Teaching a personal support worker
I am a nurse in a retirement home. One of my clients receives daily insulin injections.Today, the Director of Care asked me to assign this procedure to a personal support worker (PSW). Can I do that?
The Regulated Health Professions Act, 1991 does provide an exception that allows someone who is not a member of a regulated profession, such as a PSW, to perform specific controlled acts, such as those that are a routine activity of living. A procedure would be considered a routine activity of living if, over time, the need, response and outcome of the procedure is known. This definition may apply to a client with diabetes who receives a regular (not sliding scale) dose of insulin to regulate his or her blood sugars.
In this situation, the client’s condition should be predictable, and he or she should receive the same dose of insulin every day. The injection should be part of the client’s daily routine and put the client at minimal risk. If the insulin injection for this client meets the criteria of a routine activity of living, the PSW can be taught to administer the insulin. If the insulin injection for this client does not meet the criteria of a routine activity of living, the PSW requires delegation in order to perform it. If you choose to delegate, you must ensure that you do so according to the requirements for delegating which are listed in the Authorizing Mechanisms practice guideline.
Before teaching this procedure, it is important to assess the degree of change in the client’s condition over time, the risks to the client of the PSW performing the procedure, and possible resources or supports available to the PSW should she/he need them. These client-specific factors will determine if it is appropriate for the PSW to provide the care.
Before teaching, identify a PSW who can and wants to learn how to perform the procedure safely. Create and implement a learning plan that is based on teaching techniques and your knowledge, skill and judgment of insulin injections.
When teaching is complete, you will need to determine that the PSW has learned the skill and is now competent to provide this type of care. Direct observation of the PSW completing the skill is recommended. Ongoing determination of the PSW’s competency specific to this skill is necessary for continued client safety.
As well, you must ensure there is a mechanism in place to monitor the changes in the client’s condition and confirm that the insulin injections remain a routine activity of living. Your facility and/ or director may have performance policies that monitor the PSW’s competence.