Need help! Scope issues!

[duskyjewel]

Please help. I thought that as far as medications went, the ONLY thing a CNA can do is to give reminders, as in, "It's 2:00, time to take X." I thought that handling them in any way is outside our scope. Even if the family has placed them into a sorter box, a CNA taking out the pills and handing them to the client is outside scope. Am I wrong about that?

[happyinmyheart]

You are correct about the fact that you can't handle meds in any way. Even taking them out of the box or taking them from a nurse directly to the patient is out of a CNA scope of practice. (In Illinois)

[duskyjewel]

Okay, what about family members who take them out of the sorter into a dose cup, and tell me, "Give her these at X o'clock." I'm pretty sure that's still outside scope. I just want to have my ducks in a row when I talk to higher ups. I have looked up my company's P&P and it's pretty unequivocal. CNAs are never to administer meds, ever. But "administer" isn't defined. I'm absolutely certain my poor colleague on the shift before me crossed the line (and she should never have been put in that position!), but I'm wondering if I am too by handing the client the dose cup.

All my previous in-home cases had families who understood and had the lines clearly drawn for them. I don't know if my company wasn't clear this time or if this family is ignoring the rules.

[JustBeachyNurse, LPN]

It's a nonissue in my state as CNAs cannot work in the home. They can "upgrade" with a short class to CHHA and this is specifically covered during the training. In my state CHHAs can remind a client to take a med dose but cannot handle other than put the medication sorter (filled by the supervising nurse not family) within reach. A sorter that can be manipulated by the client is selected by the nurse case manager.

[duskyjewel]

Yeah, in my state "certified caregivers" who take a course lasting a weekend or two can administer meds, yet I can't. They make dang near minimum wage, too. It's absolutely nuts.

[happyinmyheart]

Okay, what about family members who take them out of the sorter into a dose cup, and tell me, "Give her these at X o'clock." I'm pretty sure that's still outside scope. I just want to have my ducks in a row when I talk to higher ups. I have looked up my company's P&P and it's pretty unequivocal. CNAs are never to administer meds, ever. But "administer" isn't defined. I'm absolutely certain my poor colleague on the shift before me crossed the line (and she should never have been put in that position!), but I'm wondering if I am too by handing the client the dose cup.

All my previous in-home cases had families who understood and had the lines clearly drawn for them. I don't know if my company wasn't clear this time or if this family is ignoring the rules.

Yepp you still can't hand it to them. They would have to pick it up and take it themselves :)

[SeattleJess]

In Washington, handling meds is outside the scope of the basic CNA license. (Reminding of times is permitted.) However, licensed CNAs can get additional Nurse Delegation and Nurse Delegation (Diabetes) certificates that allow them to perform limited administration of meds, nebulizer treatments and insulin shots under the supervision and direction of a nurse. CNAs with delegation credentials do pass out meds in ALFs and home health situations.

I heard that licensed home health aids have similar authority but I don't know the details for that license.

You are very wise (and ethical) to be aware of issues about your scope of practice.

[stunurse2015]

Be aware turning on/placing O2 tubing or turning on concentrators are also outside most CNA (in my state anyway) scope of practice!

[duskyjewel]

I contacted my supervisor and we had a discussion about scope and company P&P. Issue resolved for now. Thank you!

[mvm2]

As a CNA for Home Care our company has it in place that we CNA can give meds from a med box as long as they were filled by a nurse or family member. I have also given nubulizer treatments as well if they are part of the care plan. We also document as well when we do give any meds.

I have run in situations where the family members do not understand the med box and they just have meds in the original pharmacy containers and want me to give grandma her anibiotic with breakfast. Nope sorry won't do it. Or I had it once i had a client that needed a pain pill. Would not give it because it was not set up. A neighbor had to come and be on the phone with wife and ask which one it was and give it to him. I would not give him the med and let work know about it. They agreed with me 100%

[Bedside_Life RN]

Call DHHS or your state BON to identify your scope of practice. But if I had to guess, I would stray to the side of caution and politely explain that a nurse has to administer medications..... Administering unknown medications and unknown dosage for a prescription that May or may not be expired or the patient May or May not have had a change or discontinuance of this medication is not safe, and practice safely ALWAYS! Find out your scope. Get certification if you want to pass meds. But there is WAY too much nursing judgement and assessment needs for anyone not trained to do so. Even as a nurse, you have to be aware of med errors because they do occur and can be detrimental to the well being of your patients.

This is especially important, even with nursing knowledge, with sound a like and look a like drugs for instance vinblastine and vincristine. Or clonidine and clonazepam. If you are administering medications at any facility and do not recognize the vital difference between these medications then I would strongly consider asking for a different assignment until you can refresh your pharmacology. Good luck to you and the patients..... Be safe!

[amoLucia]

To OP - Kudos to you to question this topic of your legal safe-practice as it affects pt care.