Week 9 DQ 1
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Read the article: Nurse Delegation of Medication Pass to discussthese questions. You must reference the articleand the textbook to receive credit.
- What should the nurse understand about the legal authorizationof delegation?
- What does it mean when the nurse delegates medicationadministration to an UAP?
- What is the responsibility of UAPs in the delegation process(specifically administering medications)?
- What do you think about the training/education requirements forMATs in Ohio? How does this compare to other states? Are our eldersin Ohio receiving safe care in ALFs?
Article:
In assisted living facilities (ALFs), unlicensed assistivepersonnel (UAP) known as medication assistant technicians (MATs)are on the forefront administrating medication. ALFs are regulatedby their respective state, not by the federal government.Requirements for the medication pass and nurse (RN/LPN) delegationvary state by state. This nationwide study identified states thatuse MATs (n 5 32), states that do not use MATs (n 5 16), and statesthat have a pilot program to evaluate the role of MATs (n 5 2). Thehighlights of this investigation outline the limited consistencybetween state program requirements for MATs, disclosing extensivevariations within classroom, clinical, and UAP experiencerequirements as a prerequisite for MAT preparation. This lack ofcongruency should be a matter of serious concern for both publicprotection with providing safe, ethical care and for nurses who areliable. Nurses have the ability to change health care policy bybeing proactive toward legislative changes within their state NursePractice Act (NPA) to support nationwide regulation of medicationassistants.
Keywords: patient safety; medication error; nurse delegation;assisted living facilities; medication aide training; ethics
With the advent of the nursing shortage and continuedamplification in the number of elderly, health care had to adjustto increasing public needs. Part of these changes involved the roletransition of the unlicensed assistive personnel (UAP) in assistedliving facilities (ALFs). With additional training, a UAP statuscan be upgraded to a medication assistant technician (MAT) status,with entitlement to administer medication (American NursesAssociation [ANA], 1996). Historically, medication administrationwas the responsibility of the traditional nurse (RN/LPN). Havingthe nurse carry out this function suggests knowledge and competencydeemed essential for safe practice at a nationwide level. Incontrast, MATs are not mandated to undergo minimalclassroom/clinical hours to provide a standardized assessment ofcompetency. Many states require as little as 10–16 hours of MATtraining to qualify for “competency” in medication pass.Regulations and training of MATs differ state by state, yet thenurse remains ultimately responsible for supervising medicationadministration assistance and, therefore, remanding this task toMATs does not exonerate them from delegation and supervisoryliability. Whereas the state governs ALF regulations, the StateBoard of Nursing governs the role of the nurse. Allowing thisgrowing health care trend to continue without standardized MATeducation jeopardizes the nurses’ license corresponding withpatient safety and welfare (Kane, O’Connor, & Baker, 1995). Thepurpose of this article is to recognize and support the need forstandardized MAT training and certification. State-by-stateconsistency in MAT training would reduce liability to licensedpersonnel and promote patient protection with safe, competent,ethical care. BACKGROUND AND SIGNIFICANCE Health care trends areoften influenced by cost containment and profit sharing. Whenreimbursement rates change, facilities restructure theirorganizations to stay afloat and continue functioning. UAPs fillthe gap for many tasks previously designated to the nurse.
ALFs are the fastest growing segment of long-term care. Anelderly person who is not in need of skilled care but, rather,seeks some form of assistance with their activities of dailyliving, would seek out an ALF rather than a nursing home setting(Augustine & DiNatale, 2008). ALFs are regulated by theindividual state under the auspices of the Department of Health.Medication management indicates whether administration ofmedication is permitted and the extent to which it is permissible(Polzer, 2009). In a skilled nursing facility, medicationadministration is a task provided by a traditional nurse. Incontrast, medication assistance administration is provided by a MATin an ALF under the supervision of a traditional nurse (Mitty,2003).
