“I am a physical therapist and recently started to work in Home Health. During an admission, re-evaluation, or when changes in medications are reported by a patient, physical therapy is required to perform a medication reconciliation via computer software and then document/sign that this reconciliation was performed. This becomes an issue especially when nursing is not involved or has already discharged the patient and physical therapy has to create “discharge instructions” that lists all medications they are supposed to continue after DC from home health. Is this in the scope of our practice? PTAs are also asked to add new medications to the software program if reported by the patient during a treatment visit. Since I am not familiar with most of the medications, I rely solely on the software program and often do not feel comfortable adding meds or information/comments to the list, especially when it requires dosage knowledge of insulin/injectables, sliding scale values or inhalants/nebulizers, etc., which are often not available on a label. Is this common practice in home health agencies?”
You are expressing a level of anxiety over the responsibility for medication documentation that many home health physical therapists feel. However, it is really just that – documentation of the medications that the patient is to take that you are doing; the doctor bears the ultimate responsibility for the medications prescribed. It is within your scope of practice to be familiar with medications and you are fortunate to have a computer program that will check for drug interactions, reactions, etc. for you.
If the patient (or their caregiver) is not able to tell you what each medication is for and how they are to take it (frequency, dose, duration), then you need to get an order for a nurse to go out to the home for skilled medication teaching. Many agencies do have a nursing supervisor review the initial and discharge medication lists.
As far as the PTAs recording medications, we feel that is not appropriate. The PTAs are working under the license of the PT. Because the PT is accountable, it is the PT who should ultimately be entering the medication changes that the PTA discovers during routine visits to the home. Communication between PT and PTA is critical for anything that will change the plan of care, including a medication change. This communication should be routine and a common occurrence in today’s home health program.
Teri N. Thompson and Arnie Cisneros are physical therapists with nearly 40 years of combined home care experience. Co-owners of Home Health Strategic Management in East Lansing, MI, they provide clinical service management and home care consulting expertise. They are nationally renowned speakers regarding the PPS refinements of 2008 and therapy utilization under the New Rule.