There is a legal and notable difference between assisting with medications and administering medications. HCAs must be aware of this difference and understand the legal limitations of their role with both assisting and administering in order to ensure they are providing safe care.  While the terms medication assistance and medication administration were sometimes used interchangeably in the past, it is important to clearly differentiate between these terms in order to appreciate the different level of responsibility and accountability between HCAs and regulated nurses (RNs, RPNs and LPNs) when it comes to care activities involving medications. Remember, there are two types of care activities.

• Tasks: care activities that HCAs are educated and trained to perform as part of their assigned HCA role. Medication assistance is a task.
• Restricted activities: higher-risk care activities outlined in health professional regulations that an HCA cannot perform without authorization (delegation) by a regulated health professional, such as a registered nurse. Medication administration is a restricted activity.

Medication Assistance

Medication Assistance is a form of support that helps clients take their medication as intended by the prescriber. It is provided to clients who are unable to independently take their medications safely, but who are still able to direct their own care.  Medication assistance includes a range of activities from observation, to verbal reminders, to hands-on assistance. It is a task carried out by a regulated health professional (ie: RN) that may be assigned to an unregulated care provider (ie: HCA). To provide medication assistance to a client, the following criteria must be met:

• the HCA is over the age of 19
• the HCA providing the medication assistance has been assigned the task by a regulated health professional
•  the medication is indicated in the client’s care plan
• the client is able to direct their own care (this means that the client can communicate with the HCA, can consent or refuse to take the medication, and that the client is not confused)

Medication assistance includes the following activities:

• Reminding the client to take their medication
• Reading the medication label to the client
• Providing the medication container to the client
• Opening blister packs or dosettes
• Loosening or removing container lids
• Recapping the device or closing the medication container or bottle
• Placing the medication in the client’s hand
• Steadying the client’s hand while the client places medications in their own mouth or self-administers their own eye drops, nasal sprays, or other medication
• Using an enabler (such as a medicine cup, spoon, or oral syringe) to assist the client in getting the medication into their mouth
• Supervising clients during self-administration
• Providing the client with water or other fluids for rinsing the client’s mouth or to help them swallow medication

Medication Administration

Medication administration is the activity of supplying to a client a dose of a medication for the purpose of immediate ingestion, application, inhalation, insertion, instillation or injection. It is more than just the physical task of handing a medication to a client. It is a cognitive and interactive aspect of nursing care and involves assessing the client, making clinical decisions, and planning care based on this assessment. It also often involves actively moving the medication into the client’s body with either limited or no participation by the client (such as injection and insertion). Medication administration is therefore a restricted activity and requires the knowledge and skills of a regulated health professional, which are outside of the role of the HCA.

In some circumstances, a regulated health professional (a Registered Nurse) who has already performed an assessment on the client may authorize an HCA (through client-specific delegation) to perform a restricted activity, provided that the following criteria are met:

• The restricted activity the regulated health professional wishes to delegate to an HCA is listed within the regulated health professional’s profession-specific regulation. For example, an RN could not delegate an HCA to suture (stitch) a cut on a patient because suturing is not within the RN’s role or regulations. It is a task of physicians.
• The health professional’s regulatory college permits the regulated health professional to delegate that restricted activity. For example, the British Columbia College of Nurses and Midwives does not allows RNs to delegate HCAs to administer intravenous (IV) medications.
• The regulated health professional delegating the restricted activity is sure that the individual HCA has the education, training, and competency to perform the restricted activity with that specific client.
• The HCA is willing to accept the delegation.

The following restricted activities regarding medication administration are taught in the HCA curriculum. However, an HCA could only perform these restricted activities if delegated by a regulated health professional to perform it for a specific client, if the HCA is over the age of 19, and if it is indicated in the client’s care plan:

• Applying a transdermal patch
• Administering prescription ear or eye drops
• Inserting a rectal suppository or enema
• Applying a prescription cream or ointment

Team Members Involved with Medication Assistance and Medication Administration

Different levels of support may be provided by different team members working in collaboration according to their scope of practice and role function, to support the client’s assessed unmet needs in medication management. These team members include the client and their family, a Physician, a Pharmacist and a Registered Nurse. In health care settings such as complex care, assisted living, group homes and home support, it also includes the HCA and Supervisor. The role of each team member is outlined below.

The Physician is responsible for assessing the client, ordering the medication, and monitoring the client’s ongoing health status.

The Pharmacist is responsible for dispensing the medication. The Pharmacist also is responsible for teaching the client/family when and how to take the medication correctly, to understand the desired effects of the medications and to be aware for any possible side effects.

The Registered Nurse will meet with the client and possibly their family, to determine what assistance, if any, with the medication will be needed. For medication administration, the RN is responsible for authorizing the HCA to perform the restricted activity. This is done through a process called client specific delegation. The RN is responsible for ensuring that the HCA has the education, training, and competency to perform the restricted activity with that specific client. The RN ensures the client and family understand the HCA’s role either medication assistance or administration. The RN may also be responsible for monitoring the outcome of the drug therapy.

The Supervisor is responsible to ensure that HCAs are able to complete the requirements of their job. This means the Supervisor is available to all HCAs to help solve problems, answer questions, mentor and teach skills, and provide information to the HCA so that they can successfully complete their work. The Supervisor may be a Registered Nurse or they will consult with the Registered Nurse when care activities such as medication assistance or medication administration are being considered for a client.

The HCA is responsible for assisting the client and completing care activities that are listed on the Care Plans. The HCA is also responsible for knowing how to document the care they have given and how to communicate any issues regarding the client or concerns regarding their own ability to carry out the care activities required.

In some settings, like home support, the client and their family are responsible for purchasing and obtaining the medication.

Additional Conditions for HCA Involvement in Medication Assistance and Medication Administration

Employers are responsible for the assignment of work ensuring HCAs are individually competent to perform the work, regardless of their educational background or work experience. Health Care Assistants are responsible for identifying when they do not have the required knowledge/skill to perform the care activity and to ask for help if they are unsure. The following four conditions must all be met to support HCA involvement in medication management (Health Quality Council of Alberta (2012):

1. HCA job description – must state that medication care activities are included in the HCA roles and responsibilities (either assistance or administration through delegation).
2. Employer policies and procedures – must specifically describe how medication care activities are to be done safely, including the type of medication system used and the types of medications with which HCAs can assist, including use of PRNs. They should indicate approved abbreviations and medical terms, types of forms and documentation, and how supervision will be carried out.
3. Appropriate HCA education and training – must include the knowledge, skills, and attitudes required to safely participate in medication care activities, and what to do in specific situations.
4. Ongoing supervision – must be provided, whether direct or indirect, from a regulated health-care professional (ie: RN).

Levels of Medication Assistance

The following Table (12.2.2) shows the levels used to identify medication assistance:

When providing medication assistance at Level 1 (reminder), the HCA does not handle or prepare medication for the client. Therefore, they do not perform the medication rights or perform safety checks.

When providing medication assistance at Level 2 (some/partial assistance) or  Level 3 (full assistance),  HCAs are not required to know the “right reason” for medication but are required to follow the other critical 6 “rights” and perform medication safety checks.

*Regulated nurses in British Columbia follow the “7 Rights” and perform all three medication safety checks. It is important for HCAs to follow the employer’s policies and guidelines related to medication care activities.