A PA encounters a request for a restricted therapy not covered by protocol and suspects safety concerns. What should be done?

• A. Delegate to a nurse.
• B. Escalate to supervising physician to re-evaluate protocol and patient safety.
• C. Proceed with request regardless of concerns.
• D. Ignore concerns.

Answer: (B)

When a requested therapy is restricted and outside the current protocol, and safety concerns exist, the appropriate step is to escalate to the supervising physician to re-evaluate the protocol and the patient’s safety. This upholds the clinician’s responsibility to practice within approved guidelines while ensuring that any exception is clinically justified and properly documented.

Why this is best: the supervising physician oversees patient safety and treatment scope. Their review can provide a formal risk-benefit assessment, determine whether an exception or protocol modification is warranted, or identify a safe, approved alternative. This process protects the patient, clarifies accountability, and ensures all decisions are properly authorized and documented. If an exception is ultimately approved, follow the new orders and obtain informed consent as needed.

Delegating the request to a nurse bypasses necessary physician oversight. Proceeding with the restricted therapy despite safety concerns ignores patient protection and legal/ethical standards. Ignoring concerns is unsafe and unprofessional.