Defining medication reconciliation as a task to be performed specifically by RNs in nursing home settings could be key to preventing adverse events among residents, according to a recent University of Missouri study.
The study, released Dec. 14, found RNs are more likely than LPNs to discover high-risk medication discrepancies. Researchers concluded RNs might be better prepared to identify medication errors that could be harmful to patients, the study said. A common safety measure, medication reconciliation involves healthcare professionals reviewing patient medications to help reduce the risk of adverse drug events. A need may exist in nursing homes to better distinguish between RN and LPN responsibilities, according to the study.
“Nursing home work is hard,” Amy Vogelsmeier, PhD, RN, FAAN, associate professor at the MU Sinclair School of Nursing, said in a University of Missouri-Columbia press release. “The ability to manage patients’ care and keep them stable is a clinical challenge that requires highly educated, clinically savvy nurses. Currently, RNs are not functioning in nursing homes to the full scope of their practice. RNs and LPNs are assigned the same responsibilities; yet, earlier research findings show that LPNs are more focused on tasks, whereas RNs are more focused on comprehensive assessment and resident safety.”
Study participants included 32 RNs and 70 LPNs from 12 nursing homes in Missouri. Researchers cited recent data showing that 37% of adverse events, such as falls, bleeding, delirium, hallucinations and hypoglycemic episodes in skilled nursing facilities, were tied to medication use. They also noted that nearly 66% of those events were deemed preventable partly because of inappropriate prescribing or lack of monitoring by staff. Preventable adverse drug-related events stem from errors related to prescribing, documenting, dispensing, administering and monitoring medications, according to the study.
Researchers said RNs have a positive impact on nursing home care, but that many nursing homes have scarce RN resources, according to the study.
Vogelsmeier and her colleagues determined that distinguishing the differences in how RNs and LPNs perform similar responsibilities and making sure nurses complete the tasks for which they are trained could improve patient care for nursing home residents, many of whom are frail and require specialized care.
“RNs and LPNs contribute to resident safety in different ways,” the study’s authors concluded. “Despite these differences, the current nursing home paradigm is to use RNs and LPNs interchangeably. RNs provide a distinct contribution to resident care, including performing assessments and identifying risks of harm, such as high-risk medication order discrepancies during medication reconciliation. However, because RN resources are scarce in most nursing homes, future studies should include an emphasis on maximizing the contribution of the RN and LPN roles during processes such as medication reconciliation. This research could lead to the identification of education and training needs for both RNs and LPNs with an emphasis on collaboration as a means to reduce the risk of harm. Strengthening the skills of RNs and LPNs in this way could go a long way toward improving resident safety.”
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