JCPSLP Vol 20 No 2 July 2018

Entrepreneurship in speech-language pathology

Administration of Co-Phenylcaine Forte nasal spray during nasendoscopy Implementing and evaluating this extended scope role for speech-language pathologists Maria Schwarz, Elizabeth C. Ward, Marnie Seabrook, Anne Coccetti, and Bernard C. S. Whitfield

To meet changing health service demands, it is critical that speech-language pathologists (SLPs) are working to full scope, considering extended scope models when appropriate, and incorporating delegation models. One such extended scope role for SLPs is medication administration in specialist clinic settings. This paper outlines the process undertaken by SLPs in a particular service to obtain rights for the administration of Co- Phenylcaine Forte nasal spray during nasendoscopy and examines the outcomes of its use within a prospective cohort study. Data from the first 100 patients involved in Co-Phenylcaine Forte nasal spray administration within a single Queensland health facility was collected in relation to outcomes and clinician confidence. The results of the trial revealed administration was performed with 95% of attending patients, clinician confidence with administering was high, and there was only one mild adverse event. This pilot trial suggests independent SLP administration of CoPhenylcaine Forte nasal spray during nasendoscopy is safe when used in a supported environment, and following appropriate training. T he changing face of health care in Australia as a result of an ageing population and increased prevalence of chronic health conditions has increased the demand on allied health services (Allied Health Professions Office of Queensland, 2013, 2014; Queensland Government, 2014). In response to increasing workforce demands, a focus on advanced and extended scope of clinical practice has emerged for allied health practitioners (AHPs) including speech-language pathologists (SLP) (Allied Health Professions Office of Queensland, 2013, 2014; Queensland Government, 2014). This shift in disciplinary boundaries has included an expansion of the roles completed by health professionals (Nancarrow & Borthwick, 2005), with movement into

tasks and roles traditionally performed by medical and nursing colleagues such as medication management. The introduction of expanded and extended clinical practice areas aims to improve patient access to health services, improve service delivery and improve workforce productivity and efficiency, by ensuring that professionals work to their optimal capacity (Allied Health Professions Office of Queensland, 2013, 2014; Queensland Government, 2014). In the Australian context, medication management in particular is an emerging expansion of the role of AHPs, with an increased understanding that AHPs will have a role in medication prescribing and administering in the clinical setting (Allied Health Professions Office of Queensland, 2013, 2014; Australian Capital Territory Health, 2008; Gilmore, et al., 2011). Hughes and Blegen (2008) describe the medication process to consist of a number of components including (a) ordering/prescribing; (b) transcribing/verifiying; (c) dispensing/delivering; (d) administering; and (e) monitoring and reporting. Each stage of this medication process is traditionally performed by different professionals in the health care setting, with professionals including the medical officer, pharmacist, and nursing staff (Hughes & Blegen, 2008). The focus of this paper is the stage of adminstering medication , which in most western countries is performed by nursing staff, often with limited additional training (Bhanbhro, Drennan, Grant, & Harris, 2011). The role of AHPs such as SLPs in medication administration has received very little systematic research in the literature; however, it represents an area in which efficiency and effectiveness of service delivery may be improved (Allied Health Professions Office of Queensland, 2014). Research in the field of medication administration focuses primarily on the recording of administration errors (Berdot et al., 2016), with limited focus on professional roles and efficiency. Similarly, while emerging research primarily conducted in the United Kingdom is investigating the role of non-medical (nursing and AHP) prescribing (Courtenay, Carey & Stenner, 2012; Gumber, Khoosal & Gajebasia, 2012; Hale, Coombes, Stowasser & Nissen, 2011; Noblet, Marriott, Graham-Clarke & Rushton, 2017), there is a paucity of evidence regarding medication administration and the potential for AHP role expansion in this area. In comparison to other AHP professionals, such as physiotherapy, the identified need for SLP involvement in medication management is less extensive (Allied Health Professions Office of Queensland, 2014; Australian Capital Territory Health, 2008). However, within the context of adult SLP practice, particularly in the management of voice

KEYWORDS ADMINISTRATION ENT EXTENDED SCOPE MEDICATION THIS ARTICLE HAS BEEN PEER- REVIEWED

Maria Schwarz (top), Elizabeth C. Ward (centre) and Marnie Seabrook,

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JCPSLP Volume 20, Number 2 2018

Journal of Clinical Practice in Speech-Language Pathology