Safety is focal point of CMA legislation
An Editorial
by Representative Debra Maggart and Senator Diane Black
May 8, 2009 -- Quality health care for our elderly and disabled citizens who reside in nursing homes in Tennessee is the focal point of legislation that we are sponsoring to allow Certified Medication Aides (CMAs) to administer routine medications to residents. That is why it has received wide bi-partisan support from Democrats and Republicans who know the facts of the bill. The premise of the legislation is to allow CMAs, who will receive training, to administer certain medications to the residents in these homes so nurses are freed up to provide skilled nursing care to patients.
The Senate has already adopted the bill by a vote of 29 to 2. It is currently pending action in the House of Representative’s Government Operations Committee.
Let’s address three key provisions of the legislation to illustrate how the bill puts safety first for these residents. These provisions are: qualifications, medications, and supervision.
Qualifications – The legislation requires that a medication aide must at least be a high school graduate, in addition to being a Certified Nurse Assistant, a position which requires 100 hours of education. They must have worked full-time for at least one year in a Nursing Home or Assisted Living Facility before they apply to the CMA program. The CMA education requirements include completion of an additional 75 hours of instruction focusing on medication provided by a qualified education institution. Twenty-five hours of this instruction must be clinical training before the CMA is allowed to administer routine drugs to residents. This means the aides must complete a total of 175 hours of training before they would be allowed to administer any medications.
Medications -- On medications, the CMAs would be allowed to administer only oral and topical drugs to residents, under the bill. Currently, pharmacists in these facilities fill drawers in a medication cart with the resident’s medicine for that day. The medication drawer containing the resident’s medicine has the person’s name, room number and photo displayed on the outside. The CMA would then take that medication to the individuals and administer it to the resident as prescribed. The proposal does not allow CMAs to administer any controlled substances, injections, feeding tubes, or inhalers.
Supervision -- Close supervision of the CMAs by a licensed nurse is a key component of the legislation to further protect nursing home residents. Licensed nurses must evaluate the resident upon admission to a home or assisted living facility to determine whether or not it is appropriate for them to receive medication by a CMA. This is to make sure that those with acute medical concerns receive a higher skill level by a nurse. If there is any change in the resident’s status, acuity or medications, the licensed nurse would then reevaluate whether or not they should continue to receive medication by a CMA. In addition, the Board of Nursing will promulgate the rules governing this act so they will have every opportunity to make sure adequate safeguards in place.
Twenty other states have implemented medication aide programs. Clinical Nursing Research Studies have found there is no greater incidence of medication errors among medication aides as compared to licensed nurses. This could be because the CMA’s only responsibility is medication administration, thus allowing them to focus on this task without the distractions of other duties which account for most medication errors.
Finally, adding medication aides to the caregiving team in our nursing homes and assisted living facilities will not decrease the level of care providers. In fact, it will increase the ratio of caregivers to residents in these homes. The bill includes language that clearly states that the use of CMAs cannot serve as a reason for a Tennessee facility to reduce its licensed caregiver staff. Facilities are still responsible to make sure that their staffing levels include skilled nurses. The difference is that it will free up these nurses to give the residents a higher quality of care to treat illnesses or medical conditions that so often occur in these homes.
Although there is much misinformation being disseminated by those with political agendas, a careful review of this bill, as amended, shows that the resident’s safety is paramount. Tennessee should adopt this legislation.
We invite you to access the bill and amendment on the General Assembly’s website at: http://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=SB0009
An Editorial
by Representative Debra Maggart and Senator Diane Black
May 8, 2009 -- Quality health care for our elderly and disabled citizens who reside in nursing homes in Tennessee is the focal point of legislation that we are sponsoring to allow Certified Medication Aides (CMAs) to administer routine medications to residents. That is why it has received wide bi-partisan support from Democrats and Republicans who know the facts of the bill. The premise of the legislation is to allow CMAs, who will receive training, to administer certain medications to the residents in these homes so nurses are freed up to provide skilled nursing care to patients.
The Senate has already adopted the bill by a vote of 29 to 2. It is currently pending action in the House of Representative’s Government Operations Committee.
Let’s address three key provisions of the legislation to illustrate how the bill puts safety first for these residents. These provisions are: qualifications, medications, and supervision.
Qualifications – The legislation requires that a medication aide must at least be a high school graduate, in addition to being a Certified Nurse Assistant, a position which requires 100 hours of education. They must have worked full-time for at least one year in a Nursing Home or Assisted Living Facility before they apply to the CMA program. The CMA education requirements include completion of an additional 75 hours of instruction focusing on medication provided by a qualified education institution. Twenty-five hours of this instruction must be clinical training before the CMA is allowed to administer routine drugs to residents. This means the aides must complete a total of 175 hours of training before they would be allowed to administer any medications.
Medications -- On medications, the CMAs would be allowed to administer only oral and topical drugs to residents, under the bill. Currently, pharmacists in these facilities fill drawers in a medication cart with the resident’s medicine for that day. The medication drawer containing the resident’s medicine has the person’s name, room number and photo displayed on the outside. The CMA would then take that medication to the individuals and administer it to the resident as prescribed. The proposal does not allow CMAs to administer any controlled substances, injections, feeding tubes, or inhalers.
Supervision -- Close supervision of the CMAs by a licensed nurse is a key component of the legislation to further protect nursing home residents. Licensed nurses must evaluate the resident upon admission to a home or assisted living facility to determine whether or not it is appropriate for them to receive medication by a CMA. This is to make sure that those with acute medical concerns receive a higher skill level by a nurse. If there is any change in the resident’s status, acuity or medications, the licensed nurse would then reevaluate whether or not they should continue to receive medication by a CMA. In addition, the Board of Nursing will promulgate the rules governing this act so they will have every opportunity to make sure adequate safeguards in place.
Twenty other states have implemented medication aide programs. Clinical Nursing Research Studies have found there is no greater incidence of medication errors among medication aides as compared to licensed nurses. This could be because the CMA’s only responsibility is medication administration, thus allowing them to focus on this task without the distractions of other duties which account for most medication errors.
Finally, adding medication aides to the caregiving team in our nursing homes and assisted living facilities will not decrease the level of care providers. In fact, it will increase the ratio of caregivers to residents in these homes. The bill includes language that clearly states that the use of CMAs cannot serve as a reason for a Tennessee facility to reduce its licensed caregiver staff. Facilities are still responsible to make sure that their staffing levels include skilled nurses. The difference is that it will free up these nurses to give the residents a higher quality of care to treat illnesses or medical conditions that so often occur in these homes.
Although there is much misinformation being disseminated by those with political agendas, a careful review of this bill, as amended, shows that the resident’s safety is paramount. Tennessee should adopt this legislation.
We invite you to access the bill and amendment on the General Assembly’s website at: http://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=SB0009
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