A Practical Guide to Working with PTAs PDF

Leading the Team: A Practical Guide to Working with PTAs The course presentation does not include narration PT/PTA Team in Practice Welcome! Review the Course Navigation and Features If this is your first time completing an APTA online course: Review a brief overv...

Leading the Team: A Practical Guide to Working with PTAs The course presentation does not include narration PT/PTA Team in Practice Welcome! Review the Course Navigation and Features If this is your first time completing an APTA online course: Review a brief overview of the interface controls and features. If you are familiar with the interface and controls, continue to the next screen. Otherwise, review the overview. The overview will appear in a pop-up window. When finished, click the Close button to return to this screen. To begin the overview now, click here. Acknowledgements This course was made possible by the efforts of: Janet Moffitt Crosier, PT, DPT, MEd - Director, Physical Therapist Assistant Services Members of the APTA PTA Caucus. PTA Services Department Staff. Course Overview Introduction - Who are PTAs? PTA education - What do PTAs know about physical therapy? PTA role in patient/client care - What are PTAs allowed to do for patients? Legal and ethical guidelines for direction and supervision of PTAs - How do you supervise a PTA? PT role in facilitating PTA career development - How do you help PTAs develop new knowledge and skills? Course Goals After completing this course, you will be able to: Describe the clinical relationship between the PT and the PTA. Recall educational requirements and minimum skill sets of the PTA. Recall patient/client management activities PTAs may and may not perform. Discuss supervisory requirements of the PT for PTAs. Understand the physical therapist’s role in mentoring and career planning for PTAs. Who is the PTA? The first PTAs graduated in 1969: The profession has struggled to agree on the role of the PTA. That role has evolved. Available documents clarify the education and role of the PTA. Physical therapists/employers often: Utilize PTAs in as care extenders. Employ a PTA to further their ability to provide access for patients. [??] Utilize PTAs for increased access to physical therapy [??] and/or cost containment. Your goal is to maximize patient/client outcomes utilizing the assistance of a PTA. To view the APTA policy, Direction and Supervision of the PTA (HOD P06-05-18-26), click here. PTAs and the Patient/Client Management Model The role of the PT and PTA: Physical therapists provide all of the services Examination/Evaluation identified. PTAs assist the PT as directed only in the area of interventions. The PT has sole responsibility for the other components. Diagnosis Further, according to a 2000 HOD position statement, PTAs: “Are the only individuals who provide selected physical therapy interventions under the direction Prognosis and supervision of the physical therapist.” (HOD 06- 00-17-28) This position specifically: - Identifies the PT as responsible for directing and supervising the PTA. Intervention - Identifies the PTA as the only other provider of specifically selected PT interventions. - Prohibits physical therapy aides or technicians, athletic trainers, exercise physiologists, massage therapists, personal trainers, etc from Outcomes providing PT services. Overview of PTA Roles in Patient/Client Care According to A Normative Model of Physical Therapist Assistant Education: Version 2007, the PTA: Provides care. Assures safety. Educates others. Handles emergencies. Click the Resources button in the toolbar above to view a link to the Normative Model. Activity: Check Your Understanding Answer the following questions (True/False): 1. PTAs must complete an associate degree to be eligible to work in the clinic. (True) Remediation: PTAs must complete an associate degree from a CAPTE-accredited PTA program to be eligible for the national licensing examination (where available) and to work in the clinical environment. Additionally, Medicare now requires that PTAs complete a CAPTE-accredited PTA program or its equivalent to be eligible to treat Medicare beneficiaries. 2. PTs and PTAs are the only providers of physical therapy. (True) Remediation: PTs and PTAs are the only providers of physical therapy. According to APTA position statements, aides shall not provide physical therapy interventions (billable services), as these require the knowledge and skill of the PT or PTA. This position is consistent with Medicare regulations and most state practice acts. Although some practice acts do not prohibit the PT from delegating certain patient care responsibilities to the aide, APTA does not support the use of aides in the provision of direct patient care as best practice. Likewise, APTA’s position states that PTs shall not delegate interventions to be billed as physical therapy to other individuals, including athletic trainers, massage therapists, personal trainers, exercise physiologists, and so on. To do so may be a legal, regulatory, ethical, and/or contractual violation. 3. PTAs may make modifications to the PT’s plan of care for the patient. (False) Remediation: PTAs may not make modifications to the PT’s plan of care for the patient. PTAs may modify the intervention that is being provided to ensure safety and effectiveness and all modifications must be in compliance with the plan of care. If the plan of care requires modification because the patient’s medical condition or situation has changed since the plan of care was developed, the PTA will request assistance from the PT, who will determine if the plan of care requires modification. 4. PTAs collect data to measure the patient’s progress. (True) Remediation: PTAs can and should collect data relative to the interventions being provided that will measure the patient’s performance and outcomes of the interventions. For example, when a patient is working on passive range of motion of a shoulder, a PTA could and should take goniometric measurements to objectively document the patient’s response to the intervention. Overview of Physical Therapist Assistant Education Estimated Time: 15 minutes Objectives After completing this section, you will be able to: Recall required curricular content of a CAPTE- accredited PTA program. Identify performance expectations of entry-level PTAs. Differentiate between the education and duties of the PTA and aide/technician. Case Study The patient is a 28-year- old male who sustained a femur fracture in a motorcycle accident. He is day one post ORIF of the femur and is allowed touch down weight bearing. The physical therapist has completed the evaluation and determined that the patient is safe and ready to begin gait training and active-assisted range of motion of the involved lower extremity. The patient has numerous contusions and lacerations from sliding on the pavement, but there is no evidence of head trauma. Given the following scenario, should you expect a PTA to have the knowledge to care for this patient? To answer this question, let’s look at the educational content of accredited PTA programs. PTA Educational Areas Core content essential to understand the sciences that support physical therapy includes: Foundational Behavioral Sciences Sciences Foundational Sciences, such as anatomy and physiology. Anatomy and Communication Behavioral Sciences, such as communication. Physiology Information Courses required by the college/university (if any). Biology Technology Core content may be: Exercise Ethics and Values Embedded in the associated physical therapy Physiology Life Span Growth content. Kinesiology & and Development Provided through dedicated courses. Biomechanics Management Physical therapy coursework required to provide physical Math Sciences therapy services in the clinical setting includes: Neuroscience Political Performance expectations (knowledge and skills). Pathology Science/Law Behavioral expectations (behaviors). Physics Problem Solving Clinical education (clinical experience). Social & Psychological Factors Sociology Teaching & Learning PTA Curriculum and Clinical Education Overview A PTA curriculum typically: Offered by two-year institutions. Culminates in an Associate Degree. Consists of five semesters. Average credits in program = 76. Entitles eligibility to sit for the licensure exam upon graduation. PTA Clinical Education: At least one integrated experience. [Janet: What does this mean in relation to the narration, which reads “all practice settings”?] Average weeks in full-time clinical education = 16. Average hours in clinical education = 664. According to HOD P06-00-19-31, the PT must: - Provide direct supervision. - Have direct contact with the patient/client during each visit when a student PTA is involved in the patient’s care. Curricular requirements are determined by CAPTE. Click the Resources button in the toolbar above to view a link to CAPTE’s evaluative criteria. PTA Entry-Level Performance Expectations Four areas for entry-level performance expectations include: Interventions. Communication. Education. Resource management. Career development. A Normative Model of Physical Therapist Assistant Education: Version 2007 lists entry-level performance and behavioral expectations. Minimum Required Skills of the PTA Graduate at Entry-level The Minimum Required Skills document: Describes what every PTA graduate should be competent to do at time of graduation. Does not describe the experienced PTA, who may have additional depth of knowledge and skills in interventions. It may be difficult to discern if additional knowledge and skill is within PTA scope of work: Most state practice acts are vague. It is the responsibility of the supervising physical therapist to ensure the PTA has the required skills for any delegated intervention. To review this document, click here. What’s Not Included in the Minimum Required Skills? Procedural Interventions not covered in the entry-level PTA curriculum (HOD P06-00-30-36) include: Joint mobilization/manipulation. Selective sharp debridement. Airway clearance techniques: - Assistive devices, chest wall manipulation, suctioning, ventilatory aids Functional training in work: - IADL training, use of tools, instruments, and accommodations specific to a task.  Common PTA‐Performed Procedural Interventions Interventions The PTA can perform all aspects of interventions, These interventions are described in detail including: Reviewing the physical therapist’s plan of care and in A Normative Model of Physical Therapist asking questions as needed. Assistant Education: Version 2007. Assessing the patient’s readiness to participate in Therapeutic Exercise: physical therapy. Aerobic capacity and conditioning Providing selected procedural interventions. Balance, coordination, and agility training Body mechanics and postural stabilization Providing patient/client instruction. Flexibility Documenting services provided and patient Gait and locomotion responses. Neuromotor development training Progress patient/client through plan of care. Relaxation Strength, power, and endurance Collecting data to document the patient’s Functional Training progression. Manual Therapy Techniques: Responding to emergency situations Massage ROM Application of devices and equipment To view a list of the most common specific procedural Airway clearance techniques [Janet: this interventions performed by PTAs, click here. appears to conflict with previous slide] Integumentary repair and protection techniques Electrotherapeutic modalities Physical Agents JG4 Activity: Check Your Understanding Drag the job function on the left to the intervention on the right. Job role Intervention PT only Joint manipulation PT or PTA Range of Motion PT only Sharp Debridement PT or PTA Electrotherapy PT or PTA Patient Education Slide 20 JG4 Janet: this is a new activity that ties in with the objectives and helps keep learners engaged. Seem OK or would you like to see something else here? Jeff Gregory, 3/28/2011 PTA Behavioral Expectations Compared to Professionalism: Core Values Beyond A Normative Model: The Advisory Panel of PTAs developed “Value-based Behaviors of the PTA” Added PT/PTA Collaboration. Compare to the Professionalism in Physical Therapy: Core Values Click each of the value-based behaviors shown to learn more. PTA Value‐based Behaviors PT Professionalism: Core Values Altruism Accountability Compassion and caring Altruism Compassion/Caring Continuing competence Excellence Duty Integrity Integrity Professional Duty Social Responsibility PT/PTA collaboration Responsibility Social responsibility Definition: Activity: Case Study Debrief Our 28-year- old male sustained a femur fracture in a motorcycle accident. He is day 1 post ORIF of the femur and is allowed touch down weight bearing. The physical therapist has completed the evaluation and determined that the patient is safe and ready to begin gait training and active-assisted range of motion of the involved lower extremity. The patient has numerous contusions and lacerations from sliding on the pavement, but there is no evidence of head trauma. Can the PTA be directed to provide gait training and ROM activities for the patient? Possible Answer: Yes, gait training, locomotion, and therapeutic exercise are included in the PTA curriculum. One more question… Possible Answer: PTAs vs. Physical Therapy Aides and Technicians PTAs: Must complete a CAPTE accredited 2-year PTA Program culminating in an associate degree. Must pass national licensure exam and obtain licensure or certification in 48 states and DC. Provide selected interventions under direction and supervision of the PT that are billable. Measure patient outcomes and provides legal documentation. Physical therapy aides/technicians: Consist of primarily on-the-job trained support personnel who perform designated tasks related to the operation of the physical therapy service. Perform tasks that do not require the clinical decision making of the PT or clinical problem solving of the PTA: - Provide supportive, non-billable aspects of patient care, such as transport, set up, and clean up. Activity: Check Your Understanding 1. Determine if the examples shown fall into the intervention categories discussed earlier and are part of the PTA curriculum. When you’re ready, click Check Answers. - Gait training patient after CVA* - Passive ROM of the shoulder* - Joint mobilization of the wrist - Bedside suctioning after postural drainage - Therapeutic exercise to improve balance reactions* - Application of NMES to atrophied anterior tibialis* - Transfer training with a sliding board* - Application of lower extremity prosthesis in preparation for gait* 2. Any of the interventions listed above appropriate for PTA could also be directed to an aide. - True - False - Remediation: False. All interventions require the knowledge and skill of the PT or PTA. Working with PTAs for Total Patient/Client Management Estimated time: 15 minutes Topic Objectives After completing this topic, you should be able to: Identify components of patient/client management provided solely by the PT. Given a case study, apply the controlling assumptions and problem-solving algorithms used by PTAs. Recall the role of PTAs in the provisioning of physical therapy services. Identify tasks that may be delegated to the PTA. Identify specific PTA skill areas. Reviewing Your State Practice Act The laws regulating physical therapy practice, and the utilization and supervision of PTAs are determined by each state. Regulations vary from state-to-state. To ensure that PTs and PTAs are practicing in a legal manner: Read and apply the laws, rules, and regulations for your state. Review your state practice act on the FSBPT Web site. Peruse information about PTA supervision and licensure on the FSBPT Web site. Click the Resources button in the toolbar above for instructions on how to access the FSBPT Web site. Activity: Stop and Think Which of the following tasks are appropriate for a PT to delegate to a PTA? Screening Neuromuscular electrical stimulation (NMES) Simple peripheral joint mobilization Pilates routine Sharp debridement of small wounds Manual muscle testing EMG Daily progress note Medicare progress note (701) Discharge summary After completing this topic, you should be able to identify tasks that should always be performed by the PT. Responsibilities of the Physical Therapist According to HOD P06-05-18-26, physical therapists have the responsibility to perform each component of Examination/Evaluation the patient/client management model. PTs may direct PTAs to assist with: Select interventions. Some data collection and communication. Diagnosis The following tasks must always be completed by the PT: Performing the examination and evaluation. Providing diagnosis and prognosis. Interpreting referrals. Prognosis Developing a plan of care. Determining who will provide an intervention. Conducting re-examinations or re-evaluations. Overseeing care and documentation. Intervention Performing discharges and completing documentation. Outcomes Interventions Performed Exclusively by the PT As stated in HOD P06-00-30-36, any intervention requiring immediate and continuous examination and evaluation must be performed by the PT. Interventions that only the PT can perform include, but are not limited to: Joint mobilization and manipulation. Sharp selective debridement. The PT must determine if an intervention meets the requirement. If so, the intervention must be performed by the PT. Common Questions about PTA Roles Two common questions about the role of the PTA in the clinic: Can PTAs perform screening examinations? Can PTAs complete a discharge summary or note? Screening examinations: Are a component of the examination. Must be completed by the PT. Completing discharge summaries or notes: PTAs can contribute measurements and observations. PTs must determine the extent to which goals of treatment were achieved. PTs must complete discharge summaries because they are evaluative. Click the Resources button in the toolbar above to access the document, “Direction and Supervision of the Physical Therapist Assistant.” Appropriate Use of Documentation According to HOD 06-00-20-05, PTAs should document any components of the intervention provided. Most payers do not require a PT’s co-signature on notes written by a licensed PTA. There are exceptions; confirm the rules and regulations for your state and facility. Supervising PT or PTA usually must co-sign student notes. Signature demonstrates that a licensed provider was present and supervising the student’s intervention. Delegating Responsibilities to the PTA When implementing the PT’s plan of care (POC), newer PTAs may lack a depth of decision making abilities. The PT should be aware of the knowledge and skills of the PTAs she or he directs. An experienced PTA will likely: Provide safer and more effective interventions. Implement the PT’s POC more reliably. Provide the PT with more comprehensive feedback. When delegating to PTAs, keep in mind the: Education, training, experience, and skill level of the PTA. Criticality, acuity, and stability of the patient/client. Complexity of the patient/client’s case. Predictability of the treatment consequences. Setting in which care is being delivered. Federal and state statutes. Liability and risk management concerns. Mission of physical therapy services for the setting. Required frequency of re-examination. Click the Resources button in the toolbar above to access the “PTA Direction Algorithm.” Assessing the PTA’s Skills and Knowledge A newly formed PT/PTA team may benefit from treating patients/clients together: Enables the PT to assess the PTA’s skills and knowledge. Allows the PT to assign tasks to the PTA that leverage clinical strengths. Creates mentoring opportunities. Helps manage awkward or distracting team dynamics. Improves teamwork. Helps identify and address gaps in skills and knowledge. Activity: Stop and Think What can you expect from the PTA relative to decision making? Will the PTA know if the patient is stable for treatment tomorrow? Will the PTA know when the patient is ready to progress? What if something unexpected happens? Possible Answer: Yes. PTAs have knowledge and skill in clinical observations and problem solving. We’ll discuss this in more detail next. Case Study The patient is a 28 year old male who sustained a femur fracture in a motorcycle accident. He is day 1 post ORIF of the femur and is allowed touch down weight bearing. The physical therapist has completed the evaluation and determined that the patient is safe and ready to begin gait training and AROM of the involved lower extremity. The patient has numerous contusions and lacerations from sliding on the pavement, and there is no evidence of head trauma. Introducing the PTA Clinical Problem Solving Algorithm The PTA Problem Solving Algorithm represents the decision-making process used by PTAs within the intervention element of the patient/client management. Controlling Assumptions: PT determines when the PTA should be directed to assist with selected interventions. PT will direct and supervise PTA consistent with APTA positions and core documents, federal and state practice standards, and institution regulations. PT maintains responsibility for the patient throughout the episode of care. The PT is responsible to direct and supervise [Janet: Can we delete “direct and” or is this legally required language?] the PTA throughout the episode of care. Selected interventions include the procedural intervention, associated data collection, and communication. Communication between the PT and PTA is ongoing and not limited by the algorithm. Algorithm Conventions The Algorithm: Entry point depends on the delegated intervention. Should be reviewed from top to bottom. Uses standard flowchart conventions: - Hexagon image: Preparation or starting point. - Rectangle image: Action item. - Diamond image: Decision point. - Oval image: Terminator or end point. May seem complex at first but provides PTs with a better understanding of PTA skills. Using the Clinical Problem Solving Algorithm for the PTA Entry level PTAs may have more questions and require frequent communication than experienced PTAs. The algorithm describes the level of PTA skills and knowledge required at each step. In the first step, the PTA will: Read the physical therapy examination and POC. Review the POC with the PT. Determine if there are any questions about the selected interventions. PTAs should understand all of the precautions related to the patient/client condition. A well-written POC is a must to ensure the patient/client is provided with the appropriate and intended care. When working with new PTAs, the PT should include more specifics in the POC than usual. Click anywhere on the image to open the full algorithm in a new window. Collecting Data on Patient/Client’s Condition Next, the PTA: Collects data on the patient/client’s current condition. Verifies the patient/client is stable prior to initiating the intervention. - PT should note any conditions that would exclude a patient from treatment. Verifying Patient/Client Safety Prior to Treatment The PTA: Compares new and previously collected data and safety parameters established by the PT. Determines if there are any conditions that may exclude the patient/client from treatment. If the safety parameters are: Not met—the PTA must consult with the PT prior to beginning any interventions. Met—the PTA may initiate the intervention. Ensuring Patient/Client Comfort During Interventions PTAs are instructed to: Place the patient/client’s safety first. Ensure that the patient/client is comfortable during treatment. If the patient is not comfortable, the PTA should: Stop treatment. Establish if he or she can modify treatment to ensure safety and comfort. Modifying an Intervention PTA may make modifications to interventions depending on: Contents of the POC. Knowledge and skill level related to the prescribed intervention. PT’s comfort level with allowing the PTA to modify interventions for a particular patient. PTs should communicate clearly with PTAs regarding permissible modifications based on: Medical condition. Preferences. Insurance coverage. Other factors. If the necessary modifications: Fall outside the POC, the PTA should always confer with the PT before continuing. Are within the POC, the PTA may make permissible adjustments to the intervention. Collecting Data PTAs receive instruction in data collection skills. PTs should review the PTA’s work to ensure the data collected is relevant to an intervention. PTAs should not collect data during an initial examination. Data collected after initiating an intervention may be: - Used to document patient progress. - Included in the PT’s re-evaluation. Collecting Data, continued After comparing data and PT expectations, the PTA will determine if expected outcomes have been achieved. If treatment expectations are: Not met, but patient is making progress, PTA should continue intervention. Not met and patient is not making progress, PTA should modify intervention, if appropriate and able. - If PTA cannot modify intervention, he or she should confer with the PT for further instructions. Met, PTA should communicate the findings to the PT and discuss next steps. Activity: Applying the Algorithm Consider the following questions: Can the PTA be expected to make sure that the patient maintains the prescribed weight bearing status? Will the PTA know when the initial goals of treatment have been met? Using the algorithm provided, locate the component of the algorithm that addresses the questions above for this example. To view an interactive online version of the algorithm, click here. Possible Answer The component of the algorithm that addresses patient safety in the delivery of the intervention is on the far left, bottom two-thirds of the algorithm. A PT should expect that the PTA will be able to make sure that the weight bearing status is maintained and should be able to collect the required data as determined in the physical therapist's plan of care. Remember, the experienced PTA may demonstrate more skill and speed in clinical decision making. As always, it is important that the PT assess the PTAs skill in this area prior to directing interventions to the PTA. Case Study The patient is a 28 year old male who sustained a femur fracture in a motorcycle accident. He is day 1 post ORIF of the femur and is allowed touch down weight bearing. The physical therapist has completed the evaluation and determined that the patient is safe and ready to begin gait training and AROM of the involved lower extremity. The patient has numerous contusions and lacerations from sliding on the pavement, and there is no evidence of head trauma. Activity: What Else can the PTA Do? Select each activity that, based on the algorithm, the PTA can be expected to do. When you’re ready, click Check Answers. Know when to provide care or hold care (y) Ensure that the patient is safe and comfortable throughout the intervention (y) Decide if the intervention is producing the desired results (y) Modify the intervention within the plan of care to improve patient outcomes (y) Select data collection techniques to measure the patient’s progress (y) Determine when the patient is ready to be progressed within the plan of care (y) Determine when it is necessary to communicate with the physical therapist (y) PTA Skills PTAs receive instruction related to the following skills: Therapeutic exercise. Functional training in self-care and home management. Manual therapy. Application and adjustment of devices and equipment. Airway clearance. Integumentary repair and protection techniques. Electrotherapeutic modalities. Physical agents. Mechanical modalities. Data collection skills. To download and review a detailed set of descriptions related to the PTA’s entry level skills, click here. Activity: Check Your Understanding Click and drag the tasks and interventions that a newly graduated PTA should be able to perform in most circumstances. Task or Intervention Screening (PT Skill) Neuromuscular electrical stimulation (NMES) (PT or PTA Skill) Simple peripheral joint mobilization (PT Skill) Pilates routine (PT or PTA Skill) Sharp debridement of small wounds (PT Skill) Manual muscle testing (PT or PTA Skill) EMG (PT Skill) Daily progress note (PT or PTA Skill) Medicare discharge note (701) (PT Skill) Discharge summary (PT Skill) Supervising the PTA Estimated time: 15 minutes Topic Objectives After completing this topic, you should be able to: Recall the different levels of PTA supervision. Given a case study, apply the supervision algorithms to delegate tasks to PTAs. Entities Influencing PTA Direction and Supervision This concept map reviews entities that: Direct or influence if and how the PT may utilize the PTA in practice. Have direct and indirect influence on the level of supervision provided by the PT. Click on each entity to learn more. Levels of PTA Supervision As stated in HOD P06-05-18-26, PTAs must always work under the direction and supervision of the PT. When considering the appropriate level of supervision, PTs and PTAs must know and apply: State laws, rules, and regulations Payer requirements. Facility policies. Click on each of the three levels of supervision, as articulated in HOD P06-00-15-26, to learn more: [Begin Flash] The PTA Supervision Algorithm To determine the appropriate level of supervision, based on the patient/client’s situation, consult the PTA Supervision Algorithm. Some payers impose additional requirements that are more restrictive than the law. For example, Medicare has rules for PTA supervision that vary based on practice setting. To review a summary of the Medicare rules from APTA’s Web site, click here. Click the Resources button in the toolbar above to access the PTA Supervision Algorithm. Activity: Stop and Think You are supervising Ethan, a new PTA graduate in an outpatient setting. The patient has a history of unstable blood pressure and new total hip replacement secondary to a fall-related fracture. The nurses’ notes indicate that the patient’s blood pressure continues to vary. The patient is being seen today for gait training using the parallel bars. The goal is to advance the patient to a walker. Ethan indicates to you that he has not worked with a patient with unstable blood pressure in his previous clinical education experiences but notes that he is sure he can manage the patient in the parallel bars. Is it acceptable to direct the PTA to work with this patient? What level of supervision would be appropriate? Possible Answer: In the scenario provided, it would be appropriate to direct the PTA to conduct gait training with an individual who has multiple co-morbidities. But, because the PTA is inexperienced and the patient’s response to treatment is not entirely predictable, it would be appropriate to provide direct supervision or direct personal supervision until you are sure that the patient is safe in the PTA’s care. It is perfectly acceptable if your answers varied from those provided above. Assumptions about the patient’s medical condition and the PT’s and PTA’s knowledge and skills may have led you to a different conclusion. Every situation requires a thorough understanding of the abilities of the PTA and the clinical judgment of the PT. Additional Examples The document, PT/PTA Teamwork: Models in Delivering Patient Care: Provides scenarios and examples of how PT/PTA teams can deliver physical therapy services. Includes guidance on the direction and supervision of PTAs consistent with most state laws, Medicare requirements, and APTA policies. Click the Resources button in the toolbar above to access the PT/PTA Teamwork document and other related examples. Legal and Ethical Guidelines Estimated time: 10 minutes Topic Objectives After completing this topic, you should be able to: Recall legal and ethical issues related to utilization of PTAs in the provision of physical therapy services. Identify documents, laws, and APTA positions that regulate the utilization of PTAs. PTA Licensure HOD 06-00-21-33 states that: Physical therapists should be licensed. PTAs should be licensed or regulated. Individual states choose whether to regulate particular professions. All 50 states regulate physical therapists through licensure. 48 states regulate PTAs by licensure or certification. Review the map for a summary of PTA licensure and certification requirements in the US. Legal Regulation State legislatures make decisions related to licensure. Laws, rules, and regulations are enacted by elected officials to protect the public from harm. - Frequently take the form of state practice acts. State legislatures define who may provide a professional service. State regulations typically describe minimum educational and licensure requirements. Regulations may be used to: - Reserve certain titles, such as PT or PTA. - Define re-licensure or supervision requirements. APTA provides guidance to members using positions, policies, and guidelines. Legal and ethical rules are enforced by various regulatory bodies. Legal matters are managed by state boards of examiners or state regulatory boards. Click the Resources button in the toolbar above to access the FSBPT Web site. Ethical Obligations of the PT and PTA Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapist Assistant: Define our ethical obligations towards individuals, organizations, and society. Ethical matters are adjudicated by state physical therapy associations. State regulatory agencies may include ethics-related rules in state regulations. Thus some ethical violations are illegal. PTAs and supervising PTs are held accountable for violations of state law and ethical principles of the Code and Standards. To access these documents, click here. Standards of Ethical Conduct for the PTA Take a moment to review the eight Standards: Standards of Ethical Conduct for the Physical Therapist Assistant. (Revised 2010) 1. PTAs shall respect the inherent dignity, and rights, of all individuals. 2. PTAs shall be trustworthy and compassionate in addressing the rights and needs of patients/clients. 3. PTAs shall make sound decisions in collaboration with the PT and within the boundaries established by laws and regulations. 4. PTAs shall demonstrate integrity in their relationships with patients/clients, families, colleagues, students, other health care providers, employers, payers, and the public. 5. PTAs shall fulfill their legal and ethical obligations. 6. PTAs shall enhance their competence through the lifelong acquisition and refinement of knowledge, skills, and abilities. 7. PTAs shall support organizational behaviors and business practices that benefit patients/clients and society. 8. PTAs shall participate in efforts to meet the health needs of people locally, nationally, or globally. Standards Directly Related to the PT/PTA Team The following Standards address ethical behaviors related to the PT/PTA team: 3E. Physical therapist assistants shall provide physical therapy services under the direction and supervision of a physical therapist and shall communicate with the physical therapist when patient/client status requires modifications to the established plan of care. 5B. Physical therapist assistants shall support the supervisory role of the physical therapist to ensure quality care and promote patient/client safety. 8C. Physical therapist assistants shall be responsible stewards of health care resources by collaborating with physical therapists in order to avoid overutilization or underutilization of physical therapy services. Principles Directly Related to the PT/PTA Team The following three Principles address ethical behaviors related to the direction and supervision of the PTA: 3E. Physical therapists shall provide appropriate direction of and communication with physical therapist assistants and support personnel. 4B. Physical therapists shall not exploit persons over whom they have supervisory, evaluative or other authority (e.g., patients/clients, students, supervisees, research participants, or employees). 5B. Physical therapists shall have primary responsibility for supervision of physical therapist assistants and support personnel. Summary of Sources to Guide the PT and PTA Team Consider each of these resources to help ensure the ethical and legal practice of physical therapy: Legal: State practice act State statutes related to physical therapy Payers: Agreements with third party payers Employment: Facility policies and procedures Professional: APTA Positions and Policies Ethical: Code of Ethics for the Physical Therapist Standards of Ethical Conduct for the Physical Therapist Assistant Activity: Stop and Think You are a PT at a local clinic. A PTA who you work with has accused you of attempting to supervise too many people at one time. Where can you find information to support or refute this claim? Possible Answer: To determine if there is a limit to the number of individuals that a physical therapist may supervise in a particular practice setting, consider consulting the resources below. Also, when determining the total number of individuals a physical therapist may supervise, verify if you are required to include any students and physical therapy aides/technicians in your count. Legal resources: Practice acts and state regulations. (http://www.fsbpt.org) Ethics resources: Code of Ethics for the PT Standards of Ethical Conduct for the PTA Payer resources: APTA Medicare resources (http://www.apta.org/Payment/Medicare/) Contracts with payers Employer resources: Employer policies and procedures Mentoring PTA Career Development Estimated time: 15 minutes Topic Objectives After completing this topic, you should be able to: Recall the physical therapist’s role in mentoring and career planning for PTAs. Identify potential areas of career development for PTAs. Professional Growth for the PTA PTAs have many opportunities for growth within the profession: Experienced PTAs can improve their skills through clinical experience and continuing education. PTAs can enhance job satisfaction and employability by expanding beyond patient/client care. PTs can assist PTAs in developing additional knowledge and skills that benefit patients/clients. Assisting the PTA with Career Advancement According to a recent survey (source, year): Approximately two-thirds of PTAs have had at least one previous career. PTAs chose to work in the profession due to prior positive experiences with physical therapy or wanted to help others. PTAs tend to be very receptive to career growth. PTs should not place too much focus on the career path from PTA to PT. Emphasize the wide variety of opportunities for PTAs instead. Many PTAs consider pursuing DPT degrees but few are able to do so (year, source). Providing career development opportunities can yield benefits such as: Personal and professional growth for the PTA. Satisfied and stable PTA workforce. Better care for patients. The Physical Therapist’s Role in Clinical Mentoring Clinical mentoring goes beyond supervising PTAs and directing daily tasks. Provides an opportunity to help PTAs expand upon entry-level education. Teaches PTAs to provide evidence–based, effective, safe, and efficient interventions. Assessing the PTA’s knowledge and skills helps the PT to: Make better decisions about direction and supervision. Determine areas in which the PTA could benefit from new or additional instruction. PTs can help PTAs advance professionally by: Identifying PTA’s strengths and weaknesses. Developing plans to address areas of weakness. Assisting the PTA with improving skills related to clinical practice. Developing in-service education programs. Funding the PTA’s continuing education. The Physical Therapist’s Role in Professional Mentoring PTs are typically in the best position to mentor PTAs and help them to achieve their career goals. PTs can provide mentoring to PTAs in areas such as: Determining PTA abilities and areas of interest and developing plans to facilitate growth. Identifying areas of weakness and making plans for change. Identifying career development resources. Attending meeting with the PTA. Encouraging and funding participation with committees and activities. Facilitating the development of the PTA’s leadership abilities. Career Pathways for the PTA For many PTAs, physical therapy is not their first career. These PTAs bring valuable life experiences and skills from previous jobs. Example: a PTA who worked as a grocery store manager may have strong management and administration skills. PTAs have many career pathways from which to choose: Expand skills and knowledge in clinical interventions. Pursue opportunities in education, management, or volunteer service. To review a list of career opportunities for the PTA, click here. Consider ways you could assist the PTA in expanding their role in physical therapy. Activity: Stop and Think Consider the following case study. Click the Possible Answer button when you are ready. Allison, a PTA who had a previous career in the travel industry, joined your staff about a year ago. While she is relatively new to physical therapy, she has been in the work force for 20 years. During a recent performance review, Allison noted an increasing dissatisfaction with her position, referring to it as a “dead end job.” She also reported that the computer and organizational skills that she gained in her previous career are now wasted. Although she mentioned that she really enjoys working with patients and helping them get back to their normal life, she noted increasing frustration with her current work assignment and said she has even considered going back to her previous career. What can the PT do to encourage Allison to remain in the physical therapy profession, leverage her existing talents, and increase her job satisfaction? Course Wrap-Up Clinicians must wear many hats and keep current in variety of areas affecting physical therapy practice: Treatment modalities. Laws and regulations affecting patient care and reimbursement. This course emphasized: The vital role that PTAs fulfill in clinical practice. PTA’s entry-level knowledge and skills. Laws, regulations, rules, and ethical tenets affecting how the PTA may work with patients. It requires a collaborative effort to: Ensure high quality care. Retain highly skilled and satisfied clinicians. Achieve desired, reimbursable treatment outcomes. The PT/PTA team has served as a key example of how a successful partnership can: Increase access to physical therapy services. Contribute positively to the heath outcomes of patients/clients. Congratulations! In this course you learned the: Clinical relationship between the PT and PTA. Educational requirements and minimum skills sets of the PTA. Patient/client management activities that the PTA may and may not perform. Supervisory requirements of the PT for PTAs. PT’s role in mentoring and career planning for PTAs. To receive CEU credits for this course, you must: Take the post-assessment now. Complete the Online Continuing Education Courses Participant Evaluation. Thank you!