Tuesday, June 14, 2011

PSWs; Scope of Practice

Do you want your loved ones to be administered medication by someone who has just cleaned a toilet? Someone hired off of the street, with no education in the standards of personal support work (PSW) education, standards of care, lifting and moving residents, changing bedding with the resident in the bed?

There are many PSWs who have had 1 or 2-year courses, upgrading, excellent nursing supervisors; many others who have little in the way of education and training.

I was leaving a volunteer assignment, in a retirement home, looking for the aide who had been giving meds to my client, and another resident told me they were likely upstairs cleaning toilets.

Despite a complaint to the OCRA, the organization that accredits this home, they said that if I've told the family (with Power of Attorney) about this resident's condition, and my belief of neglect, they have no role in the situation. Dirty clothes, an inability to find the personnel to feed him lunch (hence my visits), a PSW making medication decisions, being in pain, unable to move, letting him lay in bed all day. This home has a bad reputation in the community.  They have told the family they can care for him. They CANNOT. The family doesn't understand end-of-life care. I sat with this man for 5 hours two days in a row. The physician who saw him, after I begged the family to intervene, said he was no worse than when they saw him the day before.

PSWs are known in the government as unregulated healthcare providers (UHP). Is this good enough for our family members? For veterans who have served our country? No nurse visited him all the time I was there.

It happens all the time. People hired off of the street, with a grade 12 education, are given the task of providing intimate care of seniors throughout North America.

In some long-term care homes (governed by the Ministry of Health & LTC Act) and retirement home (governed by the landlord/tenant act) housekeeps are given the task of dispensing and delivering medications.

My sources tell me that narcotics were being dropped on a residents bedside table...and the resident did not take the meds in front of the PSW. They don't know who got the medication, or whether it was taken by the resident, especially if you see three other doses sitting in cups on a window ledge or table. 

According to OPSWA.com,
"PSWs are not allowed to go beneath the skin or give suppositories, injections, etc. "

This is beyond their Scope of Practice.

 'HPRAC was told that, in a number of cases where PSWs were doing work within the scope of practice of  RNs and RPNs, this work was being performed under delegation or supervision.  

However, HPRAC also heard concerns that the supervision may not always be adequate'
(See: www.ocsa.on.ca/userfiles/PSW)-FinalReportSept27-06.pdf

 Administer Medications | Meds

For a newly trained PSW just out of school administering meds is beyond the basic scope of practice. Employers will try to get around this by 'training' ...

This is the reason why we need better training, continuing education, and experienced workers. This is why retirement homes need to be better regulated.

The responsibility for delegation and supervision of controlled Acts rests with the RN/RPN.  I recommend reviewing the following publications from the College of Nurses’ of Ontario, as they will allow you to interpret whether appropriate delegation and supervision occurs with respect to your duties in the future:

·         Medication
·         Working with UCPs
·         Utilizing UCPs

Administration of medication by an unregulated care provider (UCP) 
Technological advances, shorter hospital stays, fiscal constraints and a general shift to community-based care have contributed to the increased use of UCPs to assist with or perform aspects of care, including medication administration, that were formerly provided by regulated care providers. Nurses may teach UCPs medication administration, including the process of administration and documentation, as required. Although administering by some routes is not a controlled act and doesn’t require delegation, there is still a risk of harm when performing any procedure if it is not done competently.

The nurse remains responsible for the:
■ongoing assessment of the client’s needs;
■plan of care in conjunction with the health care team;
■evaluation of the client’s health status; and
■effectiveness of the medication(s).

UCPs do not have the knowledge to provide this component of the plan of care. If the nurse
decides it is appropriate for the UCP to administer medication(s), the nurse is accountable to ensure
criteria are developed and communicated to the UCP that clearly define when the UCP needs to
contact the nurse. The nurse must make provisions to ensure an ongoing assessment of the client’s condition.

The nurse should:

g)  ensuring that the client receives appropriate monitoring during and after administering the 
medication, and intervening if necessary.

This simply isn't happening in all locations.

Worker charged in death of Pickering nursing home resident

PICKERING -- Criminal charges have been laid against a worker at a Pickering nursing home after a 91-year-old resident died of complications from an injury sustained in a fall.

Durham police launched an investigation into events at the Community Nursing Home on Valley Farm Drive after a relative of the resident contacted them about the woman's injury. The senior died April 4, police said.

Diane Peck, 34, of Pickering is charged with criminal negligence causing death and failure to provide to a person under charge the necessities of life.
Sgt. van Rooy confirmed Community Nursing Home is the same institution from which a 68-year-old man went missing in April. The man, who uses an electric wheelchair, was reported missing at 10 p.m. March 27, and was located the following day at a motel in Whitby.
According to information on its website the home is operated by Community Lifecare Inc. An administrator at the home could not be reached for comment.

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