ATLAS eMAR in partnership with Cardiff University, Claremont Court, Ty Ceirios and the Graham Care group of Nursing homes used technology to delegate the task of medicine administration by nurses to carers. The initiative was named the “REMEDY” project (Nurse Delegated Medicines Administration Enabled by Digital Technology).
The inspiration for the project came from Claremont Court and Ty Cerios nursing homes where there were three full time nurses on duty at any one time with most of their time taken up by medicines related activities. The challenge was to see if nurses were able to delegate the medicines administration safely to carers, and free up their time for more clinical activities. This is a model advocated by Care Inspectorate Wales and the Department of Health in England.
Claremont Court and Ty Cerios had already been using Invatech’s ATLAS eMAR and were part of an independent evaluation by Cardiff University that showed that the system eradicated 21 out of 23 possible types of errors on MAR charts. The sister home, Regency House, a residential home with no nursing beds, was also using the ATLAS eMAR where carers administered and managed medicines just as safely as the other homes. The nursing homes worked together with Invatech and made sure the carer’s at Claremont Court and Ty Cerios were trained and competent. After consultation with the regulators a clear method of personal delegation by nurses to carers was put in place.
Challenges and implementation of the model
Initially a governance committee was set up with a remit to monitor the project. it included representatives from the care homes, Invatech Health and Cardiff University who proposed to carry out an evaluation of the project. It was important to ensure that the commissioners and regulators were comfortable with the proposed model of delegation of medicines related activities to carers. Therefore the Health Board, Care Inspectorate Wales and Royal College of Nursing were contacted and invited to contribute and provide feedback on the project. The issues raised was around safety of the system and the process of delegation which had to meet the professional requirements. The safety concerns were resolved by the fact that ATLAS eMAR has previously been evaluated to show it is safe and eradicates 21 out of 23 error types. The process of delegation and the ATLAS Scorecard that nurses use to monitor residents and the performance of carers meant that the model satisfied the professional requirements.
Two meetings were set up to explore the views and concerns of nurses and carers who would be involved in the new ways of working. The biggest topic of discussion was around who would be carrying out the activities of the carer who is now charged with administering medicines. It was agreed that an extra carer would initially be employed to work across the three units in the nursing homes to carry out any personal care that was not able to be covered. After one month this additional carer was not required as the task of medicine administration became part of providing personal care.
Cardiff University carried out an evaluation which comprised of qualitative interviews with all stakeholders before and after the model was implemented as well as a quantitative comparison of nurse and carer administration of medicines. The quantitative comparison also included data from nurses and carers at the Graham Care Group of nursing homes who had also implemented this model. Over 300,000 medicine administrations were compared across 9 homes over a 3 month period. There was no difference between nurses and carers across measures such as “missing entries”, “near misses – system interventions” and “timings of doses”. The qualitative interviews showed perceived improvement in staff morale, nurses focusing on clinical duties, a holistic approach to care, and new opportunities for personal development of carers.
From the care provider perspectives, the use of ATLAS eMAR and the ATLAS Scorecard allowed the equivalent of one full time nurse’s time to be freed up and re-directed to resident care without the need for employing an extra care worker.
The ATLAS eMAR system with its safety features allows nurses to safely delegate the task of medicines administration to carers. The ATLAS Scorecard and the method of personal delegation ensured that nurses met their professional obligation whilst maintaining overall responsibility for the care of the resident. This model produced efficiencies that could be redirected to resident care or be used to produce cost savings or address the challenges of nurse shortages.