Professional responsibility

HIPAA

• Patients’ rights to community in healthcare

• Privacy and security of healthcare records

• Patient confidentiality is maintained in all oral, written, and electronic forms

• Written consent from the patient before disclosing information about personal health

• reduce physical identification of the patient

• patent’s rights to access all their medical records

APTA Core values for PTs

• Altruism- Therapist shall adhere to the core values of the profession and act in best interest of the patients over therapist's interest

• Autonomy- Therapist shall provide all necessary information to allow the patient to make informed decisions about care

• Professional judgement- Therapist shall be accountable for making sound professional judgement

• Non-maleficence- It is the obligation of the therapist not to harm the patient. “do no harm” principle

Things to remember

• If a family is requesting medical records, you MUST get permission from the patient first

  • Exception: pt. is comatose/ demented, and POA is requesting, if no POA social work

• The Pt. reserves the right to refuse therapy, and the PT must respect this

• The PT holds the right to refuse therapy services if their safety is at risk

PT v. PTA

• Utilization- The physical therapist is directly responsible for the actions of physical therapist assistant related to patient/ client management

  • The PTA may perform selected physical therapy interventions under the direction of, and at least general supervision of PT → PTA have to follow POC of PT

  • In all practice settings, the performance of selected interventions by PTA must be consistent with safe and legal PT practice

• PT (rehab) aides/ tech’s- non-licensed, non-clinical tasks such as clerical duties, equipment setup and maintenance, facility operations, works under direct supervision of the PT or PTA

Who can do what

• Modify POC to include a new modality: PT only

• Add hamstring exercises to a POC that states “LE strengthening”: PT and PTA

• Supervise a PTA student: PT and PTA

• Supervise a PT student: PT

PT code of ethics

• PT/ PTA shall respect the inherent dignity and rights of all individuals

• PT/PTA shall be trustworthy and compassionate in addressing the rights and needs of patients/ clients

• PT/ PTA shall be accountable for making sound professional judgments

• PT/ PTA shall demonstrate integrity in their relationship with patients/ pt./ clients, families, colleagues, students, research participants, other health care providers, employers, payers, and the public

• PT/ PTA shall fulfill their legal and professional obligations

• PT/ PTA shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills, abilities and professional behaviors

• PT/ PTA shall promote organization behaviors and business practices that benefit clients and societies

• PT/ PTA shall participate in efforts to meet the health needs of people locally, nationally, or globally.

Quality improvement/ accreditation agencies

• Joint Commission on Accreditation of Healthcare Organizations (JCAHO): accredits hospitals, SNF, home health agencies, PPO, HMO, mental health institution → audit agency

• Commissions of Accreditation Rehabilitation Facilities (CARF): accredits free-standing rehab programs/ facilities → audit agency

• Center for Medicare & Medicaid Services (CMS): determines what and how much will be reimbursed by Medicare for patient care (sets reimbursement rates)

• Occupational Safety and Health Administration (OSHA): responsible for determining the safety of the work environment → your safety

Donning/ Doffing PPE

• d”ON”ning: ON

  • Gown

  • Mask

  • Goggles

  • Gloves

• d”OFF”ing: OFF

  • Gloves

  • Goggles

  • Gown

  • Mask

Contact precautions

• Condition: MRSA, VISA, VRE, C.diff, Lice, scabies, Impetigo, gram negative bateria, uncontrolled diarrhea, Aminoglycoside resistant, Hep A, B, Dermatitis, Rota Virus

• Hand hygiene: hand wash before entering and after leaving the room

• PPE: Gloves and gown only when in direct contact w/ patient in patient room (remove before leaving the room)

• Room: private room or cohort patients w/ same infection

• Patient transport: minimize transport and patient washes hands if they leave the room

Droplet precautions

• Conditions: Mumps (rubella), Streptococcus A, Neisseria meningitis, pneumonia, influenza, pertussis

• Hand Hygiene: Hand washing upon entering and leaving the room

• PPE: Mask when working w/in 3 feet of patient. Contact precautions only when skin lesions are present

• Room: Private room without negative air flow

• Patient Transport: Minimize transport, patient wears a surgical mask when leaving the room, pt. follows cough etiquettes

Airborne precautions

• Condition: Measles, Tuberculosis, Varicella, SARS, Disseminated Herpes Zoster, chickenpox, smallpox

• Hand Hygiene: Hand wash upon entering and leaving the room

• PPE: N-95 mask (fit tested), gown, and gloves if severe contamination, discard mask upon leaving the room

• Room: Private room with negative air flow, keep door closed

• Patient Transport: Minimize transport, patient wears a surgical mask when leaving the room, follows cough etiquettes

Safety and Precautions

• Abuse- infliction of physical or mental injury or the deprivation of food, shelter, clothing or services needed to maintain physical or mental health

• Sexual abuse: sexual assault, sexual intercourse without consent, indecent exposure, deviate sexual conduct, or incest adult using a child for sexual gratification without physical contact is considered sexual abuse

• Physical abuse: Physical injury results in pain, impairment or bodily injury of any bodily organ or function, permanent or temporary disfigurement or death

• Emotional abuse: Anguish inflicted through threats, intimidation, humiliation, isolation, embarrassing, blaming or rejecting behaviors from an adult towards a child, withholding love affection, and approval

• Mental abuse: impairments of a person’s well being, intellectual or psychological functioning

Guidelines for use of telehealth

• Responsibility for and appropriate use of technology: A patients appropriateness to be treated via telehealth should be determined on a case-by-case basi, based on the PT’s judgments, patients preference, technology availability, risk and benefits, and professional standards of care

• Verification of identity: Both the patient and the physical therapy provider identities should be verified at the onset of the telehealth visit

• Informed Consent: Provider must follow state law requirements and best practices for acquiring informed consent for in-person encounters, and these same requirements should be followed for telehealth communications

• Licensure: PT delivering services must be legally and authorized in the jurisdiction in which the patient is physically located; however, the provider should not be required to be physically located in that same jurisdiction

• Supervision: PT may provide supervision either while on-site or virtual. PT statues and regulation should include supervision of PTA’s for telehealth visits

Guidelines for use of telehealth cont’

• Standards of care: providers should ensure that the services provided are included in both the legal scope of practice as well as personal competency including their education, training, experience, and ability to perform safely and effectively

• Privacy and Security: Providers should be aware of the requirements for privacy and confidentiality associated with the provision of telehealth services at both the originating and remote sites

• Technical Guidelines: All providers should ensure that the equipment is sufficient to support the encounter, is available and functioning properly, and they are trained in the equipment operation and troubleshooting

• Emergency and Patient/Client Safety procedures: If the clinician feels that the patient is experiencing a medical or clinical complication or an emergency, the treatment session should be immediately terminated, and local EMS response should be initiated

Safety and precautions ergonomic guidelines

• Monitor should be 18-28 inches away

• Monitor screen top slightly below eye level

• Elbows bent 90 degrees, wrist in neutral and free while typing

• Use a mouse that contours the hand

• Thighs are horizontal and feel resting flat on the floor

• Space under the desk should be at least 30 inches wide, 19 inches deep, 25-34 inches in height should be 2-3 inches between the top of the thighs and desk

Lifting Guidelines

• Always attempt to increase your BOS

• Maintain a proper lumbar curve while you lift

• Pivot your feet while lifting; do not twist your back

• Maintain a slow and consistent speed while lifting