Scope of Perfusion Practice
AmSECT’s Task Force on the Expansion of Perfusion Scope of Practice
Purpose
The purpose of this document is to define the Scope of Practice for Clinical Perfusionist Professionals and to specify their role as members of the health care team, acting in the best interest of the patient. The scope of practice is a “living” document that will evolve as techniques and technology expand.
The scope of practice defined here and the areas specifically set forth describe the breadth of professional practice offered within the profession. Levels of education, experience, skill, and proficiency with respect to the activities identified within this scope of practice vary among individual providers; a Clinical Perfusionist does not typically practice in all
areas of the field. As the American Society of Extra-Corporeal Technology Code of Ethics specifies, individuals may only practice in areas in which they are competent based on their education, training, and experience. However, Clinical Perfusionists may expand their current level of expertise. Certain situations may necessitate that the Clinical Perfusionist pursue additional education or training to expand their personal scope of practice.
The scope of practice statement does not supersede existing state licensure laws or affect the interpretation or implementation of such laws. It may serve, however, as a model for the development or modification of licensure laws.
Clinical Perfusion is a dynamic and continuously evolving profession; listing specific areas within the scope of practice does not exclude emerging areas of practice. Although not specifically identified in this document, in certain instances Clinical Perfusionists may be called on to perform services (e.g., “multiskilling” in a health care setting, collaborative service delivery in schools) for the well-being of the individual(s) they are serving. In such instances it is both ethically and legally incumbent upon professionals to determine that they have the knowledge and skills necessary to conduct such tasks.
Definition of the Profession
The Clinical Perfusionist Professional is an individual qualified by professional credentialing and academic and clinical education to provide extracorporeal patient care services. The scope of practice of the Clinical Perfusionist Professional includes those procedures, acts and processes permitted by law, for which the individual has received education and clinical experience, and in which he/she has demonstrated competency.
Scope of Practice of the Profession
1.1.0 Extracorporeal Support
1.1.1. Cardiopulmonary bypass for Adult, Pediatric, and Neonatal Patients.
1.1.2. Cardiopulmonary bypass for congenital and acquired cardiovascular disorders.
1.1.3. Extracorporeal circulatory support for renal, neurological, hepatic and vascular surgery.
1.1.4. Extracorporeal resuscitation.
1.1.5. Extracorporeal circulation for long term support of failing respiratory and/or cardiac function.1.2. Associated Extracorporeal Support Functions
1.2.1. Myocardial protection.
1.2.2. Hemofiltration/hemodialysis.
1.2.3. Anticoagulation and hemostasis monitoring, analysis, and intervention.
1.2.4. Thermal regulation.
1.2.5. Blood gas and blood chemistry monitoring, analysis, and intervention.
1.2.6. Physiological monitoring, analysis, and intervention.
1.2.7. Administration of blood components, pharmaceuticals, and anesthetic agents2.1. Heart Failure Therapy and Support
2.1.1. Ventricular Assist Device management
2.1.2. Intra-aortic Balloon Counterpulsation
2.1.3. Temporary Pacemaker management
2.1.4. External counterpulsation
2.1.5. Transportation of Extracorporeal Supported Patients
2.1.6. Hemofiltration (i.e. “Aquapheresis”)
2.1.7. Periodic flow augmentation therapy3.1. Blood Management
3.1.1. Autotransfusion
3.1.2. Platelet Gel Production
3.1.3. Non-Differentiated Progenitor Cell Harvest
3.1.4. Acute Normovolemic Hemodilution
3.1.5. Phlebotomy
3.1.6. Hemostasis monitoring and analysis4.1. Other Clinical
4.1.1. Isolated Limb/Organ perfusion
4.1.2. Isolated limb/organ delivery of chemotherapeutics, progenitor cells, gene therapy vectors, ect.
4.1.3. Organ Procurement
4.1.4. Thermogenic lavage
4.1.5. Organ Preservation
4.1.6. Dialysis
4.1.7. Surgical assistance
4.1.8. Electrophysiological analysis
4.1.9. Therapeutic Hyperthermia
4.1.10. Therapeutic Hypothermia
4.1.11. Intravascular membrane oxygenation5.1. Non-Clinical Responsibilities
5.1.1. Documentation of duties via the official medical record
5.1.2. Education, including the establishment and management of educational programs for new and current clinical perfusionists, other healthcare providers, and consumers.
5.1.3. Administration, including managing all aspects – technical, fiscal, workflow, and human resources – of Clinical Perfusion operations.
5.1.4. Quality Control and Assurance
5.1.5. Regulatory Compliance
5.1.6. Competency/Performance Evaluation6.1. Professional Performance
6.1.1. Obtains and maintains appropriate professional credentials .
6.1.2. Works in partnership with other health care professionals to provide the best medical care possible for all patients.
6.1.3. Adheres to the standards, policies, and procedures adopted by the profession and regulated by law.
6.1.4. Stays current with required continuing medical education (CME) in order to stay abreast of changes in the field of extracorporeal technology and to maintain professional credentials.
6.1.5. Participates in continuing education activities through professional organizations, to enhance knowledge, skills and performance.
6.1.6. Adheres to the accepted professional ethical standards as defined by the Code of Ethics .
6.1.7. Acts as a patient advocate supporting patient rights.
6.1.8. Design, coordination, and implementation of original investigation.
6.1.9. Critical evaluation of published research.
APPENDIX
Code of Ethics
The purpose of a code of ethics is to acknowledge a profession’s acceptance of the responsibility and trust conferred upon it by society and to recognize the internal obligations inherent in that trust. The following paragraphs delineate the standards governing the conduct of members in their professional interactions with patients, colleagues, other health professionals and the general public. Realizing that no code can encompass all ethical responsibilities of the members, this enumeration of obligations in the code of ethics is not comprehensive and does not constitute a denial of the existence of other obligations, equally imperative, and not specifically mentioned herein. This code of ethics shall be binding on the members of this Society.
Members must uphold the dignity and honor of the profession, accept its disciplines and expose without hesitation illegal, unethical and incompetent conduct.
Interpretive Statements
Members are part of a collaborative effort to deliver proper health care to the patient under the members’ care.
The member has a personal, as well as a professional, obligation to protect and safeguard the patients from illegal and/or unethical actions or the incompetence of any person.
The member must maintain personal integrity and establish the appropriate means to fully protect his freedom of conscience for the delivery of services to the patient.
A member who demonstrates incompetence or illegal conduct as it pertains to this Code of Ethics shall be exposed to the proper authorities.
Members shall respect the patients’ rights and dignity and shall uphold the doctrine of confidentiality regarding privileged patient information.
Interpretive Statements
Information about the patient’s clinical situation will be kept confidential, unless otherwise required by law, in order to protect the welfare of an individual or community. Written guidelines or protocols of an institution or department may be instrumental in deciding the manner in which confidential information is handled for release.
Members shall provide only those services for which they are qualified. Members shall not misrepresent in any manner, either directly or indirectly, their skills, training, professional credentials, identity or services.
Interpretive Statements
Members will accept responsibility for the exercise of sound judgment in the delivery of services to the patient and shall be accountable for the quality of the service provided.
Members will provide accurate information about the profession, and services they provide, as well as the members’ own qualifications.
The members shall not engage in practices beyond their competence or training.
Members shall not delegate to a less qualified person any activity which requires the unique skill, knowledge and judgment of a formally educated perfusionist. Services rendered by supportive personnel will be under the supervision of a formally educated perfusionist.
Members shall strive to improve their medical knowledge and skills on a continuing basis.
Interpretive Statements
Members shall support quality didactic and clinical education.
Professional conduct will be maintained toward members’ peers, students, medical staff and patients.
Members shall participate in educational activities, either by individual study or through continuing education, which will enhance their basic knowledge in order to continue to provide quality health care to the patient.
Members shall maintain and promote high standards for perfusion practice which may include education, research and scientific presentations and/or publications.
Interpretive Statements
Members shall protect the rights of patients and animals involved in research and conduct research in accordance with accepted ethical and reporting standards.
All members who participate or contribute as an author or investigator will receive proper recognition and responsibility for the data being presented and/or published.
The members shall maintain and promote high standards for research, including:
Full public disclosure and/or acknowledgments of support for research.
Avoidance of fraud and plagiarism.
Scientific articles will not be published in more than one journal without referencing the primary publishing journal, and the consent of the editors of all publications must be obtained.
Representation of the Society by members should be in writing and/or at the direction of or by the Board of Directors and/or Executive Committee.
A member shall at all times hold the well-being of the patient to be paramount and shall not act in such a way as to bring the member’s interests into conflict with the patient’s interests. A member shall deliver health care services without regard to race, color, creed, national origin, sex, age, religion, sexual preference or physical and/or mental condition.
Interpretive Statements
A member’s professional practice and adherence to ethical principles shall take preference over business practices. Members shall place service before material gain.
A member should fully disclose to clientele other business practices that may appear as conflict of interest to clientele and/or public. These may include but are not limited to:
- Consultant for fee
- Clinical instructor (support staff from industry)
- Sales representative
- Technical adviser
- Lecturer for fee
- Acceptance of fees, gratuities, funding from industry
The American Society of Extra-Corporeal Technology (AmSECT) is the professional society for the cardiopulmonary perfusionist. Its membership encompasses the vast majority of practicing perfusionists. The purpose of the Society is defined in its mission statement: “The mission of AmSECT is to foster improved patient care by providing for the continuing education and professional needs of the extra-corporeal technology community.”
In that the ultimate concern of the Society is to improve patient care, it is our position that clinicians engaged in the practice of cardiopulmonary bypass are required to and must be allowed to periodically evaluate the equipment which is utilized in cardiopulmonary bypass in the effort of continuously improving patient care which should include not only patient outcomes but safety as well.
To this end, AmSECT holds that each perfusionist has the following ethical and professional responsibilities:
The perfusionist being the most qualified individual, by training, education, experience, and job description has the responsibility to evaluate, recommend, select, and implement the components of the extra-corporeal circuit so that patient safety and care are optimized.
The perfusionist will always attempt to fairly evaluate all competing products and services, with the principal selection criteria being that of regard for patient safety and well-being.
The perfusionist shall always base any decision on product and service selection on clinical evaluations and documented clinical and scientific data.
The perfusionist will not allow the opportunity to arise whereby objective evaluations of products and services are compromised by gratuities, gifts, entertainment, consulting engagements, employment status, or any other material or personal gain.
In conclusion, it is the responsibility of the perfusionist to make decisions regarding the selection of clinical products with the patient as the primary concern.
