FNP550 - Week 4 Scope of practice

Father of medicine tommy douglas

• primeir of saskatchewan

• beliwved that access to healthcare was not dependent on a persons ability to pay

• should be universal righ t

• shaped canadian identity and led to the canada health act

Canada Health Act

• federal law setting principles for health care in canada

5 canada health act principles provide for

• public administration

  • non-profit, publically accountable plans

• Comprehensiveness:

  • covers all medically necessary hospital and physician services

• universality

  • equal coverage for all residents

• Accesibility

  • reasonable access without financial or other barriers

• portability

  • coverage continues across provinces/territories and abroad

Use of standards

• ensure public of safe, ethical practices

• help dietitians and others evaluate practice

• promotes the role and accountability of dietitians to public, professionals and themselves

• act as legal reference to describe reasonable and prudent practice in employment situations, inquests, negligence cases and complaints to the professional body

Laws of dietetics

• regulated health professionals act

  • overarching framework

• dietetics act

  • profession specific rules

• regulations, standards and code of ethics set by the college of dietitians of ontario

  • set by CDO

Regulated health professional act

• establishes the rules, right s, responsibilities for regulated health professionals in ontario

• ensuring safe, ethical and competent healthcare delivery

• protect public and provide accountability

• in place for 26 health professions

Dietetic act

• controlled acts that dietitians can perform

• entry level requirements

• enforce standards of practice and ethics

• handle complaints, investigations and discipline

• protect public interest

Dietetic act scope of practice statement

• practice of dietetics is the assessment of nutrition and nutritional conditions and the treatment and prevention of nutrition related disorders by nutritional means

5 delegation standards

• delegation of a controlled act must be in the best interest of the client

• dietitians must have the knowledge, skills and judgement to accept a delegation of a controlled act

• dietitians must be aware of the laws permitting controlled acts to be berformed in certain circumstances and when a controlled act cannot be delegated

• must insure that standards for informed consent and record keeping are used when practicing under delegation of a controlled act

• Be aware of accountability, quality assurance and delegation processes in practice settings

14 RHPA controlled acts dietitians can do

• procedure below the dermis

  • skin pricking to take capillary blood samples for the purpose of monitoring capillary blood readings when doing dietetics

Main circumstances where dietitians need to be able to do procedure below the dermis

• teach blood glucose self management

• for random blood glucose checks

• for compliance with diet and insulin regimen

• for confirming hypo or hyperglycemia

Communicating a diagnosis

• NOT one of the controlled acts dietitians can perform

• Prohibited when 3 criteria are met

  • communication: information related to the client

  • Content: disease identified as the CAUSE of the symptoms

  • Content: client is likely to rely on this information to make significant treatment decisions

Vitamins and minerals scope of practice

• not a drug

  • food and drink

  • natural health products (some exceptions)

  • unscheduled items (most low dose vitamins and minerals)

  • exceptions listed in the provincial regulation of drugs and pharmacies act

Advice on vitamins and minerals

• assess, recommend and monitor intake but do not diagnose or prescribe

RHPA: Harm clause

• no person shall perform a controlled act that they have not been authorized to perform and no person should treat or advise a person about their health in circumstances where it is reasonably forseeable that serious physical harm may result from the treatment or advice given

• Eg.

  • non regulated person giving dangerous weight loss advice that can cause malnutrition

  • recommending unsafe supplements without properknowledge leading to harm

  • practitioner working outside of their scope in a way that puts a clients health at risk

Privacy

• clients right to

Confidentiality

• your duty to protect the clients right to privacy

PIPEDA- definition

• personal information protection and electronic documents act

PIPEDA - description

• applies to all organizations collecting, using or disclosing information while engaged in a commercial activity

• applies to private dietitians or companies offering nutrition services commercially

PHIPA - definition

• personal health information protection act

• information that can identify an individual or can be combined with other information to identify individual and relates to the nutritional, mental and physical health, provision of health care coverage a plan of services etc

PHIPA - description

• applies to all personal health information in ontario

• applies when you work in healthcare settings (hospitals, primary care teams, public health)

• governs how you collect, store, share and safeguard client health information

PHIPA summary

• ontario jurisdiction

• health information only

• health information custodians are required for this.

• clinical care and health records are the main context

• consent model implied within the circle of care expressing for others

• regulated by the information and privacy comissioner of ontario

PIPEDA - Summary

• canada wide jurisdiction

• scope of all personal information

• private-sector organizations in commercial activity

• commercial transactions, business records

• meaningful consent is required often expressed

• regulated by the office of the privacy comissioner of canada

Privacy vs confidentiality

• privacy is broader and principles reinforce that the information belongs to client not practitioner

  • dietitians are the custodian not the owner

  • holding the chart but the information inside the chart is the clients

• Confidentiality is the duty to ensure that information is kept safe to the greatest possible extent

Privacy summary

• persons right to control what personal information about them is collected used and shared

• focus on the clients control over their information

• client decides whether to share details about their eating habits or medical history

• privacy laws (PHIPA, PIPEDA)

• client can say i dont want my information shared with anyone else

Confidentiality summary

• professional duty to protect information that has been shared in trust

• focus on dietitians responsibility to protect the information once it is recieved

• dietitians keep the information secure and does not share it without the clients consent

• Professional code and ethical obligations (CDO and record keeping standards)

• dietitian ensures “i wont disclose your informaiton without your consent)

Privacy principles

• knowing why you are collecting the information

• only collecting what you need

• when possible collect information right from client

• destroy information when it is no longer necessary

• ensure accuracy

• dont use it for purposes other than outlined

• allow clients direct access to their information

• advise client and public about policies

• allow clients to challenge privacy policy through a clearly defined complaints process

Privacy and access code

• accountability

• identify purposes for collecting information

• consent

• limit collection to what is necessary for identified purpose by fair and lawful means

• limit use, disclosure and retention of info to original purposes unless further consent obtained or law requires otherwise

• accuracy

• safeguards

• openness

• individual access to personal information about them

• challenging compliance

Health information custodian

• responsible for collecting, using and disclosing information on behalf of clients

• institution, facility and practitioner typically

Agent of health information

• anyone authorized by HIC to provide services, activities on behalf and for the purposes of that HIC

Compliance with privacy requirements

• identify the HIC

• identify the privacy officer

• take inventory

• purpose of collecting personal information

• safeguard, retention and destruction policies

• access, correction, complaints and openness

• implement privacy policy

Step 1: Identify the HIC

• responsible for all health records in an organization

• oversee, approve and implement policies and procedures to ensure the privacy and security of records

• HIC can be the sole practitioner, employer or a facility

Step 2: Identify the privacy officer

• who would be the HIC in a hospital or private practice

  • the organizaiton

  • designated privacy officer

  • Private practice would be the owner of the practice

Step 3: Take inventory of personal information collected

• identify the personal information categories of personal information

• names, conditions, medical history

step 4: identify purpose

• primary purpose (provision of goods and services the individual is seeking)

• Secondary purpose (QA, regulatory responsibilities, marketing

Disclosure to the client

• at the begining of appointment regarding personal information

• explain

  • purpose of information collection

  • scope (what kind of information you are collecting)

  • safeguards for how you will protect it

  • limits to confidentiality when you have a duty to report

  • opportunity for questions

step 5: safeguard, retention and destruction policies

• physical (locked cabinets)

• organizational measures

• technological measures (locking documents, specific account access, safe passwords)

Safeguarding PHI

• must protect client information and ensure that only those who are required to have health informaition have access to client information

• leaving notes, forgetting to lock computers, patient names and operating times being put on boards

Retention and destruction policy

• information must be kept for 10 years from entry

• if client is a child then it is 10 years after turning 18

• should be securely destroyed in a way that is irreversible

• paper records shredded, incarcerated or pu;ped

• electronic records permanently deleted from systems and backups using data erasure software

• storage devices: if they cannot be wiped they should be physically destroyed

• document when, how and who destroys the records

step 6: access, correction, complaints and openness

• client have the right to see their chart

• only decline access when

  • quality of care information has been generated by the college

  • raw data from standardized psychological tests are requrested

  • risk of harm to treatment or recovery or serious bodily harm to another person

  • access would reveal the identity of a confidential information source

step 7: implementing the privacy policy

• reviewed how the organization handles PHI to prepare and role out the policy

• periodically monitor, review and update the policy

  • frequent within the first year

accountability-

• offences of inappropriate disposal of PHI or deliberate discolosing of PHI can be cause a compliance order

• compliance orders are given to the college and the client can sue up to $10,000 in mental anguish

Privacy breach reporting obligations

• RDs who are HIC are requried to report privacy breaches

• reports go to the information and privacy commissioner of ontario

categories of privacy breaches

• use or disclosure without authority (must report if personel are looking at information they are nto allowed)

• theft

• breaches that cause further issues (compounded effect)

• pattern of breaches (rather than insulated incident)

• disciplinary action against a college member

• disciplinary action against a non-college member

• significant breach

  • likely needs legal advice

Significant breaches

• is the info sensitive?

• was a large volume of into leaked?

• does it affect many individuals

• was more than one HIC responsible for the breach

Social media practives

• anti spam

• protect privacy and confidentiality (PHIPA)

• maintain online professionalism

  • professional conduct

  • boundaries and dual relationships

  • protecting reputation

  • integrity

• applying professional principles

• record keeping

• web-based counselling and email

• user agreements and disclaimers