Medication Management

[Snappo]

The low care hostel where I work, is in the throes of cutting our hours of work. When I complained bitterly about this, I was told I could make up the lost time by doing medications in the high care nursing home area. I asked if that was actually legal. The question was ignored, and the offer reiterated. Surely there is a vast difference in medication administration between low and high care. So, are the any legalities involved here, does anyone know?

[industrystandard]

Sorry for delay in replying, Snappo.

Part 3 of the Quality of Care Principles requires that, for all high care residents, initial and ongoing assessment, planning and management of care for residents are carried out by a Registered Nurse. There is no requirement that medications are administered by a nurse.

[Snappo]

Thanks Industrystandard, did a bit of googling and found out that the legislation was changed in August 2009. After all we write on here, the things we see, hear, and read, we are still managing to go backwards. Got to admit, that takes talent!! Seems RN's giving out meds in high care is a waste of resources. Us carers give out meds, do obs, do wound dressings, take BGL's and perform U/A's, we have also been asked to assess residents returning from hospital, If it's not a rude question, what actually do RN's do that takes up a full 8 hour shift?? I honestly don't mean to be rude here, but it seems that what used to be nursing roles are being passed onto the carers, and rhe RN's are up to their armpits in documentation. Now that's a waste of 'resources'!!

[industrystandard]

They're doing all that "initial and ongoing assessment, planning and management of care" ie. documenting for accreditation and funding purposes. After all, if it's documented, it's done, right?

[Snappo]

At least on paper, the trick is to transfer the theoretical to the practical!! It sure makes sense that the RN's are doing the theoretical.......ummmm...doesn't it?

[industrystandard]

The low care hostel where I work, is in the throes of cutting our hours of work. When I complained bitterly about this, I was told I could make up the lost time by doing medications in the high care nursing home area. I asked if that was actually legal. The question was ignored, and the offer reiterated. Surely there is a vast difference in medication administration between low and high care. So, are the any legalities involved here, does anyone know?

Yet, on 24/09/09:

"The home does not demonstrate that residents’ medication is managed safely and correctly. Management cannot demonstrate the medication management system is a safe according to relevant legislation, regulatory requirements, professional standards and guidelines. The home’s policy is not being adhered to in the staff administration of resident medication. Staff did not demonstrate knowledge of correct medication management practices and residents did not receive medication according to the doctor’s orders."

[Snappo]

Another 'quick question' (sorry). Is it permissable for a GRADE 4 PCW (note I didn't say a CERTIFICATE IV) to accompany the RN with the Schedule 8 drugs round?

Thanks, and waiting........

[industrystandard]

It used to be OK if there was no Enrolled or other Reg Nurse available. Some legislation has changed since then.

What State are you in?

[Snappo]

Hi Industrystandard, thanks for replying, I'm in the ACT. Amazing, wouldn't you think a legislation would be Australia wide??

[industrystandard]

I can't see anything in ACT regs to say it is OK. There is an exemption for correctional services (if a prescribed witness is not reasonably available) but I can't see the same exemption for residential aged care:

http://www.austlii.edu.au/au/legis/act/consol_reg/mpatgr2008470/s544.html

[Snappo]

Oh, dear, Any idea what the repercussions would be if it was found this was happening? If there is only one RN, and no EEN's on duty, the RN is accompanied by a Certificate III PCW, on a fairly regular basis!!!

[Snappo]

Hmmmm.....Industrystandard...any ideas?????

[industrystandard]

Is this common practice at other places you have worked in the ACT? In most States the second person can be a "responsible person" or words to that effect if a nurse is not available. I've probably missed something.

[Snappo]

Only worked in one other facility, and the Schedule 8's were always witnessed by an RN or EEN, that's why I am querying it. I also fail to see how a Certificate III care worker can be classed as a 'responsible person'. I mean, CSE's have absolutely no idea about schedule 8 drugs, it's not in the course module for medication, except to say it's the domain of RN's or EEN's!! The CSE's role is to 'assist' residents with medications, this means they push them out of the webster packs, count them, then give. Any idea how I can surreptitiously find out?

[industrystandard]

I've looked up the explnatory notes. You will note that even the explanatory notes mentions some exceptions in residential aged care but witnessing isn't one of them:

Section 544 Prescribed witnesses for administration of controlled medicines
– Act, s 53 (a) and (b)
Section 544 lists persons who are prescribed as witnesses in relation to the administering of a controlled medicine. Essentially, this provision enables a dentist, a doctor, a midwife, a nurse, a nurse practitioner, or a pharmacist to be a prescribed witness to the administering of a controlled medicine.

An intern doctor, or an enrolled nurse registered under the Health Professionals Act 2004 in the specialist area of medications, may also be prescribed witness to the administering of a controlled medicine, unless the administering is being performed by an intern doctor.

http://www.austlii.edu.au/cgi-bin/sinodisp/au/legis/act/num_reg_es/mpatgr200842o2008516.html?stem=0&synonyms=0

Maybe the ACT Dept Health may be able to advise?