Deviation in the Standard of Care During Physical Therapy Resulting in Injury

Evaluate breaches in the standard of care by asking and answering the questions below and analyzing with your fact pattern to determine if there has been a Deviation in the Standard of Care During Physical Therapy Resulting in Injury

Answer the following questions to find out if the standard of care was followed for your case.

  • Did the patient present to physical therapy with a complete and accurate physician's order?
    Yes
    No
    Answer unknown
    Why is this important?
    Outpatient fall risk assessments can be done on two levels. The primary care provider will do an initial screening, and then refer patients that are at risk to either physical or occupational therapy.
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  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
Risk factors are useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.

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  • Did the physical therapist obtain a full medical history from the patient? Why is this important?
    Answer this question
    
A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's therapy, and enables the clinician to make the most judicious use of the treatment plan. The understanding and cooperation of the patient can be obtained through providing insight to the therapy about to be undertaken.

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  • Did the physical therapist obtain informed consent from the patient? Why is this important?
    Answer this question
    
The laws of most states require that a physical therapist obtain informed consent before providing treatment.

    (2011) 23 EOMSCA 3 475-484 



  • Were guidelines regarding the rules and safety precautions required during therapy provided and documented in the medical record? Why is this important?
    Answer this question
    
Prior to initiating any type of therapy plan, the therapist must provide the patient with both verbal and written safety instructions regarding any and all equipment being used during therapy. All information provided to the patient needs to be documented in the medical record.

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  • Was the therapist present at all times during therapy? Why is this important?
    Answer this question
    
Patients are often better able to develop and maintain a suitable exercise program under the complete supervision of a physical therapist. Patients must also be instructed in body mechanics and posture to minimize musculoskeletal damage and the likelihood of falls.

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  • Was the therapy department adequately staffed? Why is this important?
    Answer this question
    
Ensuring adequate levels of nursing staff at times of increased likelihood for falls is an important step in fall prevention.

    (2012) 23 EPMRCA 2 305-314 



  • Were positional vital signs obtained before initiating physical therapy? Why is this important?
    Answer this question
    
Positional vital signs; vital signs that are obtained while the patient is in different resting positions, include lying down, sitting, and standing.

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  • Was footwear modification made for the patient assessed at being a high risk? Why is this important?
    Answer this question
    
Footwear modifications can contribute to reduction of falls.

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  • Was a balance assessment performed before initiating physical therapy? Why is this important?
    Answer this question
    
Standing balance must be assessed both statically, (with the base of support fixed) and dynamically, (as the base of support moves).

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  • Was balance training provided? Why is this important?
    Answer this question
    
Exercise for balance and gait dysfunction is often focused on deficits in functional activities, such as stair climbing, stepping over obstacles, or turning the head while walking. Practice can include conditions with environmental stress, such as walking on foam or sand to simulate uneven, compliant or shifting surfaces.

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  • Was a gait assessment performed? Why is this important?
    Answer this question
    
The patient who is at a high risk for falls needs to be observed from the front, back and side while walking in his usual manner, preferably without awareness that his gait is being analyzed. Details of the assessment need to be documented in the medical record.

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  • Did the gait assessment reveal any deficits? Why is this important?
    Answer this question
    
Medical conditions may contribute to gait and balance disorders for a variety of reasons.

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  • Was the patient’s coordination function assessed? Why is this important?
    Answer this question
    
Tests of coordination are necessary to establish clear and reasonable goals.

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  • Were ambulatory assistive devices provided to the patient? Why is this important?
    Answer this question
    
Ambulatory assistive devices can be used to compensate for strength or range of motion deficits and to provide additional sensory input for postural control.

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  • Was the patient provided with instructions on how to use his mobility aids? Why is this important?
    Answer this question
    
Many individuals with cognitive impairments can learn to use an ambulatory assistive device with repeated training. 

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  • Was the patient diagnosed with osteoporosis? Why is this important?
    Answer this question
    
The clinical presentation of osteoporosis is low trauma fracture(s). Low-trauma, or “fragility,” fractures are often defined as those resulting from a fall at standing height or less.

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  • Was the patient taking medication that may contribute to an increased risk of falls? Why is this important?
    Answer this question
    
The American Geriatrics Society’s (AGS) guidelines for treatment include reduction in dosages and number of prescribed medications, particularly for those individuals taking more than four medications.

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  • Was a home-safety assessment performed? Why is this important?
    Answer this question
    
Common domestic hazards include furniture, poor lighting, flooring, tripping hazards, stairways, and bathrooms.

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