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 More than half the states permit assistance with or administration of medications by unlicensed assistive personnel or med techs. Authorization of this nursing activity (or task) is more likely because of state assisted living regulation than by support and approval of the state Board of Nursing. In many states, the definition of “assistance with” reads exactly like “administration of” thereby raising concern with regard to delegation, accountability, and liability for practice. It is, as well, a hazardous path for the assisted living nurse who must monitor and evaluate the performance of the individual performing this nursing task. This article, the second in a series on medication management, addresses delegation, standards of practice of medication administration, types of medication errors, the components of a performance evaluation tool, and a culture of safety. Maintaining professional standards of assisted living nursing practice courses throughout the suggested recommendations. Section snippetsBackgroundAssisted living (AL) residents tend to receive more prescription medications and more antidepressant and antipsychotic medications than nursing home residents.1, 2 An analysis based on the Beers criteria (i.e., a list of medications to avoid completely or titrate carefully when prescribing for older adults with specific conditions) reported that 25% of AL residents are receiving inappropriate medications.3 Medications are being prescribed (and administered) in the absence of a documented Readiness for Medication Assistance/AdministrationWhether medication assistance/administration by nonlicensed staff (i.e., unlicensed assistive personnel or UAP) is authorized by state regulation or nursing board approval—and whether or not it is called delegation—the UAP’s readiness to assist with or administer medication can be estimated as well as reinforced by following the steps of delegation. Delegation is the transfer of authority “to a competent individual” for the performance of a specific act or function.8 The context of delegation Legal IssuesA nurse who has delegated a task to another is accountable for the delegation. The person accepting the task, the UAP or med tech, for example, is accountable by virtue of having accepted the delegation and for carrying out the task.11 As stated in a variety of ways in Nurse Practice Acts, the nursing functions of assessment, evaluation, and nursing judgment cannot be delegated. Yet it is patently obvious that medication administration by a UAP or med tech often requires assessment and judgment Performance EvaluationNorth Carolina has an extensive and intensive program for training and monitoring of unlicensed staff who will administer medications in adult care homes (i.e., assisted living). In addition to a written competency test administered under the aegis of the Department of Health, there is also a clinical skills observation or checklist.13 Guidelines for administration of the checklist, the checklist itself, and a medication study guide are available on the Web site.13 Performance observation must Culture of SafetySince the late 1990s, a “culture of safety” in health care organizations is slowly changing how a medication (or treatment) error is handled. Three aspects are noteworthy. First, there is movement away from “name and blame” with regard to an error toward a systems-oriented or cognitive science approach as to why an error occurred. Second, there is as much interest in actual errors as in potential errors—the “near miss.” Nurses in particular, being most involved with medications, are encouraged ConclusionA culture of safety requires monitoring and performance evaluation systems as well as meaningful reporting and data collection (i.e., quality improvement). There is a paucity of research regarding assistance and administration of medication by UAP and med techs. With regard to medication knowledge, almost 75% of UAP administering medications knew about taking the pulse of a resident receiving digoxin/lanoxin and understood metric measures.14 Yet less than half were knowledgeable about the side ETHEL MITTY, EdD, RN, is an adjunct clinical professor of nursing at the College of Nursing, New York University, and Consultant in Long Term Care at the John A Hartford Institute for Geriatric Nursing, College of Nursing, New York University.
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There are more references available in the full text version of this article. Cited by (9)Recommended articles (6)ETHEL MITTY, EdD, RN, is an adjunct clinical professor of nursing at the College of Nursing, New York University, and Consultant in Long Term Care at the John A Hartford Institute for Geriatric Nursing, College of Nursing, New York University. SANDI FLORES, RN, C, is executive director of the American Assisted Living Nurses Association and education director of Community Education LLC (www.communityed.com). View full textCopyright © 2007 Mosby, Inc. All rights reserved. Which task can be delegated to nursing assistive personnel?In general, simple, routine tasks such as making unoccupied beds, supervising patient ambulation, assisting with hygiene, and feeding meals can be delegated. But if the patient is morbidly obese, recovering from surgery, or frail, work closely with the UAP or perform the care yourself.
Which measurement can the nurse delegate to nursing assistive personnel quizlet?Rationale: The nurse can delegate turning the client every 2 hours to the nursing assistive personnel.
Which of the following should not be delegated to nursing assistive personnel NAP )? Group of answer choices?Nasotracheal suctioning should not be delegated to NAP.
Which nursing action is essential when delegating tasks to nursing assistive personnel select all that apply?The guidelines for delegation include the following: assess the knowledge and skills of the person to whom you are delegating; match tasks to the assistant's skills; and provide feedback.
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Which pain management task can the nurse safely delegate to nursing assistive personnel
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