Nurses control of drugs in aged care weakened
The Berejiklian government has opened the doors to drugs of addiction being controlled by employees who are not registered health practitioners.
New state government regulations give aged care facility managers – who do not need to be a registered nurse – total control over medications.
This includes drugs of addiction that need to be locked away for public protection.
Previously, directors of nursing were given this responsibility. They have to be a RN and comply with professional guidelines.
As registered nurses, directors of nursing have been educated in the safe and quality use of medicines.
The changes are outlined in the Poisons and Therapeutic Goods Amendment (Residential Care Facilities) Regulation 2018 issued by NSW Health Minister, Brad Hazzard, on 7 December.
They also increase by 600 per cent the amount of dangerous medicines that nursing homes can store.
NSWNMA Assistant General Secretary, Judith Kiejda, said the changes were potentially harmful to the public.
“They afford very little safeguard against the mismanagement and potential diversion of dangerous drugs of addiction,” she said.
“This signals the end of nursing oversight of dangerous medication for many thousands of vulnerable people.
“The safest option would have been to extend the legal requirement so that a DoN was employed in every facility where high-care residents are accommodated.”
A retrograde step
In a letter to Brad Hazzard, Judith Kiejda said giving increased authority over medications to people not professionally licensed was “an ill thought-out and retrograde step.”
“You will be aware that there is no current legal provision requiring residential facility managers to have minimum competencies in regard to the management of medicine. Nor are they professionally accountable for their actions in the same way that a Director of Nursing would be,” Judith said.
She said managing medications required “specialist knowledge and skills in pharmacokinetics and pharmacodynamics and a sound understanding of the ethical-legal implications related to medication management.”
Western Sydney GP Aline Smith said she did not understand how this “appalling” change could be justified.
She said the change was not in keeping with the practice in hospitals and in general practice where S8 drugs remain under the control of a RN.
“Our accreditation standards clearly prohibit staff who are not registered nurses or GPs from managing the drug register,” she said.
“In general practice, our practice manager or facility manager cannot hold the key to the S8 safe unless they are a RN.”
Medication errors more likely
RN Angelin Maharaj, who manages medications at a western Sydney nursing home, said she was concerned the new regulations would give facilities another reason not to employ RNs.
She said medication management is incorporated into pre-registration education of RNs, and nurses at her facility undertake a drug calculation quiz every year “to see whether we still have the knowledge.”
“Also, as RNs we must follow, and are held accountable to, professional codes of practice.”
Angelin said that until now, every nursing home had one RN who held the key to Schedule 8 medications on each shift.
“However, if a manager is not a qualified RN, they won’t know how to accurately calculate the doses to be dispensed and residents could be given the wrong doses.
“I think there will be a lot of errors by unqualified staff holding the S8 key and dispensing medications such as morphine.
“Also, giving unqualified staff control over much greater quantities of medicines makes it more likely medicine will go missing.”