The term Scope of Practice has a variety of meanings amongst registered healthcare professionals. Indeed, just as the scope of practice differs between health care professions, it can also differ among health professionals within a profession. The reason for this is that an individual’s scope of practice is just that - “individual”. And although common with others in their profession registered at the same level, there can be personal differences. The professions scope of practice is the standard that applies to the profession. This is normally drafted by the regulatory authority (PHECC) on a national basis. A personal scope of practice is the individual’s scope measured against the professions scope of standards.
The phrase Scope of Practice refers to the range of roles, functions, responsibilities and activities in which a registered practitioner has been educated, is competent in and has the authority to perform. Scope of practice for registered pre-hospital emergency care practitioners in Ireland is determined by legislation, EU directives, clinical practice guidelines (PHECC CPGs), along with an individual’s education and training and their level of competence. And this is also dependent upon the CPG status of the service provider or organisation on whose behalf the practitioner is providing the care.
Scope of practice frees registered practitioners to operate within the limits. These limits are;
All care delivered to members of the public must be within the constraints of existing legislation and EU directives. The authorisation for pre-hospital interventions and administration of medications are directly linked to the PHECC Establishment Orders and the Medicinal Products Regulations. These in turn are directly linked to the PHECC CPGs. This is associated with the professional scope of practice.
PHECC Clinical Practice Guidelines have been approved by Council to guide registered practitioners practice. The 3rd Edition of the CPGs recognises 3 levels of practitioner, their associated skill levels and corresponding authority. The guidelines are for best practice and are associated with both the professional and personal scope of practice.
The subject of education and training is of particular importance with the introduction of the 3rd Edition CPGs. PHECC, in conjunction with recognised training institutions, are developing an electronic upskilling package. This will facilitate the delivery of an upskilling programme directly to practitioners in their ambulance base and minimise the requirement for face-toface training. According as individuals successfully complete the particular modules then their scope of practice will grow. This is associated directly with personal scope of practice.
The CPG Status of the service provider or organisation on whose behalf the practitioner is providing the care is a significant limit. Organisations or services providing care must seek and be granted approval by PHECC to use and implement PHECC CPGs. Thus if an organisation has PHECC approval to implement CPGs at the EMT level only then the scope of practice for all registered practitioners providing care on behalf of that organisation is limited to the EMT level. This is associated with both the professional and personal scope of practice.
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Competence in delivering care, performing interventions and administration of a particular medication is essential. Practitioners must identify their own individual competence level and under no circumstances should they stray beyond this limit. This is connected to the personal scope of practice.
Scope of Practice is what defines and limits an individual practitioner’s ability to practice. It is dynamic and changes over time. Just as the EMS profession has changed dramatically in Ireland over the last 10 years, so too has the scope of practice of the profession. Scope of practiceevolves through experience, acquisition of knowledge, evidence-based practice, revised CPGs, technological development and changes in the health care delivery system. Feedback from the deployment of Advanced Paramedics will result in changes to CPGs and best practice. Reconfiguration of acute hospital services will also result in changes in the way Paramedics practice.
Current practitioners will need to practice in new settings, perform new procedures, and develop new skills during their professional careers. Likewise it is incumbent on practitioners who have had their skill level assessed through the equivalence of qualification process to address any skills or medication deficiencies that were identified.
In conclusion an individual practitioner’s scope of practice is just that and practitioners should ensure that their own scope of practice is aligned as close as possible to that of the profession. The scope of practice system is what protects the public while at the same time it protects the practitioner. Registered pre-hospital emergency professionals are free to act within the limits of their scope of practice. Registered practitioners who operate within their scope of practice, comply with the Code of Conduct and Ethics and also comply with the CPGs are safe practitioners who are complying with best practice nationally and internationally.
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“The phrase Scope of Practice refers to the range of roles, functions, responsibilities and activities in which a registered practitioner has been educated, is competent in and has the authority to perform“.
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