SCOPE OF PRACTICE RESOURCE GUIDE: Introduction Quality of

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SCOPE OF PRACTICE RESOURCE GUIDE Introduction

• Quality of Care Important to ensure
• Right provider of care
• Right clinical service performed
• Right time
• Right clinical record documentation

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SCOPE OF PRACTICE

• Organizational Risk
• Risks exist for the healthcare provider and the
  organization, when staff work outside of
• their scope of practice

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SCOPE OF PRACTICE

• Registered Nurses
• Licensed Vocational Nurses
• Medical Assistants
• Advanced Practice Providers
• RNXs

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Who defines scope of practice?
RN
LVN
Board of Vocational Nursing and Psychiatric
Technicians
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Scope of Practice References

• RN
• http//www.rn.ca.gov
• LVN
• http//wwwbvnpt.ca.gov
• MA
• http//www.medbd.ca.gov/MA.htm

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Registered Nurse

• Perform assessments and synthesize data
• Utilize independent clinical judgment
• Triage patients
• Give advice
• Assess learning needs
• Develop patient care plans
• Develop patient education plan

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Registered Nurse

• 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)

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Registered Nurse

• Use standardized procedures to initiate and
  provide care
• Laser removal of hair, moles, scars, etc.
• Cut nails of patients with known peripheral
  vascular disease and diabetes
• Care/Case management

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Licensed Vocational Nurse

• Perform basic physical assessment and data
  collection

Cannot perform level of assessment requiring
data synthesis and care plan development
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Licensed Vocational Nurse

• Work under the direction of a physician/RN
• Administer medications/immunizations
• Withdraw blood from a patient (with
  certification)
• May receive verbal physician orders for items
  under their scope of practice(comply with
  read-back policy)

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Licensed Vocational Nurse

• Give instructions as directed by the physician or
  by approved preprinted material

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Licensed Vocational Nurse

• LVN cannot
• Delegate
• Independently plan, formulate, deliver or
  evaluate patient care or patient education

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Licensed Vocational Nurse
Intravenous Certified LVN

• Start and discontinue peripheral IV
• Flush peripheral devices
• Administer fluids with or without additives,
  regulate flow, monitor peripheral site and
  systemic effects
• Administer blood and blood products
• Allowed additives vitamins, nutrients and
  electrolytes only

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Licensed Vocational Nurse
Intravenous Certified LVN cannot

• Withdraw blood from an artery
• Perform IV chemotherapy
• Insert or remove a PICC line
• Administer intravenous medication

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Medical Assistant
Medical Board Definition

• Medical Assistants are unlicensed, and may only
  perform basic administrative, clerical and
  technical supportive services under the
  supervision of a licensed physician or podiatrist
  in a medical office.

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Medical Assistant
Medical Board Definition

• The supervising physician must be in the
  treatment facility during the Medical Assistants
  performance of these non-invasive, simple,
  routine medical tasks and procedures.

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Medical Assistant

• Collect and document data
• Take weights and measures
• Routine and orthostatic vital signs
• Collect basic information on present and previous
  conditions

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Medical Assistant

• Direct Care
• Perform EEG and EKG tests
• Assist with ambulating
• Provide patient information and instructions with
  physician/podiatrist direction or approved
  preprinted material

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Medical Assistant
Medication Administration

• Inhalation (if routine to patient)
• Topical
• Vaginal
• Rectal

• Oral
• Injections
• Intradermal (TB PPD Skin Test)
• Subcutaneous
• Intramuscular

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Medical Assistant

• Procedures
• 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

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Medical Assistant

• Procedures
• Initiate care with AED (Automated External
  Defibrillator)
• Apply/remove bandages and dressings
• Remove sutures/staples from incisions

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Medical Assistant

• Procedures
• Ear lavage
• (with pre and post assessment by a physician or
  RN)
• Remove splints and casts
• Remove orthopedic appliances
• Obtain impressions for orthotics

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Medical Assistant

• Procedures
• Perform tonometry testing
• Perform visual tests
• Use optical devices in connection
• with ocular exercises

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Medical Assistant

• Procedures
• Performs EKGs
• Venipuncture/withdraw blood (with phlebotomy
  certification)
• Obtain nasal smears (anterior nares)

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Medical Assistant

• Testing
• Perform peak flows
• Perform simple lab/screening tests commonly done
  in medical offices

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Medical Assistant

• Clerical/Indirect Care
• Answer phones, collect data from patients
• Schedule and confirm appointments
• Stock rooms
• Order supplies and equipment

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Professional Responsibility

• Know Your Scope!
• Ask your manager if you have questions
• Refer to the Ambulatory Services RN, LVN, MA
  Tasks and Procedures List in the Scope of
  Practice Resource Guide