Tennessee: Audit finds medication administration rules, penalties lacking

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The board licensing the 291 assisted living communities in Tennessee needs to clarify its rules and regulations related to medication administration — and strengthen penalties for violating those rules, according to the recently released findings of a performance audit conducted by the state comptrolller's office.

The Board for Licensing Health Care Facilities currently allows unlicensed staff members to administer medications because the rules are unclear and penalties for rule violations are "insufficient," according to the November report (PDF). It recommends that the board "clearly describe licensed medical practitioners (e.g., registered nurses or licensed practical nurses) as the only individuals qualified to administer medications, including assisting in administering medications, in assisted-care living facilities."

Residents are exposed to unnecessary health risks, and communities could be legally liable if unqualified staff "harm, or appear to harm" residents, the auditors write.

Legislators also may wish to amend state law to clarify the issue, the report says. State law currently requires that medical services in an assisted living community be provided by "appropriately licensed or qualified staff or contractors of the assisted-care living facility, a licensed home health care organization, another appropriately licensed entity, or by the appropriately licensed staff of a nursing home, acting within the scope of their respective licenses."

The penalty for violating the current rule is a maximum of $500 for the first offense and up to $1,000 for the second offense in a 12-month period, and the state's Office of Health Care Facilities maintains that many communities appear to prefer to pay the fines rather than hire higher-paid, licensed staff, such as registered nurses, to administer medications. Therefore, "[t]he board should develop a set of penalties that effectively deters assisted-care living facilities from using unqualified staff to administer medications," the report recommends.

The Board for Licensing Health Care Facilities says it will bring the matter before its Assisted Care Living Facility Standing Subcommittee, which may suggest potential modifications to the rules and regulations.

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