*Student Reviews Plan of Care and Ensures Patient Readiness for Treatment

CRITICAL ELEMENTS

*Student reviews plan of care and ensures patient readiness for treatment

*Student applies knowledge of contraindications and precautions for the selected intervention

*Student cleans hands with approved hand cleanser

*Student introduces self to patient, stating name and title, and confirming patient’s identity

*Student explains procedures to patient, confirms that patient understands procedures and expectations, and obtains consent to implement procedures

*Student visually and verbally monitors the patient for safety and comfort throughout the intervention, and makes any necessary modifications

*Student communicates treatment expectations to patient

*Student protects self and patient via use of appropriate body mechanics

*Student protects self and patient via use of appropriate guarding

*Student protects self and patient via use of appropriate level of assistance

*Student protects self and patient via use of appropriate standards of safety

The above ‘Critical Elements’ pertain to all skills for PTA 112. Skill specific critical safety elements are bolded and asterisked in the specific skill’s instruction list.

FOLLOW UP

Student performs any necessary follow up measurements

Student asks patient any necessary follow up questions

Student determines patient’s response to intervention, and recommends any needed modifications to the plan of care to the supervising physical therapist

Student accurately and thoroughly documents intervention, including: required level of patient assistance and modifications to intervention

Student identifies any barriers to learning and adjusts instructional techniques to meet the patient’s learning style, as needed

DEMONSTRATION OF FUNDAMENTAL KNOWLEDGE

Student explains rationale for intervention

Student explains how to determine the patient’s required level of assistance

Student explains alternate methods that may be used

The above ‘Follow Up’ and ‘Demonstration of Fundamental Knowledge’ steps pertain to all skills for PTA 112.

HANDWASHING
Students turns on water to appropriate temperature
Student ensures that clothing is out of the way of the stream of water
Student removes all jewelry from hands and wrists
Student selects appropriate anti-bacterial soap
Student lathers hands, wrists and forearms for at least 30 seconds, working between fingers
Student rinses hands, wrists and forearms, being sure to keep hands below level of wrists
Student dries hands thoroughly with paper towel, being sure to not touch any non-sterile surfaces
Using dry paper towel, student turns off sink
GLOVE DONNING
Student places sterile paper enclosure of glove pack on a sterile surface with cuffs toward student
Student correctly opens glove pack
Student turns back wrist end of each glove on itself
Student grasps glove by non-sterile portion and works other hand into glove
Student slips gloved hand into the sterile side of the cuff of the opposite glove
Student lifts glove using the fingers inside the cuff only, and works opposite hand into the glove
Student fully pulls gloves into place over wrists, touching only sterile surfaces of gloves with gloved hands
GLOVE DOFFING
Student graps the cuff of one glove with the other hand
Student turns cuff inside out as glove is removed
Student compacts removed glove into the palm of the hand
Student hooks thumb of ungloved hand into the remaining glove, and pulls glove toward the fingers, turning it inside out over the compacted glove
Student ensures that contaminated sides of glove are inward when removing gloves
Student avoids snapping gloves when doffing
Student disposes of gloves in an appropriate container
PRECAUTIONS AND PERSONAL PROTECTIVE EQUIPMENT
Student Identifies 5 modes of infectious organism transmission
Student Identifies proper protective equipment for each transmission mode. See Below
Droplet Precautions- Young Healthy Adult With Influenza-No other comorbidities
Student adheres to standard precautions
Student dons appropriate mask
Student instructs patient on respiratory hygiene/cough etiquette
Student explains rationale for PPE selection
Contact transmission/precautions – MRSA Patient, Incontinent Patient, Alzheimers
Student observes standard precautions
Student dons gown utilizing sterile technique
Student dons faceshield/mask and goggles utilizing sterile technique
Student dons gloves utilizing sterile technique
Student discusses 3 ways to minimize spread of contact transmission organisms
Airborne transmission/precautions – Tuberculosis Patient
Student observes standard precautions
Student dons appropriate mask utilizing sterile technnique
Student Identifies room where airborne trasmission precautions are in effect via a review of the medical record
Student discusses 3 ways to minimize spread of contact transmission organisms
Student instructs patient on respiratory hygiene/cough etiquette
BODY MECHANICS
Student explains principles of safe body mechanics to patient/subject
Student demonstrates and has patient perform the following activities:

Deep Squat Lift

Half-Kneeling Lift

Carry

Golfer’s Lift

Push-Pull

Student provides appropriate patient related instructions and tactile cues to carry out intervention
Student performs all components of intervention in a timely fashion
PATIENT POSITIONING
Student prepares environment by ensuring that all under sheets, towels, and patient clothing are free of wrinkles
Student provides appropriate bolstering using pillows, towels, and/or blankets to support body parts and avoid strain/pressure
Student correctly positions patient, with appropriate support, in supine, prone, and side lying
Given a particular patient condition, student correctly positions patient
Student performs all components of intervention in a timely fashion
Follow Up
Student determines patient’s response to position change, and recommends any needed modifications to the plan of care to the supervising physical therapist
Demonstration of Fundamental Knowledge
Given a particular condition, student states maximum amount of time patient can be kept in a particular position
Student states precautions/considerations to take with each position
BED MOBILITY
Student provides appropriate instructions to patient prior to moving patient
Student positions patient’s body parts appropriately for bed mobility activities
Student seeks assistance in moving patient if student is not physically able to move patient by himself/herself
Student stations himself/herself appropriately for bed mobility activiites
If a pillow will be under the patient whle they are prone, student positions the pillow in place before rolling the patient
Student provides appropriate patient related instructions and tactile cues for bed mobility
Student identifies any barriers to learning and adjusts instructional techniques to meet the patients learning style, as needed
Student performs the following bed mobility activiites:

Prone to Supine

Supine to Prone

Supine to Side Lying

Supine > Sit

Side to Side

Up and Down

Up & Down/Side to Side with Drawsheet

Student assists patient with repositioning body parts into a comfortable position
Student positions pillow, towels, and blankets, as necessary for patient comfort and pressure relief
Student performs all components of intervention in a timely fashion
Demonstration of Fundamental Knowledge
Student suggests activities that might allow patient to improve independence with bed mobility activities
TRANSFERS - HYDRAULIC LIFT
*Students checks hydraulic lift for wear, and ensures that lift is in good working order
Student adjusts chain lengths on lift to accomodate the height and size of the patient
Student correctly positions sling under patient prior to transfer
Student moves hydraulic lift into correct position and attaches spreader bar chains to the sling
*Student engages wheel locks, moves footrests out of the way.
Student pumps hande to lift the patient to a safe sitting position
Student cradles, lifts, and rotates the patient’s lower extremities to remove the patient from the treatment table
Student steadies patient while on sling, if needed
Student moves the patient into a position over a locked wheelchair, positioning the base of the lift around the perimeter of the wheelchair
Student carefully opens the hydralic release valve and lowers the patient safely into the wheelchair
Student applies pressure to the patient’s lower extremities to ensure correct positioning of the patient in the wheelchair
Student closes the hydraulic release valve to avoid the potential of the lift arm lowering further and striking the patient
*Student assures that patient can safely sit without assistance
Student removes chains from the slings and moves hydraulic lift away from patient, being sure to keep the spreader bar and chains from striking the patient
Student ensures appropriate patient position on the wheelchair
Student removes upper portion of the sling, if a two piece sling was used
Student provides patient with appropriate verbal and tactile cues to carry out transfer
Student performs all components of intervention in a timely fashion
TRANSFERS - MULTIPLE ASSIST TRANSFERS
Student positions wheelchair close and parallel to the surface to which the patient will be transferred
Student engages wheel locks, moves footrests out of the way, and removes aremrest from the side of the wheelchair to which the patient will be transferred
Student provides appropriate instructions to helper(s)
Student ensures patient is lifted to a height that ensures clearance of the wheelchair or any obstacles
Student directs and assists with the following transfers:

Two Person Floor ↔ W/C

Two Person W/C ↔ Bed

Three Person Carry

Student provides appropriate patient related instructions
Student and helper provide support until patient is in a safe and comfortable position
Student performs all components of intervention in a timely fashion
TRANSFERS - ONE PERSON ASSIST
Student positions wheelchair close and parallel to the surface to which the patient will be transferred
*Student engages wheel locks, moves footrests out of the way, and removes armrest from the side of the wheelchair to which the patient will be transferred
*Student correctly applies transfer belt to patient
Student positions patient appropriately in preparation for transfer
Student performs transfers for the following situations:

Standing pivot - Dependent

Standing pivot – Assisted (armrest not removed to allow patient to push up to standing position)

Standing pivot- Guarding One Lower Extremity

Sitting pivot- Dependent

Squat Pivot- Assisted

Sliding Board

Floor ↔Wheelchair

Wheelchair ↔ Car

Student provides appropriate patient related instructions and tactile cues for procedure
Student maintains contact for support until patient is able to maintain a safe and comfortable position
Student performs all components of intervention in a timely fashion
WHEELCHAIR COMPONENTS & FIT
Students ensures that wheel locks can engage and release
Student ensures that caster wheels are in good working order
Student ensures that drive wheel tread is adequate
Student correctly installs and removes wheelchair armrests
Student ensures that footplates can pivot up/down and can swing to side
Student ensures that heel loops are secured to footplates
Student determines if anti-tipping devices are in place
Student properly folds and stores wheelchair when not in use
Student assesses calf clearance from seat bottom, measures seat depth of wheelchair and makes adjustments to fit patient
Student assesses seat width of whelchair, measures seat width, and recommends a different width wheelchair, if appropriate
Student assesses seat back height of wheelchair, measures seat back, and adjusts, adds or removes a seat cushion to fit patient
Student assesses thigh clearance from seat bottom, measures front rigging length, and adjusts front rigging length to fit patient
Student assesses elbow position of patient, measures armrest height, and adjusts arms rests to fit patient
Student assesses size of footplate, measures footplate, and replaces footplate with an appropriate sized footplate, if applicable
Student accurately documents any adjustments made to wheelchair for correct fitting
ASSISTED WHEELCHAIR PROPULSION
*Student ensures correct fit of wheelchair
Student releases wheelchair locks
Student performs the following wheelchair propulsion activities:

Over level ground

Over curbs (Forward & Backward)

Up & down ramps and slopes (Forward & Backward)

Through doorways

Up & Down stairs

Student maintains control of the wheelchair at all times
Student provides patient with appropriate patient related instructions to carry out ntervention
Student performs all components of intervention in a timely fashion
GAIT TRAINING - PARALLEL BARS
*Student correctly applies gait belt to patient
Student correctly adjusts the height of the parallel bars to the patient
Student positions patient appropriately in parallel bars
Student teaches patient to sit and stand in parallel bars
Student teaches patient gait training using a 2-point gait pattern
Student teaches patient gait training using a 3-point gait pattern
Student teaches patient gait training using a swing-to gait pattern
Student teaches patient gait training using a swing-through gait pattern
Student provides appropriate verbal and tactile cues to assist patient with gait training while using parallel bars
*Student ensures that patient adheres to all weight bearing guidelines during gait training
Student performs all components of intervention in a timely fashion
Demonstration of Fundamental Knowledge
Student identifies the appropriate assistive ambulatory device should the patient demonstrate an increase or a decrease in function
GAIT TRAINING - WALKERS
*Student correctly applies gait belt to patient
Student chooses a front wheeled or standard walker, based upon the patient’s functional level and the established plan of care
Student correctly adjusts the height of the walker to the patient
Student instructs patient to sit and stand using a walker
Student instructs patient to negotiate stairs using a walker
Student instructs patient to negotiate a slope using a walker
Student instructs patient to negotiate tight areas using a walker
Student instructs patient to negotiate a doorway using a walker
Student provides appropriate verbal and tactile cues to assist patient with gait training while using a walker
*Student ensures that patient adheres to all weight bearing guidelines during gait training
Student performs all components of intervention in a timely fashion
*Student visually and verbally monitors the patient for technique, safety and comfort throughout the intervention, and makes any necessary modifications
Demonstration of Fundamental Knowledge
Student identifies the appropriate assistive ambulatory device should the patient demonstrate an increase or a decrease in function
GAIT TRAINING - AXILLARY & LOFSTRAND CRUTCHES
*Student correctly applies gait belt to patient
Student correctly adjusts the fit of the crutches to the patient
Student teaches patient to sit and stand using crutches
Student teaches patient gait training using a 2-point gait pattern
Student teaches patient gait training using a 3-point gait pattern
Student teaches patient gait training using a 4-point gait pattern
Student teaches patient gait training using a swing-to gait pattern
Student teaches patient gait training using a swing-through gait pattern
Student teaches patient to negotiate stairs using crutches
Student teaches patient to negotiate a slope using crutches
Student teaches patient to negotiate tight areas using crutches
Student teaches patinet to negotiate a doorway using crutches
Student examines the patient’s skin for breakdown following the use of crutches
Student provides appropriate verbal and tactile cues to assist patient with gait training while using crutches
*Student ensures that patient adheres to all weight bearing guidelines during gait training
Student performs all components of intervention in a timely fashion
Demonstration of Fundamental Knowledge
Student identifies the appropriate assistive ambulatory device should the patient demonstrate an increase or a decrease in function
GAIT TRAINING - CANES
*Student correctly applies gait belt to patient
Student chooses the appropriate type of cane based upon the patient’s functional level
Student correctly adjusts the fit of the cane to the patient
Student instructs patient to sit and stand while using the cane
Student instructs patient to negotiate stairs while using a cane
Student instructs patient to negotiate a slope while using a cane
Student instructs patient to negotiate tight areas while using a cane
Student instructs patient to negotiate a doorway while using a cane
Student provides appropriate verbal and tactile cues to assist patient with gait training while using a cane
Student performs all components of intervention in a timely fashion
Demonstration of Fundamental Knowledge
Student identifies the appropriate assistive ambulatory device should the patient demonstrate an increase or a decrease in function