Persistent workforce shortages can hamstring even the most high-functioning skilled nursing facility. Managing medications and ensuring their integrity and proper dosing are no exception. As experts note here, the key to navigating this critical issue is respecting workers and protecting the patients they serve.
1. Identify the key workforce issues that challenge medication management. If unable to hire enough people, at least hire the right people.
“I think one of the most significant challenges in nursing homes is in the hiring and maintaining of certified nursing assistants,” says Chad Worz, PharmD, executive director of the American Society of Consultant Pharmacists. Many states allow CNAs with certain training to participate in medication administration, making them an even more critical part of the team.
But burnout can lead to a litany of errors, says Joe Kramer, vice president of sales, Geri-Care Pharmaceuticals Corp.
“Lack of training and fatigue from increased workloads and overtime shifts all are shortcomings that can cause errors in medication management,” he says.
Marti Wdowicki, PharmD, director of clinical operations-south for PharMerica, adds that achieving good coordination of care is hard when staff is “overwhelmed and inconsistent from turnover.” A consultant pharmacist can streamline things.
“The key to adapting to workforce challenges involves a combination of changing facility practices, standard operating procedures, but also technology, which is where a lot of errors and omissions occur,” adds Stephen Creasy, PharmD, director of clinical services for PharMerica.
Jennifer Hardesty, PharmD, FASCP, chief clinical officer for Remedi SeniorCare, believes staff turnover and more prevalent use of agency staffing means there is an ongoing need for efficient training, and a medication management system “that streamlines the process and minimizes the risk for errors or omissions,” she added.
2. Quickly address issues. Do not let minor problems spread.
“Anytime you have inexperienced or pressed staffing, mistakes can occur, and diversion can become too tempting,” says Worz. “Some assessments like AIMS testing may even be more effective if delivered by the pharmacist since continuity and focus on a medication-related risk falls within their expertise.”
Having standardized processes is another key way to ward off small problems before they grow.
“And it’s not just in how you administer medication, but it’s the entire system — how you’re ordering, how you are storing, how you are administering, but also how you’re documenting,” Creasy says.
3. Always seek a happy medium between punitive and positive reinforcement. Staff need to feel trusted and valued.
“Limiting access to medication may not be the best approach since staff members require the necessary tools to perform their job accurately,” observes Michael Counts, president of Guardian Pharmacy of the Heartland. “Invest time and resources in technology and training as a way to improve medication safety without compromising staff morale.”
Creasy adds that medication safety is a culture. “Everyone should feel comfortable raising their hand and saying, ‘Hey, this happened,’” he says.
4. Develop a list of best practices. “Any way that you can reduce the chaos and have consistent processes in place will reduce the opportunity for adverse events in general, but particularly with respect to medication management,” notes Wdowicki. “Having a process isn’t enough in this culture of staff turnover. We have to reinforce those processes over and over.”
“One good best practice is having pharmacists or pharmacy technicians directly participate in the medication administration and/or monitoring process,” points out Worz.
“Allow a consultant pharmacist to have a seat at the table with your medication management team,” adds Counts. “Other best practices include using smart compliance packaging and barcode technology to guarantee the right medications are given to the right patient at the right time.”
Hardesty has some other points of emphasis.
“Audits or checks by supervisory staff, periodically auditing and tracking the disposition of discontinued controlled substances, reducing overburdensome or unnecessary activities associated with medication administration, and tracking and evaluating med pass data and reports are all great ways to save time and reduce stress on staff,” she says.