Delegation

Delegation means that a person with formal education (such as a nurse or physiotherapist) gives a person without formal education but with real competence (nursing assistant, support worker, personal assistant etc.) the right to perform health and medical care tasks. The most common delegation is about medication management. Delegation can also be about tube feeding, wound dressing, injections, support stockings, special training, catheter management, etc. Delegation of injections such as insulin and anticoagulant injection drugs requires special training and education. Usually it is the nurse who delegates, but it can also happen that for example a physiotherapist delegates certain tasks.

Delegation is a trust assignment and the person who delegates should ensure that the person receiving the delegation understands and can perform the task correctly. This can be done through knowledge tests or by the nurse being present when the task is performed. The person receiving a delegation is healthcare personnel when delegated tasks are performed and is then under the supervision of the National Board of Health and Welfare. One is also obliged to decline delegation if one feels uncertain. The responsibility also includes reporting any deviations and contacting the nurse if something goes wrong.

In some cases, delegation can take place across care provider boundaries, for example from specialist care to a nursing assistant in home care. No one may receive delegation without having the management's approval to perform the task.

Special delegation insulin, tube feeding, etc.

When it comes to, for example, insulin administration and tube feeding, nurses usually provide special education and delegation to a limited number of experienced nursing assistants. Often there is also a knowledge test with a special focus on the delegated tasks included in the delegation.

Other things that may need to be delegated are the use of lifting slings, standing boards and certain other transfer aids, feeding people with particular risks may also need to be delegated as well as wound care and respiratory care.

Delegation of these tasks usually takes place with regard to the healthcare staff's education, experience and basic training to ensure that the tasks are performed in a safe and efficient manner. It is important to follow guidelines for delegation in order to maintain a high standard of care and safety in elderly care. It is often said that the person who is to receive a delegation should be suitable for the task and have an actual (real) knowledge of how the task should be performed and why.

Responsibility and design of delegation training

In municipally funded care, the medically responsible nurse is responsible for ensuring that delegations meet the requirements for patient safety. Each care provider must have documented routines for how delegations are handled in the business.

The Dementia Association, Dementia ABC, provides a web-based film, an educational material for delegation of medication to healthcare staff. The staff can answer questions after watching the film to get a certificate of completed training. The training needs to be supplemented with a review and questions by the responsible nurse, but can serve as a part of the delegation. There are also other actors offering a similar service. Some charge a fee per test.

If something happens that makes the nurse not fully trust the person who has received delegation, the delegation should be withdrawn. A nurse should not feel pressured to give delegation, for example, in the face of summer vacancies. It is important to plan the business so that it works without newly hired substitutes having to receive delegation.

Delegation education

There are many questions that should be addressed in connection with the delegation education.
- How to contact the nurse around the clock.
. How do you measure vital parameters?
- Introduce the SBAR reporting method so that contacts with others are clear.
- What to do if the nurse cannot come and the ambulance needs to pick up a resident, what should be sent with.
- Questions of different types of care hygiene to reduce the risk of infection spread.
- What routines apply when the nursing assistant discovers wounds or skin damage?
- Routines around weight measurement
- How and when not to use gloves in work?

Knowledge test in delegation

Many people today use digital knowledge tests for delegation. Many care providers also have their own knowledge tests. The best is when the nurse sits down with the person to be delegated and goes through the knowledge test to get a clear picture that the delegate understands the requirements set in connection with medication management. Then the knowledge test also becomes part of the delegation education.

The delegation training can also be followed up with further knowledge tests when the delegate has had his delegation for a period. This can then be repeated if deviations occur or there are other reasons to follow up the delegation.

How long does a delegation last

A delegation is valid for a maximum of one year. In practice, this means that it expires the day before the delegation day the following year. The delegation is based on a trust from the person who delegates to the person who receives the delegation. A delegation can therefore be withdrawn immediately, for example in connection with a serious event. The person who has received the delegation can also return it if they assess that the task cannot be performed in a safe manner.

Reflection questions - Delegation
Care staff:
- Have you been delegated any task?
- Was the training you received in connection with delegation good?
- Have you or a colleague ever had a delegation withdrawn?
- Do you put pressure on colleagues and nurses when someone lacks delegation?

Manager, nurse, occupational therapist and physiotherapist:
- Do you ever withdraw delegations?
- Could there be pressure to give delegation to substitutes, for example, before the summer?
- Do you have a uniform training and follow-up of delegated personnel in the unit?

Residents and relatives:
- Do you judge that the nursing assistants receive good further training and supervision from nurses, occupational therapists and physiotherapists?

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day