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Toni Talks about PT Today

Goals Must Be Based on Assessment

Published October 14, 2008 4:14 PM by Toni Patt

Yesterday I got a real shock when I looked at one of my patient's charts.  An OT had evaluated her and used my PT evaluation to write her transfers goals.  On the surface this may not sound too bad.  I don't understand how she could write goals on something she didn't assess.  There was nothing in her evaluation about mobility, not even something indicating mobility as per PT.  What's worse my evaluation was performed the day previous to the OT one.   The pt's status could have changed between the two.  I may be over reacting but I just don't see it. 

Let me back up.  The OT did do a bed level  evaluation.   Nothing on her evaluation indicated she moved the patient around.  I'm not saying writing "mobility as per PT" and then writing goals would be much better.  But  doing that there would at least provide an objective basis for the goals.  Besides what I wrote was very basic.  By not seeing the patient move the OT missed all the intrinsic pieces that go into planning a treatment.  I didn't mention hear or trunk control.  I didn't describe exactly where the pt placed her hands when transferring or whether she consistently reached for the chair.  Some things can't be extrapolated. 

The whole point of the evaluation is to determine a patient's functional status.  From that we write goals and develop a treatment plan.   Sometimes I co-evaluate with an OT.  If I don't assess something I see it being assessed.   I may ask the OT what the UE strength is which will affect my transfer goals.  OT will address the UE strength  which also effects my goal.   I'm writing a transfer goal, not a UE strengthening goal. 

This concerns me because it puts us on a slippery slope.  The evaluation is the key for skilled intervention.  If OT is basing its treatments on PT assessments it could raise the question of whether OT is necessary since it would appear OT was working under PT.  I must appease my OT friends by saying this isn't so.  The same would hold if a PT wrote goals based on an OT evaluation.  Bottom line, each disciple needs to do its own evaluations. 

There could also be a licensure issue.  If I assume the OT Practice Act is similar to the PT Practice Act there is something in there about assessments from which to develop individualized POCs.  I could argue that skipping part of the assessment but writing goals is in violation of the practice act.  I could be over reacting.  Maybe I'm the only one who thinks this is a problem.  It bothers me because this wasn't an oversight.  This OT read my evaluation and decided to use what I wrote rather than moving the patient herself.  It was a decision.  To me there is no excuse for that.  Assessment of transfers can be delayed to a later treatment if necessary.  This just seems wrong to me.



It  is important to identify the integrity of the Physical Therapist with his/her ability/knowledge/ skills/etc.   PT is NOT OT.... and OT is  NOT PT...... so many times the OT intervenes with  a PT program.... but in actuality they have a different underlying knowledge than PT has... if they had the same tr4aining they would be PT's /...and they are not......soooo my take on it is,

the OT should be doing his/her wn evaluation on the needs of the patient.... the reason for the evaluation is to assess the patient's needs.... and the patient and the family and the Insurance companies are looking at the assessments to be each discipline's professional judgment........ let's not shortchange our profession!!! !  

June October 15, 2008 11:26 AM

   If OT wrote the transfer goal before PT did evaluation, PT should skip the transfer goal, because PT can just get the patient out of bed and do gait training, endurance training or balance training.  We PT have many things to do.  If the patient achieved all the goals we PT listed, PT can discharge the patient.  On the other hand, if patient has no potential to do any of gait training, balance training, or endurance training, we PT don't have to pick up the patient, just leave the patient to be treated by OT.  I consider this is a good way to make PT shortage less.  We all know not all patients need OT, if OT believe they can do PT's job, the phenomenon of OT shortage is near.

   Since OT are doing transfer, I do believe they can list transfer goal, then OT have to work to achieve the goal once the OT listed the goal as OT's goal.  We all suppose to save medicare money, why do the same job when other profession is perfectly trained to do so?  I have such happy vision that in the future, OT are doing all the bed mobility and transfer, while PT are doing all the gait, balance, endurance trainings, I bet the shortage of PT will not exist any more.

Wendy, contract - physical therapist October 14, 2008 11:26 PM
Houston TX

...Why is the OT writing transfer goals anyway?  Duplication of treatment!!!! If it's to the commode, OK, perhaps I can understand that.  I think there is a little leway in the med-surg setting (if that's to what you are referring) that it can be acceptable to write a goal for a transfer even if that patient was not yet observed for transfer.  I think when we take into consideration a patient's PLF, it's certainly appropriate to write a goal even if we didn't observe it. Yet, there has to be a logical progression of goals: able to get to EOB, able to sit to stand.., etc

I would take more issues with her writing a transfer goal.

Christie, PT October 14, 2008 9:54 PM
Streamwood IL

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