Scope of practice when a task is delegated outside competence
A newly graduated respiratory therapist is asked by a senior colleague to perform an arterial blood gas on a 68-year-old patient with severe COPD who is becoming increasingly drowsy, with a respiratory rate of 8 and oxygen saturation of 84% on room air. The therapist has observed the procedure but has not been signed off as competent, and the facility's competency register confirms this. The senior colleague says 'I've done hundreds, just copy me, we don't have time to find the on-call physician - he's in theatre.' The patient's condition is visibly deteriorating.
1. Should the therapist perform the procedure? Justify your answer.
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No - but declining the procedure is not the same as declining to help. The therapist is not signed off as competent for arterial puncture, and performing an invasive procedure without demonstrated competence is outside scope regardless of who asks. A senior colleague's verbal instruction does not transfer competence, and 'copy me' supervision is not the same as assessed sign-off.
The deterioration changes what must happen next, not who may do the procedure. The therapist should immediately escalate: call the on-call physician or rapid response, initiate the non-invasive measures within their competence (positioning, oxygen therapy per protocol, continuous monitoring, preparing for assisted ventilation), and stay with the patient. The senior colleague, if competent and available, should perform the procedure or find someone who is.
2. What should the therapist document and raise afterwards?
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Document the clinical observations and timeline, the escalation made and to whom, the actions taken within scope, and the fact that the procedure was not performed by them and why - factually, without editorialising about the colleague. Record the response times.
Afterwards, raise the issue through the appropriate channel: the delegation request should be reported to the line manager or clinical lead as a near-miss, because the underlying problem is that a deteriorating patient had no timely access to a competent operator. The review should examine on-call cover during theatre lists and whether the competency register is consulted before delegation. The therapist should also request supervised training and formal sign-off so that the gap is closed, rather than simply avoiding the task in future.