Scope of Practice. Objectives

Transcription

1 Scope of Practice 1 Carol Novak, RN Practice Specialist, Compliance Carol.S.Novak@kp.org 2 Objectives At the conclusion of this presentation attendees will be able to: Have an understanding of the Advanced Practice Providers (APPs) scope of practice and the effect on practice at Kaiser. Have an understanding of the risks of practicing outside the scope of practice 3 1

2 KP Resources that Define Scope of Practice KP Job Description KP P&P KP Practices Verification of competencies to perform the job Legal Opinions 4 Other Sources that Shape Scope of Practice Payor Coverage Requirements Billing Requirements Legal Opinions Medicare Conditions of Participation in licensed space Pharmacy Law Laboratory Law JCAH Medical Center Bylaws/Rules and Regulations 5 6 2

3 Risks of Practicing Outside of Scope False Claims Vulnerabilities in Lawsuits License Suspension/Actions Loss of Revenue Damage to Reputation of the Organization Fines from Regulators 7 What can I do? Stay within your scope or job duties Provide appropriate clinical documentation Ask questions Report concerns to your Supervisor, Ambulatory Practice Leader, Compliance Officer or the Compliance Hot Line Share compliance information with your staff and peers Allow the legal department to query regulatory agencies 8 Scope of Practice Registered Nurses Licensed Vocational Nurses Medical Assistants Advanced Practice Providers (NP and PA) 9 3

4 RN Perform assessments and synthesize data Utilize independent clinical judgment Triage patients Give advice Assess learning needs Develop patient care plans/patient education plans 10 RN Monitor for procedural sedation Central line catheter care including blood withdrawal Administer IV medications Administer IV chemotherapy (with certification) PICC line insertion and removal (with certification) 11 RN Use standardized procedures to initiate and provide care Laser removal of hair, moles, scars, etc. Care/Case management 12 4

5 LVN Perform basic physical assessment and data collection Cannot perform level of assessment requiring data synthesis and care plan development Work under the direction of a physician/rn 13 LVN Administer medications/immunizations Withdraw blood from a patient (with certification) May receive verbal physician orders for items within their scope of practice Give instructions as directed by physician or by approved preprinted material. 14 MA Ear lavage (with pre and post assessment by a physician or RN) Remove splints and casts Remove orthopedic appliances Initiate care with AED (Automated External Defibrillator) Apply/remove bandages and dressings Remove sutures/staples from incisions 15 5

6 MA Assist with sterile/non-sterile procedures Set-up and assist with pap smears Set-up for minor procedures Prepare for exams (position, drape, shave and prep skin) Perform simple lab/screening tests commonly done in medical offices 16 MA Answer phones, collect data from patients Schedule and confirm appointments Stock rooms Order supplies and equipment 17 RNP Work under the supervision of the physician. A physician may supervise no more than four NPs Uses standardized procedure/protocols May give verbal orders to RNs Furnish medication May not admit or discharge inpatients 18 6

7 PA Practices under pre-approved protocols within their supervising physician s specialty Physicians may supervise up to four PAs May give verbal orders to RNs Able to order medications within the supervising physician specialty and from the formulary Five percent of notes should be signed by the supervising physician within 30 days May not admit or discharge inpatients 19 Provider Types Provider Type Responsible State Agency Website Ambulatory Pract ice Inpatient Practi ce Supervision Practice Tools RN California Board of Registered Nursing v/regulation s/index.sht ml RN, MD Standardized Procedure s, Standing Orders LVN California Board of Vocational Nurses and Psychiatric Techs RN, MD Standing Orders MA Medical Board of California a.gov/laws/ Index.html no, (ED) MD Standing Orders Other Unlicensed Staff Depends NP California Board of Registered Nursing v/regulation s/index.sht ml MD Standardized Procedure s PA Medical Board of California- Physician Assistant Committee MD Protocols 20 Terminology Standardized Procedure: A specific written authorization for an RN to perform functions in an organized health care setting that overlap with the practice of medicine and exceed the usual scope of practice of the RN. The Standardized Procedure contains a protocol describing the actions that the RN will take and under what circumstances. (See eleven requirements in BRN Standardized Procedure Guidelines). SPs only apply to RNPs, CNMs, CRNAs and RNs. A Standardized Procedure cannot allow an RN to diagnose or prescribe medication. Advanced practice nurses with furnishing authority may furnish medication under Standardized Procedure. Example: Intrauterine Insemination Standardized Procedure for RNPs in Ob-Gyn Dept. 21 7

8 Terminology Protocol: A document that directs a practitioner s actions in performing a specific procedure or evaluating and treating a specific condition, including subjective and objective assessment, the treatment plan or actions to take in response to those assessments, education, follow-up, and circumstances when physician consultation or referral is required. For RNs, a protocol is part of a Standardized Procedure and provides specific guidance as to performing a particular procedure or function that overlaps with the practice of medicine. For Advanced Practice Nurses, the protocol guides the formulation of treatment plans for specific conditions. For Physician Assistants, the protocol also serves as a means of supervision of the PA, combined with physician countersignature of at least 10% of the PA s charts. 22 Terminology Pre-printed Orders: An order sheet which was developed for use by the physicians to facilitate the ease of writing orders for a specific patient usually in the hospital setting. A pre-printed order is patient specific and signed by the patient s physician. Example: ICU Standard Admission Orderset Standing Orders: A non-patient specific order developed by a physician to be followed for a category of patients. Standing orders are not used as medication orders because they are not patient specific. Example: All obstetrical patients have a urine dipstick test at prenatal visits. 23 Terminology Policy and Procedure: The formal, approved description of how a governance, management, or clinical care process is defined, organized, and carried out. Example: Ear Irrigation in Family Practice for RNs and LVNs 24 8

9 Scope of Practice Decision Tree 25 Questions??? 26 9