Domain 3 - Intervention Planning, Safety and Risk Management
Domain 3 tests whether you can plan and deliver intervention that is effective, consented to and safe. Questions cluster around goal setting, evidence-informed choice, infection prevention, manual handling and equipment, modality contraindications, and the response to deterioration or an adverse event.
Collaborative goal setting
Goals should be patient-owned, specific, measurable and time-bound, and linked to a participation outcome the patient values. Negotiate rather than impose, and review goals at planned intervals instead of at discharge.
Evidence-informed decisions
Combine the best available evidence, your clinical expertise, and the patient's values and context. Absence of evidence is not evidence of absence - but do not present unproven interventions as established treatment, and state the uncertainty plainly.
Infection prevention and control
- Standard precautions apply to every patient: hand hygiene at the WHO five moments, PPE, safe sharps handling, spill management, waste segregation.
- Distinguish clean from sterile technique; single-use items are never reused; clean shared equipment between patients.
- Add transmission-based precautions (contact, droplet, airborne) on top of standard precautions when indicated.
Contraindications and precautions (examples)
- Thermal modalities: avoid over acute inflammation, impaired sensation, malignancy, or the pregnant abdomen.
- Electrical stimulation: pacemaker or implanted defibrillator, electrodes over the anterior neck or across the thorax, pregnant abdomen.
- Exercise: unstable fracture, uncontrolled cardiac failure, suspected acute DVT.
Adverse events
Stop, make the situation safe, assess the patient, escalate according to acuity, document the facts, actions taken and who was informed, and complete an incident report. Incident reporting exists for system learning, not blame.
Worked example
A patient with a cardiac pacemaker asks for TENS for chronic shoulder pain.
Reasoning: transthoracic or pericervical electrode placement can interfere with pacemaker sensing, so this is a precaution - not an automatic yes. Do not proceed on assumption. Check the device type, consult device/manufacturer guidance and the responsible clinician, and document the decision. Where clearance is not available, select a safer alternative (education, graded exercise, manual therapy). If treatment proceeds after clearance, avoid current paths across the thorax and monitor during the first session.
Traps that cost marks
- Treating a relative contraindication as absolute, or an absolute one as negotiable.
- Failing to document a near miss because nobody was harmed.
- Continuing a session when observations deteriorate.
- Using equipment without competency assessment, or omitting allergy and latex checks.