A Comprehensive Approach to Medication Administration - Vincent Court

The safe management and administration of medications is essential for residential aged care facilities particularly when many residents receive multiple medications due to their complex care needs and various health conditions. Medication errors can lead to adverse events and have a potential to cause significant harm to residents. To prevent medication errors and promote safe administration and documentation practices residential aged care facilities require clear policies and procedures to support staff and systems to monitor, review and evaluate the use of medications. Regular education programmes, training and competency testing are all important components of a medication management system to ensure compliance with the required standards.

Debbie Fletcher, Manager of Vincent Court has shared her facilities experience with identifying a recent rise in medication errors due to missed signatures and the strategies implemented to improve staff documentation practices.

Vincent Court is located in Kempsey NSW a 98 bed not for profit facility managed by Catholic Care of the Aged Port Macquarie who have been providing care and services to residents since 1975. We have been participating in the QPS Benchmarking program since the 1st of July 2010 and over the past QPS reporting period for Quarter 4 (April-June) we identified an upward trend in medication errors with our errors reaching an all-time high.

Catherine Raymond (RN) & Debbie Fletcher (Manager) on their S8 medication round with Mr. Ray Clinch

A detailed investigation via auditing and observations was undertaken and the contributing causal factor was identified as inconsistency in training methods. Registered Nurses providing competency based training were doing so while performing their own on the floor role and this was found to have contributed to the following;

• Inconsistencies in training methods,
• Interruptions from staff, family, GP visits & the RN workload which deviated from the concentration of all involved,
• Hurried process

We identified that our most common and notable errors were missing signatures for non packed medications such as creams and eye drops. We are currently trialling a locked bathroom cupboard in our Memory Support Unit for creams. The cupboard, which is only accessible by care staff contains;

• Creams to be applied,
• Signing sheet.

This has enabled care staff attending to hygiene to apply creams at the correct time while avoiding behaviours for staff attending to medications after the resident is dressed. The signing sheet remains with the cream and is signed onsite therefore improving the missing signature count.

As well as this strategy Vincent Court has identified the need for a Clinical Leader/Trainer to oversee the auditing, assessing and training of the processes and staff. All training will be attended by the trainer in real time but without the constraints of being required elsewhere. Auditing will identify gaps in medication competency and training needs on a weekly basis and one on one instruction and coaching will be provided to staff as required. This will take place via a moving audit and will be closed out by the trainer. The Clinical Leader/Trainer is also investigating a simpler Webster signing system to streamline the process for staff.

Knowledge & Skills Competency - Safe Practice for Medication Administration

At Vincent Court medication competent staff must also be internally credentialed by the Catholic Care of the Aged assessor on commencement of employment to be able to deliver medications. Staff are required to complete our “Safe Practice for Medication Administration” Competency which incorporates both knowledge and skills competencies. The outcome of the competency is for staff to demonstrate the knowledge and skills required to safely administer medication by various routes e.g. oral, liquid, nebulised and topical application.

A separate training process undertaken for Care Staff is the Insulin Delivery Device training. This is facilitated by an accredited Diabetic Educator onsite. Care staff are not permitted to give Insulin. Administration of Insulin is an R.N specific responsibility at Vincent Court, the training enables Care Staff to counter sign as the 2nd signatory when all checks are correct.

The competency includes the following key steps;

1.    Answer the questions posed in the Knowledge Section of the Competency,

Staff must possess knowledge in the following underpinning areas that are essential for all forms of medication delivery. (There are also additional knowledge components specific to each route of medication administered); 

• Roles,
• Safe practice,
• Problem Solving,
• Planning and Organising,
• 5 General Principles of Medication Delivery.

2.    Observe the skill twice,

3.    Perform the skill twice under supervision,

4.    Demonstrate competency using the appropriate competency assessment sheet to an approved assessor.

Catholic Care of the Aged Port Macquarie are very fortunate to have employed an organisational educator to oversee all training plans and facilitate larger planned training. Part of the ongoing plan is for all Medication competent staff across the organisation to have an annual refresher and competency. This will be delivered by the lead trainer in all facilities and will re-enforce safe medication processes and assist with the prevention of medication errors.

Debbie Fletcher, Manager, Vincent Court

Knowledge and skills are demonstrated by staff in the competency test