PSWs: Medication Assistance & the Five Rights

• PSWs assist clients with medications within regulatory limits
• PSWs must understand relevant laws, policies, and workplace guidelines for medication administration
• Medication-related tasks assigned to PSWs by healthcare professionals require proper delegation protocols

Five Rights of Medication Administration

• Right person
• Right medication
• Right dose
• Right time
• Right route
• Assist clients safely by reading OTC and prescription labels accurately
• Compile reference cards for common medications
• PSWs should explore training programs, reference materials to stay informed about medication management practices

Math for Simple Calculations

• Calculations include basic arithmetic, accurate dosages, conversions (milligrams to grams), and proper timing
• Understanding fractions, decimals, and percentages is needed for dosages

Role of PSWs in Medication Management

• Clarify what PSWs can and cannot do
• Differentiate between assisting and administering medication
• Work under supervision and delegation
• Understand ethical and legal considerations

History of PSW Medication Assistance

• PSWs now administer certain medications under specific conditions
• There is increased demand for PSWs

Delegation

• Understand who can delegate medication-related tasks
• Follow the delegation process and PSW responsibilities
• Document and report properly
• Refuse delegated tasks if lacking training or beyond scope

Introduction to Pharmacology

• Medication administration routes include oral, topical, sublingual, inhalation, injections
• Classifications include pain relievers, antibiotics, or antihypertensives
• Drug actions describe how medications work
• Side effects vs. adverse effects include mild reactions like nausea versus anaphylaxis

Role of PSW in Medication Management

• Personal Support Workers (PSWs) are guided by the College of Nurses of Ontario (CNO) Practice Standard for Medication
• Authority, Competence, and Safety are three core principles

Authority

• Nurses have legal authority
• PSWs do not automatically have authority to administer medication
• PSWs may only perform medication administration if delegated by a nurse
• If a delegated task is unclear, incomplete, or inappropriate, PSWs must not perform it
• PSWs are accountable and cannot shift responsibility
• Policies and rules vary, so PSWs should stay informed

Common Misconception

• PSWs do not share liability with nurses
• Each healthcare professional is responsible for their own decisions

Competence

• PSWs must assess their abilities
• PSWs must have the skill and judgment
• Delegation must be fully completed and documented
• PSWs must feel confident and competent
• "The nurse told me to do it" is not an excuse for errors
• Competence requires training and ongoing learning

Safety

• PSWs ensure safe medication administration
• Best practices follow standard protocols such as the "10 Rights of Medication Management"
• Speak up, communicate, and follow policies

Medication Administration in Different Settings

• In community settings (home care), PSWs may be more involved
• In LTC/hospitals, nurses are responsible
• In clinical practice, PSWs may apply topical medications
• Regulations and guidelines: comply with delegation by Ontario Legislation and employer-specific policies

Medication Management: RHPA

• The RHPA governs regulated health professionals in Ontario.
• It provides a legal framework
• Defines scope of practice
• Establishes controlled acts
• Ensures patient safety
• Including Nurses, Doctors, Pharmacists, Physiotherapists etc

Controlled Acts

• Specific medical procedures are potentially harmful if performed by unqualified individuals
• The RHPA restricts these acts to regulated professionals
• There are 14 controlled acts
• Key examples are administering by injection, prescribing, or performing a procedure below the skin
• Authorization and training is required
• Controlled acts can be delegated

Key Delegation Rules

• Professionals must assess competence
• Individuals must be trained and comfortable
• Responsibility for patient safety remains

Delegation Examples

• PSWs cannot administer medication independently
• Administering topical creams is an example
• Helping with an inhaler with supervision

PSWs Cannot

• Inject medications (e.g., insulin, vaccines).
• Adjust or prescribe medications.
• Perform invasive procedures without explicit delegation

PSWs as "Unregulated Health Care Providers"

• PSWs are not regulated under the RHPA and lack a legislated scope of practice
• PSWs cannot independently perform controlled acts
• Their role is defined by employer policies

Delegation Responsibility

• A PSW becomes accountable
• PSWs must understand what they are doing
• If a task is unclear, incomplete, or inappropriate, PSWs must not perform it
• Competence is a must

Challenges in Delegation: Educating Nurses

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

Addressing This Challenge as a PSW

• Politely clarify when a task is outside the PSWs role
• Ask for proper training before accepting a delegated task
• Ensure there is clear communication
• Advocate for safe delegation

Nurse's Accountability in Delegation

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

Responsibilities of Nurses

• Assess client stability
• Ensure proper delegation within PSW's competence
• Medication administration can only be delegated if it is safe

Confirming PSW Understanding

• The nurse must ensure the PSW understands responsibilities, whom to ask for assistance, and how to report outcomes
• Once a task is delegated, PSWs must take responsibility and act within their competence

Responsibilities of PSWs

• Verify employer policies and job description

Right to Refuse Unsafe Delegation

• If a PSW is uncomfortable, untrained, or the task is beyond their ability, they have the right to refuse the task

Recognizing That Each Client is Different

• Just because a PSW performed the task before does not mean they can automatically perform it on another client

The "Rights"

• Final delegation decision lies with the nurse
• Communicate concerns
• PSWs must raise concerns and clear communication is important in medication administration

Assisting with Medication

• Helping a client take their prescribed medication
• Reminding them, opening containers, and ensuring they follow the correct schedule

Administering Medication

• Involves actively giving the medication to the client
• Measuring and dispensing doses, injecting, monitoring for reactions

Importance of Medication Management and the Label

• Medication management involves reading labels carefully and following the 10 "rights" of administering medication

10 Rights of Medication Administration

• Provide guidelines to ensure medications are taken accurately and safely
• PSWs are responsible for verifying the "rights" every time

Right Medication

• Verify the correct drug, check the name, and read the label carefully

Right Person

• Ensure it's for the correct patient
• Especially careful where multiple clients have similar names

Right Dose

• Confirm the correct amount as listed.
• Use accurate measuring tools such as oral syringes

Right Route

• Medications can be administered through different routes

Right Time

• Give at the correct time, and know the order of multiple medications
• Notify a supervisor if confused

Right Education

• Understand why the medication is being taken

Right Day

• Ensure it's taken on the correct day
• Can lead to overdosing

Right Reason

• Medications must be taken for their intended purpose
• If a client is misusing or confused, report it immediately

Right Expiry Date

• Ensure the medication is not expired

Right Documentation

• Properly record that the medication was administered
• Use proper documentation
• Use the Medication Administration Record (MAR) to document medications
• Ask a supervisor for clarification on about documentation
• Medication management involves reading labels carefully and following the "10 Rights".
• ISMP's mission is to reduce the risk of patient harm.

Military Time

• Healthcare professionals must accurately convert between military and civilian time

Creating Drug Cards

• Can be written in a notebook, on index cards, or loose-leaf paper.
• The cards must be neatly handwritten or typed.

Include on Drug Cards

• Drug classification, action, generic and trade names
• PSW responsibilities
• PSW observations for detection of complications