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Toni Talks about PT Today

‘Passive ROM Is Not a Skilled Therapy'

Published December 11, 2013 11:20 AM by Toni Patt

Let me clarify that statement before I go any further. I refer to performing PROM as the only treatment on patients who are sedated, minimally responsive, have significant neurological involvement and the like. I'm not referring to outpatient settings, PROM as part of an overall treatment, stretching and the like.

I thought that argument was settled a long time ago. I have research that supports the position. Apparently the doctors where I work never read those journals. Currently I have two patients on my caseload with orders to hold all therapy except PROM. Both have poor prognoses. One has contractures. The other has a stage IV sacral wound and squirms into the fetal position.

I don't have a problem with checking once a week to see how the patient is doing. Then I can assess if any changes have occurred. Such an assessment is skilled and requires clinical judgment. I teach that. It's almost embarrassing to have to do something I preach against. I'm not saying PROM isn't appropriate. I'm saying neither I nor the OTs should be the ones providing the service.

I tried signing off and stating nursing would perform the PROM. That lasted less than a day. Then I put them on our maintenance program. Nope, our maintenance tech is too busy getting people out of bed. So it falls on me to do it, an expensive waste of resources. I have more patients on my caseload than I can see but I have to find time for PROM. Really? Most of the literature I've read refers to PROM being performed while the patient is being bathed since the limbs needs to be moved to complete the bath.

I don't know what irks me most about this; that the doctor, who I thought knew better, would write the order or that no one else has a problem with having a licensed therapist perform a task more suited to a CNA. When I worked in the neuro ICU, I performed PROM only when I couldn't do anything else with the patients or while I was waiting for the medical condition to stabilize so I could progress therapy.

This is an example of lack of respect for what I do. I've tried complaining. That was held against me on my performance review under not getting along with my coworkers and not being a team player. This week I will try talking to the physician. So help me, I will scream if I'm told it's because the family wants it. But that is the subject of another blog.

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