Lets be careful how we use Med Aides

CapeCodMermaid, RN · Jan 1, 2013

We don't allow medication aides in LTC in Massachusetts. I hope it stays that way.

LTCNS, LPN · Jan 1, 2013

Med. Aides are not used in LTCs MS. as far as I know. Too many risks involved IMPO.

amoLucia · Jan 2, 2013

In New Jersey, I believe they're OK in ALF. Not sure for LTC, but I don't think so.

After reading that article, the places that DO use them, really do need specific job descriptions that are compliant with education and experience and the intent of the law.

Not_A_Hat_Person, RN · Jan 2, 2013

When I worked in an ALF, Med Aids dideverything the nurses did, including assessments, wound care, and supervision. The only things they couldn't do were non-insulin shots.

OnlybyHisgraceRN, ASN, RN · Jan 2, 2013

When I worked in an ALF, Med Aids dideverything the nurses did, including assessments, wound care, and supervision. The only things they couldn't do were non-insulin shots.

Wow. Scary.

IndiCRNA · Jan 3, 2013

Only nurses (and in limited circumstanced physicians), LPNs & RNs should be passing meds period.

MedChica · Jan 3, 2013

http://www.medscape.com/viewarticle/776075
According to this article, it is mostly in LTC where med aides are used and apparently abused by being asked to perform tasks that are beyond the scope of their practice.
Is this what is really going on? Maybe we have to be as careful with our support staff's ethics as with our own. I would like to imagine that we all would refuse when asked to perform outside of our permitted scope, and that we would be annoyed if pressured to do so.

Couldn't access the article.

We use med aides. They do scheduled meds only.

The nurses do PRNS and AM meds (2a and 6a synthroid meds, for instance).

They don't treat. They don't make independent nursing decisions. They don't, for instance, just give PRNs or cough syrup or maalox, etc...w/o asking us.

They just stand at the cart and pop mounds of pills. For hours.

They do their vitals. We all do, actually. Its not something that's handed off to the aides...which makes total sense to me. Sometimes, an overworked aide will be handed a hall of pt vitals to do. They'll take the bp but guess respirations based on averages. I've seen it. I judge it but then I don't.

When someone's drowning in work, that's when they feel obliged to cut corners. It is best to relieve the aides of this and let the nurses be responsible for their own vitals.

But...I'm a Texan and thank God for med aides. There's no way in heck that any one of us could do a 40+ pt Med Pass while charting/doing paperwork/wound care/feedings/assessments/trach care/managing behavioral problems (we're geri-psych), etc....

I volunteer to play Med Nurse at my facility, on occasion. They are two roles and they're clearly defined. It's a difficult thing to find a balance between them.

08RNGrad · Jan 3, 2013

I worked in a ALF when I was taking pre-reqs in nursing school. As an aid, I was in charge of all care of patients and all meds (including insulin, including BPs that were PRN). In retrospect, this was so dangerous, I did not have the critical thinking skills or knowledge to be passing meds to 18+ patients at a time. There was only 1 LPN in the entire facility who did more mngt. Very very little presence on the floors.

What is so scary is in my state all it takes to be med tech is to pass a test. No class, no clinicals, just a SIMPLE written test. This needs to change. It just isn't safe. To my knowledge, Med techs are not allowed to pass meds in a nursing home, just ALFs.

texasRN_14 · Jan 3, 2013

Both of the facilities that I have worked at have utilized med aides. At my first facility med aides passed all meds except Coumadin or Xarelto, and PRN pain medications. The aides never did injections of any kind and weren't even allowed to apply creams/topicals.

At my new facility it is much more relaxed, but med aides give all PO meds, including Coumadin and PRN pain meds, which makes me nervous. But still, no injections, no topicals. They would never touch a res with a tube, they have enough res taking meds PO to bother with one not on their already massive list. However, I think nurses should give sensitive meds like coumadin and I would prefer to have all PRNs on the nurses cart because I am usually the one assessing the need for PRN meds and have to hunt down the aide and interrupt their med pass to have them give me xyz med. Though my med aides are very good about telling me if a pt requests a PRN and getting my permission before giving any PRN. They also always inform me if they withhold a med for any reason (low BP, res c/o loose stools, etc) Nurses also have to give all initial doses of a medication to a resident.

All that being said, I think if trained properly, med aides are a really valuable asset to the LTC. While many feel it is unsafe, I feel it is more unsafe to put a nurse with 30+ pts in charge of all treatments for patient, not to mention if something goes wrong. I find it unreal to read some of the threads here about nurses who have to do admissions, assmts, wound care, treatments, and pass hundreds of pills. Not to mention if something goes wrong with a patient. On a good day when nothing goes wrong, I still don't get a break and barely clock out on time and I pass virtually no pills (except if we get a res with a peg tube) To me they must be two different jobs and I can't imagine the nurse that would work to just pass pills day after day. Not to mention the facility that will shell out $21+/hr (in TX) per 'med nurse' per floor.

To me nurse-pt ratios in LTC would need to be cut in half for it to even be remotely safe to not utilize med aides.

martymoose, BSN, RN · Jan 3, 2013

Typical corporations- use the cheapest help you can get.Why pay for a nurse???

Jerks.

itsmejuli · Jan 3, 2013

I supervise homecare aides in a large seniors lodge, we utilize med aids.

Our med aids can only assist with meds, the meds must be in labeled blisterpacks and a careplan from the homecare RN must be in place. The aids canno crush or break tablets and they're not allowed to put the pills in the client's mouth.

The aids can assist with blood glucose monitoring and they can assist a client who uses an insulin pen. This means that the aid can only verify that the client has "26 units" clicked on the pen. I had a fit yesterday when an aid told me that she turned the dial on the insulin pen...I told her not to ever do that, she has to count the clicks as the client turns the dial then verify the number against the careplan.