ESSENTIALS OF PARAMEDICINE: TRANSITION TO PRACTICE
ESSENTIALS OF PARAMEDICINE: TRANSITION TO PRACTICE
CLS406
ASSESSMENT ITEM 1 PROFESSIONAL CASE STUDY
DUE: 19 AUGUST 2023
LECTURER: TIM SPOKES
CHERYL ROGAN
11794053
Introduction
This report investigates a complaint regarding Case 2 for Assessment 1 that is currently under investigation by the Paramedicine Board of Australia. Registered paramedics are governed by legal and ethical standards under the Australian Health Practitioner Regulation Agency (APHRA, 2023). Domain one, Domain three and Domain four of the Professional Capabilities for Registered Paramedics identify the knowledge, skills and professional attributes needed for safe and competent practice of paramedicine in Australia. These codes, standards, domains and Ambulance Services Clinical Practice Guidelines will be applied and analysed against information provided in Case 2, with recommendations for addressing any deficits in knowledge, application of skills or systemic failures for improvements in practice.
Domain 1: Professional and Ethical Conduct
As a paramedic, it is essential to maintain professional and ethical standards in all aspects of practice. Paramedic professionalism refers to professional responsibilities, behaviours and parameters expected of working paramedics which are influenced by ones culture, socialisation and identity (Lloyd-Jones, 2020). Ethical principles that guide paramedic decision-making are: respect (respecting patient decisions and values), beneficence (ethical actions when helping people), non-maleficence (acting ethically to do no harm), and Justice (do not discriminate) (Curtis et al., 2019). Paramedics must take responsibility for their actions and decisions to ensure accountability within the current medico-legal framework (Paramedicine Board of Australia, 2021). The following breaches of professional and ethical conduct have been identified in Case Study 2.
Ethical: Beneficence. Paramedics are expected to help their patients as much as possible by ensuring their actions are of benefit to the patient (Curtis et al., 2019). The actions of the paramedics in this case have breached their moral obligation in making correct decisions and taking appropriate actions that promote the well-being of their patient.
Ethical: Non-maleficence. Paramedics should, as far as possible, protect the patient from immediate and foreseeable harm (Curtis et al., 2019). The paramedics have breached the ethical decision-making principle of avoiding harm by deciding not to transport this patient to hospital, because they have not considered other provisional diagnoses in order to foresee any future complications that may arise for this patient.
Legal and Ethical: Legal and ethical aspects of paramedicine provides guidance for paramedics in decision-making for this case includes acting in the best interest of the patient (Willis & Dalrymple, 2020). The paramedics have breached their legal duty of care and responsibilities for their patient in their assessments and decision-making. The duty of care means that paramedics must act in the best interests of their patients at all times and must never compromise their safety or well-being (Willis & Dalrymple, 2020).
Code of Conduct: Principle 8: Professional behaviour. It is important for practitioners to maintain a high standard of professional behaviour in order to earn the trust and respect of their patients. This involves practicing with honesty and ethics, always putting the needs of their patients first, and providing quality care. By upholding these principles, practitioners can make a positive impact in the lives of those patients (AHPRA, 2023). The paramedics have not displayed professional behaviour which should have involved assessing the situation correctly in order to make contextual judgements, informed decisions for the best outcome of their patient (Willis & Dalrymple, 2020).
Domain 1.4 Principle of Advocacy: This includes supporting and promoting patient rights in terms of their health (Paramedicine Board of Australia, 2021). The principle of advocacy is based on the belief that people have the right to be heard and to have their needs addressed. The paramedics have not appropriately advocated for their patient by recognising the appropriate level of care that was required for their patient.
The deficits in knowledge for this case study relate to not recognising the significance of a limb that is acutely painful and numb and not assessing the limb properly. The paramedics have failed to correctly assess the affected limb. The patients sock would have to be removed to assess the patients distal pulses, limb colour, sensation, temperature and movement. The patients ability to ambulate was not assessed. The patient would not be able to ambulate normally with a limb that has sensory deficits. Differential diagnoses are an important part of clinical reasoning as they allow the paramedic to collate information from the patient and patient assessments in order to form a clinical picture of what the most likely diagnosis could be. Had the paramedics systematically evaluated information from the patient in conjunction with full assessment findings, then their actions and patient outcome may have been different. The paramedics decided to leave the patient at home, which contradicts the Specific Exclusions Criteria of patients with a limb injury, as in the case study (Appendix B) (New South Wales Ambulance (NSWA), 2023).
Recommendations for improvement for the paramedics:
GIBBS REFLECTIVE CYCLE
Improving practice involves keeping up to date with ongoing professional development and engaging in self-reflection (Willis & Dalrymple, 2020). Additionally, understanding and applying the principles of clinical governance, risk minimisation, and management is crucial in ensuring that paramedics provide the safest and most effective care possible to patients. By prioritising these practices paramedics can reduce any potential harm to the best outcomes for patients.
Clinical governance refers to the systematic approach to maintaining and improving the quality of patient care within healthcare organisations. It involves various principles and processes, such as continuous quality improvement, risk management, and professional development, to ensure that patients receive safe, effective, and high-quality care. The ultimate goal of clinical governance is to improve patient outcomes and enhance the overall performance of healthcare systems.
The Clinical Reasoning Cycle (Appendix A) is a systematic process that guides paramedics to collect relevant information from a patient that will then allow the paramedic to make clinical decisions for safe patient care (Levett-Jones & Levett-Jones, 2013). The case study has highlighted several areas of this Cycle that the paramedics have not processed correctly, which has led them to make decisions that were not in the best interest of the patient.
Additional educational support in relation to patient assessments, utilising protocols/clinical practice guidelines (CPGs) and, processing and evaluating information in order to consider differential diagnoses.
Other improvements relating to Domain one are:
Domain 1.1 Key Elements of Fitness to Practice is relevant in this case because if the paramedics competence, professionalism, responsibility/accountability, values and ethics for practice.
Domain 1.2 Assess each situation, determine the nature and severity of the problem and apply the required knowledge and experience to provide a response that is in the best interest of the patient.
Domain 1.2 Respects, in so far as possible, upholds the rights, dignity, values and autonomy of every patient. This includes their role in diagnostic and therapeutic process and in maintaining health and wellbeing.
Domain 1.3 Recognise and respond appropriately to unsafe or unprofessional practice.
Domain 3: Evidence-based Practice and Professional Learning
This domain is concerned with paramedics engagement in evidence-based practice in order to critically monitor their actions through reflective processes, which involves being able to identify, plan, implement ongoing professional learning and development needs (Paramedicine Board of Australia, 2021). The following breaches have been identified in relation to Domain 3 and the case study.
Domain 3.1 Make informed and reasonable decision. The paramedics have failed to make a correct informed and reasonable decision because they did not assess the patient correctly.
Domain 3.2 Use clinical reasoning and problem-solving skills to determine clinical judgements and appropriate actions. The paramedics have not collected and processed all relevant information to allow them to make correct clinical judgements and take appropriate actions.
Domain 3.3 Draw on appropriate knowledge, resources and skills in order to make professional judgements. The paramedics do not have the appropriate knowledge in relation to proper limb assessment and therefore were unable to make a correct professional judgement in this case.
The deficits in knowledge in relation to this case study relate to the paramedics being unable to make informed and reasonable decisions because they did not assess the patient correctly. The information they collected and processed in this case was insufficient for them to make correct clinical judgements and take appropriate actions for their patient. The paramedics did not have sufficient knowledge in doing correct limb assessments, which led them to make poor professional judgements in this case.
Recommended improvements for the paramedics:
Domain 3.1 Education in relation to the Paramedic Decision-Making Model (PDMM) (Appendix C) (Maciver, 2017), to assist in making better informed decisions for patient care.
Domain 3.2/3.4 Use the Clinical Reasoning Cycle as a tool to guide decision making in relation to clinical judgements and appropriate actions.
Domain 3.3 Additional education on assessing limbs.
Domain 4: The Safety and Risk Management Practitioner
It is the paramedics responsibility to protect patients and others from harm by managing and responding to the risks inherent in paramedicine practice, while also addressing their responsibilities to ensure high-quality professional services are provided for the benefit of patients and others (Paramedicine Board of Australia, 2021). The following are breaches have been identified in relation to Domain 4 and the case study.
When it comes to risk minimisation, it is important to consider all possible outcomes and take steps to prevent or mitigate potential harm. This can involve identifying and addressing potential hazards, implementing safety protocols and procedures, and providing training and education to ensure that everyone involved is aware of the risks and knows how to respond in case of an emergency. By taking a proactive approach to risk management, we can help to ensure the safety and well-being of ourselves and those around us.
Domain 1.1. Code of Conduct: Principle 7: Minimising Risks to Patients. It is the responsibility of paramedics to ensure the safety and wellbeing of patients. Implementing principles of clinical governance, risk minimisation in practice can reduce the risk of harm to your patients (APHRA, 2023). This involves being vigilant about potential risks, taking appropriate precautions, and always prioritising the needs of patients. These principles are vital to providing high quality care and earning the trust and respect of patients. The paramedics have caused more harm to this patient by not analysing the risks associated with leaving this patient at home and not transporting to hospital for further assessment.
Domain 4.1 Protect and enhance patient safety. The paramedics provisional diagnosis of musculoskeletal pain and their decision to not transport the patient to hospital, inherently put the patient at risk of further deterioration. The patient also has a high risk of falls since he has sensory deficits to the limb.
Domain 4.5 Monitor and review the ongoing effectiveness of their practice and modify it accordingly. The paramedics did not make a reasoned decision to cease their care/treatment because they had not assessed the patient correctly.
The deficits in knowledge in relation to this case study relate to the wrong provisional diagnosis of musculoskeletal pain and not recognising that the patient would have increased risk of falls due to sensory deficits in the affected limb. The paramedics deficit in knowledge in making reasonable decisions to cease treatment and leave the patient at home, all connects back to not assessing the patient correctly.
Recommended improvements for the paramedics:
Domain 4.1 If the paramedics had completed a full assessment on the patient, it would have included assessing how the patient was able to ambulate. This may have alerted them to sensory deficits and decreased ability to ambulate, whereby the patient would have needed to go to hospital for further assessment.
Domain 4.5 Review and comparison of the paramedics current practice in making clinical decisions with the Principles of Care: Protocol A1 (NSWA, 2003b).
Appendix A
Clinical Reasoning Cycle
Levett-Jones, T., Levett-Jones, T. (2013). Clinical reasoning: Learning to think like a nurse. Pearson, Australia.
Appendix B
Appendix C
References
Australian Health Practitioner Regulation Agency (AHPRA). 2023. Code of Conduct. https://www.ahpra.gov.au/Resources/Code-of-conduct/Shared-Code-of-conduct.aspx
Levett-Jones, T., & Levett-Jones, T. (2013). Clinical reasoning: Learning to think like a nurse. Pearson, Australia.
Maciver, K. (2017). Paramedic decision-making: Expert evaluation of anew decision-making model. Doi://10.13140/RG.2.2.16265.08800.
New South Wales Ambulance. (2023a). Referral Decision: Protocol P5. Version 3.0.0.3.
New South Wales Ambulance. (2023b). Principles of Care: Protocol A1. Vision 3.0.0.3.
Paramedicine Board of Australia. (2021). The Professional capabilities for registered paramedics (AHPRA, 2021). https://www.paramedicineboard.gov.au/professional-standards/professional-capabilities-for-registered-paramedics.aspx
Willis, S., & Dalrymple, R. (2020). Fundamentals of paramedic practice: A systems approach (2nd Ed.). John Wiley & Sons, Incorporated.
