Nursing Delegation and Medication Administration in Assisted Living

Abstract

Assisted living (AL) residences are residential long-term care settings that provide housing, 24-hour oversight, personal care services, health-related services, or a combination of these on an as-needed basis. Most residents require some assistance with activities of daily living and instrumental activities of daily living, such as medication management. A resident plan of care (ie, service agreement) is developed to address the health and psychosocial needs of the resident. The amount and type of care provided, and the individual who provides that care, vary on the basis of state regulations and what services are provided within the facility. Some states require that an RN hold a leadership position to oversee medication management and other aspects of care within the facility. A licensed practical nurse/licensed vocational nurse can supervise the day-to-day direct care within the facility. The majority of direct care in AL settings is provided by direct care workers (DCWs), including certified nursing assistants or unlicensed providers. The scope of practice of a DCW varies by state and the legal structure within that state. In some states, the DCW is exempt from the nurse practice act, and in some states, the DCW may practice within a specific scope such as being a medication aide. In most states, however, the DCW scope of practice is conscribed, in part, by the delegation of responsibilities (such as medication administration) by a supervising RN. The issue of RN delegation has become the subject of ongoing discussion for AL residents, facilities, and regulators and for the nursing profession. The purpose of this article is to review delegation in AL and to provide recommendations for future practice and research in this area.

Medication Administration Errors in Assisted Living: Scope, Characteristics, and the Importance of Staff Training

“…Others have noted the importance of nurse oversight in medication administration, which warrants better understanding in the context of AL. 7,23,24,26,30 Also, it is possible that the presence of an observer may have had an influence on the AL staff member's behavior as she prepared or administered the medications, resulting in fewer or more errors. In addition, the observer was not blind to the profession of the staff member, and not all characteristics related to medication errors were examined in this study.…”

District nurses’ perceptions of the concept of delegating administration of medication to home care aides working in the municipality: A discrepancy between legal regulations and practice

“…Delegation must never be used to cover a lack of personnel or routinely, but can be seen as being in the interests of older people, as they do not need to meet several different caregivers during the day. Mitty et al. (2010) found that satisfaction with the use of delegation ensured that daily work functioned well.…”

Registered nurses' experience of delegating the administration of medicine to unlicensed personnel in residential care homes

“…The availability of trained staff is limited, which may give the consequence that the RN not feel there that there is enough time to implement the necessary training to delegate appropriately (Mitty et al . , Craftman et al . ).…”