Safety and Professional Responsibilities Flashcards

While performing gait training in a hospital corridor, a patient suddenly stops walking, develops a blank stare, and begins to have a generalized tonic-clonic seizure. Which of the following represents the MOST appropriate IMMEDIATE sequence of actions for the physical therapist?

Answer: Carefully guide the patient to the floor, position them in a side-lying recovery position, and clear the immediate area of hazards.

The primary goals during a seizure are to protect the person from injury and maintain a patent airway. The safest course of action is to ease the person to the floor to prevent a fall, remove any nearby objects that could cause harm, and roll them onto their side. The side-lying (recovery) position helps drain any fluid from their mouth and prevents the tongue from blocking the airway. Restraining the person can cause musculoskeletal injury, and nothing should ever be placed in the person's mouth. Chest compressions are not indicated unless the person goes into cardiac arrest after the seizure.

A physical therapist makes an error while writing a daily note in a patient's paper chart, documenting that the patient ambulated 150 feet when it was only 100 feet. What is the legally-accepted procedure for correcting this error?

Answer: Draw a single line through the incorrect entry, write "error," and then add the correct information followed by the therapist's initials and the date.

A medical record is a legal document, and alterations must be transparent. The legally-defensible method for correcting an error in a paper chart is to draw a single line through the mistake, ensuring the original entry remains legible. The therapist should then write "error" or a similar notation, add the correct information, and then initial and date the correction. This method maintains the integrity of the record by showing what was changed, when, and by whom. Using correction fluid or completely obscuring the original entry can be interpreted as an attempt to conceal information.

A physical therapist assistant (PTA) is treating a patient with low back pain. During the session, the patient reports a significant increase in pain and new-onset foot drop. The PTA contacts the supervising PT, who is off-site. Which of the following is the MOST appropriate instruction for the PT to give the PTA?

Answer: Direct the PTA to discontinue the treatment session, document the patient's report, and ensure the patient is scheduled for an immediate re-evaluation with the physical therapist.

New-onset foot drop is a red flag indicating a potential serious neurological change that requires immediate assessment by the physical therapist. The PTA's scope of practice does not include performing evaluative tests, interpreting findings, or modifying the plan of care based on a significant change in patient status. The safest and most appropriate action is for the supervising PT to direct the PTA to stop treatment and facilitate a re-evaluation by the PT before any further intervention is provided.

A patient, who is a well-known artist, is very grateful for their successful rehabilitation and offers the physical therapist an original painting valued at approximately $1,000 as a thank you gift. According to the APTA's Code of Ethics, what is the MOST appropriate response?

Answer: Politely decline the gift, explaining that professional guidelines discourage accepting high-value items to avoid any appearance of a conflict of interest.

The APTA's Code of Ethics states that physical therapists shall not accept gifts or other considerations that influence or give an appearance of influencing their professional judgment. Accepting a gift of significant value can create a conflict of interest, exploit the patient-therapist relationship, or compromise professional boundaries. The most ethical response is to politely and graciously decline, providing a professional reason to depersonalize the refusal and uphold ethical standards.

A physical therapist is documenting a patient's treatment in a shared office space. The therapist is called away to an emergency and minimizes the electronic medical record (EMR) screen, which contains protected health information (PHI), but does not log out of the computer terminal. This action is a violation of which of the following principles?

Answer: Confidentiality

This is a direct violation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules, which are based on the ethical principle of confidentiality. HIPAA requires healthcare providers to implement reasonable safeguards to protect patient health information (PHI) from unauthorized access. Leaving a workstation logged into an EMR system in a shared area, even if minimized, fails to secure PHI and creates an opportunity for a breach of confidentiality.

A physical therapist is working with an 80-year-old patient who has early-stage dementia. The patient's adult child, who holds a durable power of attorney for healthcare, insists the therapist perform a painful stretching procedure that the patient is verbally refusing. What is the therapist's MOST appropriate initial action?

Answer: Pause the intervention, document the conflict, and consult with the referring physician or the facility's ethics committee for guidance.

This situation presents an ethical conflict between the patient's expressed wish (autonomy) and the legal authority of the substitute decision-maker. Even if a patient has diminished capacity, their refusal should not be ignored. Forcing treatment on a refusing patient could be considered battery. The most prudent and ethical action is to pause, document the dilemma, and seek guidance from appropriate resources like an ethics committee or the physician to formally clarify the patient's decision-making capacity and mediate the conflict.