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THORACIC AND CARDIOVASCULAR SURGERY
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THORACIC AND CARDIOVASCULAR SURGERY

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  • 1. SCOPE OF PRACTICE THORACIC AND CARDIOVASCULAR SURGERY Name Licence #Supervising PhysicianAlternating Supervising PhysicianPhysician AssistantPractice Site Address Phone *Please attach additional practice sites*Hospital or University AffiliationSignatures Supervising physician Physician Assistant Alternate supervisingDate _________________________
  • 2. SUPERVISION STATEMENTThe RelationshipGuideline for PracticeThe physician is responsible for managing the health care of patients in all practice settings.Heath care services delivered by physicians and physician assistants must be within the scope ofeach practitioners authorized practice as defined by state law. The physician is ultimatelyresponsible for coordinating and managing the care of patients and with the appropriate input of thephysician assistant ensuring the quality of health care provided to patients. The physician isresponsible for the supervision of the physician assistant in all settings. The role of the physicianassistant (s) in the delivery of care should be defined through mutually agreed upon guidelines thatare developed by the physician and the physician assistant and based on the physicians delegatorystyle. The physician must be available for consultation with the physician assistant at all timeseither in person or through telecommunication systems or other means. The extent of theinvolvement by the physician assistant in the assessment and implementation of treatment willdepend on the complexity and acuity of the patients condition and the training and experience andpreparation of the physician assistant an adjudged by the physician. Patients should be madeclearly aware at all times whether they are being cared for by a physician or a physician assistant.The physician and physician assistant together should review all delegated patient services on aregular basis as well as the mutually agreed upon guidelines for practice. The physician isresponsible for clarifying and familiarizing the physician assistant with his supervising methodsand style of delegating patient care. The relationship between a supervising physician and PA isbased on mutual respect and trust.The physician relies on the PA to provide physician-quality care to the patients of the practice, toconsult with the physician or refer to the physician those patients who require physician care and toabide by any guidelines determined by the supervising physician and the state body charged withoverseeing physician/PA practice. The PA relies on the supervising physician to be available forconsultation, provide learned advice and assume care of patients who have conditions that placethem outside the scope of PA practice. Care of the patients shall include but not be limited to: • Performance of an appropriate history and physical exam • Ordering / interpreting / performing appropriate diagnostic test • Establishing and implementing appropriate treatment plans consistent with the standard of care: o This shall include counseling / instructing / performing tasks approved by SBME o Prescribing medications and dispensing sample medications as dictated by the PAs prescriptive privilege or state law or under the verbal order of the supervising or alternate supervising MD.Medication formulary consists of those medications appropriate to the treatment of patients in ancardiothoracic practice including prescribing medical devices. Excluding – • any Class II medication • Ophthalmic steroids • MAO inhibitor • Anabolic steroids
  • 3. • Sublingual Nifedipine for BP controlFor inpatient encounters, the PA, if requested by the supervising physician may order parenteralmedicine or Category II controlled substances under the verbal order of the supervision or alternatesupervising MD. The PA may examine and write orders as directed by their supervising MD foradmission / consultations requested. • Patients presenting with conditions which are life threatening, requiring immediate hospitalization, or surgery, should be evaluated by a physician. • In a life-threatening situation the PA may direct ACLS / PALS / BLS protocols while awaiting the arrival of a MD.
  • 4. Scope of Practice for Thoracic & Cardiovascular SurgeryAll Diagnoses and Treatment Plans will be discussed by Physician and PA. In this practice the PAspends 95% of his/her practicing time in the hospital, a supervising or alternate supervisingphysician is also in the hospital. The other 5% of the practicing time is spent in the office.Abdominal Aortic AneurysmAllergic ReactionAnginaAmurosis FugaxAnemiaAortic Dissection Type I & IIAortic Valve DiseaseArterial Occlusive DiseaseAscending Aortic AneurysmAtrial MyxomaAtrial Septal DefectCardiac ArrestCardiac ArrhythmiasCardiac PacemakersCarotid StenosisCandidiasisCardiac ShockCardiac TamponadeCardiomyopathyChronic Obstructive Pulmonary DiseaseCongestive Heart FailureConstipationCoronary Artery DiseaseDecubitus UlcersDeep Venous ThrombosisDiabetesDiabetic Foot UlcersEmpyemaEndocarditisEndocarditis ProphylaxisFailure to ThriveFever of Unknown OriginFluid ManagementGastritisGastroesophageal Reflux DiseaseGoutHeart MurmursHematomaHypercholesterolemiaHypercoagulable States
  • 5. HyperkalemiaHyperlipidemiaHypernatremiaHypertensionHypoglycemiaHypokalemiaHyponatremiaIdiopathic Hypertrophic Subaortic StenosisIndeterminate Lung Nodules or MassesLung MalignanciesManagement of Prosthetic Heart ValvesMitral Valve DiseaseMyocardial InfarctionNon-Healing WoundsOsteoarthritisPeptic Ulcer DiseasePericardial EffusionPericarditisPleural EffusionPneumoniaPneumothoraxPostcardiotomy SyndromePre & Post Operative ManagementPulmonary EdemaPulmonary EmbolusRenal Artery StenosisRenal FailureRenal InsufficiencySeptic ShockStrokeSubclavian StealSyncopeThrombocytopeniaThrombophlebitisTransient Ischemic AttackUrinary RetentionUrinary Tract InfectionValvular Heart DiseaseVentricular Septal DefectVenous Stasis UlcersWound Infections
  • 6. Clinical Skills for Thoracic and CV Surgery PAsLocal AnesthesiaSuture LacerationsSuture WoundsCatheterizationsStart IVsVenipuncture*Radial and Femoral Artery catheterization*Assist in SurgeryACLS*Saphenous Vein Harvesting Open Technique Endoscopic Technique*Radial Artery HarvestingDebridement of woundsManagement of chest tubesPulling Chest tubesEKGsAdminister OxygenWound Dressing ChangesPull Pacing Wires, DrainsPatient and Family EducationPost Operative/Discharge Teaching to Patients and Family MembersCoumadin EducationPostoperative OrdersAdmission OrdersPreoperative EvaluationManagement of Anticoagulation* With Surgeon in Attendance