PSW Medication Management Responsibilities

• PSW responsibilities in medication management will be covered

Objectives of PSWs in Medication Management

• PSWs must understand their specific roles in assisting clients with medications
• PSWs must identify the legislation related to PSWs and medication management
• PSWs must understand medication management delegation
• PSWs should follow delegation protocols
• PSWs must understand the "Five Rights of Medication Administration" (right person, right medication, right dose, right time, and right route) to ensure safe assistance
• PSWs must accurately and efficiently read OTC and prescription labels
• PSWs must create drug cards for common medications
• PSWs must identify resources available to stay current with medication responsibilities

Review of Previous Learning

• PSWs need basic math skills for medication calculations
• PSWs ensure accurate dosages, conversions, and proper medication timing
• PSWs must understand fractions, decimals, and percentages related to dosages
• PSWs need clarification on what they are allowed to do versus what is outside their scope
• PSWs must differentiate between assisting and administering medication
• PSWs need to understand the importance of working under supervision and delegation
• PSWs need to be aware of ethical and legal considerations in medication assistance
• PSW roles have changed to include administering certain medications under specific conditions
• PSWs need to understand who can delegate medication-related tasks
• PSWs need to understand the delegation process
• PSWs are responsible for following instructions
• PSWs need to properly document and report when assisting with medication
• PSWs must refuse a delegated task if lacking training or if it goes beyond their scope

Introduction to Pharmacology

• Medication administration routes include oral, topical, sublingual, inhalation, injections
• Drug classifications include pain relievers, antibiotics, or antihypertensives
• Drug actions are how medications work in the body
• Side effects and adverse effects are common mild reactions versus serious adverse effects
• Anaphylaxis is a severe allergic reaction and needs emergency help

Next Steps

• Outlines the role of Personal Support Workers (PSWs) in medication management
• Guided by the College of Nurses of Ontario (CNO) Practice Standard for Medication
• Emphasizes three core principles: Authority, Competence, and Safety

Authority

• Nurses have the legal authority to perform medication-related tasks as dictated by legislation
• PSWs do not automatically have authority to administer medication
• PSWs may only perform medication administration in specific situations
• PSWs need authority delegated by a nurse or another regulated healthcare provider

Delegation Rules for PSWs

• PSWs must not perform unclear, incomplete, or inappropriate delegated tasks
• PSWs are accountable for their own actions
• PSWs cannot shift responsibility onto the nurse
• PSWs should stay informed about organizational and provincial guidelines

Common Misconception

• PSWs do not "ride along on a nurse's license"
• PSWs do not share liability with nurses
• Each healthcare professional is responsible for their actions

Competence

• PSWs must assess their abilities before administering medications
• PSWs should question if they have the skill and judgement needed
• PSWs need to check if the delegation process has been fully completed and documented
• PSWs to ask if they feel confident and competent in performing a task
• PSWs must be trained and demonstrate competency before handling medications
• PSWs must decline the task if they lack confidence or proper training
• Competence is an ongoing process, and PSWs should seek additional training if necessary

Safety

• PSWs ensure safe medication administration and promote safety
• PSWs should follow standard medication administration protocols

Best Practices for Safe Medication Handling

• PSWs need to follow the "10 Rights of Medication Management"
• PSWs should speak up if a process is not being followed correctly
• PSWs need to ensure clear communication with nurses and healthcare teams
• PSWs need to follow organizational policies and Ontario legislation regarding medication administration

Medication Administration in Different Settings

• PSWs may be more involved in Community Settings (Home Care)
• Less common for PSWs to administer medications in Long-Term Care (LTC) & Hospitals
• Registered Nurses (RNs) and Registered Practical Nurses (RPNs) are responsible in LTC & Hospitals
• PSWs may be permitted to apply topical medications in Clinical Practice

Regulations and Guidelines

• PSWs must comply with the delegation criteria set by Ontario Legislation and Employer-specific policies
• Adhering to these guidelines ensures safety and accountability in medication administration

Medication Management and Legislation “RHPA”

• The RHPA is the primary legislation that governs regulated health professionals in Ontario
• The RHPA Provides a legal framework for governing healthcare professionals
• The RHPA Defines scope of practice for various regulated professions
• The RHPA Establishes controlled acts that only authorized professionals can perform
• The RHPA Ensures patient safety by limiting high-risk medical tasks

Examples of Regulated Health Professionals

• Nurses (Registered Nurses - RNs, Registered Practical Nurses - RPNs, Nurse Practitioners - NPs)
• Doctors (Physicians & Surgeons)
• Pharmacists
• Physiotherapists
• Midwives, Dentists, Respiratory Therapists
• Each profession has a defined scope of practice

Controlled Acts

• Specific medical procedures that are considered potentially harmful if performed by unqualified individuals
• The RHPA restricts these acts to regulated professionals to ensure safety and competency in healthcare
• There are 14 controlled acts under the RHPA

Key examples of controlled acts

• Administering a substance by injection or inhalation
• Prescribing, dispensing, or selling a drug
• Performing a procedure below the skin or mucous membrane
• Applying or ordering the application of a form of energy
• Managing labor or conducting childbirth
• Allergy testing and diagnosing/treating diseases or disorders
• Each of these acts requires specific training and authorization before being performed

Delegation of Controlled Acts

• Controlled acts generally must be performed by a regulated professional
• Certain cases a controlled acts can be delegated to an unregulated healthcare worker (e.g., a PSW)

Key Rules for Delegation

• The regulated professional must assess the competence of the person receiving the delegation
• The individual receiving delegation must be trained, competent, and comfortable performing the task
• The responsibility for patient safety still remains with the delegating professional
• The PSW must follow workplace policies and Ontario regulations

Delegation in PSW Medication Management

• A PSW cannot administer medication independently
• A PSW may do so if a nurse or doctor delegates the task
• PSWs can apply topical creams like hydrocortisone or Voltaren
• PSWs can help a patient with an inhaler under supervision
• PSWs can apply medicated patches in certain home care settings
• PSWs cannot inject medications or adjust/prescribe medications
• PSWs can not perform invasive procedures without explicit delegation

PSWs as "Unregulated Health Care Providers"

• PSWs are not regulated under the RHPA and do not have a legislated scope of practice
• PSWs cannot independently perform controlled acts, including medication administration
• PSWs' role in medication management is defined by employer policies, delegation agreements, and provincial guidelines

Medication Delegation Responsibility

• When a nurse or other healthcare provider delegates a task to a PSW, the PSW becomes accountable for performing it correctly
• PSWs must understand what they are being asked to do
• PSWs must not perform tasks if they are unclear, incomplete, or inappropriate.
• PSWs cannot use "the nurse told me to do it" as an excuse if something goes wrong
• If a PSW does not feel competent to complete a delegated task, they must refuse and request further training

Challenges in Educating Nurses on Proper Delegation

• Many nurses may not fully understand the delegation process or the PSW's limitations
• Some nurses may assume that PSWs can perform tasks outside their role, leading to miscommunication or unsafe delegation
• PSWs must remind and educate nurses about proper delegation protocols and their professional boundaries

Addressing Delegation challenges

• Politely clarify a task outside their role
• Ask for proper training before accepting a delegated task
• Ensure there is clear communication about what PSWs can and cannot do
• Advocate for safe delegation by following workplace policies

Nurse's Accountability in Delegation

• Nurses ensure safe and appropriate delegation of medication administration to PSWs

Key Responsibilities of the Nurse

• The nurse must determine that the client is stable and the medication has a predictable outcome
• Ensure Proper Delegation Process:
• Medication administration can only be delegated if it is safe and within the PSW's competence
• The nurse must be confident that the PSW has the necessary knowledge, skill, and judgment
• Confirm that the PSW understands the responsibilities, how to ask for assistance and report outcomes
• PSWs take responsibility for their actions

PSW's Accountability in Delegation

• PSWs verify that their job description and employer policies align with the delegation
• PSWs can refuse to perform a task that is unsafe, inappropriate or untrained for
• PSWs are accountable for their actions and must perform the delegated task correctly
• PSWs need to recognize that each client is different, situations must be independently assessed

Final Delegation Decision

• The regulated health professional evaluate each case
• PSWs must state any concerns before accepting the task
• PSWs who are uncertain, unsafe or uncomfortable, they must raise their concerns immediately

Communication

• Clear communication ensures safe delegation
• Clear communication prevents errors

Assisting vs Administering Medication

• Helping a client take their prescribed medication, such as: reminding them, handing them
• Ensure clients follow the correct schedule
• Actively giving medication to the client such as measuring and dispensing doses
• Monitoring for side effects

Reading Labels & Following “Medication Rights"

• Medication management involves reading labels carefully and following the 10 medication rights
• These guidelines ensure that medications are taken accurately and safely
• PSWs are responsible for verifying the "rights" every time

The 10 "Medication Rights"

• Safe medication administration requires the following 10 rights
• Right Medication, confirm that you are administering the correct medication as prescribed
• Right Person ensure it is for the correct patient
• Right Dose confirm the correct amount listed
• Right Route
• Medications can be administered through different routes
• Oral (by mouth)
• Sublingual (under the tongue)
• Injection (intramuscular, subcutaneous, intravenous)
• Topical (applied to the skin)
• Inhalation (through the lungs)
• Rectal or vaginal
• Right Time medications must be taken at specific times to maintain effectiveness
• Right Education why they are taking their medication
• Right Day ensure it's taken on the correct day
• Right Reason confirm it is being given for the appropriate condition
• Right Expiry Date ensure the medication is not expired
• Right Documentation that the medication was administered

Documentation

• Proper documentation of any administered medication is required according to agency policy
• Medication Administration Record (MAR) is used for documenting medications
• It is the responsibility for the caregiver to document any medication that is taken
• The caregiver should ask a supervisor (preferably a nurse) if they have questions

Resources for Medication

• The Institute for Safe Medication Practices (ISMP) is a nonprofit organization that prevents medication errors
• ISMP is recognized as the gold standard for medication safety information
• ISMP provides recommendations to healthcare providers, etc
• ISMP works to reduce the risk of patient harm

Access to Valuable Resources for Medications

• ISMP offers a wealth of documents and tools
• ISMP website contains guidelines, best practices, and error prevention strategies
• Offers alerts, newsletters, and training materials to keep professionals updated
• Highlights dangerous medication abbreviations that can cause confusion and errors