Medication aide proposal set to go before lawmakers

Bill touted as filling staffing gap, lowering costs, but opponents fear for patient safety

Email | Print By Walker Duncan

A bill winding its way through the Tennessee State Legislature aims to expand the number of providers caring for the elderly has drawn support as well as some vocal detractors.

The bill, sponsored by State Rep. Debra Young Maggart (R-Hendersonville), seeks to create a new class of care providers called medication aides who will be able to administer certain medications to patients in nursing homes. The senate version of the bill, which is sponsored by Diane Black (R-Gallatin) and Charlotte Burks (D-Monterey), was amended to state that an aide will be allowed to administer medication under the supervision of a licensed nurse rather than a registered nurse.

The senate bill stipulates that aides can “only administer medication after each resident is evaluated by a licensed nurse on admission and after any change in status or acuity or any change in medication and the licensed nurse makes a determination that it is appropriate.”

The requirements for applicants outlined in the bill include a high school education or equivalence, one year of experience as a nurse’s aide in a nursing home and the taking of course work and a standardized exam.

If lawmakers pass the bill, Tennessee would join about 30 other states in licensing medication aides. The need for such employees has been widely noted in various circles: An aging population and shrinking nursing ranks put increased strain on the existing RNs and LPNs in senior care settings.

Maggart said her bill is about "getting the nurse out from behind the med cart, giving them more time for direct care." Doing this, she hopes, will lead to a reduction in errors as the medication aides take the onus of delivering standard medications, giving the nurses more time to focus on other patient issues.

Maggart added that many medication errors are committed by nurses are a result of their being overextended under the current set up. She hopes her bill "will cut down on errors."

Proponents also point out that medication aides will deliver care at a lower cost. While not directly addressing the medication aides issue, a member of a recent Nashville Health Care Council panel noted that the delegation of care from higher-echelon providers to people below them — doctors to RNs and RNs to LPNs — is likely to become more prevalent as providers seek to deliver more care with an eye on cost efficiency.

Some observers, however, are less enthusiastic about the type of provider the bill creates. Nursing groups from around the country have spoken out against efforts to license medication aides, most of them saying their training requirements aren’t adequate for a job so crucial to patients.

“This is not a turf issue. It’s a safety issue,” said State Rep. Joanne Favors (D-Chattanooga), who has a master’s degree in nursing administration.

Favors says the proposed bill will lower the level of nursing care. Among the factors she cites are the number of deaths caused by medication errors nationwide as well as the sheer number of medications currently in use. The U.S. health care system utilizes thousands of drugs, she says, and the level of training the aides will receive is simply not enough to handle the volume of knowledge they will need to avoid contributing to medical-error statistics that already are on the rise.

Nationwide, hundreds of thousands — the number varies in lower end of this range depending on the source — of deaths occur each year from medical errors, many of them stemming from improperly prescribed or administered medications. Year over year, those figures have continued to rise.

“I am frugal,” said Favors before reiterating, “but this is a safety issue.”

According to the State of Tennessee’s Web site, the bill has been placed on the calendar for the budget subcommittee of the Finance Ways & Means committee. That group is set to discuss the matter Wednesday.