|
|
Re: Do any PT's recommend anti-inflams for pts?
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Re: Do any PT's recommend anti-inflams for pts? - September 26, 2006 2:13:00 AM
|
|
|
SJBird55
Posts: 2438
Joined: May 10, 2004
From: Michigan
Status: offline
|
Recommending and prescribing are different.
Wags, I don't believe that I have a high percentage of patients that are drug seeking or on a path looking to sue. I have never been sued nor have seriously upset any patient to have that course of action taken toward me. Since the definitions of recommending and prescribing are different; my state practice act does not address recommending over the counter medications... I have professional liability insurance... I'm not going to live in the fear of what could be or what could happen. I refuse to do that. I will do my best to answer the questions of patients and make recommendations when asked.
Mike, I haven't read enough literature that has made significant, substantial claims to have me worry too much about an NSAID taken in the acute stage. What I have read has led to more questions, but not a definitive "never" take NSAIDS in the acute phase. The main aspect of that kind of literature is to rethink why one would want to stop the inflammatory process since the inflammatory process is an important stage of healing. Technically, how many people are there out there that have taken NSAIDS and NOT healed from whatever injury? Clinically, did taking NSAIDS reduce the rate of healing to a clinically significant degree? I would think that if there was swelling beyond belief that the edema should be controlled a bit better and that the inflammatory process is getting out of hand.
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 26, 2006 4:11:00 AM
|
|
|
Tom Reeves DPT ATC
Posts: 449
Joined: March 14, 2006
Status: offline
|
I tend to agree with SJBird. But I don't generally recommend NSAIDS in the first few days anyway just because of the anticoagulation effects. Just like when a kid gets a mild concussion I implore them NOT to take any NSAIDS, but rather Tylenol if they must.
The same rationale goes for an acute ankle sprain that bleeds internally, aspirin etc . . . will only make it bleed more. Mechanical control and resolution of swelling is more effective for things like ankle sprains anyway in my opinion.
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 26, 2006 6:09:00 PM
|
|
|
mcap56
Posts: 619
Joined: October 26, 2002
From: New York, NY
Status: offline
|
I agree with Dr. Wagner. You never know. Even in the case where the patient was taking the medication exactly as recommended on the box, and not doubling up, by recommending the med, you have put yourself on the hook. Why? Why not have the patient communicate with their physician?
You are all looking at straightforward examples. But where does it stop? Do pulmonary PTs recommend an OTC bronchodilator. Do cardiac PTs recommend low dose aspirin.
There are no lines of distinction. Either recommendations are in the scope of practice or they are not. If they are not, there are no exceptions for Advil or Tylenol.
SJ - it's good to hear from you and I hope you are well. But I fail to see any contradiction in what I wrote. The PT, familiar with meds and pharmacology can be a nice check in the system. One of many checks that includes pharmacists, nurses, etc. If a potential mistake is found, the issue is referred back to the prescribing phyisician. I don't see the issue here.
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 27, 2006 1:35:00 AM
|
|
|
SJBird55
Posts: 2438
Joined: May 10, 2004
From: Michigan
Status: offline
|
Glad to see you're still kicking :) Things are going well this way. The contradiction is the fact that you can call up a physician and point out a potential mistake, but you don't recommend over the counter products if asked? That's just plain ridiculous to me.
I guess I'm different in the sense that if I DO know something and someone askes me about whatever that something is, over the counter products included, hey, I tell them what I think and recommend what I think. Heck, I've even recommended AGAINST what a physician has ordered! Sue me! Physicians ordering flexeril with vicodan.... the patient doesn't have spasms and never did. Why is the patient taking flexeril? I recommend that the patient is doing SO much better and there aren't any spasms that flexeril is no longer needed. The flip side is, that if I don't know something... well, I admit it and don't make recommendations.
I've got a lady right now who I believe is basically dying. She's on dialysis and something isn't right. Outside of my scope of practice I did some research and recommended that she speak to someone of her crew about her nutrition... I even gave her a frickin abstract. The specialists all supposedly ignored it to her face.. 4 weeks later they ran some different blood work and decided that she's "starving to death" and isn't retaining any proteins. Now, she's sheduled for some major nutritional crap with a TPN. In my opinion... substandard care was being provided to her and in early 2006 some dialysis nutritional standards weren't being followed or acknowledged in the care provided to her by a large team of specialists.
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 27, 2006 4:01:00 AM
|
|
|
jlharris
Posts: 477
Joined: April 12, 2006
From: Nebraska
Status: offline
|
SJBird,
Do you know WHY the physician specifically ordered flexeril and vicodan? Instead of straight out telling the patient to stop, call the physician (which has many years of education and additional training, not just a semester or two of pharmacology) to discuss your observations and what you think should be done (in this case, cessation of the meds). Then, that physician, who has singnificantly more depth and breadth of pharmacology than any of us non physicians, can make the call as to if they need to stop.
Sorry, I know it's a slippery slope, but if you "know" about, say, anticonvulsive drugs, and your patient hasn't had a seisure in years...do you recommend they stop those too?? Heck even in most states PA's and NP's can't prescribe narcotics, but you're talking about making suggestions to use them or not. BTW, if followed, these "suggestions" are for all intents and purposes prescriptions.
Not trying to come across as attacking you. Hope my tone stayed somewhat neutral. This is just an earnest fear that you are putting yourself, and worst, your patient's at risk by making medical decsions only M.D.'s are trained sufficiently to do.
Thanks for reading/listening.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 27, 2006 4:29:00 AM
|
|
|
SJBird55
Posts: 2438
Joined: May 10, 2004
From: Michigan
Status: offline
|
I believe physicians prescribe them out of habit, the lack of ability to listen or some wrong assumption that pain and spasm go together. The patients generally always state they were prescribed for pain and spasms. (I don't have a big "stupid" written on my forehead - of course, I have a conversation with the patient. Of course, I also realize that a patient's perceptions can be different than a medical profesional's perceptions. I also know that flexeril IS for spasms.) They were prescribed during the initial office visit in regard to their pain and the current episode of complaint. Now, why on earth should a patient take flexeril when there is no spasm present? Again, I just apply common sense. And then, the funniest thing.. patients aren't stupid either. There are those that give me that sheepish look and feel guilty admitting that they aren't and didn't take the flexeril (sometimes didn't even fill that prescription). Why? Well, same thing I just said - they didn't have and don't have spasms. Of course, I agree with their common sense. LOL
I generally don't comment on the anti-convulsants... You are muddying the waters with what I posted. I do tend to look at the medications prescribed, what is being taken and if there is a known mixure that for example causes falls in the elderly, I do recommend a review of prescribed meds for those particular patients. You know.. the risk/benefit ratio.
I don't have the same fear as you ... I refuse to live in fear... maybe I'm whacked, but I don't believe I put patients at risk with recommendations in common sense situations.
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 27, 2006 6:30:00 AM
|
|
|
jbird007
Posts: 297
Joined: May 2, 2006
From: USA
Status: offline
|
I cannot believe what I am reading.
Going AGAINST a medical doctors orders? WOW!
I think many of you are having a hard time acknowledging the dangers. This is a serious issue.
JBird
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 27, 2006 6:39:00 AM
|
|
|
PHSPT
Posts: 119
Joined: December 1, 2005
From: Oklahoma
Status: offline
|
How many of you have ever been prescribed a med by an MD, taken it and have found that it either made you sick, or not strong enough, or upset your stomach, , etc, etc??
Most of you perhaps!, certainly a lot of our pnts have. Thast why W-E M-U-S-T be able to discuss and answer the effects of the particular drug that pnts may be on.
Many of our pnts are NOT even told as to why the drug was recommmended in the first place. Physical therapy emcompasses everything that can affect our pnts plan of care, to include drugs interactions!.
To shy away from this responsibility would also be grounds for litigation. We are as responsible for our pnts as the MD's.
Take a reverse role on the example given by Dr Wagner, a pnt comes to the PT clinic w prolonged use of ibuprofen has not been back to the MD d/t he said to return only if Sx's worsened or until the 8 weeks of P.T are over with. (NOT FAR FETCHED RIGHT?)After reading med hx of ulcers and KNOWING of the prolonged NSAIDS use, do you
a) ignore findings and continue w eval b) make recommendations to stop use d/t adverse effects to Gi system c) Tell him/her the Dr can only make recommendations, therefore bring up when he/she sees the MD .
I dont know about everyone here, but I have a responsibility to this pnt, and would make the right choice. Litigation would follow also the P.T, d/t medico negligence, if the pnt will later develop a GI bleed.
Dont be afraid people! if you are not knowledgeable in pharmacology, then take courses!, expand your knowledge.
I enjoy a good working relationship w the 4 in-house physicians at my facility. They understand that b/c i spend an hr examining their pnts, i will be able to pick up anything missed by them. Thus far my drug/supplements recommendations to their pnts have received positive comments from both physicians and most importantly the pnts.
You guys give MD's a superhuman status that somehow enables them to know everything under the sun, folks theyre human, and also make mistakes. Theres a plethora of meds out there and with vulture-like pharm reps flying in daily, its IMPOSSIBLE for any MD to be unfallible in the drugs precription arena, they rely on the judicious feedback of reputable clinicians like ourselves to inform of any adverse effects and assist the pnts if the PT has ATTAINED that level of knowledge.
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 27, 2006 8:32:00 AM
|
|
|
PHSPT
Posts: 119
Joined: December 1, 2005
From: Oklahoma
Status: offline
|
Jct13
So do you address the red flags, in the scenario I gave or simply ignore?
Your point for the MDs as the only ones to recommend is obvious,but where do you stand on discussing and advising on any red flags you encounter?.DO you tell the pnt your opinion? You have a pnt sitting in your clinic right now, w Hx of prolonged use of NSAIDS and is currently on 800 mg ibuprofen for LBP, what do you do?
Simply labeling a situation as an unfortunate case, wont get you off the hook as a clinician, which BTW is not poor practice standards, MANY MD's prescribe NSAIDs while having little/no control over what the pnt does, whether the pnt takes the NSAID sporadically versus a consistent use.
If you truly probe for this vital information at your practice, youll find time after time, there are high numbers of pnts who do not follow the instructions well. So it is not a random unfortunate case, it happens everyday!! its called non-compliance and we deal w it as well.
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 27, 2006 8:51:00 AM
|
|
|
PHSPT
Posts: 119
Joined: December 1, 2005
From: Oklahoma
Status: offline
|
The excuse of is "not in my scope of practice", does not exempt us as PT's to be judicious in the role of pharmacology as it affects the care of our pnts.
This mentality unfortunately will shy away our therapists from ever making any efforts to educate themselves and expand their quality of care.
We are not seeking to prescribe, but rather make sound clinical judgements that are in accords to our role as clinicians.
This is the APTA's take on pharmacology and our practice. Please show me where it states i cannot make clinical recommendations to my pnts.
PHARMACOLOGY IN PHYSICAL THERAPIST PRACTICE HOD P06-04-14-14 (Program 32) [Initial HOD 06-89-43-89] [Medications in the Provision of Physical Therapy] [Position]
Physical therapist patient/client management integrates an understanding of a patient’s/client’s prescription and nonprescription medication regimen with consideration of its impact upon health, impairments, functional limitations, and disabilities. The administration and storage of medications used for physical therapy interventions is also a component of patient/client management and thus within the scope of physical therapist practice.
Physical therapy interventions that may require the concomitant use of medications include, but are not limited to, agents that:
Reduce pain and/or inflammation
Promote integumentary repair and/or protection
Facilitate airway clearance and/or ventilation and respiration
Facilitate adequate circulation and/or metabolism
Facilitate functional movement.
(Program 32 – Practice, ext 3176)
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 27, 2006 9:49:00 AM
|
|
|
mcap56
Posts: 619
Joined: October 26, 2002
From: New York, NY
Status: offline
|
Nowhere in that statment does it indicate that we are in our rights to recommend medication. With regard to the patient who seems like they may have a GI bleed from prolonged NSAID administration the answer is simple. Tell them that GI bleeds are a common side effect and that they may be at risk and that it could be serious.
You then encourage them to read the labels and contact their physician immediately. If they don't follow through - it's their issue.
Perhaps you would just tell them them to stop and not contact their MD? Think about it, if this person has developed gastritis or an ulcer, they need to see their doctor anyhow. So why does the recommendation to stop have to come from you?
It's out of the scope of practice. Many people here seem to get bent out of shape when other professionals, with less training get involved in rehab. How is this so different?
And again, you can't only consider NSAIDs. You might thing NSAIDs are fine to recommend. Someone else may feel that a particular patient needs both an NSAID and an OTC acid blocker due to history of ulcers. Perhaps another therapist thinks fatigue is interfering with therapy and that caffeine or a sleep aid are in order. See where this is going? How as a profession, do we decide what is appropriate to recommend? And, you can NOT equate our status with that of a neighbor. We are medical professionals.
OTC products are powerful and potentially dangerous. Just because the public is casual with them or just because physician's often don't do a good job with them, doesn't suddenly place them under our scope of expertise.
Respectfully,
Marc
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 28, 2006 2:12:00 AM
|
|
|
Jon Newman
Posts: 1709
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
I don't use dexamethasone, an adrenocortical steroid, but I bet quite a few PTs do. That's a medication that we not only deliver but often make the decision to use.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 28, 2006 4:21:00 AM
|
|
|
mcap56
Posts: 619
Joined: October 26, 2002
From: New York, NY
Status: offline
|
That's true. But it's a topical delivery via iontophoresis or phonophoresis. There isn't much that ends up in general circulation. And I seriously doubt that phono works at all.
Ionto is in our scope of practice. We are trained in it and could expect to see questions on it for the PT exam. That's a far different story than recommending a systematic drug.
mcap
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 28, 2006 4:37:00 AM
|
|
|
Jon Newman
Posts: 1709
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Hi Mcap,
I agree that we likely give homeopathic doses of it but I disagree that it isn't systemic.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 28, 2006 7:47:00 AM
|
|
|
Shill
Posts: 1097
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
Jon,
I think that dexamethasone has not been found to get into the bloodstream in detectable amounts with ionto. Dont quote me on this yet, but I will look. OK, I couldnt find the study where I thought I read this, so never mind.
_____________________________
Steve Hill PT
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 28, 2006 9:08:00 AM
|
|
|
jlharris
Posts: 477
Joined: April 12, 2006
From: Nebraska
Status: offline
|
Systemic?? Maybe, but not in significant concentrations. Additionally, topical use bypasses the complicating factors of the GI tract and the liver.
SJBIRD Stated:
[QUOTE] I believe physicians prescribe them out of habit,...[/QUOTE]Not habit but via a clinical care pathway. Through research and clinical knoledge, the first step in many MSK injuries is to decrease pain and inflammation. Now is it appropriate for all individuals to continue on the regimend for more than a couple of weeks? My answer to handle that is at the bottom of my reply.
Also:
[QUOTE] I don't have the same fear as you ... I refuse to live in fear... [/QUOTE]Why is it that knowing my clinical skill boundaries and an ability to pick up a phone to discuss my findings with an MD instead of prescribing meds and isolating myself from MD's, being afraid???
I think you elevate your pharmacology knowlegde to a false level. I'm a new grad. Had more pharm classes than most PT's out 10 years have even considered. But I also know 2 semesters does not equal clinical ability to prescribe medications.
PHSPT said:
[QUOTE]Physical therapy emcompasses everything that can affect our pnts plan of care, to include drugs interactions!.
To shy away from this responsibility would also be grounds for litigation. [/QUOTE]There is a difference between ignoring the drug "red flags" and taking it upon yourself to eliminate the physicians role and prescribe medicaitons.
As you state later, the pt with the GI problems taking NSAIDS needs changes. However, is it that hard to pick up a phone and call their MD to tell them what you observed?? Your 3 options you present skip this VERY EASY step to take. Your fourth option should have been:
4: Tell them of the possibility of NSAIDS use on the GI track and that you are going to call their physician to discuss your observations NOW.
Whew, that was hard wasn't it?? You educated, fixed the problem, and DID NOT PRESCRIBE MEDS.
Oh, and telling to stop is as much prescribing as telling to start.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 28, 2006 9:40:00 AM
|
|
|
jbird007
Posts: 297
Joined: May 2, 2006
From: USA
Status: offline
|
Well said, Jason.
J
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 28, 2006 10:04:00 AM
|
|
|
jlharris
Posts: 477
Joined: April 12, 2006
From: Nebraska
Status: offline
|
It's slightly condesending, so I want to apologise for that. Don't mean to offend.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 28, 2006 10:58:00 AM
|
|
|
PHSPT
Posts: 119
Joined: December 1, 2005
From: Oklahoma
Status: offline
|
PT's role in pharmacology prescription can be traced back to the US Army, in the late 70's as d/t a shortage of orthopedists, PTs were used as physician extenders a role that included pharmacy prescription rights.
Since then, military PT's have continued to to "prescribe" not merely recommend NSAIDS and narcotic type medications, without any RECORD of litigation, or medical complications.
Military PT's are given prescription rights after fulfilling courses, and training requirements. As a Uniformed Service PT Ive attained those requirements and by military standards I would be able to prescribe after applying for my prescription rights, If I was assigned to a Military facility.
Again, it is unfortunate that despite constant efforts to advance our profession from DPT's that should include pharmacokinetics and advanced pharmacology courses, young PT's undermine their abilities to make a mere comment on a simple OTC pill.
Opinions on what cause harm, danger are just that, let the literature speak for itself.
If PT's that have attained pharmacology prescribing rights, are not causing any harm to their pnts, then why would PT's that CAN BE ALSO trained in pharmacology would cause any harm when making OTC recommendations?.
J Orthop Sports Phys Ther. 2005 Oct;35(10):674-8. Related Articles, Links
Risk determination for patients with direct access to physical therapy in military health care facilities.
Moore JH, McMillian DJ, Rosenthal MD, Weishaar MD.
US Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX 78234, USA. josef.moore@us.army.mil
STUDY DESIGN: Nonexperimental, retrospective, descriptive design. OBJECTIVES: This study was designed to ascertain whether direct access to physical therapy placed military health care beneficiaries at risk for adverse events related to their management. BACKGROUND: Military health care beneficiaries have the option at most US military hospitals and clinics to first enter the health care system through physical therapy by direct access, without referral from another privileged health care provider. This level of autonomous practice incurs broad responsibilities and raises concern regarding the delivery of safe, competent, and appropriate patient care administered by physical therapists (PTs) when patients are not first examined and then referred by a physician or other privileged health care provider. While military PTs practice autonomously in a variety of health care settings, they do not work independently within any facility. Military PTs and physicians rely on one another for sharing and collaboration of information regarding patient care and clinical research as warranted. Additionally, military PTs are indirectly supervised by physicians. METHODS AND MEASURES: To reduce provider bias, a retrospective analysis was performed at 25 military health care sites (6 Army, 11 Navy, and 8 Air Force) on patients seen in physical therapy from October 1999 through January 2003. During this 40-month period, 95 PTs (88 military and 7 civilian) were credentialed to provide care throughout the various medical sites. Descriptive statistics were analyzed for total workload, number of new patients seen with and without referral, documented patient adverse events reported to each facility's Risk Management Office, and any disciplinary or legal action against a physical therapist. RESULTS: During the 40-month observation period, 472 013 patient visits were recorded. Of these, 112 653 (23.9%) were new patients, with 50 799 (45.1%) of the new patients seen through direct access without physician referral. Throughout the 40-month data collection period, there were no reported adverse events resulting from the PTs' diagnoses or management, regardless of how patients accessed physical therapy services. Additionally, none of the PTs had their credentials or state licenses modified or revoked for disciplinary action. There also had been no litigation cases filed against the US Government involving PTs during the same period. CONCLUSIONS: The findings from this preliminary study clearly demonstrate that patients seen in military health care facilities are at minimal risk for gross negligent care when evaluated and managed by PTs, with or without physician referral. The significance of these findings with respect to direct access is important for not only our beneficiaries but also our profession and the facilities in which we practice.
Jason, you said:
"I think you elevate your pharmacology knowlegde to a false level. I'm a new grad. Had more pharm classes than most PT's out 10 years have even considered. But I also know 2 semesters does not equal clinical ability to prescribe medications"
Sounds to me my young new grad that the one who is elevating their level is yourself.
Not offended BTW :) just amused
|
|
|
|
|
Re: Do any PT's recommend anti-inflams for pts? - September 28, 2006 12:51:00 PM
|
|
|
jlharris
Posts: 477
Joined: April 12, 2006
From: Nebraska
Status: offline
|
I apologise for making assumptions about your training. My observations where more towards PT's with general/standard PT educations. It's hard to make an argument using the exception instead of the rule.
I believe if a PA or ARNP can be trained to prescribe non-narcotics, then a PT can also (as you are an example of). However, in the PA/ARNP example, they are "overseen" by a physician, which wouldn't be practical for the PT profession.
Also, I argue that classes cannot prepare a PT, solely, to despense meds competantly. I have first hand knowledge of an MD's education, and know that pharm is incorporated in EVERY aspect of their education and subsequent years of residancy. Do you need that much to make recommendations re: OTC NSAIDS?? Of course not. But the proper training is not in the current, civilian, PT education to prescribe medications.
BTW, I am offended in you implication that I am unwilling to allow the profession to move forward. To know me would understand that I'm a firm believer in the advancement of the Doctoring profession. I also am able to objectively evaluate my civilian education and understand what my state laws allow me to do. And to step outside of that because it's inconvient to me is, IMO, unethical.
I'm afraid we are somewhat trying to compare apples (civilian PT's) to oranges (military PT's) in our respective arguments. Therefore, I think it may be difficult for you and I to come to a common ground. Although, my argument isn't so much against PT's attaining the right to prescribe, but more that civilian PT's aren't adequately trained, at this time, to do so.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
 Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.109
|
Printable Version
All Forums >> [RehabEdge Forum] >> Open Forum >> Re: Do any PT's recommend anti-inflams for pts? 
