Indications and Contraindications to Implementing the Medical Directive should be included
- Some directives are very specific (e.g. in case of GI bleed, medication should not be prescribed) or very vague (e.g. in the case of medical directove for history taking, indication is any patient admitted in X hospital, under X service, with X physician).
- Some directives advise to refer to external resources (e.g. Clinical Practice Guidelines or Rx Files) for indications and contraindications of medications and procedures.
There should be a statement defining the Certification and Education requirements of Physician Assistants that are to implement the medical directive. This may include:
- “Physician Assistant passed the PACCC, or be PA-C
- “Physician Assistant must have liability insurance”
Without title protection that may come with PA regulation in Ontario, education that is listed in directive helps define “Physician Assistant” role (i.e. Physician Assistant is someone who went to PA school)
Optional: Additional Competency Assessment
If a PA is performing a delegated controlled act, they must be capable of performing it safely and competently. Without regulation in Ontario, there is no official process for determining an individual’s competence other than the PA Entry to Exam. The medical directives may have a component of “competency assessment”.
For example, perhaps an MD is to observe you doing 3 lumbar punctures are your own properly, and sign off on the medical directive before you can start doing this on your own.