Case studies for working with assistants in podiatry practice

Alex is a podiatrist and works in a busy community health centre where they work with Tien, an assistant. While Tien has no formal qualifications, they have been working as a podiatry assistant for a number of years.

The podiatrist has a patient, Jane, who they have been seeing for about five years. Jane is an older adult with no history of vascular disease or significant health concerns other than an inability to reach her feet. The podiatrist regularly reviews the patient’s overall treatment plan, and the assistant supports the patient with nail care and skin integrity checks. On a recent visit, the assistant observed a wound on the top of the patient’s foot. The patient tells the assistant that the wound was caused by a scratch from the garden. As per the written practice protocols for delegation and escalation, the assistant asked the podiatrist to review the patient before providing any treatment. The podiatrist assesses the patient’s vascular status and the wound appearance and believes the wound will likely heal with observation and regular dressing changes.

The podiatrist wants to delegate the dressing changes to the assistant. The podiatrist is satisfied that the assistant has the necessary knowledge, skills and experience to dress the patient’s wounds safely and effectively. The assistant has observed the podiatrist dressing wounds and has dressed wounds under the podiatrist’s supervision for a few years. The podiatrist creates a wound management plan, discusses this with the patient and seeks their consent for the assistant to undertake wound management, in addition to usual nail care. The patient agrees to see the assistant for this care.

The podiatrist explains the wound management plan to the assistant in detail, making sure the assistant understands the tasks involved and the importance of reporting any concerns about the wound immediately. The assistant knows that effective and timely communication are crucial for maintaining safe patient care. The podiatrist regularly assesses the assistant’s work in their weekly supervision meetings to ensure the patient is progressing as expected.

Even though the assistant will dress the patient’s wound, the podiatrist remains responsible for the overall management of the patient’s care. The podiatrist will review the patient and the overall management plan again in four weeks.

Summary

This case study shows how the podiatrist applies the Code of conduct by:

• ensuring that the assistant has the appropriate training, experience, skills and competence for the tasks delegated to them, and
• clearly defining the roles and responsibilities of the podiatrist and the assistant, and who has overall responsibility for management of the patient.

The podiatrist’s practice also reflects that they have appropriate protocols and procedures in place to ensure patients receive safe and effective care from an assistant.

Banan is a podiatrist working in private practice where they employ Andrew as an assistant. Andrew holds a Certificate IV in Allied Health Assistance and has a number of years of experience. The podiatrist has a patient, Joe, who has been participating in a rehabilitation program to improve mobility and strength following a recent sporting injury.

The podiatrist developed a rehabilitation program for the patient and has delegated responsibility to the assistant to oversee the completion of exercises in the program. While the assistant helps with the exercises, the podiatrist retains overall responsibility for the patient’s care.

At one appointment, the assistant is working with the patient to undertake an exercise as part of the rehabilitation program when the patient reports increased pain and tingling in their foot. The assistant reviews the written practice protocols for delegation and escalation and knows that these types of symptoms should be escalated to the treating podiatrist.

The assistant reports this to the podiatrist immediately, knowing that timely escalation is crucial for safe and effective patient care. The podiatrist consults with the patient to reassess their condition and reviews the management plan and rehabilitation exercises.

Summary

This case study illustrates how the podiatrist applies the Code of conduct by ensuring protocols and procedures are in place for the assistant to raise concerns about risks to patients, while retaining overall responsibility for patient care and ensuring the assistant has the appropriate knowledge and skills for the tasks delegated to them as well as the knowledge and skills to recognise when to escalate to the podiatrist.

Priya is a podiatrist working in a community health service and works with an assistant who holds a Certificate III in Allied Health Assistance. The assistant, Lachlan, has been working under the podiatrist's guidance for 18 months, primarily supporting basic foot care needs for low-risk patients.

The podiatrist has been treating Dorothy, a 72-year-old patient who has well-controlled type 2 diabetes. Assessments have shown that the patient is very low risk under current guidelines. The patient's main difficulty is arthritis which limits their ability to reach their feet. The podiatrist has been providing routine nail care every 8 weeks for the past year.

After carrying out a comprehensive clinical assessment and determining Dorothy remains low-risk, the podiatrist considers delegating routine nail care to the assistant. The podiatrist has previously observed the assistant performing nail care on other patients and has directly supervised their technique multiple times. The podiatrist is confident that the assistant has the necessary skills and knowledge to perform this task safely.

The podiatrist discusses this change with the patient, explaining the assistant's role, qualifications, and experience. During this discussion, the podiatrist clearly outlines the financial implications, including changes to the fee structure and any relevant healthcare rebates when care is provided by an assistant. The podiatrist ensures the patient understands that while the assistant will provide the nail care, the podiatrist will continue to oversee their overall foot health and conduct regular risk assessments. The patient's consent, including their understanding of the modified fee structure, is documented in their clinical record.

The podiatrist documents the delegation plan, including clear parameters for when the assistant should escalate concerns. These include any signs of infection, changes in skin colour or temperature, new lesions, or if the patient reports any changes in sensation or medical status. The assistant understands these protocols and knows to immediately consult the podiatrist if any concerns arise.

The podiatrist schedules regular supervision sessions with the assistant to monitor technique and ensure consistent quality of care. They also plan to review the patient's risk status every three months, or sooner if the assistant raises any concerns. Each review includes confirmation that the patient remains satisfied with both the care arrangements and the associated costs.

Summary

This case study illustrates how the podiatrist applies the Code of conduct by implementing appropriate practices to support delegation to an assistant for a common podiatric task. It demonstrates appropriate risk assessment, clear communication with both patient and assistant, clear escalation protocols, and ongoing supervision arrangements. The case also shows how the podiatrist maintains overall responsibility for patient care while appropriately using the assistant's knowledge and skills, ensuring the patient provides consent and is aware of any financial implications including changes in costs or reimbursement when the care is provided by an assistant.