HAC Code of Practice by chenshu


									HAC Code of Practice

Revisions - 01st September 2004
         HAC Code of Practice
• Background to revisions
     • Last revised March 1999
     • Makrotest report / recommendations
          - Fast Track Disciplinary Proceedings/CPD
     • Interpretations from Disciplinary Hearings
     • Removal of gaps and ambiguities
     • Improve clarity and precision
     • General update and modernisation
     • Maintenance and improvement of RHAD
     • Introduction of CPD
• Implementation date 01st September
         HAC Code of Practice
• Consultation
  – Consultation exercise commenced
    June 2002
  – Consultation (two formal occasions)
     •   dispensers
     •   employers
     •   other interested parties
     •   HAC Lawyers
     •   DTI
     •   Lord Chancellor‟s Department
• Final draft = 24th draft!!!
                 Clause 1
• High standard of ethical conduct
• Operation of practice, dispensing of
  hearing aids and in the training of
• All Dispensers and all employers
   – Not binding on DC’s interpretation
     • Bowlam principle - Opinion of any
       reasonable body of HADs
     • Conduct which makes DC feel that you
       cannot do that!
     • Dishonesty / Deliberate fraud
     • Conduct “beyond incompetence”
  – Dispensing activities
     • Negligently taking an aural impression
     • Negligently performing a hearing test
       where a deterioration of hearing resulted
     • Induced tinnitus following a hearing test
               Clause 1
• 1(b) Considered to have fallen below
  the high standard of ethical conduct if
  they fail without good reason to act in
  accordance with any qualifying
  promise given to Disciplinary
• Qualifying promise made by
   – Promise relates to operation of their
     practice including dispensing and
     training of trainees
               Clause 1
– Promises made to Disciplinary
  Committee binding
– Promise to undertake
  training/retraining/re-examination is a
  qualifying promise
– Breach of promise = below “high
  standard of ethical conduct”
   • DC costs / fines not a qualifying promise
                   Clause 2
• “Whistle blowing”           • is believed on
  /reporting misdeeds           reasonable
                                grounds to have
  (public protection            acted in a manner
  clause)                       which constitutes
• Notify Council when           serious
  an HAD, trainee or            misconduct
  employer                      dishonesty, fraud,
     • is believed on           cheating, false
       reasonable               accounting
       grounds to have        • has been
       acted in a manner        convicted of any
       which has fallen         criminal offence
       significantly below      involving
       the “high standard       dishonesty, fraud,
       of ethical conduct”      cheating, false
             Clause 2
• has been convicted of any other criminal
  offence which is not a trivial offence
   - excluding spent convictions
• or where custodial sentence has been
  imposed whether suspended or not
                  Clause 2
• Rehabilitation of Offenders Act 1974
  – Provision for the rehabilitation of
    offenders who have not committed a
    further serious offence
  – Restriction of disclosure
  – Varying time periods according to
    penalty and age of offender
     •   under 18 halves the period
     •   imprisonment >30 months :- no protection
     •   6 months - 30 months :- 10 years
     •   fine or sentence < 6 months :- 5 years
Clause 3, 4
Clause 5 (Advisable conditions)
• Changes to opening   • “Registered Medical
  paragraph              Practitioner”
                            • Replaces
• Amendments to               “medically
                            • Avoids confusion /
• Additional sub-           • If HAD is not RMP,
                              he must advise
  clauses                     client to seek
                              medical advice
                              (unless client has
                              already done so) if
                              HAD finds
                              conditions in (a) to
  Clause 5 - opening paragraph
• Requirement to            – Advice must be
  send copy of                given to client /
  findings to GP /            appropriate person
  appropriate medical         at time of findings
  specialist if             – Requirement to
  Dispenser finds             record findings
  conditions in sub-          (positive or
  clauses (a) to (o)          negative)
   – With permission of     – Requirement to
     client / appropriate     record advice
     person if client is      given
     under 18
   – Record reasons if
     no copy sent
      Clause 5 - amendments
• (a) Obstruction of   • (e) Conductive loss
  external auditory       – No change
  canal                   – 25dB bone-air gap
   – specifically         – Two out of .5KHz,
     includes wax,           1Khz, 2KHz
     foreign bodies    • (f) Unilateral loss /
• (b) Abnormal           asymmetrical loss
  appearance of           – 20dB or greater
  eardrum and / or           difference in
  outer ear                  left/right BC
                             • (TTSA Guidelines)
                          – Two out of .5KHz,
                            1Khz, 2KHz, 4KHz
 Clause 5 < 24 hours (sudden)
• (g) Sudden onset of hearing loss
• (h) Sudden worsening of hearing loss
    Clause 5 < 90 days (rapid)
• (c) Persistent (7+ days) earache within
  the last 90 days
• (d) Discharge other than wax within
  the last 90 days
• (g) Hearing loss of rapid (up to 90
  days) onset
• (h) rapid (up to 90 days wo0prsening
  of an existing hearing loss
• (I) Fluctuating loss not associated with
  head colds within the last 90 days
• (k) Tinnitus (unilateral, pulsatile or
  distressing) within the last 90 days
• (l) Rotary vertigo within the last 90
    Clause 5 < 1 year (recent)
• (h) Recent worsening of an existing
  hearing loss
     • If there is an existing audiogram within the
       last 24 months - difference of 15dB or
       more in AC thresholds at two or more
       frequencies out of .5, 1, 2, 4KHz
     • Up to 10dB drop in 10 years can be
       regarded as presbyacusis
          Clause 5 > 1 year
• 5 years
   – (j) Hearing loss that may be associated
     with noise exposure
   – Exposure has taken place within 5
     years preceding examination
             Rotary vertigo
• Rotary vertigo        • Rotary vertigo only
   – “Hallucination of     – Excludes non-rotary
     movement where          symptoms
     sufferer feels        – HADs must ask
     he/she is rotating      about rotary vertigo
     in the environment        • but do not need to
     OR the                      ask about other
     environment is              balance problems
     rotating around       – If client informs HAD
     them”                   of other balance
                             problems, he/she
                             should consider the
                             need for medical
       Clause 5 - additions
• The “unwritten rules”
• Premature hearing loss (18-40 years of
     • 30dB + loss @ two or more of .5KHz,
       1KHz, 2KHz, 4KHz in either ear
• Poor speech discrimination (replaces
  obscure auditory dysfunction)
     • Unaided speech discrimination appears
       significantly poorer than PTA would
       suggest (no speech audiometry req‟d)
• Client is a minor (under 18 years of
     • Advise to seek medical advice whatever
       the findings
                 Clause 6
• If HAD is not an RMP, he / she cannot
   – Assume the status or knowledge of
     someone who has that level of medical
     or surgical knowledge (other than CoP)
   – Practice medical / surgical treatment
     for deafness
   – Advertise they can cure any human
     failing or physical ill
   – Practise any form of wax removal
     • unless qualified to do so in an HAC-
       approved manner
                    Clause 7
• Written Indication of        • “Registered
  registration under             hearing aid
  the Act
                               • “RHAD” (only after
      • No other terms or        name)
        abbreviations than
        those specified        • “Registered under
                                 the Hearing Aid
      • Put RHAD first?          Council Act 1968”
• Descriptions                 • “All hearing aid
  include                        dispensers are
      • “Registered              required to be
        dispenser(s)”            registered with the
                                 Hearing Aid
           Clause 7 (cont.)
• Dispensers shall describe themselves
     • “Dispenser” / “Registered dispenser”
     • “Registered hearing aid
     • “Hearing aid dispenser”
     • “Hearing aid audiologist”
     • “Hearing aid consultant”
     • “Hearing aid specialist”
• No other terms or abbreviations shall
  be used in a manner that might be
  expected to mislead or deceive
  members of the public
Clause 8
               Clause 9
• Audiometry
  – To be taken in accordance with BSA
    recommended procedures
  – Not more than 2 months before supply
    of new hearing aid
  – Not more than 24 months since last
    audiogram for identical replacement /
    identical guarantee replacement
  – When client reports hearing has
    changed (HAD to ask and record)
  – (always use new audiogram form)
           Clause 9 (cont.)
• Audiograms
  – Must be dated, signed or securely
    electronically recorded
  – Must include make, type and serial
    number of audiometer
  – Must include calibration date (BSA)
  – Retention (minimum periods)
     • 5 years from supply of hearing aid
     • 90 days from testing if no aid supplied
          Clause 9 (cont.)
• Impressions
   – To be taken in accordance with BSA
     recommended procedures
   – If no BSA recommended procedure
     (eg: open jaw impression taking)
     impressions to be taken in accordance
     with appropriate professional practice
     and with due care and attention (Bolam
         BSA procedures
• Revised procedure for PTA
  – Currently displayed on BSA website
    (procedures dated March 2004)
  – Environment
  – Client History
  – Transducers
  – Audiometric descriptors
  – ULL testing
          BSA Procedures
• Environment
  – “Dispensers should use their
    professional judgement to test in the
    quietest available environment”
  – Evidence of HAD‟s own thresholds
    from suitably quiet environment
    compared with own thresholds in test
    environment required
      • when audiometry carried out
     • record on the audiogram
  – Any disparity to be considered carefully
           BSA Procedures
• Client History
  – Recent noise exposure (last 24 hours)
     • record on audiogram
     • preferably avoid; retest when no recent
  – Tinnitus
     • record if present
     • tell client to ignore tinnitus and respond
       only to test tones, or report any difficulty
            BSA Procedures
• AC Transducers               • BC Transducers
   – Record type of               – Cover test ear with
     earphone used                  supra-aural
       • Supra-aural (TDH           earphone or insert
         39)                        foam plug when
       • Circum-aural               testing at 3KHz or
         (covers entire pinna)      4KHz
       • Insert earphones
                                  – Avoids inaccurate
   – Can affect results             thresholds
     due to sound                   pericranial
     attenuation                    transmission
     properties and
                                  – DO NOT occlude
                                    at any other
     transmission values
BSA Procedures
          BSA Procedures
• ULL testing
  – “… should only be performed when the
    audiological professional considers the
    information will be clinically useful …”
  – “This information is generally helpful
    for hearing aid fitting”
  – Contraindications
     • significant tinnitus
     • hyperacusis, other distress from noise
  – 110dB HL maximum recommended
       Clause 10 Home Visits
• “Potential clients”         • written-booked home visits
                                need written agreement to
   – Similar to previous        visit on a particular day or
     Clause 10 except           written record if verbal
     where the test is          confirmation by potential
     following an               client
     approach by
      • telephone-booked
        home visits no
        earlier than 10
        calendar days after
        despatch of notice
        unless an earlier
        date is requested
        by the potential
      • HAD/rep must
        make written
        record of reason
        why < 10 days
                Clause 10
• “Existing clients”
   – Removes some restrictions from
     previous Clause 10
     (Notice/Opportunity to decline)
     • home visits by request or agreement
     • a written record of request or agreement
       must be made by HAD/rep
  – “Existing client” = dispenser or
    employer previously supplied him/her
    with a hearing aid
Clause 11 Information for Client
• Written particulars
• Plain and intelligible manner
• Before supply or commitment
  – Name, business address and „phone
    number of firm and HAD (if different)
    supplying hearing aid(s)
     • precise contact name (if different) for terms
       of trial periods, cancellation, terms/details
       of refund right, repairs, service, batteries
       etc. should be made clear
  – Terms of any Guarantees
     • both from firm / dispenser supplying aid(s)
       and manufacturer
     • explanation of guarantee obligations (see
       Cl 19)
    Clause 12 Employers shall
• (a) Compliance with    • Notwithstanding
  Code of Practice         Clause 12 (a)
                            – The Council will
   – Employers shall          take into account
     ensure dispensers         • any steps taken
     employed by them            by the employer to
                                 alert them of any
     comply with the             CoP breach by an
     CoP and trainees            employee
                               • if employer has
     dispense under              already taken all
     supervision and             reasonable steps
                                 to prevent, remedy
     dispense in                 or mitigate any
     accordance with             CoP breach;
     CoP                       • and breach is
                                 outside the terms
                                 of employee‟s
Clause 13
               Clause 14
• “Employers shall describe themselves
  or their employees as …”
   – This Clause has been amended to
     reflect the changes in Clause 7
   – “Dispenser” / “Registered dispenser”
   – “Registered hearing aid dispenser”
   – “RHAD”
   – “Hearing aid dispenser / audiologist /
     consultant / specialist”
   – No other terms or abbreviations shall
     be used in a manner that might be
     expected to mislead or deceive
     members of the public if they were to
     see the description
Clause 15
               Clause 16
• Premises
  – “Dispensers and employers who are
    not Registered Medical Practitioners
    shall not designate their premises as a
    Clinic or Institute”
  – Avoids potential confusion to the
    general public
                Clause 17
• Survey enquiries
  – Now specifically prohibits direct or
    indirect participation in survey
    enquiries with a view to securing
    business by
     • personal visits (previously personal
     • telephone enquiries
  – Applies to dispensers and employers
Clause 18
                 Clause 19
• Previously the           – Where assignment
  benefit of any             impossible,
  guarantee offered          HADs/employers
  by the manufacturer        undertake to use
  had to be given to
  clients.                   all reasonable
• New Clause                 endeavours to
  implementation of          provide client with
  guarantees                 benefit of any
  (supplier’s and            guarantee
  manufacturer’s)            provided to the
   – Wherever possible       HAD or employer
     to do so                for that hearing aid
   – Assignment of
     guarantee for
     hearing aid at time
     of supply
              Clause 19
– Undertaking to provide client with all
  reasonable assistance in taking
  advantage of guarantee provided by
  the manufacturer to the dispenser
   • return to manufacturer for repair /
   • arrange for client to receive new/repaired
   • give to client any financial rebate /
     compensation from manufacturer / refund
     if appropriate unless refund given
– Undertaking given at the time of supply
               Clause 19
• No charge to client
  – for assignment/undertaking
  – for provision of assistance
     • except reasonable postage / telephone
• Client can access Manufacturer’s
  guarantee directly
   – HAD/Employer insolvency
• Guarantee attached to the aid rather
  than supplier
• Expectation is that HAD will provide
  support for the duration of the
  manufacturer’s guarantee. Failure to
  do this has been a common reason for
  DC appearance
• DC will pursue RHADs beyond a
  change in career
Clause 20
              Clause 21
• Response to enquiries from the
  – “ … with reasonable expedition …”
  – Reasonable expedition = 21 days
  – Extension is possible if requested
    within that period
Clause 22 Notified Supervisors
• Supervisors
  – RHADs who have been registered at
    least 2 years and comply with CPD -
    1st April 2005
  – Supervisors must ensure dispensers
    supervised by them comply with the
  – 22 (b) The Council will take into
    account any steps taken by the
    supervisor to alert them of any
    potential CoP breach by a trainee and
    where he has already taken all
    reasonable steps to prevent, remedy or
    mitigate the recurrence of any CoP
  – breach is outside terms of trainee‟s
               Clause 23
• Notified Trainee particulars
  – Supervisor responsible for notifying
    Council of the particulars of trainees
    he/she is to supervise
  – Supervisor responsible for notifying
    changes in particulars to Council
  – Changes must be notified within 28
    days of occurrence
               Clause 24
• Completion of pre-Registration period
  – Notified Supervisor may not continue
    supervision beyond 60 (previously 30)
    days of time when pre-Reg is invited to
    join the Register of Dispensers i.e. post
    exam/approval of log book
  – Pre-Reg must register within 60 days
    or may not continue to dispense
  – Does not apply to degree entrants
    Clause 25, 26, 27, 28

– takes into account BSc Audiology
  students and clinical placement
                Clause 30
• Disciplinary proceedings
  – Disciplinary proceedings may be
    brought against registered dispensers
    who are alleged to have breached CoP
  – Preliminary investigation by
    Investigating Committee in order to
    decide whether a case ought to be
    referred to the Disciplinary Committee,
    leading to
     • case dismissed
     • “fast-track” proceedings (ie: no need for
       full DC)
     • full DC
                     Clause 31
• Definitions
   – Amendments include
      •   “dispenser” = “dispenser of hearing aids”
      •   “employer” = “employer of dispensers”
      •   “pre-registered hearing aid dispenser”
      •   “degree entrant”; “BSc Audiology student”
      •   “Registered Medical Practitioner”
      •   “existing client”
• Reminder
   – Criminal offence to dispense if not RHAD or
     THAD acting under RHAD supervision
     Standard of Competence
• Entry requirements
  – 2 “A” levels (or equivalent) for those
    born after 01st January 1974
      • 4 “O” levels (or equivalent) if born 01st
        June 1949 - 31st December 1973
• Completion of full-time training
  – not more than 5 years
      • need not be continuous as long as
        Registrar has been informed in writing of
        cessation / re-commencement
      Examination Syllabus
• Examination syllabus
  – to be published separately
  – more flexibility in implementing change
           Registration Rules
• Register of                   • Retention
  dispensers                       – registration fees due
   – Surname,                        01st April each year
     forename, date of
                                      • non-payment =
     birth, address                     removal from register
      • avoids confusion                and subsequent
         between identical
         names                          restoration to register
                                        only via Disciplinary
   – Two passport sized
     photographs                        Committee
   – Any changes to be                • Cannot escape
     notified by recorded               investigation by
     delivery                           failing to renew
   – Application for               – Restoration after
     registration                    voluntary removal
      • within 60 days of             • Aptitude Test /
        satisfying all                  Adaptation Period if 3
        requirements for
        registration i.e. Log           years or more
        book approval
• Continuous Professional Development
   – Mandatory from 01st April 2005
   – 25 CPD points required per annum
     • 20 structured points
     • 5 non-structured points
     • 50 CPD points per rolling two year period
  – CPD details to be sent each year with
    application for re-registration OR on demand
     • first required 01st April 2006
  – CPD record folder
     • Retained for 5 years?
  – Summary Sheet of accumulated points
  – Samples will be checked

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