Delegation of medication administration from registered nurses to non-registered support workers in community care settings: A systematic review with critical interpretive synthesis

Abstract

Introduction Healthcare workforces are currently facing multiple challenges, including aging populations; increasing prevalence of long-term conditions; and shortfall of registered nurses. Employing non-registered support workers is common across many countries to expand service capacity of nursing teams. One task delegated to non-registered support workers is medication administration, which is considered a complex task, with associated risks. This is an important topic given the predicted global increase in patients requiring assistance with medication in community settings. This review explores the evidence on delegation of medication administration from registered nurse to non-registered support workers within community settings, to better understand factors that influence the process of delegation and its impact on service delivery and patient care. Methods The review followed key principles of Critical Interpretative Synthesis and was structured around Preferred Reporting Items for Systematic Reviews and Meta‐analysis guidelines. Literature searches were conducted in MEDLINE, CINAHL, Embase, and ProQuest-British Nursing Index databases. Twenty studies were included. Results Findings are reported under four themes: 1, Regulatory and contextual factors; 2, Individual and team level factors; 3, Outcomes of delegation; and 4, Process of implementation and evaluation. Delegation was found to be a complex phenomenon, influenced by a myriad of interconnecting factors at the macro, meso, micro level. At the macro level, the consistency and clarity of government and state level regulations was found to facilitate or impede delegation of medication administration. Lack of clarity at the macro level, impacted at meso and micro levels, resulting in confusion around what medication administration could be delegated and who held responsibility. At the micro level, central to the interpretation of success was the relationship between the delegator and delegatee. This relationship was influenced by personal views, educational and systems factors. Many benefits were reported as an outcome of delegation, including service efficiency and improved patient care. The implementation of delegating medication administration was influenced by regulatory factors, communication, stakeholder engagement, and service champions. Conclusion Delegation of medication administration is a complex process influenced by many interrelating factors. Due to the increased risk associated with medication administration, clear and consistent regulatory and governance frameworks and procedures are crucial. Delegation of medication administration is more acceptable within a framework that adequately supports the process, backed by appropriate policy, skills, training, and supervisory arrangements. There is a need for further research around implementation, clinical outcomes and medication errors a...

Delegation of insulin administration to non‐registered healthcare workers in community nursing teams: A qualitative study

“…In line with delegation of medicines administration internationally (Shore et al, 2021), insulin delegation was primarily driven by increased service demand, and the principal benefits related to increased service capacity. However, a surprising range of additional benefits were reported for patients, healthcare support workers, the community nursing teams and service provision.…”

“…Previous research has shown delegation to be influenced by inter‐professional and team relationships (Campbell et al, 2020; Hopkins et al, 2012), the clarity of roles and responsibilities (Blay & Roche, 2020; Munn et al, 2013) and the quality of supervision (Bifarin & Stonehouse, 2017). While benefits of delegation have been identified for services, patients and staff, concerns have also been raised by registered healthcare workers about staff acceptance, role blurring and patient safety (Shore et al, 2021). It has been reported that some registered nurses view the employment of healthcare support workers as a cheap replacement for Nurses (Alcorn & Topping, 2009; Thornley, 2000).…”

“…The nature of delegated work undertaken by healthcare support workers includes, but not limited to, electrocardiograms, complex wound care, cannulation, suture and administration of medication (Blay & Roche, 2020; Shore et al, 2021; Spilsbury et al, 2013) demonstrating an evolving and increasing level of skill (Blay & Roche, 2020; Fee et al, 2020; Hand, 2007). Literature specific to the delegation of insulin injections reports potential benefits, such as improved capacity and flexibility to meet service demand (Cook, 2015; Dutton et al, 2018; Owen, 2009), improved diabetes knowledge of staff (Cook, 2015; Owen, 2009) and greater continuity of care and timeliness of medication administration for patients (Cook, 2015; Gregory, 2019).…”

“…Delegation of medicines administration from registered nurses to healthcare support workers is practiced in a range of countries (Shore et al, 2021) and can include administering insulin injections (Owen, 2009; Spilsbury et al, 2013). A recent review of delegation of medicines administration in community settings found delegation can be a complex process influenced by multiple factors that impact on staff confidence and patient safety (Shore et al, 2021). However, there is a lack of research specific to the delegation of insulin injections that can inform the development of safe practice in this area.…”

Abuse and Wellbeing of Long-Term Care Workers in the COVID-19 Era: Evidence from the UK

“…As a result, COVID-19 rapidly spread in care settings, leading to a significant rise in deaths and excess mortality, especially in care homes [4]. Meanwhile, the Government's response was perceived as slow and indecisive [5], managers had to keep up with continuously changing guidance [6], and care workers had to take on tasks usually undertaken by registered nurses [7,8]. The increased volume of tasks during the pandemic resulted in higher workloads among existing staff [9].…”