I'm a CNA being asked to sign med counts

[Nurse Beth, MSN]

State Regulations

Not every state allows medication aides.

Every state has its regulations for medication administration in sub-acute settings. In residential or nursing home settings, the handling and security of medication are subject to strict rules to ensure patient safety and compliance with legal standards. 

In states that do allow medication aides, typically, an experienced certified nursing assistant (CNA) is eligible to be a medication aide after completing a course of classroom study (20-40 hours), a determined amount of clinical supervised hours, and a competency exam.

If you have not had any training, you should have nothing to do with meds, including signing med counts.

Your Role

I'm concerned that you may not clearly understand your role and responsibilities. This is not your fault but a result of the facility administration's oversight in your hiring and orientation. I suggest requesting a copy of your job description from your supervisor to clarify whether medication management is included in your responsibilities and what qualifications are necessary for this task.

Your residential facility should have policies and procedures regarding medication management that outline the roles and responsibilities of medication aides. I recommend referring to these policies for specific guidance.

Here are some essential points to consider regarding your concerns:

Security of Medication Keys

Regulations and best practices. Please remember the following information:

There should never be a situation where medication keys are left hanging where anyone could retrieve them. It is a valid concern that any patient or visitor could steal medications. Medication keys should be securely stored and accessible only to authorized personnel.

Leaving keys where anyone can retrieve them goes against best practices and most likely violates state or federal regulations. The facility has become very lax in this regard. I can assure you that the medication keys would be secured if they were notified about an upcoming survey.

Potential Consequences. If the keys are not properly secured, unauthorized medication access could result in errors, theft, or diversion. This poses significant risks to patient safety and can have legal ramifications for the facility.

Accountability and Responsibility

Missing medications. If medications go missing, the facility will investigate the cause and identify the responsible parties. The individuals who would be held accountable can vary depending on the circumstances and findings of the investigation.

It's very easy to imagine a scenario where you are blamed and become a scapegoat.

Your responsibility as a CNA. As a CNA, you are generally not responsible for medication administration unless you have specific training and certification (such as a Med Aide certification). However, you could be implicated if there is evidence of negligence or failure to follow established protocols, especially if you were involved in medication-related tasks.

Signing Off on Med Counts

Signing off on medication counts. It is common practice for nurses to conduct medication counts at the beginning and end of each shift to ensure that all medications are accounted for. When signing off on these counts, you attest that you have verified the count and it matches the records. If there are discrepancies, they must be reported immediately.

Again, clarify if this is in your job description. It is unlikely unless you are a trained medication aide.

Just know that if you sign off on incorrect medication counts, you could be held accountable if discrepancies are discovered later.

Steps You Can Take

Address management concerns. Raise your concerns about the security of the medication keys with your supervisor or the facility's management. Highlight the potential risks and suggest implementing more secure practices.

Follow proper procedures. Always follow the facility's procedures and best medication handling and documentation practices. Do not sign off on medication counts unless it is part of your job description, you have been trained, and you are confident the count is accurate.

Training and education. Continue your education and training, mainly if you are working towards becoming a Med Aide. Understanding the legal and regulatory requirements for medication administration and handling will help you perform your duties effectively and safely.

In summary, while the responsibility for medication security primarily lies with those authorized to handle medications (like nurses and Med Aides), all staff members should be vigilant and adhere to protocols to ensure patient safety and regulatory compliance.

As you advance in your career, always remember the significance of your signature. It carries a substantial amount of responsibility. No one will safeguard your signature and certification like you will.

I hope this helps. Best wishes,

Nurse Beth