Medical Assisting Scope of Practice

5/16/2023

AAMA - State Scope of Practice Laws

What is a medical assistant?

Unlicensed individuals who perform non-invasive routine technical support services under the supervision of a licensed physician and surgeon, podiatrist, physician assistant, nurse practitioner, or nurse midwife in a medical office or clinic setting without the need of receiving a certification
Supervisor must be on the premises in order for the medical assistant to perform non-invasive technical support services

Supervision

The licensed practitioner is physically present in the treatment facility during the performance of those procedures

Specific Authorization

A specific written order prepared by the supervising physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife authorizing the procedures to be performed on a patient , which shall be placed in the patient’s medical record
A standing order prepared by the supervising licensed practitioner authorizing the procedures to be performed, the duration of which shall be consistent with accepted medical practice
- A notation of the standing order shall be placed in the patient’s medical record

What is a “qualified medical assistant”?

Certified by a medical assistant certifying organization approved by the Board
Holds a credential to teach in a medical assistant training program at a community college or
- Authorized to teach medical assistants in a private postsecondary institution accredited by an accreditation agency recognized by the United States Department of Health or approved by the Bureau for Private Postsecondary Education

What is acceptable and appropriate training for an MA?

What kinds of technical supportive services can we perform?
- Applying and removing bandages and dressings
- Suture removal
- Performing ear lavage
- Preparing patients for examinations
- Shaving and disinfecting treatment sites
- Handing patients properly-labeled and pre-packaged prescription drugs (except controlled substances) that have been ordered by the licensed practitioner
We can receive training from the supervising physician, podiatrist, or instructor
In general, who can train us?
- Licensed physician
- Podiatrist
- Registered nurse
- Licensed vocational nurse
- Physician assistant
- Qualified medical assistant
Where else can we be trained?
- Postsecondary or adult education program in a public school authorized by the Department of Education
- Community college program provided for in the Education Code
- Postsecondary institution accredited or approved by the Bureau for PRivate Postsecondary and Vocational Education in the Department of Consumer AFfairs
Which procedures in particular require minimum training?
- Medication administrations- IM, SQ, and ID injections
- Skin tests
- Blood draws- puncture capillary, venipuncture
How much time is required minimum for training?
- 10 hours of training in administering injections and performing skin tests
- 10 hours of training in venipuncture and skin puncture for the purpose of withdrawing blood
- At least 10 of each IM, SQ, and ID injections and 10 skin tests
- and/or at least 10 venipuncture and 10 skin punctures
- 10 hours of training in administering medical by inhalation
What else should include instruction and demonstration?
- Pertinent anatomy and physiology appropriate to the procedures
- Choice of equipment
- Proper technique including sterile technique
- Hazards and complications
- Patient care following treatment or tests
- Emergency procedures
- California law and regulations for medical assistants
Prior to administration of medicine by an MA, a licensed physician/podiatrist/appropriate licensed person shall verify the correct medication and dosage
- We can’t do anything if it hasn’t been authorized by them
- Our preceptors must be present while we administer procedures
- Exceptions are found in section 2069(a) of the Business and Professions Code
Are MAs required to be licensed or certified by the State of California to perform procedures within their “scope of practice”?
- No
- Or employer and/or supervising physician’s/podiatrist’s malpractice insurance carrier may still require that we are certified by a national or private association
How is “administering medications” defined for medical assistants?
- To inject, handle, or provide medications to a patient after a physician or other appropriate licensed person has verified the correct medication and dosage
- General definition- Direct application of medication by simple injections, ingestion and inhalation, or pre-measured medications
Can MAs administer injections of scheduled drugs?
- Yes, if they were trained appropriately
- Licenced person must verify the correct medication and dosage
- IM, ID, or SQ injections only
- Licensed person must be on the premises
- We do not handle administration of anesthetic agents
Can we start or disconnect IVs or administer injections or medication into an IV?
- No, these are considered invasive
- Out of our scope of practice
Can we do nasal smears?
- Yes, if the procedure is limited to the opening of the nasal cavity
Can we do “finger sticks”?
- Yes, if we received the proper training
- Prick the finger in order to collect a sample of blood
Can we do throat swabs for throat culture?
- Yes, if we received the proper training
Can we take a patient’s vitals?
- Yes- height, weight, BP, T, P
Can MAs give narcotic injections?
- Yes, once the licensed person has verified the correct medication and dosage
- IM, SQ, or ID
- No anesthetic agents allowed
Are MAs allowed access to the keys to the narcotic medication cabinet?
- Depends on the supervising physician/podiatrist
Can MAs chart pupillary responses?
- No- this is an assessment → interpretation
- We may not read, interpret, or diagnose symptoms or test results
- We can only observe
Can MAs insert urine catheters?
- No- invasive
Can MAs perform telephone triage?
- We can’t do it independently
- We are not legally authorized to interpret data or diagnose symptoms
Can MAs inject collagen?
- No
Can MAs use lasers to remove air, wrinkles, scars, moles, or other blemishes
- No
Can MAs administer chemotherapy and/or monitor patients?
- No
Can we apply orthopedic splints in emergency situations, such as splints in a physician’s office?
- No
- However, we can remove casts, splints, and other external devices
Can MAs interpret the results of skin tests?
- No
- We can measure and describe the test reaction and make a record in the patient’s chart
Can MAs be supervised by an NP, nurse midwife, or PA in absence of a physician and surgeon?
- The supervising physician and surgeon can provide written instructions to be followed by the MA in regards to a performance of tasks or supportive services when they are not on site
- At their discretion and in consultation with the NP, certified nurse midwife, or PA
- Written instructions may provide that the supervisory function for the MA has been delegated to the NP, nurse midwife, or PA
Can MAs call in refills to a pharmacy?
- Yes, under direct supervision of the physician or podiatrist
- Refills must be exact and have no changes in the dosage levels
- Refill must be documented in the patient’s chart as a standing order, patient specific
- MAs man not call in new prescriptions or any prescriptions that have any changes
Can MAs perform hearing tests?
- Yes, under direct supervision of a licensed physician/surgeon/podiatrist
Can MAs administer flu shots and other vaccines?
- Yes, after receiving appropriate training and the licensed person has verified the correct medication and dosage
- The supervising practitioner must be present in the facility
Can MAs hand patients prescription medications
- Yes, if the medication has been properly-labeled and pre-packaged and was ordered by the licensed practitioner
- Prescriber must first ensure the medication has the patient’s name, the medication dosage, the right medication, and provide consultation
Can an MA lawfully perform spirometry pulmonary function testing?
- Yes, if there was proper training and the test is a usual and customary part of the medical practice where the MA is employed