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AHPRA decision

Discussion in 'Australia' started by daisy, Jul 15, 2014.

  1. daisy

    daisy Active Member


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    Hi,

    I am writing to bring a recent decision of AHPRA to the attention of podiatrists working in the public sector in Australia, as I feel it has much wider implications.

    I am a Qld Health podiatrist and last year I was working alongside a diabetes educator (Registered Nurse). On this particular day I was treating patients at a nursing home but unbeknown to me an outpatient appointment had been made for one of my patients in the community clinic. I did not know about this appt until somebody rang me to tell me that the patient was waiting. I was therefore late for the patient c 1 hour but the appt letter said a 2 hour wait was considered normal.

    I had previously assessed this patient and my care plan involved managing her painful ingrown nails. I had planned to discuss nail surgery with her at our next appointment. However, on my arrival for her appointment at the community clinic the diabetes educator (Nurse) had given herself authority to step in without my permission or knowledge and treat or rather cut this patient's nails. On enquiring why she had treated my patient without even advising me beforehand she responded by saying treating podiatry patients was within her scope of practice. In addition, she had not even seen the patient's chart or care plan as I had collected the patient's chart myself on my way back to the clinic.

    I put in a notification complaining to Qld AHPRA about what had happened as I felt this nurse was well out of her scope of practice, without authorisation. I subsequently received the following decision from AHPRA:

    "The Committee does not consider the practitioner's performance to be unsatisfactory as:

    i. The Committee notes that nurses are required to provide treatment to outpatients in a broad range of clinics. As such, the patient being a podiatry outpatient does not necessarily mean treatment carried out by a nurse should be considered beyond their scope of practice.

    ii In her submission the practitioner indicated she advised the patient she was not a podiatrist, furthermore the treatment provided was limited to cutting the patient's nails, providing limited/general advice and providing a foot massage. The Committee does not consider this treatment to be beyond the practitioner's scope of practice having considered the practitioner's training and experience.

    iii You identified the patient had presented for treatment for ingrown toe nails and the practitioner had cut the patients nails. However, the Committee considers the practitioner's submission that the patient had cut the corners of the nails, prior to the consultation, and her cutting of the nails was to 'straighten them' demonstrates satisfactory performance.

    iv The Committee also considered that the practitioner's reason for initiating treatment on the patient was reasonable in the circumstances. The patient had been waiting for a number of hours (Note to Podiatry Arena readers - this is completely wrong, the nurse's own patient notes stated the patient had been waiting for less than an hour and the Nursing & Midwifery Board came to this conclusion even though I and the diabetes educator had put the patient had been waiting for about an hour) and the practitioner had been advised you had been further delayed".

    I am absolutely flabbergasted by this decision.

    This decision suggests that AHPRA thinks it is entirely acceptable for a nurse to come into any podiatry clinic and treat a podiatry patient (who has been referred to the podiatrist, not to the nurse) without benefit of the clinical notes or care plan, and without any authorization or delegation from the podiatrist, and that this action is "within their scope of practice"??? I found out after the situation that the diabetes educator nurse had done a basic foot care course many years ago, but have no evidence of its currency or syllabus.

    This response has implications for all podiatrists working in the public sector and I am interested in hearing whether any other podiatrists (especially those working in Australia) find this decision problematic?

    Thanks

    Helen
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    What did management at the community clinic think about what had happened?
     
  3. daisy

    daisy Active Member

    Hi Craig,

    I raised the matter with her manager and there was no response.

    Rgds

    Helen
     
  4. Paul Bowles

    Paul Bowles Well-Known Member

    I am pretty sure as an RN routine foot care is within their scope of practice regardless of any other "footcare" courses they may have completed. AHPRA's role is to protect the public, not punish the practitioner remember. Maybe keep trying as has been suggested at your local community level, as the issue seems to be there not at a public safety level.
     
  5. daisy

    daisy Active Member

    Hi Paul,

    I have no issues with nurses doing footcare. I do have a major issue with nurses treating a patient with no handover, referral or clinical notes.

    Queensland Health's guidance relating to nursing scope of practice states that in determining scope of practice consideration must be given to three factors, i.e. nurses' education, competency and authority. In this case the nurse had no authority either from her Manager nor from myself to treat this podiatry patient. Neither was this an emergency situation.

    Lack of reference to clinical notes and care plan IS a matter of patient safety.

    The fact I am competent to administer LA to the foot does not give me the authority to administer this to a colleague's patient (of any other discipline)without reference to the clinician in whose care they are, simply because I decide to do so (whilst they are out at lunch for example, or 10 minutes late for clinic).

    Rgds

    Helen
     
  6. Paul Bowles

    Paul Bowles Well-Known Member

    Hi Helen - i'm not disagreeing with you at all - just making the point that locally you will probably have more effect with her Manager than at an AHPRA level. However if the patient in question made the complaint that may have illicit different response from them. Good luck with it.
     
  7. daisy

    daisy Active Member

    Hi Paul,

    The manager did not respond to my complaint. He was also my manager. The nurse was absolutely adamant that she was well within her scope of practice and her manager was not telling her otherwise. I don't work in this Health District anymore. There were just too many clinical governance issues to practice safely in this District and this particular incident was one of many.

    Thanks

    Helen
     
  8. Paul Bowles

    Paul Bowles Well-Known Member

    Sounds like a good decision to move on!
     
  9. daisy

    daisy Active Member

    It was indeed and a year later, we (my husband was also working as a podiatrist there) are still trying to resolve issues from afar. I am a born and bred Qlder but gee if there is a corrupt or "fast and loose" way of doing things then govt bodies in this great state of ours will take the crooked path!!!
     
  10. brekin

    brekin Active Member

    Was there any negative outcomes from the nurses treatment? Was the client unhappy in any way?

    If there were no negative outcomes I don't see the big issue. Can nurses cut nails? Of course. And the nurse probably thought she was doing the client a favour as they had been waiting.

    Taking the issue to AHPRA seems a bit harsh.
     
  11. daisy

    daisy Active Member

    Hi Brekin,

    Well the patient came to see me for painful ingrown nails which I was managing conservatively but at this particular appointment we were going to discuss nail surgery. The nurse cut her nails and the patient went away with her painful ingrown nails unresolved. The nurse did not have the patient's chart and management plan so was unaware of what I was doing with the patient and did not discuss treating this patient.

    The patient had been waiting just on an hour. Appointment letters state that a wait of two hours is usual. The nurse did not give the patient the option of waiting an extra five minutes for me to return.

    As I said before, whatever her abilities or competence and wanting to do the patient a favour, not getting authorization to carry out treatment on a patient she had never seen before and had no clinical notes for, concerned me greatly. She would have done the patient a bigger favour by letting the podiatrist treat the ingrown nails rather than cutting the patient's nails and carrying out a foot massage.

    Rgds

    Helen
     
  12. W J Liggins

    W J Liggins Well-Known Member

    Hi. Forgive a Pommie shouldering in here, but I have every sympathy with you. However, if Aussie bureaucrats are anything like ours, I believe that the only way to counter their decision is to prove them wrong. If you have proof - the patient statement should be enough - that their point iv) is erroneous, then they are bound to retract. Having proved them wrong on one point, then it would be easier to show that they are wrong in the other areas. However, you must be certain to have incontrovertible proof.

    All the best and go get 'em.

    Cheers

    Bill
     
  13. daisy

    daisy Active Member

    Hi Bill,

    Funny you should suggest that. That is exactly what I am going to do ;) I have had a few toings and froings with them in the last couple of days and I'm waiting for their final comments before I move on this. They are wrong on two counts and I have irrefutable proof.

    Thanks :eek:

    Helen
     
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