Physical therapists and wound care

JEWmongous · Mar 10, 2008

I am doing a peer review and poster presentation on wound care and maggot debridement therapy. This guy I'm friends with works for a physical therapist and he claims the DPT is performing surgical debridement on diabetic/pressure ulcers. It doesn't sound too legal to me but I'm curious of your opinions. I did not think phys therapists were trained to do procedures like this...

Dr_Feelgood · Mar 10, 2008

JEWmongous said:
I am doing a peer review and poster presentation on wound care and maggot debridement therapy. This guy I'm friends with works for a physical therapist and he claims the DPT is performing surgical debridement on diabetic/pressure ulcers. It doesn't sound too legal to me but I'm curious of your opinions. I did not think phys therapists were trained to do procedures like this...

I think your friend maybe mistaken. DPTs do a lot of wound care but they are not surgeons.

SportPOD · Mar 10, 2008

JEWmongous said:
I am doing a peer review and poster presentation on wound care and maggot debridement therapy. This guy I'm friends with works for a physical therapist and he claims the DPT is performing surgical debridement on diabetic/pressure ulcers. It doesn't sound too legal to me but I'm curious of your opinions. I did not think phys therapists were trained to do procedures like this...

Well, they can perform debridements of the wound (11042) which is considered a surgical code by CMS. So that may be what your friend is talking about.

JEWmongous · Mar 10, 2008

SportPOD said:
Well, they can perform debridements of the wound (11042) which is considered a surgical code by CMS. So that may be what your friend is talking about.

Thanks for the help. What about prescribing bactroban, regranex, etc for the patient after the treatment? How about apligrafs? Sorry to sound dumb but I am not sure if DPT's have a DEA # to prescribe antibiotics among other medications.

Dr_Feelgood · Mar 10, 2008

JEWmongous said:
Thanks for the help. What about prescribing bactroban, regranex, etc for the patient after the treatment? How about apligrafs? Sorry to sound dumb but I am not sure if DPT's have a DEA # to prescribe antibiotics among other medications.

Another good question, I don't know the answer but I do know that they do not have a DEA number.

Someone can correct me if I'm wrong but no to Apligraf b/c that is sew or stapled to the wound and is done in a surgical suite. I know that they cannot do Dermagraft for sure and that does not require suturing or stapling.

JEWmongous · Mar 10, 2008

Dr_Feelgood said:
Another good question, I don't know the answer but I do know that they do not have a DEA number.

Someone can correct me if I'm wrong but no to Apligraf b/c that is sew or stapled to the wound and is done in a surgical suite. I know that they cannot do Dermagraft for sure and that does not require suturing or stapling.

My friend was pretty adamant that the DPT was doing debridement (scalpel). He even mentioned one case where the infection went into the achilles (kind of serious it seems). The pod I regularly shadow revolves nearly his entire practice on wound care so I've been exposed to a number of treatments for over a year. The thing is, most of the time has the patient on some type of oral or topic antibiotic, along with silvadene, regranex, etc. Of course, I see him using the prescription pad for a number of these things. The reason I'm so curious about DPT's is that I really did not think they have prescribing rights (since they are not a MD/DO, DPM, DDS, NP, PA, some things for OD). It wouldn't make sense to just do a debridement and not be able to prescribe a certain antibiotic if needed.

Let me know what yall think. Thanks!

Dr_Feelgood · Mar 10, 2008

JEWmongous said:
My friend was pretty adamant that the DPT was doing debridement (scalpel). He even mentioned one case where the infection went into the achilles (kind of serious it seems). The pod I regularly shadow revolves nearly his entire practice on wound care so I've been exposed to a number of treatments for over a year. The thing is, most of the time has the patient on some type of oral or topic antibiotic, along with silvadene, regranex, etc. Of course, I see him using the prescription pad for a number of these things. The reason I'm so curious about DPT's is that I really did not think they have prescribing rights (since they are not a MD/DO, DPM, DDS, NP, PA, some things for OD). It wouldn't make sense to just do a debridement and not be able to prescribe a certain antibiotic if needed.

Let me know what yall think. Thanks!

Well the thing that you must understand is one the 11042 is debridement to tendon, subq, ect (11043 is debridement to bone). The second thing that you must understand is oral antibiotics are abused. The pod you shadow should not have people on oral antibiotics unless there is an infection. Think of it this way, 1) you are removing dead tissue which bacteria feeds on, 2) you are doing good local wound care which will decrease the bacterial load, 3) the patients have an immune system. So you are using three "antibiotic" practices everytime you see a patient. It is similar to anitbiotics in surgeon. Research has proved that they are not needed.

SportPOD · Mar 10, 2008

Dr_Feelgood said:
Another good question, I don't know the answer but I do know that they do not have a DEA number.

Someone can correct me if I'm wrong but no to Apligraf b/c that is sew or stapled to the wound and is done in a surgical suite. I know that they cannot do Dermagraft for sure and that does not require suturing or stapling.

No to tissue like substance applications. But yes to sharp debridement and application of bactroban or bacitracin. No to prescribing antibiotics. So, if they're doing more than that, you may want to report them to their board.

SportPOD · Mar 10, 2008

Dr_Feelgood said:
Well the thing that you must understand is one the 11042 is debridement to tendon, subq, ect (11043 is debridement to bone). The second thing that you must understand is oral antibiotics are abused. The pod you shadow should not have people on oral antibiotics unless there is an infection. Think of it this way, 1) you are removing dead tissue which bacteria feeds on, 2) you are doing good local wound care which will decrease the bacterial load, 3) the patients have an immune system. So you are using three "antibiotic" practices everytime you see a patient. It is similar to anitbiotics in surgeon. Research has proved that they are not needed.

Sorry, have to get technical here, 11042 is debridement of subcutaneous tissues (ulcer). 11043 is debridement to muscle or tendon. 11044 is debridement to bone.

Yes, do not abuse antibiotics, this is how resistant bacteria arises and makes it more difficult to treat.

JEWmongous · Mar 10, 2008

Dr_Feelgood said:
Well the thing that you must understand is one the 11042 is debridement to tendon, subq, ect (11043 is debridement to bone). The second thing that you must understand is oral antibiotics are abused. The pod you shadow should not have people on oral antibiotics unless there is an infection. Think of it this way, 1) you are removing dead tissue which bacteria feeds on, 2) you are doing good local wound care which will decrease the bacterial load, 3) the patients have an immune system. So you are using three "antibiotic" practices everytime you see a patient. It is similar to anitbiotics in surgeon. Research has proved that they are not needed.

My bad, I should have emphasized that the pod uses far more topical antibiotics than oral..and obviously, if only there is an infection. A number of the patients are sent to him (referrals) and present initially with infections. I made a mistake with my wording.

What I was getting at with DPT's...what happens if a patient comes regularly for debridement of a diabetic ulcer and the wound begins to get infected. Topical antibiotic agents are not responding. So they must refer out to an MD/DO/DPM who can order a stronger topical (or oral) abx prescription? I am curious about liability issues in this area, especially if their treatment does not work and results in osteo.

Honestly, I had no idea that DPT's could do sharp debridement!

SportPOD · Mar 10, 2008

JEWmongous said:
My bad, I should have emphasized that the pod uses far more topical antibiotics than oral..and obviously, if only there is an infection. A number of the patients are sent to him (referrals) and present initially with infections. I made a mistake with my wording.

What I was getting at with DPT's...what happens if a patient comes regularly for debridement of a diabetic ulcer and the wound begins to get infected. Topical antibiotic agents are not responding. So they must refer out to an MD/DO/DPM who can order a stronger topical (or oral) abx prescription? I am curious about liability issues in this area, especially if their treatment does not work and results in osteo.

Honestly, I had no idea that DPT's could do sharp debridement!

Yes, they should refer out to a physician who can prescribe medications especially when the problem becomes complicated.

krabmas · Mar 10, 2008

I don't want to sound like I think the PT is not capable of doing a debridement. Maybe they are. I did not go to PT school and am not trained to be a PT so I do not know what their training involves.

How is debriding a wound in the scope of practice of a physical therapist?

Again, not questioning capability just logisitics of scope.

diabeticfootdr · Mar 10, 2008

DPTs (or PTs, since DPT is more of a research degree) can debride a wound with a physicians order. Who cares if they do? You're the doctor, you diagnose a fibrotic wound, you recognize the wound requires debridement, you order the wound to be debrided, the wound gets debrided.

DPTs have no clinical privileges above a PT. They cannot apply a medication without a physicians order.

About applying topical antibiotics in the face of an infection .... if there is an infection present, oral antibiotics and frequently IV antibiotics are required. Topical antibiotics are hardly enough to control a diabetic foot infection.

LCR

MaseratiGT · Mar 10, 2008

JEWmongous said:
Thanks for the help. What about prescribing bactroban, regranex, etc for the patient after the treatment? How about apligrafs? Sorry to sound dumb but I am not sure if DPT's have a DEA # to prescribe antibiotics among other medications.

DEA numbers are only required for prescribing controls. O.D.'s can prescribe medications like antibiotics, but hold no DEA number.

beephlatPT · Mar 11, 2008

diabeticfootdr said:
DPTs (or PTs, since DPT is more of a research degree) can debride a wound with a physicians order. Who cares if they do? You're the doctor, you diagnose a fibrotic wound, you recognize the wound requires debridement, you order the wound to be debrided, the wound gets debrided.

DPTs have no clinical privileges above a PT. They cannot apply a medication without a physicians order.

About applying topical antibiotics in the face of an infection .... if there is an infection present, oral antibiotics and frequently IV antibiotics are required. Topical antibiotics are hardly enough to control a diabetic foot infection.

LCR

DPT is actually just an 'upgraded' (supposedly) version of the old PT degrees (i.e. MPT, BSPT) but it is clinical, not research based. Ph.D is still the gold standard degree for research/academia (I think that there's some DSc degrees out there as well). As far as debridement goes, you're dead on: PTs can debride and apply topical meds WITH a doc's order.

dawg44 · Mar 21, 2008

PTs are usually doing debridements at the order of a supervising physician at least they are at present. I put in orders for them to debride what they feel necessary along with whirlpools all of the time. A physician is overseeing the patient so any antibiotics are prescribed by the physician. So they are entirely in their "scope". Its analagous to a nurse putting in a foley or starting an IV. They are following orders.

Physical therapists and wound care

JEWmongous

Member

Dr_Feelgood

SportPOD

Arizona Sports Pod

JEWmongous

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Dr_Feelgood

JEWmongous

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Dr_Feelgood

SportPOD

Arizona Sports Pod

SportPOD

Arizona Sports Pod

JEWmongous

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SportPOD

Arizona Sports Pod

krabmas

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diabeticfootdr

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MaseratiGT

Legilimens!

beephlatPT

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dawg44

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