Unlicensed personnel administering medications to older persons living at home : a challenge for social and care services

BACKGROUND: Administration of medication to care recipients is delegated to home-care assistants working in the municipal social care, alongside responsibility for providing personal assistance for older people. Home-care assistants have practical administration skills, but lack formal medical knowledge. AIM: The aim of this study was to explore how home-care assistants perceive administration of medication to older people living at home, as delegated to them in the context of social care. METHODS: Four focus groups consisting of 19 home-care assistants were conducted. Data were analysed using qualitative content analysis. RESULTS: According to home-care assistants, health and social care depends on delegation arrangements to function effectively, but in the first place it relieves a burden for district nurses. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among home-care assistants about the content of the statutes of delegation. Accepting delegation to administer medications has become an implicit prerequisite for social care work in the municipality. CONCLUSIONS: Accepting the delegation to administer medication was inevitable and routine. In practice, the regulating statute is made subordinate and consequently patient safety can be threatened. The organisation of health and social care relies on the delegation arrangement to meet the needs of a growing number of older home-care recipients. IMPLICATIONS FOR PRACTICE: This is a crucial task which management within both the healthcare professions and municipal social care needs to address, to bridge the gap between statutes and practice, to create arenas for mutual collaboration in the care recipients' best interest and to ensure patient safety.

EXPOSURE OF PHARMACY PERSONNEL TO ANTINEOPLASTIC DRUGS

This dissertation consists of two parts: (1) Exposure of pharmacy personnel to antineoplastic drugs. The Salmonella reversion test was used to measure the mutagenic activities of urine concentrates from individuals preparing antineoplastic drugs for intravenous administration. Longitudinal studies were performed in which the total urine produced in 24-hour periods was collected, starting on a Sunday at 7 P.M. after a duty-free weekend and extending over an eight-day period. There was no detectable increase in mutagenic activity in the urine concentrates of three pharmacy administrators who had no contact with these drugs. All six individuals admixing drugs in open-faced, horizontal laminar flow hoods displayed a two-fold increase in mutagenesis by the fourth day with peak values of 2.7 to 24-fold occurring on days five and six, reduced values by day seven with a return to the spontaneous level by day eight. When four of the six positive individuals in the preceding experiment admixed comparable amounts of antineoplastic drugs in a closed-faced, vertical laminar flow hood, no increase in mutagenic activity was detected in their urine concentrates over the eight-day period. (2) Estimate of potential carcinogenic risks of antineoplastic drugs. Excision repair is the major repair system that is involved with the elimination of chemically induced DNA (deoxyribonucleic acid) lesions. This DNA excision repair capability increases in mammalian species with longer life span such as humans. In this study, the effect of functional DNA excision repair on the mutagenesis invoked by 17 antineoplastic drugs was determined by using a Salmonella/Microsome assay which was expanded to include some uvr('+) counterparts of the excisionless (uvrB) tester strains routinely employed. Although extrapolation cannot be made from bacteria to humans, one should be able to make a qualitative comparison as to which antineoplastic drugs are more potentially carcinogenic to humans based on the effects of excision repair on their mutagenesis in bacteria. The tested antineoplastic drugs were divided into three classes: those requiring excision repair for mutagenesis; those producing nonrepairable genetic damage; and those producing mostly repairable premutational DNA lesions. ^

Estimates and projections of Black and Hispanic personnel in selected health professions, 1980-2000.

Item 507-J-1

A report on public and community health personnel : prepared for the Committee on Interstate and Foreign Commerce, House of Representatives and the Committee on Labor and Human Resources, United States Senate, as required by section 793 of the Public health service act

"December 7, 1979."

Manual for police traffic services personnel performance evaluation system. Supervisor's guide.

Mode of access: Internet.

Manual for police traffic services personnel performance evaluation system. Management and implementation. Volume I.

Mode of access: Internet.

Public health personnel in the United States, 1980 : second report to the Congress of the Secretary of Health and Human Services as required by section 793 of the Public Health Service Act.

Mode of access: Internet.

Nursing personnel in hospitals : 1972 survey of hospitals registered with the American Hospital Association.

"Health manpower references."

Staff training for personnel in institutions for juvenile delinquents; report of a workshop

"Sponsored by Children's Bureau ... in cooperation with: the Council on Social Work Education, Rutgers University, Graduate School of Social Work, National Association of Training Schools and Juvenile Agencies [and] National Probation and Parole Association."

Occupant protection systems: lesson plans and instructor's guide for EMS personnel.

Mode of access: Internet.

Decentralization of the Area Health Education Center program : orientation of regional personnel, Dallas, Texas, Sheraton-Dallas Hotel, February 20 and 21, 1974.

Mode of access: Internet.

Report to the President and Congress on the status of health personnel in the United States

Mode of access: Internet.

Police traffic services personnel performance evaluation system. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Analyses of demographic, attitudinal and behavioral characteristics of participants in the diagnostic inspection demonstration projects. Volume III - perceptions of repair industry and Auto/SEE staff personnel.

National Highway Traffic Safety Administration, Washington, D.C.

Helping bereaved children : a booklet for school personnel /

Mode of access: Internet.