May 10, 2021

Should personal care workers be giving out medication?

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.

Weak regulation

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.”

Mr Gilbert said the industry is well aware of the extent of complaints about medication mismanagement and 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% 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% 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.”

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  1. Very well written article! Great insight! As a EEN I personally believe PCA staff shouldn’t be administering medication.

    1. I completely agree with you Linda. The Drugs and Poisons Act needs to be amended to stop PCAs giving medications. This has to stop.

    2. DIV 1 RNS OR DIV 2 ENROLLED NURSES should be giving out medications. Some personal care workers have paid for a qualification and don’t even try to learn then when they can’t complete the basic course that’s meant to assess p.cs being able to give meds they get someone to cheat for them because it’s not a strict examination situation. With a history of working as a Div 1 nurse i can see that it seems some aged care RNs are so lazy they don’t care to give out meds & those people are just in nursing since wages went up in the early 2000s. There are still some excellent RNs & ENs in aged care but they’re being outnumbered by those that dont care and enable the Carers who abuse residents. . RNs in charge need to keep an eye on carers who have no interest in working in the area.

  2. The role of the carer should never include medication administration in any form. It is the domain of the EEN. Even RN’s should not be tied to a drug trolley any longer. The RN should always be in a supernumerary role with a span of control not exceeding 60 residents. An EEN should have no more than 30 residents on any shift and carers should not have a resident load exceeding 6 residents. This model is affordable and safe. It works

    1. Dear Peter,

      Your name title looks interesting and I am guessing you work in corporate level for aged care. I am a AIN too and asked to medication at all time in my aged care facility. Even me and my other colleagues raised the concerns about having a stress due to overload of work and probably reason to make medication mistakes but the management refused to listen us continuously ask us to do medications. In some medication training or principal I read that we can refused to do medication if we feel it is unsafe from us to do medication for clients. I wss trying to find those guidelines in googles but could not find one. Do you have any known those guidelines on any Australian law about the rights of AINs and PCA right to refuse to do medication to aged care clients?? If you have. Please do forward it in my email. It would be great help. Thank you.

  3. Part of the issues have arisen with the legislative changes in 2014 where the hostel level and the NH levels of care were made into one to become aged care. This was largely a Fed Govt financial decision. Pre 2014, Hostel or low care had multi-packed meds given by med competent PCAs. and nursing home meds were single packed given by EEN or RN. now no differentiation across the aged care arena, but the regulations around medications have not caught up. Therefore meds in ex-hostel (low care) type facilities even though now taking many high care persons, are still multi-packed and given by PCAs and for all other areas (nursing homes) meds are given by RNs or EENs. I doubt though that med errors in aged care facilities are as numerous as those in public/private hospitals. The stats for there are hideous.

    1. I agree Penny. I have been in hospital on some occasions when several times I have been given the wrong dosages of medications and sometimes some tablets have not been given at all. Luckily I know my regime very well and have always been able to advise the nurse administering them. My husband has been in hospital for six weeks this year and had the same type of problems but he too was able to have them corrected. I know nurses are often understaffed and very busy but being careless or rushed is not
      acceptable as the wellbeing of the patient surely must be paramount.

  4. I work in a aged care facility where personal care workers give out medications, all workers are required to do a basic medication competency training before administering any medications, this training is only recognized in our facility, I feel this training is not enough, its very basic and does not really explain the different types of medication and what it being taken for. Over the years I have seen personal care workers make mistakes while administering medications. (luckily nothing serious) Personally I feel all medications should be distributed by nurses. .

  5. Anti hypertensives and the need to assess the patient prior to delivery and after to ensure efficacy is non existent in PCA delivered medication that I have seen lead to increased syncopal episodes and injuries and that is only one medication. So many side effects with individual medications, then add more as in poly-pharmacy and the results are disastrous. An RN, I left residential aged care due to lack of support, too much PCA responsibility, not enough Dr access for the aged, too much doping of residents to ‘keep them quiet’, poor end of life care, lousy meals, inconsistent care, continence product rationing, non English speaking staff not even trying to communicate, to name just a few. Voluntary Euthanasia will be my out, I will never allow myself to be treated with such disrespect with no communication as the end of my days.

  6. My mother was in an aged care facility in Narrandera NSW and this particular time she went to the Dr that day with ear problems – that evening the personal carer came in to give her medications (I was out of her room at the time) and the PC said ‘you don’t have ear drops you have eye drops’ and promptly put the ear drops in her eyes – thankfully I got back to her room and found her distressed – she said my eyes are burning – she said something about you don’t have ear drops – my mum has dementia and was confused – I ran and found the first person I could and they rinsed her eyes.

    I reported the incident the next day to management but nothing changed. I nave my mum in another local facility where only Nurses give out the medications.

    There were other reasons I also took her out of the first facility.

    1. Well done, you are her voice, my father had tinea ointment meant for his toes slathered on his ‘privates’ for 6 days before he made me aware. The staff I reported it to, laughed and thought it was funny. Disgusted

  7. NO!!!!It must be hard enough as a trained nurse. I refused to hand out medication (I’m a PCA) PCA’S made SO many mistakes, and even forgot medications. Refusing did not help my job

    1. good on you for being brave enough to refuse a delegated task because you do not feel confident or adequately trained to shoulder that level of responsibility. As a health professional, EN’s and RN’s are directed to work within their scope of practice which changes with exposure to training and experience. Unfortunately there doesn’t seem to be the same guidelines for PCA’s as yours is an unregulated position.

  8. Well done Caroline. It was always confusing to me that as a RN and now as an educator of ENs, the importance and seriousness of medication administration and associated monitoring and management was always strongly impressed upon me. The regulations and requirements are stringent for us. The point that PCA’s were supposed to just assist an otherwise competent person who is able to participate in their own medication management is still not reasonable. the rationale bandied about at the time was that a relative or carer would be assisting the person at home. but those family members only have their one person to care for. They have a vested interest in the wellbeing of their loved one. They are able to attend doctors appointments, read information and discuss with pharmacists ect. How they can take that same premise and say that PCA’s are doing the same thing for 30 or 40 residents never equated.

  9. Hi Linda I was a Nurses aid back in the days when only sisters ( now called RN’S) where the only ones that gave out medication, when i started in aged care EN’S where the same as PCA’S and still only the RN’S gave out medications until they introduced the course for EN’S to become endorsed then they became EEN’S. I never renewed my registration when I left the hospital so I worked as a PCA and did the course to be PCA medication endorsed and have being doing it for years I have more experience than most EEN’S and RN’S,
    you would be surprised how many don’t know what the medications are used to treat and the interactions, most of the learning is in the class room!!!!!!!!!!!! I was trained on the floor, so you are surmising that all PCA’S started out as PCA’S I have been in aged care for 20 years

    1. Hello, I to am a AIN administering meds in a large facility. I get paid $30 a shift to do this. How do I find out abt the allowance, as I dont believe $30/shift is adequate ?

  10. The previous Aged Care facility my mother was in had personal care workers giving out medication. My mother had daily eye drops but this particular day she was at the doctor’s to get eardrops – that evening the PCW put the ear drops (clearly labelled) in my mother’s eyes saying to her that she didn’t have ear drops only eye drops. Thank goodness I came in shortly after with my mother telling me her eyes were burning.

  11. Leaving aside the issues of error in the medication process, there is clearly a fundamental issue that has led to health care workers assisting care recipients with medication. That being the inability to attract and retain registered nurses in the aged care industry. This employment gap is now exacerbated by Home Care, Hospitals, Aged Care and the NDIS all competing for a scarce resource that is also highly mobile. When I look around my friends, who like me are registered nurses, I see an older population of people who are on the cusp of retiring, and insufficient numbers of new graduates to fill the vacancies. Paying staff more is a short term stop gap that does not work in the long term. It does not address the perceptions of older staff that the profession itself is now a victim of destruction by documentation and managerial deliberation and at times indifference. And that will not improve, it is the way we live in the modern world.

  12. Since we are incredibly short staffed and staff stay back for double shifts I am disgusted that our AINs/PCW have to do double shifts and on top of that hand out medications to residents on 4 wards due to the shortage of AINs who are either not able to administer due to shortages of AINS or new young foureign staff not trained to be “medication competent.” A joke on us. The beautiful young Nepalese man was so angry he actually spoke up about the conditions staff are working under and then stated that he never loses his temper and apologized to management the following day, but the next day it was exactly the same situation. 4 to 6 staff a day are sick! Over worked and fed up!

  13. Where I work sins do all the medication and us een that are qualified do not medication and we do 2 days a fortnight because the sins are cheaper and as they say more qualified. Most nursing homes are not having een using the sun do all the meds. In my facility I work on the floor and Ain do the pills

  14. I am a Registered Nurse in Aged Care, I have been practicing for 23 years and the direction in which Aged Care is going worries me. Currently my biggest concern is we are introducing PCW’s with “Medication Competency” to do the med round. I have been told I just need to be on site. The Union has told be that I have to supervise, this means standing beside them. How can I do my work if I am supervising someone else doing their work (which I do not believe they should be doing)? Also, I have been told that if they make a mistake, I am held accountable because I should be watching them. I’m sorry, but I would rather just do the round myself. At least then if I am in trouble for an error it is my error. The stress is enormous and I am constantly sick, can’t sleep, have headaches etc. All that goes along with constant stress. And the reason my employer is doing this? They are only saving about two or three dollars an hour. They have also informed us that as EN’s leave they will be replaced by Medication Competent PCW’s. Someone please tell me how this is improving the care of our aged? I am in my 60’s now and I am concerned about what care is going to be like when I need it.

    1. Thank you for your info . My mother was giving the wrong medication ( overdose ) . A carer gave my mother her medication plus other resident ( 6 tablets ) . She went to my mothers room with 2 sets of tablets . We don’t know what do do , or where to go to seek help, the most amazing thing is that ,the Nurse on duty didn’t call us, called a doctor or even called an ambulance . My mother got very ill.

  15. Great read and even though this is so much later than when this was done, it is still prevalent that pcas are giving out meds. I am in the process of trying to find a facility for my elderly mother and I have been asking how many nurses are on throughout the day and at night. who is giving meds at night time especially if it is a scheduled drug. Is there 2 nurses to do this or what is the procedure and often there is one nurse and pca’s that do it. Pca’s help with the medication after the nurse has dispensed it. Getting disheartend on finding somewhere that takes medication and the possible implications of the medication on the patient is it likely to interact with something else etc

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