Supervision and assigning care to support personnel (PTAs, Rehabilitation Assistants) Flashcards
Assigning US to PTA
- Determine if the Pt is appropriate for this care (CI & precaution cleared?)
- Educate the Pt about the use of US & gain informed consent for the use of this modaility
- Teach the assigned task
- Why the modality was chosen
helps encourage tissue repair and healing
- MOI, benefits, risks of the modality
*sound wave pass through the skin & cause a vibration of local tissues–>inc. local blood flow & scar tissue breakdwon
Risk: skin irritation from the gel, bone burn
Neuro ward: Slide board transfer for experienced PTA
- I would assign only activities that I have the knowledge, skill and judgement to perform
- I would learn about the PTA who is involved in the care.
- What is their knowledge and skill level
- What experience do they have?
*What patient care activities have they done in the past (e.g. slide board transfers, working with deconditioned Pts) - Teach the assigned task/review the assigned task
- Since this is the first time I work with the PTA, I would prefer to assess their competency. - I would supervise the PTA program appropriately
- If required, I would ensure I was available to intervene promptly
- I would adjust the level of supervision in accordance with the Pt’s needs - I would discontinue the PTA’s involvement in a Pt’s care if their actions place the Pt at risk or if the Pt withdraws their consent to Rx by the PTA
What should be discussed with the Pt before introducing a PTA
- Understand what is a PTA and difference between PT & PTA
- PTA carried out program as directed by the PT
- PTA cannot change the program in any way and must report to PT if any Pt questions, concerns or issues arise - I would explain why I feel it would be beneficial to the Pt to have the PTA help them perform their exercise program
E.g.
- More weekly PT sessions by introducing a PTA into the care plan
- More feedback & motivation which will help you adhere to your exercise program and aid in your recovery - I would gain consent from the Pt to work with the PTA
- can revoke at any time.
How would you supervise the PTA?
I would supervise the PTA program appropriately
- If required, I would ensure I was available to intervene promptly
- I would reassess the Pt and the assigned tasks at timely intervals
- I would adjust the level of supervision in accordance with the Pt’s needs
More supervision for higher risk Pt
When would you discontinue services with the PTA?
- If PTA’s actions place the Pt at risk
- If the Pt withdraws their consent to Rx by the PTA
How can a PT supervise a PTA
Direct observation
- Watch the PTA perform a task on the Pt
Periodic chart reviews
- Review the PTA’s chart records
Discussion about Pt
- Discuss Pt’s care in the morning before shift starts
Email/other means of communication
- Reply an email from PTA regard Pt care
When should a PTA contact their supervising PT?
- Pt become medically unstable
- A change in the Pt’s condition (adverse reaction from the Rx)
- A Pt/PTA have questions about the Rx
- If the Pt appears to have plateued and requires a re-assessment by the PT
PTA demonstrate an exercise wrongly to Pt
I would work with them to help them gain the knowledge, skills, and confidence to perform the task
- Review the Ex again (I demonstrate)
- Let the PTA practice demonstrating the Ex
- Watch the PTA demonstrating the Ex to the Pt
- Provide education and training to fill any gaps identified
Once I deemed them ready, I would re-assign the task and follow-up in a timely manner
Monitor chart notes by PTA
Reveiw the PTA chart recrods
- an accurate reflection of care provided
- chart notes meet the College standards
How often I review the PTAs chart notes is up to me
Factors that will influence how often I review the PTAs chart records can include:
- My personal experience working with the PTA
- The PTAs knowledge/skill level
- The Pt’s status and program
- I am not required to co-sign chart notes made by PTA
Tasks that should not be assigned to a PTA
Require PT clinical judgement
- Interpretation of referrals, Dx/prognosis
- Ax/evaluation procedures
- Interpretation of Ax findings
- Discussion of PT Dx/Rx rationale with Pt
- Plan/initiate PT Rx goals/programs
- Modificaiton of Rx beyond established limits
PT responsibility
- Completion of documentation
- Teaching of the assigned task to another person
- DC planning
- Controlled act: acupunture, spinal manipulations, treating wound below dermis, pelvic internal exams
Pt dun want to work with a new PTA due to inexperience and causing pain
- I would ask the Pt if they would feel comfortable if PROM is reviewed again with the current PTA to ensure correct technique and pain free moving forwards
- Acknowledges the Pt’s concerns and offers me a chance to correct any technique issue with the PTA
–>new PTA need more supervision with hands on practice/mentorship to improve handling skills
my responsibility to ensure the PTA is performing their tasks safely and appropriately - If the Pt still wanted to discontinue services with that PTA, I would provide them with other options for Rx (working with a new PTA)
Document the interaction and the plan of action
Pt said the PTA is rude and make them feel uncomfortable (PT does not witness the situation)
Adress Pt concerns and act
Therapeutic alliance has been broken–>best to provide the Pt with an alternative PTA to work with
- Talk to management(ppl incharge of the PTA) and come together for a team meeting to address the concerns stated by the Pt.
Only use Pt’s name if consented when discussing - I am responsible for the activities the PTA performs with the Pt, I am not PTAs employer. Any concerns regarding the PTA’s behaviour need to be brought up with management
Document the incident and the action taken
Vaction for 2 weeks and not reachable by phone, steps to take with the PTA.
Pt consent
- Inform the Pt of my leave and gain consent for temporary transfer in care
Designate another PT with whom the PTA can contact
Speak to a PT colleague and ask if they can supervise the caseload while I am away
- Choose someone with knowledge, skill, and judgement to perform the assigned care
- Ensure the alternate supervision PT agrees the assume the responsibility for all Pt decisions and care that the PTA deliver
intervene if needed
- Ensure alternate supervising PT establishes a communication plan with the PTA
Debrief my colleague on any pressing matter about the caseload
E.g. upcoming DC but delayed by medical needs
Inform the PTA about my leave
- transfer of care will take place, alternative supervisor will assume responsibility for decisions about the Pt’s care and the care PTA delivers
- the communication plan discussed with the alternate supervisor
- the alternate supervising PT’s contact information (phone, email, place of work etc.)
PTA increased reps of wall squat without consulting you
- Changning the FITT parameters beyond what was established is not within the scope of PTA and is not allowed
- I would pull the PTA aside and discuss the issue at hand
- Let the PTA know that I noticed that they increased the no. of repetitions without first consulting me
- Take the time to educate the PTA about the importance of sticking to the prescribed no. of reps for Pt safety
- Encourage the PTA to contact me if the exercise becomes too easy so I can reassess the Pt and adjust the program as necessary to ensure Pt safety
Stroke Pt who need 4 session a week but have 2 PT sessions+2 PTA session:
Pt’s family ask whether can bill PTA session as PT sessions
I understand that they have the best interest of their loved one in mind
- Billing sessions wtih a PTA as direct PT sessions is fraudulent
If they chose to stop working with PTA/I am not available for more PT session
Provide other options
- HEP to maintina a high intensity of daily exercise
- PT session with a colleague/other local PT clinic that can offer 4 days/week so the Pt has a choice in their rehabilitation.
