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PTA Blog Talk

My First Write-Up

Published April 7, 2010 5:01 PM by Jason Marketti

For the first time in my career as a PTA, I have been written up. It would be easy to say it was not my fault, and technically it was not, however after discussing it with the HR person I accepted it, but still do not agree with it. The circumstances surrounding this involved me informing the DOR and the PT about a patient needing updated goals and a reassessment. Frankly I ran out of things to do with the patient and needed the PT's skilled insight and knowledge to continue.

Since there was no reassessment done and no goals updated the patient was not seen and I was the one who took the blame. Fine. So when I asked how we can prevent this in the future and improve communication I thought I was asking a legitimate question. The frustrating part was the patient is the ultimate loser in this. The patient did not receive the best possible care that the therapy department could give and as a group we all should have been responsible for this. If we all cannot or do not want to take responsibility for situations then we all are not working as a team.

10 comments

Hi Im a lic.PTA with over 10yrs experience. Would love to continue on to become a PT. Are ther any schools in NJ that have a transitional program PTA to PT ?Without having to start all over again.  

Ruben , SNF - PTA May 19, 2010 10:51 PM

I highly doubt you would have gotten had issues with the state unless there is a predetermined time at which a PT must see this patient (every 12 visits, etc).  In which case, the PT should have already been aware, and should have indeed been written up...but this does not appear to be your case.  For someone who did not have a decline in status, there should be no legal reason for you to not see this patient.  I feel you've failed to demonstrate that that PT HAD to see this patient before the patient got their butt out of bed...you'd been seeing them already...time to stop scape goating...

Christie ,, April 14, 2010 10:32 PM

Is it California law that prohibits a PTA to upgrade goals after discussing with the PT and documenting this discussion ? Was there a new POC required? Do you not meet weekly with the evaluating PT to discuss the Pts status and concerns?

I sense a lack of communication between yourself and the PT hence the Pt was not seen. How did you document the lost treatment? It is a standard of practice to be in frequent communication with the PT and document. Based upon the above information it appears you may have assumed the PT would reassess the Pt that day but apparently did not and may be an issue of compliance

Tom April 14, 2010 1:56 PM

Thank you everyone for the comments.  I would have seen the patient, however state laws often get in the way of doing the right thing.  A change in state laws to allow PTA's more input in patient assessments will ensure they get the care deserved. (ie, PTA's updating goals with a PT co-sign)

Suppose I did see the patient and someone from the state board shows up and asks me questions regarding the patient and how often they are being seen by the PT.  I will not risk my license for anyone.  

If nsg has the time they would get people up and moving.  

Jason Marketti April 14, 2010 12:40 AM

My opinion on the matter is that the real issue here why everyone got upset is that the patient probably has a need for some level of activity.  In the hospital setting, PT isn't always PT, physicians and nurses want to make sure that the patient has an activity plan in mind...it doesn't always have to be "theraputic" and if there is no skilled level of PT required, its time to pass them to the nursing staff for daily acitivity.  How I would have handled this would have been to approach the nurse and explain the situation as the patient having had reached the current goals.  I would presume that this patient would have been appropriate then to have some level of activity that could have been performed with the nursing staff.  

So here's a patient who has already been through a course of PT and is ready for more...but is their a dire emergency for this patient to get reassessed? Unless a discharge is impending, in my opinion, no.  It would have been pertinent at this point to make sure that the nursing staff is doing their job with the appropriate level of activity rather than acquiesce the situation.  

Your other option would have been simply to just see this patient...in a setting based on DRGs anyway, there is no consequence to you seeing a patient under "non skilled" services.  

...the real issue here is that this patient probably did not get his butt out of bed all day...THIS is why RNs and physicians get upset. In the hospital setting, being "reassessed" does not take priority over someone having their daily activity.  If you failed to communicate this patient's activity needs with the nursing staff, I'm sorry, I'd write you up too.  Our job is to meet the needs of the patient and not act in a passive manner to say "well, they need new goals" so I'm not going to see them.  

Unless this patient had an impending discharge that really required the PT to see them that day for reassessment, I would have bit the bullet and seen this one....

Christie ,, April 13, 2010 9:41 PM

I beieve that if you made intension to have the Eval PT update the GOALS and they were not update then you should have NOT seen the patient of atleast contacted teh Evaluation PT via PHONE and document it in the chart.  If we make every intension on showing that we attemtped communication with the Evaluation PT then it fall on the PT and they should have been written up as well.  next time if you come across this isue and can't have the PT see the patient maybe you could just re-scheduel the patient so that the PT can see him.  FYI I don't think you should have been written up and verbal conversation would have been enough.

Israel Suarez, OUTPATIENT - PTA, Fortaleza April 13, 2010 9:13 PM
Philadelphia PA

I have been an assistant for 30 years now, and I have seen a lot. I don't know why you got written up. If the goals have not been upgraded or made current, you are not suppose to see the patient. It sounds like the  PT was slacking off. California law is very different from GA and, you should have a little more autonomy in California . I first acquired my license from California. There should have been a meeting between you and the PT to discuss plan of care before proeeding. If the pt has plateaued or has met the previous goals, then why continue to see. In cases like that, if it continues, I would begin looking for another place of employment. I've worked with PTs that are not real strong in the field and I've worked with some excellent ones that respect my input. Unfortunately, reality kicks in and I realize that some PT's don't respect us. I will tell you this though, I have pretty good judgement to know when a pt needs to be DC'd or progressed and I get respect for that. A good Pt will appreciate that because that makes their job easier when it comes to deciding what to do with the pt.. We assistant in the decision making,DC planning, etc.. I am sorry you went through that though. Hang in there.

Lisa Salter, Skilled Nsg - PTA April 13, 2010 9:01 PM
Atlanta GA

 was this a MED B patient...because, honestly i dont think it is appropriate  for a PTA to keep seeing a pt when they are past their reassesment date,,tx or no tx..its easy for these people to voice an opinion, its not their license on the line...we are always taking the fall for the tx problems, when we are usually the ones most  aware of what is needed for goals...you are a scapegoat, and you are not alone in this

maureen April 13, 2010 8:14 PM

The write up was about missing a treatment on the patient.  You are right I was within my scope of practice, (HR and the DOR did not see it that way) and I became a scapegoat for what was not done by the PT.

Jason Marketti April 8, 2010 9:40 AM

What exactly were you written up for? If the patient wasn't seen because the initial goals were met and there was no plan of care beyond that, you acted within your scope of practice. If this is the case, you need to march yourself to HR and have a chat. If not, you need to reassess.

Dean Metz April 7, 2010 5:04 PM

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    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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