Developing a Statewide Medication Technician Pilot Program in Nursing Homes

Randolph, Pamela; Scott-Cawiezell, Jill

doi:10.3928/00989134-20100330-06

Cited by 7 publications

(5 citation statements)

References 11 publications

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“…This holistic approach at the heart of nursing may be at threat from a rationing or task-orientated approach which has been associated with increased incidents of missed care, lower satisfaction, and poor staff retention ( Mandal et al., 2020 ). The evidence reported in this review from four studies ( Kapborg and Svensson, 1999 ; Young et al., 2008 ; Randolph and Scott-Cawiezell, 2010 ; Hughes et al., 2006 ) presents mixed findings on medication errors related to non-registered support workers and a lack of comparison of error rates between registered nurses and non-registered support workers. Findings reiterate the importance of creating a patient safety culture that encourages reporting and learning from errors as this has been linked to improved patient outcomes ( Bonner et al., 2009 , Thomas et al., 2012 2).…”

Section: Discussionmentioning

confidence: 83%

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

Shore

Maben

Mold

et al. 2022

International Journal of Nursing Studies

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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...

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Section: Discussionmentioning

confidence: 83%

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

Shore

Maben

Mold

et al. 2022

International Journal of Nursing Studies

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“…Our study found that delegating medicines support to CCAs did not increase the rate of medication incidents. Several studies have reported similar findings [ 31 , 34 , 35 ], while others have reported medication incidents associated with use of care workers [ 9 , 20 , 36 , 37 ] or have been inconclusive [ 8 , 14 , 15 ]. Consistent with our findings, previous studies have reported that using care workers for medicines support could provide opportunities for cost-saving [ 8 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 92%

“…Several studies investigated associations between care workers’ involvement in medicine support and a range of outcomes in residential care and hospital settings [ 14 , 31 – 35 ]. They reported evidence that care workers’ involvement in medicine support could lead to improved job satisfaction for both nurses and care workers, as well as improved people’s satisfaction with care, and improved quality of care by reducing workload pressure on nurses, enabled nurses to spend more time undertaking complex nursing activities [ 14 , 20 , 31 , 33 , 34 ]. Similarly, our study found that an expanded CCA role in medicines support resulted in improved job satisfaction for CCAs, that nurses and clients were generally comfortable with the role, and that it sometimes freed up nurses to spend time on more complex nursing tasks.…”

Section: Discussionmentioning

confidence: 99%

“…There is evidence that some medicines support tasks, such as prompting or assisting people to take their medicines, can be undertaken by trained support workers (known by various titles, such as medication aides, personal care workers, nursing assistants) [ 6 – 8 ], and that nurses can successfully delegate medicine support tasks [ 2 , 9 – 15 ]. Using support workers to assist with medicine administration within residential care facilities/nursing homes is common in some countries including Australia [ 6 , 9 , 10 , 14 , 16 – 23 ]. However, this workforce group is under-utilised in the home care setting [ 6 , 21 , 24 , 25 ], and there is little evidence related to their use [ 3 , 21 , 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a support worker role, within a nurse delegation and supervision model, for provision of medicines support for older people living at home: the Workforce Innovation for Safe and Effective (WISE) Medicines Care study

Lee

Beanland²,

Goeman

et al. 2015

BMC Health Serv Res

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BackgroundSupport with managing medicines at home is a common reason for older people to receive community nursing services. With population ageing and projected nurse shortages, reliance on nurses may not be sustainable. We developed and tested a new workforce model: ‘Workforce Innovation for Safe and Effective (WISE) Medicines Care’, which enabled nurses to delegate medicines support home visits for low-risk clients to support workers (known as community care aides [CCAs]). Primary study aims were to assess whether the model increased the number of medicines support home visits conducted by CCAs, explore nurses’, CCAs’ and consumers’ experiences with the CCAs’ expanded role, and identify enablers and barriers to delegation of medicines support.MethodsA prospective before-after mixed-methods study was conducted within a community nursing service that employed a small number of CCAs. The CCAs’ main role prior to the WISE Medicines Care model was personal care, with a very limited role in medicines support. CCAs received training in medicines support, and nurses received training in assessment, delegation and supervision. Home visit data over two three-month periods were compared. Focus groups and interviews were conducted with purposive samples of nurses (n = 27), CCAs (n = 7) and consumers (n = 28).ResultsMedicines support visits by CCAs increased from 43/16,863 (0.25 %) to 714/21,552 (3.3 %) (p < 0.001). Nurses reported mostly positive experiences, and high levels of trust and confidence in CCAs. They reported that delegating to CCAs sometimes eliminated the need for duplicate nurse and CCA visits (for people requiring personal care plus medicines support) and enabled them to visit people with more complex needs. CCAs enjoyed their expanded role and were accepted by clients and/or carers. Nurses and CCAs reported effective communication when medicine-related problems occurred. No medication incidents involving CCAs were reported. Barriers to implementation included the limited number of CCAs employed in the organisation and reluctance from some nurses to delegate medicines support to CCAs. Enablers included training and support, existing relationships between CCAs and nurses, and positive staff attitudes.ConclusionsAppropriately trained and supervised support workers can be used to support community nurses with providing medicines management for older people in the home care setting, particularly for those who are at low risk of adverse medication events or errors. The model was acceptable to nurses, clients and carers, and may offer a sustainable and safe and effective future workforce solution to provision of medicines support for older people in the home care setting.

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“…, 2007). Most recently, Randolph & Scott‐Cawiezell reported no differences in patterns of medication errors in nursing homes before and after the introduction of medication technicians (Randolph & Scott‐Cawiezell, 2010).…”

Section: Resultsmentioning

confidence: 99%

Prescribing for older people in nursing homes: a review of the key issues

Parsons

Lapane²,

Kerse³

et al. 2011

Int J Older People Nursing

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Prescribing of medication is one of the most common interventions that residents in nursing homes will experience. There is little doubt that medication has greatly contributed to improvements in symptom control, long-term management of medical conditions and greater longevity. However, the quality of prescribing has also been criticised and this paper outlines the issues that have proved to be most problematic and have been repeatedly highlighted in the literature. There have been numerous reports of over-use of inappropriate medicines for which there is no clinical indication or for which there is little evidence of effectiveness, and under-use of medicines that would be indicated for residents with certain medical conditions. Residents may also suffer from adverse drug events and enforced or erratic compliance. Some of these problems may arise because of the difficulties encountered by staff or a breakdown in communication when residents move from one setting to another (e.g. hospital to nursing home or vice versa).

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Developing a Statewide Medication Technician Pilot Program in Nursing Homes

Cited by 7 publications

References 11 publications

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

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

Evaluation of a support worker role, within a nurse delegation and supervision model, for provision of medicines support for older people living at home: the Workforce Innovation for Safe and Effective (WISE) Medicines Care study

Prescribing for older people in nursing homes: a review of the key issues

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