Scope of Practice. Objectives

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Scope of Practice

Carol Novak, RN

Practice Specialist,

Compliance

626-405-3177

[email protected]

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.

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KP Resources that Define Scope

of Practice

† KP Job Description

† KP P&P

† KP Practices

† Verification of competencies to

perform the job

† Legal Opinions

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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

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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

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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

Scope of Practice

† Registered Nurses

† Licensed Vocational Nurses

† Medical Assistants

† Advanced Practice Providers (NP

and PA)

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RN

† Perform assessments and synthesize

data

† Utilize independent clinical judgment

† Triage patients

† Give advice

† Assess learning needs

† Develop patient care plans/patient

education plans

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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)

RN

† Use standardized procedures

to initiate and provide care

† Laser removal of hair, moles, scars,

etc.

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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

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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.

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

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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

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MA

† Answer phones, collect data from

patients

† Schedule and confirm appointments

† Stock rooms

† Order supplies and equipment

RNP

† Work under the supervision of the

physician. A physician may supervise

no more than four NPs

† Uses standardized

procedure/protocols

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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

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Provider Types

California-Physician Assistant Committee PA Standardized Procedure s MD yes yes http://www.rn.ca.go v/regulation s/index.sht ml California Board of Registered Nursing NP Depends yes yes Other Unlicensed Staff Standing Orders MD no, (ED) yes http://www.medbd.c a.gov/laws/ Index.html Medical Board of California MA Standing Orders RN, MD yes yes http://www.bvnpt.ca .gov/ California Board of Vocational Nurses and Psychiatric Techs LVN Standardized Procedure s, Standing Orders RN, MD yes yes http://www.rn.ca.go v/regulation s/index.sht ml California Board of Registered Nursing RN Practice Tools Supervision Inpatient Practi ce Ambulatory Pract ice Website Responsible State Agency Provider Type

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

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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.

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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.

Terminology

Policy and Procedure:

† The formal, approved description of how a governance, management, or clinical care process is defined, organized, and carried out.

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Scope of Practice Decision Tree

http://

www.ambulatorypractice.org

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