I recently received a question from a medical assistant who had developed a PowerPoint for her employer about medication reconciliation. While her managers approved her work, she was concerned that a second PowerPoint created by another employer group contradicted some of the points she made about medication reconciliation.
In response, the medical assistant asked me whether it is correct—as she wrote in her PowerPoint—to say that medical assistants can note in the medical record the fact that a patient is no longer taking a medication.
Note the following excerpt from the handout I used during my presentation this summer for the American Academy of Ambulatory Care Nursing. This provides a general legal rule about the scope of practice of medical assistants in all states:
General legal principles—
- It is not permissible for medical assistants to perform tasks that are restricted in state law to other health professionals—often licensed health professionals;
- It is not permissible for medical assistants to perform tasks that require the exercise of independent clinical judgment, and/or the making of clinical assessments, evaluations, or interpretations;5
- Medical assistants must not be delegated (and must not perform) any tasks for which they are not sufficiently knowledgeable and competent
I believe the confusion between the two PowerPoints is based on a different understanding of terms. The medical assistant’s position is that medical assistants are permitted to remove a medication from a patient’s list of medications based on the patient’s statement only to inform the provider that, for example, another provider has discontinued a medication. The current provider can then determine whether they agree with the other provider about the discontinuation of the medication or whether they think that the patient should resume taking the medication.
I suspect that the other employer group’s PowerPoint slides define the removal of medication as a decision by the provider to remove medications from the list of medications the patient should be taking. A decision about what medications a patient should be taking can only be made by a licensed provider.
Note the following excerpt from my opinion letter on medication reconciliation (note a related Legal Eye blog post):
[Medication reconciliation, as defined by the Joint Commission,] “ … comprises five steps: (1) develop a list of current medications; (2) develop a list of medications to be prescribed; (3) compare the medications on the two lists; (4) make clinical decisions based on the comparison; and (5) communicate the new list to appropriate caregivers and to the patient.”
It is my legal opinion that knowledgeable and competent medical assistants can be assigned steps 1, 2, and 3 as long as step 2 entails compiling a list of prescribed medications from the prescription orders of providers. However, step 4 requires the exercising of independent professional judgment and the making of clinical assessments. Therefore, in my judgment, medical assistants cannot be assigned step 4. In regard to step 5, medical assistants can communicate verbatim new lists of medications as specifically approved by the overseeing/delegating provider and only when the provider directs the medical assistant to do so.
Step 3 above involves comparing the list of medications in the patient’s record with the patient’s statement about the discontinuation of medications. My legal opinion is that a medical assistant is permitted to perform this task, delete any medications from the list based on the patient’s statement only for the purpose of informing the licensed provider, and submit the list for evaluation by the provider. The provider must decide to accept the discontinuation of a medication or to reinstate it in the patient’s list of medications.
Therefore, I agree with the medical assistant who reached out to me that medical assistants are permitted by federal and Texas law to eliminate a medication from a list for the purpose of informing the provider. In such situations, medical assistants do not make any clinical decisions based on the comparison of the previous and current medication lists, which is the responsibility of the licensed provider.