Section 172-29-004 - USE OF UNLICENSED PERSONNELThe full utilization of chiropractors or chiropractic physicians may require auxiliary client or patient care services provided by persons carrying out tasks, treatments, or interventions to support the provision of chiropractic services as assigned or directed by a licensed chiropractor or chiropractic physician. The scope of assignment or direction may vary depending on the level of judgment required for the task, treatment, or intervention, the knowledge and skills of the unlicensed person, the method and frequency of supervision, and the client or patient's condition, ability and willingness to be involved in the management of their own care.
004.01ACCOUNTABILITY. A licensed chiropractor or chiropractic physician retains accountability for the application of the chiropractic service when making the decision to assign or direct chiropractic tasks, treatments, or interventions and for the adequacy of client or patient care and outcomes related to the assignment or direction decision. 004.02ASSIGNMENT OF TASKS, TREATMENTS, OR INTERVENTIONS; ALLOWED. A licensed chiropractor or chiropractic physician may assign or direct unlicensed persons to perform selected tasks, treatments, or interventions that: (A) Reoccur frequently in the care of a client or patient or group of clients or patients;(B) Do not require the unlicensed person to exercise independent chiropractic judgment;(C) Do not require the performance of a complex tasks;(D) The results of the task, treatment, or intervention are predictable and the potential risk is minimal; and(E) Utilize a standard and unchanging procedure.004.03ASSIGNMENT OF TASKS, TREATMENTS, OR INTERVENTIONS; NOT ALLOWED. Tasks, treatments, or interventions that may not be assigned or directed include, but are not limited to:(A) Tasks, treatments, or interventions that require a license or other credential, unless the individual has the required license or credential.(B) Activities, including data collection, problem identification, and outcome evaluation that require independent chiropractic judgment;(C) Coordination and management of care including collaborating, consulting, and referring; or(D) Tasks, treatments, or interventions that are complex based on the definitions of this chapter.004.04PATIENT OR CLIENT ASSESMENTS. An unlicensed person as assigned or directed by a chiropractor or chiropractic physician may contribute to the assessment of the health status or determination of diagnosis by a chiropractor or chiropractic physician of individuals including interactions of individuals with family members or group members by: (A) Collecting basic subjective and objective data from observations and interviews. The data to be collected must be identified by the chiropractor or chiropractic physician; and(B) Reporting and recording the collected data.004.05PATIENT OR CLIENT PLANS OF CARE. An unlicensed person as assigned or directed by a chiropractor or chiropractic physician may participate in the implementation of a plan of care for clients or patients by the performance of non-complex tasks, treatments, or interventions. This includes documenting and communicating completion of the tasks, treatments, or interventions and client or patient responses and seeking guidance and direction when appropriate.004.06SUPERVISION. A licensed chiropractor or chiropractic physician must provide direction to unlicensed persons or assign tasks, treatments, or interventions to unlicensed persons through either direct or indirect supervision or a combination of both. 004.06(A)INDIRECT SUPERVISION. Indirect supervision may occur when client or patient conditions are stable or predictable, and the client or patient is competent to make informed decisions and provide necessary information relative to the tasks, treatments, or interventions. Indirect supervision may be provided through protocols and periodic inspection and evaluation in combination with plans of care. 004.06(A)(i)INDIRECT SUPERVISION THROUGH PROTOCOLS. When using protocols as a method of indirect supervision, the protocols approved by the chiropractor or chiropractic physician must: (2) Identify any specific assessment data to be gathered and reported and the specific parameters for any task, treatment, or intervention to be performed; and(3) Identify tasks, treatments, or interventions that may be provided. Tasks, treatments, or interventions may include, but are not limited to: (a) Monitoring client or patient's condition by the unlicensed person;(b) The direct or provision of chiropractic tasks, treatments, or interventions;(c) Referral to another licensed health care provider for service; or(d) Consultation with the chiropractor or chiropractic physician for specific direction.004.06(A)(ii)INDIRECT SUPERVISION THROUGH PERIODIC INSPECTION AND EVALUATION. When using periodic inspection and evaluation as a method of indirect supervision, the chiropractor or chiropractic physician must include: (1) An evaluation by the chiropractor or chiropractic physician to determine the adequacy of the protocols to serve the intended purpose; and(2) The availability of the chiropractor or chiropractic physician, or an appropriate substitute, to the unlicensed person by consultation and collaboration. An appropriate substitute may be another licensed practitioner in an emergency room, the client or patient's primary health care provider, or another specifically designated chiropractor or chiropractic physician.004.06(B)DIRECT SUPERVISION. Direct supervision of unlicensed personnel is required when the client or patient is not competent to make informed decisions or cannot provide necessary information relative to the tasks, treatments, or interventions.172 Neb. Admin. Code, ch. 29, § 004
Amended effective 10/20/2020