terminate employment so the facility can make arrangements to find someone else to provide continued treatment. All practitioners should know and follow the policies regarding termination of services at their place of employment. Policies Organizational/management issues vignettes Vignette 1 – Physical therapist, occupational therapist, speech therapist – they’re all the same anyway ● “My boss wants me to fill in for the occupational therapist who is out on maternity leave. That’s OK, isn’t it?” said Felicia (a physical therapist). ● “The speech pathologist is sick today. I’m supposed to provide speech therapy today,” said Betty, who is a physical therapist. The APTA Code of Ethics for the Physical Therapist (2010b) states that “physical therapists shall make judgments within their scope of practice and level of experiences and shall communicate with, collaborate with, or refer to peers or other healthcare professionals when necessary” (Principle 3C). Stated simply, physical therapy personnel cannot substitute for any Competency vignettes Vignette 1 – No education needed ● “I use electrical modalities, but I don’t think we covered their use in school, and those continuing education courses are too expensive,” said Victoria. The APTA Code of Ethics for the Physical Therapist (2010b) states that “physical therapists shall make judgments within their scope of practice and level of expertise” (Principle 3C). Principle 6B states that “physical therapists shall take responsibility for their professional judgment.” Physical therapy practitioners are expected to be competent in their ability to perform assigned duties and apply methods, approaches, or techniques used with clients. Professional competency includes three aspects: technical training to know how to do the task or apply the method, judgment to follow the correct or best strategy to achieve the desired results, and normative to be conscientious in using moral reasoning or following an accepted code of conduct (Beauchamp & Childress, 2013). If a practitioner does not have the expected professional competence to use a particular task or technique, that technique should not be used until competence is obtained through additional training (on-the-job, continuing education, academic courses, etc.) and supervised practice with someone who has already obtained competence in performing the particular task or technique. Vignette 2 – One splint, many uses ● “I make the same splint for every client; it’s the only one I know how to make, so it will have to do!” said Ronald. ● “How was I supposed to know that billing Medicare for treatments I did not provide would be a problem? My brother-in-law billed Medicare for 155 treatments he did not provide, and besides, I really need the money for student loans and the house payment,” said Stanley. ● “I hired my relatives to treat clients so I could increase my billable units,” said Eddy. “And sometimes I only see the client for one billable unit but bill for two or three.” The APTA Code of Ethics for the Physical Therapist (2010b) states that “physical therapists shall seek remuneration as is deserved and reasonable for physical therapist services” (Principle 7A). It also states that “physical therapists shall comply with applicable local, state and federal laws and regulations” (Principle 5A). Physical therapy personnel are expected to be trustworthy and honest in their behavior and actions. Medicare fraud is not only unethical; it is illegal. A court of law could Documentation vignettes Vignette 1 – Missing something?
vary regarding how much notice must be given and to whom notice must be given. Practitioners should read and follow the policy manual.
other professional unless they hold credentials in that discipline as well. Vignette 2 – Too much of a good thing ● “My boss says I should treat this client until the insurance cap is reached. The client has not made any progress since treatment number 17, and this is treatment number 32,” said Tammy. The APTA Code of Ethics for the Physical Therapist (2010b) states that “physical therapists demonstrate independent and objective professional judgment” (Principle 3A) and “shall promote practice environments that support autonomous and accountable practice” (Principle 7A). Overutilization of physical therapy services to collect insurance reimbursement when therapeutic goals have been met is unethical and a violation of the practice acts in all states. The APTA Code of Ethics for the Physical Therapist (2010b) states that “physical therapists shall achieve and maintain professional competence” (Principle 6A) and “physical therapists shall take responsibility for their professional judgment based on critical self-reflection and changes in physical therapy practice” (Principle 6B). Both the previous vignette about using electrical modalities and this vignette on making one kind of splint appear to share the same problem with competence: lack of technical training. However, competent training (knowledge and skills) must be accompanied by competency in judgment to apply the technical skills in a manner that will achieve the desired results and competence in moral reasoning to ensure benefit and not harm to the client. Vignette 3 – KISS principle (keep it simple, stupid) ● “I use the same assessment instrument for all my clients, so I have consistent results. Using one instrument also saves money, energy, and time,” said Samantha. The APTA Code of Ethics for the Physical Therapist (2010b) states “physical therapists shall demonstrate professional judgment informed by professional standards, evidence …, practitioner experience and patient/client values” (Principle 3B). The key phrase here is professional standards. One assessment instrument is unlikely to meet the criterion of applying professional standards of practice to evaluate patients/clients with various impairments and functional limitations. impose a fine and time in prison. The state regulatory board could remove the license or certification to practice. Vignette 2 – More homework – ugh! ● “When I get too busy, I take charts home with me to catch up on writing progress notes and discharge summaries,” said Jennifer. “Sorry, I forgot to bring those charts back today. Just start new ones.” The APTA Code of Ethics for the Physical Therapist (2010b) states that “physical therapists shall protect confidential patient/client information” (Principle 2E). Documentation, including written progress notes and discharge summaries in clients’ charts, is privileged communication covered by the concepts of confidentiality and the right to privacy. Keeping the documentation at the facility helps ensure that the privileged communication will stay confidential and private. Taking charts home increases the opportunity for others to read the documents in the chart or for the charts themselves to get lost
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Book Code: PTNJ0824
EliteLearning.com/Physical-Therapy
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