Transforming and Supporting Patient Care - Health Professions ...

124Chapter 5 – Scope of Practice of Medical Laboratory Technologycatheterization). In view of the government’s emphasis on prevention,screening and disease management initiatives, the proponents suggestedthat authorizing MLTs to perform these acts will improve access to care,reduce wait times and better support these efforts.As with the above requests, educators advised HPRAC that the currentcurriculum lacks the significant patient care component that would berequired for MLTs to perform these acts. Educators, other professions andkey stakeholders alike were unanimous in their negative comment on Paptesting in particular. The procurement of Pap test specimens is inextricablylinked to a comprehensive clinical examination that is only performed by aphysician or nurse practitioner. MLTs do not have the competencies to dothe specimen collection, and it is not appropriate to separate this from amore thorough physical examination.The proponents suggest that pre-analytical errors related to improperspecimen collection could be alleviated by allowing MLTs to do theprocurement and ensure the viability of the specimen. As will be discussedbelow, there is indeed a role for MLTs to play in addressing pre-analyticalerrors relating to specimen quality, but the type of specimen collection thatwould require access to these controlled acts is not an appropriateexpansion of MLT practice.It is conceivable that MLTs with proven competencies could obtainspecimens other than blood from veins or by skin pricking when requiredand where appropriate to the patient, such as throat, eye, wound or cheekswabs. HPRAC feels that, were these situations to arise, delegation and notan expansion of scope would be the appropriate process for authorizationwhere a controlled act is involved. Through delegation, the healthprofessional with the authority would be assured of the knowledge, skillsand judgment of the MLT accepting the delegation.The jurisdictional review conducted by HPRAC revealed that only MLTs inQuebec are permitted to put an instrument, hand or finger beyond theurethra and labia majora for specimen collection. As for other types ofspecimens, some jurisdictions indicated that MLTs occasionally performthroat swabs, but this depends largely on the employer and is not a typicalMLT function.HPRAC’s ConclusionsThe proposals for changes to the scope of practice represent a significantdeparture from MLTs’ current scope of practice, and from the recentlyrevised MLT competencies. HPRAC appreciates that demographic and otherpressures on the health care system will increase demand for laboratoryservices to assist in the diagnosis, prevention and treatment of illness anddisease. HPRAC is not convinced by the arguments put forward by theproponents and did not find sufficient evidence to support the claims,either in the proponents’ material or in its own independent research.HPRAC is firmly convinced that the most appropriate response for Ontario’shealth care system is to ensure that the right health professionals areproviding the right care, at the right time, and in the right place. In otherHPRAC Critical Links January 2009