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Union calls for clearer medication management guidelines in aged care

The peak nursing union for NSW has warned aged care providers, policymakers and the broader community that current medication management practices allow for an unacceptable margin of error and risk to residents.

The call stems come from a NSW Nurses and Midwives’ Association (NSWNMA) survey conducted earlier this year of more than 700 of its members, the results of which have been published in the report The state of medication in NSW residential aged care.

According to the report, AIN’s are now required to do more than assist people to self-administer their medications, yet the administration of medications by AINs appears to be overlooked in legislation and guidelines.

“There must be clearer guidelines for RNs to refer to when delegating medication tasks to AINs that extend far beyond existing good practice guidelines,” the report read. “To suggest that an RN or EN has sufficient time during their span of duty to safely provide direction to or supervise AINs assisting with self-administration is naïve at best and at worst, potentially dangerous.”

One RN who responded to the union’s survey said:

I was working in a RACF where AIN’s were giving out meds. I saw ear drops being put in eyes, creams being applied inappropriately and tablets would go missing.

An AIN respondent said at their facility, staff walked away after putting medication in a resident’s food, only for another resident to eat it. They added medication was given whole when it was clearly stated it should be crushed.

NSWNMA general secretary Brett Holmes said government reform has enabled all residential aged care facilities to accommodate those with complex healthcare needs, including sites that don’t employ registered nurses, but legislation and guidelines for best practice medication management have failed to keep pace.

The report said a lack of appropriate governance measures and inadequate staffing of experienced, skilled nurses are key contributing factors to the issues.

“RNs, ENs and unregistered AINs are required to ensure medication practices comply with the guidelines, but our members tell us they are constantly providing care for too many residents, with little or no support, and medication is now being administered by more AINs with minimal training,” Holmes said.

Given the rising acuity of residents in aged care, it’s essential that policymakers introduce minimum staffing ratios to ensure residents in aged care have access to protections for safe management of medications, he said.

The report also said the lack of clear and relevant legislative guidelines leaves RNs professionally compromised.

Holmes said: “It is paramount that nurses of all skill levels are provided the resources necessary to conduct their jobs safely and efficiently. Those with registration, such as RNs and ENs, depend on it.”

He added the union would continue to push for legislative reform to ensure medication management appropriately protects aged care residents and the nursing staff delivering their care.

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