On October 22, an article by Shawn Jeffords, reprinted in HuffPost online, talked about the government’s call for feedback on letting nurses prescribe certain medications.
This is a critical issue and one in which I and the Ontario Medical Association (OMA) Board are actively involved. For us, patient safety and continuity of care must come first. The ultimate goal of any scope of practice change should be to improve and enhance high quality patient care, not just to provide convenience.
In the summer and fall of 2018, the OMA shared our concerns directly with the College of Nurses. We are now completing our submission to the Ontario government.
In short, we welcome and appreciate the value all health care providers bring to patients and the broader healthcare system. I personally have been strongly supportive of nurses in the past as there is simply no way I could look after patients without their help. Both I and the OMA encourage collaborative, team-based, patient-centred delivery of health care. To that end, the OMA evaluates any changes in scope based on the OMA’s Set of Principles outlined below.
The ability to seamlessly share information is equally critical to the continuity of care for patients. Ideally this information would be shared through electronic health records, so this should be a consideration when looking at any changes to prescribing authority. A complete medical history, including all diagnoses and treatment information, is essential for any practitioner to effectively treat a patient.
OMA Set of Principles
OMA’s highly rigorous process for evaluating scope of practice changes involves using the following key principles. Scope changes should:
- Be consistent with the knowledge, skill and judgment of the professionals involved
- Be subject to a rigorous regulatory structure
- Support a truly collaborative, team-based approach to care as opposed to parallel care
- Not raise patient safety concerns
- Be accompanied by system initiatives/supports to ensure that no health care provider is unreasonably burdened with complications arising from expanded scopes of practice from other professions
- Be subject to stringent conflict of interest provisions
- Be applied with consideration of current best practices and lessons learned from other jurisdictions
- Be applied with consideration to cost effectiveness at a health system level
- Promote inter-professional communication and information sharing
- Promotes continuity of care
- Promote positive relationship with patient
- Should be subject to system evaluation to determine if leading to positive outcome.
To some, the above principles may seem overly onerous. Others may view this as “turf protection”. But the reality is that multiple studies have shown that the best care provided to patients is when continuity of care is maintained. This does not mean that you must get a treatment from your family doctor, it means that your family doctor must be aware of what treatment has been given, so that it can be part of your medical record to inform future decisions made about your care.
Also, to be clear, there are many instances where the changes in scope of practice have been beneficial. My own ophthalmologist has a collaborative relationship with three optometrists that provides continuity of care, and ensures patients get care in a timely manner. These type of unique models (not just in ophthalmology) occur throughout Ontario, and must be supported.
The priority of every doctor in Ontario is the health and well-being of their patients. We care for more than 340,000 patients every day. There is simply no substitute for a doctor. In order to ensure our patients get the best care, it is important that policy decisions always focus on appropriate high quality health care. It is this way that we can help to fix the health care system and solve critical issues like hallway medicine.