How To Handle A Patient Care Delegation

Transcription

1 GUIDELINE NO: 132 THE COLLEGE OF PHYSICIANS AND SURGEONS OF MANITOBA AND THE COLLEGE OF REGISTERED NURSES OF MANITOBA JOINT GUIDELINE SHARED COMPETENCIES AND DELEGATED PHYSICIAN SERVICES Definitions Agency: Facility or organization where health services are provided (e.g., regional health authorities, hospitals, community health centres, home care programs, etc.) Patient: The recipient of nursing or physician services May be an individual, group, or community Collaboration: Working together to meet a common goal of the provision of safe, ethical and appropriate patient care. Collaboration is characterized by an atmosphere of mutual respect for one another s knowledge and competence, and a mutual concern for the provision of quality care. Competence: The integration and application of knowledge, skills, attitudes and judgement required for provision of safe and appropriate care. Context of Practice: The conditions in which nursing and medicine are practiced, encompassing the patient population, and the availability of appropriate resources. Scope of Practice of Medicine: The Medical Act (1987) defines the practice of medicine as subject to section 2, the carrying on for hire, gain, or hope of gain or reward, either directly or indirectly, of the healing art or any of its branches. 1-G33

2 Scope of Practice of Registered Nurses: The Registered Nurses Act (2001) defines the practice of nursing as the application of nursing knowledge, skill, and judgment to promote, maintain and restore health, prevent illness and alleviate suffering, and includes, but is not limited to, (a) assessing health status; (b) planning, providing and evaluating treatment and nursing interventions; (c) counseling and teaching to enhance health and well-being; and (d) education, administration and research related to providing health services. In accordance with any requirements set out in the regulations of the Act, a registered nurse may do any of the following in the course of engaging in the practice of nursing: (a) order and receive reports of screening and diagnostic tests designated in the regulations; (b) prescribe drugs designated in the regulations; (c) perform minor surgical and invasive procedures designated in the regulations. The College of Physicians and Surgeons of Manitoba and the College of Registered Nurses of Manitoba recognize the need for a flexible and responsive approach to providing health services. Advances in knowledge and technology and rapid changes in health care systems have contributed to changes in the traditional roles of health care professionals. This document is intended to assist registered nurses, physicians and health care agencies make safe, appropriate decisions regarding both the overlapping scopes of practice of physicians and registered nurses and the delegation of physician services to registered nurses. Shared Competencies: The overlap in the scopes of practice of registered nurses and physicians, or shared competencies, are areas of common ability to provide services. Decisions regarding which professionals provide service in areas of shared competency must consider the needs of the patient, individual competencies and the context of practice. This decision-making process recognizes the unique and shared competencies of registered nurses and physicians, and promotes optimal use of their competencies in the interest of patient care. Collaborative decision making, conducted in an atmosphere of trust, respect, and open communication, facilitates coordination and integration of care. It is inappropriate to delegate these shared competencies. Delegated Physician Services: Delegated physician services are those functions unique to the practice of physicians, which can be delegated to registered nurses provided the principles for delegation are satisfied. The decision-making process for delegating services from the physician to the registered nurse is guided by principles that ensure safe, appropriate and ethical patient care. 1-G34

3 Guidelines for Delegated Physician Services: The following principles and guidelines are based on the premise that physicians, registered nurses and agencies are accountable for making patient care decisions that serve the public interest. Patients: The decision to delegate physician services must be driven by the desire to meet the patient needs in the safest, most effective way possible, and must contribute to quality patient care. An assessment of patient needs must include state of health and health problems, level of care, and outcomes (predictability, possible complications). Physicians and Registered Nurses: Physicians and registered nurses are guided by codes of ethics and professional standards. The decision-making process surrounding delegation of physician services must support the accountability of registered nurses and physicians to their professional regulatory bodies. Only those services deemed reasonable by the College of Physicians and Surgeons of Manitoba and the College of Registered Nurses of Manitoba may be delegated to a registered nurse. Both physicians and registered nurses involved in the service must agree to the delegation. The parameters and clinical guidelines for such delegation must be established and well understood by the registered nurse and physician. The delegating physician is accountable for the decision to delegate. By accepting the delegation, the registered nurse is accountable for performing the delegated service competently. The College of Physicians and Surgeons of Manitoba and the College of Registered Nurses of Manitoba will collaborate to: Provide consultation services related to the scopes of practice of physicians and registered nurses. Provide consultation services related to delegated physician services. Competence: Competence requires the integration of knowledge, skills, attitudes and judgement in order to practice safely and ethically. Competence to provide the service must precede delegation of authority to provide the service. Nurses and physicians must meet competency standards for knowledge, skills, attitude and judgement to engage in the delegation of physician services. The physician must possess the required competencies for the particular service in order to delegate the service. The registered nurse must possess the required competencies in order to accept the delegation. 1-G34i

4 Both physicians and registered nurses are accountable for acquiring and maintaining the level of competence required for the provision of safe and appropriate care. Competence is attained through education and practice. Competence is maintained through practice and a commitment to life long learning. Competence is best achieved when there are sufficient opportunities to practice over time. A process must be in place to ensure continued competence. Context: Agencies, physicians and registered nurses share accountability for decisions. Safeguards must be in place to protect patients from incompetent and unethical practice. Physicians and registered nurses are accountable to participate in delegated physician services only if the agency provides: a formal mechanism for collaborative decision making an approval process for delegated physician services. support for meeting standards of care that are consistent with professional competencies and the legislated scopes of practice. mechanisms for monitoring and implementing quality improvement measures that address competent performance of delegated physician services.. Educational Programs for Delegated Physician Services: The required competencies must be identified by the delegating physician(s). The delegating physicians must be satisfied that registered nurses accepting the delegation meet the required competencies. Education consisting of both theory and practice must be provided to the registered nurse(s) accepting the delegation. A registered nurse or physician possessing the required competencies must carry out teaching and evaluation of competence. Re-evaluation of competence must be done at reasonable intervals, dependent on the nature of the service and frequency of opportunity to provide the service. Dated records must be kept denoting the delegating physician(s) and the registered nurses who successfully meet the initial competency requirements, and the re-evaluation of competency. Evaluation: Re-evaluation of the delegation decision needs to be carried out periodically to determine the appropriateness of all of the components. This process should address changes in the patient population, changes in physicians and registered nurses, currency of the competence requirements, changes in the context of practice, and changes in educational requirements. 1-G34ii

5 PRINCIPLES FOR DECISION MAKING REGARDING DELEGATED PHYSICIAN SERVICES 1. PATIENT Appropriateness of the patient or patient group Appropriateness of the service for delegation 2. PHYSICIAN AND REGISTERED NURSE COLLABORATION Agreement regarding delegation Establish parameters and clinical guidelines 3. COMPETENCE Physician competent in service being delegated Registered Nurse acquires and maintains competencies 4. CONTEXT Supports for meeting standards such as physical resources and backup Mechanisms for monitoring quality and safety 5. EDUCATION Required competencies defined Theory and practice Competent professional to teach and evaluate Re-evaluation at reasonable intervals Record keeping 6. EVALUATION Periodic review of the delegation decision. Also see College Statement, #130, Delegation of Function: Principles, page 1-S19. First Print Revision Revision L&E/12-91 Exec/12-00 CPG/09-02 A guideline is practice generally recommended. 1-G34iii