Scope of Practice and Controlled Acts in Healthcare

Occupational Therapy Practice

The practice of occupational therapy focuses on the assessment of function and adaptive behavior. OTs work to treat and prevent disorders that affect a person's ability to perform in the areas of self-care, productivity, and leisure.

Psychotherapy in OT

A significant authorized controlled act for Occupational Therapists is psychotherapy. Under section 27 of the RHPA, OTs are authorized to perform psychotherapy, which is generally described as "talking work". The goal is to relieve distress, help change unhelpful attitudes or behaviors, and promote constructive coping mechanisms through a supportive therapist-patient relationship.

Physiotherapy Practice

Physiotherapists focus on assessing physical function and diagnosing and treating dysfunctions caused by pain, injury, disease, or other conditions. Their goal is to maximize independence and prevent further dysfunction.

Physiotherapists are authorized to perform several controlled acts, including:

• Spinal Manipulation: Moving the joints of the spine beyond a person's usual physiological range of motion using a fast, low-amplitude thrust.
• Acupuncture: This includes the practice of dry needling.
• Tracheal Suctioning: A procedure often used in hospitals to clear mucus from a patient's airway.
• Wound Care: Treating a wound that extends below the dermis (skin) through methods like cleansing, debriding, or packing.
• Internal Pelvic Floor Physiotherapy: Using a hand, finger, or instrument beyond the labia majora or the anal verge for rehabilitation.
• Administering a Substance by Inhalation: For example, administering oxygen.
• Communicating a Diagnosis: Identifying a disease or physical disorder as the cause of a person's symptoms.
• Ordering the Application of a Prescribed Form of Energy: Such as requesting an X-ray or ultrasound imaging.

The Role of the OTA/PTA

Occupational Therapist Assistants (OTA) and Physiotherapy Assistants (PTA) operate under the supervision of a regulated professional. Unlike OTs and PTs, the scope of an OTA/PTA is not fixed; it is highly dependent on two factors:

1. The experience and training of the supervising OT/PT (a PT cannot delegate something they are not competent in themselves).
2. The experience and training of the OTA/PTA.

Common Tasks and Limitations

Common tasks for assistants include patient education, assisting with transfers, supervising exercises, and applying modalities like TENS or ultrasound.

However, there are strict limits on what can be delegated. Physiotherapists may only delegate three specific controlled acts to PTAs:

1. Tracheal suctioning
2. Wound care
3. Administering a substance by inhalation (e.g., oxygen)

Before delegating, the PT must ensure the assistant has the necessary knowledge, skills, and judgment to manage foreseeable adverse outcomes. Crucially, PTAs are strictly prohibited from delegating these acts to anyone else.

The "No-Go" Zone: Medication Advice

A critical boundary for all rehabilitation staff (OT, PT, OTA, and PTA) is the controlled act of prescribing, dispensing, or selling drugs.

Clinical Scenario: If a patient asks, "Which medications should I be taking for my pain?", you cannot provide advice or opinions on medications. This is outside your scope of practice. You must decline to answer and refer the question to the appropriate medical professional.

Professional Boundaries and Legal Risks

Working within your scope is essential to avoid Negligence and Professional Misconduct.

• Negligence (Malpractice): Occurs when a provider fails to meet professional standards of care, which may result from forgetting an action, failing to document, or providing substandard care.
• Professional Misconduct: Behavior that falls short of what is proper, such as violating professional-patient boundaries or deviating from standards (e.g., falsifying documentation).
• Conflict of Interest: A situation where a provider's personal interests interfere with their professional duties, such as a PT recommending a family member's equipment company without disclosure.

By adhering to these defined scopes and respecting the boundaries of controlled acts, healthcare providers ensure the safety of their patients and the integrity of the profession.