Since starting a career in the aged-care industry 10 years ago, fresh out of pharmacy school, I have noticed a profound shift in the perceptions of a care worker’s capabilities and role.
I can recall early interactions with directors of nursing and clinical co-ordinators who would specifically ask me to avoid consulting with care staff when gathering information for the resident’s medication review (RMMR). There were also common requests that our Quality Use of Medicines resources and education target only RNs.
It has been great to see the industry recognise and include an able and willing carer cohort in certain medication management roles and responsibilities. Indeed, it is the carer’s interface that accounts for the vast majority of interactions a client has with their service provider.
The shift towards medication-competent carers assisting with medications has been a profound change in the sector’s approach to medication management.
There are several factors that have compelled this transition:
- The RN and EN workforce has been unable to match the growth in the aged-care sector.
- RN and EN skills are increasingly demanded for other roles, for example aged-care funding instrument assessments and complex healthcare procedures.
- The sophistication and reliability of the supply pharmacy’s Dosage Administration Aid (such as sachets) and charting systems have improved.
- The increasing emphasis on person-centred care lends well to a resident’s familiar carer assisting with their medications.
- Employers are recognising a need to promote staff loyalty and satisfaction by providing career learning paths, opportunities, enhanced responsibilities and training.
- Lengthy and unwieldy medication rounds, which compromise QUM principles, can be overcome with the administration burden being shared by several medication-competent carers.
- Service providers are under increasing financial pressure to extract the optimal contribution from each member of the resident’s health team.
However, the transition has not come without its growing pains, many of which present a risk for service providers if not well managed.
There has been growing concern regarding the quality of some training that has been provided to aged-care workers. This has culminated in the recent recall of several hundred certificate-level qualifications delivered by a large registered training organisation. There also seems to be a growing concern from clinical managers regarding the capabilities of some staff arriving in the workplace (ranging from Certificate 3 level carers through to RNs coming out of tertiary level studies).
Service providers have a duty of care to clients to ensure that staff have the competency and sufficient training to perform their delegated tasks and also that the necessary resources are available to support that role. Risk management and quality assurance measures must be incorporated into an organisation’s medication policy and procedures.
Nurses also have a professional obligation to ensure any carer they delegate to assist with medications is indeed competent and capable of performing the task and is afforded adequate supervision.
There is the risk that in removing some of the RN/EN interface with clients, health issues may be identified later, leading to poorer health outcomes. Care staff are not qualified to conduct clinical observations or make clinical judgements. However, medication-competent carers can (and should) be trained beyond the scope of understanding healthy body systems and also need to know the basic QUM principles for drugs commonly used on older people. This in turn will empower care staff to be in a position to positively contribute to the resident’s health team.
Medication management and administration of medications should not become task orientated. By limiting a carer’s role to simply counting the number of tablets in a sachet, we risk administration becoming focused on process rather than the person. For example, in attending to the 5 Rights, the carer should not lose sight of any subtle day-to-day changes in a resident (and report such to the supervising nurse).
A further consideration is that several aspects of medication management are required by commonwealth and state legislations to remain under direct control of registered nursing staff.
Similarly, an organisation’s medication policy and procedures should not include tasks or responsibilities that are beyond the carer’s scope or training.
Hence, empowering care staff in medication management requires a consolidated approach.
In the first instance, the RTO delivering the training should be in a position to provide relevant (aged-care specific), reliable and consistent training to aspiring medication care staff.
From an organisational level, aspects of clinical governance and medication policy must be accommodated to reflect the carer’s scope and capabilities.
It is only through the genuine inclusion of the medication-competent carer in the resident’s wider healthcare team that we can truly tap into this still largely underused human resource. The benefits beyond simple assistance with medications are significant and rather than being a potential liability to a site’s medication management compliance, carers up-skilled and empowered with QUM training and resources can contribute to positive resident health outcomes.
Surrounding resources must be made available by the service provider to support the safe and effective use of medications when administered by care staff. This important component of Accreditation Standard 2.7 can be facilitated, to a large degree, by a site’s contracted RMMR/QUM service provider.
Some examples of such resources provisioned by the clinical pharmacist include: medication crushing and dosing guides; medication guides for care staff; refresher training for medication; onsite QUM education; online QUM modules; ongoing hands-on support; and Medication Advisory Committee (MAC) contributions to ensure the site’s practices and policies are aligned with principles of QUM and Accreditation Standard 2.7.
The addition of formal, nationally recognised medication competency training to Choice Aged Care’s government-funded QUM service has been well received. The training packages are specifically adapted to each client’s actual medication policy and procedures with several in-built quality assurance considerations. The extension of our RTO training service to a client’s affiliated community care operations also helps ensure a consistent and streamlined organisation-wide approach to staff training.
I expect that in the years to come, care staff will continue their integration into various medication management functions, and whilst this should be embraced by the industry, the right mix of resources and support structures needs to be co-ordinated and present.
Michael Bonner is a clinical pharmacist and owner of Choice Aged Care.
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