'Lansley must listen to nurses on the front line' 
Share
Should drug administration be delegated to HCAs? What do you think?
A recent research study found nine out of 10 care home patients are regularly exposed to drug administration errors, with half deemed to be serious mistakes. Lack of time and interruptions were identified as a major cause rather than lack of training.
Drug rounds for 345 older patients were monitored in “real time” over three months using a new barcode medication administration system. The system identified when a potential mistake was about to be made, alerting the nurse or care assistant so that an error was averted.
Study author Deidre Wild, a senior resarch fellow at UWE, told Nursing Times both staff and managers needed to be more aware of the “high level of risk of medication error” that residents were routinely exposed to and “greater effort needs to be made to protect staff undertaking medication rounds from other work demands”.
Ms Wild added that the findings highlighted the potential for increasing patient safety by using technology such as that used in her study.
She said care staff in nursing homes might be able to use it to safely deliver more simple medications, so registered nurses had more time for higher level nursing activities. But she warned: “This should not be perceived as an opportunity to reduce valuable registered nursing time in favour of employing more care staff at less cost.”
View results 10 per page | 20 per page | 50 per page
Have your say
You must sign in to make a comment.
From Behind the Rituals
Why do you do the things you do? How much of nursing practice is based on ritual and myth and how much on sound evidence? If you have a ritual you’d like to discuss here, email nursingtimescomments@emap.com
Readers' comments (43)
Anonymous | 30-Jan-2012 2:36 pm
Drug administration should be done by registered nurses who have the knowledge to carry out this role. RN's are accountable for what they do, and are trained for drug administration. They also have the knowledge of pharmacology that the HCA's don't have, and can spot drug incompatibilities or contraindications that an HCA wouldn't be able to do as they aren't trained for it. If we are going to go down the road of HCA's doing the drugs, they will have to be registered and accountable for their actions, and be trained for that role. We registered nurses might as well give up then as HCA's would have encroached too far onto RN territory. Of course, they would be probably get band 4 pay which is cheaper than band 5, and therefore more affordable.. Cynical, me? yes, of course I bloody am.
Unsuitable or offensive?
Anonymous | 30-Jan-2012 6:27 pm
Should drug administration be delegated to HCAs?
No.
Don't be so silly. They will not be interrupted any less than RNs, they don't have the training and the RN in charge will be held accountable for their mistakes.
Anonymous | 30-Jan-2012 2:36 pm
You are absolutely right.
Unsuitable or offensive?
Anonymous | 31-Jan-2012 2:00 pm
@ Anonymous | 30-Jan-2012 2:36 pm
and
Anonymous | 30-Jan-2012 6:27 pm
I agree with you both. Although some HCA's will receive training it is us RN who are accountable.
Unsuitable or offensive?
Anonymous | 31-Jan-2012 2:50 pm
No.
Next silly question?
Unsuitable or offensive?
Anonymous | 3-Feb-2012 3:56 am
I'm a Senior HCA and have worked in Neuro ITU for 10 years. Firstly, we are all accountable for our actions so read the policy before HCA bashing. If a HCA is stupid enough to think they know what thier doing regarding drug administration, on thier head be it. We've been without a governing body for years, it won't change, but it doesn't effect our accountability.
If you think we want more responsibility for the same money, your having a laugh! I also love the fact that RN's always have the latest BNF to hand for the most simple maths! I've never administered drugs and all other HCA's should follow my example untill they've completed thier full Nurse Training!
Unsuitable or offensive?
Anonymous | 3-Feb-2012 8:02 am
" I also love the fact that RN's always have the latest BNF to hand for the most simple maths!
spiteful remark which is not constructive and is irrelevant to the discussion!
not everybody has a gift for maths and this is no reflection on their nursing skills. everybody has different strengths and weaknesses. surely it is better than making mistakes with calculations although what is the link between the BNF and simple maths? As long as nurses are using safe practice it is up to them how they choose to do it. such criticism does little to help good team working relationships.
furthermore, I was not aware that staff are paid by tasks.
Unsuitable or offensive?
Anonymous | 3-Feb-2012 8:07 am
the article actually refers to drug administration in care homes and not hospital wards. It could be argued that residents in their own homes looked after by carers do not have registered nurses to administer all of their medication.
Unsuitable or offensive?
Anonymous | 3-Feb-2012 10:20 am
Seeing as most nursing homes do what they like and appear to be getting away with it, they might as well let carers give out meds as well as all the other nursing tasks they are already performing. But isn't that the whole idea of having carers in the first place? To eventually get rid of nurses as nurses and keep the select few as managers. Pay carers less and reduce the cost. And the RCN are playing along with this game by pushing for registration of HCAs. So effectively they will be nurses just not called nurses.
Unsuitable or offensive?
Anonymous | 4-Feb-2012 3:53 pm
Completely agree with 'Anonymous | 3-Feb-2012 8:02 am'
Very spiteful and completely unnecessary remark.
Not having an aptitude for maths does not make you any less of a nurse. How does highlighting someones weakness help the team spirit on any unit?
My maths skills are not as good as some but I have still managed to complete my BSc my MSc and reach a band 7 before I was 30!!
If you pick up a BNF you would actually see that it is more an aide memoire for alot of equations rather than something to help you with simple maths.
Also very helpful if someone is on a new drug to check to see what it is, what the dose should be (mistakes do happen with prescribing too as we all know) and to check for interactions.
We have some very brilliant HCAs in our unit who do a fabulous job but giving out drugs with no idea about their phamacodynamic/kinetic properties and no idea what it is other than its name? Am sure they'd not want to do it either.
Unsuitable or offensive?
Anonymous | 4-Feb-2012 4:08 pm
Anonymous | 3-Feb-2012 3:56 am
The article refers to Nursing Homes......but perhaps you didn't read it properly. Which brings me to my next point. Your obvious lack of understanding extends to a very basic issue.
" If a HCA is stupid enough to think they know what thier doing regarding drug administration, on thier head be it."
It isn't "...on their own head....", is it? What about the consequences for the poor patient and the nurse in charge, who IS ACCOUNTABLE for what happens in their ward/unit. Read the policy!
I agree with you that HCAs should not administer drugs as they are not trained. However, no one here has been guilty of HCA-bashing. You are being over-sensitive.
Finally, perhaps next time, you could address your own spelling and grammar before taking cheap shots at the arithmetical shortcomings of others.
Unsuitable or offensive?
Anonymous | 5-Feb-2012 3:10 pm
Anonymous 4th feb, 4.08pm.
I agree with all you say wholeheartedly. The effect of an error would fall on the head of firstly the patient, and then the RN. The HCA who said those spiteful things, (anonymous 3td feb; 3.56am) obviously has a very big chip on their shoulder. Perhaps she/he would like to do his/her training, and find what it is like to have the same responsibilities as we do. There wasn't any suggestion of HCA bashing in the posts; the first post was mine.I'm aware that the article was mainly directed at nursing homes, but I thought that nursing homes had to have an RN for their drug administration. Drugs still have contraindications and side effects in nursing homes, just like they do in hospitals.
Unsuitable or offensive?
Anonymous | 5-Feb-2012 8:25 pm
Have to say that despite the RNs receiving training, on my course there was very little proper training in pharmocology and other drug related issues. Much of this has been learnt from a previous job, and whilst employed as a RN. I know many nurses that are unsure of contra-indications and interactions, and even worse do not know what certain drugs are for.
I find the BNF a wonderful resource when dealing with new medications, and also my trust uses a book that details how to mix IVs.
In my humble opinion there are nurses that should not do drug rounds and HCAs that would be able to complete the round with the same resources that are available to RNs.
The main thrust of this article should be what is in the patient's best interest and not two different trades bashing each others skills. At the end of the day it is the teamwork in the health care provision that makes it work.
You all need to get of your high horses and accept that this constant culd HCAs take on a wider role, possibly encroaching on the traditional RNs role (a role that itself has expanded taking on traditional junior doctor tasks), will continue forever and a day
Unsuitable or offensive?
Anonymous | 5-Feb-2012 10:34 pm
Anonymous | 5-Feb-2012 8:25 pm
It is not in the patient's best interest to have drugs administered by untrained personnel. If you have received inferior training and work with idiots who are prepared to administer drugs they know nothing about, then that is a whole other problem. I would hope that you have taken action about this? Either way, it most certainly should not be used as an argument in support of untrained staff giving out drugs!
Like I said in an earlier post, this is not about HCA bashing. I wouldn't go off to perform open heart surgery, because I am not qualified to do that. If another nurse thought that cardio-thoracic procedures of that nature should be within her remit: then I would have no problem with anyone pointing out that he/she is not trained and should not be allowed to take scalpel in hand and set about a patient. And I wouldn't be telling others to get off their high horses for stating the obvious!
Unsuitable or offensive?
Anonymous | 6-Feb-2012 1:04 am
.... Seeing as most nursing homes do what they like and appear to be getting away with it.
This statement is based on what?
Care Homes have been inspected by CQC for many years, when hospitals had exemption.
We are only now seeing the horror stories emerge, as hospitals are now subject to inspection.
If RN's give up the Meds round in hospital, they will get no exercise as all, as that is the only time you see them move from the desk, as has been my recent experience.
Unsuitable or offensive?
Anonymous | 6-Feb-2012 8:18 am
I would like to muddy the waters here. patients at home self administer their own drugs, dont they?
You do not have to be a registered nurse to administer drugs as long as you have had the theoritical knowledge in and the practical skills (performance) assessed to a competency frame work and deemed competence. There is no reason why the HCA cannot dadminister drugs. as long as she has been deem competent. We all make mistakes. so listen all stop reflect on the issue with facts rather then feelings.
Unsuitable or offensive?
Anonymous | 6-Feb-2012 9:23 am
Never in this world. The in-patient I work with has a Band 4 HCA who is very ambitious and the manager has allowed her to check controlled drugs. If I have to work on the unit I shall make it clear I shall not use her as a checker. The boundary lines are becoming less and less clear. Unfortunately it will take serious errors to make managers make clear decisions.
Unsuitable or offensive?
Anonymous | 6-Feb-2012 10:51 am
Anonymous | 6-Feb-2012 9:23 am
what is the policy and legal position on unqualified staff checking controlled drugs?
Unsuitable or offensive?
Anonymous | 6-Feb-2012 10:59 am
if staff without training in drug administration, pharmacology and pathology administer drugs will they be able to immediately pick up prescribing errors, the need to alter the route of administration, unsuitable and potentially dangerous dosages, side effects and drug interactions, etc? Unfortunately even qualified personnel, nurses and doctors make human errors but the risk to elderly residents could be far greater if individuals without appropriate training did the drug round.
Unsuitable or offensive?
Anonymous | 6-Feb-2012 11:02 am
There seems to be some confusion in the comments between drug administration in care homes and in hospitals. this article only considers residents in a care home and does not mention how they should be administered in hospital.
Unsuitable or offensive?
Anonymous | 6-Feb-2012 9:57 pm
Prior to my nurse training I worked in a care home for adults with learning disabilities and I handed out the residents medication from their dosset boxes. This happens regularly in care homes where the most senior worker is likely to have NVQ level 3 and are not RNs. Does this cause me concern? Not really, after all people self administer in their own homes or their relatives may give them their medication. It is my strong belief that wherever possible patients should self administer their oral medication, sometimes we disenable patients, how many times do we administer insulin to diabetic patients when they would do this themselves at home?
Really it is only iv and im routes that need an RN to administer.
Unsuitable or offensive?