In Colorado no. The regulations are very vague. However, most facilities on the front range will only employ CNAs and LPNs. They use CNAs with their QMAP to pass the meds under the supervision of an LPN. The western slope has not caught up to speed with this practice yet. Most tend to not require CNAs, unfortunately in most cases, you are doing the work of a CNA without adequate training or pay. With that said, some residents at one point or another require basic skilled care. This is when HH or hospice is brought in for further assistance as long as the resident still meets the criteria of AL. Then skilled care can be completed under the supervision of an LPN or RN, while the resident continues to live at the ALF.
On another note, QMAPs are NOT allowed to administer anything considered invasive. We aren't even allowed to do finger sticks. So, if a resident is diabetic, then they must be able to perform their own finger sticks and their own injections. If not then one of two things happens, either they are sent to a nursing home or they bring in HH or hospice(which ever is appropriate) to do the invasive procedures. Insulin is tricky though, QMAPs are not allowed to fill syringes. So, generally HH is called in to fill them, although there is a growing trend towards the insulin pens as long as the resident can use it with minimal assistance. The regs are vague there too. The same goes for ostomy care and incontinence. They MUST be able to manage it on their own. However, if an incontinent resident has an accident every once in a while that is considered acceptable. We're all human, it happens whether you're young or old. If the incontinence accidents become more frequent though, then they are sent to skilled care.
What if a resident has a medical need and HH or hospice is not appropriate you may ask. Then we contact the resident's doctor or nurse via phone or fax and get their advice. However, QMAPs are not trained to assess, so wording is key! We can only make observations and report that as such. We can also contact the nurse or doctor on resident request, however per resident request MUST be stated in the inquiry.
A growing trend among QMAPs is they are going out of their scope of practice, which is very easy to do. Trust me! I've heard of plans to eliminate QMAPs all together. However, I feel if better training were provided(instead of a 2 day course that only teaches you how to fill out a MAR, administer medications according to state regulations, and fill MRBs)this problem could be alleviated. I can't tell you how many times a resident has asked me what a medication is and what it's for. The only thing they teach you in QMAP class is to refer to your drug handbook
. I for one feel that this kind of information needs to be included in the curriculum, such as commonly given geriatric medications. (Lasix, Metoprolol, Warfarin, etc...) I believe that if I am the one administering the meds, then I should be aware of the uses, common side effects, and affects. Any one else in CO that is a QMAP feel this way? Also, QMAPs are NOT allowed to administer anything, prescription medications, OTCs, even titrate O2 without doctor's orders.
Doctor's orders can be even more of a headache. They MUST be complete and detailed! We cannot assume anything, as we are not trained to do so. A lot of doctors and nurses do not understand this practice and send incomplete orders. Then we have to contact the office once again to get them complete.
So, Colorado seems to be somewhat different than the aforementioned states. The state regulations are difficult to decipher because of so much gray matter. I for one am fairly knowledgeable after 5 years experience. It does take time to fully understand all the regulations, some of which I am sure I do not know. As mentioned before it does vary by state. I just gave what knowledge I had. Hope it helps!