††††† 201 KAR 22:053. Code of ethical standards and standards of practice for physical therapists and physical therapist assistants.

 

††††† RELATES TO: KRS 327.040, 327.070

††††† STATUTORY AUTHORITY: KRS 327.040(11), (12), (13)

††††† NECESSITY, FUNCTION, AND CONFORMITY: KRS 327.040 (12) and (13) authorize the Board of Physical Therapy to establish by administrative regulation a code of ethical standards and standards of practice for physical therapists and physical therapist assistants. This administrative regulation establishes those standards which, if violated, are a basis for disciplinary action under KRS 327.070.

 

††††† Section 1. Code of Ethical Standards. (1) Physical therapists and physical therapist assistants shall:

††††† (a) Respect the rights and dignity of all patients;

††††† (b) Practice within the scope of the credential holderís training, expertise and experience;

††††† (c) Ensure that all personnel involved in the delivery of physical therapy services are identified to the patient by name and title;

††††† (d) Report to the board any reasonably suspected violation of KRS Chapter 327 or 201 KAR Chapter 22 by another credential holder or applicant within thirty (30) days; and

††††† (e) Report to the board any civil judgment, settlement, or civil claim involving the credential holder's practice of physical therapy made against the credential holder relating to the credential holder's own physical therapy practice within thirty (30) days.

††††† (2) Physical therapists and physical therapist assistants shall not:

††††† (a) Verbally or physically abuse a client; or

††††† (b) Continue physical therapy services beyond the point of reasonable benefit to the patient, unless the patient consents in writing.

 

††††† Section 2. Standards of Practice for the Physical Therapist. While engaged in the practice of physical therapy, a physical therapist shall:

††††† (1) Perform screenings in order to:

††††† (a) Provide information on a personís health status relating to physical therapy;

††††† (b) Determine the need for physical therapy evaluation and treatment;

††††† (c) Make a recommendation regarding a personís ability to return to work or physical activity; and

††††† (d) Provide physical therapy services;

††††† (2) Evaluate each patient prior to initiation of treatment;

††††† (3) Upon receipt of a patient under an active plan of care from another physical therapy service, the receiving physical therapist shall:

††††† (a) Complete an initial evaluation in compliance with Sections 2(2) and 5(1)(a)-(e) of this administrative regulation; or

††††† (b) Ensure the evaluation and plan of care from the other physical therapy service are current and appropriate;

††††† (c) Retain the evaluation and plan of care from the other physical therapy service in the medical record;

††††† (d) Document the patient transfer of care in the medical record; and

††††† (e) Comply with reassessment requirements based on the date of the most recent evaluation.

††††† (4) Reassess each patient in accordance with the following:

††††† (a) Reassessing inpatients in either a hospital or comprehensive rehabilitation facility every fourteen (14) days;

††††† (b) Reassessing every ninety (90) days, with the physical therapist assistant present, patients in:

††††† 1. A facility defined in 902 KAR 20:086 as an intermediate care facility (ICF) for the mentally retarded (MR) and developmentally disabled (DD); or

††††† 2. A school system.

††††† a. A forty-five (45) day grace period shall be allowed upon transfer from another school district or from the start of the school year;

††††† b. During this grace period treatment may continue based upon the previous reassessment or initial evaluation;

††††† (c) Reassessing each patient not otherwise noted every thirty (30) days following the initial evaluation or subsequent reassessment;

††††† (d) Reassessing a patient whose medical condition has changed;

††††† (5) Refer the patient to other professionals or services if the treatment or service is beyond the physical therapist's scope of practice;

††††† (6) Be responsible for the physical therapy record of each patient;

††††† (7) Provide services that meet or exceed the generally accepted practice of the profession;

††††† (8) Explain the plan of care to the patient, to others designated by the patient, and to appropriate professionals;

††††† (9) Make it clear to the patient that the patient has the right to choose any qualified professional or equipment supplier if the physical therapist makes recommendations for those; and

††††† (10) Disclose in writing to each patient any financial interest, compensation, or other value to be received by the referral source:

††††† (a) For services provided by the physical therapist;

††††† (b) For equipment rental or purchase; or

††††† (c) For other services the physical therapist may recommend for the patient.

††††† (11) Unless prohibited by law, all members of a business entity shall be allowed to pool or apportion fees received in accordance with a business agreement.

 

††††† Section 3. Standards of Practice for the Physical Therapist Assistant. While engaged in the practice of physical therapy, the physical therapist assistant shall:

††††† (1) Provide services only under the supervision and direction of a physical therapist;

††††† (2) Refuse to carry out procedures that the assistant believes are not in the best interest of the patient or that the assistant is not competent to provide by training or skill level;

††††† (3) Initiate treatment only after evaluation by the physical therapist;

††††† (4) Upon direction from the physical therapist, gather data relating to the patient's disability, but not determine the significance of the data as it pertains to the development of the plan of care;

††††† (5) Refer to the physical therapist inquiries that require an interpretation of patient information related to rehabilitation potential;

††††† (6) Comply with the plan of supervision established by the physical therapist;

††††† (7) Communicate with the physical therapist any change or lack of change that occurs in the patient's condition that may indicate the need for reassessment; and

††††† (8) Discontinue physical therapy services if reassessments are not done in compliance with Section 2(4) of this administrative regulation, and communicate to the appropriate parties.

 

††††† Section 4. Standards for Supervision. While supervising the physical therapist assistant and supportive personnel, the physical therapist shall:

††††† (1)(a) At all times, including all work locations in all jurisdictions, be limited to supervising not more than four (4) physical therapist assistants or supportive personnel; and

††††† (b) Abide by the maximum staffing ratio of physical therapists to physical therapist assistants or supportive personnel required in this section except that a maximum of seven (7) work days in a sixty (60) consecutive day period shall not constitute a violation of this standard;

††††† (2) Provide direct supervision when supervising supportive personnel as defined by 201 KAR 22:001, Section 1(20), effective September 1, 2013;

††††† (3) Not delegate procedures or techniques to the physical therapist assistant that are outside his or her scope of training, education or expertise;

††††† (4) Not delegate procedures or techniques to supportive personnel that are outside his or her scope of training, education or expertise.

††††† (a) Scope of training and competency for supportive personnel shall be documented and verified at least annually.

††††† (b) Documentation of training and competency shall be immediately available for review;

††††† (5) Be responsible for:

††††† (a) Interpreting any referral;

††††† (b) Conducting the initial physical therapy evaluation;

††††† (c) Establishing reporting procedures to be followed by the physical therapist assistant and supportive personnel;

††††† (d) Evaluating the competency of the physical therapist assistant and supportive personnel;

††††† (e) Supervising the physical therapist assistant by being available and accessible by telecommunications during the working hours of the physical therapist assistant;

††††† (f) Ensuring that if supportive personnel provide direct patient care that there is direct supervision as defined by 201 KAR 22:001, Section 1(6), effective September 1, 2013 by a physical therapist or physical therapist assistant;

††††† (g) Ensuring that a physical therapy student fulfilling clinical education requirements shall receive on-site supervision by a physical therapist;

††††† (h) Ensuring that a physical therapist assistant student fulfilling clinical education requirements shall receive on-site supervision of which eighty (80) percent may be by a credentialed physical therapist assistant; and

††††† (i) Establishing discharge planning for patients who require continued physical therapy.

††††† (6) The physical therapist shall direct and be responsible for services rendered by physical therapist students or physical therapist assistant students, including documentation requirements in Section 5 of this administrative regulation.

 

††††† Section 5. Standards for Documentation. The physical therapist shall be responsible for the physical therapy record of a patient. The physical therapy record shall consist of:

††††† (1) The initial evaluation, a written or typed report signed and dated by the physical therapist performing the evaluation or supervising the physical therapist student performing the evaluation shall include:

††††† (a) Pertinent medical and social history;

††††† (b) Subjective information;

††††† (c) Appropriate objective testing;

††††† (d) Assessment, which may include problems, interpretation, and a physical therapy diagnosis identifying the nature and extent of the patientís impairment; and

††††† (e) Plan of care, including:

††††† 1. Treatment to be rendered;

††††† 2. Frequency and duration of treatment; and

††††† 3. Measurable goals;

††††† (2) Progress notes which shall:

††††† (a) Be written or typed, signed, and dated:

††††† 1. By the person rendering treatment; or

††††† 2. By the student or by the supervising physical therapist or physical therapist assistant if treatment was rendered by a physical therapist or physical therapist assistant student;

††††† (b) Be countersigned and dated by the physical therapist if written by supportive personnel, students, or physical therapy examination candidates; and

††††† (c) Include:

††††† 1. A current record of treatment;

††††† 2. Patient's adverse response to treatment;

††††† 3. Any factors affecting treatment; and

††††† 4. Data obtained by all objective tests performed;

††††† (3) Reassessment, which shall be written or typed, signed, and dated by a physical therapist. This reassessment shall be in compliance with Section 2(4) of this administrative regulation:

††††† (a) If a physical therapist or physical therapist student is treating the patient, these reports may be incorporated into the progress notes.

††††† (b) If a physical therapist assistant, physical therapist assistant student, or supportive personnel are treating the patient, the report shall be a separate entry into the record.

††††† (c) A reassessment shall include directly observed objective, subjective, and medical information completed by the physical therapist, or physical therapist student, that is necessary for the revision or reaffirmation of the plan of care and measurable goals;

††††† (4) Discharge summary, which shall be a written or typed, signed, and dated statement.

††††† (a) A physical therapist assistant, physical therapist student, or physical therapist assistant student may write the discharge summary, which shall be signed by the responsible physical therapist.

††††† (b) The discharge summary shall include:

††††† 1. The date of discharge;

††††† 2. The reason for discharge;

††††† 3. The physical therapy status upon discharge; and

††††† 4. A discharge plan, which shall include recommendations the physical therapist has regarding the need for continuing physical therapy.

††††† 5. A discharge summary, which shall be written within thirty (30) days of the termination of the current plan of care if a subsequent plan of care has not been established; and

††††† (5) The correct designation following the signature of the person who has entered a statement into the patient record shall be as follows:

††††† (a) If written by a physical therapist: "PT". Appropriate designations for advanced physical therapy degrees may follow "PT";

††††† (b) If written by a physical therapist assistant: "PTA";

††††† (c) If written by supportive personnel: "PT Aide", or "Physical Therapy Aide", or "PT Tech"; and

††††† (d) If written by a student: "Physical Therapist Student" or "PT Student"; "Physical Therapist Assistant Student" or "PTA Student". (16 Ky.R. 2616; Am. 17 Ky.R. 34; 1350; eff. 8-17-1990; 18 Ky.R. 1379; eff. 1-10-1992; 28 Ky.R. 132; 559; eff. 9-10-2001; 31 Ky.R. 811; 1067; eff. 1-4-2005; 35 Ky.R. 1859; 2215; eff. 5-1-2009; 36 Ky.R. 1305; 2047-M; eff. 4-2-2010; 37 Ky.R. 776; 1184; eff. 11-17-2010; 38 Ky.R. 91; eff. 10-19-2011; 1467; 1701; eff. 5-4-2012; 39 Ky.R. 827; 1113; eff. 12-11-12.)