Unlicensed Assistive Personnel (UAPs) and Medication Administration

• Unlicensed assistive personnel or UAPs are utilized in a variety of healthcare settings. They help fill in the gaps and provide support to other healthcare professionals.  
• Federal and state requirements outline the scope of practice of UAPs and work under the delegation of RNs or LPNs. 
• Medication administration is an often an area where UAPs can assist. This article examines key aspects of successful medication administration by UAPs. 

Unlicensed personnel are employed in diverse settings and are required to follow the federal/state requirements and accreditation standards set forth by an organization when delegation of tasks and medication administration have been delegated by a Registered Nurse (RN) or Licensed Practical Nurse (LPN).   

In these various settings, the question has been asked many times if unlicensed assistive personnel (UAP) should be allowed to administer medications that are delegated to them by licensed nurses and if so, what are the proper ways to do so?   

The North Carolina Board of Nursing (NCBON) and other boards of nursing in various states allow unlicensed assistive personnel to administer medications under the delegation of a Registered Nurse (RN) and/or licensed practical nurse (LPN).   

The main questions to be considered when dealing with medication administration among unlicensed assistive personnel involving RN/LPN delegation and medication administration. 

A series of studies conducted suggest that unlicensed assistive personnel can safely administer medications as long as strict compliance is followed with state regulations, adequate training is received and adhered to, and adequate supervision is provided by the registered nurse (Budden, 2012).   

However, it is important to note that tasks should not be delegated to UAP’s if the patient is “medically fragile”.  Tasks should only be assigned if the task needed is low risk, has a predictable outcome, and does not require assessment according to Joyce Fitzpatrick in Encyclopedia of Nursing Research (2017). 

Even though each organization is required to have policies and job descriptions pertaining to specific UAPs’ responsibilities, the ultimate accountability bears on the RN and/or LPN.  

It is imperative that the RN/LPN be cognizant of the education, training, and experience of the UAP, and assess competency in the specific tasks.   

Delegation of UAPs by RNs/LPNs

Responsibilites of RN Delegation

In any type of delegation between a RN and UAPs, it is imperative that the RN maintains overall responsibility and accountability in relation to the capabilities of UAP.  These include the following: 

• Validation of qualification of the UAP – ensuring the credentials of the UAP are currently active with no restrictions 
• Knowledge of the UAP in relation to the procedure/task being delegated by the RN 
• Competency in skills of the procedure/task being delegated by the RN 

All of these must be in place and confirmed BEFORE delegation begins in order to ensure that proper delegation is being delivered by the RN with appropriate ongoing supervision, teaching, and evaluation.    

Responsibilities of LPN Delegation

The LPN must also be accountable for his/her decisions to delegate technical tasks of medication adminisration to UAP and must do the following: 

• Validate competency of the UAP 
• Monitor the performance of the UAP by ensuring that medication administration is being conducted within the standards of practice  

The LPN must ensure that all laws, standards, policies, procedures, and rules are being applied to each specific practice setting.   

Keys to Successful Medication Administration by UAPs

The key to having successful UAPs administer medications without an increased number of medication errors seems to correlate with how well the staff members have been trained.  Each individual facility can choose how to train their staff regarding medication administration practices, and this is the number one way to ward off an alarming high number of medication errors.   

In a single-state survey conducted of UAPs employed in 45 different facilities, 52% of these facilities were found to have inadequate medication administration training (Carder & O’Keeffe, 2016).   

It is important to note the relevance of this statistic and allows one to realize how the fundamental source to decrease medication errors among the unlicensed personnel is to ascertain that a strong and qualified medication training program is in place.   

Likewise, it is imperative that involvement from the RN/LPN is in place and that the training provided is at the appropriate level of a UAP’s understanding.   

Even though each organization can formulate their own training requirements and the program used among its staff, training and oversight are two of the most successful strategies in meeting this important goal among unlicensed assistive personnel. 

Criteria needs to be in place to ascertain that medication safety is understood fully and is being utilized in the proper way by unlicensed staff in an effort to make sure that correct procedures are being followed.  Strict compliance with state regulations, adequate education, supervision, and proper duties need to be in place for the UAP’s role to function safely.

Medication Error Prevention

The following strategies have also been effective in preventing medication errors among various settings and should be implemented: 

• Ensuring the 6 rights of medication adminisration are followed each time 
• Double checking orders and Medication Administration Records (MARS) with another RN/LPN 
• Using name alerts to help identify similar sounding names  
• Documenting appropriately and accurately  
• Ensuring proper storage of medications 
• Observing a mock medication pass among the delegee to ensure that competency is being maintained 
• Following medication policies, procedures, and regulations that are set forth by each agency and each state 
• Accessibility to drug reference guides should be available at all times
  

The Bottom Line

The utilization of medication management among  UAPs allows for nurses to directly influence the quality of care through supervision and training of UAPs.  The oversight by the RN/LPN is essential in ensuring safety in the medication administration process.   

While it is fundamental to ensure that UAPs are properly administering medications, it is also important for unlicensed personnel to fully understand the consequences and accountability issues for any medication errors. 

The importance of extreme and detailed care in medication administration is always encouraged as individual lives are being impacted each time a medication is given. 

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