Med Passers at Nursing Homes 8HR course and giving out NARCS ...

jadelpn, LPN, EMT-B · Oct 19, 2012

I have heard of med assistants watching residents in mostly assisted living and psych residential treatment facilities take their own meds, and documenting that they observed. It must vary by state.

As I have seen it, the resident identifies, pours and takes them on their own, med assistants just observing and reminding if needed. It is a new concept to me to have med assistants following a MAR and dispensing and giving meds to patients and/or residents who are unable to take their own medication. Seems like a HUGE liability to the licensed nurses.

BlueDevil,DNP, DNP, RN · Oct 19, 2012

It's the same as non-licensed family members passing them out at home. In assisted living, they re not promised nursing care. They are promised a helping hand. They know that when they sign up. In a nursing home, my opinion would rest on the level of care required for the individual.

Narcotics are not inherently dangerous, by the way. I'm not sure why you focused on that. People routinely take far more dangerous medicines every day.

SpeakUp4ever · Oct 19, 2012

Yes, I do understand its just like a non-licensed family member passing out medication, but I have seen and heard that mistakes such as giving the wrong Blood Pressure Med to the wrong person or not giving it or giving the wrong dose .. many many times. It just gets looked at as a 'ut-oh' and forgotten. Yes the Med Assistants do read the MARS and are responsible for dispensing and giving ( just as a family member would) but with only a 1 day course on administration not the importance of the drug or what its is even for, is just not right. I use to work in a AL where there was 1 med passer for 40 residents, most of the residents were not so 'assisted' but the company did not care ( I'm also talking about a multi-level building where most of the residents love to wander). 1 med tech doing treatments, pills, insulin's even (just trained on the job).. didn't sound logical to me, setting that person up for failure and the RN responsible. I wouldn't let my family live there if thats how they are treated for how much they pay for just having their pills dispensed.

I understand also that not all Narcotics are dangerous, but keep in mind that its the elderly.. or mentally challenged, wouldn't feel horrible if you gave the wrong dosage of a controlled substance to someone or overdosed and not have known because of lack of knowledge?

BlueDevil,DNP, DNP, RN · Oct 20, 2012

LOL, what RN? Most assisted living centers do not have nurses on staff. They might have a RN stop by on a monthly basis-to check the paperwork, not the residents. My spouse administers medication to our children without having taken even a one-day course, btw. We have seven children. There could be a mix-up. Should I be concerned about this?

I don't think you understand the nature of assisted living centers. They are not intended to provide skilled nursing care. So, no, it does not surprise, offend, frighten or upset me that there are non-licensed people "assisting" the people living there. That is the definition of assisted living, and the the purpose of their existence. It is not a skilled nursing center.

I am a doctorally prepared advanced practice nurse, so I wouldn't be working as an aide at an assisted living center, so I am not sure in what context you are asking me would I feel badly if I made a medication error that harmed a person. However, for the sake of argument, my response is yes, I would feel bad. I don't know if I would go so far as to say "horrible," but certainly would feel badly.

If the bottle says "give one tablet to Mrs Smith at 8pm," just about any literate person ought to be able to do that. You do not need to know what it is for. Mrs Smith is well. She probably just has difficulty opening the bottle herself. I write orders for this stuff everyday for reasons just like that. They can't get their compression hose on/off alone, can't grasp small pills, can't see well enough to tell pills apart, can't open the lids. They aren't ill, per se, they just need assistance. For whatever reason, they don't have a family, their family lives far away, or just despises them, so they are relying on hired help. It is not a travesty that the hired help are not doctorally prepared APNs. However, I understand there are a lot of unemployed new grad RNs, so perhaps they will be interested in going to work for $8 an hour at an assisted living center. Go ask 'em.

So let me sum up: You are making a mountain out of a mole hill here. You don't need a plumber to clean the toilet, and you don't need a RN to hand out pills. Even to old people.

Long Term Care Columnist / Guide · Oct 20, 2012

Thank you, BlueDevil. You just explained AL beautifully. :yes:

I've been an assisted living nurse for five years, and with my well-trained med staff, I don't lose sleep over the med passes any more than I would if I were passing the meds myself. Yes, they've committed med errors. So have I. This happens everywhere, in every kind of setting and by every level of personnel; and anyone who claims never to have made a med error is either fresh out of training, or lying through their teeth. Med errors are an unfortunate fact of life.......the best we can do is learn from them, get past them, and move forward.

BlueDevil,DNP, DNP, RN · Oct 20, 2012

I had to laugh a little. Here I am the bigshot "doctorally prepared APN," and I made a medication error tonight in my very own home. I put otic drops in my son's eye by mistake. Oops. Grabbed the wrong bottle. His little eye burned like fire for a minute or two. He is still very upset about this error. Probably more upset than Ms SpeakUp4Ever, even. If only we'd had a MD here to administer his eye gtt, this would not have happened. Assisted living centers should have research MD-PhDs doing the med pass I guess. It is just too dangerous for anyone else. It's a good thing I didn't put a darvocet in my son's eye, he could have died!!!!!!!!!

I kid, I kid. All in good fun.

DoGoodThenGo · Oct 20, 2012

LOL, what RN? Most assisted living centers do not have nurses on staff. They might have a RN stop by on a monthly basis-to check the paperwork, not the residents. My spouse administers medication to our children without having taken even a one-day course, btw. We have seven children. There could be a mix-up. Should I be concerned about this?
I don't think you understand the nature of assisted living centers. They are not intended to provide skilled nursing care. So, no, it does not surprise, offend, frighten or upset me that there are non-licensed people "assisting" the people living there. That is the definition of assisted living, and the the purpose of their existence. It is not a skilled nursing center.
I am a doctorally prepared advanced practice nurse, so I wouldn't be working as an aide at an assisted living center, so I am not sure in what context you are asking me would I feel badly if I made a medication error that harmed a person. However, for the sake of argument, my response is yes, I would feel bad. I don't know if I would go so far as to say "horrible," but certainly would feel badly.
If the bottle says "give one tablet to Mrs Smith at 8pm," just about any literate person ought to be able to do that. You do not need to know what it is for. Mrs Smith is well. She probably just has difficulty opening the bottle herself. I write orders for this stuff everyday for reasons just like that. They can't get their compression hose on/off alone, can't grasp small pills, can't see well enough to tell pills apart, can't open the lids. They aren't ill, per se, they just need assistance. For whatever reason, they don't have a family, their family lives far away, or just despises them, so they are relying on hired help. It is not a travesty that the hired help are not doctorally prepared APNs. However, I understand there are a lot of unemployed new grad RNs, so perhaps they will be interested in going to work for $8 an hour at an assisted living center. Go ask 'em.
So let me sum up: You are making a mountain out of a mole hill here. You don't need a plumber to clean the toilet, and you don't need a RN to hand out pills. Even to old people.

Quite correct. Excellent post/response.

The entire idea behind "assisted living" is that they are just that, and are not usually contractually or otherwise obligated to provided any sort of skilled nursing service. Indeed if residents of such facilities do require such services they are often asked or forced to move on to a place (LTC, nursing home, etc..) able to provide skilled nursing.

IIRC there was a story last year or so ago in the news about an older couple whose assisted living residence was "evicting" them because either the husband or wife developed health issues requiring "skilled nursing" and the residence stated it simply wasn't set up for such things.

katiedid53 · Oct 21, 2012

I have worked in LTC facilities that have had very reliable med techs and they actually were better and had fewer medication errors than the nurses. In my state the course is 6 weeks long. Of course I have also seen some med techs that are not safe, but for the most part, the ones that I have seen are very good and when it comes to nurses, I have seen more nurses that are terrible with med pass in LTC. Besides, the LTC nurses have 30-40 patients and if they have to do their own med pass, that is all that they are doing is passing meds their whole shift and then that is how important patient issues are missed. It is the facility's responsiblity to make sure that the med tech receives an intense orientation. I do not mind med techs, but I am surprised that in a LTC facility that they are aloud to give narcs. This has always been only alowed by the nurse so that she can assess the pain and the effectivenes of the pain management.

proudauntie415, LPN, RN · Oct 21, 2012

I do not mind med techs, but I am surprised that in a LTC facility that they are aloud to give narcs. This has always been only allowed by the nurse so that she can assess the pain and the effectivenes of the pain management.

Hey ladies! I have to say even being a new nurse who is obsessed with double and triple checking every treatment I do (nerves?!lol), I thank THE LORD that we have med techs, honestly. At first, I was like WTH! :***: They are passing BP meds like beta blockers?!?! (but think, it's a skilled facility, they have been taking this beta blocker for years it's not really a "new" med, I'm sure if they had a reaction, someone would know by now) I mean, my grandma who is 75 ensures her husband gets his meds every night, and she isn't a nurse or need a nursing judgement to give his routine meds he is taking for years.

I am on my own finally and usually have 35 patients.... and ya know, that med tech saved me! My declining patients, or more severe patients received sooo much more of my time!! The med techs I work with are VERY knowledgeable and have been doing it for years.

However, at my facility, they only pass routine meds and controlled meds (no prn such as benzo's etc), no narcs, and we do our own insulin. I like that, the three main ways a medicine would need a nurses judgement I get to use, but the endless amts of vitamins our routine synthroid, iron ,etc...let them do it! They KNOW to ask me if for ANY reason they hold something.

No matter if it is you or the med tech, keeping an open communication is the key! Teamwork!!

itsmejuli · Oct 21, 2012

I work in a seniors' lodge as a homecare supervisor.

Our HCAs (homecare aids) assist clients with meds, the meds are packed in bubblepacks so there's little chance of error. Some clients require that the meds be popped from the bubblepack while others just need to be observed. The HCAs do not assist with PRN meds nor insulin administration. The HCA can watch the client click the insulin pen to the correct dose and then the client must administer their own insulin.

All of this is a helping hand, nothing more.

BrnEyedGirl, BSN, MSN, RN, APRN · Oct 24, 2012

I understand also that not all Narcotics are dangerous, but keep in mind that its the elderly.. or mentally challenged, wouldn't feel horrible if you gave the wrong dosage of a controlled substance to someone or overdosed and not have known because of lack of knowledge?

When I first became aware of this, I too thought no way,...but then I got to thinking,....When my children were small,..before I became a nurse, I was qualified to give them meds,...When I discharge someone home with 3 prescriptions, I don't send them home with a nurse to administer them. When my Mom came home from facial surgery on antibiotics and narcotic pain meds I was 14 and completely capable of reading the bottle and giving meds a prescribed. I'm sure that before these "elderly/mentally challenged" patients came to assisted living a spouse, friend, neighbor, grandchild etc gave the meds. While I've never worked in LTC and I see your point about being responsible for what a med tech does,...how hard is it to give one Norco every 6 hours?