Errors in Physical Therapy & Techniques to Reduce Them (TX)

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Errors Identified in Physical Therapy

Before looking into specific errors that have been identified in the practice of physical therapy, let’s review a few populations that are especially susceptible to medical errors.

– Pediatric Patients – 4 factors that set pediatric patients apart from adults:

Development

Dependency

Different Epidemiology

Demographics

– Older Adults

Elder people in the community

Hospitalized elders

– Individuals with limited health literacy

– Individuals/families with limited English

The American Physical Therapy Association endorses the following:

“Physical therapists and physical therapist assistants should be involved and should be leaders throughout development, implementation, refinement and maintenance of Safe Patient Handling programs on an institutional level and at the local, state and federal government levels.” With this in mind, it is important that no matter the setting, physical therapists should step up to the plate and insert their knowledge to help in their workplace.

There are several areas that have been identified that are prone to injury or medical errors. The list below is not all-inclusive, but provides a broad range of activities that every therapist should be familiar with.

1) Use of rolling stools/equipment

2) Gait training

3) Allergic reactions

4) Manual therapy techniques

5) Wound care

6) Activities requiring increased balance

7) Use of strength or aerobic equipment

8) Infections from inappropriate cleaning of equipment

9) Modalities

10) Lack of proper supervision

11) Burns

12) Using expired supplies

13) Lack of equipment safety checks

Techniques to Reduce Errors in Physical Therapy

Each and everyday, it is the responsibility of physical therapists to prevent harm and to ensure that every patient is safe under their care. A few of the techniques/processes that help therapists protect a patient’s safety include:

1) Methods to control infection

– Cleaning equipment

– Hand washing

– Cleaning of whirlpools

2) Use of safety equipment/devices

– Gait belts

– Lifts

– Additional clinical staff

3) Screen for “red flags” – indicators of pathology (non-musculoskeletal) that need additional testing

– Night sweats

– Fatigue

– Weight loss

– High blood pressure (over 160/95)

– Nausea

– High body temperature

– Diarrhea

– Dizziness

– High pulse rate (over 100)

– Vomiting

– Pallor

4) Screen for contraindications for treatment

– For manual therapy – history of cancer, bone disorders, non-healing sores

– For modalities – diabetes, pacemaker, allergies (including latex and ultrasound agents)

5) Cardiovascular screening prior to exercise/treatment

6) Safety checks of all equipment (electrical and non-electrical)

7) Factors that require immediate medical attention and termination of therapy:

– Symptoms during physical exam that are not mechanical in nature

– Increasing/progressive neurological deficit

– Numbness in perianal region

– Change in mental status or loss of consciousness

8) Pool Safety Precautions

– Appropriateness of patient for pool activity

– Immediate access to rescue equipment

– Inclement weather

9) Communication with co-workers, physicians, and any other individuals involved with the patient or their care and should include:

– Written communication

– Phone or verbal communication

– Fax or electronic communication

10) Documentation

– Provide sufficient information to identify the patient

– Provide support for diagnosis

– Justification of the treatment

– Course of treatment and the results

– Only authorized individuals provide documentation in medical record

The information, processes and techniques listed above are a small but valuable beginning for the clinician to constantly employ and ensure that all co-workers utilize to work toward elimination of errors in therapy practice.

Back to: Medical Errors and Prevention Techniques – Texas

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