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I am an RN, clinical manager for a home health company. I have to sign off on plans of care done by clinical staff as part of my job. The problem starts here... We have a physical therapist who has been very difficult to deal with in setting vital signs parameters for vital signs that would be reported to physician. She is pissed off that she has to get a complete set of vital signs, especially o2 sats. To buck the system, she has written her plans of care with o2 sat parameters as low as 70%!!! After lots of drama and nonsense that no professional adult should cause, she has starting writing as 80 or 85%. I am not very comfortable with setting a resting o2 sat parameter at 80 or 85% on any patient, let alone patients with extensive cardiac history, yet this individual thinks she has a right to set her POC parameters where she wants. My question is, since I have to sign off on her plan of care is where does my liability end? If something were to happen to this patient due to therapist not reporting an o2 sat below 89%, am I looking at potential for being sued and or/actions being taken against my license because I signed off on this plan of care? It is part of my job duty to audit OASIS and sign off... and so far, the company refuses to address this clinician. Please advise.

If you have tried to address things directly with the PT then I think you need to go to management/supervisor because this is a patient safety issue.

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Funny how your description pretty much matches a PT I met on the job recently. Very passive-aggressive. Liked to play the "stupid" game with me and would denigrate me in particular, and the other nursing staff in general, to the patient in my presence while simultaneously playing stupid! I would bite my lips until I drew blood while she was in the home, and work around her as much as I could, because I knew that saying anything at all to my supervisors would go nowhere. I concur with the suggestion to allow your boss to sign off on this person's input from now on.

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If you have tried to address things directly with the PT then I think you need to go to management/supervisor because this is a patient safety issue.

This just happened. Discussed with President of our region. She agreed with me 100%. Moving forward wit some backing... thanks for all of the replies.

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Get the written policy covering this in hand from your facility. If there is not one, tell them that there needs to be one because until there is one in writing you will no longer be signing off on care plans for any other discipline. Let the administrator sign off on it because personally I would not do this. You sign off on this and you will be the first person thrown under the bus for negligence when there is a bad outcome from what is nothing more than supervised negligence. Of course they want you to sign off on these care plans, they need someone to scapegoat and they don't want it to be them.

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Get the written policy covering this in hand from your facility. If there is not one, tell them that there needs to be one because until there is one in writing you will no longer be signing off on care plans for any other discipline. Let the administrator sign off on it because personally I would not do this. You sign off on this and you will be the first person thrown under the bus for negligence when there is a bad outcome from what is nothing more than supervised negligence. Of course they want you to sign off on these care plans, they need someone to scapegoat and they don't want it to be them.

Exactly. Thanks!

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Get the written policy covering this in hand from your facility. If there is not one, tell them that there needs to be one because until there is one in writing you will no longer be signing off on care plans for any other discipline. Let the administrator sign off on it because personally I would not do this. You sign off on this and you will be the first person thrown under the bus for negligence when there is a bad outcome from what is nothing more than supervised negligence. Of course they want you to sign off on these care plans, they need someone to scapegoat and they don't want it to be them.

I do legal reviews of medical records and this is EXACTLY what's going on. While you're at it, better go back and check the last couple of years of her work, because the suits don't come in that fast-- usually they take to to five years to develop.

On a possible related note: besides the princess-ism, is there any chance that she could have a vision or hearing deficit she's been covering up? And has somebody checked her credentials lately? For someone who's doing PT she sounds, well, ignorant.

It's common (though sometimes dangerous) to think that SpO2 (percentage of red cells saturated with oxygen, normal 95-100% on room air) is the same as PaO2 (pressure of oxygen in arterial blood, normal 80-100mmHg, or torr, on room air). It is really, really not. While a PaO2 of 92torr on room air is just fine, a SpO2 of 92% is definitely concerning if a new finding and especially if it develops with exertion, like ....PT. Ask her outright, in front of the board who will be reviewing this, to explain the difference, and see if she even knows.

Last, check the scope and standards of practice for licensed PTs in your state. If checking VS and setting parameters isn't in there, you can fire her ass right now.

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Sorry isn't there an attending physician or a medical doctor who has standing orders? Notify them. Look up the facility's policy re and highlight the discrepancy. This is surely dangerous medical practice, so always notify your supervisors and chart your discomfort along with the supervisor's name and their recommendation. This should cover you?

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Specializes in CICU, Telemetry.

Have you asked the PT what her rationale for such low parameters is? E.g. if someone has COPD and their baseline sat is 88% on 2L and MD is okay with that, one would have to expect a lower sat during activity, such as a PT session. This is an example of when I'd be okay with 85% or above, or even 80% for some patients as long as they felt okay.

Using 80% as a baseline parameter for all patients is definitely criminally negligent, though. Since it doesn't seem like your company wants to get rid of this individual, I'd probably try to begin by understanding where she's coming from. She may have a solid rationale, or she may be misinformed, but the only way you're going to find out is to get to the bottom of her thinking process.

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We have agency parameters that we all have to follow. The only exception is if the doctor wants a different set of parameters.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Get the written policy covering this in hand from your facility. If there is not one, tell them that there needs to be one because until there is one in writing you will no longer be signing off on care plans for any other discipline. Let the administrator sign off on it because personally I would not do this. You sign off on this and you will be the first person thrown under the bus for negligence when there is a bad outcome from what is nothing more than supervised negligence. Of course they want you to sign off on these care plans, they need someone to scapegoat and they don't want it to be them.

Can't "like" this enough. They don't want to piss her off but they need a handy scapegoat to throw under the bus. The turd needs to go back in their pocket where it belongs.

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Have you asked the PT what her rationale for such low parameters is? E.g. if someone has COPD and their baseline sat is 88% on 2L and MD is okay with that, one would have to expect a lower sat during activity, such as a PT session. This is an example of when I'd be okay with 85% or above, or even 80% for some patients as long as they felt okay.

Using 80% as a baseline parameter for all patients is definitely criminally negligent, though. Since it doesn't seem like your company wants to get rid of this individual, I'd probably try to begin by understanding where she's coming from. She may have a solid rationale, or she may be misinformed, but the only way you're going to find out is to get to the bottom of her thinking process.

Nah... she does this on every patient. These are ALF residents receiving home health services. These are a bunch of elderly rich folks, none of which are really critically ill. After many arguements and attempts at her trying to set parameters at LITERALLY 70% or 75%.

. Finally did she bring it up to 85%. These are also resting o2 sats/pre-therapy. There is no "thought ptocess". She doesnt feel like a Pt should be responsible for vitals. Her rationale = "I set my parameters low enough, I will never have to be bothered with calling the md or intervening in any way." A copd patient on oxygen at 88% is ready for hospice... not physical therapy. :-) (criteria is literally less than 89% on room air for Copd dx)

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