Medication Administration in Nursing Homes: RN Delegation to Unlicensed Assistive Personnel

      Medication administration in nursing homes is a complex process that requires careful oversight by registered nurses (RNs) to minimize risks of errors and adverse effects. However, the declining number of RNs in nursing homes requires RNs to delegate some aspects of medication administration to other nursing staff members, including unlicensed assistive personnel (UAP). Delegating medication administration allows RNs to focus on all aspects of the medication use process, including communicating with physicians about residents’ conditions and medication therapy needs as well as assessing and evaluating residents’ responses to medication therapy. With a carefully supervised delegation process, UAP should be able to administer medications safely, and RNs can oversee the complex needs of frail, vulnerable nursing home residents.
      To read this article in full you will need to make a payment

      References

        • Agency for Healthcare Research & Quality
        AHRQ Research Report. The Characteristics of Long-Term Care Users. Author, Rockville, MD2001 (Retrieved from) (AHRQ Publication No. 00-0049, January 2001)
        • Arizona State Board of Nursing
        Report to the legislature: Arizona medication technician pilot project.
        (Retrieved from)
        • Barker K.N.
        • Flynn E.A.
        • Pepper G.A.
        • Bates D.W.
        • Mikeal R.L.
        Medication errors observed in 36 health care facilities.
        Archives of Internal Medicine. 2002; 162: 1897-1903
        • Budden J.
        The safety and regulation of medication aides.
        Journal of Nursing Regulation. 2011; 2: 1-6
        • Budden J.
        The first national survey of medication aides.
        Journal of Nursing Regulation. 2011; 2: 4-12
        • Corazzini K.N.
        • Anderson R.A.
        • Mueller C.
        • McConnell E.S.
        • Landerman L.R.
        • Thorpe J.M.
        • et al.
        Regulation of LPN scope of practice in long-term care.
        Journal of Nursing Regulation. 2011; 2: 20-39
        • Doshi J.A.
        • Shaffer T.
        • Briesacher B.
        National estimates of medication use in nursing homes: Findings from the 1997 Medicare current beneficiary survey and the 1996 Medicare expenditure survey.
        Journal of the American Geriatric Society. 2005; 53: 438-443
        • Gurwitz J.H.
        • Field T.S.
        • Judge J.
        • Rochon P.
        • Harrold L.R.
        • Cadoret C.
        • et al.
        The incidence of adverse drug events in two large academic long-term care facilities.
        The American Journal of Medicine. 2005; 118: 251-258
        • Horn S.
        • Buerhaus P.
        • Berstrom N.
        • Smout R.J.
        RN staffing time and outcomes of long-stay nursing home residents.
        American Journal of Nursing. 2005; 105: 58-70
        • Institute of Medicine
        Preventing medication errors.
        National Academies Press, Washington, DC2007
        • Kaushal R.
        • Bates D.W.
        • Landrigan C.
        • McKenna K.J.
        • Clapp M.D.
        • Federico R.
        • et al.
        Medication errors and adverse drug events in pediatric inpatients.
        Journal of the American Medical Association. 2001; 285: 2114-2120
        • National Coordinating Council for Medication Error Reporting and Prevention
        About medication errors.
        (Retrieved from)
        • National Coordinating Council for Medication Error Reporting and Prevention
        Aiming at administering: Practice recommendations to prevent error.
        USP Quality Review. 2000; 71: 1-2
        • National Council of State Boards of Nursing
        Concepts and decision-making process.
        (Retrieved from)
        • National Council of State Boards of Nursing
        Joint statement on delegation. American Nurses Association/National Council of State Boards of Nursing.
        (Retrieved from)
        • Pepper G.A.
        • Towsley G.L.
        Medication errors in nursing homes: Incidence and reduction strategies.
        Journal of Pharmaceutical Finance, Economics, & Policy. 2007; 16: 5-133
        • Randolph P.K.
        • Scott-Cawiezell J.
        Developing a statewide medication technician pilot program in nursing homes.
        Journal of Gerontological Nursing. 2010; 36: 36-44
        • Rantz M.J.
        • Hicks L.
        • Grando V.
        • Petroski G.F.
        • Madsen R.W.
        • Mehr D.R.
        • et al.
        Nursing home quality, cost, staffing and staff mix.
        The Gerontologist. 2004; 44: 24-38
        • Scott-Cawiezell J.
        • Pepper G.
        • Madsen R.
        • Petroski G.
        • Vogelsmeier A.
        • Zellmer D.
        Nursing home error and level of staff credentials.
        Clinical Nursing Research. 2007; 16: 72-79
        • Seblega B.K.
        • Zhang N.J.
        • Unruh L.Y.
        • Breen G.M.
        • Paek S.C.
        • Wan T.H.
        Changes in nursing home staffing levels, 1997 to 2007.
        Medical Care Research Review. 2010; 67: 232-246
        • United States Pharmacopeia
        The medication use process.
        (Retrieved from)
        • Vogelsmeier A.
        • Scott-Cawiezell J.
        • Zellmer D.
        Barriers to safe medication administration in the nursing home.
        Journal of Gerontological Nursing. 2007; 33: 5-12
        • Weech-Maldonado R.
        • Meret-Hanke L.
        • Neff M.C.
        • Mor V.
        Nurse staffing patterns and quality of care in nursing homes.
        Health Care Management Review. 2004; 29: 107-116

       Learning Objectives

      • Describe medication administration in the nursing home.
      • Recall steps of the delegation process.
      • Identify the role of unlicensed assistive personnel in medication administration.
      • Discuss how a registered nurse can appropriately delegate medication administration.
      Ce
      CE Posttest
      Medication Administration in Nursing Homes: RN Delegation to Unlicensed Assistive Personnel
      If you reside in the United States and wish to obtain 1.4 contact hours of continuing education (CE) credit, please review these instructions.

       Instructions

      Go online to take the posttest and earn CE credit:
      Members – www.ncsbninteractive.org (no charge)
      Nonmembers – www.learningext.com ($15 processing fee)
      If you cannot take the posttest online, complete the print form and mail it to the address (nonmembers must include a check for $15, payable to NCSBN) included at bottom of form.

       Provider accreditation

      The NCSBN is accredited as a provider of CE by the Alabama State Board of Nursing.
      The information in this CE does not imply endorsement of any product, service, or company referred to in this activity.
      Contact hours: 1.4
      Posttest passing score is 75%.
      Expiration: October 2014

      Posttest

      Please circle the correct answer.
      • 1.
        What is the average number of medications a nursing home resident receives daily?
        • a.
          2 to 4
        • b.
          5 to 6
        • c.
          7 to 8
        • d.
          10 to 12
      • 2.
        Excluding wrong-time errors, the percentage of doses administered to nursing home residents that is wrong is:
        • e.
          2%.
        • f.
          5%.
        • g.
          10%.
        • h.
          12%.
      • 3.
        The stages of the medication use process include:
        • a.
          monitoring.
        • b.
          checking.
        • c.
          counting.
        • d.
          reporting.
      • 4.
        Which statement about responsibilities in the medication use process in nursing homes is correct?
        • a.
          Unlicensed assistive personnel (UAP) are responsible for ensuring timely administration.
        • b.
          The physician communicates directly with the pharmacy.
        • c.
          The on-site pharmacist is responsible for verifying dosages.
        • d.
          The registered nurse (RN) must evaluate residents’ responses to medication therapy.
      • 5.
        The average medication pass in the nursing home involves how many medications?
        • a.
          48
        • b.
          52
        • c.
          73
        • d.
          81
      • 6.
        Which statement about licensed health care professionals and the medication use process in nursing homes is correct?
        • a.
          RNs are only responsible for administering medications.
        • b.
          RNs are involved in the entire process.
        • c.
          Physicians play a more active role in medication administration.
        • d.
          Pharmacists closely evaluate residents for adverse effects.
      • 7.
        RNs account for what percentage of nurses in nursing homes?
        • a.
          24%
        • b.
          35%
        • c.
          Less than 9%
        • d.
          Less than 14%
      • 8.
        What term is defined as “an RN and in some states LPNs [licensed practical nurses] having the authority to direct another individual to perform nursing tasks and activities they would otherwise not be assigned”?
        • a.
          Delegation
        • b.
          Monitoring
        • c.
          Assigning
        • d.
          Prescription
      • 9.
        The step in the delegation process that includes follow-up to problems or a changing situation is:
        • a.
          evaluation and feedback.
        • b.
          surveillance and supervision.
        • c.
          communication.
        • d.
          assessment and planning.
      • 10.
        The step in the delegation process that includes determining the need to adjust the plan of care is:
        • a.
          evaluation and feedback.
        • b.
          surveillance and supervision.
        • c.
          communication.
        • d.
          assessment and planning.
      • 11.
        Which “right” of delegation includes available resources?
        • a.
          Task
        • b.
          Supervision
        • c.
          Circumstances
        • d.
          Direction
      • 12.
        Which “right” of delegation includes objectives, limits, and expectations?
        • a.
          Task
        • b.
          Supervision
        • c.
          Circumstances
        • d.
          Direction
      • 13.
        Which statement about medication-aide training is correct?
        • a.
          Application requirements, training, testing, and continuing education vary widely.
        • b.
          Application requirements and training vary widely, but testing and continuing education are standardized.
        • c.
          Retraining is required every 2 years.
        • d.
          Retraining is required every 4 years.
      • 14.
        According to research, which statement about medication aides’ roles and responsibilities is correct?
        • a.
          Medication aides are not permitted to administer topical medications.
        • b.
          Medication aides do not administer as-needed medications without prior assessment.
        • c.
          Many medication aides have little to no supervision.
        • d.
          Most medication aides have contact with a supervisor twice a shift.
      • 15.
        Which statement about RNs and medication aides is correct?
        • a.
          RNs should focus on transcribing and dispensing, while medication aides should focus on administering routine medications.
        • b.
          RNs should focus on medication assessment, monitoring, and evaluation, while medication aides should focus on administering routine medications.
        • c.
          RNs should focus on medication assessment, monitoring, and evaluation, while medication aides should focus on administering complicated medication regimens.
        • d.
          RNs should focus on dispensing and calculating, while medication aides should focus on administering oral, intramuscular, and intravenous drugs.
      • 16.
        Nursing home administrators should:
        • a.
          ensure UAP who administer medications meet the state competency requirements.
        • b.
          directly supervise UAP who administer medications to reduce errors.
        • c.
          keep job descriptions and role responsibilities for RNs and UAP who administer medications general in scope.
        • d.
          keep off-site documentation of the competence of UAP who administer medications.
      • 17.
        Which statement about the regulatory issues related to UAP administering medications is correct?
        • a.
          State boards of medicine should assume responsibility for UAP regulation.
        • b.
          State boards of nursing (BONs) should not list what drugs UAP cannot administer.
        • c.
          Each state BON should create a unique training program.
        • d.
          State BONs should define what is needed in training programs.
      • 1.
        Rate your achievement of each objective from 5 (high/excellent) to 1 (low/poor).
        • Describe medication administration in the nursing home.
          1 2 3 4 5
        • Recall steps of the delegation process.
          1 2 3 4 5
        • Identify the role of unlicensed assistive personnel in medication administration.
          1 2 3 4 5
        • Discuss how a registered nurse can appropriately delegate medication administration.
          1 2 3 4 5
      Rate each of the following items from 5 (very effective) to 1 (ineffective):
      • 2.
        Were the authors knowledgeable about the subject?
        1 2 3 4 5
      • 3.
        Were the methods of presentation (text, tables, figures, etc.) effective?
        1 2 3 4 5
      • 4.
        Was the content relevant to the objectives?
        1 2 3 4 5
      • 5.
        Was the article useful to you in your work?
        1 2 3 4 5
      • 6.
        Was there enough time allotted for this activity?
        1 2 3 4 5
      Comments: _____________
      ________________________
      ________________________
      Please print clearly
      Name _______________________________________
      Mailing address _______________________________________
      Street _______________________________________
      City _______________________________________
      State ____________________Zip___________________
      Home phone _______________________________________
      Business phone _______________________________________
      E-mail _______________________________________
      Method of payment (check one box)
      • Member (no charge)
      • Nonmembers (must include a check for $15 payable to NCSBN)
      PLEASE DO NOT SEND CASH.
      Mail completed posttest, evaluation form, registration form, and payment to:
      NCSBN
      c/o Beth Radtke
      111 East Wacker Drive
      Suite 2900
      Chicago, IL 60601-4277
      Please allow 4 to 6 weeks for processing.