Creating a Pathway to Role Optimization with Lidocaine Administration

Dermatology is a specialty that focuses on diagnosing and treating skin conditions. According to the Academic Alliance in Dermatology (AAD), there are 4 types of dermatology; derma-pathology, pediatric dermatology, Mohs surgery, and cosmetic dermatology. Specialized procedures are done to aid patients in overcoming various types of skin conditions, such as acne, eczema, psoriasis, autoimmune disorders and skin cancers, which requires specialized diagnostic procedures. Treatment of these conditions often requires the use of local anesthetics, i.e. lidocaine. Use of lidocaine is crucial to establishing a state of numbness to the nerve endings without causing unconsciousness. Most dermatological procedures are done in an outpatient setting, that is staffed with medical assistants (MAs) supporting the clinical team.
A large academic medical center in Georgia treats roughly 32, 000 patients per year with various skin conditions. Using PDSA methodology an opportunity was identified for the medical assistant (MA) to administer dermal lidocaine utilizing provider orders. A comprehensive guideline in the form of standard work was created to include physician orders, education, training, and competency checklist. Over the duration of a year, research and collaboration was conducted to elevate the role of the MA, which included education, training, and assurance of competency in safety administering dermal lidocaine. Elevating the role of the MA to safely administer dermal lidocaine to assist the provider in anesthetizing the patient allowed for a quicker and more efficient treatment plan for patients. By creating standard work and establishing a detailed training program with competencies, the providers were able to efficiently care for patients within 15- to 20-minute appointment slots. This quick turnover of appointments depends on the speed and efficiency of the MAs to conduct clinical intake and vital signs and prepare patients for their procedures.
The Georgia regulations for MAs (section § 43-34-44) outline the role of the medical assistant, stating that a physician may delegate a task to the MA who has been trained, deemed competent, and meets the expectations of their respective organization. Using the standard work with competency checklists created, MAs were educated and trained on dermal lidocaine injection techniques to safely inject the patient. After three documented competencies under the guidance of a physician, the MA was deemed competent by the physician to inject lidocaine prior to a dermatological procedure. As a result of this work, organizational policy was changed to reflect that dermatology MAs would be able to practice at an optimal level of their scope of responsibility with in the standard work and competency. This new competency introduced a change in scope of responsibility and ultimately changed the dermatology MA titles to medical assistant proceduralist.
Creating a pathway to role optimization with lidocaine administration has improved efficiency in dermatology to allow for patients to be seen timely, which adheres to the division’s scheduling process of patients to be seen in 15- to 20-minute appointment time slots. Additional anectodical comments from the MAs include role/job satisfaction.