Although I understand your concern and acknowledge that as a nurse you are acutely aware of the possible consequences of medication errors, I have a different perspective.


I was first trained in medication administration at the age of 19 when working for the Baltimore Association for Retarded Citizens.  As a resident assistant in that setting, one of my responsibilities was to make sure that my developmentally disabled residents received the correct medication.  I was trained to read, understand, and follow prescribing information on prescription bottles and to document that I had done so.  I received some sort of DDA certificate for this.


At 21, I began working in psychiatric residential rehabilitation, where again part of my responsibility was to ensure that residents received their medications correctly (and actually took them  ;).  What was different in this setting was that we were not permitted to "administer" the medications, as we had in the DDA system, because that required licensure, but were instead assisting and training the residents to correctly self-administer their medications.  Don't freak out, but this involved assisting and training them to check their blood sugar and take their insulin, too, and there wasn't a single nurse employed by  the program.  I didn't work for a bad or understaffed program, that was how it was done in all the programs in and around Baltimore (and probably still is), as well as in the homeless shelter where I moonlighted.  We also transcribed the orders to handwritten MARs (where we were documenting that we had observed the resident to take the medication correctly, not that we had administered it), counted pills, kept track of narcotics, etc.  For most of the residents, the medications were kept locked in our office and taken to the residents' apartments at medication times.  Some were independent and reliable enough to pack their medications in 7-day pill/dose boxes under our supervision and then we'd check from time to time that the pill boxes reflected that they seemed to be taking the medication correctly.  They recorded on their own copy of the "MAR" when they had taken each dose.  I would estimate that at least half of the residents were on 9 or more meds, between psychiatric medications, medications for the side effects of their psychiatric meds, anti-hypertensives, hypoglycemics, the ubiquitous benadryl for sleep, etc.


The idea was that our people had been discharged from the (mostly) state hospitals to community living with supports in place to prevent rehospitalization.  Since taking medication incorrectly (or just not taking it) was a well-documented precursor to rehospitalization, it was essential to make sure they took it correctly without taking the responsibility away from them and onto the provider.


After 13 years, the public mental health system in Maryland basically collapsed, and after a couple of moves within the imploding system, I left it for eldercare, starting in assisted living.


In 2001 in assisted living in Maryland, a resident assistant did not have to be a CNA or GNA, although it was the standard in the "special care center" I managed for the staff to be certified.  Without any certification or license I showered people, dressed people, changed or toileted people, fed people, whatever was necessary to keep them well and comfortable.  And I took a 12-hour course to become certified as a medication aide for the assisted living setting.  The MARs were pre-printed by the pharmacy and checked and corrected as needed by an LPN.  The medications were "bubble-packed," a card per dose of each medication, the cards kept on rings by a hole punched in the top corner.  I was trained in the 5 R's and to check, double-check, re-check the card, MAR and resident, etc.


The residents in assisted living facilities here are not allowed to self-administer their medications unless they can pass a test every 45 days.  Unlike the residents with psychiatric disabilities, who maintain responsibility for taking their medication, but receive assistance to do so correctly, assisted living residents have to insist on self-administration and the burden is on them to prove that they can do so correctly without assistance, or else the ALF takes that responsibility and the residents' meds are administered to them by a CMA.  There is no middle way, no support for self-administration, and little chance that someone who has failed the test and is having her medications given to her by the CMA in a souffle cup will be able to learn them well enough to pass the test and regain what has become a privilege to self-administer her own medication.


Effective October, 2004, Maryland no longer licensed medication aides in assisted living facilities differently than CMA's, and current assisted living medication aides were grandfathered in and made CMA's by sending a form to the Board of Nursing attesting that they were currently administering meds in an ALF.  Unfortunately for me, I began working in a SNF at that time, where I could not administer meds, so I was unable to get the grandfather CMA license.


The current CMA license in Maryland requires a 60 hour course in addition to 2 years as a CNA/GNA.  (see:   http://www.mbon.org/main.php?v=norm&p=0&c=medaide/factsheet.html)


So to get back to your concern that a CNA license and 70-hour course are not enough training to administer medication, on the one hand, I hear you.  Having done med-passes on a 27 bed dementia unit, I can confirm that it's hard and requires unusual ability to concentrate and focus and not lose your place in an important sequence of actions in the midst of an environment that can range from lively to chaotic.  But can you see that we have made it that way and maybe didn't need to?


I loved the idea in the households of having the medications kept in each resident's room.  The CMA can then sit down with the resident in the privacy of her room and provide whatever level of assistance is necessary to ensure that she receives her medication correctly.  I love that it would eliminate those sad and (to my mind) humiliating lines at the med station where residents wait to swallow their pills or get their eye drops or whatever in front of everyone else who's waiting, too.  How likely are you, the resident, to ask what your pills are, or comment on changes, or commit the terrible crime of taking your pills one-by-one with a swallow of water each  and then drink an extra cup of water, while 6 people are impatiently watching and waiting for their turn so they can take their seat in the dining room or get to their activity?


I submit to your consideration that the conditions I've cited above of the medication station have greater potential to be a source of error than the aide with 60 hours of training assisting a resident one-on-one to do something that all of us have had to do at one time or another.  I don't mean to diminish the work of nurses, but taking medications as prescibed is not rocket science and is not something that adults are presumed to be unable to do for themselves.  Except in long-term care settings.


I appreciate that you are interested and involved in this movement and in providing health care.  Your work will reward you in ways you can't imagine and will benefit others in ways you may never even know.  Best wishes.

Kristen,
I worked in a group home where staff are responsible for administering meds. They each including myself were required to take the 72 hr. course and pass a written exam and actually demonstrate how & when etc. meds were to be given. These were nurses teaching the course and over seeing the actual exam. If you did not do it with out errors you did not pass. You were only able to pass when you completed all steps correctly. I don't think the nurses would allow for those to just be certified without being sure that they did it correctly, not only that but I'm sure they weren't willing to put their licesnces on the line. As far as errors, I now work in a Nursing home setting and know that there have been medication errors. I didn't see that we had any more in the other setting.
I didn't feel that because we could administer meds. that we were nurses, just able to assit in an area where there are few nurses and we were able to meet the needs of the residents in these homes.
Families also felt confident in our abilities to be able to give their family members medications that they needed.
I see it as a positive move and could free up nurses to be able to do other things they have been trained to do.

Kristen,
I see by the dates that by the time you read this the pilot test will have been completed. I hope that maybe the results were positive for CMA use.
I am an RN in Oklahoma. I have worked in long term care since 1970, starting as a Nursing Assistant. In Oklahoma Certified Medication Aides have been used in nursing homes for many, many years. It is not a perfect situation, but if we had LPN/LVN's and RN's to fill every position which require licensed nurses there would not be a need for CMA's.  

Just as with nurses there are good, bad and mediocre ones.

We have safe guards in place and the CMA's do not make nursing judgement calls or assessments. They are supervised by and report to the nurses. Essentially they are doing as a family member, or home care giver would be doing, reading an RX label and giving the medication as perscribed.

An RN and a RPh review the MAR's each month and make corrections. The Attending Physician reviews and signs the comphrensive orders each month. The CMA's are required to attend continuing education as well as the initial training and testing. They also receive in-house training.

Medication errors still occur significant and non-significant, but these happen in hospitals too where only nurses and physicians administering.

I hope this makes acceptance of this addition to your healthcare team easier.
Sincerely,
Sandra Adkins, RN,C