Standard 18: Physiotherapy

Why it matters. Physiotherapy starts with a clear picture of the patient’s problem, function and goals. Without an assessment before treatment, the treatment is guesswork and cannot be measured later.

Sample. Review 10 completed assessments in the last 3 months, and the assessment template in use.

1. Each patient is assessed before treatment begins.

Method. Check each sampled record for an assessment dated before the first treatment.

Evidence to show. Physiotherapy assessment record (PHY-FRM-001).

Pass when. Every sampled patient has an assessment before the first treatment.

2. Each assessment records the problem, goals, contraindications and red flags.

Method. Check each assessment for the four items.

Evidence to show. Physiotherapy assessment record (PHY-FRM-001).

Pass when. Every assessment has all four items recorded.

3. Each red flag is referred to a doctor, and the goals are agreed and recorded.

Method. Check each red flag for the referral, and each assessment for the agreed goals.

Evidence to show. Physiotherapy assessment record (PHY-FRM-001).

Pass when. Every red flag has a referral recorded, and every assessment has agreed goals.

Immediate fail (any one means the criterion is not met)

• Treatment starts with no assessment on file.

Why it matters. Physiotherapy is a skilled service. Patients are safe when treatment is given by qualified staff, and when assistants work only within the scope set for them and under supervision.

Sample. Review the qualification and scope register for all staff who treat patients, and the supervision record for the last 3 months.

1. Each physiotherapist’s qualification is verified and current.

Method. Check each entry for the verification date and expiry.

Evidence to show. Qualification and scope register (PHY-REG-001).

Pass when. Every physiotherapist has a verified, current qualification.

2. Each assistant has a written scope of practice.

Method. Check each assistant for the scope recorded and approved.

Evidence to show. Qualification and scope register (PHY-REG-001).

Pass when. Every assistant has a written scope.

3. Each assistant’s treatment is supervised within that scope.

Method. Check the supervision record and the treatments by assistants in the period.

Evidence to show. Qualification and scope register (PHY-REG-001).

Pass when. Every assistant treatment is within scope and supervised.

Immediate fail (any one means the criterion is not met)

• An assistant treats a patient alone beyond their scope.

Why it matters. Physiotherapy methods vary, and some do more harm than good when used without evidence. Following current guidance protects patients and shows that choices are made on reasons, not habit.

Sample. Review the clinical guidance register and 5 treatment plans, each with the reason for the intervention.

1. Each main condition has current guidance recorded.

Method. Check each condition on the register for the guidance and its review date.

Evidence to show. Clinical guidance register (PHY-REG-002).

Pass when. Every main condition has guidance within its review date.

2. Each intervention is based on the guidance.

Method. Check each sampled plan for the guidance it follows.

Evidence to show. Treatment plan record (PHY-FRM-002).

Pass when. Every sampled intervention follows recorded guidance.

3. The reason for each intervention is recorded.

Method. Check each sampled plan for the reason recorded.

Evidence to show. Treatment plan record (PHY-FRM-002).

Pass when. Every intervention has a reason recorded.

Immediate fail (any one means the criterion is not met)

• A treatment method is used because it has always been used.

Why it matters. A treatment without measured progress cannot be shown to work, and it is easy to continue for months with no benefit. Measuring progress at set intervals tells the team when to change the plan.

Sample. Review 5 patients with an ongoing course of treatment, and their progress records.

1. Progress is measured at the set interval against the agreed goals.

Method. Check each progress record for a measure at each interval.

Evidence to show. Progress record (PHY-FRM-003).

Pass when. At least 90% of intervals have a measure recorded.

2. Where progress stops, the plan is changed and the change recorded.

Method. Check each stalled progress entry for the plan change.

Evidence to show. Progress record (PHY-FRM-003).

Pass when. Every stalled progress entry has a plan change recorded.

3. Where Module 4 applies, validated functional outcome tools are used.

Method. Check the measures used against the validated tools list in Module 4.

Evidence to show. Progress record (PHY-FRM-003).

Pass when. Every measure is a validated tool where Module 4 applies.

Immediate fail (any one means the criterion is not met)

• A patient is treated for months with no measurement.

Why it matters. Therapy equipment that is dirty or faulty can infect or injure the patient. Keeping it clean and taking faulty items out of use is what keeps treatment safe.

Sample. Review the equipment fault and cleaning log for the last 30 days, and walk through the treatment area.

1. Equipment is cleaned after each patient.

Method. Check the log for a cleaning entry after each patient.

Evidence to show. Equipment fault and cleaning log (PHY-REG-003).

Pass when. At least 95% of patient sessions have a cleaning recorded.

2. Faulty equipment is labelled and taken out of use.

Method. Check each recorded fault for the label and the removal.

Evidence to show. Equipment fault and cleaning log (PHY-REG-003).

Pass when. Every fault is labelled and taken out of use.

3. Equipment in use at the walk-through is clean and in working order.

Method. Check the equipment in use at the visit.

Evidence to show. Equipment fault and cleaning log (PHY-REG-003).

Pass when. No faulty or uncleaned equipment is in use.

Immediate fail (any one means the criterion is not met)

• A faulty machine is used on a patient.

Why it matters. Most of a patient’s progress happens between visits. Written advice and exercises that the patient understands and can follow at home make the treatment last beyond the clinic.

Sample. Review 5 patients’ home advice records, and the written advice given to each.

1. Each patient is given written advice and exercises to continue at home.

Method. Check each sampled record for the written advice given.

Evidence to show. Home advice record (PHY-FRM-004).

Pass when. Every sampled patient has written advice recorded.

2. The advice is explained to the patient.

Method. Check each record for the explanation recorded.

Evidence to show. Home advice record (PHY-FRM-004).

Pass when. At least 95% of records show the advice explained.

3. Understanding is checked by teach-back.

Method. Check each record for the teach-back recorded.

Evidence to show. Home advice record (PHY-FRM-004).

Pass when. At least 90% of records show teach-back checked.

Immediate fail (any one means the criterion is not met)

• A patient is sent home with no written advice.

Why it matters. A service that does not look at its own outcomes cannot tell whether it is working. Reviewing outcomes regularly and using the results to change the service is how physiotherapy improves.

Sample. Review the outcome review register for the last 12 months, and the changes made from each review.

1. Treatment outcomes are reviewed at a set interval.

Method. Check the register for a review at each interval.

Evidence to show. Outcome review register (PHY-REG-004).

Pass when. Every interval has a review recorded.

2. Each review result is used to improve the service.

Method. Check each review for a change made.

Evidence to show. Outcome review register (PHY-REG-004).

Pass when. Every review has a change or a reason for no change recorded.

3. Each change is checked for its effect.

Method. Check each change for the check made afterwards.

Evidence to show. Outcome review register (PHY-REG-004).

Pass when. At least 90% of changes show a check.

Immediate fail (any one means the criterion is not met)

• Outcomes are not measured at all.