June 2020

Issue 21

Chair’s message
Board news
Practice tips
- Examples of deficient patient health record-keeping
- Your obligations when issuing payment receipts
National Scheme news
Keep in touch with the Board

Chair’s message

Distinguished Professor Charlie Xue

Welcome to our winter newsletter. Since our last edition there has been an unparalleled global upheaval due to the coronavirus pandemic that has reshaped all our lives. As the global community, including Australia, emerges from the containment phase, we encourage our Chinese medicine practitioner community to remain safe and continue to be vigilant in adhering to all public health directives as advised by the Australian Government Department of Health. Chinese medicine as an allied health profession makes a very important contribution to health and wellbeing in the community.

Unfortunately, we have had to cancel some planned roadshows for practitioners due to the pandemic, but we are planning alternative, virtual arrangements and will keep you informed.

In this issue you will find updates on the progress of two scheduled reviews of draft guidelines, information on the Board’s position statement on the use of unregistered assistants to remove acupuncture needles from patients, a follow-up on our previous article about complying with the guidelines on patient health records and information on practitioner obligations when issuing receipts.

The Chinese translation of the newsletter will be available to view on our website shortly, please check our Newsletters page from Monday 6 July 2020.

本期新闻稿的中文翻译件将很快在我们的网站上发布，请从2020年7月6日星期一开始查看新闻稿(Newsletters)页面。

Best wishes for the rest of the year from the Board.

Distinguished Professor Charlie C. Xue

Chair, Chinese Medicine Board of Australia

Board news

Planning for 2020-21

The Board held its annual planning day in February 2020. Our priorities during 2020-21 are to:

focus on the critical issues for public protection
distinguish between strategic and operations/business-as-usual activities
ensure alignment with the National Scheme and as far as possible support regulatory consistency across all the registered professions.

We have confirmed our regulatory and business plans for 2020-21.

On April 16 the Board met with professional associations and we have issued a communique on matters discussed on our website.

Revision of the Infection prevention and control guidelines for acupuncture practice

As noted in the summer 2019 newsletter, we conducted a detailed mapping exercise of the 2019 Australian guidelines for the prevention and control of infection in health care released by the National Health and Medical Research Council in collaboration with the Australian Commission on Safety and Quality in Healthcare. The purpose is to update the current infection prevention and control guidelines for acupuncture practice.

An analysis was also done of relevant state and territory regulations governing skin penetration and infection control, clinical waste management and workplace health and safety, to determine what additional requirements might apply to registered practitioners. The analysis was provided to states and territories for their feedback and the outcomes will be incorporated into the draft guidelines.

The preliminary consultation will begin before the end of the financial year. We expect the draft revised guidelines to be distributed for wider public consultation later in 2020 and the completed guidelines to be published at the end of 2020 or early 2021.

Revision of Guidelines for safe Chinese herbal medicine practice

In 2019 the Board commissioned an independent survey to test the usefulness of the guidelines and nomenclature compendium to the profession. The results showed that the purpose of the guidelines and compendium has been well accepted by most practitioners and a significant proportion of Chinese herbal medicine practitioners follow the guidelines.

The annual update of the compendium together with a review of the associated user guide have been completed and these documents are now available on the Board’s website.

The draft of the revised guidelines is now ready for preliminary consultation. We expect the draft revised guidelines to be distributed for wider public consultation later in 2020 and the completed guidelines for safe Chinese herbal medicine practice to be published at the end of 2020 or early 2021.

Unregistered assistants must not remove acupuncture needles from patients

The Council of Australian Governments has directed Ahpra and the National Boards to prioritise public protection in their work. Earlier this year the Board decided that as patient safety is paramount, we do not accept that registered acupuncturists can delegate the removal of acupuncture needles from patients to unregistered assistants/personnel. After consultation with professional associations we released a statement on our position.

The removal of acupuncture needle from patients is part of the professional service delivered by registered acupuncturists. This includes the requirement for a level of skill to avoid the risk of injury to the patient and involves direct physical contact with patients.

Practice tips

Examples of deficient patient health record-keeping

In our last newsletter we outlined your responsibilities under the Patient health records guidelines. Here are some real-life examples that come to us from notifications (complaints), which show deficient record-keeping has been a contributing factor to the complaint.

Real-life example 1

The practitioner gave the patient some forms to complete before their first appointment. The forms are intended to collect vital information about the patient such as their address, a contact person in case of emergency and the presenting condition. The patient did not complete the information.

Practitioner shortcoming: The practitioner did not review the documentation to check that it was complete and relied instead on verbal information from the patient.
Implications: The patient record was inadequate to allow proper patient management in an emergency and would not have allowed another practitioner to effectively take over or continue the care of the patient if necessary.

Real-life example 2

The practitioner did not adequately record in the patient’s health record, the Chinese medicine assessment/s and or examinations, diagnosis, treatment and treatment plan.

Practitioner shortcoming: The patient record did not comply with the Patient health record guidelines.

Implications: Inability to assess treatment outcome/s; insufficient information to allow another practitioner to continue care; emergency services unable to evaluate patient’s condition if there is an adverse reaction; and minimal evidence of care in the context of a notification.

Real-life example 3

The health summary information in the patient’s health record was incomplete: it did not include current health status, relevant health and family history, known allergies, adverse drug reactions and current medications.

Practitioner shortcoming: The practitioner missed red flags including high blood pressure, fluctuating blood glucose levels and serious condition/s which may have changed the possible treatment or referral options.

Implications: Delay in appropriate referral (which could have serious consequences for the patient); best possible treatment may not be not given; and avoidable allergic reaction.

Your obligations when issuing payment receipts

Make sure you issue a receipt for all payments received and without patients having to ask for the receipt. This is consistent with normal business practices and in line with proper healthcare practice.

You must:

issue this receipt at the time the payment is made
retain copies and make these available for auditing if necessary
use sequentially numbered receipts, in the order they appear and in the order that you provide services
write on the receipt the patient’s name, the date of the service/s, the details of the service/s received, and the respective fees charged.

If the patient declines to accept the receipt, leave it in the book with the duplicate – they might change their mind later and ask for it.

The patient is the person who received the health service. If the person paying is someone other than the patient, the receipt should be made out to the person paying, but the patient’s name should also be recorded.

The information on the receipt must be fully accurate and not false or manipulated for the purpose of maximising claimable rebates.

If you use a rubber stamp or pre-printed receipts with your professional details on them, you are personally responsible for their use.

You must not allow other people to use your name or any membership numbers or health fund provider numbers which are specific to you.

You are professionally responsible for receipts issued for your professional services. If there is a reception person issuing receipts it is assumed they are doing so in accordance with your instructions.

National Scheme news

Podcasts on the pandemic and beyond

Ahpra has released more than a dozen podcasts on areas of interest to all health professionals in the Taking care podcast series. The topics covered in the podcasts include pandemic and non-pandemic related issues.

In a recent episode on Health practitioner wellbeing in the pandemic era and beyond, psychiatrist Dr Kym Jenkins, clinical psychologist Margie Stuchbery and Dr Jane Munro, a rheumatologist, share personal and professional insights on practitioner wellbeing. They discuss practical and evidence-based strategies to safeguard and support practitioners and teams through the COVID-19 pandemic and beyond.

Ahpra releases a new episode every fortnight. You can download on the Ahpra website or listen and subscribe on Spotify, Apple Podcasts and by searching ‘Taking Care’ in your podcast player.

Previous podcasts available include:

A glimpse of healthcare in our rural and remote communities
Professor Valerie Braithwaite on the importance of trust
Balancing purpose and process in regulation: Professor Kieran Walshe
Telehealth in the pandemic era
Introducing the COVID-19 pandemic sub-register
Dr Gerald Hickson on patient safety and high-risk practitioners
Eliminating racism from the health system is a team effort
A new look at mandatory notifications
Ahpra’s role in the health system
A view of mental health from both sides
The practitioner experience of a notification
Safe, competent and ethical health practitioners
Vexatious notifications.

Protecting our health practitioners of the future: clinical education principles

National Boards, accreditation authorities and Ahpra, with the Australian Government through the Health and Education portfolios, have issued national principles for clinical education during the COVID-19 pandemic.

This unique multi-sector collaboration to protect Australia’s future health workforce is helping students learning to become health practitioners during the COVID-19 pandemic continue their studies and graduate.

Some student placements have been paused, cancelled or otherwise modified as health services respond to the pandemic. This has led to uncertainty and change for students and educators as education providers, accreditation authorities, clinical supervisors and others explore alternative options for students to progress towards graduation.

The principles aim to provide helpful guidance about how placements can occur safely, taking into account the significant changes across the health and education sectors due to COVID-19. Visit the National principles for clinical education during COVID-19 to find out more.

No place for racism in healthcare

In April, the Australian Indigenous Doctors’ Association (AIDA) issued a media release detailing occasions of medical practitioners denying Aboriginal and Torres Strait Islander people access to culturally safe healthcare. They were seeking testing for COVID-19. These cases in rural New South Wales and Western Australia involved refusal of care on the grounds of patient identity and racist stereotypes of Aboriginal and Torres Strait Islanders not practising self-hygiene.

Racism from registered healthcare professionals will not be tolerated, particularly given the vulnerability of Australia’s Aboriginal and Torres Strait Islander Peoples to the virus. They continue to experience prejudice and bias when seeking necessary healthcare. Discrimination in healthcare contributes to health inequity.

We encourage Aboriginal and Torres Strait Islander people who have experienced culturally unsafe incidents of care or refusal of care by a registered health practitioner to submit a notification or complaint to Ahpra. We will not tolerate racism, particularly given the impact it has on community members trying to access critical healthcare at this time.

In February 2020, the National Scheme’s Aboriginal and Torres Strait Islander health and cultural safety strategy 2020-2025 was released, proving our commitment to achieving patient safety for Aboriginal and Torres Strait Islander Peoples as the norm and the inextricably linked elements of clinical and cultural safety. The strategy strives to achieve the national priority of a health system free of racism.

We remind all registered health practitioners that they are required to comply with their profession’s Code of conduct, which condemns discrimination and racism in health practice.

More professions added to the pandemic response sub-register

Ahpra and National Boards have established a short-term pandemic response sub-register to help with fast tracking the return to the workforce of experienced and qualified health practitioners. It was established following a request from Australia’s Health Ministers to enable more qualified and experienced health practitioners to quickly return to practice.

The pandemic response sub-register came into effect on 6 April 2020 with over 40,000 doctors, nurses, midwives and pharmacists added in the first phase and an additional 5,000 diagnostic radiographers, physiotherapists and psychologists in the second phase later that month.

The register operates on an opt out basis and anyone with a health issue that prevents them from practising safely or who will not have professional indemnity insurance arrangements in place was encouraged to opt out of the sub-register. So far over 35,000 practitioners remain on the sub-register.

There is no obligation for anyone added to the sub-register to practise or remain on it. They can opt out at any time for any reason.

Practitioners who choose to stay on the pandemic sub-register and go back to work, must comply with their profession’s Code of conduct, professional indemnity insurance requirements and work within their scope of practice. After 12 months, they will be removed from the sub-register. If they would like to continue practising after that time, they will need to apply for registration through the standard process.

Being added to the sub-register is the first step in returning to practice. We encourage practitioners to go to their state and territory health department website where they can express interest in joining their COVID-19 workforce. Employers, including health departments, will also play an important role by carrying out employment and probity checks and providing any induction and training that may be needed.

More information, including FAQs, is available for practitioners and employers is available on the COVID-19 information page.

False and misleading advertising on COVID-19

Ahpra and National Boards recognise the vital role of registered health practitioners in treating and containing the COVID-19 emergency. We know you are working hard to keep people safe in a demanding and fast-changing environment.

A consequence of the current situation is greater public awareness of individual health and wellbeing, leading to many questions about treating and containing the disease. Members of the public are likely to seek reassurance and answers about COVID-19 from their trusted health professional. While most health practitioners are responding professionally to the COVID-19 emergency and focusing on providing safe care, we are seeing some examples of false and misleading advertising about COVID-19.

It is vital that health practitioners only provide information about COVID-19 that is scientifically accurate and from authoritative sources, such as a state, territory or Commonwealth health department or the World Health Organization (WHO). According to these sources, there is currently no cure or evidence-based treatment or therapy which prevents infection by COVID-19 and work is currently underway on a vaccine.

Other than sharing health information from authoritative sources, you should not make advertising claims about preventing or protecting people from contracting COVID-19 or accelerating recovery from COVID-19. To do so involves risk to public safety and may be unlawful advertising. For example, we are seeing some advertising claims that spinal adjustment/manipulation, acupuncture and some products confer or boost immunity or enhance recovery from COVID-19 when there is no acceptable evidence to support this.

We will consider action against anyone found to be making false or misleading claims about COVID-19 in advertising. For a registered health practitioner, breaching advertising obligations is also a professional conduct matter which may result in disciplinary action, especially where advertising is clearly false, misleading or exploitative. There are also significant penalties for false and misleading advertising claims about therapeutic products under the Therapeutic Goods Act 1989.

For more information, see Ahpra’s Advertising resources web page.

Keep in touch with the Board

Visit the Chinese Medicine Board website for news about the profession, information on the National Scheme and for registration standards, codes, guidelines, policies and fact sheets.
Read the National Board Communiqué each month on the website: these publications inform everyone of the decisions made at the Board’s monthly meeting.
Lodge an online enquiry form.
For registration enquiries call 1300 419 495 (from within Australia) or +61 3 9275 9009 (for overseas callers).
Address mail correspondence to: Distinguished Prof. Charlie C. Xue, Chair, Chinese Medicine Board of Australia, GPO Box 9958, Melbourne VIC 3001.