Snappo wrote: Another interesting point, due to the medication errors occuring, management put an EEN on morning shift solely to do the medications. Believe it, or not, there are as many, if not more errors occuring. Carers at least had a reason for making the occassional error, they were doing 10 things at once, but what excuse did the EEN have when all she did was meds?? I have also seen RN's making medication errors, so it all boils down to not necessarily your training, but the care you take when doing this role. RN's, EEN's,EN's, Medication credentialled carers, they all have to follow the same basic '5 R's', right resident, right route, right medication, right dose, right time. This is not hard, if you're careful....
Indeed, you can teach any-one the five R's and no-one is better or worse at avoiding errors (my stats show an even spread across the three job descriptions*). My concern is around the pharmacology knowledge that carers and a lot of ENs lack. A good working knowledge of drug actions and interactions is essential to give excellent care to the elderly. Seemingly simple decisions about medications can have serious consequences. For example, recently I was called to look at a resident who was suffering from episodes of agitation. These had grown worse over the preceding fortnight and she was falling more frequently, becoming dehydrated and losing weight - well on the slippery slope of decline. The ENs had been trying to deal with it by giving PRN medication but the actual problem was related to alprazolam (ordered regularly) and it's short-term action with severe rebound effects. I fixed it by getting a psychogeriatrician in but it would have been better if that had happened two weeks earlier. The ENs weren't doing anything wrong - they were giving the regular and PRN medication as ordered. It was just a lack of knowledge about that particular medication which meant that the possibility of a drug adverse effect was being overlooked. GPs do rely on us to give them good feedback and that includes noting drug effects. I don't think the value of a greater RN to EN/care staff ratio can be downplayed wether it's actually administering medications or having enough hours to oversee clinical care.
* anecdotally, carers tend to be the most conscientious. I think it's the fear factor. They are so aware of their responsibilities and afraid of making a mistake.