Home care aides in the administration of medication

To assess to what extent home care aides (HCAs) within the social services are engaged in medication administration, including their knowledge of how to perform this work correctly, and also to assess their knowledge of pharmacology, adverse drug effects, diseases, and symptoms. Furthermore, we wanted to study if there were any changes to be seen in these areas since a previous study.

A repeated survey, carried out in 1998, 5 years after a cross-sectional study. In a stratified sample of personnel within the social services in nine of Malmö's (Sweden) 10 administrative districts, a questionnaire with multiple-choice and open-ended questions was answered individually and under supervision. Statistical analyses were carried out using the chi-square test, except for logistic regression where odds-ratios were presented.

Employees (341) within the social services in the municipality of Malmö, of whom 313 were HCAs and 28 were supervisors, most of whom also were HCAs, at a total of 36 workplaces. The study 5 years earlier included 393 employees, of whom 39 were supervisors and 354 were HCAs.

Where possible, the answers in the knowledge test were classified as 'correct', 'partially correct' or 'erroneous', or were assigned to the group 'do not know/have not answered'.

Most (95%) of the HCAs were engaged in medication administration. On average, 53% managed to give a correct or partially correct answer on questions concerning medication administration. The result concerning indications for common drugs was 55%, contra-indications and adverse drug effects 25%, and symptoms 59%. Some general improvements in knowledge were seen from 1993 to 1998, mostly in the area of medication administration, but the results also indicated a change for the worse in the area of indications for common drugs.

Although most HCAs are engaged in medication administration, to a great extent they lack knowledge in the area. There is a need for additional personnel with the appropriate professional background, i.e. registered nurses, and a need for further training of HCAs in order to ensure patient safety. With respect to this, issues of learning and quality improvement are discussed.