Introduction
Following on from my first assignment I will be looking into the legal, ethical and professional frameworks which correspond within the ambulance service setting. Alongside regulations, law and ethics which adjoin controlled drugs and how using stronger analgesia can be of benefit and comfort to our patients. Looking into legalities using the controlled drug Morphine within the ambulance service, ethics expected from myself as a health care professional and the frameworks I am expected to work from. I shall delve more into using a drug that is currently out of my scope of practice as a Technician but one that I would be able to use following trust policies and procedures as a registered Paramedic. Meanwhile, whilst discussing the role and responsibilities of an aspiring paramedic it is crucial that I follow the rules and regulations set out by the HCPC as a healthcare professional in my day to day work in the community. (Health and Care Professionals Council 2015). Therefore, I shall delve more into what is expected from me as a registered Paramedic concerning the frameworks I must adhere to whilst in practice.
Legal
As a paramedic we are required to work within legal boundaries which are governed by legislation within the National Health Service and other health care contributors. Looking into my own trusts policy (EMAS) in regard to controlled drugs and other sources available, I have been able to look more into the legal aspect from registered practitioners who are able to administer controlled drugs. Furthermore Morphine Sulphate is a Class A schedule 2 controlled drug which is classified under Section 2 of the Misuse of Drugs Act 1971. Schedule 2 drugs are classed as highly addictive and are the most strictly controlled. It is an offence to possess any drug belonging to Schedule 2 or 3 without prescription or lawful authority (Excellence, 2001). Bearing this in mind it is subject to the full requirements of the act in question in relation to supply, security, administration and recording (East Midlands Ambulance Service, 2020). To supply would mean passing on a controlled drug from one person to another whether this be of financial gain or not. As a registered Paramedic I would not be entitled to supply Morphine to a patient in its physical form of containment such as the vial or bottle it is housed in but I am able to supply via administration of the drug by intravenous, intramuscular or the oral route. (Evans. M, 2008). However, ambulance services can supply controlled drugs to their employees for the purposes of immediate treatment of sick or injured persons. (England. E, 2020). As a Paramedic it is my responsibility to secure, administer and record any relation to the drug. Paramedics are to be given a CD (controlled drug) key by the trust, this would be the responsibility of myself and must not be given to any other member of staff. This would gain access to the CD drugs safe onboard trust vehicles. Any loss or theft of a key must be reported to the Police. Morphine must be signed out by myself (the registered practitioner) at the beginning of a shift and at the end of my shift. A stock check should also be taken once again at the beginning and at the end of the shift. These stock checks are to be followed through and witnessed by another member of staff who will also countersign the recordings of what is found. When a CD analgesic drug such as Morphine is administered it must also be documented on the patient’s paperwork/EPRF (Electronic Patient Report Form) and also in the stock check record book after use the administration of the drug and if there is any wastage (which must be witnessed discarding of) or damages occurred (Trust, E. 2020). Also of upmost importance is referring to JRCALC guidelines before and whilst using the drug. Morphine is not licensed for use in children but it has been approved by the Medicines and Healthcare Products Regulatory Agency (MHRA) for ‘off label’ use. It can therefore be legally administered under such guidelines by Paramedics exceeding children over the age of one (JRCALC, 2016).
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Ethical
There are 4 principals which are represented via the ethical clinical decision making tool. Beauchamp and Childress appears to be the most utilised framework which proposes a variety of deliberation for medical ethics. These principals can be put into practice as an aspirant paramedic or any health care professional. (Levitt. D, 2014) Within these 4 principals the basis we are looking at is that we are allowing our patient to have the right to decide on their treatment and care, knowing what is beneficial for our patients best interests, to do no harm to the patient and that each and every individual has equal and fair access to treatment. The above therefore should provide a simple and impartial perspective within our clinical practice. It will also set out the standard basis of decision making for health care professionals when reflecting on issues that we face daily within the community whilst working. We are finding within the emergency ambulance setting currently we are faced more so with ethical decision making incidents. This is due to us now attending more incidents that are not classed as ‘emergencies’ where usually our patient may not be able to express their wishes due to their condition/injury. Currently we are attending more ‘social’ or ‘primary care’ incidents which may lead to other pathways outside of the accident and emergency department therefore the 4 commitments come more into play as the patient tends to have full awareness and capacity of knowing their own wishes and what should be expected from us as their health care provider. “Ethics is often seen as a proscriptive activity—telling you what you cannot do. But in many cases it can be very freeing. It can affirm that you are doing the right thing.” (Medscape, 2018). Thankfully we are adhered to clear policies and guidelines in which support our ethical clinical decision making which helps support ourselves as paramedics and for our patient to reap the benefits from the decisions made. Therefore taking into consideration those 4 basic moral commitments in regard to pain relief we should follow through that our patient has the right to decide on their choice of analgesia if it is available and applicable to their need, that we should always do what is right for our patient, that we shall follow guidelines and keep within our scope of practice therefore causing no harm to our patient and treating the patient as an individual and allowing them all equal access to treatment.
Professional Frameworks
The healthcare profession of the title Paramedic is regulated by the Health Care Professionals Council (HCPC). The council was established to state rules and regulations set out to registered health care professionals with a protected title such as Paramedics, Nurses and Doctors. The intention of the frameworks provided by the HCPC is to protect the public/patient when being treated by a registered health care professional. To be provided with a registration with the HCPC a person must present to them that they meet the standards of proficiency to be registered with them and those standards must be maintained and fit within your scope of practice. The standards set out by the HCPC will also coincide with your employer or professional body (HCPC, 2007). The HCPC will approve qualifications gained by the Paramedic and assure they are of standard, that you are continuous in your learning approach via professional development. Therefore as a registered paramedic you are to keep your skills and knowledge up to date with annual CPD. You are expected to document your development as a professional and reflect on learning and development, documenting of skills that you can apply within your practice and a variety and knowledge of varied communication skills. Alongside this willingness to keep up to date with current and new guidelines (Health Careers, 2019). It is of upmost importance to stay within the professional frameworks laid out to us from the HCPC and our own ambulance trust guidance and policies. Therefore we must practice within the legal and ethical boundaries of our work role as defined in the HCPC, practice in a non-discriminatory approach, exercise a duty of care, maintain confidentiality and obtain consent from the patient and not work outside our own scope of practice and qualified skills (Moore, J. 2020). The College of Paramedics published the Interactive Career Framework back in 2015 which acts as a guide to highlight the education, knowledge, and expertise available to paramedics as they develop their skills along their career pathway. It is a key milestone in leading the development of the paramedic profession, which Health Education England and the College of Paramedics are committed to furthering. The framework offers guidance for paramedics seeking to further their careers and for education providers offering CPD and qualification routes. It also promotes the continuously evolving variety of roles that paramedics are undertaking in clinical practice, leadership and management, education and research (Lowery-Richardson, K. 2017).
Conclusion
As an aspiring paramedic we are our patients first point of contact, it is our duty of care to provide them with urgent and emergency care. The role has developed significantly throughout the years and Paramedics have become multi skilled not only within emergency pre hospital care but also delivering patient centred care alternative pathways for individuals that do not require the emergency department or onward hospital care. Paramedics are expected to have an abundance of skills for the role as practical skills alone no longer are sufficient enough for the role itself. Communication which must be appropriate and effective, empathising with the individual, resilience and decision making. All of the above must be embraced whilst working solely as an individual and as a team member. Paramedics often encounter the public in exceedingly difficult and distressing personal circumstances and at critical times in their lives. Patients and families can be vulnerable during these moments, so it is pivotal that as ambulance clinicians they have an understanding of the relevant legal and ethical issues that may impact on their decision making. Without an understanding of the ethical principles, legislation or legal precedents that apply to their practice, paramedics may potentially be at risk of incurring fitness to practise investigations, civil litigation, or in uttermost cases, criminal charges (Clarke, V. 2013).
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