HEALTH FORUM

Here starteth the contoversy ...


I work in a Private sector nursing home ( UK )
The Proprietor ( also a reg nurse ) is toying with the idea of HCAs who are
appropriately trained to give/administer drugs to Residential Clients.
( as opposed to nursing clients ) Extending their role to include giving
drugs to Nursing Clients.
My questions are :
1/ Is this possible
2/ Would the Reg Nurse be accountable for the actions of the HCA ( I
suspect this is so )
3/ Is there legal reasons why this could not happen

thanks in advance Graham

as he stands back and awaits the post man :-)

Nivaone wrote:

Q1 - yes, some guidance at http://www.rpsgb.org.uk/pdfs/adminmedguid.pdf ,
see 6.2 on page 17. However there is no guidance as far as I know on what
constitutes proper training. Does the HCA need to have the same training
as a nurse? For example, the NMC says that nurses must know the therapeutic
uses of the medicine to be administered, its normal dosage, side effects,
precautions and contra-indications, and have considered the dosage, method
of administration, route and timing of the administration. Does
administration include injections and other non-oral routes? Its the
age-old problem in nursing - viewing nursing as tasks which anyone can
perform with training, but ignoring the context in which the tasks are
performed, often for extremely vulnerable people.
Q2 - yes, the nurse is professionally accountable for all care delegated to
others therefore advice should be sought from the NMC.
Q3 - no, not as far as I know but there are a lot of legal issues to
consider, especially in common law. The employer is liable for the actions
of its employees via vicarious liability therefore the companys legal
advisors should be consulted. The HCAs and nurses have a duty of care to the
client; breach of that duty could amount to negligence.

See also http://www.nmhct.nhs.uk/pharmacy/cclg-hc.htm which states that:

In the UK, anyone can legally administer a medicine which may include a
Prescription-only medicine (POM) or Controlled Drug to another person if it
has been prescribed for that person.

Devils Advocate wrote...


I suspect you are missing the point.

Administering drugs is not an issue. the issues arises when a drug is
administered inappropriately, and harm comes to the patient.

There are then various issues

Consent (did the patient realise the administrator had no formal
training?)
Professional accountability - had the RN delegated inappropriate tasks to
one untrained to do it?
Safe Practice - was the establishment being run in a way that made it a time
bomb?

Any RN who took a job where such ludicrously stupid rules were in place was
choosing to risk their registration - and any manager who chose to run the
estavblishement on unsafe levels of skills would also be culpable, provided
they knew.

The RN, even having accepted a suicidally stupid job, could still protect
themselves by recording their fears, in writing, to the managment, passing a
copy of the document to a solicitor (or Union).

But any RN who simply accepted the situation wouldnt have a prayer.

The HCA should be untouched by all this, simply seeing the task as one of
delivery: Heres your letter Mr Smith, your postcard Mrs.Jones, and 280mg
of furosamide, Mr. Jenkins

(Note - I am not a lawyer!)
--
Andrew

Andrew Heenan,
Human Being (I think).

Nivaone wrote ...

Look at it another way: provided the RN reviews the prescriptions and orders
which drugs to withhold, wheres the problem?

Or: The prescriptions are a matter between the client and their GP (provided
the patient is capable of judgement). Wheres the harm in asking the HCA to
help mrs smith with her medication.

If the clients are aware that the HCA is simply helping and isnt a nurse,
and if the client is of sound mind, there may not be a problem - it rather
depends on the clients and why they are resident in that establishemnt.
--
Andrew Heenan
http://www.realnurse.net/

Andrew Heenan wrote:

I was attempting to answer question 1/ Is this possible and question 3/ Is
there legal reasons why this could not happen.

As the law stands in the UK it is NOT unlawful for an HCA to administer
medication as there are no laws that make such administration a criminal
offence, providing the medication has been prescribed for that person. It
would be unlawful to administer any medication to a patient who has not
given legally valid consent, although there are several instances when
medication can be given without consent but which are too complicated to go
into here. I presume that appropriate training in drug administration for
HCAs would need to include issues of informed consent, patient refusal and
the situation regarding the covert administration of drugs.

There may well be professional, ethical and moral reasons why drug
administration should remain the responsibility of professionally qualified
practitioners, but at the moment there are no legal reasons to prevent
people without professional health care qualifications from doing this.

If the original poster didnt ask the questions that I have answered then
what else did he mean by questions 1 and 3?

I knew this was difficult question thats why I asked it ..

I accept that as the RN who delegates the task I would be responsible(
act and ommisions ? )

My interpretation of appropriatly trained is that the training opur HCAs
get is provided by a MAJOR company recognised as provider of MDS systems.
( and indeed a household name ) The HCAs are already giving drugs to
residential clients in the home where the RN has a DUTY of CARE so are we
not already in the situation of Accountable for the administration of drugs?

My main problem arises more from a legal point of view..
Should I request that HCAs be relieved of drug administration for
residential clients?

I have ( as everyone does ) certain levels of acceptability and would not
allow anyone to give drugs unless I personally felt that they were able,
capable and knowledgable to do so......

Now for the bombshell ... the HCAs will come and ask at every query/problem
including typos on a script!
However the RNs will do their own thing ( accountability ) even down to
borrowing meds or with holding meds because Mrs Smith doesnt need it
or client asleep despite colleagues requesting the med to be given ...
i.e. Zopiclone ... then the morning report states poor nights sleep or up at
04:30 etc.

So at this time I feel the HCAs read the PXs and listen to reports better
than the RNs there by indicating a safer / better work practice.

I do not mean to be controversial but I feel these question need to be asked
.. and I thank you for your imput..

Kindest regards Graham ... getting more overworked as each day passes :-(

p.s. I really love my job in care of the elderly .. but sometimes feel out
on a limb :-)

Nivaone wrote ...

Yes; whatever training HCAs have, the responsibility will remain with the
person doing the delegating. The HCA is simply doing a task and hopefully
using some common sense to aopply wehatever knowledge they happen to have -
which may be considerable, bit may be nil (with nil common sense)


Does reading the prescription and saying give em, Dan-o (assuming youve
reviewed all the clients by then) save RN time? If so, why shouldnt they?

The problem comes if you delegate badly (ie you arent up to speed on the
cklients current state of health, or you give an ambiguous order. Local
paperwork may be a way forward - another form!


Not the point - its not their judgement that matters, but yours; all they
need is enough knowledge to follow your orders safely.


I should hope so!


Thats called using professional judgement - thats why they did the htree
years, isnt it?


If they read, listen and follow orders efficiently, thats great - thats
what you pay them for. But every medivcine round should be a matter of
individual judgements - does Mrs Smith need one or two temazepam tonight?
Should you give that furoisemide, or call the doctor?

Unthinking obedience may be a plus in a care assitant - but *no-one*
exercising judgement is poor care, isnt it?
--
Andrew Heenan
http://www.realnurse.net/