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Care home drug administration confusion sparks guidance

  • 7 Comments

Nursing home managers have been quizzed by inspectors about care assistants administering medication even though this is perfectly legal, according to those behind new guidance designed to clear up confusion.

The guidance, which was developed by the University of Leeds for the Department of Health, makes it clear that care assistants can give medication with the right training and assessment.

“CQC inspectors can be bit surprised at care assistants giving out medication”

Karen Spilsbury

Professor Karen Spilsbury, investment chair in nursing at the university’s school of healthcare, led work to develop the guidelines over the past year.

She said the guidelines, launched last month, had been devised mainly to clear up confusion about whether it was legal or appropriate for care assistants to give out medication in settings employing registered nurses – including among some social care inspectors.

“The residential care sector has had guidelines for quite a while but the confusion seems to be in the nursing home sector where you have a nurse in the care environment,” she told Nursing Times.

Enabling care workers to give medication can free up nurses to do other important care tasks. However, some nursing home managers were worried this was not allowed while others reported being challenged on the practice by Care Quality Commission inspectors, explained Professor Spilsbury.

“CQC inspectors can be bit surprised at care assistants giving out medication,” she said. “When I presented the guidance to a group of managers they said they were delighted because sometimes they get challenged by inspectors even though it is acceptable practice.”

University of Leeds

Care home drug admin confusion sparks guidance

Karen Spilsbury

The CQC has supported the development of the guidance and confirmed it is now part of training for inspectors.

“We have incorporated this into our training sessions and this guidance awareness has also been cascaded to all our medicine, pharmacy and adult social care inspector teams,” a CQC spokeswoman told Nursing Times.

Nursing home managers – often nurses – and others have also welcomed the fact the guidance addressed key questions for management, nurses and support staff, added Professor Spilsbury.

“This was about promoting clarity for providers but also the registered nurses and care assistants,” she said.

“I think there is sometimes confusion about appropriate delegation. As a registered nurse you have to feel absolutely confident when you delegate something – in this case medication – to a care assistant. You have to know and feel confident that person is competent to perform that task to the standard required.

“It is also important for care assistants to feel confident they have had the right training including what to do if things go wrong.”

She said delegating straightforward medication tasks to a care assistant could be “a real bonus and benefit to nurses” especially given current pressures on the care workforce.

“The sector is under such pressure and facing such challenges that people are having to think differently because they can’t afford not to,” she said.

“Looking at different or innovative ways of working is critical to supporting the workforce and ensuring residents get the quality of care they deserve.”

“Administering medication is a central part of the care assistant role”

Martin Green

But she stressed “that doesn’t take away from nurses having to focus on those more complex cases or acutely ill residents”.

“As a registered nurse they are responsible and accountable for doing a thorough assessment of every resident,” she added.

“If you are delegating, it is because you think a resident is relatively stable. You are not going to delegate activity where there is a resident who is a bit more unstable or acutely unwell because as a registered nurse you have the understanding and knowledge to know what to do if things don’t go quite to plan.”

The National Care Forum (NCF), which represents not-for-profit care providers, was involved in shaping the guidance via the DH’s Care Sector Nursing Taskforce and said it provided “much-needed” clarification.

The body previously led DH-funded work on the safe administration of medicines in care homes.

“This guidance was needed to bring clarity to all involved in medicine administration,” said NCF policy and communications manager Sharon Blackburn. “A number of our members have enhanced care assistant roles, are committed to learning and development and have seen good outcomes for people using services.”

Martin Green, chief executive of Care England, which represents independent care providers, also welcomed the guidance.

martin green

martin green

Martin Green

“I see no reason why care assistants, if they are properly trained and supported, cannot give medication,” he said. “The majority of people have co-morbidities before they go into a care home so administering medication is a central part of the care assistant role.”

Work to draw up the guidance included a review of UK research, policy and guidelines on administering medication.

One thing this revealed was a lack of research on the administration of medication by care support workers.

This made it hard to get an overall picture of the type and level of training given and whether there was a risk some may be giving medication with little or no training, said Professor Spilsbury, who hoped the project would prompt further research.

The team is currently drawing together the international evidence including research on the impact of “medication aides” – healthcare assistants trained to administer medication - in the US.

“Some states have introduced medicine care aides but other states have really resisted the idea so we are having a look at that,” said Professor Spilsbury.

The key messages from the international evidence review will be published in a report due out by the end of this year.

  • 7 Comments

Readers' comments (7)

  • This is welcomed. Some inspectors are still back in the early 90's with their approach. All guidelines state clearly even CQC guidelines that medication should be administered by a trained and competent person.....this is simple. And for 'nursing' category patients the nurse can delegate under NMC guidelines to again someone trained and competent!

    It's about time the care sector looked at skill mixing of teams to deliver resident outcomes not 1 nurse per so many residents as this is not sustainable and now long in the tooth

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  • michael stone

    Just one more example of 'confusion' - but at least this one might have been sorted out. That still leaves plenty to be sorted.

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  • SPECIFICALLY what is the right training and assessment? And how are people searching for the right care home for their relatives meant to know when some home owners are so lacking in morals?

    A display board on clear view upon entering a home showing photos, full names and qualifications plus length of service in that part of the home would assist people in working out if the home was subject to a lot of moving traffic in staff i.e. bad management.

    Also it is not just about doses and reactions, it is also about timing.

    I have observed trained (though not NMC registered nurses) giving out medicines with too little time between doses. So in effect they were giving out a double dose to already frail people. Yes the CQC did observe it and take action thankfully.

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  • we cant afford to tinker about with medication. So we need o get it right every time. A solid training is essential and competency assessment

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  • Pussy

    As ever care on the cheap. Nursing home patients are taking most medications in the BNF and I'm sure mistakes and disasters have been well hidden. Why bother training at all? We all know a registered nurse should administer meds,it's not rocket science is it?

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  • What a nurse would want to know is who is going to be accountable for an error? Reading the above it seems the nurse will be held accountable for an error by the care worker because they will have been deemed to have delegated to a person who was not 'competent'.

    Professor Spilsbury saying “As a registered nurse they are responsible and accountable for doing a thorough assessment of every resident,” ...should also have included a thorough assessment of every care worker too.

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  • Would I as the trained nurse in a large nursing home be responsible for a drug error if the new nurse assistants gave the wrong drug

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