Standards of Practice, Supervision, and Delegation
This domain tests how the OT remains accountable when care is delivered by an OTA or aide, and how supervision levels are matched to patient need.
Who supervises whom
The supervising OT must hold a North Dakota license and retain responsibility for the patient’s OT plan. Supervision is not transfer of liability. The OT decides what to delegate after considering patient complexity, stability, predictability, the setting, and the assistant’s competence. Board rules set the required level-direct (on-site, immediate availability) or general (available by telecommunication)-so the exam may ask you to match the level to the situation rather than assume one level always applies.
Delegation limits
OTAs may carry out delegated interventions and report findings. They may not perform the initial evaluation, interpret referral information, establish or change the plan of care, make discharge decisions, or independently provide services that require the OT’s clinical judgment. Unlicensed aides may perform non-clinical tasks only; they cannot provide skilled OT treatment. The OT must document supervision and ensure the assistant does not practice beyond competence or law.
Worked example
A rural clinic asks an OTA to complete an initial evaluation because the OT is two hours away. The OTA cannot do it. The OTA could gather interview data or perform assigned intervention, but the OT must perform the evaluation, set goals, and design the plan. If the OT delegates follow-up treatment, the OT must ensure the required supervision level is met and remain available as the rules require.
Traps
“General supervision” does not mean no supervision. An OTA cannot supervise another OTA or an aide in place of the OT. A physician’s order does not expand the OTA’s scope. Do not assume a task is delegable because it is routine; check the Act, Board rules, and the assistant’s competence.