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Can a PTA...
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Can a PTA... - October 21, 2000 4:51:00 AM
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Kerry
Posts: 7
Joined: October 18, 2000
From: FL
Status: offline
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Hi group, Im a new member who owns a small clinic that subcontracts to home health agencys. I was hoping that someone could clarify and issue/problem that Im having with the HH agency. Heres the scenario... I have a PTA treating a home health patient that shes treated prior in the SNF. In the SNF the pt required periodic checking of his O2 sats w/ his PT treatments. The PTA was concerned about the patients status at home and talked to nursing about the issue, who then told her to contact the case manager at the HH agency. The PTA did notify the case worker, and I guess apparently documented that she was requesting orders to monitor the patient. Heres my deliema...#1 The home health agency was very concerned that a PTA would be requesting to do something thats a nursing issue, #2 they dont feel that a PTA is qualified under their licence to check his 02 sats. #3 theyre upset that she documented that she wanted orders, that shes only an assistant. Whats your opinion before I go in and defend my PTA on monday. Personally I feel its great that she had such communication with everyone. Oh, one last thing, we dont think that the agency has the proper equiptment to check his 02 sats. THANKS- Kerry
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Re: Can a PTA... - October 21, 2000 5:24:00 AM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
Status: offline
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A few thoughts:
Checking O2 sats is certainly not a nursing only issue. Don't many PT's use portable pulse ox's when performing PT on fragile patients? I used to use it all the time when working with adult patients with spastic quadriplegia in the developmental center when we got em' up and walking after being confined to a wheelchair for 20 years with no PT services (their O2 sats and pulses went wacky when we got 'em to standing . . . orthostatic hypotension is one heck of a party pooper).
I understand that you think it's great that the PTA took it upon him or herself to communicate all of this stuff to other healthcare workers. I'm not sure I agree, but the more significant issue is that there was clearly a breakdown in the communication from the PTA to the PT. The PT should be making these kinds of recommendations to the rest of the team, not the PTA. Consider how you might take to the recommendations of a nursing assistant (who may have no more than a high school degree), regarding how you as a PT should be changing your treatment strategy.
That may not be a direct analogy, but that's certainly the RN/BSN's perception of what's going on. I can see why the nurse would be upset if she didn't understand the training of the PTA. Understanding PTA training and scope of practice, I'm not sure why you're not upset though.
I don't find it in ANY practice act that it is within the practice act of a PTA to evaluate and make recommendations independent of the PT. That's what happened here. The PTA is able to examine the patient, and report back to the PT . . . whose responsibility it is to analyze those results, and take action as appropriate. The PTA may be absolutely correct, and that's great. He/She may also be capable of documenting a quick request for MD orders, that doesn't take much brainpower either . . . the point is, that neither are the issue. This is out of the PTA's scope of practice. The PTA should have discussed the examination with the PT, evaluation and recommendation is not within the PTA's scope of practice.
I think that there was a breakdown here, and I don't think that his/her documentation of wanting doctor's should be praised. I think that the nurse is right. It should have been you asking for O2 sat monitoring, once you’d re-evaluated the patient. Speaking of which, given her history, why did you choose not to recommend O2 sat monitoring for the patient upon your initial evaluation????
Drew
PTA's and PT's need to work in a more cooperative, and cohesive manner . . . but also respect the guidelines set forth in the Guide to Physical Therapist Practice. I don't feel that this situation is a particulalry good example of how that cooperative arrangement is supposed to work.
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Re: Can a PTA... - October 22, 2000 4:09:00 AM
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dc
Posts: 5
Joined: September 13, 2000
Status: offline
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Kerry,
It appears that the supervising PT was not included in the comunications to change the plan of care. This issue should be addressed with the PT, PTA, and nurse involved in this client's case. I mention the nurse because, based on the information you provided, the PTA was instructed by the nurse to contact the case manager for a change in the plan of care. Although the PTA's observation regarding the client's status was excellent, the channels for instituting a change in the plan of care based on your information appear incorrect.
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Re: Can a PTA... - October 22, 2000 1:01:00 PM
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Dana D
Posts: 142
Joined: September 18, 1999
Status: offline
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I agree with the above postings regarding the importance of communication...I definitly don't think checkin O2 sats is just a nursing duty... without a doubt is it crucial with certain patients... you can't exercise with them if they are below a certain percentage of their normal... i think the nurses in certain facilities would start getting pretty aggrivated if at the beginning, middle and end of every therapy session they were called to check certain patients O2 sats...that's why the machines are portable and that's why we learned that skill as part of our basic education....
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Re: Can a PTA... - October 22, 2000 5:23:00 PM
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Kerry
Posts: 7
Joined: October 18, 2000
From: FL
Status: offline
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More food 4 thought on this, even though it seems kinda trivial, I have to apologize that I didnt have all info on this matter...
The PTA who treated this patient in SNF, was the one who monitoed his sats in the SNF, and requested the pt be D/C'd w/o2 through the HH agency.
The PTA never requested orders, but was inquiring if nursing was monitoring his o2 sats .. my mistake on the info. What she did do, is check his o2 sats since she had the machine in her pocket, and document before and after activity.
The case manager was pissed off because she felt that it was out of a PTA's training to do this in a Home health setting,(According to her there are different things you can do under your license depending on the setting) and was going to investigate if she is allowed to do this. Personally I think theyre pissed because theyre not monitoring him, and if something happens they want to CYA. The PTA wants to also CYA, and thus this has turned into a nursing/PT issue.
The PTA feels that if she has the machine, that she is obligated to monitor...
This is not an issue of lack of communication between the PT and the PTA,(She did report her concerns). The PTA was simply more familar with the patient and was dicussing it w/nursing who was at the patients home.
K-
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Re: Can a PTA... - October 22, 2000 8:57:00 PM
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edilling
Posts: 139
Joined: January 10, 2000
From: pullman,wa,usa
Status: offline
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Out of a PTA's training to monitor pulse and O2 sats? How much training does it take to know the difference between 85% and 93% and write it down (my 3yo can do that)
As long as the PTA does not change the plan of care based on the readings independent of the PT they should be well within their scope of practice (reguardless of setting)
The case manager should manage the case and not your staff.
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