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Medication Aides: Regulations, Safety, & Practice Jill Budden, PhD.

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Presentation on theme: "Medication Aides: Regulations, Safety, & Practice Jill Budden, PhD."— Presentation transcript:

1 Medication Aides: Regulations, Safety, & Practice Jill Budden, PhD

2 Introduction Part I: Medication Aide safety and practice: A review of the literature Part II: State-by-state review of Medication Aide regulations

3 PART I: Literature Review The Medication Aide role Medication Aide program implementation Medication Aide medication management policies Characteristics of facilities using Medication Aides Medication Aide medication administration processes Delegation to Medication Aides Medication Aide & licensed nurses job satisfaction and stress Medication Aide medication error rates

4 The Medication Aide Role May drastically vary both between and within states: job descriptions training testing supervision Job analysis (NCSBN, 2007) Concerns and uncertainty surround the role (Quallich, 2005) Future research: standard job description core competencies

5 Medication Aide Program Implementation Unique set of challenges: (Randolph, 2008) personnel shortages curriculum rigors licensed nurses initial resistance Potential benefits: (Randolph, 2008) freeing nurse time staff satisfaction increased ability to meet residents care needs NCSBNs Medication Assistant model curriculum (Spector & Doherty, 2007; NCSBN, 2007) Future research: indepth investigations on program aspects Ex: amount/type of training, testing, and supervision

6 Medication Aide Medication Management Policies No evidence of harm to patients receiving nurse delegation in Washington State (Young et al., 1998; Young & Sikma, 1999) Nurse delegation enhanced the quality and intensity of supervision in Washington State (Young et al., 1998; Young & Sikma, 1999) Case study of policy application (Sikma & Young, 2003) Lack of clarity in practice parameters may result in confusion and procedures that push the envelope (Reinhard, et al., 2003; 2006) however, no evidence of harm related to med admin Future research the effects of specific state or facility policies on outcomes

7 Characteristics of Facilities Using Medication Aides Only 1 study (Hughes, Wright, & Lapane, 2006) Homes that utilized Medication Technicians: substitution style of working fewer CNAs and RN/LPNs per 100 beds more deficiency citations related to med errors questionable supervision Future research more rigorous comparisons of facilities that do versus do not utilize Medication Aides

8 Medication Aide Medication Administration Processes Vary widely from facility-to-facility and from state-to- state. Subtle differences between assisting versus administering (Mitty, 2009) Outline of the top areas in which Med Aides need additional training (Center for Excellence in Assisted Living, 2008) Difficult to provide timely med admin to large groups of residents & communication related to administration and monitoring was the core of many problems (Vogelsmeier et al., 2007) Future research In-depth investigation of communication related to medication administration and monitoring

9 Delegation to Medication Aides Assessment, evaluation, and judgment cannot be delegated – yet medication administration by UAPs often requires assessment and judgment (Mitty & flores, 2007) Administration errors were detected in 20% of doses and almost all errors (99%) occurred during preparation or recording rather than final administration (Dickens, Stubbs, & haw, 2008) Future research Nurse delegation of medication management activities and resident outcomes (Munroe, 2003) Kind and quality of education, training, and monitoring for the safety of UAP practice and on errors and adverse outcomes (Mitty & Flores, 2007)

10 Medication Aide and Licensed Nurse Job Satisfaction and Stress Medication Nursing Assistant role enhances nursing care and decrease stress among nurses in long-term care facilities (Walker, 2008) Future research A study with a large sample with a quantitative survey design

11 Medication Aide Medication Error Rates Arguably, the most important aspect right drug, dose, client, time, route, & documentation No significant difference in errors by level of credential (Scott-Cawiezell, et al., 2007) UAP risks appear to be minimal & generally do well with med admin given level of preparation (Young, et al., 2008) Of 99 Cefepime administrations, 80% were incorrectly administered (Hoefel & Lautert, 2006) Future research studies with sufficient group sample sizes control for the medication administration job

12 Discussion Studies not cohesive Numerous limitations Difficult to draw broad, generalizable, conclusions given wide variations in testing, practice, and supervision between and within states In general, studies mostly supported Medication Aides safety of practice Regardless of an articles direction of support for Med Aides – recommendations for safety and practice were evident throughout

13 Part II: State-by-State Review of Medication Aide Regulations Exploring characteristics of Medication Aide program regulations State/jurisdiction breakdowns Regulatory oversight Applicant requirements Training Testing Continuing education and supervision Exploring Medication Aide limitations to practice by jurisdiction

14 Exploring Regulations: state/jurisdiction breakdowns

15

16 Titles for Unlicensed Assistive Personnel that Administer Medications Frequency Percentage of states with UAPs that administer medications using title (n = 34) Medication Aide 27 79% Medication Assistant 9 26% Unlicensed Personnel 5 15% Medication Technician 4 12% Medication Administrative Personnel 1 3%

17 Facilities that Utilize Unlicensed Assistive Personnel that Administer Medications Frequency Percentage of jurisdictions (n = 46) Nursing Home/Skilled Nursing Facilities1839% Assisted Living Facilities1737% Intermediate Care Facility/Mental Retardation920% Long Term Care Facilities817% Residential Care Facilities715% Adult Care Homes/Adult Foster Care511% Correctional Facilities49% Facilities for the Developmentally Disabled37% Mental Health Facilities37% Schools37% Group Homes24% Juvenile Facilities24% MISSING37%

18 Length of Time Medication Aides have been Practicing in Nursing Homes nMSDMinMaxMedian Years31 15 years, 5 months 11 years, 5 months 9 months45 years12 years

19 Exploring Regulations: regulatory oversight

20 Of the agencies that provide regulatory oversight: 43% (n = 20) are the Board of Nursing 44% (n = 21) are some other state department (e.g., Department of Health) 8% (n = 4) are some combination of the Board of Nursing and some other state department

21 Exploring Regulations: applicant requirements

22 Percentage of Jurisdictions Requiring CNA Status Prior to Training

23 CNA Experience Requirements Frequency Percentage of jurisdictions (n = 46) CNA work experience requirements1533% Not applicable (CNA not required)920% Not required to be a CNA, but have work experience requirements 613% Not specified920% MISSING715%

24 Exploring Regulations: training

25 Percentage of jurisdictions that followed NCSBNs Medication Assistant Certified (MA-C) Model Curriculum

26 Total Hours of Training Required nMSDMinMaxMedian Training hours3473.9740.60415072

27 Hours of Didactic Training Required nMSDMinMaxMedian Training hours3055.9736.474.00150.0054.00 Hours of Clinical Training Required nMSDMinMaxMedian Training hours3022.2014.860.0040.0020.50

28 Time Frame Training Must be Completed (not all data reported) Frequency Percentage of jurisdictions (n = 46) Not specified1124% Determined by training program49% From 3 to 15 weeks24% The clinical portion must be completed within 6 months of the theory portion. 24% 1 day a week for 6 to 10 weeks12% 1 to 2 weeks12% 14 days for theory, 30 days for clinical, for a total of 44 days 12%

29 Percentage of Jurisdictions with Some Form of Training Exception

30 Percentage of Jurisdictions with Training Exception if Education from Another State is Substantially Similar Frequency Percentage of jurisdictions (n = 46) No1022% Yes920% Not specified12% Not applicable (no training required or no training exception) 1430% MISSING1226%

31 Percentage of Jurisdictions with Training Exception if Pass Exam Frequency Percentage of jurisdictions (n = 46) No511% Yes1430% Not specified12% Not applicable (no training required or no training exception) 1430% MISSING1226%

32 Percentage of Jurisdictions with Training Exception if Applicant has Some form of Work Experience Frequency Percentage of jurisdictions (n = 46) No1839% Yes12% Not specified12% Not applicable (no training required or no training exception) 1430% MISSING1226%

33 Percentage of Jurisdictions with Training Exception if Applicant has Some form of Nursing Education Frequency Percentage of jurisdictions (n = 46) No920% Yes1022% Not specified12% Not applicable (no training required or no training exception) 1430% MISSING1226%

34 Percentage of Jurisdictions that have Training Locations in Facilities Frequency Percentage of jurisdictions (n = 46) Yes1839% No1430% Not defined12% Not enough information given24% Unknown12% Not applicable (no training required) 12% MISSING920%

35 Percentage of Jurisdictions that have Training Locations in Education Institutions Frequency Percentage of jurisdictions (n = 46) Yes – training in education institutions2861% No – no training in education institutions 511% Not defined12% Not enough information given12% Unknown12% Not applicable (no training required)12% MISSING920%

36 Exploring Regulations: testing

37 Wide variations in design and administration of the exam: Board of nursing (design) Department of health (design) The training program (design & admin) Committee (design) Instructors (admin) D&S Diversified Technologies Comira testing Pearson Vue Psychology Services Incorporated Professional Healthcare Development (PHD)

38 Test Administered After Training has Been Completed Frequency Percentage of jurisdictions (n = 46) Yes (written)2350% Yes (written & manual)1226% No24% No – tests are a part of training24% Yes (written or oral & manual)12% Determined by education program12% MISSING511%

39 Pass Rates for the Written Exam nMSDMinMaxMedian Pass rates (written)11.73.17.40.94.80 Pass Rates for the Written Exam Frequency Percentage of jurisdictions (n = 46) Not public information12% Not tracked817% Unknown511% Not applicable (no written exam)49% MISSING1737%

40 Passing Score for the Written Exam nMSDMinMaxMedian Passing score (written)32.77.07.70.90.80 Passing Score for the Written Exam Frequency Percentage of jurisdictions (n = 46) Determined by education program12% Not Applicable (no written exam)49% MISSING920%

41 Passing Score for the Manual Exam Frequency Percentage of jurisdictions (n = 46) 100%511% 80% with no critical items missed12% Determined by education program12% Not applicable (no manual exam)2350% MISSING1635%

42 Number of Times Individuals are Allowed to Take Exam nMSDMinMaxMedian Times allowed to take exam 282.36.561.003.002.00 Number of Times Individuals are Allowed to Take Exam Frequency Percentage of jurisdictions (n = 46) 1 time 1 2% 2 times 16 35% 3 times 11 24% No limit 3 7% Determined by education program 1 2% Not applicable (no exam)49% MISSING1022%

43 Time Frame Individuals are Allowed to Take and Retake Exam (subset of data) Frequency Percentage of jurisdictions (n = 46) Within 30 days12% Within 60 days of training completion12% 2 nd exam completed within 45 days from failure notification 37% Retake within 90 days37% Within 3 months of training completion12% Within 6 months of training completion49% Within 1 year of classroom training completion12% Within 1 year of training completion12% Within 1 year from the date of application12% Within 12 months after the first day of training12%

44 Are Individuals Allowed to Retake Training then Retake the Exam? Frequency Percentage of jurisdictions (n = 46) Yes1839% Candidates who fail will be withdrawn from the program 12% Determined by education program12% Not applicable (no exam)49% MISSING2248%

45 Exploring Regulations: supervision and continuing education

46 Supervision: A licensed health car professional A licensed nurse or physician A licensed nurse RN charge Nurse or LPN charge nurse A licensed nurse who is physically present on the same unit The delegating nurse A licensed nurse on duty or on call Prescriber or RNs The facility manager/administrator

47 Continuing Education Requirements and Time Frames (subset of data) Frequency Percentage of jurisdictions (n = 46) None920% 8 hours, every 2 years37% 7 clock hours, every 1 year37% 6 hours, every 1 year24% 10 hours, every 2 years24% Competency assessment, every 2 years24% Clinical update, every 2 years24% 16 clock hours, every 2 years12% 12 hours, every 1 year12% 8 of 24 hours medication related, every 2 years12% Retraining, every 2 years12%

48 Exploring Medication Aide Limitations to Practice by Jurisdiction

49 Jurisdiction 1 Shall not: Receive, have access to, or administer any controlled substance. Administer parenteral, enteral, or injectable medications. Administer any substances by nasogastric or gastrostomy tubes. Calculate drug dosages. Destroy medication. Receive orders, either in writing or verbally, for new or changed medications. Transcribe orders from the medication record. Order initial medications. Evaluate medication error reports. Perform treatments. Conduct patient assessments or evaluations. Engage in patient teaching activities.

50 Jurisdiction 2 May not administer: Parenteral or injectable medications Initial dose or non-routine medications when the patients response is not predictable When the patients condition is unstable or the patient has changing nursing needs If the supervising nurse is unavailable to: Monitor the progress of the patient Monitor the effect of the medication on the patient A nurses assessment of the patient prior to or following the medication is required Calculation of dosage or conversion of dosage is required

51 Jurisdiction 3 Do not: Convert drug dosages Administer injectable medications (including medications via subcutaneous, intradermal, intramuscular, or itnravenous routes) Administer medications via tubes inserted into any body cavity Administer antineoplastic drugs Accept verbal/phone orders from those with prescriptive authority Dispense medications for residents temporarily out of the facility

52 Discussion Variations in training, testing, and practice, intuitively suggest that some Medication Aide program models result in better safety outcomes versus others. Should be a push for more uniformity in training, testing, and practice. A more consistent Medication Aide model may result in more assurance in the general safety and practice of Medication Aides.


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