Delegation
Order Instructions:
Assignment #3: Delegation
Instructions:
Review APTA guidelines for supervision of support personnel at: http://www.apta.org/Practice&Patient Care/PracticeAdministration/Supervision&Teamwork. Review state requirements for supervision of support personnel for the state you intend to seek licensure. Links to each state’s practice act are available at: https://www.fsbpt.org/LicensingAuthorities/index.asp
Analyze the two supervision scenarios provided in the course syllabus. What did the PT (and/or PTA) do wrong? What should s/he have done? You MUST cite your state PT practice act and APTA guidelines in your analyses. Submit both analyses as one document.
For your record attaching copy of scenarios, practice act of state of Connecticut(CT) for your reference.
All assignments are to be word processed; 12 point font and double spaced are preferred. Do not use color, pictures, etc. in your documents. Use only black text. Number the pages and make sure your name is on every page.
PT referral for scenario 1 is right after surgery when pt was discharge from hospital
SAMPLE ANSWER
Delegation
Supervision Scenario 1
In the first supervision scenario, the physical therapist (PT) delegated the task of stretching the patient and putting ice on the patient’s shoulder to the athletic trainer (ATC)/the clinic manager. The athletic trainer did exactly what he was asked by the PT to do: stretch the shoulder of the patient and then ice it. However, this caused the patient pain since what the ATC did brought about re-injury to the repaired site. However, a second surgical operation repaired the rotator cuff. What the physical therapist did wrong was to delegate the supervision to an athletic trainer rather than a physical therapist assistant (PTA). As per the Connecticut General Statutes, a physical therapy assistant is an individual who is licensed to aid in the practice of physical therapy in Connecticut under a PT’s supervision (Connecticut General Statutes, 2014).
In essence, the Connecticut General Statutes 376§20-74 does not forbid anyone who is a PTA from assisting in the practice of PT under the supervision of a licensed PT so long as such assistance is limited to the treatment of an individual by using effective properties of physical measures to prevent, correct, or alleviate a mental or physical disability (Connecticut General Statutes, 2014). In this scenario 1 however, the PT did not delegate the task of stretching the shoulder of the patient and putting ice on it to a PTA, but to an athletic trainer who is prohibited by Connecticut General Statutes from assisting the PT. Moreover, the other thing that the PT did wrong was that she did not supervise the athletic trainer in the tasks that she had delegated to him. Supervision, according to the Connecticut General Statutes (2014), implies the participation in, or the overseeing of a PTA by a licensed PT. This supervision basically includes (i) constant availability of direct communication between the PTA and a licensed PT. (ii) Availability of a licensed PT on a regular basis to (a) assess the PTA’s practice; and (b) support the Physical Therapist Assistant during the execution of the PTA’s services. (iii) A prearranged plan for crisis situations, such as the designation of an alternate licensed PT if the regular licensed PT is absent.
What the PT should have done is that she should have delegated the tasks of stretching the shoulder of the patient and putting ice on it to someone who is actually a physical therapist assistant, instead of an athletic trainer. Secondly, as a licensed PT, she should have supervised the task which she had delegated to that person by ensuring there is (a) constant availability of direct communication between the two of them; (b) support the PTA as the PTA carries out his services; and (c) develop a prearranged plan for situations that are emergency, like in this scenario when the patient experienced severe pain in his arm during the stretching done by the athletic trainer (Federation of State Boards of Physical Therapy, 2014). Supervision and direction are vital in providing quality PT services and the PTA should at all times work under the direction and general supervision of the licensed PT (American Physical Therapy Association, 2014).
Supervision Scenario 2
In the second scenario, the physical therapist carried out an initial examination and assessment of the patient, developed a plan of care and established that a physical therapist assistant could perform therapy interventions for the 60-year-old patient. The PT supervised the PTA, which was actually an apt thing to do. In this second scenario however, what the physical therapist assistant (PTA) did wrong was that she determined a treatment plan for the patient; something that she should not have done. What the physical therapist (PT) did wrong is that he did not develop a plan of care basing on the initial examination that is specific enough and which actually includes the goals and outcomes of the physical therapy. In this second scenario, the written physical therapy plan of care did not specify if the hip prosthesis was uncemented or cemented. Moreover, it did not record particular limitations to the weight bearing status of the patient on the patient’s operated leg. Given that the plan of care did not have precise information with regard to the sort of prosthesis utilized, the physical therapist assistant determined to follow a care progression that she thought was in line with that of a cemented hip. The PTA began the patient at toe touch weight bearing on the lower extremity that was affected, and progressed the patient to minimal weight bearing over the next 21 days and later on partial weight bearing. The patient’s physician pointed out that these initial weeks of weight bearing progression in physical therapy was essentially the primary reason of the failure of initial prosthesis. What the PTA should have done is that she should have asked the licensed PT and confirm with him about the patient’s treatment plan as well as a specific physical therapy plan of care.
What the PT should have done right is provide a physical therapy plan of care that documented whether the hip prosthesis was uncemented or cemented. The PT should also have ensured that the PT plan of care record specific limitations to the patient’s weight bearing status on his operated leg. According to APTA (2014), the physical therapist has the crucial task of creating a plan of care basing on the initial examination or reexamination that includes the goals as well as outcomes of the physical therapy. The Connecticut General Statutes 376§20-74 states that it shall not ban a PTA from aiding in the practice of PT under the supervision of a licensed PT so long as that assistance does not include the determination of treatment plans. The PTA in this second scenario actually determined the patient’s treatment plan, which is prohibited (Connecticut General Statutes, 2014).
References
American Physical Therapy Association. (2014). Direction and Supervision of the Physical Therapist Assistant. Retrieved from http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/DirectionSupervisionPTA.pdf
Connecticut General Statutes. (2014). Chapter 376: Physical Therapists. The Commissioner of Public Health.
Federation of State Boards of Physical Therapy. (2014). Scope of Practice. Retrieved from https://www.fsbpt.org/FreeResources/RegulatoryResources/ScopeofPractice.aspx
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