The concepts of resident safety and medication errors go inextricably hand-in-hand.  Nursing as a profession has a long history of regarding patient safety as a primary precept of the profession.  Florence Nightingale stated in her book entitled Notes on Hospitals, published in 1859, “the very first requirement in a hospital that it should do the sick no harm.”  The same must be said for nursing homes and other senior living and long-term care settings.

It is difficult it is to quantify medication errors and there has been a scarcity of studies, until very recently, of med errors related to administration.  However, several reports are beginning to shed some light on the issue:

• A 2002 published report – “State Assisted Living Policy: 2002, (Mollica) (report not available), states 51% of the state licensing directors reported that state surveyors found numerous problems with medication errors, but the frequency of the problems was not related to states’ policies on who is permitted to administer medications.
• In a 2003 published study - Nurse Delegation of Medication Administration for Elders in Assisted Living” (Reinhard, et al) – during interviews with state boards of nursing, there were concerns expressed that there is not enough training of medication aides, that nurses do not understand their responsibilities in delegation, or that aides may replace nurses (these are in states permitting medication aides).  Despite these concerns, few stated there is any evidence of harm to residents in AL in relation to medication administration by trained aides.  In addition, the following was stated in the article: “Nurses have the opportunity to shape this evolving practice arena and to enhance awareness of the professional and clinical issues inherent in working with UAP in medication delivery.”
• In the first systematic evaluation of nurse delegation in the U.S., a state pilot study in the state of Washington examined assisted living, adult family homes, and residential settings for developmentally disabled persons.  Of the 25,556 complaints to the Abuse and Neglect Hotline for all long-term care settings during the pilot two-year period, only 13 cases (0.05%) involved nurse delegation issues.  There was no evidence of significant harm or adverse outcomes for consumers specifically related to nurse delegation of medication administration.
• Click here for a Review of Literature on Medication Errors.

Detailed results of more rigorous studies are included in the Fact Sheet.  Additional resources include OSCAR Med-Error raw data and an Executive Summary of this data. In addition, several states have pilot studies on medication aides in progress right now, and results should be forthcoming.

Over 850 nurses belonging to LSN member organizations filled out a survey last Fall on their thoughts and feelings about delegation of medication administration in long-term care settings.  The top five reasons respondents ranked in order of highest ranked cause to lowest ranked cause for medication administration errors were:

1. Distractions or interruptions during medication pass
2. Frequent changes in dosages
3. High usage of agency nurses
4. Lack of communication among staff
5. Lack of knowledge about the medication

Three of these reasons (#1, #3, and #5) are the very basis we should be using to make a case for medication aides:

1. Nurses have so many things to be thinking about and doing, that staff cannot help but interrupt them constantly.  Why not delegate routine medication administration to an aide who does nothing else during the med pass?  Think about how focused she/he can be during that time.
3. If nurses didn’t have to do routine med passes, could we not cut down on agency use by a great deal?  Isn’t it better to use a well-trained aide that knows our residents to pass routine medications, than a highly paid agency nurse who does not know our residents at all?
5. As far as lack of knowledge about the medication, how many nurses have had 60 hours of classroom and 40 hours of clinical training just on pharmacology and medication administration?  That was part of the three-association proposal on this issue two years ago.

Resident safety is of prime concern of all of us.  LSN is advocating for medication aides because we believe that this model provides real benefits to the resident, the nurse and the CNA and there is no real evidence that the position increases medication errors.  Furthermore we cannot turn a blind eye to the challenge of balancing health care needs with available human and monetary resources.

We must work together to improve the medication error rate in our residential elder care and senior living settings by employing the best available systems approaches and using existing data to help guide our efforts.  Life Services Network believes that medication aides can play a significant role in these efforts.