Understanding Professionalism in Physical Therapy Practice

Tertiary Care

Highly Specialized medical services, e.g. heart/liver/lung transplants/major surgical procedures.

Secondary Care

Specialized care including inpatient hospitalization, ambulatory care, same-day surgery (e.g. Hernia repair).

Primary Care

Basic/entry point level of health care, includes outpatient services.

Acute Care/Inpatient

Care for patients that are medically unstable.

Acute Rehab Hospital

Rehab intensive care with an average stay of 4-5 days.

Sub-Acute Care

Intermediate level of care with an average stay of 15 days.

Long Term Acute Care

Care for medically complex patients requiring specialized 24 hr care.

Skilled Nursing Facility

Facility for patients with permanent disability or nonreversible pathology, average stay of 25 days or more.

Nursing Home

Facility for patients requiring daily and 24/7 skilled nursing care.

Home Health

Care for patients who cannot leave their home or are unsafe in the community.

Hospice

Palliative, end of life care where PT and OT are optional.

Custodial Care

Care for people unable to care for themselves, may be medical or nonmedical.

Outpatient Care

Less costly than inpatient care, patients have potential for improvement.

PTA Participation

A PTA can participate in discharge planning for a patient.

Documentable Progress

A patient must be making documentable progress to continue PT services.

Direct Access PT

A patient may access physical therapy directly depending on the state.

Outpatient Services Requirement

A patient must receive a set number of hours or units per week to continue outpatient services.

Outpatient services

A patient must receive a set number of hours or units per week to continue outpatient services.

General Supervision

Applies to the PTA under general supervision of the PT; PT must be available to the PTA by telecommunication.

PTA assessment

PT assesses PTAs provision of services on an ongoing basis.

Offsite supervision

If PT is supervising the PTA in an offsite setting, PT must be available by telecommunication at all times.

Regular meetings

Regularly scheduled meetings between PT and PTA to determine the needs of the patient and PTA.

Supervisory visits

Supervisory patient/client visits shall be made by the PT when PTA requests reexamination, change in POC, conclusion of care, or there has been a change in patient status.

Monthly supervision

Supervisory visits should occur once per month or more depending on patient needs.

Direct Supervision

Applies to student PTs and PTAs under direct supervision of the PT and student PTAs under direct supervision of the PTA; PT or PTA is physically present and immediately available, telecommunication is not acceptable.

Direct Personal Supervision

Applies to PT aides and technicians under direct personal supervision of the PT or PTA; PT or PTA is physically and immediately available and supervises tasks related to patient care and services.

Role of the PTA

A PTA is a graduate of an accredited PTA program with licensure in the state of practice; the PT is responsible for actions of the PTA in all settings.

PTA responsibilities

The PTA modifies elements of intervention for patient progress, safety, and comfort, and collects selected examination and outcome data.

Role of the PT Aide

Support personnel who perform tasks assigned to them by the PT or PTA that do not require clinical decision making, under direct personal supervision.

State supervision ratios

Many states have ratios of aides/student/PTAs to PT for supervision; this varies by state and is found in state legislature.

Dry needling

An intervention performed by physical therapist only.

Selective sharp debridement

An intervention performed by physical therapist only, specifically for wound care.

Grade V mobilizations/manipulation

An intervention performed by physical therapist only.

PTA supervision during PT absence

The PTA can supervise PT aides in the clinic while the PT is absent.

PT availability during vacation

The PT must be available by telecommunication during all business hours while on vacation.

Post-vacation meeting

Upon returning to the clinic, the PT and PTA should have a scheduled meeting to discuss the patients seen by the PTA.

POC changes by PTA

The PTA cannot add exercises to the POC in the absence of the PT without calling the PT to discuss.

PTA

Physical Therapy Assistant

POC

Plan of Care

Health Condition

Umbrella term for diseases/disorder/injury/trauma/other circumstances such as aging, stress, congenital anomaly, genetic predisposition, information on etiology/pathogenesis

Body Function

Functions of the body + psychological functions

Body Structures

Anatomical parts of the body (organs/limbs and their components)

Impairments

Problems in body function/structure/significant deviation/loss

ICF Model

International Classification of Functioning, Disability and Health

Activity

Execution of a task/action by an individual

Participation

Involvement in life situation

Activity Limitations

Difficulties an individual may have in executing activities

Participation Restrictions

Problems an individual may experience in involvement in life situation or role

Contextual Factors

Entire background of an individual's life and living situation

Environmental Factors

Physical/social/attitudinal environment in which people live and conduct their lives, including social attitudes/architectural characteristics, legal and social structures

Personal Factors

Particular background of an individual's life, gender, age, coping styles, social background, education, profession, past/current experience, overall behavior/character/other factors that influence how disability is experienced by an individual

Performance

What an individual does in his/her current environment

Capacity

An individual's ability to execute a task/action HIGHEST PROBABLE FUNCTIONING in a given domain at a given moment

Documentation

Complete, accurate, timely documentation is essential for patient safety, compliance with STATE + FEDERAL regulations, accurate communication between health care providers, appropriate utilization with for third-party payers, and historical record for potential legal situations

Medical Records

Records to be placed in safe & secure place for a certain number of years (7 yrs)

Outcome Measures

Documentation is enhanced by using measurements with demonstrated reliability and validity

Guidelines for Documentation

Comply with all applicable state/federal/regulatory agency laws & regulations

Medically approved symbols/abbreviations

Can be used in documentation.

Mistakes in medical records

Must be crossed out with a single line through the error then initialed/dated by PT/PTA.

White out material

Should never be used to correct text in a medical record.

Informed consent for treatment

Must be given only by a competent adult.

Consent for non-competent adults/minors

Must be given by a parent/legal guardian in written form.

Documentation of treatment

Each episode of treatment must be documented.

Patient's response to treatment

Must be documented after each treatment session.

Patient identifier on documentation

Patient name and other unique identifier should be on each page.

Date each entry

Payers require length of time per visit, e.g., Medicare/Medicaid.

Sign each entry

Must include first and last names and professional designation.

Significant events documentation

Record significant events such as phone conversations with physician/nurse.

Treatment rendered documentation

Must be in OBJECTIVE, MEASURABLE, FUNCTIONAL TERMS (e.g., ROM, strength, sitting tolerance).

Discharge plan

Must be completed when goals/outcomes are reached.

Electronic documentation

Must have security and confidentiality practices in place; e-signatures are acceptable.

Charting error correction

Clearly indicate that a change was made without deletion of the original medical record.

Health Insurance Portability and Accountability Act (HIPAA)

Immediate purpose is to disclose minimum necessary information about personal health.

Patient confidentiality

Must be maintained in all oral, written, and electronic forms.

Patient's right to access medical records

Patients have the right to request their records and to request amendments.

Provider response time for records

Providers have 30-60 days to respond to requests.

Exceptions to HIPAA

In emergencies, treatment may commence if delay will prevent timely care.

Individuals with Disabilities Education Act (IDEA)

Ensures children with disabilities receive appropriate and free public education.

Early Intervention Programs (EIP)

Programs that serve children with developmental delays.

Individualized Education Plans (IEPs)

Plans created for children, allowing them the option of not attending planning meetings.

Americans with Disabilities Act (ADA)

Prevents discrimination against people with disabilities (physical/mental health).

ADA Requirements

Requires employees (15 or more) to accommodate needs of people with disabilities for economic independence in public/private sector.

EEOC Regulations

Abides by Equal Employment Opportunity Commission (EEOC) regulations.

Reasonable Accommodation

Reasonable accommodation to workplace by removing barriers unless would cause 'undue hardship' - an action requiring significant difficulty/expense.

Example of Undue Hardship

Installing an elevator for an individual to access upper floors might be an undue hardship for a smaller business.

PT Role

Consultant to employers to help them meet their responsibilities, and to individuals with disabilities to help them achieve their rehabilitation potential and rights under law.

Mandatory Reporting

PTs and PTAs are MANDATORY REPORTERS for all categories of abuse in all 50 states.

Reporter Immunity

As a reporter, the PT or PTA is immune to criminal or civil liability.

Consequences of Not Reporting

NOT REPORTING is considered a crime and can result in a loss of license or other penalties.

Reporting Procedure

Call the state specific hotline, report findings, and follow any/all facility procedures.

Do Not Confront Offenders

Do not confront possible offenders yourself.

Relay Information

Relay information to the PT and facility.

Elder Abuse Reporting Scenario

While treating an elderly female patient 6 weeks post THR, the patient reports to a PTA that her children are neglectful and sometimes abusive when she requires help at home and she rolls up her sleeve to reveal bruising.

First Action for PTA

Alert the PT of the situation and allow the PT to decide the next step.

Alternative Action for PTA

Wait until witnessing interactions of the patient and her children in order to establish reasonable suspicion.

Contacting Family

Contact the patient's family and discuss her statements in a private conversation.

Reporting to Authorities

Contact an elderly abuse hotline or report to the appropriate authority.

Assess and Document Findings

Assess and document all findings.