Should staff be performing clinical tasks?

Increasingly, for business productivity or convenience purposes, non-medically trained support staff in practices (usually receptionists) are required to perform clinical work directly for patients, including for example, applying eye drops, holter monitor set-up, allergy patch testing, dressing wounds, and ear syringing.The obvious question for practitioners and owners is whether this syst is risky for patients and the practice. Understandably, it may be a desirable division of labour to adequately service patients in a timely fashion and may be driven by commercial factors.{{quote-A:R-W:450-Q: The position on support staff who undertake or assist with clinical care for patients is grey. It is simply not clearly regulated by industrial award or legislation. }}The position on support staff who undertake or assist with clinical care for patients is grey. It is simply not clearly regulated by industrial award or legislation.The Health Practitioner Regulation National Law (NSW) states that non-medically trained staff should not practice medicine. However, when we called the Medical Board of Australia and the Australian Medical Receptionists Association neither had a clear answer on the topic and neither were willing to directly address the issue.So what does this mean for non-medically trained staff who undertake clinical tasks as they too may be at risk?Research reveals diversity within and between practices and the extent to which medical receptionists undertake clinical procedures.There are certain factors to consider in assessing the competency of support staff to perform clinical tasks including:

• Level of training – This is probably the most important factor. For example, a receptionist who is also an unregistered nurse is likely to be more competent to perform certain clinical tasks.
• Process by which the task was delegated – Was the delegation made with knowledge that the receptionist is sufficiently competent (ie, experienced and appropriately capable) to perform the task?
• Patient consent – How are staff presenting thselves to patients who have every right to know who will be administering their treatment and, if appropriate, details of related medical supervision by a qualified practitioner? In the absence of such information, the patient may be giving an uninformed, implied consent to treatment if the ployee involved is not clearly identified as a receptionist rather than a nurse. Consequently, the patient may be deprived of the opportunity to either refuse treatment or pose questions about the level of oversight being provided.
• Supervision – Is the task being carried out under the supervision – whether direct or indirect – of a medical practitioner and has the patient been informed accordingly?

In performing clinical tasks, a duty of care is owed to the patient. If a patient is injured, a test is applied or interpreted incorrectly, or a step is omitted in the course of being treated, the level of skill, knowledge and competency of staff involved with the patient’s care will be of direct relevance to issues of legal liability. {{quote-A:L-W:450-Q: It is important to assess the competency of support staff to perform clinical tasks }}As a medical practitioner you may be held liable for the conduct of your non-medical ployees and as such you should review your personal and practice insurance to ensure it covers non-clinical staff.Medical practice indnity policies usually cover claims against ployees or errors by unsupervised staff. Medical practitioners are more exposed if ployees are unqualified, untrained and/or unsupervised. These policies commonly have exclusion clauses stating that acts or omissions that are beyond training and outside terms of ployment are not covered.Please review your staff skill mix, delegation procedures, ployment contracts and insurance arrangents with this in mind.