There is a legal difference in assisting and administering medications for clients that HCAs need to be aware of to ensure they are providing safe care (see Table 12.2.1).  Medication  Assistance support can be described as a range of services provided to support the client in taking medications as directed by the authorized prescriber.  Different levels of support may be provided by different team members working in collaboration according to their scope of practice and role function. While the terms medication assistance and medication administration are sometimes used interchangeably, it is important to differentiate between these terms in order to appreciate the different level of responsibility and accountability between HCAs and regulated nurses (RN, RPN and LPN) when it comes to medication support activities.

Medication assistance is a service provided to clients to ensure medication is taken as intended by the prescriber when the client is assessed as being unable to independently take their own medications safely.  This may include opening packages of medication and providing medications to the client for immediate use. Medication assistance includes a range of activities from verbal reminders to full hands-on assistance and observation. Medication assistance is a task carried out by a nursing professional and may be delegated to an unregulated care provider when it is safe and appropriate to do so. Clients requiring medication assistance recognize the need to take medications and consent to the assistance provided. Clients unable to take their own medications because of cognitive impairment may have medication assistance assigned to an HCA when a clinician has assessed it is safe to do so and when the client does not refuse to take the medications.

Medication administration is the activity of supplying to a client a dose of a medication for the purpose of immediate ingestion, application, inhalation, insertion, instillation or injection. It is more than just the psychomotor task of giving a medication to a client. It is a cognitive and interactive aspect of nursing care and involves assessing the client, making clinical decisions, and planning care based on this assessment. Medication administration requires the knowledge and skills of a nursing professional and is beyond the role of the HCA. The HCA providing medication assistance must be supervised by a regulated nurse. The regulated nurse is also responsible for communicating with other health care team members, including the physician/prescriber and/or the pharmacist.

Team Members Involved with Medication Assistance

Different levels of support may be provided by different team members working in collaboration according to their scope of practice and role function, to support the client’s assessed unmet needs in medication management. When assistance with medication is required, an HCA, the Client and their family, a Physician, a  Pharmacist, a Registered Nurse and/or a Supervisor are all involved in the process.

The HCA is responsible for assisting the client with care tasks that are listed on the Care Plan and DOT Standard Care Plans kept in the  client’s home. As well, the HCA is also responsible for knowing how to document the care they have given and how to communicate any care issues regarding the client or concerns regarding their own abilities to carry out the tasks required.

The Supervisor is responsible to ensure that HCAs are able to complete the requirements of their job. This means the Supervisor is available to all HCAs to help solve problems, answer questions, mentor and teach skills, and provide information to the HCA so that they can successfully complete their work. The Supervisor may be the Registered Nurse or they  consult with the Registered Nurse when a DOT is being considered for a client and help to determine if HCAs have been trained will require training in the tasks that will be needed. If additional training is needed for the HCA, the Supervisor ensures all staff receive training in the task and are competent in the required skills.

The Registered Nurse will meet with the client and possibly their family, to determine what assistance, if any, with the medication will be needed. They are responsible for authorizing the task on the Care Plan, completing a DOT Standard Care Plan if the task is delegated, and for ensuring both these items are left in the client’s home for the HCAs to use. The RN may also be responsible for monitoring the outcome of the drug therapy. The RN ensures the client  and family understand that it will be a HCA assisting with the medication tasks and any limits or possible consequences that may occur as a result if delegation is required.

The Physician is responsible for assessing the client, ordering the  medication, and monitoring of the client’s ongoing health status.

The Pharmacist is responsible for dispensing the medication. The Pharmacist also is responsible for teaching the client/family when and how to take the medication correctly, to understand the desired effects of the medications and to be aware for any possible side effects the client/family should watch for.

In some settings, like home, the Client and their family are responsible for purchasing and obtaining the medication.

Conditions for HCA Involvement in Medication Assistance

Employers are responsible for the assignment of work ensuring HCAs are individually competent to perform the work, regardless of their educational background or work experience. Health Care Assistants are responsible for identifying when they do not have the required knowledge/skill to perform the assigned task, and to ask for help if they are unsure (Health Quality Council of Alberta (2012). The following four conditions must all be met to support HCA involvement in medication support activities (Health Quality Council of Alberta (2012):

1. HCA job description – must state that medication assistance is included in the HCA roles and responsibilities.
2. Employer policies and procedures – must specifically describe how medication related tasks are to be done safely including the type of medication system used and the types of medications with which HCAs can assist, including use of PRNs. They should indicate approved abbreviations and medical terms, types of forms and documentation, and how  supervision will be carried out.
3. Appropriate HCA education and training – must include the knowledge, skills, and attitudes required to safely assist with medications, and what to do in specific situations.
4. Ongoing supervision – must be provided, whether direct or indirect, from a regulated health-care professional (e.g., RN, RPN or LPN).

Levels of Medication Assistance

The following Table (12.2.2) shows the levels used to identify medication assistance:

When providing medication assistance at Level 1 (reminder), the HCA does not  handle or prepare medication for the client. Therefore, they do not perform the medication rights or perform safety checks.

When providing medication assistant at Level 2 (some/partial assistance) or  Level 3 (full assistance),  HCAs are not required to know the “right reason*” for medication but are required to follow the other critical 6 “rights” and perform medication safety checks.

*Regulated nurses in British Columbia follow the “7 Rights” and perform all three medication safety checks. It is important for HCAs to follow the employer’s policies and guidelines related to medication assistance.