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North Carolina Additional Physical Therapy Practices

EMG & Nerve Conduction Studies

The Board has received numerous questions over the years about EMGs (electromyography) and the subject has led to discussions between the Physical Therapy Board, the NCPTA and the Board of Medical Examiners. As an outcome of these meetings, the Medical Board has sent a letter in which they concur with the previous Physical Therapy Board ruling concerning the performance of EMG and nerve conduction studies by physical therapists. In this letter they state, the (Medical) Board after extensive legal and medical inquiry has determined that physical therapists can perform EMG and nerve conduction studies and may make physical therapy interpretation but not medical diagnosis based on the results. EMG is within the scope of practice of appropriately trained physical therapists.

Position Statement – NC Board of Physical Therapy Examiners

Reprinted from Board Newsletter, Issue 14, Spring 1995 Reviewed by Board – September 23, 2010, June 17, 2015

Performance of Finger Blood Specimens

The performance of fingerstick blood specimens for analysis of Pro-times is not considered part of the scope of practice for physical therapy; however, it would not be a violation of the North Carolina Physical Therapy Practice Act for a PT or PTA to do a fingerstick with a physician's order provided that the physical therapist has been properly trained and is competent, and makes it clear to the patient that this procedure is not physical therapy. When the PT or PTA performs a finger stick, the PT or PTA should communicate the results to a nurse so that the nurse can interpret and communicate the results to the physician to make medications modifications. (See Board Position regarding the “Physical Therapist’s Role in Recording Medications on OASIS Forms”.) In addition, the physical therapist cannot bill for his or her time as physical therapy. Lastly, the NCBPTE cannot speak for other Boards as to whether the performance of fingersticks would violate other practice acts. The NCBPTE can only say that it is not a violation of the North Carolina Physical Therapy Practice Act.

Position Statement – North Carolina Board of Physical Therapy Examiners

Adopted – December 28, 2001 Updated – December 6, 2006 Reviewed by the Board – September 23, 2010, June 17, 2015

Physical Therapist’s Role in Managing and Recording Medications

Gathering information on the medication a patient is taking and the patient's ability to take the proper dosage would be considered within the scope of practice for a physical therapist. It would also be appropriate for a physical therapist to provide basic information on medications that may have an impact on the PT plan of care; however, to provide an educational intervention, especially on medications unrelated to the PT plan of care, would not be considered within the scope of practice for a physical therapist.

It is also appropriate for a PTA to document medication changes if all the PTA is doing is simply recording changes in medication orders from the physician, PA, or nurse practitioner, but it is not appropriate for the PTA to make any interpretations or recommendations regarding medications. However, if a PTA believes that a medication change could result in harm or injury to the patient, the PTA should immediately notify the PT, who will then contact the referring practitioner.

If a PT identifies a discrepancy between the discharge medication order and the prescription on the bottle or the amount that the patient says he/she is taking, it is the physical therapist’s responsibility to contact the appropriate health care practitioner to let him / her know of the discrepancy. As always, the PT should document the conversation or correspondence.

Any change in medication should be forwarded to the home health nurse. The health care practitioner can ask the PT to confirm with the patient the medications that the patient is taking and there are no changes in the dosages, etc.

It would not be a violation of the North Carolina Physical Therapy Practice Act or Board’s rules for a PT to advise a patient as to what PRN standing orders involving the medications exist.

Position Statement – North Carolina Board of Physical Therapy Examiners

Adopted – June 28, 1999 Revised – September 23, 2010, June 17, 2015

Use and Storage of Medications for Iontophoresis and Phonophoresis

Based on this response from the Pharmacy Board, when physical therapy licensees incorporate iontophoresis or phonophoresis in the treatment, the Physical Therapy Board encourages licensees to consider the following:

  • All patients who receive iontophoresis or phonophoresis with prescription medications by a physical therapist or physical therapist assistant must have a signed prescription or written protocol from a physician that indicates specific dosages. A “blanket order” foriontophoresis or phonophoresis is not sufficient. Physical therapy direct access does not allow a physical therapist to administer prescription medications without a physician’s order.
  • A patient can obtain an individual prescription from a prescriber for a product, which would then be used by a physical therapist on a specific patient.
  • A prescriber could issue an order for a stock container of a specific concentration of medication (i.e., hydrocortisone, dexamethasone) for use within a physical therapy practice. The physical therapist would then use the medications from the stock container on patients from the prescriber in his/her practice according to written procedures developed between the prescriber and the physical therapy practice. With the prescriber’s written permission, a physical therapist may use the prescriber’s stock container for patients from other referring physicians.
  • The physical therapy practice should maintain accurate records of all patients who receive iontophoresis and phonophoresis that includes the name of the patient, date of treatment, referring physician, type of treatment, and specific dosage of medications.
  • The physical therapist may store iontophoresis and phonophoresis prescription medications (but not controlled substances) in stock containers; however, all expired medications should be properly discarded in a timely manner.

Position Statement – North Carolina Board of Physical Therapy Examiners

Adopted – September, 23, 2005 and October 12, 2005 Reviewed – September 23, 2010, June 17, 2015

Removal of Sutures or Staples by a PT

While not a part of the scope of physical therapy practice, the Board has determined that a properly trained physical therapist can remove sutures or staples provided that he/she makes it very clear to the patient that this is not physical therapy and does not bill it as such.

Position Statement – North Carolina Board of Physical Therapy Examiners

Adopted – August 11, 2006 (PT); July 13, 2007 (PTA)

Reviewed – September 23, 2010, June 17, 2015

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