Patient Care Management

(1) Responsibilities of Physical Therapists. (a) For each patient on each date of service, a physical therapist shall provide: 1. All of the therapeutic intervention that requires the expertise of a physical therapist and shall determine the appropriate utilization of physical therapist assistants or Physical Therapy Aides that provide for the delivery of care that is safe, effective and efficient. Documentation in the patient record of any considerations, treatment and changes in patient care. 2. Primary responsibility for communication with the patient and sole responsibility for obtaining informed consent prior to initiating intervention. Primary responsibility for physical therapy care rendered by the physical therapist assistant or supportive personnel rests with the Physical Therapist of Record or another physical therapist accessible and willing to assume the responsibility or direction of care for that patient and is documented as such. (b) A Physical Therapist of Record or another physical therapist accessible and willing to assume the responsibility or direction of care for that patient must be on call and readily available when physical therapy services are being provided by a physical therapist assistant. (c) All components of clinical care, and their supporting documentation, are the sole responsibility of the physical therapist. These include: 1. Complete an initial clinical examination. 2. Determine a PT diagnosis and PT prognosis. 3. Develop a Plan of Care which is based on the initial clinical examination. The Plan of Care should include: a. identified precautions, special problems, contraindications to care; b. interventions and anticipated progress; c. goals; d. type, amount, frequency and duration of intervention and care; and e. plan for reevaluations and discharge. 4. Designate modes of written and oral communication regarding course of care. 5. Select, delegate and direct appropriate tasks in the Plan of Care to a physical therapist assistant. Decisions should be based on, but not limited to, the following considerations: a. the physical therapist assistant's education, training, experience and skill level; b. the patient's acuity, stability, and complexity; and c. the setting in which the care is being delivered. 6. Perform reexaminations and document findings when a change in the Plan of Care is needed, prior to any planned discharge, and in response to a change in the patient's medical status. Summarize patient's status and document reason for discharge. Ensure safe and quality care at all times and, in those situations in which a physical therapist assistant provides patient care, serve as the supervising physical therapist. 8. Serve as the only supervisor of physical therapist assistants. 9. Determine the frequency and amount of supervision of the physical therapist assistant by regularly consulting with the physical therapist assistant to discuss the needs of the patient and the needs of the physical therapist assistant and by utilizing the following factors: a. professional judgment; b. the number of physical therapist assistants the physical therapist can safely and effectively supervise. In the absence of evidence to the contrary, the Board will presume that a ratio that exceeds one physical therapist to three physical therapist assistants is not safe and effective; c. the complexity of the patient's status; and d. the competence of the physical therapist assistant. 10. Provide supervision to the physical therapist assistant, including at a minimum: a. on-site reexamination of the Patient; b. on-site review of the Plan of Care with appropriate revision or termination; c. evaluation of need and recommendation for utilization of outside resources; and d. availability via verbal communication to the physical therapist assistant while the physical therapist assistant is treating Patient. Provide direct supervision to the following persons rendering physical therapy services: a. Physical Therapy Students, interns and Physical Therapy Co-op Students; and b. Physical Therapy Assistant Students. Co-sign the documentation of Physical Therapy Students and Co-op Students or Physical Therapy Assistant Students. (2) Responsibilities of Physical Therapist Assistants. (a) Work under the supervision of a licensed physical therapist. (b) Cannot initiate a treatment program without prior evaluation and the development of a Plan of Care by the Physical Therapist of Record. (c) Assume the following duties and documentation responsibilities: Examine and treat the patient based on the patient's current status and the Plan of Care established by the Physical Therapist of Record; 2. Respond to inquiries regarding the patient status within the protocol established by the Physical Therapist of Record; Adjust a specific treatment procedure in accordance with changes in patient status within the Plan of Care designed by the Physical Therapist of Record or another physical therapist accessible and willing to assume the responsibility or direction of care for that patient; 4. Interpret data within the scope of their physical therapist assistant education; 5. Alert the Physical Therapist of Record or another physical therapist accessible and willing to assume the responsibility or direction of care for that patient of a change in patient's status or plateaus in the course of care; Refer inquiries regarding patient prognosis to the Physical Therapist of Record or another physical therapist accessible and willing to assume the responsibility or direction of care for that patient; and Provide direct supervision to the following persons rendering physical therapy services: a. Physical Therapy Assistant Students; and b. Physical Therapy Aides, rehabilitation aides, or other unlicensed personnel. Responsibilities of Physical Therapy Aides and Non-physical Therapy Co-operative Education Students. (a) Work under the direct supervision of a physical therapist or physical therapist assistant (b) Perform only non-skilled activities such as: 1. Ambulation and activity programs for endurance established by the physical therapist and previously completed by the patient requiring the presence of an aide for patient safety. 2. Exercise programs established by the physical therapist and previously completed by the patient. Preparation of the patient environment, equipment, or modality for the physical therapist or physical therapist assistant. a. Non-treatment related activities such as secretarial, housekeeping, patient transport; and b. Application of superficial heat and cold. (4) Responsibilities of Physical Therapy Co-operative Students. (a) Work under the direct supervision of a physical therapist. (b) The PT Co-op Student shall only carry out those duties contained in 259 CMR 5.02(1)(c) and (2)(c) in which the Physical Therapy Co-op Student has been educated and deemed competent by the academic institution and pursuant to the agreement between the academic institution, the work site, and the student, and delegated to them by the physical therapist directly supervising them. (c) PT Co-op Students may also perform those duties listed for a Physical Therapy Aide. (5) Responsibilities of Physical Therapy Students. (a) Work under the direct supervision of their Clinical Instructor (CI) and perform only those duties contained in 259 CMR 5.02(1)(c) as are appropriate. (b) Have all notes co-signed by their CI. (6) Responsibilities of Physical Therapist Assistant Students. (a) Work under the direct supervision of a licensed physical therapist or physical therapist assistant. (b) Have all notes co-signed by the supervising physical therapist or physical therapist assistant.