Supervision, Delegation, and the PTA Role; Documentation of Supervision
What this domain tests
This domain tests the line between delegation and abdication: what a PT may delegate to a PTA or aide, what supervision level applies, and how supervision is documented in the patient record.
Core rules
- The PT must supervise the PTA. Board rules distinguish direct or immediate supervision (the PT is on the premises and immediately available) from general supervision (the PT is accessible by telecommunications and provides periodic review). The applicable level depends on the setting, patient condition, and task.
- Delegation must be consistent with the PTA’s education, training, and competence and with the plan of care. The PT may not delegate evaluation, interpretation, plan modification, or discharge decisions.
- Aides may perform only non-skilled tasks under the required supervision; they may not perform skilled interventions or modalities.
- Supervision must be documented. The plan of care and supervisory records should identify the supervising PT; PTA notes are reviewed and countersigned as board rules require.
Worked example
A PTA is treating a patient with shoulder pain and wants to increase the ultrasound intensity beyond the parameters in the plan. The PTA may continue within the established parameters but must contact the PT before changing them. The PT reassesses and documents the change. Reasoning: progressing within plan limits is implementation; changing parameters is a plan modification reserved to the PT.
Traps that cost marks
- Assuming “general supervision” means no PT involvement.
- Letting a PTA perform an initial evaluation or discharge summary.
- Allowing an aide to apply a modality because the PT is nearby.
- Failing to document who supervised and when.
- Treating a physician’s referral as a substitute for PT supervision.