Health Professions Act, 1974 (Act No. 56 of 1974)RegulationsRegulations Defining the Scope of Practice of Clinical Associates, 20162. Acts deemed to be acts pertaining to the scope of practice of Clinical Associates |
The following acts are deemed to be acts pertaining to the scope of practice of clinical associates and must be performed within ethical rules of the Health Professions Council of South Africa and all applicable clinical protocols and strategies for all age groups:
| (a) | Obtaining a patient's history and performing a physical examination of the patient in accordance with the clinical associate's level of education, training and experience; |
| (b) | ordering or performing diagnostic and therapeutic procedures for common and important conditions in South Africa and in accordance with the clinical associate's level of education, training and experience; |
| (c) | performing or ordering and interpreting the following investigations: |
INVESTIGATIONS |
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Performing finger prick blood tests (on accreditation compliant instrumentation under the guidance of an accredited laboratory according to Point of Care Testing guidelines). |
HIV (including counselling), Haemoglobin, blood glucose, blood type, etc. |
Ordering and interpreting X Rays |
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Performing/ordering and interpreting ECG |
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Performing/ordering urine tests and interpreting results |
Dipstix, pregnancy test, Microscopy, Culture and Sensitivity (MC & S), etc. |
Ordering stool tests and interpreting results |
MC & S, etc. |
Performing throat swab, ordering tests and interpreting results |
MC & S, etc. |
Collecting sputum samples, ordering tests and interpreting results |
Acid Fast Bacillus (AFB) , MC & S, etc. |
Ordering blood tests and interpreting results |
Full Blood Count (FBC) |
Liver Function Tests (LFT) |
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Urea and Electrolytes (U & E) |
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C- reactive protein (CRP), etc. |
| (d) | interpreting findings and formulating a diagnosis for common and emergency conditions referred to in paragraph (b) in accordance with clinical associate's level of education, training and experience; |
| (e) | performing the following procedures under supervision of a medical practitioner and in accordance with the clinical associate's level of education, training and experience: |
AGE GROUP |
PROCEDURE |
All age groups |
Administration of Oxygen |
Acute debriefing/Sharing bad news |
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Administration of nebulisation |
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Apply POP - all types |
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Arterial blood gas - radial, femoral |
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Check for union of fractures |
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Cranial Nerve II -XII Examination |
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Completion of J88 Assault Form |
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Counselling - bad news |
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Counselling - death |
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Counselling - family/mental health |
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Counselling - HIV |
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Counselling - Pregnancy |
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Defibrillation Automatic Emergency Defibrillator (AED)/manual |
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Death notification |
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Dress abrasions and burns |
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Foreign body removal - ear and nose |
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Gastric Lavage |
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Intravenous line insertion |
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Inter costal drain insertion |
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Injections - Intradermal |
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Injections - Intramuscular |
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Injections - Subcutaneous |
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Lumbar Puncture (except in neonates) |
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Mantoux |
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Medical condition notification |
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Metered Dose Inhaler technique and demonstration |
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Nasogastric Tube Insertion |
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Paraphimosis reduction |
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Patient referral |
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Peak Flow Meter use and Interpretation |
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Pulse Oximetry |
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Removal of foreign body - ear and nose |
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Removal of POP |
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Sick leave certification |
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Snellen Visual Chart Exam |
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Suprapubic aspiration/catheter insertion |
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Syringe of ear/Ear irrigation |
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Venipuncture |
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Adults and children 13 - 17 years |
Aspiration and incision and drainage of abscess |
Assist in Caesarean Section |
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Assist in closed fracture reduction |
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Assist in diathermy/cautery |
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Assist in emergency laparotomies |
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Assist in epidural and spinal anaesthesia |
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Assist in knee and other joint aspiration |
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Assist in medico legal examination |
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Assist in open reduction of fractures |
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Assist in/perform reduction of joint dislocations |
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Assist in tubal ligation |
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Bag and mask ventilation |
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Basic life support |
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Bladder catheterisation - female |
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Bladder catheterisation - male |
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Blood transfusion |
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Bone marrow aspiration |
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Cardiopulmonary resuscitation (CPR) |
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Cardiotocographic fetal heart monitoring |
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Cautery/excision of condylomata |
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Central line insertion- external jugular vein, femoral vein |
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Circumcision - uncomplicated |
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Close surgical incisions (all layers) |
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Cricothyroidotomy |
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Cryotherapy |
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Debridement of minor limb injuries |
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Dilatation & Curettage |
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Dilatation of pupil |
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Drainage of simple hydrocele |
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Dry mopping of ear |
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Episiotomy - perform and suture (including repair of vaginal tears) |
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Eye staining |
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Excision of skin glands/cysts/masses/lesions |
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Fine Needle Aspiration - breasts and nodes |
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Full spine immobilization & log roll |
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Genital swabs |
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Glasgow Coma Scale (GCS)assessment |
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Glue lacerations |
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Incision and drainage of Quinsy |
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Incision and drainage of paronychia |
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Instruction in use of crutches |
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IV Infusion |
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Incision and drainage of superficial abscess |
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Incision of thrombosed haemorrhoid |
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Intra- and post-operative observation |
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Intrauterine contraceptive device insertion |
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Insertion and removal of long- acting subdermal contraceptive implants |
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Knee examination |
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Leg ulcer chronic dressing |
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Lymph node biopsy |
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Maebomian abscess removal |
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Mental health examination |
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Mental Health History |
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Mini Mental State (MMS) examination |
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Normal vaginal delivery |
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Oral airway/Laryngeal mask airway/other airway devices |
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Oral endotracheal intubation |
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Packing of nose |
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Paracentesis |
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PAP smear |
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Portable ventilation |
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Pre-op assessment |
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Pleural tap; Pleural biopsy |
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Preparation of malaria smear |
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Reduction of shoulder dislocation |
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Removal of K-wire |
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Regional Blocks - penile |
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Regional blocks - ring blocks |
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Removal of foreign body - ear, eye, eyelid and vagina |
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Restraining a patient |
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Conscious sedation |
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Skin applications (Podophyllin) |
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Skin biopsy |
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Skin grafts - small |
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Sputum collection |
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Stool specimen collection |
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Suture lacerations |
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Suturing ear |
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Suturing eyelid |
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Tamponade of epistaxis |
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Trauma survey (primary & secondary) |
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Triage |
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Venous cut down |
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Wound care and debridement |
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Children up to 12 years of age |
Apply Gallows traction |
Assist at lumbar puncture - Neonate |
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Lumbar puncture - Children |
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Hearing Screen |
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Immunisations |
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Intraosseous infusion |
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Initiate Neonatal Resuscitation (bag and mask) |
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Initiate Paediatric Resuscitation (bag and mask) |
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Complete the Road to Health booklet |
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Nutritional assessment |
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Assess for and initiate CPAP in newborns with respiratory distress syndrome (RDS) |
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Prescribe and initiate phototherapy in newborns |
| (f) | developing, implementing and monitoring a comprehensive management plan for common and important conditions; |
| (g) | issuing sick certificates for a period not exceeding 3 days, which must contain the name and contact details of the supervising medical practitioner; |
| (h) | prescribing medicines for common and important conditions according to the primary health care level Essential Drug List (EDL) and up to schedule IV, except in emergencies when appropriate drugs of higher schedules may be prescribed. The prescription must contain the name of the supervising medical practitioner. In the case of drugs not on the EDL the prescription must be countersigned by a medical practitioner; |
| (i) | being the required assistant at surgery; |
| (j) | making appropriate admissions, discharges and referrals; |
| (k) | performing any act delegated to him or her by the supervising medical practitioner in accordance with the education, training and experience of the clinical associate; and |
| (I) | assisting medical practitioners within district level health care services and with the focus on primary health care. |