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”. We have more tasks and demands than ever. At the same time, we need to keep tabs on everything; it always comes down to the economy, who pays for what. This discrepancy underlines the importance of communication across levels and management capable of addressing the needs of the staff (Backman, Sjögren, Lövheim, & Edvardsson, 2017; Hollnagel, 2012). Administrative tasks are often considered a nurse prerogative, and nurses may find themselves swamped because of their inherent task flexibility, being able to undertake a variety of roles. The first author then coded openly in the margins of the transcribed material, extracting meaning units pertaining to the research question. 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). Before observations, the researcher informed all participants that professional ethics overrode researcher neutrality, meaning that the staff would be alerted if the researcher identified situations where patient harm could be averted (Guillemin & Gillam, 2004). An example of analysis is shown in Table 1. The nurse in charge realises that there are no nurse set up on the next shift and that they have a patient suffering from pains hard to relieve. Posted on: May 5, 2017 by Huntersure LLC.. Although most residents are elderly, many are younger. Learn more. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. Iowa allows medication aides in nursing homes, but requires them to be certified nurses ' aides first. Available skills and competencies on a given shift are demarcated partly by the professions in the team. Medication administration in nursing homes is often considered a simple task of “passing medications.” However, in reality medication administration is a complex process requiring many interactions of specific decisions and actions (Kaushal et al., 2001). 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. In all nursing homes medication is sometimes administered by qualified nurses, but the majority of medications is administered by nurse attendants, who have in general less specific training in handling of medication than nurses do. After each observational session, all notes were transcribed and expanded on while the memory of the events was clear in the mind. The registered nurses’ (RNs) role in the nursing home often encompasses care of complex residents, implementation of resident care plans, and teaching and directing of licensed practical or vocational nurses (LPNs) and certified nurse aides (CNAs). Learn about our remote access options, Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway. 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. In effect, administration of drugs and the subsequent observations were delegated to RN’s or NA’s without first‐hand knowledge of the patients. The study underscores the importance of first‐hand knowledge of the clinical setting before implementing interventions or enforcing any organizational changes. Most often, they have a sheet of paper with pre‐authorization from the doctor on various drugs. The objective of this study was to expand the knowledge of the nurse role during medication administration in the context of nursing homes. 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). There is an apparent lack of studies investigating the nurse role during medication administration in nursing homes. Safety Challenges in Nursing Homes: Medication Administration. The NA’s acknowledge the nurses’ workload: Although the staff are supposed to update on the patients on their own by reading from the electronic medical record, they also had an informal roundtable discussion before commencing each shift. As a consequence, the staff may be balancing precariously close to unsafe medication administration in their daily routines without knowing. This flexibility depended on the capabilities of the workgroup on a specific shift, as well as their training and competence. Medication management is a strategy for engaging with patients and caregivers to create a complete and accurate medication list using the brown bag method. I know how experienced the nurses on this ward are when it comes to administering morphine, so I probably often note the indication and give the nurses space to be flexible. Consequently, some shifts end up being vulnerable. 2. Figure 1 illustrates the balancing act of safe medication administration documented in the study. Method: A self-administered questionnaire was given to all participants (n = 763) at eight regional study days for nurses employed in independent nursing homes. Long-term care nurses care for patients in need of extended care, including geriatric, wound care, chronic diseases and disabilities. A substantial number of the tasks related to medication administration were delegated from the MD and could not be delegated to nurse assistants. Sometimes these adaptations may lead to unsafe situations, but most often they will have a successful outcome (Hollnagel, 2009). Observations document that the nurses often regard themselves as being “the spoke of the wheel” and often define specific medication administration tasks as more important than other tasks. Otherwise, it's like the toss of the dice.”, “We experience a lot together, stressful and taxing situations…for the most part we are good at talking to each other, but there are variations, it depends on who you're working with; it's all about personal chemistry.”. Shortly after, the first author briefed the entire staff on both wards during regular staff meetings and asked whether they would consider participating in interviews. Work system factors such as competence, leadership and staffing may influence the ability to perform safe medication administration. Examples of additional tasks could be how the nurse offered to take on documentation tasks belonging to the doctor (transcribing), merely to ensure that this was done. Nursing homes have certain federal regulations which they must follow related to medication administration, especially concerning psychotropic drugs. Under high workload, administrative tasks related to medication administration took precedence for the RN’s, thus delegating the remaining workload to the other staff members. Nursing homes take care of our society’s most vulnerable members. This is the term used when describing the process of dispensing medication to nursing facility residents according to … Such high workloads may have positive professional outcomes, as the staff claim to work more smoothly. A complete and accurate medication list is the foundation for addressing medication reconciliation and medication management issues. Medication administration in nursing homes is a complex process taking place in a complex system with inherent vulnerabilities, placing high demands on the sociotechnical work system and the staff (Carayon et al., 2014; Choo et al., 2010; Grigg et al., 2011; Odberg et al., 2017). 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. The first author collected all the data in two nursing home wards in Eastern Norway. 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. 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. NA’s perceive medication administration as an easy task, describing it as only preparing and administering medicines. NURSING HOME SAMPLE POLICY & METHODS Drug Administration POLICY: All medications are to be administered only as prescribed and only by licensed medical or nursing personnel. Staff shortage, lack of competence and scarce resources may impede the staff’s ability to be adaptive and find workarounds (Hollnagel, 2009). and you may need to create a new Wiley Online Library account. An inductive content analysis was performed. Findings in the current study document this complexity and elaborate on how the staff and particularly the RN’s … The medication administration process is not to be taken lightly. There is seldom a right or wrong, but the nurses have to substantiate their opinions or when they make alterations. It may also lead to adverse patient outcomes in that the healthiest patients receive less attention and care. There is a dynamic interaction between several contributory factors, those being shifting responsibility, a need for competence, invisible leadership, varying available competence, staff stability and vulnerable shifts. Like one nurse said: IRN‐B “When it’s busy we are like well‐oiled machinery.” Another nurse stated that it is a balancing act. This may lead to vulnerability as the team may experience a lack of skill redundancy. Recent reforms have led to increased collaboration between primary care and specialist health care. No data from the pilot study were used in the current study. One nursing home ward with ten patients was rurally based and catered mostly to patients suffering from dementia and minor disabilities. The paper was prepared according to SRQR guidelines (O’Brien, Harris, Beckman, Reed, & Cook, 2014). There were eight staff nurses, three nurse assistants, two nurse managers and two doctors. An alteration in work tasks and workload is sometimes predictable, but most often not. The teams were formed so that professions complemented each other with the aim of always having a nurse on all shifts. A semi‐structured observation guide based on the elements in the work system of Human Factors theory (persons, tasks, physical environment, tools and technology, organization) guided the researcher when observing the different stages of medication administration (Carayon et al., 2006). 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. One nurse manager described it in an interview as: Some shifts may experience staff lacking the competencies to administer certain medications. The majority were women (12). These findings seem universal as RN’s often are required to undertake multiple tasks simultaneously in stress‐inducing physical environments, making them more prone to making errors (Carayon et al., 2014; Monroe & Graham, 2005; Odberg et al., 2017). Other attributes usually associated with nurses’ performance are motivation, fatigue and stress (Al‐Jumaili & Doucette, 2017; Carayon et al., 2006; Grigg et al., 2011). 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. It is hard to identify who is the leader, but after a while, the nurse with seniority becomes the centre of attention and makes final decisions on which patients they will have responsibility for. Kansas. It's an important question. It gave me a lot of the basic skills necessary, but of course, there is a lot more responsibility as a nurse. Situations observed were noted between sessions, while excerpts from relevant conversations between staff members were written down verbatim immediately. “If it’s too hectic, we do not work so well together”. Medication administration in nursing homes is a complex process taking place in a complex system with inherent vulnerabilities, placing high demands on the sociotechnical work system and the staff (Carayon et al., 2014; Choo et al., 2010; Grigg et al., 2011; Odberg et al., 2017). If they considered the doctor to be “weak,” they compensated by taking on tasks that were not theirs initially. This vulnerability was directly linked to the professions and competencies of the staff at work. Azithromycin has been frequently prescribed when they are having respiratory symptoms requiring an antibiotic. They must undergo 50 hours of training and then engage in administering medication under the supervision of a nurse (Iowa Code § 135C.34). Regulations governing pharmacy practice in nursing facilities have evolved over time to ensure that the special needs of nursing facility residents are met. Identifying medication order discrepancies during medication reconciliation: Perceptions of nursing home leaders and staff. Nursing home surveys are conducted in accordance with survey protocols and Federal requirements to determine whether a citation of non-compliance appropriate. In a fast-paced healthcare environment, administering medications is a high-risk nursing task. The data collection took place in 2016, consisting of 140 hr of observations supplemented by 16 semi‐structured interviews of staff members. Data were collected using partial participant observations and semi‐structured interviews of all staff members involved in medication administration. ™u’Åı¶$œ;?¡ÈO—Dì�mp/ä;Y$ç'Ø}û=È~�ñgô *h[°8²Ñ«�ozF�Evè,ã.mÖÜ_[DhÊ\_˜`q‰Ú i?¡PWêÌÕ Also, sharing experiences together seems vital, allowing the staff to form bonds that would not otherwise have formed. These areas are on an individual level (Need for Competence and Shifting Responsibility), team level (Leadership and Available Competence) and organizational level (Staff Stability and The Vulnerable Shifts). They decide to prepare a dose of morphine in advance, doing the double‐checking now. The interviews were digitally recorded and lasted from 30 min ‐ 1 hr. Kristian Ringsby Odberg, Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway. The staff were aware of the vulnerable shifts in advance and did their best to plan accordingly, as shown in this observation note: Because the vulnerable shifts could be particularly unpredictable, the staff prepared medications in advance or sent notice to the staff on the neighbouring wards that they might need assistance. Three main categories in the margins of the most common types of mistakes made by staff involved. 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