17. Mandatory medication training? (resolution)

Management and Leadership Forum

That this meeting of RCN Congress urges Council to lobby for comprehensive validated medication training to be made mandatory to all health care support workers/health care assistants working in the independent sector.

On this page:

• Watch the debate
• Read the progress report
• Read the debate report
• Read the background information

Progress reports

Council Committee: NPPC
Committee decision: New work
Council member/other member/stakeholder involvement: Ann Marie O'Neill, Kevin Bell, Susan Fern
Staff contact: tanis.hand@rcn.org.uk

Although there is already a project to establish induction resources for HCAs, the issue of mandatory medication training has not been covered. Views will be sought on the best way to take this forward.

The following task and finish group has been established:

• Ann Marie O’Neill, Vice Chair of RCN Council (chair)
• Steve Watson, RCN Learning and Development Facilitator
• Iain McGregor, Chair of RCN Older People’s Forum
• Tanis Hand, RCN HCA Adviser
• Ruth Bury, Inspector – Health, Regional Office North Wales, Care and Social Services Inspectorate Wales (CSSIW)
• Susan Went, Senior Expert in Healthcare Quality Improvement RCP/RCGP/RCPsych
• Ann Close, Head of Quality CQC
• Margaret McCambridge (MMC) Learning Representative, Northern Ireland

Regulation of HCSWs will assist in setting mandatory training standards for HCSWs. Until then, there is a need for clear standards for medication administration by support workers. The task and finish group has met and agreed to collate relevant standards and lobby for medication training for HCSWs to become mandatory in the independent sector.

Key milestones:

• Literature review
• Collation of existing standards
• Lobby relevant bodies to agree that training becomes mandatory

The following action plan to achieve the milestones has been agreed:

• Perform a literature review to define the extent of the problem associated with medication management in the independent sector, in particular with regard to HCAs
• Collate the guidance available on the provision of training and supervision of support workers in the safe administration of medication in the care home setting.
• Task and finish group to advise on best way forward for project (end October 2010)

Progress made so far:

• Task and finish group met.
• The literature review is complete.

In addition, Tanis Hand has joined the clinical reference group for a piece of work being undertaken by Susan Went (senior expert in healthcare quality improvement) on behalf of the joint Colleges (RCP/RCGP/RCPsych) on medicines management in care homes. This is commissioned by the Department of Health and covers the whole medicines management pathway. The preparatory work is due to be complete by the end of March 2011. The role of the clinical reference group is to assist in producing tools that will help staff on the ground improve the quality of medicines management in the care home setting.

Tanis Hand has responded to an email conversation between members of the reference group reviewing a list of ideas. These are being collated by Susan Went. Susan has had a copy of the literature review and has requested further information on examples of good practice across all care settings prior to the first meeting of the clinical reference group. She would like to know:

1. Are there any medicines management tools being used in acute and other settings that make management of medicines safer/easier and that could be transferable to the care setting?
2. Are there elements of red flag/early warning of deterioration that would also be relevant to residents in the care setting? She is looking for practical examples where systems enable staff to identify deteriorating health in the elderly patient.

A request has gone out to RCN nursing advisers and disseminated to their networks for information on the above questions.

Next steps:

• Tanis Hand to continue to keep the task and finish group and MRC updated on the work of the clinical reference group
• Ask Council to lobby for support of the finished document when complete
• Susan Went will establish task and finish groups, one for each of the main clinical groups – medical, pharmacy and nursing. Each group may be led by the relevant profession but we should aim to keep each group multidisciplinary in membership. Once we have identified the priorities, these groups will be charged with sourcing/designing/developing prototype tools.
• The joint colleges’ project “An integrated approach to medication safety in care homes: Working together to develop practical solutions” was launched formally on 17 March, and the RCN was represented at this meeting by Tanis Hand and Matthew Griffiths. The aim of the project is to jointly develop a set of practical tools to reduce the incidence of medication errors and near misses in care homes.
• Tanis Hand is on the Training and Education of HCSW Group which will be meeting over the next few months. The project is due for completion in September 2011 and Council will be asked to support the outcomes and, in particular, the mandatory medication training on completion of the project.

Debate report

Proposer Steve Watson, RCN Management and Leadership Forum, highlighted the danger of medication being administered to vulnerable adults by untrained health care assistants (HCAs), focusing on the independent care home sector. He said that sometimes HCAs were forced to do medication rounds unsupervised, and called for accredited training for all who administer drugs.

Steve stressed that the training needed to be accessible to small care homes, which have tight training budgets.  He said: "Congress – we need to ensure our HCA members feel confident in this role."

Seconder Iain McGregor, RCN Older People's Forum, stated that there are currently many courses offered by different companies, some of which are not competence based. He called for a nationally-recognised course.

Jean Richards, Flintshire and Wrexham Branch, felt that the training offered in her small care home is not adequate. She said: "The half day, or full day given by our pharmacy is not enough."

Some speakers felt the issue was just as important for those working in the community. Heather Blake, Southampton Branch, said: "I see an awful lot of people in their own homes whose compliance with medication is nil."

Soline Jerram, RCN Older People’s Forum, felt that GPs should support HCAs in training, as they are delegating the administering of medication to them.

The only speaker against the resolution was David Jones, Greater Bristol Branch, who pointed out that there is no governing body for health care support workers and HCAs. He asked: "If we pass this, who gets the blame if something goes wrong?"

Congress passed the resolution with 59.95% of the vote.

FOR: 256 – 59.95%
AGAINST: 171 – 40.05%
ABSTAIN: 15

Background

Medication errors appear in the top five incidents reported across all areas of care provision – according to the National Patient Safety Agency which monitors them. In October 2009 the BBC (Triggle N, 2009) reported on the findings of research which revealed that elderly people living in care homes were being put at risk as a result of care home drug errors. This issue has also been highlighted by other bodies, including the Alzheimer’s Society, and debated by an all party Parliamentary Group on Dementia.

The Care Quality Commission in England and the Care Commission in Scotland and Wales currently inspect independent care homes. This includes checking whether employees meet standards relating to the handling, administration and disposal of medicine and have received appropriate training and education. 

The national minimum standard requires accredited training in medication to be made available to all staff responsible for the administration of medication. However, regulators report inconsistencies in the skills and training of staff, while recent research on quality and safety in health care in care homes (Barber et al., 2009) identified that two-thirds of residents were exposed to one or more medication errors.

References and further reading
Age Concern (2009) Age Concern and Help the Aged respond to BMJ report: care home residents subject to drug errors, 06.10.09. London: Age Concern
www.ageconcern.org.uk/AgeConcern/BMJ-drug-errors-report-response-061009.asp 

Barber ND, Alldred DP, Raynor DK, Dickenson R, Garfield S, Jesson B, Lim R, Savage I, Standage C, Buckle P, Carpenter J, Franklin B, Woloshynowych M and Zermansky AG (2009) Care homes’ use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people. Quality and Safety in Health Care, 18 (5), Oct., pp341 – 346

Nursing Standard (2009) Reports highlight drug errors in residential care homes, Nursing Standard, 24 (6), Oct 14-21, p11

Triggle N (2009) Fears over care home drug errors, London: BBC News
http://news.bbc.co.uk/1/hi/health/8291629.stm