Survey finds better staff ratios and clearer guidelines for administering medications are needed in aged care.

Reports of ear drops being put in a resident’s eyes, a cleaner dispensing medicines and a resident ending up in hospital after being given a beta blocker meant for someone else are just some of the stories that have come out of a NSWNMA survey of medications in aged care.

The stories are contained in a new report called The state of medication in NSW residential aged care, the result of a survey of over 700 members working in residential aged care.

Brett Holmes, NSWNMA general secretary, said an overwhelming number of aged care nurses and AiNs expressed deep concerns over poor staffing ratios, the lack of training given to assistants, and the unclear legislation governing the sector.

“We found that 83 per cent of nurses said they have witnessed a medication error,” Brett said.

“Poor staffing ratios and skills mix in aged care impacts on the ability of nurses to follow safe medication practices. And RNs are professionally compromised by a lack of clear and relevant legislative guidelines. Consequently, aged care residents are being exposed to avoidable risks.”

The errors reported by members in the survey ranged from wrong medication dosages being administered, to residents not being given prescribed medicines or receiving incorrect medicines.

Members spoke of medicine being put in a resident’s food that was eaten by another resident after staff walked away, AiNs being given medication competency training by trainers who aren’t competent themselves, and RNs being given the impossible task of overseeing medications for up to 200 residents in a facility where residents are housed on different sites.

The report notes that medications management was among the top five complaints received by the Aged Care Complaints Commissioner during 2015/16.

Pain relief a particular issue

Over 60 per cent of nurses experienced a delay in acquiring pain relief and other essential medications for a resident because there was no RN on the premises, the survey found.

The problem is particularly acute in Residential Aged Care Facilities that were former hostels, and where there has never been a legal requirement to provide an RN on site around the clock.

“Leaving residents in pain due to unnecessary delays in acquiring the right skill mix of staff not only contravenes residents’ human rights and is an abusive practice, it also places RNs’ registration at risk,” the report states.

Legislation out of step with high needs residents

Department of Health Guidelines require that medication tasks are only assigned to staff who possess medication training, and that skills are regularly tested and updated. However, nurses reported that the training provided for AiNs was often inadequate and did not prepare them sufficiently.

The lack of training is occurring against a backdrop of residents entering facilities with increasingly complex care needs, Brett said. “Most people entering aged care now have high care needs in some form. Dementia is increasingly prevalent, and end of life care place extra demands on an already over-stretched workforce.”

“The report demonstrates that guidelines designed for unlicensed AiNs assisting people to self-administer medications are now irrelevant in RACFs where high care is mainly provided.

“To suggest that an RN or EN has sufficient time during their span of duty to safely direct or supervise AiNs assisting with self-administration is naïve at best and at worst, potentially dangerous.”

The NSWNMA believes the report provides clear evidence that RNs and ENs are the most appropriate workers to manage and administer medications across the spectrum of RACFs.

The association is calling for a review of staff ratios and staffing mixes, and clearer guidelines for RNs to refer to when delegating medication tasks to AiNs.