Scope Of Practice And Supervision

(1) Scope of Practice (a) Physical therapists may provide physical therapy services without a referral in accordance with T.C.A. § 63-13-303. (b) Practice of Physical Therapy 1. Examining, evaluating and testing individuals with mechanical physiological and developmental impairments, functional limitations, and disability or other health and movement-related conditions in order to determine a physical therapy treatment diagnosis, prognosis, a plan of therapeutic intervention, and to assess the ongoing effect of intervention; and 2. Alleviating impairments and functional limitations by designing, implementing, and modifying therapeutic interventions that include, but are not limited to: therapeutic exercise; functional training; manual therapy; therapeutic massage; assistive and adaptive orthotic, prosthetic, protective and supportive equipment; airway clearance techniques; debridement and wound care, physical agents or GENERAL RULES GOVERNING THE PRACTICE OF PHYSICAL THERAPY CHAPTER 1150-01 modalities, dry needling, mechanical and electrotherapeutic modalities including patient-related instruction and electrophysiologic studies (motor and sensory nerve conduction, and somatosensory evoked potentials). (i) Invasive kinesiologic electromyography may be performed only in a university academic setting as part of a research project that has been approved by the educational institution’s Internal Review Board without a referral or; (ii) Notwithstanding the provisions of subpart (i), diagnostic electromyography must be performed by a licensed physical therapist who has complied with the requirements of paragraph 1150-01-.04(5) and; (iii) Notwithstanding the provisions of subpart (i), diagnostic and invasive electromyography may only be performed when there is a referral for such service from: (I) An allopathic physician licensed under T.C.A. §§ 63-6; or (II) An osteopathic physician licensed under T.C.A. §§ 63-9; or (III) A doctor of dentistry licensed under T.C.A. §§ 63-5; or (IV) A doctor of podiatry licensed under T.C.A. §§ 63-3; or (V) A nurse practitioner licensed under T.C.A. §§ 63-7; or (VI) Physician assistant pursuant to Tenn. Code Ann. §§ 63-19; and 3. Reducing the risk of injury, impairments, functional limitation and disability, including the promotion and maintenance of fitness, health and quality of life in all age populations; and 4. Engaging in administration, consultation, education and research; and 5. Manual Therapy Techniques. (c) Substandard Care 1. Overutilization of appropriate physical therapy services or the lack thereof. 2. Providing treatment intervention that is unwarranted by the condition of the patient. 3. Providing treatment that is beyond the point of reasonable benefit. 4. Abandoning the care of a patient without informing the patient of further care options. 5. Failing to practice in accordance with the standards set forth in the “Guide to Physical Therapist Practice,” pursuant to Rule 1150-01-.02(1)(f). (d) “Physical therapy” or “physiotherapy” are identical and interchangeable terms. “Practice of physical therapy” and “physical therapy assistive personnel” are defined in Rule 1150-01-.01. GENERAL RULES GOVERNING THE PRACTICE OF PHYSICAL THERAPY CHAPTER 1150-01 (e) Nothing in this rule shall be construed as authorizing a physical therapist, or physical therapist assistant, or any other person to practice medicine, chiropractic, osteopathy, podiatry, nursing, or practice as a physician assistant. (f) The Board adopts, as if fully set out herein, and as it may from time to time be amended, the current “Guide to Physical Therapist Practice” issued by the APTA. Information to acquire a copy may be obtained by contacting the: American Physical Therapy Association 1111 North Fairfax Street Alexandria, VA 22314-1488 Telephone: (703) 684-2782 Telephone: (800) 999-2782 Fax: (703) 684-7343 T.D.D: (703) 683-6748 Internet: www.apta.org (g) Universal Precautions for the Prevention of Transmission of Human Immunodeficiency Virus (HIV) – The Board adopts, inclusive of any guidelines of the Department of Health, the Guidelines for the Standard Precautions (Guidelines) published by the Centers for Disease Control and Prevention (CDC) that can be found in The Healthcare Infection Control Practices Advisory Committee 2007 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control. 2007 Dec; 35(10 Suppl 2):S65-164, https://doi.org/10.1016/j.ajic.2007.10.007 and any amendments made by the CDC to the Guideline. (2) Supervision. (a) Supervision of licensed physical therapist assistants – Supervision, as applied to the licensed physical therapist assistant, means that all services must be performed under the supervision of a physical therapist licensed and practicing in Tennessee. Guidance for the rendering of such services is as follows: 1. The licensed physical therapist shall perform the initial evaluation of the patient with the development of a written treatment plan, including therapeutic goals, frequency and time period of services. 2. The licensed physical therapist shall perform and document re-evaluations, assessments, and modifications in the treatment plan at least every thirty (30) days. For patients seen longer than sixty (60) days, the licensed physical therapist shall inspect the actual act of therapy services rendered at least every sixty (60) days. 3. The supervising licensed physical therapist must be available to communicate by telephone or other means whenever the physical therapist assistant is delivering services. 4. The discharge evaluation must be performed and the resulting discharge summary must be written by the licensed physical therapist. 5. The licensed physical therapist and the physical therapist assistant shall be equally responsible and accountable for carrying out the provisions of this subparagraph. (b) Supervision of physical therapy assistive personnel (See Rule 1150-01-.01). GENERAL RULES GOVERNING THE PRACTICE OF PHYSICAL THERAPY CHAPTER 1150-01 1. A physical therapist may use physical therapy aides for designated tasks that do not require clinical decision making by the licensed physical therapist or clinical problem solving by the licensed physical therapist assistant. Direct supervision must apply to physical therapy aides and is interpreted to mean that services are provided under the supervision of an on-site physical therapist or physical therapist assistant licensed and practicing in Tennessee. 2. A physical therapist may use other assistive personnel for selected physical therapy designated tasks consistent with the training, education, or regulatory authority of such personnel. Other assistive personnel (nationally certified exercise physiologists or certified athletic trainer and massage therapists, etc.) must perform the delegated task under the on-site supervision of a physical therapist. The physical therapist shall then co-sign all related documentation in the patient records. 3. “On-site supervision” means the supervising physical therapist or physical therapist assistant must: (i) Be continuously on-site and present in the department or facility where assistive personnel are performing services; and (ii) Be immediately available to assist the person being supervised in the services being performed; and (iii) Maintain continued involvement in appropriate aspects of each treatment session in which a component of treatment is delegated to assistive personnel. (c) A physical therapist may concurrently supervise no more than the equivalent of three (3) full-time physical therapist assistants. A physical therapist may concurrently supervise no more than the equivalent of two (2) full-time assistive personnel or physical therapy aides. (d) Pursuant to Rule 1150-01-.01, physical therapists and physical therapist assistants shall provide direct onsite supervision of volunteers. Volunteers may not provide physical therapy to patients. (e) A physical therapist shall provide on-site supervision, as defined in part (b)3. of paragraph (2) of this rule, to physical therapy clinical students at all times, and will be in accordance with the APTA guidelines for clinical education which suggest a minimum of one (1) year of licensed clinical experience prior to functioning as a clinical instructor for physical therapist students. (f) A physical therapist assistant shall provide on-site supervision, as defined in part (b)3. of paragraph (2) of this rule, to physical therapist assistant clinical students at all times, and will be in accordance with the APTA guidelines for clinical education which suggest a minimum of one (1) year of licensed clinical experience prior to functioning as a clinical instructor for physical therapist assistant students.