ADMINISTRATION OF INSULIN IN THE COMMUNITY BY ATTENDANT CARE SUPPORT WORKERS

Transcription

1 Title Purpose ADMINISTRATION OF INSULIN IN THE COMMUNITY BY ATTENDANT CARE SUPPORT WORKERS This guideline is to assist: Attendant care service providers (organisations and individuals), participants, stakeholders and funders Regarding safe and acceptable administration of subcutaneous Insulin in the community by attendant care support workers (support workers). Background Historically Insulin administration was considered the role of a registered nurse. The number of people receiving attendant care in the community continues to grow, and there are limited registered nurses available. It is therefore imperative to address the need of people in the community who require insulin injections who cannot access a registered nurse. ACIA has discussed this issue with the Australian Nurses and Midwifery Federation (ANMF). Whilst the ANMF understands the issue they do not agree with support workers administering Insulin. However, they have been unable to provide a solution when Insulin is required to be administered and a registered nurse is not available. It should be noted that there is no prohibition under the NSW Poisons and Therapeutic Goods Act 1966 and Regulation 2008 for any person administering or assisting in the administration of a medication prescribed by an authorised prescriber and labelled for the patient (participant) by a registered pharmacist. A precursor to the shift in practice and thinking in relation to the administration of Insulin comes from risk analyses performed by government departments such as Family and Community Services NSW and legislation such as various Poison s Acts (that no longer address medication administration in the community). Furthermore the Boarding Houses Regulation 2013 supports the concept that appropriately trained support workers may administer medication to people living in the community. The Boarding Houses Regulation was developed in consultation with NSW Health and applies in respect of the administration, and supervision of the administration, of medications to additional needs residents who are unable to administer medications to themselves or who need supervision or assistance to administer medications. It is now acceptable under certain conditions for support workers with appropriate training and assessment to administer Insulin. This has also been supported by the NSW Health Pharmaceutical Services Unit, Legal and Regulatory Branch with reference made to Employers should be ACIA 011 Administration of Insulin in the Community by Attendant care support workers Page 1 of 7 Copyright Attendant Care Industry Association (Australia) Ltd 2015

2 aware of their employees levels of skill and knowledge and provide the necessary training and support to ensure duty of care is met. Research has also included legislation and reports in all states and territories of Australia including Guiding Principles for Medication Management in Community 2006 (Australian Pharmaceutical Advisory Council) There are many areas where support workers have been administering Insulin where registered nurses are not available. These include the Northern Territory, South Australia and remote communities in Far North Queensland. Whilst it remains best practice for a registered nurse to administer subcutaneous injections (SC) it is considered a low risk area of injectables and is often, when possible, delivered by a participant or family. The risk is very low as there are no significant blood vessels, muscles, ligament or organs that could be damaged in the process. To this end it is considered safe for support workers who have achieved relevant competencies to deliver subcutaneous insulin injections As participant involvement and service direction has increased it is imperative to involve the participant in all aspects of the service delivery and the direction of their services to their ability. It is further acknowledged that dignity of risk is an important part of this choice and control. Disclaimer Definitions and Supporting Information This guideline is provided to help guide best practice in the attendant care industry. This information does not in any way replace legislative, regulatory or contractual requirements. Users of this document should seek appropriate expert advice in relation to their particular circumstances. The Attendant Care Industry Association (Australia) Ltd does not accept any liability on the use of this guideline. Attendant Care means any paid care or support services delivered at a person s home or in their community to assist them to remain living in the community. It targets people of all ages, with ill health or a disability. Attendant care aims to maintain or improve a person s independence and reduce his/her risk of admission to a facility or hospital. This is achieved by providing assistance based on each person s individual needs. It may include nursing care and assistance with all activities of daily living including personal assistance, domestic services, community access, vocational support, educational support, child care services, gardening/home maintenance, respite care, palliative care, social support, therapy program support. Provider means the organisation accountable for the delivery of attendant ACIA 011 Administration of Insulin in the Community by Attendant care support workers Page 2 of 7 Copyright Attendant Care Industry Association (Australia) Ltd 2015

3 care services. Attendant care support worker (support worker) means any person who is employed, hired, retained or contracted by the service provider to provide care or other services. A support worker may also be a sole trader Support Worker Competency means a support worker who has been trained and assessed as competent by a registered nurse or enrolled nurse to safely and appropriately perform a specified task as a support worker. Competent means having been trained and assessed by a registered nurse or enrolled nurse as competent to safely and appropriately perform a specified task. Medication means any substance which is supplied by a pharmacist or doctor, or dispensed by a pharmacist on the prescription of a doctor, or supplied directly by the doctor, and has a label attached to it. The term also includes any over the counter medication or natural therapy products. Participant means the client, consumer or person receiving the attendant care service or support Administration means the act of giving a prescribed therapeutic substance orally, by injection, by inhalation, per rectum, per vagina, topically or enterally and ensuring that the substance has entered the participant s body correctly. Assistance means to give aid to participants in taking their medication by either reminder, prompting or by physical assistance. Registered nurse means a person qualified and registered (current) by the Australian Health Practitioner Agency to deliver nursing supervision and care. Registration should be published on AHPRA Register of Practitioners Supervision and oversight (of the support worker by a Registered nurse) encompasses the broad areas of monitoring of the practice, implementation and administration of Insulin by the support worker; training and assessment of competency of the support worker in relation to administration of Insulin; provision of advice and guidance to the support worker when needed; identification of potential risks, issues and ACIA 011 Administration of Insulin in the Community by Attendant care support workers Page 3 of 7 Copyright Attendant Care Industry Association (Australia) Ltd 2015

4 Scope development of management strategies in relation to administration of Insulin. Supervision and oversight can be provided face to face, by video link, and by phone and as a combination of these. SC means a subcutaneous injection (directly under the skin) These guidelines apply to the administration of Insulin in the community in Australia or Australians visiting overseas with their Australian support workers. Desired Outcome To maintain a quality and safe standard of care To reduce confusion as to when it is appropriate to use trained support workers to administer Insulin to participants in the community Guideline Where all possible avenues of sourcing a registered nurse have been explored and a support worker is trained and deemed competent in administering Insulin to a person in the community (by a Registered nurse). The treating doctor must support the arrangement by completing a written consent that indicates trained and deemed competent support workers may administer the Insulin. The approval to implement individual services in accordance with this Guideline remains at the discretion of the treating doctor. See attached template: Doctors Order for Insulin to be Administered by Support Workers Prior to the decision to allow a support worker to administer Insulin, the service provider should consider and ensure: They understand what circumstances a trained and supervised support worker can administer Insulin (e.g. when a registered nurse is unavailable) That a Risk Assessment of the individual service involving the administration of Insulin by a support worker has been completed by a registered nurse. The service provider also undertakes a Risk Assessment to ensure adequate governance for this level of service. For example, insurance, staff qualifications, clinical supervision That a registered nurse has developed a written procedure for administration of Insulin by a support worker to the participant That the treating doctor has been given this guideline on administration of Insulin by support workers in the community ACIA 011 Administration of Insulin in the Community by Attendant care support workers Page 4 of 7 Copyright Attendant Care Industry Association (Australia) Ltd 2015

5 That the treating doctor who prescribed the Insulin to the participant has agreed in writing to support the arrangement of a trained and supervised support worker administering Insulin to the participant (the provider may choose to use the attached Doctors Order for Insulin to be Administered by support workers letter) The procedure and doctors approval is attached to medication order and retained in the home of the participant with a copy retained by the service provider They recognise consumer directed care and dignity of risk A registered nurse provides support and supervision of the participants program and Insulin administration (that in circumstances of regional and remote service delivery may be managed via Skype, telephone etc). Support workers involved in the administration of Insulin should: Resource documents Have access to the provider s Insulin Administration policy and procedures and the medication orders and doctors authority to administer Be trained and assessed in all aspects of subcutaneous injection by registered nurse or diabetes nurse educator prior to administering Insulin Undergo a period of practical supervision by the registered nurse until they are satisfied of the support workers competency to administer insulin independently Undergo continuous education in order to maintain this competency ACIA Guidelines 002 Provision of Paid Attendant Care and Nursing in the Community ACIA Guidelines 004 Administration of Oral Medications in the Community ACIA Guideline 011 Administration of Insulin in the Community by Attendant Care Support Workers ACT The Drugs of Dependence Act 1989 SA Controlled Substances (Poisons) Regulation 1996 TAS Poisons Regulation 2002 NT Poisons and Dangerous Drugs Act 1983 QLD Health (Drugs & Poisons) Regulation 1996 VIC Drugs, Poisons & Controlled Substances Act 2004 ACIA 011 Administration of Insulin in the Community by Attendant care support workers Page 5 of 7 Copyright Attendant Care Industry Association (Australia) Ltd 2015

6 Guiding Principles for Medication Management in Community 2006 (Australian Pharmaceutical Advisory Council) Guiding principles for medication management in residential aged care facilities October 2012, Department of Health and Ageing, Australian Government Medication Support and Administration Policy WA HACC Program and Office of the Chief Nursing Officer, Department of Health WA ACIA 011 Administration of Insulin in the Community by Attendant care support workers Page 6 of 7 Copyright Attendant Care Industry Association (Australia) Ltd 2015

7 DOCTORS ORDER FOR INSULIN TO BE ADMINISTERED BY SUPPORT WORKERS AS PER THE PROVIDERS INSULIN GUIDELINES Date: Patient Details Name: DOB: Address: To Whom It May Concern This is to certify that in accordance with the Service Providers Guideline on the Administration of Insulin in the Community by Attendant Care Support Workers, I consent for support worker/s who have been comprehensively trained and signed off as competent by a Registered nurse, to administer insulin as per my Medication Order that is in place. Doctor s Details Name: Provider number: Phone number: Stamp: OR Doctor s Signature: