Nursing Issue - Medication Aides

dd_txrn, ASN, BSN · Mar 28, 2005

Okay folks, let's think about this for a second.
1 semester unit is equal to 18 classroom "hours" (50 minute hours)
1 quarter unit is equal to 12 classroom "hours" (50 minute hours)
1 semester unit is equal to 3x18 hours or 54 hours (50 minute hours)
1 quarter unit is equal to 3x12 hours or 36 hours (50 minute hours)
Therefore, the person who had 60 classroom hours had the equivalent
of a little over a 3 semester or 5 quarter unit lecture class, and about 3/4 unit of "lab" in semester units, and slightly over 1 quarter unit of lab.
While I have pharmacology for a full year, to compare it to what the QMA had I need to compare hours to hours; not "semester" vs "weeks" -- that is like comparing apples vs. oranges.
NurseFirst
PS And yes, I think med aides are a bad idea. So, does the med aide give all meds? Or just PO meds? PR meds? Do they give dig? Do they know which medications to check bp and/or pulse rate for? How would they know? Heck, I've even seen nurses miss the comments that the pharmacy puts into the MAR about appropriate administration. And does the aide mark down what time the medication was given? How does the nurse know when to go in to check the patient for any reaction. It really does seem like it's more work than it's worth.
Oh yeah, and then I was wondering...if someone is a CNA and a med aide, will they start thinking that's equivalent to an LPN??

I work in LTC in Texas w/e dbl shifts with a Med Aide. It is trying at times because I don't have the "back up" of a LVN or RN. She is a good med aide, but it takes a long time to pass her pills. And everyday, she passes her "window" of time alloted to get those pills out--some days she is still passing 8ams at 11am and our capacity in only 29 on the Rehab unit--the other med aides in the building are responsible for double that.. YIKES!!! I have asked her about this--since it is my license on the line and she says that she does the best she can. The Unit mgr thinks it isn't a "big deal" b/c "state" rarely comes in on the weekends--oh yeah but what if there is a complaint about the timeliness of the pills!!!

I am currently looking for another job btw.

But the med aides in Texas have to have started out as a CNA--I don't know how long their school is tho. They give all PO meds. I give PR and of course the GTubes and insulins and nebulizers, and the ONE RN on staff for the weekends comes and gives any IV meds. If a new med order comes in the nurse on duty is responsible for giving the ID of the med and monitoring for s/e.

Marie_LPN, RN, LPN, RN · Mar 28, 2005

A unit manager that doesn't see a problem with a pt. getting their meds 3 hours after they're schedules shouldn't be a unit manager.

SmilingBluEyes · Mar 28, 2005

The longer I've been a med tech, the more I'm CONVINCED that passing meds is a NURSE'S job. Med techs at our facility are expected to pass meds, call or fax in drug refills, check blood pressures, and act as shift supervisors (with or without a nurse on the premises). We're not allowed to give injections, use an epi-pen or test blood sugar. (Home health comes in to do these.) We are also not allowed to use souffle cups to hold a person's meds. They have to be placed directly in the resident's hand and we have to tell them what we're giving them. Sorry, but I barely know anything about the medications I'm passing! Now, due to mistakes in the med books, the nurse has decided she will not write up med techs anymore--they will be fired. Personally, this would not even be an issue if assisted-living facilities paid nurses to pass their own meds! How can my boss do her assessments properly if five or ten other people are passing her meds? Med techs are not trained to "think like a nurse", so we don't know to assess a person's reaction to a new drug. One time a resident broke out in a body rash and her face swelled up, so she was sent to the hospital. Turns out she was having a sulfa drug reaction to the Bactrim we were giving her. Who knew? All I know is that this med tech stuff is scaring me more and more every day, and I have half a mind to put in my notice without another job lined up. Get me a job where I don't have to worry about protecting my BOSS' license AND my own rear end. A lot of my med tech co-workers are talking about leaving as well. We don't get paid any extra for the huge liability we take on by passing meds (with no real pharmacology training) and working under someone else's license. For me, it's no longer worth $8/hr. to play nurse. No thanks.

There you have it folks. Why I believe med techs should not exist. An honest assessment from one of them.

Thank you for being truthful. It is true, you can't replace a nurse w/a QMA or med tech and expect the same level of care. It IS a matter of dollars and (lack of)sense.

Sheri257 · Mar 28, 2005

Here's some interesting info on the training and other requirements which, apparently, vary widely from state to state. Check out this link. It gives a run down on each state's requirements.

http://www.alfa.org/membersonly/articles/MedAide_Spec_Rpt.pdf

4 states require 8 hours training

3 states require 16 hours

3 states require 20 hours

5 states require 40 hours

3 states require 60 hours

6 states do not list a specific number of hours (huh?)

6 states require that medication aides become CNA's first.

Other interesting info:

12 states restrict medication aides exclusively to assisted living centers

10 states restrict them to assisted living and skilled nursing centers

8 states restrict them to assisted living, adult day care and residential care.

What meds can be administered by medication aides?

With few exceptions, most states allow medication aides to administer orals, suppositories, topical creams, eye and ear drops, nasal sprays and inhalants.

Insulin:

6 states allow medication aides to draw up and administer insulin shots. 6 states allow them to hand out pre-filled insulin shots, 7 states allow them to administer pre-filled shots. 7 states don't allow insulin injections at all.

Blood Sugar:

18 states allow medication aides to test blood sugar, 10 states don't.

PRN Drugs:

22 states allow PRN meds to be administered. 2 states allow PRN meds to be administered after a nurse delivers the first dose. 5 states don't allow PRN meds.

Doctor's Orders:

17 states don't allow medication aides to take doc's orders. 5 states do allow medication aides to administer doc orders that are signed and faxed (nurse consultation is sometimes required). 2 states allow medication aides to take doc orders verbally. 4 states allow med aides to take doc orders but the orders must be signed/faxed.

:uhoh21:

rnmi2004 · Mar 28, 2005

No. We are not the equivalent of an LPN. We are QMAs. We were taught all those things in class but not in depth. Even though the State board exam only comprised of 100 questions we were expected to know everything in our syllabus and textbook. My problem at work has a lot more to do with the volume of work and the interruptions and on weekends the sometimes chaotic environment when not everybody shows up. I do take a full set of vitals when I give drugs such as Metoprolol and I make the nurse aware if the VS is too low or even borderline. Many times we have to withhold it. Same thing with Digoxin. I won't give it with a pulse less than 60 bpm. When it comes to charting: each drug is assigned a time. Some PRNs I have to chart 4 times: once in the MAR, then in the back of the MAR and then I enter it in the controlled drug book and then I write it down on the report sheet so the next person at a glance knows that Mrs. Smith had, say, 1 vicodin po at 1:45P and I also chart the result when the med takes effect.
NO DOUBT there are a lot we have to learn. Many of the residents families will ask me what these drugs are, and what they are for and I have to be able to tell them. But that's not the hard part. Sometimes some of our residents get confused and will argue with you that they didn't get their supper meds or something like that. I always let the nurse know and she charts on the resident and the next time I bring her meds I bring another person with me.

You give prn's & chart results? :confused: This requires assessing a patient--something that is the nurse's scope of practice.

klondike · Mar 28, 2005

That's not an answer--that's a reason.
And, to be true to our profession, we must fight when the profit driven enterprise interferes with the health of our patients. Remember, at any time, that patient could be YOU or ONE YOU LOVE.
NurseFirst
Student Nurse

And when you do decide to advocate for your patient, on an issue that could cost your boss some real bucks, be sure you either have a new job lined up or an independent source of income. Remember the old saying " The squeaky wheel gets the grease."? Well, I'm afraid for the average nurse who doesn't have a powerful DC lobby or who's not the member of a union or profession organization that saying is superceded by a different one, " The squeaky wheel can be replaced." And the harsh reality, answer, reason or what ever we care to call it is. Because in the corporate world, "Money talks and BS walks." It's not right but it's the way it is. Without someone to advocate for us and if we will not join together and advocate for ourselves we are not free to really advocate for our patients. In many states we work at the mercy of an employeer who is allowed to fire us for no reason at all. However, in those states we do have the right not to join a union. In other words, " They have the right to throw you off the boat but you have the right not to wear the life preserver." Makes as much sense. Unqualified low paid individuals passing out meds increase the revenues of corporations whose bottom line is profit and not proper patient care. They have powerful lobbies which grease the palms of the people who write the laws, both at the state and and federal levels. In most cases, perhaps not all but most, they will pervail over the altruist. Pick your battles wisely. Live to fight another day.

snowfreeze, BSN, RN · Mar 28, 2005

Its not gonna work, either you are able to give your own meds at home or a family member takes that responsibility or you have a nurse with training give your meds. Giving medications to one person whom you know and go to the doc with is one thing. Giving meds to 5 or 10 people you dont know and you dont understand their medical condition or what the meds are supposed to do is kinda scary.

Penguinurse · Mar 29, 2005

I work as a hospice field manager, and deal with a few assisted living facilities that use med techs. As an RN, I can tell you it's truly frustrating to have nonlicensed staff giving meds to my terminal patients! I have one ALF that won't allow our patients to receive Roxanol (liquid morphine) unless their local pharmacy draws up individual syringes of the med. This means that instead of a bottle with an eye dropper for dosing, the techs have about a hundred individual syringes, each with 0.25ml of morphine in them! When I ordered a regular bottle of Roxanol from our mail-order pharmacy, you'd have thought I'd tried to kill someone - apparently, at this ALF, the med techs can't count liquid meds. The facility RN told me that in the past, the techs had been off count by bottles - yes, BOTTLES, not ml's - of Roxanol. :uhoh21:

boulergirl, CNA · Mar 30, 2005

And I have a question.....why do they not let you have souffle cups to put the residents meds in?
You are NOT supposed to touch the medication, and without souffle cups how do you manage that?
What about liquids? How do you pour up those? Do you have the graduated measuring cups for liquids?

Doing away with the souffle cups was our boss' idea. We had an inservice recently (the boss was NOT present) about doing the medication pass. According to the lady giving the presentation, state law allows us to use souffle cups as long as we tell the resident what meds they're taking. She talked to the boss, but the boss will not budge. Using the souffle cups (for meds that come in blister packs or pill bottles) saves a lot of time. I don't know if my boss is that paranoid about her license, or what. (I figure if you really value your license, pass your own darn meds!)

By the way, we still have some souffle cups, and use them. Our med passes would go on for several hours if we didn't.

We are allowed to use graduated measuring cups for liquid meds (whew!)

LPN2RN05 · Apr 6, 2005

There was a similuar discussion on another thread that I posted on conserning this very issue. I work in Alaska and in a long term care facility CNA's pass the medications after a 4 hour course on correct ways to pop the meds out of the prepack,,they teach nothing about the medications themselves..except for digoxin..like taking pulse etc.

I was a CNA doing this very same thing for about four years. I looked up my meds to see what I was giving, but honestly I knew I did not have the knowledge base. Although I was accurately passing medications and only had had one minor med error (Thank God) I knew that I was taking a Nurse position. It upset me that not only was I expected to do this among other nursing skills, but I was not getting paid for it, and working outside my scope of practice, because of a loophole in the state law.

So I went into nursing..took my pharmocology and then it hit me hard. the realization of when I was a CNA...I had not clue.

Now that I am a LPN..I am having a hard time finding a job..(guess why)..all that learning for nothing...

I had to recert for my CNA lisence so I can get a job in this town!!!!

Thank God that I am almost finished with my RN..because LPN just arent wanted.

Why pay an LPN if you can have a CNA do the same job for less money??

Pretty much sucks!!

LPN1974, LPN · Apr 6, 2005

Doing away with the souffle cups was our boss' idea. We had an inservice recently (the boss was NOT present) about doing the medication pass. According to the lady giving the presentation, state law allows us to use souffle cups as long as we tell the resident what meds they're taking. She talked to the boss, but the boss will not budge. Using the souffle cups (for meds that come in blister packs or pill bottles) saves a lot of time. I don't know if my boss is that paranoid about her license, or what. (I figure if you really value your license, pass your own darn meds!)
By the way, we still have some souffle cups, and use them. Our med passes would go on for several hours if we didn't.
We are allowed to use graduated measuring cups for liquid meds (whew!)

I don't want ya to think I keep harping on this, but actually using souffle cups and telling the resident what their meds are for are actually two totally different issues.

You're supposed to tell the resident what their meds are no matter how you get them to their mouth. That's their basic right to know what you are giving them.

The souffle cups are for the purpose of keeping you from TOUCHING the pills and for transporting them from the blister pack to the resident's hand or mouth.

What about resident's who can't get the meds to their mouth on their own?

Not all resident's are alert enough and able to it, I would imagine.

What do you do for them? Do you place them in their mouth with your hand?

All she's doing is saving money by not buying you the souffle cups.

There is too much risk for dropped pills when you don't use cups.

On my job we have two types of plastic cups. Graduated, for measuring liquids, and plain plasitc for pills, of which we also have lids that fit both cups.

We have to transport our meds from one building to other buildings AFTER they've been set up, hence the need for lids.

Someone is pulling the wool over your eyes. There is no reason in this world other than money, why your boss won't buy you paper souffle cups.

I wish you could explain to me how your boss thinks that telling the resident what the meds are and the use of paper cups are related.

I just do not understand that.

LPN1974, LPN · Apr 6, 2005

I work as a hospice field manager, and deal with a few assisted living facilities that use med techs. As an RN, I can tell you it's truly frustrating to have nonlicensed staff giving meds to my terminal patients! I have one ALF that won't allow our patients to receive Roxanol (liquid morphine) unless their local pharmacy draws up individual syringes of the med. This means that instead of a bottle with an eye dropper for dosing, the techs have about a hundred individual syringes, each with 0.25ml of morphine in them! When I ordered a regular bottle of Roxanol from our mail-order pharmacy, you'd have thought I'd tried to kill someone - apparently, at this ALF, the med techs can't count liquid meds. The facility RN told me that in the past, the techs had been off count by bottles - yes, BOTTLES, not ml's - of Roxanol. :uhoh21:

So for Narcotics then the job of actually setting up those narcotics has been placed upon the pharmacy, as if THEY don't have enough to do.

An LPN or an RN would have the knowledge to draw those liquids up in a syringe anyway, at the medication cart before administration.

Apparently since they are making the pharmacy do it, some of the poweres that be don't think the med techs have enough sense to do that, so they require it to be done by the pharmacy.

What a waste of time and money.

I bet they charge the heck out of that for all those prefilled syringes.

Also seems like there would be a high risk of those syringes getting mixed up, or out of the package. Is EACH and every syringe labeled?