Medication Aide Program. Medication Aide Program. Medication Aide Program. Ohio Assisted Living Association

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1 Jean B. Thompson Executive Director, OALA September, 2008 Initial Pilot May 1, 2006 to June 30, 2007 Report to be issued by Bd. Of Nursing, March 1, 2007 from input by pilot sites Pilot extended last budget due to small numbers of aides certified at the time New budget language called for report process to begin when 75 th medication aide certified Bd. Of Nursing to publish implementation date on their website March 26, 2009 Statewide implementation March 26, 2009 At statewide implementation, all RCFs may use certified aides within limit of rules Only glitch would be if thwarted by report, or groups opposed Certified Medication Aides will be called MA-C as another group has the CMA acronym Ohio Assisted Living Association

2 MA-Cs will be able to administer law/rule defined medications using law/rule defined routes/methods as a delegated nursing task Nurse delegation already defined in Ohio law, ORC , OAC RN/LPN (with medication authority, unrestricted license med adm) working in RCF/NH may delegate med admin to MA-C On-site nursing supervision of MA-Cs required in NHs On-site or off-site supervision of MA-Cs allowed RCFs. If off-site, nurse must be available via telecommunications, as permitted in delegation law, MA-C rules added immediately & continuously Limitation in RCFs when nursing supervision not on-site for PRN meds RCF, nurse not on-site, only OTC meds by MA-C, after telephonic consultation with nurse familiar with resident/their nursing regimen RCF/NH, nurse on-site, all allowed PRN meds may be delegated, provided rule procedures followed. Ohio Assisted Living Association

3 A RN, RCF/NH has done nursing assessment resident/whom PRN to be administered Nursing regimen established that contains PRN interventions Nurse determines need from sources: a) direct observation, b) nursing regimen c) resident record Nurse determines safe for MA-C admin. Law/Rule prohibited medications: may not be delegated to MA-Cs in RCFs/NHs Schedule II drugs containing controlled substances, medications requiring dosage calculation, including inhalants delivered by inhalers/nebulizers/aerosols, medications that are not approved drugs, drugs administered as clinical research or oxygen Permitted medications/routes for delegation to MA-Cs Nasal sprays, drops or ointments applied to eyes, ear or nose, oral medications, topical medications (to intact skin only), vaginal, rectal and inhalant medications provided inhalant is pre-measured single dose, not requiring dosage calculation. Ohio Assisted Living Association

4 Prohibited methods of administration: may not be delegated to MA-Cs in RCFs/NHs Injectables, intravenous therapy procedures, splitting of pills for purposes of changing dosage, feeding tubes (jejunostomy, gastrostomy), nasogastric or oral gastric tubes. Other prohibitions for MA-Cs May not receive, transcribe, alter med orders or act without appropriate delegation, nor delegate to anyone else Have access to Schedule II controlled substances Accept care assignments that conflict with/interrupt adm. duties, other times yes Administer initial dose of any medication Administer meds to persons outside of residents of participating RCFs/NHs Administer meds to pediatric residents (NH) May not falsify any resident record or document in conjunction with medication administration Ohio Assisted Living Association

5 MA-Cs may not engage in any abusive physical, verbal, mental, emotional behavior. Misappropriate resident property or engage in any sexual behavior or activity with residents MA-Cs may not submit false, misleading information to Board of Nursing or employers MA-Cs shall act in accordance with rules governing their certification Display at all times their title when administering (MA-C) Demonstrate competence for their tasks Accurately document medication administration Maintain resident confidentiality Use/maintain professional boundaries Promote resident safety by: 1) Reporting to nurse appropriately, timely 2) Preparing/storing meds with manufacturer s, pharmacists instructions 3) Removing meds only from dispensed/properly labeled containers 4) Verifying identity of resident Ohio Assisted Living Association

6 5) Witnessing resident taking med 6) Immediately document/reporting errors to nurse 7) Utilizing med delivery process in use RCF/NH 8) Administering in accordance w/standards in med aide curriculum Nurse responsibilities prior to delegation: Evaluate resident, their med needs, mental & physical stability, med. Timeframes, route or method of administration & ability of MA-C to safely administer Allows delegating nurse to decide if resident and/or MA-C appropriate for delegation. Can not be arbitrary/safety issue Delegating nurse must communicate Residents MA-C to administer to, meds to be administered, timeframes for administration and any special instructions Nurses in RCF/NH utilizing MA-Cs remain responsible for: 1) Reviewing med delivery process (no errors in stocking, preparing meds) Ohio Assisted Living Association

7 2) Accepting, transcribing, reviewing resident med orders 3) Monitoring residents to whom meds are adm., side effects, changes-health status 4) Reviewing documentation of MA-Cs Nurses who delegate according to rule/laws not be liable damages persons, govt. entities in civil action for acts, omissions MA-Cs Requirements to be a MA-C 18 years old, HS diploma or GED In RCF, have 1 year direct care experience or be an STNA (if only direct care experience limited to RCF work) In NH, must be an STNA MA-Cs change, RCF/NH if become STNA Submit criminal record background check, certified copy within last 5 years, DC standards Satisfactorily attend approved training, pass standardized test (80% classroom, 100% clinical, 2 tries, then must retake course) Apply to Board of Nursing on specified form During pilot, no fee for MA-C certificates After pilot, fees/ma-c certificates Ohio Assisted Living Association

8 Approved training program fees will vary, set by individual programs Board of Nursing website will list approved training programs Once certified, MA-Cs will be on MA-C registry, Board of Nursing website, renewal every two years Certificates good for 2 years, but after pilot, for 1 year, interim certificate issued Interim certificate $15, Regular certificate $50 MA-C renewal will require 15 CEUs/2 years Interim certificate, 8 CEUs, 12 hours CEU content defined in rules MA-Cs will receive certificates, wallet card Certification by other states not recognized MA-C certificates can be revoked or not granted by Board as disciplinary action. Can lapse or be made inactive by MA-C MA-C standardized testing will be done by D & S Diversified Technologies, contract with Board of Nursing, test fee $96, written multiple choice exam also testing reading, writing, math skills to safely administer, skills test/demonstration fixed sites, will come to training programs, provided 7 21 days notice, if on-site, secure test team from testing company list themselves Testing co. web: Ohio Assisted Living Association

9 Test results same day or next, up to individuals can be tested, test ½ day Testing company offer workshops for training programs, share student results to improve training/pass rates, provide vocabulary lists, sample tests Students can pass both or one part of test only re-take failed part, less cost Training program: 80 hrs. classroom, lab (labsimulated clinical) & 40 hrs. supervised clinical Clinical on the floor, 1 on 1 direct RN/LPN supervision/med administering During pilot, clinical must be in RCF/NH in pilot, classroom other locations After pilot, clinical still must be in RCF/NH without citations required for pilot facility sites Model curriculum designed by Board of Nursing Training programs can use model, or develop own covering all subjects/time allocations in Board model, faster approval with Board model, Board model is minimum Training/class & clinical must be given in no less than 20 business days/more than 90 Testing within 60 days of training finish Ohio Assisted Living Association

10 Following the pilot, fee of $1000 to be a training program, good for 2 years with a $500 renewal fee, pilot program training programs can do $500 renewal Must not sign up applicants until approved To be approved, submit name(s) 1 or more nurses who meet following 1) RN 2 yr. unrestricted OH license who will administer program; 2) 1 yr. experience nursing RCF, NH; 3) Nurse with past experience adult education training; Nurse (RN/LPN) who will serve as clinical skills supervisor; 4) RN who will teach classroom component If classroom, clinical not same locations, must have agreement between qualified entities to provide both class/clinical No online programs Non STNA candidates/class, clinical in NH Agree to all rules, regulations established by Board of Nursing, keep records 6 years, follow curriculum, allow on-site visits by Board of Nursing Ohio Assisted Living Association

11 Apply on Board specified form, forms online Supply training program objectives and outcomes, teaching strategies, core competencies Needs to be consistent with law and rules, implemented as written, made available to students Must disclose policies to students/refunds Clinical part of training program must maintain student skills checklist to record skill performance with dates skills successfully demonstrated, name/signature of supervisor nurse Indicates if student did not have opportunity to demonstrate skill in clinical component Skills checklist given to student, to be presented by MA-C to any employer MA-C not to perform any skill not checked until direct nurse supervision of skill, name, signature & date of nurse supervising Provides assurances for appropriate administration, for example, rectal/vaginal Ohio Assisted Living Association

12 Minimum Curriculum Training Programs 1) Communication/interpersonal skills 2) Resident rights related to med. adm. 3) Six rights of med. adm. 4) Drug terminology, storage and disposal 5) Fundamentals of body systems 6) Basic pharmacology, drug classifications/med affects body systems 7) Safe administration of medication 8) Infection control, universal precautions 9) Documentation meds clinical record 10) MA-C reporting, consulting with nurse 11) Medication errors 12) Role of MA-Cs, delegation Program important beginning, many states already offer (over 27) in AL, way to address nursing shortage, allow nurses in AL to do more nursing, keep AL affordable for public In future hope to expand PRN capabilities of MA-Cs in RCFs Ohio Assisted Living Association