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.”

Medication mismanagement a major aged care problem

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

“Seventy-five per cent of all complaints to the Aged Care Commissioner in 2017/18 were about residential aged care. The most common issue raised in complaints was medication administration and management,” he said.

Mr Gilbert said 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 per cent 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 percent 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. 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

  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

  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!

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