As you may know, the Standards of Practice set out the minimum standards in paramedic services. Each regulated member is required to understand and comply with these Standards, but how does this translate to the day-to-day work of EMRs, PCPs and ACPs?
In an effort to help regulated members understand and apply the Standards to real life situations, we will be sharing scenarios that give context to the Standards and ideas on how to implement this into practice.
The following scenario will attempt to address restricted activities.
4.1 Restricted Activities
The Health Professions Restricted Activity Regulation authorizes regulated members to perform restricted activities as defined in Section 43 of the Health Professions Restricted Activity Regulation.
When performing any restricted activity, a regulated member must adhere to all of the following:
- Only perform restricted activities they are educated, trained and competent to perform.
- Only perform restricted activities that are authorized by the Health Professions Restricted Activity Regulation and in accordance with the profession’s Standards of Practice and Code of Ethics
- Practice within the restrictive condition(s) and/or endorsements placed on their practice permit.
- Practice in accordance with practice setting (organization/employer) policies and procedures.
- Only perform restricted activities that are appropriate to their clinical practice area, and the procedure being performed.
- A regulated member shall assess the risks and benefits associated with the performance of a restricted activity prior to performing or supervising the restricted activity and
- Communicate these risks and benefits to the patient and obtain informed consent to proceed unless consent is not possible because of emergency,
- Monitor the response to the restricted activity and adjust the restricted activity as necessary, and
- Ensure strategies are in place to address any critical or unexpected occurrences associated with the performance of the restricted activity.
Scenario:
Allisa, a Primary Care Paramedic, works full time in a rural industrial clinic in northern Alberta and is occasionally required to host seasonal influenza vaccine clinics for the company’s staff. The clinic is a physician-led clinic which does all the prescribing and filling of vaccine orders. In her practice setting, Allisa realizes she will be performing a restricted activity under the Health Professions Restricted Activity Regulation (HPRAR). Alissa understands that the only way she is permitted to administer a seasonal influenza vaccine is if she adheres to all of the following criteria laid out to her in the College’s Standards of Practice.
Before Alissa hosts the vaccine clinic and administers the seasonal influenza vaccines, she ensures that she has submitted proof of College-approved training and secured an endorsement on her practice permit to administer the vaccine. This demonstrates that Alissa will be performing a restricted activity that she was educated, trained and competent to perform, in turn, practicing within the endorsement placed on her practice permit.
Prior to administering the vaccine to a patient (employee of the company), she will assess the risks and benefits associated with the performance of administering the vaccine and:
- Communicate these risks and benefits to the patient and obtain informed consent to proceed
- Monitor the response to the vaccine administration and adjust as necessary, and
- Ensure strategies are in place to address any critical or unexpected occurrences association with administering the flu vaccine.
In addition, she will also reference the Standard of Practice 4.1.4.3, Administer a Vaccine, and ensure the patient is fit/eligible for the vaccine being administered. As a regulated member she must:
- Obtain informed consent from the patient/patient’s alternate decision-maker.
- Ensure the patient is at least five years old.
- Be satisfied that legislative and regulatory requirements related to the storage, handling and transporting of vaccines (e.g., cold chain) have been followed.
- Document the administration in the patient record in accordance with immunization legislation and regulation.
- Conduct appropriate follow up monitoring.
- Manage and report adverse events.
- Provide relevant information to other regulated healthcare professionals and provincial health agencies as appropriate.
- Report refusals of vaccination as defined in regulation.
Once Alissa has reviewed the HPRAR and the Standards of Practice, Alissa feels ready to proceed with hosting a flu clinic.
On her first day of opening the Flu Clinic, a 46-year-old male comes into her office for his seasonal influenza vaccine. Alissa makes sure to discuss with the patient both the risks and benefits of getting the vaccine and obtains his informed consent to receive the vaccine. She then proceeds to conduct a full patient assessment prior to the vaccine administration. Once that is completed and her patient gives her the consent to proceed, she administers the vaccine. After administration, Alissa moves on to conducting appropriate follow-up monitoring for her patient while making sure to manage and report any adverse events if they arise. Once she has completed the administration and appropriate follow up monitoring, she proceeds to document the administration in the patient’s record in accordance with immunization legislation and regulation.
This scenario demonstrates a regulated member’s responsibilities under Standard 4.1 Restricted Activities while also referencing the sub-Standard 4.1.4.3, Administer a Vaccine.