Roles, Responsibilities and Limitations of the Pdiatry Assistant

Podiatry is the branch of health care related to foot and lower limb disorders. The role of the podiatrist (previously known as a chiropodist) is to prevent or correct injury and deformity and maintain normal mobility and function. 

Podiatrists aim to provide the basis for the ideal walking style and posture and identify any medical or surgical conditions that may require further referral and management. They also relieve pain, treat infections and skin, nail, soft tissue and connective tissue  problems. This is done in conjunction with other members of the health care team. 

Podiatrists can also give expert advice on footwear and provide high level care of high risk lower limb conditions such as peripheral vascular disease, neuropathy and wound
care.
Podiatry Practice in Australia & Podiatry Board of Australia
The podiatry professions National Health Practitioner Board is the Podiatry Board of Australia. Members of the inaugural Podiatry Board of Australia were appointed for three years by the Australian Health Workforce Ministerial Council on 31 August 2009. 
 
The Australian Health Practitioner Regulation Agency (AHPRA) is the organisation responsible for the implementation of the National registration and Accreditation Scheme across Australia.

AHPRA supports the 10 National Health Practitioner Boards in implementing the National Registration and Accreditation Scheme.
 
AHPRA was formed by an Act of Parliament and is bound by the Health Practitioner Regulation National Law as in force in participating jurisdictions, and its Regulations.In Victoria; Health Practitioner Regulation National Law (Victoria) Act 2009

The Podiatry Board of Australia has decided not to establish State and Territory Boards. However the work of the Board will be supported by
AHPRA in each State and Territory.

Functions of the Board - these include:
        -  Registering podiatrists and students 
        -  Developing standards, codes and guidelines for the podiatry profession 
        -  Handling notifications, complaints, investigations and disciplinary hearings 
        -  Assessing overseas trained practitioners who wish to practise in Australia
        -  Approving accreditation standards and accredited courses of study.
Podiatry Board of Australia Guidelines for Podiatrists working with Podiatric Assistants in Podiatry Practice
The full guidelines can be found on http://www.ahpra.gov.au/Search.aspx?q=podiatry%20assistant. These guidelines have been
developed by the Podiatry Board of Australia under Section 39 of the Health Practitioner Regulation National Law1 (the National Law).The guidelines provide guidance to podiatrists in relation to a matter of professional practice not set down in the legislation and which can be used in proceedings under the National Law as evidence of what constitutes professional conduct or practice for podiatry under Section 41 of the National Law.
Definitions under the Guidelines
Podiatry Assistant 
A member of staff employed within a facility or practice who is not a registered podiatrist and who assists a podiatrist in the delivery of services to his or her patients or clients.
Low risk patients or clients
In this context, is defined as a person who may have systemic disease however it is managed and stable and there are no systemic complications involving the foot or lower limb.
Education level. 
A training package is a set of nationally endorsed standards and qualifications for recognising and assessing people’s skills in a specific industry, industry sector or enterprise. They are developed by the national Industry Skills Council (ISC).
Role of the Podiatry Assistant 
 The role of the podiatry assistant will vary according to the practice
context, their respective training, experience and competence and the needs of the patients. Activities delegated to podiatry assistants are to be within the boundaries of the scope of practice described in this policy.

Hands-on foot care provided by a podiatry assistant involving
instrumentation may be in the form of foot hygiene and may be conducted on toe nails and skin surfaces of the foot within the scope of Certificate IV training or the New Zealand tertiary course equivalent, and is to be only conducted on low-risk patients. The use of scalpel blades on patients by podiatry assistants is
not allowed under this policy.
Supervision 
Supervision must uphold patient safety and efficacy of care at alll times. It is the mutual responsibility of the podiatrist and podiatry assistant to understand each others scope of practice and work collaboratively. The podiatrist must ensure the podiatry assistant understands the limits of their scope of practice and is not requested or required to undertake activities outside of this scope. The podiatry assistant is directly accountable to the podiatrist/s who delegate support tasks and therefore are required to operate
under their respective supervision at all times.
 A.Pod.C policy Overarching Principles
The A.Pod.C policy clearly defines some key areas of obligation and limitation of practice of the podiatry assistant. These include;
        -  Podiatry assistants scope of practice
        -  Referral processes
        -  Informed consent
        - The provision of continuing care needs of suitable patients     
        - That policies and procedures surrounding the use of podiatry assistants must be documented
        - Clinical governance
        - Insurance coverage, and 
        - Professional support available to podiatry assistants
 
The A.Pod.C. policy notes that; 
The podiatrist must therefore ensure that the patient has been appropriately assessed and that the podiatry assistant to whom they have delegated:
 1.   Understands what is expected of him/her and has a clear, written care plan with expected outcomes and target dates.
 2.   Has the knowledge, skills and recognized qualifications to carry out what the podiatrist has asked him/her to do safely and effectively.
 3.   Documents all care provided to patients in accordance with practice/clinic protocols.
 4.   Is aware of when and under what circumstances the patient should be referred back for reassessment.
 5.   Is able to refer the patient back to the delegating podiatrist or another podiatrist without delay, if he/she is uncertain or concerned in any way as to the patient’s altered health status or the patient’s response to the care being provided.

When things go wrong
As podiatry assistants are under the supervision of a registered podiatrist when things do go wrong, firstly ensure that the client is safe and
well, then inform the supervising podiatrist of the issue at hand. 
As part of the Certificate IV in Allied Health Assistance up to three (3) Podiatry electives can be choosen. For Podiatry specialisation all group E electives are required: 

    HLTAH404C Assist with basic foot hygiene (Note pre-requs: HLTAP301B, HLTCSD305D, HLTAH301C, HLTIN302C)
    HLTAH405C Assist with podiatric procedures (Note pre-requs: HLTAP301B, HLTCSD305D, HLTAH301C, HLTIN302C)
    HLTAH406C Assist with podiatry assessment and exercise (Note pre-requs: HLTAP301B, HLTCSD305D, HLTAH301C)
    HLTIN302C Process reusable instruments and equipment in health work (Note pre-requ: HLTIN301C)
Assist with basic foot hygiene
This unit of competency describes the skills
and knowledge required to assist with basic foot hygiene under the direction of a podiatrist
The application of knowledge and skills described in this competency unit may relate to functions such as providing basic foot hygiene, according to the directions of a podiatrist, including skin and nail care and
applying dressings, padding and cushioning
Assist with podiatric procedures
This unit of competency describes the skills and knowledge required to assist with procedures performed by the podiatrist.
Procedures may include surgical procedures of the skin and nails;
preparation, modification and repair of orthotic devices and footwear
The application of knowledge and skills described in this competency unit may relate to functions such as assisting in podiatry surgery and/or the preparation /modification/repair of orthotic devices and footwear. These functions are to be performed in accordance with
the directions of a podiatrist or podiatric  surgeon
Assist with podiatry assessment and exercise
This unit of competency describes the skills
and knowledge required to assist a podiatrist with the delivery and monitoring of specific client exercise and rehabilitation programs and in the completion of client foot health assessments
The application of knowledge and skills described in this competency unit may relate to functions such as delivering and monitoring
exercise and rehabilitation programs that have been developed and are being monitored by a podiatrist, and the provision of assistance during podiatric assessment procedures. This could take place in a range of health settings
Process reusable instruments and equipment in health work
This unit of competency describes the skills and knowledge required for workers in the health care setting to clean and sterilise reusable instruments and equipment and to maintain associated environments. All procedures must be carried out in accordance with current infection control guidelines, Australian and New Zealand Standards and the policies and procedures of the health care establishment.
All tasks must be carried out in accordance with State or Territory legislative requirements that affect work practices of the health care
establishment and/or health care worker
This unit is applicable to health care workers who are responsible for processing reusable instruments and equipment and maintaining associated environments in a health care
facility.
Application of this unit should be contextualised to reflect any specific workplace infection risks, hazards and associated infection control
practices relating to specific workplace instruments and equipment in line with
individual workplace policies and procedures