Countersign First Aid Risk Assessment Made Easy

Countersign first aid risk assessment

Hello this is Dr. Christine Balderas from San Diego Mesa College Physical Therapist Assistant program. Today you will be watching a YouTube video prepared for the DPT students at the University of St. Augustine and the PTA students at San Diego Mesa College regarding the California rules and regulations for the physical therapist and the physical therapist assistant. It also will include a couple sample case scenarios from the APTA Learning Center regarding teamwork for the PT/ PTA in the acute care setting. This slide will give you the contact info if you have any questions regarding any of the video content prior to our meeting. This has my name on here , Amanda Johnson our program director, Professor Fischer who is our neurology professor, and contacts at University of Saint Augustine, Dr. Matthews and Dr. Bellezza. There will be several others from your school from the University of Saint Augustine involved that you can also contact. I believe it's Dr. Rodriguez, Dr. Volland and Dawnwho will be helping us with the debriefing. Here we go! First we're going to talk about the PT Board of California definitions for the physical therapist and the physical therapist assistant. You can look on the PTBC website as well as a resource for yourselves if you want to get a little bit more involved in the rules and regulations. You both will need these prior to your board exams but you'll get these probably in your curriculum as you go further on in your education in your programs. A physical therapist means a person who is licensed pursuant to this chapter to practice physical therapy. PTA means a person who is licensed pursuant to this chapter to assist in the provision of physical therapy under the supervision of a licensed physical therapist . Physical therapy assistant and physical therapist assistant shall be deemed identical and interchangeable terms. Currently we tend to use physical therapist assistant. That seems to be the more accepted term .Also, the physical therapist assistant is the only licensed extender to give care underneath the physical therapist. We have the California business and profession codes and again you can look that up under the PTBC board. Unfortunately here you can see there's a little bit of an error so just get rid of that one dot there. (ptbc.ca.gov) That is our consumer affairs. We are under division 2, the Healing Arts ,Chapter 5.7 Physical Therapy and Title 16 Division 13.2 if you're wanting to look specifically at our laws and regulations. Here we're going to talk about Chapter 5.7 Article 2. The Scope of Regulation and Exemptions -2622 (a)A physical therapist shall be responsible for managing all aspects of the care of each patient as set forth in regulations promulgated by the board. This is important that you as the DPT when you become licensed are responsible for all care for that patient and so that also includes any delegation you give to your physical therapist assistant, to your aides ,anybody else that is helping provide care underneath you. (b) A physical therapist shall not supervise more than two physical therapists assistants at one time to assist the physical therapist in his or her practice of physical therapy. (c) A physical therapist may utilize the services of one aide engaged in patient related tasks to aide the physical therapist in his or her practice of physical therapy. The next chapter 5.7 Article 2 is 2630.3 which is the Scope of Regulation and Exemptions. This one is kind of the crux of what you as a DPT want to be cognizant of when you're delegating to a PT assistant. A licensed physical therapist assistant holding a valid unexpired and unrevoked physical therapist assistant license may assist in the provision of physical therapy services only under the supervision of a physical therapist licensed by the board. A licensed physical therapist shall at all times be responsible for the extent, kind, quality and documentation of all physical therapy services provided by the physical therapists assistant. This is important that you realize when you're writing your plan of care that you have the knowledge of the competency of your PT assistant and that you as the PT assistant also feel comfortable that you're competent to follow the plan of care that your PT has given you and to realize that you cannot be supervised by a licensed applicant like a PT licensed applicant. They have to be licensed before they can start delegating to you. It is unlawful for any person or persons to hold himself or herself out as a PT assistant unless at the time of doing so they hold a valid,unexpired ,unrevoked PT assistant license issued under this chapter as authorized in subdivisions F and G of section 2630.5 . So those personal trainers ,athletic trainers, aides ,kinesiology specialists, regardless of their competency cannot call themselves physical therapist assistants and they are not allowed to bill and treat as the extender underneath the supervision of that PT, licensed PT. We're going to keep going with a scope of regulation so number (c) the physical therapist assistant shall not be independently supervised by a physical therapist licensed applicant which was what I was just talking about or PT student. A physical therapist assistant shall not perform any evaluation of a patient or prepare a discharge summary. The supervising physical therapist shall determine which elements of the treatment plan if any shall be assigned to the physical therapist assistant. Assignment of patient care shall commensurate with the competence of the commensurate with the competence of the physical therapists assistant and we'll get into this a little bit more with some samples and examples for you down the road. Basically this is just saying that it's really important for you to know the years of experience of your physical therapist assistant, their competency ,your communication with them, the acuity of your patient ,the stability of your patient before you delegate interventions for them. Now that being said where it says here they can't perform any evaluation of the patient. prepare discharge summary. This is absolutely true. They can help you with that evaluation but they cannot treat that patient prior to you doing the evaluation, but if you're doing the evaluation together and you're in the hospital and you're working on bed mobility, transfer training, gait training, and you need two people and you're working together and then you're going to pass that patient on to the physical therapist assistant afterward, that works really as a teamwork role-model for you to use when you're in the acute care setting. Here's the Title 16 Division 13 ,some of the different numbers that you can look up in order to be able to have reference for different things depending on what setting you're in will require certain supervision of your physical therapist assistant and your students and your aides, licensed applicants all of the above. These are just letting you know what those different numbers are so that you can look them up. We'll go over the more important ones here. The first one is that 1398.4. Adequate Supervision. Adequate supervision of a physical therapist assistant shall mean supervision that complies with this section. A physical therapist shall at all times be responsible for all physical therapy services provided by the physical therapist assistant and shall ensure that the physical therapist assistant does not function autonomously. The physical therapist has a continuing responsibility to follow the progress of each patient and is responsible for determining which elements of a treatment plan may be assigned to a physical therapist assistant. The PT does not need to co-sign the license PTA's documentation. They repealed this several years ago. The thought being that you are ultimately responsible as a licensed PT. So anything you're delegating you have given that delegation based on what we call adequate supervision defined. We're going to kind of just go over this briefly as you guys are all students right now so it's good for you to know how you should be utilized properly when you go out to your clinical rotations or experiences.You need to be supervised by a PT or PTA under the supervision of a PT if you're a PTA student .Also there needs to be at least a PT, licensed PT on staff, on the floor where you're at in order for there to be a PTA student there. But a PTA, licensed PTA can be your clinical instructor. PT provides on-site supervision of assigned patient care rendered by the student. The PTA student or intern shall document each treatment and patient record along with the signature. Their CI will countersign that with their initial and last name on the same day as those tasks were performed, and the supervising PT shall conduct a weekly case conference and document in the patient record that they have been supervising and have looked over the chart and that the interventions are appropriate. A licensed applicant PTA, I'm not going to read over this right now because this really isn't going to involve anything we're doing at our event .but this is just a reference for all of you guys to have as far as like the amount of supervision you have to. You have to have direct and immediate supervision by a PT until you have that official license as a PTA. So basically all the rules that apply to you as a student still apply to you as a licensed applicant. Here are the definitions for general supervision. direct supervision .and direct personal supervision. We tend to follow general supervision in most settings and direct supervision are those Medicare outpatient Medicare B patients that we have to follow. Here's Medicare supervision definitions for you and there's also a resource to the Medicare benefit policy manual that describes that for you. In most settings under Medicare A, it's general supervision. California state regulation is silent on the level of supervision but emphasizes that if physical therapists should at all times to be responsible for all physical therapy services provided by the physical therapists assistant and shall ensure that the physical therapist system does not function autonomously .So if you're in a skilled nursing facility treating Medicare A patients your physical therapist needs to at least be available by phone, text ,some kind of communication. With the outpatient private practice, which is our Medicare B's and sometimes you'll have Medicare B's in Skilled Nursing Facilities when they run out of their Medicare A. Those require direct supervision, and so there the PT has to actually be in the line of sight, there at the facility. Here is a little cheat sheet that Dr. Kelly Prescher from San Diego State created. The practice setting, the physical therapist student, the physical therapist assistant student and the licensed physical therapist assistant. You can see that as a PT student and a PT assistant student you both require direct supervision regardless of what setting you're in. Once you become licensed, Medicare and we talked about it for the PT assistant its general supervision in the home health skilled nursing facility, outpatient practice where we have Medicare B is direct supervision, and they don't really specify inpatient/ outpatient hospital therapy services , so just based on each facility's own regulations. California regulation is silent on all these as far as supervision but it always seems to fall back on what your insurance is going to reimburse for you. This comes from the APTA Learning Center site on the PT/PTA teamwork Models and Delivering Patient Care. I felt like this was a good synopsis of how to decide as a physical therapist how you want to delegate to your PT assistant, feel comfortable that your patient is going to get the best care that they need and everybody's safe. The PT is solely responsible for completion of the exam, the evaluation, the diagnosis and prognosis as well as the development of the plan of care. The plan of care is where as you become more skilled as a PT, the way you write that plan of care will really delegate how much autonomy you want to give your PT assistant or how narrowed depending on their experience level you want to make that. Once you have established a plan of care, the PT may involve the PT assistant to assist with selected interventions. The things you might consider as the PT to direct those interventions to your PTA are the interventions within the scope of work of the PTA. So thus you know you're not going to delegate an evaluation or a discharge summary to your PTA, because we know that's outside their scope of practice. Is the patient's condition sufficiently stable? Are the intervention outcomes sufficiently predictable ? Is the intervention within the PTA's personal knowledge ,skills and abilities?( so their competency ) Are there risk and liabilities that should be considered prior to directing interventions to the PTA? and that kind of goes back to number four and number three .Number six :When any payer requirements be affected by the involvement of the PTA in providing interventions ? That's where you need to go back to your general supervision verses direct supervision and how you're going to delegate that to them depending on where you're at. When the PT directs the intervention to the PTA, the PT continues to maintain responsibility of patient management. As we know that's part of your rules and regulations as a licensed physical therapist, that ultimately everything as far as the patient care is underneath your responsibility. You provide the direction supervision to your PT assistant in accordance with applicable laws and regulations. Some of you may end up working outside of California so then you will need to know what those laws are for those specific states. You're going to conduct periodic reassessment , reevaluation of the patient as directed by the facility, federal and state regulations, payers and the needs of the patient. This too is also just that constant communication with your PT assistant and as a PT assistant with your PT when there's a status change, whether it's a progression or a regression that you're talking with each other on a daily basis as to how that patient is doing to give them ultimate outcomes. Lastly to provide support to your PTA and when appropriate assist the PTA's development of knowledge and skills necessary to perform selected interventions and related data collection. So be their mentor, help them take continuing education courses ,work with them on skills that you have to share with them so that you become a team and you feel confident that they can also share and do some of those interventions that you've helped mentor them and got them competent in .Things that the physical therapist assistant shall not do: They cannot perform measurement data collection or care prior to the PT eval. They can help the PT during the eval collect these things but they cannot do it prior to. They cannot document the patient eval or the re-evaluation. They cannot write a DC summary .They cannot establish or change a plan of care. They can communicate with the physical therapist if they feel a plan of care needs to be revised. They can not write progress reports to another healthcare professional . They cannot be the sole PT representative in meetings with other healthcare professionals where patients plan of care is assessed or may be modified. This is part of that rehab team. They can be in there with the PT but they cannot be the only one in there, because they cannot make those changes if the rehab team decides those things that need to be done you need that licensed PT to be in there as well. They cannot supervise PT aides in performing a patient related tasks and they cannot provide treatment if the PTA holds a management position. Lastly the PTA's can notify the PT of record and document in the patient record any change in the patient's condition not within plan progress or treatment goals and any other change in patient's general condition. Along with that though they should actually verbally be communicating to the PT as well if they can, ultimately so that they know what's going on and that helps with the outcomes for that patient. I won't read these out loud but these are for the physical therapists students to just kind of know what a PTA basically our CAPTE criteria for them of what we teach them and what they have to be competent in with the CPI once they're done with their clinical rotations ,so that you feel comfortable at that point in time being able to delegate to them. This talks about communication, being able to establish things in the plan of care, carrying out that plan of care. Being able to talk with the PT regarding the plan of care ,Being able to critically think and adjust things based on that patients outcomes. Educating the patient, their family members. Being able to act in an emergency situation. Being able to document appropriately. Being able to give feedback to the supervising physical therapist as far as needs of that patient prior to discharge. Being able to keep up with evidence-based research. Here's the couple sample scenarios for you to read over. These will give you an idea of maybe a patient that you would feel comfortable delegating interventions to and then one may be that you would be holding off delegating until that patient was more stable. So I'll let you guys go back and give you a little bit of time to read this one about the Total knee patient that normally , a lot of times these are just even an outpatient setting but this is a patient that's got some comorbidities. They have a blood disorder and so there's a little bit more care taken and them having to stay in the hospital, and The outcomes are pretty predictable, the patient is stable. The PT and the PTA worked together on the evaluation and so now the PT is going to feel comfortable delegating the interventions to the PTA. This patient's a little bit more complicated. they are pregnant with twins and they have some unpredicatability as far as their pain .There's this here that we can have a discussion if we end up doing some outpatient settings with you. The selected intervention of joint mobilization is not within the scope of work of the physical therapist assistant. In the state of California, our physical therapist assistants if they have been trained appropriately and are competent and showed that skill they are allowed to do joint mobilizations. So it just depends on the state. The APTA has a position paper regarding this. It is kind of important for you to know the difference between APTA position statements and what are actual rules and laws in California. Sometimes that's a confusion and we can have that discussion when we meet in person if you want to go into that a little bit more in-depth. I can help you out with that. Also, this is a high-risk patient so that's probably more the main reason why this patient is probably going to stay on the PT's schedule for now.Thank you again and I'll see you on February 5th.