title: Evaluation of a support worker role, within a nurse delegation and supervision model, for provision of medicines support for older people living at home: the Workforce Innovation for Safe and Effective (WISE) Medicines Care study.
abstract: BACKGROUND
  Support with managing medicines at home is a common reason for older people to receive community nursing services. With population ageing and projected nurse shortages, reliance on nurses may not be sustainable. We developed and tested a new workforce model: 'Workforce Innovation for Safe and Effective (WISE) Medicines Care', which enabled nurses to delegate medicines support home visits for low-risk clients to support workers (known as community care aides [CCAs]). Primary study aims were to assess whether the model increased the number of medicines support home visits conducted by CCAs, explore nurses', CCAs' and consumers' experiences with the CCAs' expanded role, and identify enablers and barriers to delegation of medicines support.
  
  
  METHODS
  A prospective before-after mixed-methods study was conducted within a community nursing service that employed a small number of CCAs. The CCAs' main role prior to the WISE Medicines Care model was personal care, with a very limited role in medicines support. CCAs received training in medicines support, and nurses received training in assessment, delegation and supervision. Home visit data over two three-month periods were compared. Focus groups and interviews were conducted with purposive samples of nurses (n = 27), CCAs (n = 7) and consumers (n = 28).
  
  
  RESULTS
  Medicines support visits by CCAs increased from 43/16,863 (0.25 %) to 714/21,552 (3.3 %) (p < 0.001). Nurses reported mostly positive experiences, and high levels of trust and confidence in CCAs. They reported that delegating to CCAs sometimes eliminated the need for duplicate nurse and CCA visits (for people requiring personal care plus medicines support) and enabled them to visit people with more complex needs. CCAs enjoyed their expanded role and were accepted by clients and/or carers. Nurses and CCAs reported effective communication when medicine-related problems occurred. No medication incidents involving CCAs were reported. Barriers to implementation included the limited number of CCAs employed in the organisation and reluctance from some nurses to delegate medicines support to CCAs. Enablers included training and support, existing relationships between CCAs and nurses, and positive staff attitudes.
  
  
  CONCLUSIONS
  Appropriately trained and supervised support workers can be used to support community nurses with providing medicines management for older people in the home care setting, particularly for those who are at low risk of adverse medication events or errors. The model was acceptable to nurses, clients and carers, and may offer a sustainable and safe and effective future workforce solution to provision of medicines support for older people in the home care setting.
authors.affiliation: Royal District Nursing Service, RDNS Institute, 31 Alma Road, St Kilda, Victoria, 3182, Australia. clee@rdns.com.au.|Monash University Centre for Medicine Use and Safety, 381 Royal Parade, Parkville, Victoria, 3052, Australia. clee@rdns.com.au.
authors.forename: Cik Yin
authors.initials: CY
authors.lastname: Lee
authors.affiliation: Royal District Nursing Service, RDNS Institute, 31 Alma Road, St Kilda, Victoria, 3182, Australia. cbeanland@rdns.com.au.
authors.forename: Christine
authors.initials: C
authors.lastname: Beanland
authors.affiliation: Royal District Nursing Service, RDNS Institute, 31 Alma Road, St Kilda, Victoria, 3182, Australia. dgoeman@rdns.com.au.|Monash University, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Commercial Rd, Prahran, Victoria, 3004, Australia. dgoeman@rdns.com.au.
authors.forename: Dianne
authors.initials: D
authors.lastname: Goeman
authors.affiliation: Royal District Nursing Service (Koonung), 690 Elgar Road, Box Hill, Victoria, 3129, Australia. ajohnson1@rdns.com.au.
authors.forename: Ann
authors.initials: A
authors.lastname: Johnson
authors.affiliation: Austin Health Aged Care Services, P.O. Box 5444, Heidelberg West, Victoria, 3081, Australia. juliet.thorn@austin.org.au.
authors.forename: Juliet
authors.initials: J
authors.lastname: Thorn
authors.affiliation: Monash University Centre for Medicine Use and Safety, 381 Royal Parade, Parkville, Victoria, 3052, Australia. skoch@rdns.com.au.
authors.forename: Susan
authors.initials: S
authors.lastname: Koch
authors.affiliation: Monash University Centre for Medicine Use and Safety, 381 Royal Parade, Parkville, Victoria, 3052, Australia. rohan.elliott@monash.edu.|Austin Health, Pharmacy Department, P.O. Box 5444, Heidelberg West, Victoria, 3081, Australia. rohan.elliott@monash.edu.
authors.forename: Rohan A
authors.initials: RA
authors.lastname: Elliott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel / Q000458:organization & administration*; D017028:Caregivers; D005260:Female; D017144:Focus Groups; D006699:Home Care Services; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D008962:Models, Theoretical; D009726:Nurses; D011446:Prospective Studies; D012111:Residence Characteristics; D012648:Self Care