Aged Care
Vanessa: Why medication errors happen in aged care
Vanessa Muir is a Registered Nurse who works in aged care in Queensland. When she read an article about the high rate of medication errors in nursing homes, Vanessa was not surprised.
Here Vanessa outlines some of the factors she thinks lead to errors.
As a Registered Nurse working in a residential aged care facility, I have encountered numerous factors that contribute to and make medication errors unfortunately inevitable. This shouldn’t be the case as our elderly deserve only the best care. I love working as an aged care nurse but there is much room for improvement in the industry.
- Patient/resident identification: In hospitals, adhering to the Rights of Medication Administration eliminates the possibility of error. However in aged care facilities, the basic necessity of identifying that you indeed have the Right Patient (resident) isn’t always easy. Residents aren’t wearing identification bands on their wrists replete with a UR number and date of birth. Residents might not have a photo/name at their door due to the red tape of privacy issues (plus residents aren’t confined to their rooms anyway). If you are not familiar with the residents, this leaves you with asking residents what their names are (fingers crossed they don’t have advanced dementia), checking their clothes for labels (fingers crossed they don’t have another resident’s clothing on on that particular day- which does happen!) and asking other staff for direction. I’m not suggesting that people be branded or tattooed with identification but an attractive stainless steel bracelet or dog-tag necklace (similar to the med-alert bracelets) would definitely go a long way. Especially when agency nurses are so highly utilised in nursing homes in light of staffing shortages. This issue desperately needs to be addressed.
2. Unsafe nurse-to-resident ratios: On day/afternoon shift, I am responsible for administering medications to over 40 residents on one medication round. When you have to work at breakneck speed to get medication to all 40 of these people in timely manner, it is a mad rush. You are not simply handing over a cup of pills and walking away. You are expected to watch the resident swallow every last pill before signing the medication sheet. Even if there are 20 pills in that cup that are taken one at a time and very slowly. Swallowing difficulties (dysphagia) are a common occurrence with age which can make taking oral medications a laborious, time-consuming task. And in addition to the pills there are liquid medications, multiple eye drops and ointments, nebulisers, inhalers, topical creams, nasal sprays, ear drops, suppositories, patches, etc. This is a recipe for error. Residents understandably get upset when they don’t receive their medication on time but it is just not humanly possible as things currently stand. Unions are lobbying for the introduction of nurse-to-resident ratios in aged care. This is long overdue. Quality and safety will continue to be compromised until the government steps in and does something.
3. Multiple distractions: In hospitals, nurses on med rounds have the option of wearing a ‘Do Not Disturb’ vest. In aged care, we are doling out dangerous drugs such as insulin, warfarin and Schedule 8s yet we have no such provisions. On my med rounds I have assistant nurses approaching me with concerns. I have residents approaching me often just for a chat. I have emergency buzzers going off that I have to drop everything to respond to. I have family members of residents coming up to me and asking why their husband/wife/mother/father is sitting in a particular chair (for example). And on top of all that, I have to field phone calls from hospitals who have multiple questions about residents who have been recently discharged that I often can’t answer and from family members with non-urgent requests. Preparation and dispensing of drugs requires our full attention. We want to ensure that we are not giving someone something that they are allergic to. We need to check that we are giving the right dose at the right time. We need to check that the medication hasn’t expired. We need to consider and foresee any negative drug interactions or side effects and make a mental note to monitor for these. If we injected the wrong resident with the insulin that we have prepared, the consequences could be fatal. Eliminating some of the multiple distractions could be as simple as not expecting RNs to answer phone calls during their med rounds but diverting these to reception. Assistant Nurses cannot be expected to distract and entertain residents and keep them away from the RN whilst they are on their med round as they are simply flat-out with endless toileting requests, etc.
The propensity for error in the area of medication administration in nursing homes is huge. Registered nurses cannot alone improve the current situation but need to lobby those higher up (ie. government and nursing management) to instigate positive change. With the ageing population, hopefully there will be more impetus for change. Aged care nurses certainly shouldn’t beat themselves up for making the odd medication error in the current environment.
We’d love to hear from other aged care nurses about this.
Previously on Nurse Uncut:
Olwen B says
I was a Cert 111 assistant at a Sunshine Coast nursing home and on my first morning shift was handed over the medication trolley and very little explanation. I did not know the residents and with much anxiety did my best to correctly issue meds, eye drops etc.
Much distress amongst residents with my apprehensive approach which led to complaints. Some meds were located in fridges away from dispensing trolley.
The stress of such instances and the lack of trained, experienced staff to mentor newbies finally forced me to ditch that job. I have not returned to the aged care sector and have vowed my mother will NEVER become a resident of these “elderly waiting rooms”.
Vanessa says
That sounds terribly dodgy Olwen. I worked as an AIN (both permanently at one facility and casually for an agency) with a Cert III prior to becoming a registered nurse and was NEVER expected to help with medication rounds. Anywhere. I did see it happening at one home but those staff were expected to undergo thorough training prior to touching any meds.
Avalon says
I can attest to the feeling nurses get when they realise a medication error has been made – something to make your blood run cold. I know this as I have worked in a couple of aged care facilities of differing care requirements.
Lack of support, too many distractions, AINs and ENs whisking away residents for a shower or going for activties before giving them their routine medications makes it all the more difficult. I have made various medication errors, luckily nothing regarding schedule 8 drugs, but even when other staff made those very dangerous medication errors there is no change to the protocol or extra support provided to the ever busy RNs.
Georgina Hoddle says
It is quite alarming to hear of these occurrences in medication mis-management when vulnerable people (residents) are put at risk. The contributing factors for medication incidents are compounded when you have staff who are not trained to give medications actually doing it! The task needs to be delegated by an RN to an appropriately trained person. See the NMBA document “A national framework for the development of decision-making tools for nursing and midwifery practice” on the NMBA website and also the Australian Nursing and Midwifery Federation Guideline: “Delegation by registered nurses”.
Who is the DoN of a facility that allows that to happen? Do the RNs who delegate understand their legal responsibilities? They need to consult the Standards of Practice (NMBA 2016). Untrained Cert III and Cert IV staff have a right to refuse the delegated task if they are not suitably trained. I can see lots of Incident Reports being written.
I currently work as a CNE in residential disability services where there is often only one RN on duty to do medication rounds checking S4D and S8 drugs, with the added necessary skill of administering medications via a gastrostomy tube. This also occurs in some aged care facilities where people are on respite as they recover from strokes and surgery. All the skills required to give medications safely and appropriately must be maintained and supported by training, assessment and legislation.
Please access the Australian Commission on Safety and Quality in Health Care website for briefing papers on this subject. –
also the NSW Dept of Health Website
Look for PD 2013_043 on the same website.
Melissa Anne says
It’s a nightmare. In 2015 I gave the Aged Care sector a go. I am an experienced acute sector RN. So I worked as an agency RN to get a feel of the Aged Care sector. On one shift I was responsible for 160 residents and had to give out 50 S8s. I kid you not. The AINs rang me every 15 mins with issues and the EENs were angry when I couldn’t get to their part of the facility to administer S8s. At another facility I was in charge of 91 residents and the subsequent S8 round. I was so flustered after these shifts I sat on the beach, in the rain, trying to calm down. The Clinical Managers of these facilities hound the RNs on the floor endlessly with paperwork and demands. It’s a nightmare. Gave up and went back to the acute sector.
Mary says
I’m an een who had been out of nursing for a few years but continued my education and also upgraded my anatomy and physiology and medication endorsement. I gained employment but could not cope with administering 30 medications, insulin, dds and everything in between. I ended up being unable to work in nursing at all due to the trauma I had suffered.
Stressless says
I work as a care worker and the pressure to give out meds and look after residents is immense. ive had some near misses and it is very scary. All for $23 an hour. Given a half hour training and no supervision after that. Also no time for a designated med round so we have to do it on the go in between all the other tasks. Im considering leaving for and ACF where there is no meds given out by AIN’s
Dale says
Working in age care is like trying to loosen a rusty old nut and bolt with a broken spanner and then have management jump down your throat because you didn’t get the job done.