Safety Challenges in Nursing Homes: Medication Administration. Use the link below to share a full-text version of this article with your friends and colleagues. One nurse manager described it in an interview as: Some shifts may experience staff lacking the competencies to administer certain medications. Then the nurse rationalises the decision and the doctor agrees. If we have a nurse on that shift, she will have the final say. The use of specially trained CNAs in nurs… Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. A clear leader with a hands‐on approach may impose more direct control and strictures in relation to the myriad of regulations and guidelines on medication administration, while a more distant leader lets the staff regulate more independently. Check the order. As a consequence, the staff may be balancing precariously close to unsafe medication administration in their daily routines without knowing. Kansas. The nurse then asks the doctor if he may formalise the changes, which means to transcribe them in the electronic medication administration record. The task‐allocation often took into account the wishes of the staff members and was in contrast to the manager’s prior assignments: Staff stability is critical to achieving optimal care for the patients, underlining the importance of knowing your co‐workers when working in a demanding and complex environment. The leadership and style of management seem to affect how the staff perform and delegate tasks. To reduce medication administration errors and to ease the burden of medication management for nurses, most nursing homes in Australia use dose administration aid (DAA) devices that are prepared by pharmacies [ 8 ]. If a nurse spots a weakness in a colleague or does not trust him or her to do a specific task, they do it themselves instead. ôöşpQ £ùÑ$TıÂÜæé±n¹?ßûªj²Ky²Ë•ŸıøÛpkV"ÎYvSæhÎãm}1D`U>âO€ Betc endstream endobj 32 0 obj <> endobj 33 0 obj <>stream According to WHO (2016), MAE’s are preventable at different levels. The staff often noted that patients have more diagnoses and are in need of more advanced medication administration than before; they had to take responsibility for patients before they were adequately treated or diagnosed and in turn more complex tasks related to medication administration. This may be exemplified by the RN who in a potential situation would consider using the mobile phone to message an image to a colleague rather than asking the manager to double‐check a medication to be a reasonable solution. At other times, the nurses make changes or adjustments themselves, based on observations and patient needs and inform the doctor on a later occasion. I feel that I lose control and when Monday finally arrives, I send a silent thanks that everything went well.”. I would have done something like that if the situation demanded it. Many tasks during a shift are indirectly care‐related or related to medication administration; these are perceived as administrative tasks. The objective of this study was to expand the knowledge of the nurse role during medication administration in the context of nursing homes. They were informed of the objective and content of the study and agreed to participate. A substantial number of the tasks related to medication administration were delegated from the MD and could not be delegated to nurse assistants. The reason for including professions apart from the nurses was observations showing a strong dynamic interaction between all staff members during medication administration. No one chose to withdraw during or after data collection. The current study identified six areas (subcategories) necessitating adaptive behaviour to ensure safe medication administration. This vulnerability was directly linked to the professions and competencies of the staff at work. nursing home residents who leave the nursing home for several days; persons receiving home care - Up to 8 days of medications can be prepared (pre-poured) for self-administration by such individuals. Number of times cited according to CrossRef: A work system analysis of the medication administration process in a Norwegian nursing home ward, https://doi.org/10.1016/j.jamda.2016.12.069, https://doi.org/10.1136/bmjqs-2013-001828, https://doi.org/10.1111/j.1365-2834.2010.01164.x, https://doi.org/10.1111/j.1365-2648.2007.04569.x, https://doi.org/10.1016/j.ergon.2011.01.014, https://doi.org/10.1007/s40264-013-0090-2, https://doi.org/10.1097/01.NAJ.0000512274.79629.3c, https://doi.org/10.1186/s12913-017-2556-x, https://doi.org/10.1136/bmjopen-2014-006539, https://doi.org/10.1590/0102-311X00114113, https://doi.org/10.1097/ACM.0000000000000388, https://brage.bibsys.no/xmlui/handle/11250/2428043, https://apps.who.int/iris/bitstream/10665/252274/1/9789241511643-eng.pdf?ua=1, Differences in individual competencies. Since there was no involvement of patients or use of patient information, the study did not require approval from the Norwegian Regional Committee for Medical Health Research Ethics. It may also lead to adverse patient outcomes in that the healthiest patients receive less attention and care. Drug administration is the act in which a single dose of an identified drug is given to a patient. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. The freedom to ask colleagues for help during medication administration is reported as crucial by most staff members and depends on a shared understanding of the situation and that all staff members report on their location at all times. NA’s perceive medication administration as an easy task, describing it as only preparing and administering medicines. Over time, this behaviour may evolve to be a part of normal operations, stretching the boundaries of safe medication administration. An example of analysis is shown in Table 1. The nurse managers were in charge of the team composition on the individual shifts, distributing staff across the various shifts, weeks in advance. Each municipality independently governs Norwegian nursing homes, and there are local and regional variations in size, patient types and the style of management. ™u’Åı¶$œ;?¡ÈO—Dì�mp/ä;Y$ç'Ø}û=È~�ñgô *h[°8²Ñ«�ozF�Evè,ã.mÖÜ_[DhÊ\_˜`q‰Ú i?¡PWêÌÕ Nurse managers had indirect control of staff allocation and task delegation in that the staff often made their own decisions and planned contrary to prior assignments. Everyday adaptations to cope with dynamic events can be described as performance variability, encompassing individual adaptations and how the surroundings react to them (Hollnagel, 2009, 2014 ). That is not okay. The National Coordinating Council for Medication Error Reporting and Prevention defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. The nurse role is highly regulated, but the unpredictable nature of healthcare systems often forces RN’s to improvise, to find workarounds and adapts to the conditions offered by the current situation (Lindblad, Flink, & Ekstedt, 2017). The study underscores the importance of first‐hand knowledge of the clinical setting before implementing interventions or enforcing any organizational changes. Consequently, the staff members may have different skill sets and competencies. By law, an “advanced unlicensed assistive person” who has completed a certified training program can assist licensed nurses as permitted by … Check the medication label. The previous doctor used to spend some time with us, refreshing competencies and skill—not anymore though—and sometimes we arrange some educational stints, The nurse is regarded as pivotal for the running of day‐to‐day business, IRN‐E It may be slow at times if the doctor is uncertain. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispe… Specific requirements must be followed to avoid, insofar as possible, medication pouring and medication administration errors. The nurse is responsible for determining the degree to which an individual is self-directive. Some staff members expressed gratitude when they finished a so‐called vulnerable shift and opined that sometimes it was due to luck or coincidence that no ADE’s occurred. 2. care home staff administering medicines (including covert administration) and non-prescription products; training and competency of care home staff; Who is it for? Over time, this may contribute to lowering the overall competence of the staff. There is seldom a right or wrong, but the nurses have to substantiate their opinions or when they make alterations. Sometimes these adaptations may lead to unsafe situations, but most often they will have a successful outcome (Hollnagel, 2009). Some shifts have only one nurse, and most administrative and medication‐related tasks will fall on that nurse. The quality of the care depends on the stability of the staff and when staff members know each other, there seems to be less need for direct communication and delegation of tasks. Situations observed were noted between sessions, while excerpts from relevant conversations between staff members were written down verbatim immediately. Due to the complexity of medication administration, the acknowledgement of MAE’s in primary care and the essential role of the RN, the objective of this study was to expand knowledge of the nurse role during medication administration in the context of nursing homes. Observations documented that when the doctor was uncertain, the nurses experienced more responsibility together with a feeling of uneasiness. Consequently, they consider the nurses to be their superior in all settings, referring to them if questions or problems arise. The first author then coded openly in the margins of the transcribed material, extracting meaning units pertaining to the research question. Assigning the task of medication administration to the CMA allows for the nursing staff … Working off-campus? The Administration of Medication in the Nursing Home In most nursing facilities, the medication is given when the nursing staff member completes what is known as a “med pass”. Learn about our remote access options, Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway. Staff shortage, lack of competence and scarce resources may impede the staff’s ability to be adaptive and find workarounds (Hollnagel, 2009). Azithromycin has been frequently prescribed when they are having respiratory symptoms requiring an antibiotic. The nurse also compensates for the other team members’ strengths and weaknesses. One nurse (IRN‐C) said during observations that “when it is busy we prioritise medication to the patients most needing it.” At the same time, several stated that they like working when it is busy since it gives them a feeling of higher self‐worth. Administering Medication in Nursing Home In most nursing homes, medication is administered when a nurse or nursing staff member completes a “med pass.” A “med pass” is the common term used to describe the process of dispensing medicine to nursing home patients as ordered. Participants working more than a 50% position for more than a year were interviewed. Medication Administration in Nursing Homes. The nurses have a considerable responsibility, and they tend to take on tasks belonging to the other staff members as well as their own. However, the declining number of RNs in nursing homes requires RNs to delegate some aspects of medication administration to other nursing staff members, including unlicensed assistive person-nel (UAP). Examples in the current study indicate that even though managers endeavour to structure the workday of the staff, they simultaneously encourage flexible behaviour without giving clear indications of where this delineation ought to be. If they considered the doctor “strong,” they let the doctor handle things as they stood. 2. Right patient. They must undergo 50 hours of training and then engage in administering medication under the supervision of a nurse (Iowa Code § 135C.34). This was countered by a research team, discussing and reflecting on the data throughout the research process. Some argue that nurses (RN) may have insufficient knowledge and skills to perform safe medication management (Andersson, Frank, Willman, Sandman, & Hansebo, 2018; Simonsen, 2016); others point to normalization of risk‐inducing behaviour and interruptions (Odberg et al., 2017), or use of technology, design flaws, time constraints, poor communication, lack of leadership, as well as outdated policies and guidelines (Al‐Jumaili & Doucette, 2017; Carayon et al., 2014; Keers, Williams, Cooke, & Ashcroft, 2013; Lapkin, Levett‐Jones, Chenoweth, & Johnson, 2016; Marasinghe, 2015). Many factors influence safe medication management. When the staff know each other, they are less vulnerable if something unpredictable happens. This invisible role designation led to a hierarchical structure, especially evident on shifts with a single nurse. However, they are trained in-house to handle medication in general and the robot packages in specific. Rights of Medication Administration. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of medication administration in order to: When they did, it was not explicitly stated and was viewed by the others as expected behaviour. The relationship with co‐workers is illustrated in the following excerpt from an interview with a nurse assistant: Both nursing home wards reported staff levels to be adequate during the day shifts on weekdays. Shortly after finalizing the data collection, the authors read all the material multiple times to reach a common understanding of the data as a whole. Learn more. The interview guide was constructed in line with observational findings and from elements in the work system in Human Factors theory (Carayon et al., 2006). In effect, administration of drugs and the subsequent observations were delegated to RN’s or NA’s without first‐hand knowledge of the patients. State regulation § 2600.190(a) requires that in order for a non-medically licensed, certified, or registered staff person to administer certain medications, the staff person must complete a Department-approved medication administration training course within the past two years. An earlier study exploring the nurse role during medication administration in nursing homes (Odberg et al., 2019), found that the staff members were seldom aware of the risk of ADE's. I send a silent thanks that everything went well. ”, Beckman, Reed, &,! Stages of administering medicines background, which means to transcribe them in day‐to‐day! 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