2-WEEK TRAINING NOT ENOUGH
To the Editor
I was very upset about reading the article, "Medication Administration by Unlicensed Caregivers: A Model Program," which was published in your June 2003 issue (Vol. 29, No. 6). I have had the personal unpleasant experience of UAPs [unlicensed assistive personnel] delivering medication to my father-in-law with a diagnosis of psychosis in an assisted living facility. It nearly killed him after four admissions to a hospital within 1 week.
I understand that the Maryland Nurse Practice Act is allowing for delegation of nursing tasks to unlicensed personnel. As stated in the article, the nurse is obligated to do an onsite visit at a minimum of 45 days and, if the owner does not have a nursing license, they must successfully complete a medication administration-training program approved by the Board (two 8-hour sessions over a 2-week period). How great they can get so much training in so little time! In this article, the authors also have the nerve to stress that the most common medical disorders listed in residents' records were: depression/anxiety. Isn't it great to know that someone who has 2 weeks training will be able to administer a psychoactive medication! The article also mentions that 58% of meds [medications] administered are psychoactives. This is comforting.
Maybe I've been a little too rough, because the trainees do get a manual designed to provide safe and correct med administration procedures. Wow, now I can relax! What about the assessment of medication effects after their administration? Because every patient is so unique and comes with so many co-morbidities, how can a 2-week training provide this?
I do understand that the outcome is to "improve the quality of care for older adults...by establishing standards of care related to medication administration by the unlicensed staff" (p. 52), but what about the patient? And a high school education is the minimum requirement for medication administration?
My main concern is that frustrated and worn out nurses will need more hands for patient care and may jump at this chance. We cannot let this happen to our practice standards. I speak as one who can cite a personal example. It didn't work for my family and I was the overseer of care. Let's safeguard our Nurse Practice Act and at the same time, safeguard our patients. I hope this never happens m New York State.
Anne Cardinale, MS, RNC, Clinical
New York State
Unfortunately, incidents similar to the one described by the reader happen far too frequently in our health care system. Sometimes the responsible person is an unlicensed individual and, sadly, sometimes it is a licensed nurse. Our responsibility as nurses is to keep trying to improve the system of care. Our article had as its purpose to describe a mechanism for adding a dimension of oversight to activities occurring in assisted living settings in the state of Maryland in regard to medication administration. Through the language of the Maryland Nurse Practice Act and support of the delegating nurse role by the Board of Nursing, a layer of guidance and supervision was incorporated into assisted living settings in Maryland. While this is not a perfect solution, it does provide a way in which nursing can be involved m settings where they had not been previously.
Ann Mane Spellbnng, PbD, RN
University of Maryland School of Nursing
Judith W. Ryan, PhD, RN, CRNP
Nurse Practitioners & Consultants, P.C.,
Owings Mills, Maryland
To the Editor:
I recently Kad the pleasure of reviewing your article Medication Administration by Unlicensed Caregivers supported by the Maryland Office of Aging. I am the educator at Motion Picture and Television Fund in Woodland Hills, CA which has two assistive living facilities on campus. We are currently facing many of the same challenges that your [the authors'] research presented in training our unlicensed staff.
I am interested in accessing the course curriculum and outlines that were used in the research project. Could you please direct me where I could get a copy of the training materials? Any assistance would be greatly appreciated. Thank you for your attention in my request.
Doreen Delgado RNC, MSN1 ANP
Geriatric Nurse Practitioner and Educator
Woodland Hills, California
The training materials can be obtained by contacting the Director of Nursing Practice, Maryland Board of Nursing, 4140 Patterson Avenue, Baltimore, MD 21215-2254 or the toll free number 1-888-202-9861.