The provision of person-centred services to people with learning disabilities requires the consideration of all aspects of the person’s needs and the meeting of these needs in an accessible manner. For a considerable number of people a core aspect of his/her needs is medication management. Services are now delivered in a very different manner than in the past.
Services are moving from settings staffed largely by registered nurses, to home-, community-, and work-based services staffed by a variety of people. This service model change means that issues such as medication management require the input of people from a range of backgrounds including the individual him/herself, family members, nursing staff, home-care staff, workplace supervisors, social care workers, care staff and others. This raises questions about how well equipped these people are to take on the responsibility of managing medication, and to ensure this is done effectively, safely and in the interest of the person with a learning disability. With this in mind, specific focus needs to be placed on the training needs of:
- service users
- nursing staff, and
- non-nursing staff.
Training of service users and families
Promoting independence and self-sufficiency in terms of medication management is a crucially important life-skill for a person to acquire if they are capable of self-administering medication. Equipping the person with skills in monitoring the effectiveness of his/her medication, adverse reactions to the medication prescribed and identification of problems—such as medication regime times and access to support when required— is hugely important in terms of independence, empowerment and autonomy. At present, training on medication management is often delivered by services to service users and is linked with ongoing assessment of the person’s ability to continue to self-administer his/her medication, but this is largely dependent on the individual staff member in place and the specific resources available to staff, and it is not available in all services. A more substantial, comprehensive approach is necessary nationally to promote self-administration of medication by people with learning disabilities.
The training of families in medication management is largely ad hoc, and very often it is dependent on the goodwill of the team and individuals involved. Families provide the backbone of support to people with learning disabilities and often face significant expectations in terms of being knowledgeable with regard to all aspects of their family member’s needs. Supporting families by providing education on the medication their family member requires is likely to:
- increase knowledge of medication and the conditions for which it is used,
- improve medication compliance,
- improve the effectiveness of medication monitoring,
- reduce medication errors,
- enhance family confidence, and ultimately
- benefit the person with learning disabilities.
Training of nursing staff
Nursing staff have had, and continue to have, a considerable role in medication management in services for people with learning disabilities. Nursing staff undergo considerable education regarding medication management during their initial training, equipping them to comprehensively manage medication upon qualification. In addition to this, nursing staff are required to maintain their knowledge and skills in line with their Code of Practice. In this regard ongoing medication management updates for registered nurses are important for promoting best practice and highlighting areas of development—such as medication aids, changes in medication types and routes of administration etc. Issues such as swallowing difficulties, medication errors and covert administration of medication can prove challenging in clinical practice and are also covered in update training programmes.
An area for potential development is the active involvement of registered nurses in the delivery of training to others involved in medication management. The nurse’s background in medication management and health/ill health places him/her in an ideal position to lead the training of others. This approach has been applied in a number of other countries, where the trainer-nurses have been required to undertake further training themselves before carrying out this role. Some of the benefits of registered nurses being involved in this way include:
- the utilisation of the professional knowledge, skills and attitude of registered nurses to enhance the training of others
- the customisation of training to service users and services, by staff familiar with the person’s needs and abilities and the organisational policy
- the ability of the nurse to underpin the training with relevant and useful examples drawn from extensive experience in medication management
Training of non-nursing staff
Medication management in a number of services in Ireland requires the administration of medication and provision of support by staff who are not registered nurses. Staff may not have had specific training in medication management. Non-nursing staff may also be involved in medication management in the absence of support of an organisational policy. Clearly, this is not a sufficiently robust response to an important area of service provision. The absence of policy for non-nursing staff involved in medication management results in a lack of clarity on roles and responsibilities. This can potentially impact on the safety of a person using the prescribed medication.
Internationally services for people with learning disabilities vary in how they address the issue of medication management by staff other than registered nurses. In some situations, staff involved in medication management receive no further education regarding their role and responsibilities. However, it is more usual that some form of education and training is provided.
With the overall aim of providing person-centred services, it is important that this must also extend to medication management. If the service user wishes to avail of support from staff other than registered nurses, particularly in the absence of a sufficient number of nurses, the service concerned must be able to vouch for the safety of staff involved in medication management. The starting point for the service is the provision of a comprehensive policy on medication management generally and on the involvement of non-nursing staff in medication administration specifically. A comprehensive system needs to be established within services for the training, support and assessment of non-nursing staff in medication management. A number of services have addressed the issue of non-nursing staff involvement in medication management and have in place a policy and training. The training format can be an in-house programme of varying duration or an external programme.
Joe Wolfe and Associates have provided training to families, services users, and staff (in excess of 2,000 people) over the last number of years and have found that individuals value being well informed with regard to medication management. Feedback from those trained illustrates:
- a genuine enthusiasm to understand their role in medication management,
- an eagerness to understand how to administer medication safely
- an increased awareness of the use of, effects and side effects of medication
- increased knowledge and confidence with regard to medication management generally
- a reduction in medication errors
- improved communication between those involved in medication management
- improvements in organisational policy, and
- a direct impact on the lifestyle choices and opportunities of service users.
Provision of training to families and carers directly is a worthwhile investment, particularly as this training can be specifically designed around a family’s needs. For example, this has been delivered with good effect in supporting families around issues of epilepsy and Stesolid administration, resulting in the ability of families to confidently continue to deliver quality care and support to their family member. The added value for the individual and his/her family and thereby reflecting the individual’s wishes and lifestyle should not be under estimated.
Investment in service-user training also yields results and promotes independence, confidence and, perhaps most importantly, improved health outcomes for the person concerned.
Service policy needs to address the changes in style of service provision and offer support to staff who are involved in medication management in a variety of settings, including the person’s home and workplace, where access to registered nurses may be limited. Training needs to harness the knowledge, skills and experience that nursing staff bring to this area.