Scope of Practice
Everyone with a physical therapy license should be familiar with the concept of scope of practice. It spells out which therapeutic activities a physical therapist may perform. For example, passing medicines is not permitted but applying autolytic debriders as part of wound care is. For the most part, it is definitive about what is and isn't permitted except for a gray area that overlaps with OT.
In many instances, PTs and OTs overlap in what they're doing. We both do transfer training. We take patients to the bathroom. I might help someone dress. An OT might help someone stand. When describing the differences to patients, I explain that PTs want to walk to the sink. OTs want to work at the sink. I thought that captured the main difference. OTs don't do gait.
Or so I thought until last Saturday. I was working on a general neuro floor. One patient had orders for a PT and OT consult prior to discharge. An hour or so after seeing the patient, the OT called me. She said I didn't have to see the patient because she'd already cleared her for discharge. In fact, the OT said, the patient walked just fine. Since when do OTs decide if a patient walks "just fine?"
As far as I know, OTs don't receive any education on gait or gait training. Obviously they need some knowledge since they often must walk patients to the sink or bathroom. To me, there is a big difference between walking someone 10 feet to the bathroom and determining that person is safe to go home and under which conditions. I don't tell OTs if someone is able to dress himself. I tell them how much and what kind of assist I provided and let them decide.
I was sort of surprised by the whole conversation. I'm not sure why an OT would think I wouldn't need to see someone walk to clear for discharge. Nor do I understand why an OT thought she could make that determination. OTs don't gait-train people. They aren't taught how to assess gait. Sure, they can intuitively see if someone is safe or not. That doesn't mean an OT should clear someone for discharge based on ambulation.
I think this OT thought she was helping me out by saving me an evaluation. I appreciate that. I just don't think it's within her scope of practice to make that determination. I think this is probably unique to my facility. So where did she get the idea it was OK for her to do that? The PTs she normally works with should have stopped the practice before it started. Apparently they didn't. I wonder if this happens routinely. I guess I'll have to ask.
I'm all for PTs and OTs working together. I appreciate her trying to help me out. I was very busy that day. It's just that a PT can't make OT judgments and an OT can't make PT judgments. What would be wrong with both PT and OT seeing the patient for clearance prior to DC? I frequently clear stroke patients for safe discharge. I've had OTs follow me and pick up on things I completely missed because they were outside my area of assessment.
Maybe I'm nitpicking. But it is a fair question.