Medication aides are common in assisted living, nursing homes and other long term care settings. They are used instead of registered and licensed practical nurses to administer medications to aged and disabled patients.

Medication aides are unlicensed individuals, most of whom are certified nursing assistants who have completed a median of 40 hours of classroom hours of education. State regulations define what they are and are not permitted to do.

National Survey Reveals Safety Issues

A national survey of 3,455 medication aides conducted by Budden examined their role, training, and demographics.

The findings showed the aides were frequently being asked to perform tasks for which they were not trained. This included administering morphine, calling physicians to change medication orders, packing wounds, giving controlled drugs, making decisions about giving or not giving insulin, and assessing patients when administering as-needed medications.

These activities are all beyond the scope of an aide because they require assessment skills and nursing judgment.

Administering Versus Dispensing Medications

The attorney handling a medication error case should know the distinction between administrating and dispensing medications.

Dispensing can be as simple as placing medications in a container for the resident to take on his or her own. Administering medications involves giving the medications directly to the resident or even placing them in her or his mouth.

The Budden survey showed that 17% of the aides reported administering medications through a nasogastric tube and 29% administered injections. These activities were clearly not dispensing.

Under most statutory schemes, a nurse’s aide can dispense medications but cannot administer them.

The attorney should check the state’s statutory scheme to determine who can administer medications.

Depending on the state, there may or may not be regulations on who can administer medications. Some states require a trained professional (such as a RN or a LPN) administer any medication. Other states allow nonprofessionals to administer medications under the supervision of the wellness nurse. Still others allow nonprofessionals to administer medication without supervision.

Discovery in Medication Error Case

In the event of a medication error, look to the facility’s practice. Who was given the authority to administer medications; did that person actually administer them? Then check the state’s regulations. Was the person with medication administration authority authorized by the state to do so?

Common Violations

According to a study conducted by USA Today, more than one in five of the assisted living facilities inspected in several states were cited for at least one significant violation with respect to medications. Several violations were repeatedly cited:

• Over or under medication.
• Improperly labeling medications.
• Failing to properly train staff in dispensing medications.
• Failing to have prescriptions refilled on time.
• Failing to ensure residents were taking the medication as prescribed.

Medication errors can lead to many other problems within an assisted living facility. For example, a resident could fall if she or he was given too much or too little of a prescribed medication. The medication may affect the resident’s balance or focus, causing him or her to be unsteady on his or her feet. If a resident is given too much Coumadin, a blood thinner, the resident may suffer from injuries or fatal internal bleeding.

A common defense in medication error cases is that the resident refused prescribed medications. If there is such a defense, the attorney should investigate the competency of the resident, what efforts were made by the facility to encourage the resident to take the medications, if the facility advised the resident of the ramifications of failing to take the medications and whether or not the resident’s treating physician was advised of the resident’s refusal.

Legal Nurse Consulting Role in Medication Error Case

A medical expert or legal nurse consultant should review all prescribed medications as well as all administered medications. These should be examined for the correct application of medications according to resident’s mental capabilities.

The critical question is whether the resident has the capacity to self-administer medications. If the resident suffers from cognitive deficits, the facility’s staff must diligently assess and reassess the resident’s ability to self-administer. The initial assessment is rarely incorrect.

The more common scenario is the failure to reassess the resident’s ability after a decline in mental capacity. Because medication errors can lead to serious harm if a resident is not reassessed, the nurse, medication aide and facility may be liable for any resulting harm.

Med League provides medical expert witnesses to trial lawyers. Please call us at (908)788-8227 or contact us today to discuss your next case.

Sources:
Budden JS, A National Survey of Medication Aides: Education, Supervision and Work Role by Work Setting, Geriatric Nursing 2012; 33: 454-464
Nursing Malpractice, Fourth edition, Lawyers and Judges Publishing Company
Laurie Scudder, Medication Aides: Disconnect Between Regulations and practice? Medscape. December 17, 2012
USA Today reviewed inspection records for the period of 2000 through 2002 for the states of Alabama, Arizona, Colorado, Florida, Indiana, New York and Texas. This report can be found at http://www.usatoday.com/money/industries/health/2004-05-24-assisted-living-cover_x.htm, last visited September 22, 2005.