Medication administration

There has been some confusion over the application of the Health (Drugs and Poisons) Regulation 1996 aged care facilities. The clear intention of the Regulation is that unlicensed staff may only provide assistance to residents who have been assessed by a doctor or a registered nurse as capable of self-administration. In all other circumstances, medication administration can only be performed by a registered nurse or an enrolled nurse with a medication endorsement under the supervision of a registered nurse.

Medications and the Aged Care Standards and Accreditation Agency

The Accreditation Agency has expressed some concerns about the issue of medication management in Queensland aged care facilities and have made a submission to Queensland Health suggesting amendments to the 'carers guidelines' to ensure that the intent is quite clear. In making their submission, the Accreditation Agency indicated as follows:

"In order to ensure that medication is administered safely and correctly in the residential aged care setting, application of the Carer Provisions should be limited to helping a resident who is self-medicating, and should not include helping a resident who is not self-medicating. The help provided by a carer should be other than the direct giving of the medication, as is described under the definition of administer in the regulation."

Please note: A Webster pack or blister pack is a form of dispensed medication only. The move away from traditional individual bottles or boxes of drugs to blister packs was to assist in the time taken to give out medicine and to help with drug administration error. The Poisons regulations still require for those people who cannot self administer that an authorised person administers the medication irregardless of how the pharmacy packages it.

Staffing levels and the psycho social needs of residents

The QNU recently conducted a survey of members in aged care about nurse staffing levels. Preliminary results of this survey are quite disturbing. 70% of the registered nurses who responded to the survey indicated they are responsible for the care of 30 or more residents.

Of these 38% are responsible for the care of more than 60 residents, with 9% having responsibility for the care of more than 100 residents.

One of the major concerns expressed by nurses was their inability to adequately meet the emotional and psychosocial needs of residents due to time constraints imposed by inadequate staffing and skills mix levels.

There is no time to deal with residents' feelings such as fear, anxiety, grief, anger, frustration, and perhaps for some, their sense of loss. There is no time to assist relatives of residents to deal with their feelings, not to mention that there is no time for nurses themselves to deal with emotional situations.

As Dawn Underwood, QNU Councillor and an AIN in aged care put it "We are faced with situations where patients we have nursed for years pass away during the night. The very next day, informed of this sad news, we have to put on a smiling face and welcome the new resident who is taking their place….Very often we have to deal with families in these situations and provide them with sympathy and support, but our work must go on." Or as Nancy Coll, QNU Councillor and an RN in Aged Care puts it "these days we seem to just keep them alive, we don't give them a life."

The problem is that if the emotional and psychosocial needs of residents are left wanting they ultimately manifest in physical health problems, resulting in greater dependence for the resident which often exacerbates their feelings of isolation and dependence.

The QNU believes that meeting these types of needs should be just as important as tending to the physical well-being of residents, but are rarely given priority in the establishment of staffing numbers in facilities.

NATIONAL AGED CARE NEWS -ANF National Aged Care Forum

The ANF, in conjunction with some of the major stakeholders in aged care including Aged and Community Services, Australia, Catholic Health Australia and Uniting Care Australia sponsored a forum which was held in April to discuss the current state of the industry and develop strategies to move beyond the current controversy over quality of care in aged care facilities.

As a result of that Forum, working parties have been established (with a strong role for consumer representatives) to:

• Explore the efficacy of the existing complaints mechanism and its links to the accreditation system; 
• Flesh out a brief for the development of a methodology for a standard benchmark of quality care; 
• Look at the development of a strategy linking staffing levels and skill mix to resident acuity; 
• Determine how increased funding will be achieved; 
• Look at the accountability mechanisms for funding.

Research Project to examine Nursing Workforce Issues

Federal Aged Care Minister Bronwyn Bishop has recently instigated a research project to examine issues surrounding nursing workforce matters.

While such an initiative is welcomed, we also note that Minister Bishop has done nothing to stem the tide of cuts to nursing positions, hours and skills mix across Queensland aged care facilities, not to mention the inaction of the federal government in relation to recommended increases in funding for Queensland arising from the Productivity Commission Inquiry in 1999. The removal of accountability by providers for government funding given to them to employ nurses (one of the major causes of nursing hours cuts) also remains unaddressed.