PTA Delegation With a New DVT Red Flag and an Aide Requesting Modalities
At a Concord outpatient clinic, one PT, one PTA, and one unlicensed PT aide are scheduled on a busy Tuesday. The PT must leave the building for a two-hour regional meeting. Before leaving, she reviews the plan of care for four patients the PTA will see: (1) a 72-year-old six weeks after total knee arthroplasty with new unilateral calf swelling and warmth; (2) a 45-year-old with cervical radiculopathy whose plan includes intermittent cervical traction; (3) a 60-year-old two weeks after stroke working on gait with a hemi-walker; and (4) a 28-year-old with shoulder impingement doing elastic-band strengthening. The aide plans to apply hot packs to two patients and ultrasound to one patient, and to 'adjust' the PTA's exercise program if patients are sore. The PT will be reachable by phone but not physically present. The PTA has not performed cervical traction before, and the clinic policy says 'PTs supervise PTAs generally.'
1. Which patients may the PTA treat, and what supervision and clinical limits apply?
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The PTA may implement delegated interventions for stable patients under the supervision level the Board requires, generally with the PT available by telephone. Patient 1 has new unilateral calf swelling and warmth after total knee arthroplasty, which suggests possible deep vein thrombosis; the PTA must not treat, must stop, and must contact the PT and arrange urgent medical evaluation. Patient 2's cervical traction is a delegated intervention only if the PTA is competent; because the PTA has not performed it before, the PT must perform it or provide direct training and supervision. Patient 3 may receive gait training per the plan if medically stable; if new symptoms appear, the PTA must stop. Patient 4 may perform strengthening. The PTA cannot perform an initial evaluation, interpret examination findings, or change the plan of care.
2. May the aide apply hot packs or ultrasound and adjust exercises?
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No. An unlicensed aide may not apply ultrasound or hot packs as skilled modalities and may not 'adjust' exercises. Aides may perform non-skilled tasks such as transport, setup, cleaning, and clerical work under direct supervision, and may assist a PT or PTA with a patient only as Board rules allow. Applying modalities and making clinical decisions is physical therapy practice. The PT should assign the aide only non-clinical tasks and ensure direct supervision while the aide is assisting with patients.
3. What should the PT document before leaving the building?
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Before leaving, the PT should document the delegation plan, each patient's status, the supervision method, how the PTA can reach her, and the PTA's competence for cervical traction. The PT should also document instructions to stop and call for red flags such as new swelling, chest pain, shortness of breath, or neurological change. Upon return, the PT should review the PTA's notes and re-examine patient 1. If the PT cannot be available by phone or cannot ensure safe supervision, the PTA should not treat the patients that require supervision.