The Busy Clinic
Riverside Outpatient Therapy has one licensed PT, one PTA with six months of experience, and two unlicensed rehabilitation aides. On Tuesday the PT has 14 patients scheduled between 8:00 a.m. and 4:00 p.m., including three new evaluations. The clinic manager proposes the following to keep the schedule: (1) the PTA will perform the initial evaluation for a new patient with a total knee replacement and will write the plan of care because the PT is double-booked; (2) the PTA will change a post-operative patient's exercise progression and add ultrasound without contacting the PT; (3) an aide will apply hot packs and ultrasound to two patients and will document the treatment; (4) the PTA will discharge a patient who has met goals. The PT is also scheduled to be off-site at a marketing lunch from 11:30 to 1:00. The PTA asks the PT to sign off on the evaluation and discharge notes at the end of the day.
1. Which of the proposed assignments are within the PTA's scope and which must be performed by the PT? Explain.
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The PTA may implement the plan of care and may adjust interventions within the plan if the PT has authorized that and the PTA is competent. The PTA may not perform the initial evaluation for the new total knee patient, establish the plan of care, or discharge the patient. Those are PT responsibilities. The PTA also may not independently add ultrasound or change the post-operative exercise progression beyond the plan. The aide may not apply ultrasound or make clinical decisions; hot packs may be delegated only as a non-skilled setup under the required supervision and with the PT's initial assessment.
2. What level of supervision does DC law require, and how does the PT's off-site lunch affect the plan?
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DC requires the PT to supervise the PTA and to be responsible for the plan of care. The exact level-direct, on-site, or general-depends on the setting and the Board's rules, but a PT who is off-site at a marketing lunch cannot provide on-site supervision if the PTA is treating a new or complex patient. The PT should not schedule the PTA to cover evaluations or complex changes while unavailable. If the setting requires direct supervision, the lunch plan violates it. The PT should rearrange the schedule, remain available, or have another PT on site.
3. What should the PT do about the aide's application of modalities and documentation?
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The aide's application of ultrasound is a skilled intervention and should not be delegated to an unlicensed aide. Hot packs may be applied by an aide only under the supervision the Board allows and after the PT has assessed the patient. The aide should not document skilled treatment in a way that implies the aide made clinical judgments. The PT should stop the practice, train the staff, and document the corrective action. Signing off on notes for services the PT did not supervise would be false documentation.