Committee approves 31 changes to scopes of practice in first year

Since early last year, our Scope of Practice & Regulations Review Committee has been working with teams and groups requesting changes to nursing and allied health scope of practice, including requests to optimize/expand scope or for delegations. They have developed a variety of helpful tools and templates to simplify and streamline the submission and review process, and meet regularly to discuss requests. When they consider a practice change they ensure conditions, such as additional education, clinical practice documents and operations support, are in place to ensure the change is implemented successfully. They also check-in after the change has been put in place to see how it is going and if there are any learnings that can be shared and used to improve future changes.

Offers Employer Level Control and Smooth Practice Changes

As an employer, Vancouver Coastal Health is ultimately accountable for the care provided to patients, clients and residents. The organization has a responsibility to determine scopes of practice for certain care settings and to provide the necessary limits on and supports for any practice changes. SPRRC serves as the mechanism for the employer level of control on practice in VCH and has been set up to centralize and streamline the process or those seeking changes – whether a clinical unit or a project team at VCH.

As soon as you identify a proposed scope of practice change, connect with Professional Practice or your SPRRC committee member. The aim of the committee is to work with you to ensure practice changes proceed smoothly from the outset, without unnecessary delays.

Application and approval processes are “smooth sailing”

Andrea Wnuk, Professional Practice lead for Respiratory Therapy, has submitted a couple of requests including one that resulted in Respiratory Therapists in primary care receiving approval to provide oxygen therapy to patients with a suspected opioid overdose without a physician order.

According to Andrea, the application and review process has been smooth sailing. She says the team was welcoming, there was lots of great discussion with many good questions, meetings were quick and the follow up by email was great. She’s also noticed that the entire process has improved over time as the team gains more experience and knowledge.

“As a matter of fact, they were almost too quick,” she says. “I needed more time to get my ducks in a row and make sure that all the necessary prep and follow up work was in place.”

“These changes to scope really increase staff’s level of job satisfaction. It means they are able to make their own decisions to be in line with colleagues and have the confidence and respect of their peers.”

A seat on both sides of the table

Kevin Enns, Interim Regional Manager of Quality for Medical Imaging, has been involved with SPRRC from both sides of the table: he has submitted several requests and is also a member SPRRC.

“The Committee gets a real variety of requests,” he says, “The majority are from areas with a strong desire to improve and optimize patient care. They want to go “about and beyond” in a safe manner.”

At any particular committee meeting, there are 12-14 people from very diverse groups sitting around the table – Professional Practice, Clinical Education, Pharmacy, EE, Quality & Patient Safety, Risk Management, and Medical Imaging. During the discussion, some members ask detailed questions about the specific role and change requested while others ask broader questions that explore the implications of those changes on other areas and groups. The end result is a comprehensive discussion that could not take place with just one or even a few groups talking about it on their own.

“I have great confidence in the quality of the group’s decision-making because of the robust discussions and wide scope of opinions and expertise around the table,” says Kevin.

How the committee came to be

There are 26 regulated health professions in British Columbia, of which 25 are self-regulating professions governed by 22 regulatory colleges. From 2001 to 2011, the repeals of individual profession-specific statutes and statutory provisions were enacted and most regulated health professions were brought under the ‘umbrella’ legislative framework of the Health Professions Act. BC is implementing a new shared scope of practice/restricted activities regulatory model under the Act.

This change provides a standard structure, common language and clearly articulates each professions scope of practice based on what the profession is educated and competent to do, which is appropriate for the educational preparation of the profession, however, it also means that regulation changed a great deal and became more complex.

At the same time, within Vancouver Coastal Health, the Professional Practice team often got involved in changes to scope of practice near the end of the project planning cycle and was put in the untenable role of a gatekeeper “policing” changes and saying “no” a whole lot. They decided to adopt a more proactive and collaborative approach by creating a multidisciplinary review committee, and were the first health authority in the province to adopt this approach. Vancouver Island Health and Fraser Health are both now in the process of creating similar committees.

“Everybody wins with this approach, “says Barb Lawrie. Vice President, Professional Practice and Chief Clinical Information Officer.  “Staff get more job satisfaction, patients get better quality, safe care and the organization enacts changes to scope of practice and delegations with less risk and more employer level control.”

“When we review requests for changes to scope of practice and delegations, we’re not trying to put up walls but to open doors. Our goal is to help you find good, solid, safe and sustainable solutions. We look forward to partnering with you and your teams to ensure the right person is in the right place doing the right job with the right amount of support so that they can do their best every day to deliver safe, high quality care and achieve the best outcomes for patients, clients  and residents.

For more information, speak to your local Professional Practice.