Med Techs in California

[blusueNP, MSN, APRN]

I don't know if this is the right place to find out about med techs in an ALF, but here goes. I am a home health RN who sees pts in an ALF in Tracy. I have never seen a nurse there. They say there is one that is "on call", but I have never seen this person and I have been there on different days and at different times. The med techs do not take blood pressures on pts who are receiving BP meds Yesterday, I went to re-certify a pt who is getting B12 shots monthly, when I took her VS, BP was 218/94 on her left arm and 198/92 on her right arm, I called the MD and got an order for an extra dose of her Coreg 12.5mg po now. The med tech stated she could not f/u with a BP later on in the evening. This woman is on multiple BP meds, and takes some of them TID. What is the risk to my license as an RN going in to a facility that allows their med techs to dispense cardiac meds without first obtaining VS.

[LadyinScrubs, ASN, RN]

I believe ALF refers to an assisted living facility. First, you need to be aware that an assisted living facility does not operate under a medical model; it operates under a business model. That is where you have difficulty understandy who works there, etc.

The dead give away for the business model versus medical model is the use of med techs delivering meds (med techs = someone who has taken an 8 hr med course). There may be an LVN on the premises (this is determined by how many pts they have) or the LVN may be on call. The owner may be an RN, which fulfills the LVN requirement.

Most Assisted Living Faciliities provide room, food, medication management, as well as transportation to appointments, and some entertainment events. Pts cannot be on IM or IV meds. The ALF does not monitor blood pressure or other assessment tests. Should there be a problem the physician or 911 is notified. The reason your pt is receiving home health is the home does not provide medical monitoring or care. If they did, your services would not be needed. The ALF is essentially just a home with someone to minitor and help the guest. There is a trend in home health to train relatives or the caregiver to provide care to the pt--which decreases the need for home health. However, that option is not valid in ALFs.

Those facilities with dementia or Alzheimer's facilities, may fall under the medical or business model. The Calif state has rules/regs for operation of an ALF, which you should be able to bring up on line.