As long as they are appropriately trained and assessed as competent to do so. Really? Who says so?
At the request of the DH Care Sector Nursing Taskforce I was asked to set out evidence-based guidance on whether care assistants can administer medicines to residents in care homes with nursing.
The Department of Health recently published guidance on the administration of medicines in care homes (with nursing) for older people by care assistants. This guidance and the underpinning review (informed by legal frameworks, policy and research) was completed by Dave Alldred, John Baker and I at the University of Leeds.
This guidance provides clarity for care home providers and staff about the legal and safety issues of care assistants administering medicines to residents in this setting. This has been an area of confusion. In some care homes, trained care assistants can administer medications. In other care homes, care assistants do not. This is often due to concerns about whether this is legal, or appropriate, if there is a registered nurse in the home.
The guidance and review make it clear that it is lawful for care assistants to undertake this enhanced role as long as they have been appropriately trained and their competence is regularly assessed.
I know some registered nurses may have concerns that this will erode their role. However, freeing up registered nurses from administration of medicines (an activity that can take up a considerable proportion of time during a shift) will enable them to engage with residents and spend more of their time on other areas of important work.
This can include caring for, assessing and managing residents who have the most complex care needs, focusing on managing complex therapy and medicine regimes, or supervising care delivered by other staff. Supervision is vital so that the highest quality of care is delivered and staff feel supported and confident in the work that they perform. Part of that supervision will include ensuring that the delegation of medicines administration to care assistants is being carried out safely and effectively.
More effective use of staff in this way may lead to more satisfaction in their roles and career progression, which in turn will lead to lower staff turnover. We have known for some time that there is a relationship between how staff feel about their work and the quality of care delivered: happy staff = happy residents.
Many medication errors occur due to interruptions during a medicine round. Registered nurses are far more susceptible to interruptions as they have to deal with many and various demands on their time, particularly if there is only one registered nurse on duty. Involving care assistants in this activity may therefore support best practice in this setting.
There is no evidence to suggest that there will be more medication errors, as long as the correct training, assessment and support are provided, alongside procedures for reporting any errors.
In the last 30 years, the number of people aged 90 and over has almost tripled. People admitted to nursing care homes are entering them later, older and frailer, with complex needs due to living with long term conditions, including dementia. The challenge of meeting the demand of caring for more people with higher levels of need is going to require innovative solutions. It makes sense to use the human resources available in the care home to best effect, and care delivery models should evolve to meet the changing demands of society.
Do you use care assistants to administer medications in your organisation? If so, please share your experience in the comments section below.
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