1
Working The Role of the Registered Nurse Nursing Care Quality Assurance Commission Nursing Practice Program
3 Objectives To provide an overview of the medical assistant categories and their scope of practice To identify the roles & responsibilities of the nurse in delegating & supervising medical assistants
4 What is Delegation? Direct authorization by a health care practitioner to a medical assistant (MA) to perform functions within the scope of practice of the health care provider & the training & experience of the MA
5 Who Can Delegate to MAs? Health Care Practitioners: Advanced Registered Nurse Practitioner (ARNP) Medical Doctor (MD) Osteopathic Doctor (DO) Podiatric Doctor (DPM) Naturopathic Doctor (ND) Physician Assistant (PA) (Medical & Osteopathic) Optometry Doctor (OD) Registered Nurse (RN)
6 Nursing Delegation RNs may delegate nursing care tasks within the scope of practice of the nurse and within legal parameters RNs may delegate medical regimens but this is not required since the order for the medical regimen comes directly from the prescriber to the MA
7 Levels of Supervision Immediate Supervision: Practitioner is on the premises & available for immediate response if needed Direct visual supervision: Practitioner must be physically present & within visual range of the MA
8 Delegator Duties Is the task within the delegator s scope of practice? Is the task indicated for the patient? Can you provide appropriate supervision? Is the delegation of the task legal? Is the person receiving the delegated task competent to do the task?
9 Delegator Responsibilities May the task be delegated? Yes Can be performed without clinical judgment, complex observations, critical decisions or repeated clinical assessments Yes Yes Results of the task reasonably predicable Not likely to present serious or life-threatening harm if performed improperly Yes Within the Medical Assistant s scope of practice Yes Appropriate supervision available
10 MA Scope of Practice Comparison Table MA- Phlebotomist MA-Hemodialysis Technician MA-Certified MA-Registered Capillary, venous, arterial blood & line draws Only in this setting: Hemodialysis Give drugs & oxygen Fundamental procedures Clinical procedures Specimen collection Patient care Laboratory tests Medication administration (eye drops, topical & vaccines) Urethral catheterization Fundamental procedures Clinical procedures Specimen collection Patient care Diagnostic testing Laboratory tests Medication administration Urethral catheterization Fundamental procedures Clinical procedures Specimen collection Patient care Laboratory tests Medication administration (eye drops, topical & vaccines) Urethral catheterization
11 Tasks MA-Phlebotomist MA-Dialysis Technician Clinical Procedures Perform hemodialysis Venipuncture for fistula needle placement Connection to vascular catheter for hemodialysis Preparing for sterile procedures Taking vital signs Preparing patients for examination Observing & reporting patient signs or symptoms
12 Tasks MA-Phlebotomist MA-Hemodialysis Technician Specimen Collection Diagnostic Testing Laboratory Testing Capillary, venous & arterial blood or line draws EKGs CLIA-waived testing Moderate complexity non-waived CLIA tests Capillary, venous & arterial blood or line draws Medications None Local anesthetics for fistula needle placement (ID, SQ or topical) IV Heparin & sodium chloride solutions as part of dialysis Intraperitoneal administration of sterile electrolyte solutions & heparin for peritoneal dialysis Oxygen (nasal cannula or mask) Other None None
13 Tasks MA-Registered MA-Certified Fundamental Procedures Wrapping & autoclaving equipment & instruments Biohazardous materials disposal Practicing standard precautions Wrapping & autoclaving equipment & instruments Biohazardous materials disposal Practicing standard precautions Clinical Procedures Preparing for sterile procedures Taking vital signs Preparing patients for examination Observing & reporting patient signs or symptoms Eye drops & topical medications Vaccines (PO, IN, SQ, IM) Preparing, assisting & performing & assisting in aseptic/sterile procedures (except in hospitals) Taking vital signs Preparing patients for examination Venipuncture & capillary blood draws ID, SQ & IM injections Observing & reporting patient signs or symptoms
14 Tasks MA-Registered MA-Certified Patient Care Telephone/in-person screening to gather information Obtaining vital signs Obtaining & recording patient history Preparing & maintaining examination & treatment areas Preparing patients/assisting with routine and specialty examinations, procedures, treatments & minor office procedures using no more than local anesthetics Maintain medication & immunization records Screen & follow-up on test results as directed by practitioner Telephone/in-person screening to gather information Obtaining vital signs Obtaining & recording patient history Preparing & maintaining examination & treatment areas Preparing patients/assisting with routine and specialty examinations, procedures, treatments & minor office procedures using local anesthetics Maintain medication & immunization records Screen & follow-up on test results as directed by practitioner
15 Tasks MA-R MA-C Specimen Collection Diagnostic Testing Laboratory Testing Finger or heel stick capillary puncture Obtaining specimens for microbiological testing Instructing patients in proper technique to collect urine & fecal specimens Capillary puncture & venipuncture Obtaining specimens for microbiological testing Instructing patients in proper technique to collect urine & fecal specimens None EKGs Respiratory testing CLIA-waived testing Moderate complexity nonwaived CLIA tests Medications Eye drops Topical ointments Vaccines (combination or multidose) CLIA-waived testing Moderate complexity non-waived CLIA tests Over-the-counter medications Legend drugs/controlled substances See MA-C Medication Table Other Urethral catheterization Urethral catheterization
16 Responsibility & Accountability The MA is responsible & accountable based on: Scope of education or training Rules and laws Competency demonstration to delegating provider Written competency documentation by the employer
17 MA-C: Medication Administration Table Drug Category Routes Permitted Level of Required Supervision Controlled Substances (Schedule III, IV & V) Oral (PO) topical, optic, ophthalmic, inhaled Subcutaneous (SQ), intradermal (ID), intramuscular (IM), peripheral intravenous (IV) injections Immediate Direct visual Other Legend Drugs All other routes Immediate Peripheral IV injections Direct visual Only unit dose or single dose medications or by a dose calculated by the practitioner Multi-dose vaccines or combination-dose vaccines shall be considered a unit dose Must have order documented in medical record
18 MA-C: Prohibited Medication Delegation Drug may cause life-threatening consequences or serious harm Complex observations or critical decisions are required Patient is unable to: Physically ingest the medication Safely apply independently or take the medication with assistance Indicate awareness that medication is being given
19 MA-C: Prohibited Medication Delegation Schedule II controlled substances May assist RN in performing narcotic count Chemotherapy agents Experimental drugs IV lines May not start peripheral, central or IV lines May not give medications via central or arterial lines May interrupt a peripheral IV line, give a medication & restart at the same rate
20 Discussion/Questions
21 References/Resources RCW 18.360 Medical Assistants WAC 246-827 Medical Assistants Substitute Senate Bill 6293-Medical Assistant Phlebotomists
22 NCQAC Contacts Debbie Carlson, RN, MSN, Nurse Practice Advisor 360-236-4725 Debbie.carlson@doh.wa.gov Linda Patterson, RN, BSN, Nurse Consultant 360-236-4729 Linda.patterson@doh.wa.gov Margaret Holm, RN, JD, Nurse Consultant 360-236-4731 Margaret.holm@doh.wa.gov Brett Cain, Program manager 360-236-4766 Brett.Cain@doh.wa.gov