 hour days) and then they wanted to put me on 11-7 shift. Here is the really scary part - With my 2 months experience I would be the "lead" CNA on the shift and responsible for making sure the other CNAs (some with many years experience) did their jobs. I would be responsible for all 3 floors!!! :uhoh21: There would be no LPN or RN on site, but one would be available for me to call. :uhoh3: I would have been responsible for basically anything that happened!!! I went home and thought about it and decided that was nuts ... I didn't have the experience and I couldn't help but think that this had to be illegal because there would not be a nurse on site. :nono:

I am thinking that it all had to do with the company's bottom line. This position with all this responsibility was going to pay this very inexperienced CNA 7.25 an hour.

I hope this facility finally came to their senses and hired a nurse. :)

Specializes in Home care, assisted living.

I get paid $8.00/hour for the responsibility I have, and I have trained people who made more than I do with less experience. Ludicrous...

Oh, and here's an example of how dangerous this responsibility can be. One day the 7-3 med tech handed a cup of pills to a nurse's aide (not a med tech) and told her to give them to a certain patient after describing what that patient looked like. Two patients ended up taking EACH OTHER'S meds. Thankfully nothing serious happened, although one of the patients started acting like she took a happy pill or something. Oy...:uhoh21:

About vital signs: I don't know why they aren't taught at my facility. It is assumed that most employees have experience working at nursing homes or other places, but I still think refresher courses are a good idea.

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

The CNA should have wound up in front of the board for giving a pt. those meds, if they're not trained and cert. for it.

So what? Is the nurse right there when they are administering medications? No they are not, so they are still passing meds on thier own, so they ARE out there doing thier own stuff. Even if the med techs are "working directly" under a nurse, it still doesnt make them competent to administer meds. What role does the nurse play anyway in this situation? Explain this to me..

I would like to know what nurse (who values thier license) would accept responsibility for an unlicensed person to give medication? :uhoh21:

I sure wouldn't. Not only that, but nurses are not only trained to take off doctor's orders but to look for inconsistencies and notice mistakes. Yes, doctors can and do make them. The most common one I have seen is where a doctor takes a patient off Lasix and forgets to D/C the KCL as well, or prescribes Lasix without KCl. Rarely there is a reason for prescribing one without the other, but most of the time it is a physician error.

Also, the pharmacy can and does make mistakes. Where we work we frequently notice wrong lables and dosages or meds. altogether not sent.

I have mentioned it before, that I read where app. 200,000 people die each year due to medical errors. Do you think that maybe some of these errors were made by people who did not have the proper training to give the medication or perform a certain procedure? If so, guess who still gets the blame? Nurses!

Thank goodness we do not use med. tech's in the facility where I work. It isn't fair to the the med. tech to stick him or her out there even if they don't realize how dangerous they could be, but most of all it is unfair to the patients.

Med Clerk?

Man, healthcare's changed that much eh?

Used to be where only licensed (LVN OR RN) staff passed meds.

Edited in:

In the news today involving a San Mateo hospital here in California, a chemo patient died of OD because the licensed staff weren't monitoring his med care.

Can you imagine what will happen now with all these workers passing out medicines? I don't know about you guys, but I'd rather trust a nurse with 18 months to 4 years education in nursing anyday.

"SAN MATEO, Calif. (AP) -- A cancer patient at San Mateo Medical Center died after he was given 10 times his prescribed dose of intravenous chemotherapy medicine.

"This is tragic," said David Hook, a spokesman for the medical center. "We accept full responsibility. ... It was a series of system and human errors."

Hospital officials have not released the man's name but say he died of an overdose, possibly administered by a registered nurse, which led to his death on Aug. 16.

Dr. Edgar Pierluissi, the hospital's medical director for performance improvement, said that there could have been a major communication lapse between the nurse, doctors and pharmacists.

"It's never one individual (at fault)," he said. The San Mateo County Board of Supervisors will appoint an outside consultant to find out what led to the death. "

We had a resident pass away because they were only giving her antibiotics during the day. None in her system at night. I had it scheduled to be in her system at the right times and amount a day and they switched it after my shift. I told the DON about it and she did nothing. I am sort of glad I did not stay there. I hope that they will get a better protocal and policy to deal with medication.

Actually, under California law, you were required to report this to the ombudsman or law enforcement, not your supervisor, within two days of the incident. Otherwise, you could be charged for not reporting it to the authorities. Especially since there was a death involved.

:uhoh21:

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