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Guideline Document Number # QH-GDL-940:2013

Aboriginal and Torres Strait Islander Health Practitioner Clinical Governance Guideline

1. Purpose

This Guideline provides recommendations regarding best practice for the clinical governance of Aboriginal and Torres Strait Islander Health Practitioners (Health Practitioners). The purpose of the document is to provide Hospital and Health Services with a standardised and comprehensive clinical governance framework which supports safety and quality in the clinical practice of Aboriginal and Torres Strait Islander Health Practitioners.

2. Scope

This Guideline provides information for all Queensland public health system employees (permanent, temporary and casual) and all organisations and individuals acting as its agents (including Visiting Medical Officers and other partners, contractors, consultants and volunteers).

The guideline is of particular relevance to service managers in the establishment and support of Aboriginal and Torres Strait Islander Health Practitioner roles.

3. Related documents

Forms and templates: Aboriginal and Torres Strait Islander Health Practitioner Practice Plan

4. Review

This Guideline is due for review on: 01/07/2016

Date of Last Review: N/A

Supersedes: N/A

5. Business area contact

Clinician Planning and Leadership

6. Approval and implementation

Policy Custodian: Jan Phillips, Executive Director, Health Systems Innovation Branch

Responsible Executive Team Member: Dr Michael Cleary, Deputy Director-General, Health Service and Clinical Innovation Division

Approving Officer: Dr Michael Cleary, Deputy Director-General, Health Service and Clinical Innovation Division

Approval date: 16 June 2013

Effective from: 1 July 2013

Department of Health: Aboriginal and Torres Strait Islander Health Practitioner Clinical Governance Guideline

Version No.: 1.0 Effective From: 1 July 2013 of 23

7. Table of contents

Aboriginal and Torres Strait Islander Health Practitioner Clinical Governance Guideline................. 1

1. Purpose ............................................................................................................................... 1

2. Scope .................................................................................................................................. 1

3. Related documents .............................................................................................................. 1

4. Review ................................................................................................................................. 1

5. Business area contact .......................................................................................................... 1

6. Approval and implementation ............................................................................................... 1

7. Table of contents ................................................................................................................. 2

8. Background .......................................................................................................................... 3

9. Role overview ...................................................................................................................... 3

10. Clinical governance framework ............................................................................................ 4

10.1 Overview ................................................................................................................ 4

10.2 Entrance and commencement ................................................................................ 4

10.2.1 Registration ............................................................................................ 4 10.2.2 Pre-employment screening .................................................................... 5 10.2.3 Defining individual scope of practice ...................................................... 6 10.2.4 Practice plan .......................................................................................... 7 10.2.5 Professional indemnity ........................................................................... 8 10.2.6 Re-entry assessment ............................................................................. 8

10.3 Ongoing monitoring and development .................................................................... 8

10.3.1 Clinical supervision ................................................................................ 8 10.3.2 Professional support .............................................................................. 9 10.3.3 Performance appraisal and development ............................................. 10 10.3.4 Continuing professional development .................................................. 10 10.3.5 Scope of practice review ...................................................................... 11 10.3.6 Delegation ............................................................................................ 11 10.3.7 Referral ................................................................................................ 12 10.3.8 Registration status monitoring .............................................................. 13

11. Definitions of terms used in the guide and supporting documents ...................................... 14

12. References and suggested reading .................................................................................... 15

13. Consultation ....................................................................................................................... 16

Appendix 1. Course information - Clinical ..................................................................................... 18

Appendix 2. Practice plan template ............................................................................................... 20



8. Background

The Aboriginal and Torres Strait Islander Health Practitioner role became nationally registered from 1 July 2012 under the National Registration and Accreditation Scheme for health professions. It had been identified that some Aboriginal and Torres Strait Islander primary health care roles across Australia involved a significant clinical component and the performance of a number of high risk clinical activities. On this basis, Health Ministers agreed that national registration was required to provide for the protection of the public by ensuring that only health practitioners who are suitably trained and qualified to practice are registered.

The Aboriginal and Torres Strait Islander Health Practice Board of Australia (National Board) has been established to regulate the profession. With a broad aim of protecting the public and guiding the profession, the National Board establishes registration standards and professional guidelines for Aboriginal and Torres Strait Islander Health Practitioners. The website of the National Board (http://www.ahpra.gov.au/atsi.aspx) includes details about current registration standards

9. Role overview

Aboriginal and Torres Strait Islander Health Practitioners are responsible for delivering safe, high-quality clinical services and patient care. These practitioners operate in accordance with the Primary Clinical Care Manual and applicable legislation and regulations to deliver a range of clinical primary health care services to Aboriginal and Torres Strait Islander people and communities. They may assess and treat health consumers, deliver specific health care programs, maintain health care systems and provide culturally safe and appropriate advice and support in order to contribute to better health outcomes for Aboriginal and Torres Strait Islander people.

To practise as an Aboriginal and Torres Strait Islander Health Practitioner, an individual must hold registration with the National Board. In accordance with the National Board’s registration standards, registrants must be Aboriginal and/or Torres Strait Islander and must hold a Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care (Practice) or equivalent qualification. Until 30 June 2015, applicants with other qualifications and experience may be considered for registration under the Grandparenting Provisions Registration Standard.

An Aboriginal and Torres Strait Islander Health Worker is not required to be registered unless it is necessary for employment purposes and to use the title Aboriginal and Torres Strait Islander Health Practitioner, Aboriginal Health Practitioner and/or Torres Strait Islander Health Practitioner. However, a person may independently apply for registration if they wish to do so.

The National Health Training Package outlines the competencies gained through the achievement of the Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care (Practice) and provides information about the competency areas in which these practitioners are educated. Appendix 1 includes a list of the clinical skills on which students of the prescribed course are assessed. This information may be useful in determining the individual’s scope of practice (refer section 10.2.3).

In practice, the role of Aboriginal and Torres Strait Islander Health Practitioners will vary across Australia, depending on context, service need, organisational policy and regulatory framework. At service level, an Aboriginal and Torres Strait Islander Health Practitioner’s role will be determined by the services provided, model of care, team skill mix and roles, patient profile, supervision framework, facilities and the individual’s scope of practice.

http://www.ahpra.gov.au/atsi.aspx



10. Clinical governance framework

10.1 Overview

Clinical governance refers to the systems for managing, maintaining and improving patient safety and quality of care. The diagram below illustrates the core components of a clinical governance framework for Aboriginal and Torres Strait Islander Health Practitioners.

Strong clinical governance for Aboriginal and Torres Strait Islander Health Practitioners relies on the application of a robust system of verification and endorsement processes upon the entrance and re-entrance of incumbents into these roles. The information obtained through the checking and assessment processes instituted at the outset of employment then provides a platform from which ongoing governance and development mechanisms may effectively operate.

Fig. 1 Clinical governance framework for Aboriginal and Torres Strait Islander Health Practitioners

10.2 Entrance and commencement

Each of the six governance mechanisms identified under Entrance and Commencement in the clinical governance framework presented in section 10.1, is explained below.

10.2.1 Registration

The National Board, in partnership with the Australian Health Practitioner Regulation Agency (AHPRA), is responsible for the registration of Aboriginal and Torres Strait Islander Health Practitioners.

As registration is a mandatory requirement for employment as an Aboriginal and Torres Strait Islander Health Practitioner, Hospital and Health Services should ensure that a registration status check is incorporated in the recruitment and selection process for these positions.

Registration

Pre-employment screening

Defining individual scope of practice

Practice plan

Professional indemnity

Re-entry assessment

Scope of practice review

Delegation

Referral

Registration status monitoring

ENTRANCE AND COMMENCEMENT

ONGOING MONITORING AND DEVELOPMENT

Leadership and accountability

Clinical audit

Legislation

Regulations

Clinical Service Capability Framework

Quality standards

Clinical supervision

Professional support

Performance appraisal and development (PAD)

Continuing professional development (CPD)

Primary Clinical Care Manual - Health management protocols and clinical care guidelines



Recruitment and selection processes should include a rigorous pre-employment

screening process whereby a practitioner’s

qualifications, experience and professional standing

are evaluated, verified and documented.

Hospital and Health Services should establish local processes

to ensure that a check of registration status and

conditions is incorporated in the recruitment and selection

process, and the outcome recorded in the Health

Practitioner’s personnel file.

Information about practitioner registration is readily obtained via the online Register of Practitioners on the AHPRA website (http://www.ahpra.gov.au/Registration/Registers-of-Practitioners.aspx). Importantly, in verifying registration, each of the following must be reviewed:

Profession

Registration status

Registration expiry date

Conditions

Undertakings

Reprimands

Restrictions

Notations

Where conditions or notations have been placed upon a Health Practitioner’s registration, these may impact scope of practice and should be monitored via the practice plan (refer sections 10.2.3 and 10.2.4).

Hospital and Health Services should also be aware of ongoing requirements for monitoring registration status (refer section 10.3.8).

10.2.2 Pre-employment screening

As Aboriginal and Torres Strait Islander Health Practitioners are performing clinical functions, working directly with health consumers, it is essential to verify their qualifications and experience as part of a thorough pre-employment screening process.

Hospital and Health Services should establish recruitment and selection processes which provide for the collection, evaluation, verification and recording of information about a Health Practitioner’s education, qualifications, special authorisations, licences, work experience and professional standing.

Applicants for Aboriginal and Torres Strait Islander Health Practitioner positions should be required to submit the following information:

Certificate of qualification/s

Course transcript/s showing units of study

Evidence of current registration (refer 10.2.1)

Completed clinical log book (from training course – refer Appendix 1)

Evidence of licences or special authorisations (e.g. pap smear provider licence)

Details of work history

Professional referees

Other relevant professional information

As well as providing a level of assurance about a practitioner’s training, experience and skills, the information collected and verified at this stage will form the basis for establishing the practitioner’s scope of practice (refer section 10.2.3).

http://www.ahpra.gov.au/Registration/Registers-of-Practitioners.aspx



Aboriginal and Torres Strait Islander Health

Practitioners and their supervisors should work together to define a clear

scope of practice and document this in the

practice plan.

10.2.3 Defining individual scope of practice

Scope of practice refers to the activities that an individual is educated, competent and authorised to undertake (ANMC, 2007). A health practitioner’s scope of practice informs their work activities and accountabilities.

As registered health care professionals, Aboriginal and Torres Strait Islander Health Practitioners are recognised as having their own scope of practice. Although they work under direct or indirect clinical supervision, Health Practitioners may initiate and undertake a specified range of clinical activities in the normal practice of their work.

A clearly defined scope of practice has the following potential benefits:

reduces ambiguity and helps to ensure that the Health Practitioner practices safely within their scope

gives the Health Practitioner the awareness and confidence to articulate when an activity is outside scope

helps to identify activities which could reasonably be brought into scope - with or without further training

provides clear information to share with other team members to enhance mutual understanding of roles

An Aboriginal and Torres Strait Islander Health Practitioner’s scope of practice should be defined upon their commencement in a particular role and documented in their practice plan (refer section 10.2.4). The scope of practice should be periodically reviewed and redefined, and the practice plan updated (refer section 10.3.5).

Scope of practice is impacted by many factors. The following should be considered in defining (and re-defining) an Aboriginal and Torres Strait Islander Health Practitioner’s scope of practice:

Individual skills, experience and knowledge (refer section 10.2.2)

Individual training and competencies (refer Appendix 1)

Service models

Context and acuity of service provision

Skills mix in team settings

Supervision arrangements

Patient profile

Facilities

Registration conditions or notations

Legislative, regulatory and policy authorisations

Importantly, in accordance with the Health (Drugs and Poisons) Regulation, 1996, Indigenous Health Workers with Isolated Practice Authorisation who are working in specified isolated locations, have authority to supply and administer medications. Although Aboriginal and Torres Strait Islander Health Practitioners may undertake training and simulated competency assessment in medications as part of their training, they are not authorised to work with medications in Queensland unless they meet the prescribed Isolated Practice requirements.



An Aboriginal and Torres Strait Islander Health

Practitioner’s practice plan provides clear boundaries for

their professional practice and should be utilised as the

basis for ongoing clinical supervision, support and

development.

10.2.4 Practice plan

The practice plan is a document which formalises arrangements for the clinical practice and supervision of an Aboriginal and Torres Strait Islander Health Practitioner. The principal purpose of the plan is to support patient safety and high quality care with respect to the clinical practice of the Health Practitioner.

Implementation of the practice plan offers a number of key benefits:

Enhances clarity and transparency in relation to the Health Practitioner’s scope of practice and work activities

Provides a framework for clinical supervision and practice

Provides a mechanism to identify and address areas for ongoing professional learning and development.

Facilitates continuity in the event of changes in nominated clinical supervisor for the Health Practitioner

Supports effective inter-disciplinary practice, where practice plan information is shared with other team members to enhance understanding of role and scope

A practice plan template is included as Appendix 2. This template may be varied in line with local priorities and practices however it is suggested that the practice plan include the following:

Individual scope of practice (refer section 10.2.3)

Practice restrictions or exclusions (e.g. due to notations on registration)

Referral point and process

Practice objectives

Clinical supervision structure and levels of supervision

Any entry or re-entry competency review or assessment requirements

Development requirements/processes/outcomes (e.g. linked to CPD)

Formal agreement, term and review commitments

The following guidelines are recommended for the use of practice plans:

New plan developed every twelve months

Plan is reviewed at least three-monthly in Health Practitioner’s first year in the role, and at least six-monthly thereafter

Plan developed between Health Practitioner and clinical supervisor, with review and input by line manager

Plan linked with the PAD process (refer section 10.3.3)

Copies of plan retained by clinical supervisor, line manager and the Health Practitioner between reviews.

The practice plan is a particularly useful clinical governance tool for Aboriginal and Torres Strait Islander Health Practitioners since these individuals will generally work under the clinical




Practitioners are covered for professional

indemnity, as documented in HR Policy

I3.

Robust pre-employment screening processes will

identify practitioners who are re-entering practice, enabling Hospital and Health Services to undertake an assessment and put appropriate clinical

supervision and support mechanisms in place.

supervision of a health practitioner from another discipline. The plan may assist the clinical supervisor in the process to build understanding about the Health Practitioner role.

To ensure the effectiveness of the practice plan as a governance mechanism, Hospital and Health Services are encouraged to tailor the plan and its use to suit local circumstances and needs.

10.2.5 Professional indemnity

Aboriginal and Torres Strait Islander Health Practitioners are required to hold professional indemnity insurance in accordance with the applicable National Board registration standard. This is an important governance mechanism, ensuring that practitioners are covered in the conduct of their practice.

Health Practitioners employed by the Chief Executive, Department of Health or Hospital and Health Services are included under HR Policy I3, “Indemnity for Queensland Health Employees and Other Persons”. Health practitioners operating within their scope of practice need not secure additional coverage in accordance with the Queensland Health Circular “Professional Indemnity Insurance Standards for Occupational Therapists, Medical Radiation Practitioners and Aboriginal and Torres Strait Islander Health Practitioners” (http://paweb.sth.health.qld.gov.au/qhot/documents/nras_prof_ind_ins_ot_mrp.pdf).

10.2.6 Re-entry assessment

The National Board’s Recency of Practice Registration Standard and related guideline describe particular requirements for Health Practitioners who have not practiced for three or more years (ATSIHPBA, 2013b). In such cases, the National Board may impose conditions upon the practitioner’s registration and require them to undertake further training or assessment.

Health practitioners re-entering practice should be assessed to determine competency and to determine individual scope of practice. Awareness of a practitioner’s lack of recent practice

experience will enable appropriate mechanisms for re-skilling, support and supervised practice to be put in place.

10.3 Ongoing monitoring and development

The clinical governance framework presented in section 10.1 identifies eight mechanisms for governance through Ongoing Monitoring and Development. These are explained below.

10.3.1 Clinical supervision

In order to ensure that Aboriginal and Torres Strait Islander Health Practitioners develop and maintain high standards of professional practice, they should have access to quality clinical supervision.

In addition to their line manager who provides administrative or operational supervision (such as a Senior Health Worker or Health Worker Coordinator), an Aboriginal and Torres Strait Islander Health Practitioner should have an identified clinical supervisor. The clinical supervisor should:

be an experienced nursing, allied health or medical clinician

http://paweb.sth.health.qld.gov.au/qhot/documents/nras_prof_ind_ins_ot_mrp.pdf



It is important that Aboriginal and Torres Strait Islander Health Practitioners have an

identified clinical supervisor and agreed processes for ongoing

clinical supervision.


Practitioners may benefit from having

structured professional support mechanisms in

place.

have the clinical and leadership skills to assess and support the development of the Aboriginal and Torres Strait Islander Health Practitioner’s clinical practice

have a strong understanding of how Aboriginal and Torres Strait Islander cultural issues impact on the clinical environment and be able to provide an effective and sensitive response in the management of these relationships

have capacity to observe and provide feedback on the Health Practitioner’s clinical practice

be competent to participate in clinical supervision discussions and to oversee the practice plan (refer section 10.2.4)

The Aboriginal and Torres Strait Islander Health Practitioner and their clinical supervisor should establish and maintain agreed processes for clinical supervision. These will vary depending on the individuals and work context but may include:

Periodic meetings

Practice observation

Clinical practice reflection and discussion

Case reviews

Teleconferencing or videoconferencing

It is important that a Health Practitioner has clarity about the availability and accessibility of clinical supervision and guidance. To this end, the clinical supervisor should clearly communicate:

supervision mechanisms and schedules, including back-up and remote supervision arrangements

their expectations with regard to the Health Practitioner’s clinical practice, including their level of autonomy

expected delegation and referral arrangements

requirements for direct supervision (observed practice) compared to indirect supervision (where the supervisor is accessible but not necessarily present)

It may be necessary for Health Practitioners who are new to the role to receive training on the objectives, principles and expectations of the clinical supervision process, so as to have clarity about the developmental rather than punitive nature of this type of supervision.

10.3.2 Professional support

In addition to the clinical supervision arrangements explained above, Hospital and Health Services should consider establishing other professional support mechanisms for Aboriginal and Torres Strait Islander Health Practitioners. As a new role, professional support may provide the potential for enhanced clinical practice and better understanding, utilisation and application of the role. Professional support mechanisms to be considered include:

Coaching



Hospital and Health Services should support


Practitioners to maintain their registration and to

enhance and update their skills by engaging in CPD.

An Aboriginal and Torres Strait Islander Health

Practitioner’s line manager may conduct the PAD process with input from the clinical

supervisor.

Mentoring

Multi-disciplinary peer support

Aboriginal and Torres Strait Islander Health Practitioner peer support networks

Peer review

Given that Aboriginal and Torres Strait Islander Health Practitioner numbers may be low initially, it may be appropriate to establish state-wide mechanisms or networks for professional support.

10.3.3 Performance appraisal and development

For Aboriginal and Torres Strait Islander Health Practitioners, the Performance Appraisal and Development (PAD) process should be led by the line manager, rather than the clinical supervisor. The line manager is well-placed to appraise the Health Practitioner, and to provide feedback and guidance about their development, progression and career aspirations.

Clinical practice and professional development matters being addressed through the practice plan should be referenced during

the PAD process. Open communication between the two supervisors should enable the clinical supervisor to provide valuable input about the practitioner’s clinical practice and development needs, into the appraisal and development process.

10.3.4 Continuing professional development

Aboriginal and Torres Strait Islander Health Practitioners are required to engage in continuing professional development (CPD) as a condition of registration. This ongoing learning enables Health Practitioners to extend their knowledge and skills and to ensure they stay up-to-date with contemporary practice.

The Registration Standard for CPD stipulates that registrants undertake 60 hours of documented CPD every three years (minimum of 10 hours in any one year) and that 75 per cent of this involve formal learning activities (ATSIHPBA, 2013a). The National Board’s CPD guideline identifies acceptable formal and non-formal CPD activities as follows: Formal learning activities

Tertiary courses

Accredited courses

Conferences, forums and seminars

Undertaking research and presentation of work

Courses leading to a certificate, diploma, degree or higher degree

Online learning (interactive discussion and chat rooms)

In-service education programs

Making presentations

Videoconferencing



Hospital and Health Services should ensure that

Aboriginal and Torres Strait Islander Health Practitioners and their supervisors work

together to periodically review and develop the practitioner’s scope of

practice.


Practitioners are responsible for the

completion of clinical tasks delegated to them

by their clinical supervisor or other clinicians.

Non-formal and incidental learning activities

Reflecting on experience in day-to-day activities

Reading books, journals, etc

Secondment and/or contact with other health professionals

Quality assurance activities, such as accreditation

Participation in committees

Information sharing at meetings

Discussion with colleagues

Internet research Aboriginal and Torres Strait Islander Health Practitioners should be supported to ensure they fulfil their CPD requirements for ongoing registration.

10.3.5 Scope of practice review

Following initial definition of the Aboriginal and Torres Strait Islander Health Practitioner’s scope of practice (refer section 10.2.3), scope should be the subject of ongoing discussion and review between the practitioner and their clinical supervisor. The practice plan and clinical supervision arrangements provide the vehicle for ongoing assessment and redefinition of scope of practice.

Other team members should be made aware of key changes to the Aboriginal and Torres Strait Islander Health Practitioner’s scope of practice as these may impact team roles, delegation and other service delivery.

10.3.6 Delegation

Aboriginal and Torres Strait Islander Health Practitioners may be required to take responsibility for clinical tasks that have been delegated to them by other clinicians, where these tasks are within their scope of practice. Hospital and Health Services should ensure that delegation is guided by clear and formal processes to ensure patient safety and quality of care.

In delegating to an Aboriginal and Torres Strait Islander Health Practitioner, a clinician should ensure that the task is:

Within the clinician’s own scope of practice

Within the Aboriginal and Torres Strait Islander Health Practitioner’s scope of practice

Lawful

Appropriate in the context of the patient’s care

Consistent with the standards of the Aboriginal and Torres Strait Islander health practice profession

With consideration to the patient’s cultural needs

Consistent with Hospital and Health Service policy (ANMC,



It is important that Aboriginal and Torres Strait Islander Health Practitioners have a clear understanding of their responsibilities in

making and receiving client referrals, with particular consideration to client

cultural needs.

2007)

In delegating a task, the delegating clinician shares accountability for its completion, and therefore may be expected to undertake an assessment to determine that the activity is within the Aboriginal and Torres Strait Islander Health Practitioner’s scope of practice, and to provide instruction, training and clinically-focussed supervision where required to ensure safe completion of the delegated task (Queensland Health, 2013).

In accepting a delegated activity, an Aboriginal and Torres Strait Islander Health Practitioner:

Acknowledges that they accept the delegated task

Agrees that the task is within their scope of practice

Agrees not to further delegate the delegated task

Acknowledges their degree of accountability for performing the task

10.3.7 Referral

Aboriginal and Torres Strait Islander Health Practitioners may work in multidisciplinary teams where high quality service delivery requires team members to have good communication, a good understanding of each other’s skills and responsibilities, and respect for the diversity and value of all members’ contributions. Teamwork of this nature also provides the basis for timely, appropriate and effective referrals.

Aboriginal and Torres Strait Islander Health Practitioners may need to refer patients to other health professionals, or they may receive patient referrals to provide some aspect of their care. In

receiving referrals, Aboriginal and Torres Strait Islander Health Practitioners take responsibility for the referred aspect of patient care and must ensure that the required clinical activities are within their scope of practice.

As with delegation processes, Hospital and Health Services should ensure that referral processes are clear and formal. Specific referral arrangements and expectations, tailored to the local staffing and service model, should be discussed with the clinical supervisor and recorded in the Aboriginal and Torres Strait Islander Health Practitioner’s practice plan (refer section 10.2.4).

In making referrals, the referring health practitioner should ensure that the referral is:

Based upon clinical assessment of patient need

With consideration to the patient’s cultural needs

Within the authority of the referring health practitioner

Within the scope of practice of the health practitioner receiving the referral

Consistent with Hospital and Health Service policy

Supported by appropriate and sufficient communication and information about the patient and their treatment to enable continuing care (ANMC, 2007)

In accepting a referral, the health practitioner:

Acknowledges that they accept the referral

Agrees that the task is within their scope of practice

Acknowledges their degree of accountability for performing the task



Hospital and Health Services should establish local processes to ensure

that the registration status of each Aboriginal and Torres Strait Islander

Health Practitioner is verified annually.

Understands requirements to provide communication and information to the referring health professional.

10.3.8 Registration status monitoring

The ongoing monitoring of health practitioners’ registration status is as important as the initial pre-employment check. Hospital and Health Services should ensure that mechanisms are in place to verify that Aboriginal and Torres Strait Islander Health Practitioners maintain their registration and to be made aware of altered conditions or notations (refer section 10.2.1).

The National Board operates a standardised annual registration cycle ending on 30 November, thus registration status checks should be in place to ensure evidence of ongoing registration from 1 December annually.



11. Definitions of terms used in the guide and supporting documents

Term Definition / Explanation / Details Source

Accountability Accountability refers to the expectation of being answerable for one’s decisions, actions and behaviours and may not be delegated.

ANMC, 2007

Clinical supervision The oversight of clinical procedures and processes, in accordance with agreed arrangements, for the purpose of:

providing education, guidance and support to the individual being supervised

directing the individual’s performance

monitoring and evaluating outcomes, especially the client’s response to the activity

ANMC, 2007; HWA, 2012

Competence Competence is the combination of knowledge, skills, attitudes, values and abilities that underpin effective performance in a profession. It encompasses confidence and capability.

ANMC, 2007

Continuing Professional Development (CPD)

CPD is the means by which members of the profession maintain, improve and broaden their knowledge, expertise and competence, and develop the personal and professional qualities required throughout their professional lives.

ATSIHPBA, 2013

Delegation In a health care context, delegation involves the transfer or conferring of authority on another health care professional to provide some aspect of patient care, with accountability for the delegated activity becoming shared.

ANMC, 2007

Practice Practice means any role, whether remunerated or not, in which a registered health professional uses their skills and knowledge in their profession.

ATSIHPBA, 2013

Professional support Professional support relates to the systems and environmental factors that facilitate personal and professional growth. Professional support:

enables high standards of practice

safeguards and improves the safety and quality of patient care

maximises employee morale and retention

Queensland Health, 2012d

Referral In a health care context, referral involves the transfer of primary health care responsibility to another qualified health service provider, while continue to provide their services collaboratively as required.

ANMC, 2007

Scope of practice The scope of practice of an individual is that which the individual is educated, authorised and competent to perform.

ANMC, 2007



12. References and suggested reading

Aboriginal and Torres Strait Islander Health Practice Board of Australia (ATSIHPBA), 2013a, Continuing professional development registration standard, http://www.atsihealthpracticeboard.gov.au/documents/default.aspx?record=WD12%2F7069&dbid=AP&chksum=IW1w0wrEL1MR7BHsvozNIA%3D%3D

Aboriginal and Torres Strait Islander Health Practice Board of Australia (ATSIHPBA), 2013b, Recency of practice registration standard, http://www.atsihealthpracticeboard.gov.au/documents/default.aspx?record=WD12%2F7074&dbid=AP&chksum=UEmtbSARpJ0V1x0B2kXD8A%3D%3D

Australian Health Practitioner Regulation Agency, http://www.ahpra.gov.au/

Australian Nursing & Midwifery Council (ANMC) 2007, National framework for the development of decision-making tools for nursing and midwifery practice, Australian Nursing Midwifery Council, Canberra, http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD10%2f3341&dbid=AP&chksum=3SWDivwEVXM4K6MsMHxTmw%3d%3d.

Health (Drugs and Poisons) Regulation 1996, http://www.legislation.qld.gov.au/LEGISLTN/CURRENT/H/HealDrAPOR96.pdf

Health Practitioner Regulation National Law Act 2009, http://www.legislation.qld.gov.au/LEGISLTN/ACTS/2009/09AC045.pdf

Health Workforce Australia, 2011, National Clinical Supervision Support Framework, http://www.hwa.gov.au/sites/uploads/hwa-national-clinical-supervision-support-framework-201110.pdf

Medical Board of Australia, 2013, Good Medical Practice: A Code of Conduct for Doctors in Australia, http://www.medicalboard.gov.au/Codes-Guidelines-Policies.aspx

National Safety and Quality Health Service Standards, 2011, http://www.safetyandquality.gov.au/wp-content/uploads/2011/01/NSQHS-Standards-Sept2011.pdf

Patient Safety and Quality Improvement Service – Policies, Standards and Guidelines, http://qheps.health.qld.gov.au/psq/policies.htm

Queensland Health, 2011a, Primary Clinical Care Manual, 7th Edition 2011, http://www.health.qld.gov.au/pccm/default.as

Queensland Health, 2011b, Clinical Governance for Nurse Practitioners in Queensland: a guide, http://www.health.qld.gov.au/nmoq/nurse-practitioner/clinical-governance.asp

Queensland Health, 2012c, HR Policy I3, Indemnity for Queensland Health Employees and Other Persons. http://www.health.qld.gov.au/hrpolicies/other_policies.asp

Queensland Health, 2012d, Allied Health Professional Support Guidelines, http://qheps.health.qld.gov.au/cunningham-centre/docs/allied-health/ah-psp/ahpsgdl_v2_sept2012.pdf

Queensland Health, 2013, Professional interface: Nurses and the Aboriginal and Torres Strait Islander Health Practitioner – Guide for Nurses 2012-13, Consultation Draft, Unpublished.

http://www.atsihealthpracticeboard.gov.au/documents/default.aspx?record=WD12%2F7069&dbid=AP&chksum=IW1w0wrEL1MR7BHsvozNIA%3D%3D

http://www.atsihealthpracticeboard.gov.au/documents/default.aspx?record=WD12%2F7069&dbid=AP&chksum=IW1w0wrEL1MR7BHsvozNIA%3D%3D

http://www.atsihealthpracticeboard.gov.au/documents/default.aspx?record=WD12%2F7074&dbid=AP&chksum=UEmtbSARpJ0V1x0B2kXD8A%3D%3D

http://www.atsihealthpracticeboard.gov.au/documents/default.aspx?record=WD12%2F7074&dbid=AP&chksum=UEmtbSARpJ0V1x0B2kXD8A%3D%3D

http://www.ahpra.gov.au/

http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD10%2f3341&dbid=AP&chksum=3SWDivwEVXM4K6MsMHxTmw%3d%3d

http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD10%2f3341&dbid=AP&chksum=3SWDivwEVXM4K6MsMHxTmw%3d%3d

http://www.legislation.qld.gov.au/LEGISLTN/CURRENT/H/HealDrAPOR96.pdf

http://www.legislation.qld.gov.au/LEGISLTN/ACTS/2009/09AC045.pdf

http://www.hwa.gov.au/sites/uploads/hwa-national-clinical-supervision-support-framework-201110.pdf

http://www.hwa.gov.au/sites/uploads/hwa-national-clinical-supervision-support-framework-201110.pdf

http://www.medicalboard.gov.au/Codes-Guidelines-Policies.aspx

http://www.safetyandquality.gov.au/wp-content/uploads/2011/01/NSQHS-Standards-Sept2011.pdf

http://www.safetyandquality.gov.au/wp-content/uploads/2011/01/NSQHS-Standards-Sept2011.pdf

http://qheps.health.qld.gov.au/psq/policies.htm

http://www.health.qld.gov.au/pccm/default.asp

http://www.health.qld.gov.au/nmoq/nurse-practitioner/clinical-governance.asp

http://www.health.qld.gov.au/hrpolicies/other_policies.asp

http://qheps.health.qld.gov.au/cunningham-centre/docs/allied-health/ah-psp/ahpsgdl_v2_sept2012.pdf

http://qheps.health.qld.gov.au/cunningham-centre/docs/allied-health/ah-psp/ahpsgdl_v2_sept2012.pdf



13. Consultation

Key stakeholders invited to review this version:

Name Role Area

Simone Kolaric Chief Executive Torres Strait – Northern Peninsula HHS

Andrew McGill HR Manager Torres Strait – Northern Peninsula HHS

Karl Briscoe A/Director, Primary Health Care Cape York HHS

Peter McCormack Manager, Clinical Quality and Safety, Rural and Remote Clinical Support Unit

Cape York HHS

Marek Klein Executive Director, Community and Primary Health

North West HHS

Michelle Garner District Executive Director of Nursing

North West HHS

Debra Davis Director, Human Resources North West HHS

Helen Congoo Manager, Health Worker Services Cairns HHS

Frederick Yasso Indigenous Health Coordinator, Indigenous Health Service

Townsville HHS

Ross Atu Senior Indigenous Health Worker Central Queensland HHS

Dean Johnson Indigenous Health Coordinator West Moreton HHS

Melissa Browning Coordinator, Indigenous Health Service

Gold Coast HHS

Morven Gemmill Executive Director, Allied Health Gold Coast HHS

Dr Peter Bristow Chief Executive Darling Downs HHS

Tarita Fisher Manager, Community Health, Cherbourg

Darling Downs HHS

Warren Locke Program Manager, Capability, Leadership and Placement

Human Resource Services, System Support Services Division

Dr Susan O’Dwyer Executive Director, Medical Services

Metro South HHS

Robyn Brumpton Nursing Director, Quality and Safety

South West HHS

Lyn Rowland Chief Human Resources Officer Human Resource Services Branch, System Support Services Division

Dr Jeannette Young

Chief Health Officer Office of the Chief Health Officer

Dr Humsha Naidoo Principal Medical Officer Office of the Principal Medical Officer

Julie Hulcombe Chief Allied Health Officer Office of the Chief Allied Health Officer

Dr Frances Hughes

Chief Nurse Nursing and Midwifery Office, Queensland



Name Role Area

Nola Simpson Manager, Regulatory Instruments Unit

Policy and Planning Branch, System Policy and Performance Division

Elizabeth Robertson

Nursing Director, Patient Safety Unit

Health Systems Innovation Branch, Health Service and Clinical Innovation Division

Colleen Jen Senior Director Policy and Planning Branch, Systems Policy and Performance Division

Michael Zanco Executive Director Clinical Access and Redesign Unit, Health Systems Innovation Branch, Health Service and Clinical Innovation Division



Appendix 1. Course information - Clinical Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care (Practice)

Students of the Certificate IV in Aboriginal and Torres Strait Islander Primary Health Care (Practice) undertake clinical practice and assessment, acquiring the knowledge and skills to perform a number of clinical procedures. As such, Aboriginal and Torres Strait Islander Health Practitioners may be reasonably expected, and assessed on their competency, to perform the types of activities outlined below:

Clinical Practice Area Types of Activities

Common procedure - hand hygiene

Hand rub

Routine hand wash

Clinical hand wash

History taking SOAP-F

Assess client’s physical well-being

Assess client’s social and emotional well-being

Observations Measuring temperature, pulse and respiration

Measuring blood pressure

Measuring blood glucose level

Head circumference

Measuring height

Measuring weight

Cardio-vascular system ECG

Pulse oximetry

Haemoglobin - Hb

Respiratory system Chest sounds

Oxygen therapy

Suction

Peak flow

Spirometry

Special senses Ear examination

Ear management

Eye examination

Eye management

Visual acuity

Skin Skin assessment

Simple dressing

Wound closure

Removal of wound closures

Complex dressings

Gastro-intestinal system

Abdominal assessment, auscultation and palpation

Waist circumference

Oral assessment

Nervous system

Pain assessment

Neurological observations

Neurovascular assessment



Clinical Practice Area Types of Activities

Medications* Medication administration - common activities relevant to this skill

Oral

Sublingual / buccal

Inhalers DPI - dry powder

Inhalers MDI - metered dose / spacer

Nebulisers

Topical

Suppositories

Injections - common activities relevant to this skill

Injections - intra-muscular (IMI)

Injections - subcutaneous (SCI)

Injections - Intra-venous (IVI)

Injections – Z-track

IV infusion / cannulation - fluid

Monitoring the cold chain

Anaphylaxis

Specimen collection Venepuncture

Urinalysis

Collection of urine specimens from older children and adults for PCR, ACR and MSU

Application of paediatric bag and collection of mid-stream urine

Wound swab

Nose swab

Throat swab

Faeces collection

Tissue sample

Sputum swab

Eye swab

* In Queensland, Aboriginal and Torres Strait Islander Health Practitioners (excluding eligible Isolated Practice Authorised Health Workers) are not authorised to supply or administer medication under the Health (Drugs and Poisons) Regulation, 1996. Students undertake simulated assessment of medications related skills, as required.

For further information about the Certificate IV in Aboriginal and Torres Strait Islander Primary Health Care (Practice), including details about competency areas and assessment, refer to http://training.gov.au/.

http://training.gov.au/



Appendix 2. Practice plan template

Aboriginal and Torres Strait Islander Health Practitioner

PRACTICE PLAN

The purpose of this practice plan is to provide a framework for the clinical practice, supervision and development of the Aboriginal and Torres Strait Islander Health Practitioner. A new plan should be developed each year and the plan should be reviewed at least three-monthly in the first year and at least six-monthly in subsequent years. The Aboriginal and Torres Strait Islander Health Practitioner’s line manager should be consulted in the development of the practice plan, and should endorse the final plan. The practice plan should be referenced during the Performance Appraisal and Development (PAD) process.

1. Personal details

Record details of the Aboriginal and Torres Strait Islander Health Practitioner for whom this plan is written, and their clinical supervisor.

Practitioner name:

Commencement date in role:

Qualifications:

Authorisations:

Experience overview:

Clinical supervisor name:

Position:

2. Scope of practice

The Aboriginal and Torres Strait Islander Health Practitioner and their supervisor should discuss and determine the practitioner’s scope of practice in the role, based on their education, competencies and authorisations. Use the space below to note broad parameters defining the practitioner’s scope. This is not intended to be a complete list of activities or responsibilities, but should be indicative of the types of activities that the practitioner may perform in the role.



3. Practice restrictions and exclusions

The Aboriginal and Torres Strait Islander Health Practitioner and their supervisor should discuss and determine any particular practice restrictions or exclusions for the practitioner, that is, activities which are outside their scope of practice and which should not be performed.

4. Practice referrals

The Aboriginal and Torres Strait Islander Health Practitioner and their supervisor should discuss and agree upon an appropriate referral process and referral parameters, considering the scope of practice of the practitioner and the particular clinical setting.

Clinical assessment process for determining need for referral:

Types of clinical tasks likely to be referred:

Practitioners to whom clinical referrals are likely to be made:

Agreed referral process:



5. Practice development plan

The Aboriginal and Torres Strait Islander Health Practitioner and their supervisor should discuss clinical practice aspirations and expectations within the practitioner’s scope of practice. Use this section to record agreements about clinical practice objectives and development needs.

Clinical practice objective for the practitioner’s clinical practice for the next 12 months:

Clinical practice development priorities i.e. experience and/or competencies the practitioner needs to develop in order to achieve the practice objective:

Specific plans for achievement of development priorities (e.g. supervised practice, CPD, practice assessment etc.)

6. Clinical supervision arrangements

The Aboriginal and Torres Strait Islander Health Practitioner and their clinical supervisor should discuss and reach agreement about the supervision arrangements that will be in place for the implementation of the practice plan.

Agreed supervision structure that will be in place for the duration of the plan (e.g. Fortnightly meetings, monthly case review, etc). Include expected duration and location of meetings and any resource requirements:

Arrangements for access to clinical supervisor between supervision sessions:



Clinical supervision arrangements (continued)

Process for practice conflict and/or dispute resolution:

Types of activities for which direct supervision by the clinical supervisor is required (i.e. observed practice):

Types of activities for which indirect supervision is acceptable (i.e. clinical supervisor is accessible but need not observe practice).

7. Agreement

Practice plan start date: End date:

Review date 1:

Review date 2:

Review date 3:

Aboriginal and Torres Strait Islander Health Practitioner name:

Signed: Date:

Clinical supervisor name:

Signed: Date:

Line manager name:

Signed: Date:

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