Medication Administration for Unlicensed Personnel

1. Medication Administration for UnlicensedPersonnel

2. Legislation was Passed • Tennessee Code Annotated (TCA) is the basis for the program • The Medication Administration for Unlicensed Personnel Program is a gift which allows agencies to hire fewer nurses keeping costs down • TN Dept of Health’s Board of Nursing had a hand in creating the curriculum and the rules which drive the program

3. DIDD Nurse Educators certify RN Trainers - both independent and agency RN Trainers are responsible for their classes, but receive support from Region.

4. Responsibilities of DIDD Regional Nursing Dept • Train RN trainers on curriculum and rules • Monitor classes and paperwork • Create tests and forms for maintaining the program • Keep accurate data base to determine eligibility and expiration of issued certifications • Help trainers advertise their classes by posting calendars to DIDD website • Assist with investigations of all issues related to medications

5. Responsibilities of Certified RN Trainers • Maintain current certification of their RN license and their Med Administration training certification • Follow the training curriculum approved by the Board of Nursing – 20 hours instruction • Maintain the integrity of the test • Process class paperwork timely and accurately and send to regional office • Notify agencies within 2 business days following class with pass/fail information

6. Responsibilities of Agencies • A provider agency must have a written policy and procedure demonstrating compliance with TCA rules for employees who administer medications • These policies and procedures shall be reviewed and accepted by DIDD prior to the implementation of medication administration by unlicensed employees in that agency • Agencies must have a separate medication administration record (MAR) of medications for each person receiving medications • These records are subject to review by DIDD

7. Responsibilities of the Agency RE: Newly Hired Staff • Verify status of Med Administration certifications of all new hires by contacting the Regional Office nursing department • Provide training materials to staff who will be taking the Med Admin class for study prior to attending class • Send staff to class well-rested and ready to learn – trainers may send staff home who are falling asleep or who are disruptive

8. Agency Responsibility - when trained staff fail to administer medications safely • When an agency has evidence that staff is unable to safely administer medications due to the inability to function with reasonable skill and safety for any reason, the agency shall immediately suspend the authority of the employee to administer medica-tions and shall contact the Regional Office nursing department in writing. Certification will be suspended and cause noted in the data base. Authority TCA 4-5-202 and 68-1-904

9. The Privilege is Terminated • When an agency determines a certification needs to be suspended, agency med policies should be followed. The usual procedure seems to be: compile the documentation supporting the agency decision, a letter is sent from the agency to the staff person and to the regional office informing them of the decision to withdraw the certification with cause. • Regional office then adjusts the data base and sends a letter (registered mail) to the staff confirming that certification has been terminated and they are no longer certified to administer medications.

10. Ongoing Responsibilities of Agency • Track certification dates of employees so as to keep certifications current, they expire 2 years from last day of class (test date) • i.e. Class is Sept 12 -16, 2010 then certificate will Expire Sept16, 2012 • Schedule staff for retraining timely (may attend class up to 45 days before expiration date) • Enforce expiration dates. There is no grace period for administering medications! Expiration date is the last day staff can administer medications. • If staff have not attended retraining before expiration date, he/she must stop administering meds but can attend recert class up to 30 days after expiration. After that, staff must take the 20 hour course again to be recertified.

11. What if certified staff have been out of the field? • The rules say that if certified staff have been working out of the field for 6 month or more they must be recertified before administering medications at the hiring agency. • Agencies are expected to check the level of competency of their staff to ensure the health and safety of the people served.

12. What Does the Med Admin Course Cover? • Administration, storage and disposal of medications • Documentation and record keeping – the MAR • Types of medications, their actions, interactions and potential side effects • Appropriate emergency responses to adverse reactions • Terminology abbreviations, measurement abbreviations • State and federal regulations regarding medications • Legal and ethical aspects of medication administration • An introduction to pharmacology and sample forms

13. How Many Students can be in a Class? • Initial training and recertification training has a 20:1 ratio - 20 students to 1 RN/certified instructor mandated by Tennessee Code Annotated

14. What do you have to do to Pass? • Attend the required hours of classroom instruction (20 for initial, 8 for recertification) • Then pass the written examination with a score of at least 80% and • Demonstrate competency (score at least 80%) on the hands-on skills check off for administration of various types of medications (at least 3 different types shall be tested and scored)

15. What about my agency policies? • Individual agency policies must be taught separately, outside the 20 or 8 hour time frame.

16. How do reservations for class seats work? • The monthly calendar is posted on the “DIDD Clinical” website • Contact info for each class is listed next to the class dates and location • Use that contact info to enroll employed staff giving name & social security number • Staff info is checked against the data base and if eligible, staff enrolled taking up one of the 20 available seats

17. Who Pays for these Classes? • Currently DIDD pays the independent trainer at a rate of $50 for staff who have never taken the course before and $20 for an 8- or 20- hour recertification. • Agencies who employ their own RN who is a certified trainer receive a check based on those same rates made out to the agency

18. Data on “No Shows” • When staff do not attend it takes money out of the trainers’ pockets • Staff needing class are told classes are full, but when there are no shows there is no way to get those other staff into the class. • Trainers end up teaching to small classes or may cancel the class due to low numbers and No One Wins!

19. How can Agencies Help Keep this Important Program? • Enroll only employed staff who meet the age, legal and language requirements • Monitor expiration dates of certified staff so as to retrain timely • Communicate with staff the class time and location and send them rested, prepared and ready to learn • Supply staff with the course materials and explain and practice the paperwork especially the MAR • Be prepared, after staff pass, to train on your agency policies and monitor their competency.

20. Questions? Contact your regional Nurse Educator or Director of Nursing: East # 423-787-6757 ext 128 Middle # 615-231-5434 West # 901-745-7360