NCQAC RNs Working with Medical Assistants

4/14/15 NCQAC RNs Working with Medical Assistants

The Role of the Registered Nurse

Nursing Care Quality Assurance Commission

Nursing Practice Program

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

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

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)

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

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

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

Delegator Responsibilities

•

May the task be delegated?

Yes

•  Can be performed without clinical judgment, complex

observations, critical decisions or repeated clinical assessments

Yes

•  Results of the task reasonably predicable

Yes

•  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

MA Scope of Practice Comparison Table

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

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

Tasks

•  MA-Phlebotomist

Specimen Collection

•  Capillary, venous & arterial blood or line draws

Capillary, venous & arterial blood or line draws Diagnostic Testing •  EKGs Laboratory Testing •  CLIA-waived testing

•  Moderate complexity non-waived CLIA tests

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)

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

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

Tasks

MA-R

MA-C

Specimen Collection

•  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 Diagnostic Testing •  None •  EKGs •  Respiratory testing Laboratory Testing •  CLIA-waived testing

•  Moderate complexity non-waived CLIA tests

•  CLIA-waived testing

•  Moderate complexity non-waived CLIA tests

Medications •  Eye drops

•  Topical ointments

•  Vaccines (combination or multi-dose)

•  Over-the-counter medications •  Legend drugs/controlled

substances

See MA-C Medication Table

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

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

Immediate

Subcutaneous (SQ),

intradermal (ID),

intramuscular (IM),

peripheral intravenous

(IV) injections

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

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

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

References/Resources

•

RCW 18.360 Medical Assistants

•

WAC 246-827 Medical Assistants

•

Substitute Senate Bill 6293-Medical Assistant

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