Guidelines For The Administration Of Medications
In Michigan Assisted Living Facilities
II. WHO CAN ADMINISTER MEDICATIONS IN AN ASSISTED LIVING FACILITY?
A. General philosophy
In assisted living facilities, the functional level of each
resident, and whether medication administration is a full responsibility
of the resident (self-administration), a shared responsibility
with the facility staff, or the full responsibility of the facility
staff, are the key elements in determining who is appropriate
to administer medications.
The number and educational level of the staff in each type
of assisted living facility depends upon the Michigan statute
and standard of practice, if any, and on safe standards of practice
as defined by the nursing and pharmacy professions. In general,
in assisted living settings where residents function independently
or need minimal assistance with activities of daily living,
unlicensed staff may be appropriate to provide adequate care
and services.
However, if residents are significantly cognitively impaired,
or have medical regimes or medications which require complex
care or monitoring, and/or the facility has an "aging in
place" philosophy, the services of a registered nurse are
necessary to assess residents' needs; plan for care; coordinate
care and services; delegate, train, and oversee the care provided.
Public Act 368 (Public Health Code) provides the legal definition
of nursing which defines the RN and LPN scope of practice and
is to be utilized by the facility administrator to determine
staffing. (See Appendix B)
Many assisted living facilities recognize the value of having
an RN on staff. Although such staffing is not always a requirement,
an RN allows the facility to provide a higher level of assisted
living care, may contribute to a greater degree of wellness
and often averts the need for hospitalization because issues
are addressed earlier and acute situations avoided. Such staffing
contributes to quality of care and quality of resident life.
Other assisted living facilities may utilize home health nurses,
pharmacists and RN consultants to provide professional care
and services. Such care and consultation is necessary to provide
guidance and direction to the facility staff.
B. Levels of Care for Medication Administration Guidelines
Level I Assistance is indicated for residents who are independent
or need only occasional assistance from staff in taking medication(s).
For example, this may involve providing reminders to the resident
to take medications or physical assistance with the opening
and removing of medications from containers or may involve assistance
with obtaining prescription renewals.
Level II Assistance is indicated for residents who need substantial
support with medication management. For example: staff need
to provide these residents with medication administration assistance,
or to administer necessary medications and treatments including
assistance in monitoring or arranging for monitoring of the
effects of medication(s) as in the case of a stable diabetic
needing regular glucose testing; or a stable cardiac resident
needing blood pressures, weights and pulses monitored.
Level III Assistance is indicated for residents who need on-going
assessment and coordination of health services by a RN. Staff
needs to be able to provide comprehensive support with medication
management. This level of care requires a RN to administer and
monitor medications and/or a RN to delegate such functions to
the LPN or trained staff. Examples of this level of care are
provided for residents with Dementia/Memory Loss or in hospice
facilities. Residents who meet the continuous nursing care definition
(See Appendix C) exceed the care that can be provided in the
assisted living facility.
C. The Role of Registered Nurses (RN)
When the professional practice of nursing is needed and total
responsibility for care including medication administration
is necessary, then a RN must provide or appropriately delegate
that care. The delegating RN shall bear ultimate responsibility
for the performance of nursing acts, functions, or tasks performed
by the delegatee within the scope of the delegation. A RN, per
the RN's independent license, is legally accountable to the
client/recipient of care and an employer cannot absolve the
RN from this responsibility. (Refer to Appendix
B.)
D. The Role of Licensed Practical Nurses (LPN)
Licensed practical nurses (LPNs) who can verify successful
completion of a medication course may administer medications
by any route, including injectable medications. The LPN is not
an independent nurse, as is the RN, and may not teach or delegate
these functions to other staff members. (Refer to Appendix
B.)
E. The Role of Unlicensed Staff
Unlicensed staff who have successfully completed a medication
administration training course, which meets the training requirements
outlined in section V of this document, may give specified medications
when this is a shared responsibility with the resident or responsible
party or when delegated by an R.N. Unlicensed staff may not
administer injectable medications.
The minimum qualifications for unlicensed staff who administer
medications would include a person who is:
- 18 years of age or older
- High school graduate or G.E.D.
- English language proficiency (which includes reading,
writing and speaking)
- Satisfactory references including criminal background
checks;
- Successful completion of medication administration course(s)
that minimally meets the curriculum requirements listed
in section IV, demonstration of safe medication administration
practice, and completion of a facility orientation program.
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