Medication Aides

78BugRN · Feb 28, 2005

WOW... that's more than a bit scary.

As nursing students, we have pharmacology training and prepare for each clinical day by looking up ALL medications and knowing their effects, side effects, and interactions. And our instructors STILL look over every medication with us before we pass meds.

kellisdomain · Mar 2, 2005

i was once a licensed med-aide in texas. had to go through 6 months of school learning pharmacology, parts of body (a&p) and med terminology. i thoroughly enjoyed. we were not able pass out narcotics or any scheduled drugs. i do think though that the cma should work with a licensed nurse on duty. are they letting the cma do everything?

amypsychrn · Mar 7, 2005

I do believe that our Med Techs will not have to take that much pharmacology. I think they are just going to have to know the routes of administration and may not be doing IM's. However, I prefer to pass my own meds and be responsible for monitoring for effectiveness and side affects. The techs will have to work under a nurse's license and I don't want them working under mine. I think it undermines the education that we have.

military spouse · Mar 7, 2005

Hello,

I worked at a facility in TX that utilized med aides and it was great. The nurses were still responsible for all G-tube meds & IV meds. We had GREAT med aides that made an impossible job a little easier. Everybody in our facility was grateful to them and they were excellent at keeping nurses informed and always seemed to be reading their drug books. This was a SNF so many of the meds were quite routine. The nurses were responsible for documenting prns which meant that we would often give those .

Erin

VickyRN, MSN, DNP, RN · Apr 10, 2005

HI. I am new. I am a nursing student scheduled to graduate in May. My state is proposing legislation soon regarding Medication Aides. I am very leary of the wording of the proposal because it states that these aides are mandatory in non-healthcare facilities such as: daycares, prisons, schools, group homes, and long term care facilities. However, it is optional for other healthcare facilities such as acute care facilities. I know programs such as this has passed in over half of the states. Does anyone have any imput? How is it working? Has there been any problems? Are med errors increasing? It really bothers me because these people have no prior medical experience and will have 24 hours of training. The RN will delegate to them. This is real scary. This program came about in our state because these med aides were already working in some of these facilities and had no formal training. From what I understand, this is suppose to help alleviate the nursing shortage for our state. I am looking for help, please. I would love your imput and any suggestions.

On March 17-18, the North Carolina Council of Practical Nurse Educators (NCCPNE) came out with the following press release concerning both the medication aide and geriatric aide:

Position Statement of the NCCPNE
Geriatric Aide and Medication Aide:
While we as an organization acknowledge the increased demand for more qualified nurses, we do not believe that the solution to the problem exists with creation of a larger unlicensed workforce. The average geriatric client that is in long term care is a person with age related physiological changes and multiple chronic diseases that require a variety of medications, critical thinking skills, complex health care, and other health services. We believe that we need more licensed nurses not more unlicensed personnel to safely care for our geriatric population. Issues exist that have not been addressed as to competency evaluation, supervision, number of unlicensed persons supervised, access to controlled substances, etc. We believe that the movement will produce adverse effects in a vulnerable, valuable population.

The worst part (besides putting the public at grave risk) is that these unlicensed personnel will be working under the RN or LPN's license. If these people make an error, who do you think will be held accountable??? In case you are still wondering about the answer, see: http://www.ncbon.com/forms/Interface%20between%20Licensed%20Nurse%20and%20Med%20Aide.pdf

This latest action by our Board is perplexing, as they are the agency who is supposed to be safeguarding the health of the public by ensuring "safe, effective nursing care." Instead, they are giving away bits and pieces of our profession, and putting the health of everyone who enters an acute care facility across the state at risk:

http://www.ncbon.com/Education-factsheet.asp

We need to contact our state legislators ASAP! This bill (House Bill 783 and Senate Bill 662) has already been introduced into committee. This is legislation that could cause medication errors to skyrocket. Polly Johnson, the Executive Director of the NCBON, with the Institute of Medicine's blessing, made a presentation before the subcommittee in support of these bills. Apparently, there are also large numbers of physicians backing these bills. The Senate bill has support from the large counties including Meck, Wake, Guildford, Durham.

Here is an excellent template to use:

Dear ______
This letter is in reference to House Bill 783, filed on March 16 and sent to the Committee on Health. This bill will allow medication aides to give medications in health care settings. The Division of Facility Services along with the Board of Nursing introduced this as a measure to improve the medication delivery in unskilled facilities such as group homes, rest homes, and other residential settings.
In the update on nonlicensed personnel, it was reported that the intent was to require at least minimal training to unlicensed personnel who currently give medications to individuals (not patients) in residential settings. The Board of Nursing updates also stated this. However, in the bill there is no exclusion from using these technicians in acute settings or in skilled nursing home facilities.
As I am sure you have read and seen in the media, medication errors account for a huge amount of mortality and morbidity in our country. The residents in skilled nursing homes are requiring more complex care now than ever. The medication regimen, if not followed correctly can be ineffective or harmful.
I am certain that you would agree that for our loved ones and potentially in the future, for ourselves the person administering our medications needs more than 24 hours of training (primarily by video). I would venture to guess that a fast food employee obtains more than this amount of training.
I implore you to restrict the use of these technicians to only unskilled residential settings. Thank you for your careful consideration of this matter. The safety of health care across our state is at stake.
Sincerely,
______________

This is a link that should tell you who your representative is:

http://tm.wc.ask.com/r?t=c&s=a4&id=30787&sv=za5cb0d88&uid=0FB508AAC527FAD14&sid=3ccd325ddccd325dd&p=%2ftop&o=0&u=http://www.ncga.state.nc.us/House/House.html

We also need to send letters-to-the-editor to newspapers across the state. Here is an excellent template to use:

Dear Editor:
I am a registered nurse/ licensed practical nurse who is concerned about a bill being introduced into the Health and Heath Care Committees. This bill, if passed, would allow unlicensed medication aides to administer medications to patients in health care settings. These "med aides" are only required to have 24 hours of video training, whereas a licensed practical nurse has a minimum of one year of training in pharmacological theory, lab, and clinical. You have to ask yourself, "Would I want someone with only 24 hours of training giving me or my loved ones medications rather than a licensed nurse with extensive knowledge of medications and their side effects? I think the answer is obvious.
This bill has been proposed as a solution to lessen the strain of the nursing shortage and to address rising healthcare costs by replacing licensed practical nurses with med aides. I believe that this is the wrong solution and can seriously jeopardize the health and well being of our patients. The very people that have proposed this solution are the ones that would like the bill to pass without public knowledge. If you feel as strongly as I do that this poses risks you are unwilling to take, please write your state representatives and senators requesting only licensed nurses be allowed to give medications and vote "no" for med aides.

Let's get the word out! We still have time to stop this madness!

VickyRN, MSN, DNP, RN · May 7, 2005

nc house bill 783/ senate bill 662

submitted on march 17, 2005, and referred to the committee on health.

house bill 783 (h783):

http://www.ncga.state.nc.us/sessions/2005/bills/house/html/h783v1.html

http://www.ncga.state.nc.us/gascripts/billlookup/billlookup.pl?session=2005&billid=h783

senate bill 662 (s662):

http://www.ncga.state.nc.us/sessions/2005/bills/senate/html/s662v1.html

http://www.ncga.state.nc.us/gascripts/billlookup/billlookup.pl?session=2005&billid=s662

medication aide proposal (as outlined by the ncbon):

http://www.ncbon.com/education-factsheet.asp

only 24 hours worth of video training required. "curriculum for med aides focuses on the six rights of medication administration via oral, topical and instillation routes. it is a 24-hour course and addresses these common routes of medication administration but excludes injections. after passing the course the med aide may take the state competency test. the med aide must pass the state test and is then placed on the medication aide registry." of course, these "med techs" are operating under the rn or lpn's license (who will be ultimately responsible should any adverse patient reactions occur). http://www.ncbon.com/forms/interface between licensed nurse and med aide.pdf

this legislation was originally intended to regulate medication administration in assisted living facilities, but both the house and senate versions of the bill make no distinctions as to the type of facility in which these medication aides will be utilized. as such, these unlicensed personnel with only 24 hours worth of training could be utilized in both nursing homes and hospitals. i believe nursing homes are the primary targets.

the medication aide is already being piloted in eight settings, including several nursing homes, one hospital (dorothea dix), and a correctional facility.

please email the ranking members of the committee on health care noting your concerns about this serious threat to public safety. medication aides need to be limited to assisted living facilities only.

health care committee

http://www.ncleg.net/committees/

co-chairmen:

senator william r. purcell [email protected]

senator stan bingham [email protected]

vice-chairmen:

senator austin m. allran [email protected]

senator katie b. dorsett [email protected]

ranking minority member:

senator james forrester [email protected]

deskilling and deprofessionalizing nursing by eroding essential nursing tasks (such as medication administration) is not the answer to the statewide nursing shortage!

VickyRN, MSN, DNP, RN · May 18, 2005

Good news!!!!

Yesterday, the Board of Nursing reversed themselves on the issue of medication aides and voted to oppose it.

Not so coincidentally, the Health Care committee of the House voted to table the discussion of H 783. It was taken off the calendar for action in the legislature.

RNPATL, DNP, RN · May 18, 2005

Nice to hear that! I am glad they are tabling this discussion. But, it does leave the door open for future discussions to take place. Perhaps they will be more open to listening to the nurses of North Carolina in the future.

VickyRN, MSN, DNP, RN · Aug 8, 2005

Dirty politics at its worst :angryfire Tacked onto SENATE BILL 622, 2005 Appropriations Act, 6/16/05. This was after this very dangerous bill was tabled in committee after being rejected by 12 out of 14 members of the NCBON at their meeting in May.

http://www.ncga.state.nc.us/Sessions/2005/Bills/Senate/HTML/S622v7.html

http://www.ncga.state.nc.us/gascripts/confcomm/confcommittee.pl?BillChamber=S&BillID=622

Sections 10.40C a-d, and 10.40D a-f of the 2005 Appropriations Act read as follows:

Requested by: Representatives Insko, Barnhart
USE OF UNLICENSED HEALTH CARE PERSONNEL TO PERFORM TECHNICAL ASPECTS OF MEDICATION ADMINISTRATION IN NURSING HOMES
SECTION 10.40C.(a) Article 6 of Chapter 131E of the General Statutes is amended by adding the following new section to read:
131E 114.2. Use of unlicensed health care personnel to perform technical aspects of medication administration.
(a) Facilities licensed and medication administration services provided under this Part may utilize unlicensed health care personnel to perform the technical aspects of medication administration consistent with G.S. 90 171.20(7) and (8), and G.S. 90 171.43.
(b) The Commission shall adopt rules to implement this section. Rules adopted by the Commission shall include:
(1) Training and competency evaluation of medication aides as provided for under this section.
(2) Requirements for listing under the Medication Aide Registry as provided for under G.S. 131E 271.
(3) Requirements for supervision of medication aides by licensed health professionals or appropriately qualified supervisory personnel consistent with this Part.
SECTION 10.40C.(b) Article 9C of Chapter 90 of the General Statutes is amended by adding the following new section to read:
90 171.56. Medication aide requirements.
The Board of Nursing shall do the following:
(1) Establish standards for faculty requirements for medication aide training; and
(2) Provide ongoing review and evaluation, and recommend changes, for faculty and medication aide training requirements to support safe medication administration and improve client, resident, and patient outcomes.
SECTION 10.40C.© Article 16 of Chapter 131E of the General Statutes is amended by adding the following new section to read:
131E 270. Medication Aide Registry.
(a) The Department shall establish and maintain a Medication Aide Registry containing the names of all health care personnel in North Carolina who have successfully completed a medication aide training program that has been approved by the North Carolina Board of Nursing and successfully passed a State administered medication aide competency exam.
SECTION 10.40C.(d) This section becomes effective October 1, 2005. The North Carolina Board of Nursing and the Department of Health and Human Services shall report on the implementation of this act to the House of Representatives Appropriations Subcommittee on Health and Human Services, the Senate Appropriations Committee on Health and Human Services, and the Fiscal Research Division not later than March 1, 2006, and annually thereafter.
Requested by: Representative Wright
DHHS AND COMMUNITY COLLEGES STUDY USE OF MEDICATION AIDES TO PERFORM TECHNICAL ASPECTS OF MEDICATION ADMINISTRATION
SECTION 10.40D.(a) The Secretary of Health and Human Services and the President of the Community Colleges System shall jointly convene a study group to review and consider the use of medication aides to perform the technical aspects of medication administration. The study group shall consist of members representing at least the following entities and licensed health care facilities and providers:
(1) Appointed by the Secretary of Health and Human Services:
a. Adult care homes.
b. Home care agencies.
c. Ambulatory surgical centers.
d. Hospitals.
e. Facilities providing mental health, developmental disabilities, and substance abuse services.
f. Nursing homes.
g. The nursing profession, as recommended by the Board of Nursing.
(2) Community colleges appointed by the President of the Community Colleges System.
(3) The Secretary of the Department of Correction.
(4) Others as may be appointed by the Secretary of Health and Human Services or the President of the Community Colleges System.
SECTION 10.40D.(b) The study group shall address at least the following in its study and its recommendations regarding medication aide performance of the technical aspects of medication administration:
(1) Training and competency evaluation of medication aides;
(2) Training standards;
(3) Ongoing review and evaluation of medication aide training; and
(4) Requirements for supervision of medication aides.
SECTION 10.40D.© The Secretary of Health and Human Services and the President of the Community Colleges System shall report the progress and recommendations of the study group to the 2006 Regular Session of the 2005 General Assembly upon its convening, and the 2007 General Assembly upon its convening. Recommendations to the 2006 Regular Session of the 2005 General Assembly may include proposed legislation. A copy of the report shall be provided to the House of Representatives Appropriations Subcommittee on Health and Human Services, the Senate Appropriations Committee on Health and Human Services, and the Fiscal Research Division at the same time as the report is submitted to the General Assembly.
SECTION 10.40D.(d) The Department of Health and Human Services shall continue its pilot program on the use of medication aides and shall report on the status of the pilot programs at the same time and to the same persons as the study group report to the General Assembly.
SECTION 10.40D.(f) G.S. 115C-47 is amended by adding the following new subdivision to read:
115C 47. Powers and duties generally. In addition to the powers and duties designated in G.S. 115C 36, local boards of education shall have the power or duty:
(45) At the discretion of the board, to adopt policies and procedures authorizing schools that operate programs under G.S. 115C 307© to utilize unlicensed health care personnel to perform the technical aspects of medication administration to students. If adopted, the policies and procedures shall be consistent with the requirements of Article 9A of Chapter 90 of the General Statutes and shall include the following:
a. Training and competency evaluation of medication aides as provided for under G.S. 131E 270.
b. Requirements for listing under the Medication Aide Registry as provided for under G.S. 131E 271.
c. Requirements for supervision of medication aides by licensed health professionals or appropriately qualified supervisory personnel consistent with Articles 5, 6, 10, and 16 of Chapter 131E of the General Statutes.

This is truly a sad day for nursing and for patient safety (especially those of school children and our frail elderly nursing home population) in North Carolina :crying2:

VickyRN, MSN, DNP, RN · Aug 8, 2005

your help is greatly needed in helping to spread the word about this underhanded "back door" legislation. the public needs to be informed. would you want your medications given to you by a licensed nurse or by someone off the street with 24 hours' worth of "training?"

http://www.ncbon.com/education-factsheet.asp

curriculum and training:

curriculum for med aides focuses on the six rights of medication administration via oral, topical and instillation routes. it is a 24-hour course and addresses these common routes of medication administration but excludes injections. after passing the course the med aide may take the state competency test. the med aide must pass the state test and is then placed on the medication aide registry. the

rn

with two years practice experience including medication administration is eligible to take a 16-hour teacher training course which is required in order to teach med aides. the teacher is certified after taking the course and is placed on the teacher certification registry which will be maintained by the board of nursing. the med aide curriculum and teacher training curriculum will be reviewed periodically by a medication aide advisory committee appointed by the board. this committee will make recommendations for change to these curricula and other related recommendations based on the results of periodic survey of those involved in the med aide process. (please note that persons being trained to perform this medication administration task must also meet the nurse aide requirements in addition to the medication aide requirements before being allowed to perform these tasks in health care settings.)

legal responsibilities of the licensed nurse:

the board approved a position statement: the interface of the licensed nurse with the medication aide to clarify the accountability of the nurse with the med aide. this is available on the board's website:

http://www.ncbon.com/forms/interface%20between%20licensed%20nurse%20and%20med%20aide.pdf

and is consistent with the criteria for delegation to the unlicensed person found in the rule 36 ncac .0221 (b) also on the website:

http://www.ncbon.com/prac-rnrules.asp#bm21_36_0221_

as defined in nursing law and rule, the licensed nurse may only delegate technical components of medication administration to unlicensed personnel. nursing judgment and decision making related to when or if a medication would be administered by the med aide and monitoring the client's response to medications are responsibilities of the licensed nurse that may not be delegated to assistive personnel.

http://www.ncbon.com/forms/interface%20between%20licensed%20nurse%20and%20med%20aide.pdf

the registered nurse is accountable for validating the qualifications, knowledge and skills of the medication aide as well as for the on-going oversight of the performance of activities by the medication aide. the lpn
may participate in the delegation to and supervision of the medication aide in situations where the technical activity of medication administration has been delegated by the licensed practical nurse and provided there is the continuous availability of the registered nurse as stipulated in nursing law and rules. accountability for any professional judgments or decision-making surrounding medication administration is the responsibility of the licensed nurse and may not be delegated to the medication aide.

http://www.ncbon.com/prac-rnrules.asp#bm21_36_0221_

© the registered nurse or licensed practical nurse shall not delegate the professional judgment required to implement any treatment or pharmaceutical regimen which is likely to produce side effects, toxic effects, allergic reactions, or other unusual effects; or which may rapidly endanger a client's life or well-being and which is prescribed by a person authorized by state law to prescribe such a regimen. the nurse who assumes responsibility for implementing a treatment or pharmaceutical regimen shall be accountable for:
(1) recognizing side effects;
(2) recognizing toxic effects;
(3) recognizing allergic reactions;
(4) recognizing immediate desired effects;
(5) recognizing unusual and unexpected effects;
(6) recognizing changes in client's condition that contraindicates continued administration of the medication;
(7) anticipating those effects which may rapidly endanger a client's life or well-being; and
(8) making judgments and decisions concerning actions to take in the event such untoward effects occur.

write your legislators in the general assembly, send letters to the editor, and contact your local television stations today!

http://www.ncga.state.nc.us/gis/representation/who_represents_me/who_represents_me.html

members of senate bill 622 house and senate conferees:

http://www.ncga.state.nc.us/gascripts/confcomm/confcommittee.pl?billchamber=s&billid=622

VickyRN, MSN, DNP, RN · Aug 8, 2005

North Carolina Professionals Against Medication Aides

True nursing advocacy on behalf of patients throughout the state! "Nurses protecting North Carolina patients..."

http://www.ncpama.org/index.htm