Unlicensed personnel administering medications to older persons living at home: a challenge for social and care services

Abstract

Background Administration of medication to care recipients is delegated to home‐care assistants working in the municipal social care, alongside responsibility for providing personal assistance for older people. Home‐care assistants have practical administration skills, but lack formal medical knowledge. Aim The aim of this study was to explore how home‐care assistants perceive administration of medication to older people living at home, as delegated to them in the context of social care. Methods Four focus groups consisting of 19 home‐care assistants were conducted. Data were analysed using qualitative content analysis. Results According to home‐care assistants, health and social care depends on delegation arrangements to function effectively, but in the first place it relieves a burden for district nurses. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among home‐care assistants about the content of the statutes of delegation. Accepting delegation to administer medications has become an implicit prerequisite for social care work in the municipality. Conclusions Accepting the delegation to administer medication was inevitable and routine. In practice, the regulating statute is made subordinate and consequently patient safety can be threatened. The organisation of health and social care relies on the delegation arrangement to meet the needs of a growing number of older home‐care recipients. Implications for practice This is a crucial task which management within both the healthcare professions and municipal social care needs to address, to bridge the gap between statutes and practice, to create arenas for mutual collaboration in the care recipients’ best interest and to ensure patient safety.

The evolving role of the personal support worker in home care in O ntario, C anada

“…While no Canadian research could be located which examined the monitoring and evaluation of skills transferred to PSWs, international studies recommend a variety of measures to ensure regular review of added skill, such as time-limited delegations (Craftman et al, 2015), "control visits" by RHPs with frequencies determined by the level of care required by the service user (De Vliegher et al, 2015), and more traditional methods of evaluations such as observed clinical skills examinations (Smyth, 2015). However, these measures would require additional funding and time commitments.…”

“…This transfer of more advanced care activities to PSWs has been labelled "task-shifting" in the literature Denton et al, 2015;Zeytinoglu et al, 2014). Care activities identified in the literature as being shifted to PSWs in home care include assistance with medications including eye drops and injections (Axelsson & Elmstahl, 2004;Craftman, Hammar, von Strauss, Hilleras, & Westerbotn, 2015;De Vliegher et al, 2015;Denton et al, 2015;Moorman & Macdonald, 2013;Sharman et al, 2008;Swedberg et al, 2013;Zeytinoglu et al, 2014), wound and stoma care (De Vliegher et al, 2015;Denton et al, 2015;Moorman & Macdonald, 2013;Sharman et al, 2008;Swedberg et al, 2013;Zeytinoglu et al, 2014), complex lifts and transfers (De Vliegher et al, 2015;Denton et al, 2015;Zeytinoglu et al, 2014), home exercise routines Zeytinoglu et al, 2014), enteral feeding (De Vliegher et al, 2015;Denton et al, 2015;Zeytinoglu et al, 2014), catheterisation Zeytinoglu et al, 2014), and assistance with complex home-care technology such as feeding pumps, glucose monitors and home ventilators (Craftman et al, 2015;De Vliegher et al, 2015;Denton et al, 2015;Moorman & Macdonald, 2013;Sharman et al, 2008;Swedberg et al, 2013;Zeytinoglu et al, 2014).…”

“…While issues have been identified in regard to the quality, safety and feasibility of PSWs performing these added skills (Craftman et al, 2015;Denton et al, 2015;De Vliegher et al, 2016;McBride et al, 2011;Zeytinoglu et al, 2014), previous research has demonstrated that with added training and support, PSWs can play a vital role in the delivery of quality specialised home-care services such as palliative care (Herber & Johnston, 2013;Ingleton et al, 2011), teambased stroke care (Giosa et al, 2015) and home ventilation (Swedberg, Michelsen, Chiriac, & Hylander, 2015). However, the majority of studies conducted to date have been qualitative in nature with small sample sizes.…”

The role of unregulated care providers in home care: A scoping review

“…However, the language and terminology used to describe these skills were inconsistent. The most frequently reported added skills provided by UCPs were: (1) assistance with oral and injectable medications, including the administration of insulin, chemotherapy agents, eye drops, nebulisers and suppositories (n = 13) (Axelsson & Elmstahl, 2004;Barken et al, 2015;Craftman et al, 2014;Delvin & McIlfatrick, 2010;De Vliegher et al, 2015Denton et al, 2015;Hittle et al, 2016;Moorman & MacDonald, 2013;Odegård & Andersson, 2001;Sharman et al, 2008;Swedberg et al, 2013Swedberg et al, , 2015; (2) wound and stoma care (n = 9) De Vliegher et al, 2015Denton et al, 2015;Hittle et al, 2016;Moorman & MacDonald, 2013;Sharman et al, 2008;Swedberg et al, 2013Swedberg et al, , 2015; and (3) patient transfers and exercises (n = 9) De Vliegher et al, 2015Denton et al, 2015;Hittle et al, 2016;Moorman & MacDonald, 2013;Sharman et al, 2008;Swedberg et al, 2013Swedberg et al, , 2015. TA B L E 2 (Continued) and authorised professionals.…”

“…Articles identified in this scoping review revealed that UCPs were often not supported to meet the increased responsibilities assigned to them (Axelsson & Elmstahl, 2004;Craftman et al, 2014;Sharman et al, 2008). UCPs were frequently requested to provide basic nursing tasks without additional training, professional support, supervision or remuneration (Delvin & McIlfatrick, 2010;Sharman et al, 2008).…”