Who is administering the medication?
The use of medicine is common in healthcare and extensive research internationally has identified medication usage as the leading cause of unintended harm for patients. The medication-use process is complex, with a total of 54 identified phases (and numerous actors including pharmacists), for which many activities, tools, equipment, and information systems are needed and for which several interfaces are typically required. Many of these phases, particularly the medication administration process, carry high risks for patient and person administering medication (who may be a non regulated healthcare staff member).
It is important that patients and their carers and prescribers are provided with a comprehensive service from their pharmacist who facilitates the safe and timely supply of medicines, as well as information and care to ensure the best possible outcome for each person. A structured set of policies and procedures should be in place to govern effective medicines management in long term care settings. Pharmacists are an essential component of any medication use process.
Pharmacists should be aware who will be administering medication in the long term care setting. Pharmacists should be aware if the person administering medicines is the patient, a family member who has/has not some specific training, a volunteer, a registered qualified nurse, a non regulated health care worker with some basic training, a non regulated healthcare worker with no medication administration training. Risks will vary depending on the individual medication, personnel involved and location.
The unregulated nature of healthcare assistants (HCA) has been highlighted in studies and reports and this is an issue for patient safety, professional conduct, educational standards and defining a scope of practice. HCAs should only administer medicines they have been trained, and are competent, to give. In care homes in the UK without nursing (that is, residential care homes), these will generally include:
• Tablets, capsules or oral mixtures
• Medicated creams or ointments
• Ear, nose or eye drops
• Inhaled medication (RPSGB, 2007).
Administering medicines using invasive or specialised techniques will normally involve a registered nurse who has received up-to-date training.
Threats to medication safety include miscommunication among health care providers (e.g. prescribers, pharmacists, nurses, family members) drug information that is not accessible or up to date, confusing directions from doctors and pharmacists, confusing labelling of dispensed medications, poor or unsafe administration technique, inadequate patient information, lack of drug knowledge (doctor, pharmacist, nurse, care staff, patient and/or family member), incomplete patient medication history, lack of redundant safety checks, lack of evidence-based protocols, and staff and/or family members assuming roles for which they are not prepared.
Adverse events are common in health care with the incidence of medication administration errors high. Medication errors are among the most frequent adverse events. These adverse events may result in morbidity, mortality, increases in monitoring and costs of care.