The assistant secretary of the Australian Nursing and Midwifery Federation says aged care operators see medication administration as a “task that anyone can do”, despite industry awareness that medication errors are a serious problem.
Paul Gilbert, Assistant Secretary of the ANMF, told HelloCare that despite several reports recognising that medication errors are a major problem in aged care, medication is being administered by untrained personal care workers.
Though nurses manage medication, due to staff shortages personal care workers are being delegated to actually administer the medicines to residents.
The “high-risk consequence” of staff shortages
“In Victoria, since 2004, registered nurses have been responsible for the ‘management’ of medication administration only,” Mr Gilbert said.
“With as few as one registered nurse to 120 residents, this change has had the high-risk consequence of enabling assistants in nursing/personal care workers to administer medicines,” he explained.
“These staff are not regulated, so are not bound by standards set by a registration authority such as the Nursing and Midwifery Board or Australia,” he said.
“Too many operators in residential aged care continue to see medication administration as simply a task that anyone can do,” he said.
“Enrolled nurses with medication qualifications were previously known as ‘endorsed’ enrolled nurses. Providers are now using the term ‘endorsed’ personal care worker to imply these workers have accredited or formal education that allows them to administer medication,” he said.
“This is not the case. The education available to personal care workers is voluntary education that aims to equip them to assist competent residents to self-administer medication.”
Those giving medication need to be able to assess residents
Mr Gilbert said having more nurses on staff in aged care facilities would mean nurses would have time to give medication themselves, rather than having to delegate it.
“The reality is we have a system without minimum staffing levels or skill mix that leaves nurses with little option but to delegate administration of some medications to other staff, including assistants in nursing/personal care workers, who do not have sufficient education to know the side effects and contraindications of these medications, particularly Schedule 4 and 8 medications, and consequently know when not to give them.”
Mr Gilbert said those giving medication need to be able to assess the recipient, which requires a high level of skill and experience.
“The person administering the medication needs to able to make an assessment of the resident, at the time the medication is scheduled to be given.
“For example a resident with dementia will have difficulty telling a staff member whether or not they are in pain. The nurse needs to use their assessment skills to make this judgement,” Mr Gilbert said.
Regulation of the administration of medication is weakened by the fact it is governed by state laws, whereas most of the aged care industry is regulated at a federal level, Mr Gilbert said.
“While most residential aged care standards are set by the Commonwealth, in terms of medication administration, this reverts back to the relevant State or Territory law, in Victoria the Drugs and Poisons Act and Regulations,” he said.
“Across Australia these laws have failed to protect our vulnerable aged care residents from inappropriate medication use, and over time have weakened rather than strengthened the quality and safety one might expect.”
Medication mismanagement a major aged care problem
Mr Gilbert said the industry is well aware of the extent of complaints about medication mismanagement.
“Seventy-five per cent of all complaints to the Aged Care Commissioner in 2017/18 were about residential aged care. The most common issue raised in complaints was medication administration and management,” he said.
Mr Gilbert said a number of reviews have highlighted the problem of medication errors in aged care.
“Since 2010, we’ve had numerous reviews, including a 2017 review of Coroner’s recommendations showing complications in clinical care, including medication administration errors, featured in almost 13 per cent of deaths,” he said.
Residents’ medication needs becoming increasingly complex
People in aged care have more complex needs than ever, Mr Gilbert said.
“People are older and frailer when they enter aged care,” he said
“Older residents have more complex care needs. The prevalence of chronic conditions requiring more complex care increases markedly with age.
“A high proportion of residents in residential aged care facilities have cardiovascular disease and/or dementia, and many require specialised services (for example, pain management, palliative care and end-of-life care),” he said.
“Most residents in RACFs use multiple medicines because of their complex care needs.
“Polypharmacy, the concurrent use of five or more medicines, is prevalent in RACFs. A 2010 study showed 91.2 percent of residents in the study were using five or more medicines, at an average of 9.75 medicines each,” he said.
“Polypharmacy is a significant risk factor for adverse medicines events and outcomes.”
“Most residents in RACFs are using ‘high risk’ medicines to manage chronic conditions. High risk medicines such as anticoagulants, insulin, chemotherapy agents, narcotics and sedatives require careful monitoring.
“Error rates are not necessarily higher with these medicines, but when an error occurs, the consequences can be severe.”