RN Delegation to CMT/CMA: Medication Administration in Long Term Care

1. RN Delegation to CMT/CMA: Medication Administration in Long Term Care Amy Vogelsmeier, PhD, RN, BC-GCNS Sinclair School of Nursing University of Missouri, Columbia

2. Medication administration in nursing homes is a complex interaction of many decisions and actions performed by diverse staff.

3. Processes of Medication Administration • Ordering/Prescribing • Transcribing/Verifying • Dispensing/Delivering • Administering • Monitoring/Reporting (NCCMERP, 2000)

4. Routine order entry

5. Diverse Perceptions of Safe Medication Administration Practices • Concerns related to communication, competing demands, and documentation systems. • Concern about diligence to accuracy of medication administrators. • Medication administrators shared stories of feeling “set up” to fail; however most concerns were about time. • (Vogelsmeier et al., 2007)

6. Medication Error by Level of Credential Doses administered • RNs 15.3% • LPNs 23.3%, • CMT/A 61.43%. Medication error rate • RNs =34.6%, • LPNs=40.1%, • CMT/As=34.2% • RNs had more interruptions (39.9%) and LPNs had more distractions (41.6%) • Scott-Cawiezell et al., 2007

7. Unique Medication Administration Challenges for CMT/A staff • Preparation technique errors • Resident refusals • Omitted medications Scott-Cawiezell et al., 2009

8. “But in both (hospitals and private houses), let whoever is in charge keep this simple question in her head, not how can I always do the right thing myself, but how can I provide for this right thing to always be done? Florence Nightingale quote

9. Delegation is a process that, used appropriately, can result in safe and effective nursing care. Delegation can free the nurse for attending more complex patient care needs, develop the skills of nursing assistive personnel and promote cost containment for the healthcare organization. NCSBN and ANA, 2006

10. Five Rights of Delegation • Right task • Right circumstance • Right person • Right direction/communication • Right supervision NCSBN, 1995

11. Medication Safety Considerations How can the role of the CMT/A be safety utilized in partnership with the RN? How can the role of the RN be maximized with the presence of the CMT/A?

12. Resources • NCSBN at • www.ncsbn.org • American Nurses Association at • www.nursingworld.org • Local state board of nursing • State agency providing CMT/A oversight