Supervision and Task Assignment 2019

Definitions

1. (1) In this policy

a. Competent means ability or capacity to perform the task correctly;

b. Direct Supervision means the supervising physiotherapist is present when the assigned task is carried out;

c. Assignment means the assignment of a task that is part of a physiotherapy treat-ment plan to an individual who is not a registered physiotherapist;

d. Indirect Supervision means the supervising physiotherapist or substitute is not present when the assigned task is carried out, but is readily available onsite;

e. Supervision means the provision of adequate guidance including periodic review to:

i. ensure that physiotherapy services provided are safe and effective; and

ii. communication, both written and verbal, is appropriate and professional;

2. (1) Supervision encompasses all assigned activities; 

(2) When determining the level of appropriate supervision, the following factors must be   considered: 

a. Practice setting and type; 

b. The nature of the task; 

c. The acuity of the client’s  condition; 

d. The complexity of the client’s needs; 

e. The degree of judgement and decision making required for modification of    treatment based on client response. 

(3) In determining the type of supervision required, the physiotherapist must consider the education, training, skills, job experience, personal attributes, abilities and compe-tence of the individual being supervised. 

(4) The nature of the supervisory relationship may be direct, indirect or a combination of the two, and:

i. Physiotherapists exercise their best clinical judgment to provide the appropriate mix of direct and indirect supervision as required; 

ii. In situations where indirect supervision is used, it is reasonable and expected that the supervising physiotherapist, or their alternate, be readily available for consulta-tion; 

iii. The physiotherapist remains responsible, accountable and liable for the quality of physiotherapy provided and it is essential that the supervising physiotherapist eval-uate the standard of work performed by the individuals under their supervision; 

iv. Physiotherapists ensure, through chart review or regular reporting and dialogue, that the physiotherapy treatment plan is documented and carried out appropriately and that changes are made as needed. The physiotherapist provides follow-up instruc-tion when the physiotherapy treatment plan or the clinical diagnosis needs to be changed; 

v. Physiotherapists establish and document a process, to ensure that ongoing, collabo-rative communication exits between the various parties. 

Physiotherapists cannot assign to others a task they are not competent to perform themselves.

3. (1) Assignment of tasks occurs when a physiotherapist has determined that: 

a. The treatment plan is suitable for implementation by an individual who is not a registered physiotherapist; 

b. The individual has the competence to carry out the plan under supervision; 

c. The individual will implement the prescribed treatment plan under supervision. 

(2) The responsibility for the care and safety of the client cannot be assigned or trans-ferred and it remains with the physiotherapist. The physiotherapist is accountable for the physiotherapy the client receives. 

(3) The assignment of tasks always includes the informed consent of the client docu-mented by the Physiotherapist, along with the specifics and parameters of the assignment; 

(4) It is the physiotherapist’s responsibility to ensure individuals under their supervision are able to competently carry out the physiotherapy functions assigned to them.   Physiotherapists must not assign treatment plans to individuals they have not ob-served performing similar tasks competently;

(5) Physiotherapists must ensure that individuals carrying out assigned tasks have the ability or capacity to recognize changes in client status and to document what they see and report the change to the supervising physiotherapist; 

(6) Reassessment of the client by the physiotherapist, and subsequent changes to the treatment plan, must occur as frequently as necessary to maximize expected outcomes; 

(7) Physiotherapists must communicate to individuals under their supervision: 

a. Relevant assessment findings, goals, interventions planned, acceptable range of treatments and the expected response; 

b. Potential changes in client’s condition expected with the treatment delivered; 

c. The client’s actual response to the treatment; 

d. Observed changes in the client’s health status during or as a result of the physiotherapy intervention; 

e. Any changes in the treatment plan and goals. 

(8) Tasks that may be assigned to a supervised individual include but are not limited to: 

a. Participation in the collection of qualitative and quantitative client data related to the client’s physical status and functional ability; 

b. Performance of selected objective measures, tests or procedures; 

c. Implementation of therapeutic interventions as assigned. 

d. Reinforcing the physiotherapist’s explanations and providing verbal instructions  to the client with regard to the treatment plan; 

e. Assisting the physiotherapist in evaluating the effectiveness of specific interventions in relation to identified client outcomes; 

f. Documenting work and collection of workload measurement statistics; and 

g. Performing any task that contributes to the creation of a safe and effective prac-tice environment;

(9) Subject to subsection (b), the types of tasks that are not assigned to supervised indi-viduals are of an evaluative nature and include but are not limited to: 

(a)  i. Interpretation of referrals, diagnosis or prognosis; 

ii. Interpretation of assessment findings, treatment procedures and goals of treat-ment; 

iii. Planning or modification of the treatment program beyond the established limit; 

 iv. Discussion of treatment rationale, clinical findings and prognosis with client or family; 

 v. Documentation that should be done by the physiotherapist; 

vi. Discharge planning; 

vii. Any task or procedure that requires continuous clinical judgment e.g. any inter-vention that has an evaluative component that immediately influences the treat-ment program. 

(b) Subsection 9(a) does not apply to physiotherapy students and sponsored physiotherapists who may be assigned evaluative tasks in a mentoring and/or learning capacity.

• Physiotherapy Act 1998 c.22
• Registration Regulations Sec 34
• NSRHPN Principles of Assignment and Delegation Guide;lines for Working with Unregulated Care Providers

• Current version approved by NSCP Board September 18, 2019.
• Original version approved by NSCP Board 2011.