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 holder’s 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 person’s

health status relating to physical therapy;

      (b) Determine the need for physical

therapy evaluation and treatment;

      (c) Make a recommendation regarding a

person’s 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 patient’s 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.)