UNIVERSITY OF GONDAR

College of Medicine and Health Sciences

School of medicine
Department of physiotherapy

STANDARDS FOR

PHYSIOTHERAPY

SERVICES

DRAFT SUBMITTED BY:

 Mr Asmare Yitayeh ( BSC,MSc PT)
 Mr.Balamurugan Janakiraman PT(BPT,MPT,PGCDE)
 Mr Moges Baye (BSc, MSc PT)
 Mr.Gashaw Jember(BSc,MSc PT)

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Safe and effective practice of physiotherapy

Date of Submission: 20 June, 2017

Acknowledgements

The review of draft of standards for physiotherapy was made possible by

the vision, commitment and contribution of staff members of department

of physiotherapy and administrative authorities of University of Gondar

Hospital, College of medicine and health sciences, University of Gondar.

The department level committee, consisting of Mr Asmare Yitayeh PT,

Mr Balamurugan Janakiraman PT, Mr Moges Baye PT, and Mr.Gashaw

Jember PT, were involved in drafting the set of standards that describes

the framework for physiotherapy practice which is client focused.

The draft also meets the needs of the relevant stakeholder groups.

Special thanks are extended to all physiotherapy professionals, CEO of

the hospital, Dean, CMHS, University of Gondar Hospital.

This draft is a sole property of University of Gondar physiotherapy department

Gondar, Ethiopia

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Contents
1. INTRODUCTION.............................................................................................................................4
2. ADMINISTRATIVE STAFFS...................................................................................................................6
2.1 Head, Department of physiotherapy...........................................................................................6
2.2 Head, clinical physiotherapists....................................................................................................8
2.3 Office secretary............................................................................................................................8
2.4 Cleaners and messengers............................................................................................................9
2.5 Both academic and clinical physiotherapy staffs.........................................................................9
3. PATIENT INFORMATION AND INFORMED CONSENT.......................................................................11
4. LEGAL...............................................................................................................................................13
5. TRANSFER OF CARE AND DISCHARGE..........................................................................................13
6. PLAN OF CARE/INTERVENTIONS/TREATMENTS...........................................................................14
7. REFERRAL.........................................................................................................................................15
8. RE-EXAMINATION /RE-ASSESSMENT...............................................................................................15
9. DISCHARGE/DISCONTINUATION OF INTERVENTION/TREATMENT..................................................15
10. DOCUMENTATION...................................................................................................................16
11. EDUCATION /ACADEMIC STAFFS.............................................................................................17
12. RESEARCH................................................................................................................................18
13. COMMUNICATION...................................................................................................................19
14. COMMUNITY RESPONSIBILITY.................................................................................................19
15. INFECTION CONTROL....................................................................................................................20
16. EQUIPMENTS AND BOOKS.......................................................................................................20
17. STAFF (PERSONAL/PROFESSIONAL DEVELOPMENT)................................................................21

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 1. INTRODUCTION
Gondar College of medicine and health sciences has always focused on
consolidation of health care services by improving quality, enhancing sustainability,
improving accessibility and strengthening human resource development and
deployment.

Based on the principle of delivering quality physiotherapy services, physiotherapy

department of University of Gondar has endeavored to draw up standards for
services, equipments, infrastructures/facilities and human resources. The efforts of
the division are approved and appreciated at this point of time as it has come at a
critical juncture where our efforts are geared towards providing quality health care
services.

This document sets out the standards of Physiotherapy service for safe and effective
practice that must be met.The service standards includes generic elements and
profession elements of the physiotherapy service for which the organization is
responsible, in order to maintain the safety and quality of service to customers and
provide an environment conducive to the safety of staff and continuing their
continuing development.

The standards in this document are vital tool and will provide a benchmark against
which the service can be measured, and a framework for an organization to review
and improve its service provision. We will keep these standards under continual
review, and we will update them to take into account changes in practice in the
professions we regulate.

The service standards are intended to apply to all physiotherapists, whether newly
qualified or highly specialized, direct or indirect contact with patients, care givers,
and other professional colleagues. The service standards are not minimum, nor

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standards of excellence, but they are considered to be achievable and expected
to be met.

These standards will help to:-

Define performance expectations for the delivery of quality physiotherapy service.

Provide references for service users regarding performance expectations for
physiotherapists working University of Gondar Hospital.
Provide guidelines for physiotherapists and others in evaluating and maintaining
competence.
Provide a reference for reviewing and resolving professional practice and conduct
issues.
Identify the outcomes that clients may expect when physiotherapists provide
services.

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 2. ADMINISTRATIVE STAFFS

2.1 Head, Department of physiotherapy

i. Responsibilities to members of the department
i A department head have to lead, guide and support members of the
department and to oversee their career development.

ii The department head have to organize and manage staff members towards
achievement of goals.

iii The department head should ensure establishment of a clinical mission and
goals; the recruitment, selection, and retention of key human resources; the
everyday management of patient care services.

iv The department head shall address staff members privacy concern,

continuing education, training, career development, safe working place, recognition
of excellent service, staff promotions and legal benefits.

v The department head shall periodically conduct in-service to review strategies

for improved practice and communication.

vi The department head should monitor and evaluate the discipline and
performance of the staff members periodically
vii A department head have to arrange department meetings on a regular basis
and to keep minutes of these meetings.

viii The department head should review and circulate department policies to the
staff members.

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 ix A department head should delegate departmental duties by agreement with
regard to each colleague’s interests, abilities and his/her overall commitment to the
department.
x A department head should provide job descriptions for assistants, secretaries
and technicians where appropriate and direct their work.
xi A department head have to monitor and evaluate academic staffs of
physiotherapy department.
xii Accept suggestions from customers and colleagues.

xiii The department head shall be responsible for dissemination of client records,
logs, staff activity and budget reports to the office of higher attorney.

xiv The department head must involve and encourage research planning process
in the institution.

xv The department head is accountable for implementing the components of

department budget.

xvi The head shall have the authority to warn and issue memo to staffs members
on unethical behaviour and not committed or breach of duty.

xvii .The head of the department shall execute confidentiality of patient

information and certain bureaucracy records.

ii. Budget, Resources and Planning

i In consultation with the dean of college of medicine and health sciences the
department head has to prepare the annual budget request and has to manage
the resources.
ii The head of the department should organize, arrange, plan and divide the
activities of the department to each academic staffs.
iii The head of the department should periodically report to deans office and
/school of medicine.
iii. Program and schedules

2. The department head should prepare and maintain a detailed schedule of

duty, practise and work at all level for the use of staff members.

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3. The department head shall establish and maintain collaboration with other
institutions and organizations, encourage inter disciplinary [inter professional]
knowledge and skill sharing.

4. The department head should participate and take the lead in Curriculum
developing monitoring and refining.

2.2 Head, clinical physiotherapists

The head of clinical physiotherapy center:-
i Should lead and coordinate center.
ii Should organize, arrange, plan and divide the activities of the center to each
clinical staffs.
iii Should periodically report to clinical director and /hospital director.
iv Monitor each clinical staff regularly/ periodically.

v Plan / communicate the academic head to create a good working environment

between the clinical and academic staff (integration of the both staff,
consulting).

vi Monitor physiotherapy equipment’s.

vii Weekly meeting and reporting and clinical discussion about the works done
along with the 1-5 ( but still demarcating the differences)

viii Detailed activities has to be written about monitoring and evaluation

ix Collect feedbacks from customers/ specially from the patients

x Communication with other healthcare professionals

xi Monitor the clinical record keeping, documentation and other works done by
the clinical staff

2.3 Office secretary

i. Should assist HOD in drafting official documents.

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 ii. Should maintain records of the department.

iii. Should assist the HOD in maintaining registration of library books, Audio Visual

aids and equipments of the department.

iv. Make sure that the office is open and ready for work before time (she has to

maintain the working hours as per the government policy.

2.4 Cleaners and messengers

1. Should cleanse the equipments, furniture and flooring of the department on all
working day.
2. Should rearrange equipment’s and furniture and clean the department prior to the
working hours (between 1:30-2:00 am local time).
3. Make the working materials such as gloves, blades, cotton, alcohol..etc readily
available for work
4. Should arrive early before the staffs to keep the department prepared for days work.
5. Should transport official document to the respective departments and offices.
6. Should be responsible for the confidentiality and safety of the documents they
transport.
7. Should hand over the received document only to the HOD or delegated head.
8. Should be punctual and regular in office works

2.5 Both academic and clinical physiotherapy staffs

1. Physiotherapists should practise within the legal and ethical boundaries of
their profession.

1.1.Physiotherapist should practise in a non-discriminatory manner, maintain

confidentiality and exercise a professional good duty of care.
1.2.Academic and clinical staffs should complement each other’s work and present
united front towards development of profession.

2. Physiotherapists should respect the rights of services of good quality

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A. Physiotherapist shall conduct appropriate evaluation with documentations and
deliver appropriate management with optimal setting of timescales
Appointment card has to be given to OPD patients

B. Patient handover from a therapist to therapist should be clear and with detailed
explanation.

C. If the therapist cannot make it work with a justifiable reason, he/ she shall call
his/ her immediate boss and allocate other therapist for the patients to be
treated.

D. Patient transfer has to be done based on the agreement between the two
therapists

E. Patients discharges has to be done based on the assessment of the therapist

which is very important (after re-evaluating and reassessing of the patient)

F. We have to always maintain patients confidentiality at any point in our care plan

G. The treatment time for the patient before treatment has to be 45 minutes

H. New patients has to be contacted within 15 minutes before they are told

I. Patient appointment has to be very strict

J. Physiotherapists should respect the rights and dignity of all individuals

K. All persons who seek the services of physiotherapists have the right to service
regardless of age, gender, race, nationality, religion, ethnic origin, religion,
sexual, disability, health status or politics.

L. A patient should be Valued as an individual, treated with dignity and treated

with respect.

1.1. Physiotherapists comply with the laws and regulations governing the practice

of physiotherapy in the country in which they work and the WCPT ethical

principles.

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1.2. Physiotherapists accept responsibility for the exercise of sound judgment

1.3. Physiotherapists are professionally independent and autonomous

practitioners.

1.4. Physiotherapists make independent judgments in the provision of services for

which they have knowledge and skills and for which they can be held

accountable.

1.5. Physiotherapists shall not delegate any activity which requires the unique skill,

knowledge and judgment of the physical therapist.

1.6. The physiotherapist should consult with the referring medical practitioner if

the treatment programme or a continuation of the programme, are not in

accord with the judgment of the physical therapist.

1.7. In-service training should be given once in two weeks by both academic and

clinical staffs.

1.8. Physiotherapists should provide an honest, competent and accountable

professional service.

1.9. Physiotherapists should be entitled to a just and fair level of remuneration for

their services.

3. PATIENT INFORMATION AND INFORMED CONSENT

3.1. Physiotherapists should provide accurate information to patients/clients,
other agencies and the community about physiotherapy and about the
services physiotherapists provide

i Sufficient information should be provided at the right time to patients to allow

them to fully participate in their care.

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ii The physiotherapist should inform the patient verbally and where required in

written form of the nature and expected duration of treatment, maximum time for

attainable functional recovery.

iii Patients, wherever possible, should be given information as to the

physiotherapy treatments proposed, so that the patient is:

1) Aware of the findings of the examination/assessment

2) Given an opportunity to ask questions and discuss the preferred

treatments, including any significant side effects with the physiotherapists

3) Given the opportunity to decline particular modalities in the plan of

treatment

4) Given the opportunity to discontinue treatment

5) Encouraged to be involved in the assessment process.

iv For patients who are unable to give informed consent, consent is obtained

wherever possible from parents, guardians, or others designated to act on their

behalf.

v Physiotherapists shall participate in public education programmes, providing

information about the profession.

vi Physiotherapists have a duty to inform the public and referring professionals

truthfully about the nature of their service so individuals are more able to make a

decision about the use of the service.

vii Physiotherapists could advertise their services

viii Physiotherapists shall not use false, fraudulent, misleading, deceptive, unfair or

sensational statements or claims.

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 3.2. Physiotherapists should contribute to the planning and development of
services which address the health needs of the community

Physiotherapists have a duty and an obligation to participate in planning services

designed to provide optimum community health services.

Physiotherapists are obliged to work toward achieving justice in the provision of

health services for all people.

3.4. Physiotherapists should demonstrate professional behaviour appropriate

to physiotherapy
Physiotherapists have the absolute responsibility to ensure that their behaviour is at
all times professional, ensuring that the potential for misconduct cannot arise.

4. LEGAL
i The physiotherapist should comply with all the laws and legal requirements of

the University of Gondar, college of medicine and health sciences and

university hospital

ii The physiotherapist should not release patient information to a third party

without consent of the patient or legal authorization.

iii The physiotherapist with first-hand knowledge should report violations by

physiotherapy and other health personnel of laws and legal requirements of the

jurisdiction to his immediate supervisor.

5. TRANSFER OF CARE AND DISCHARGE

5.1 Registration and assessment

I. Every patient visiting the physiotherapy centre should be registered.

II. The physiotherapist card/slip of every registered patient must bear the
minimum following legibly at every visit.
III. Registered patient must bear the minimum following legibly at every visit

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 IV. The physiotherapist should perform an initial examination/assessment and
evaluation to establish a diagnosis and prognosis prior to intervention/
treatment.
V. The patient card has to have appointment dates and number of treatment
days.
VI. The physiotherapist examination should be documented, dated, and
appropriately authenticated by the physiotherapist who performed it
VII. The physiotherapist examination has to identify the physiotherapy needs of the
patient
VIII. The physiotherapist examination should incorporate appropriate tests and
measures to facilitate outcome measurement
IX. The physiotherapist examination should produce data that are sufficient to
allow evaluation, diagnosis, prognosis, and the establishment of a plan of
care/interventions
X. The physiotherapist examination could result in recommendations for
additional services to meet the needs of the patient
XI. The physiotherapist examination has to provide written evidence of the reasons
why no further management has been given to the patient and, when
appropriate, to the family members.

6. PLAN OF CARE/INTERVENTIONS/TREATMENTS
i The physiotherapist should establish a plan of care/interventions/treatments
and manage the needs of the patient based on the examination,
evaluation, diagnosis, prognosis, goals, and outcomes of the planned
interventions/ treatments for identified disabilities (impairments, activity
limitations and participation restrictions) and/or for prevention, health
promotion, fitness, and wellness.
ii The physiotherapist should collaboratively involve the patient and others as
appropriate in the planning, implementation, and assessment of the plan of
care/intervention/treatment.
iii The physiotherapist, in consultation with appropriate disciplines, should plan
for discharge of the patient taking into consideration achievement of anticipated

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 goals and expected outcomes, and provides for appropriate follow-up or
referral.
iv The plan of care should be based on the examination, evaluation, diagnosis,
and prognosis and informed by current evidence
v The plan of care should identify goals and outcomes
vi The plan of care should describe the proposed intervention/treatment, including
frequency and duration.

7. REFERRAL
1. The physiotherapist should inform and refer the patient to the appropriate
practitioner/professional if the examination, diagnostic process, or any change in
status reveals findings outside this scope of knowledge, experience, and/or
expertise.

8. RE-EXAMINATION /RE-ASSESSMENT
1. The physiotherapist should re-examine the patient as necessary during a
treatment session to evaluate progress or change in patient status and modifies
the plan accordingly or discontinues physiotherapy services.

2. The physiotherapist re-examination should be documented, dated, and

appropriately authenticated by the physiotherapist who performs it

3. The physiotherapist re-examination could include modifications to the plan of

care/intervention/treatment

9. DISCHARGE/DISCONTINUATION OF INTERVENTION/TREATMENT

i The physiotherapist should discharge the patient from physiotherapy services

when the anticipated goals or expected outcomes for the patient have been
achieved.
ii The physiotherapy team/ board should discharge some patients who refuse to
be discharged

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 iii The physiotherapist should discontinue intervention/treatment when the patient
is unable to continue to progress toward goals or when the physiotherapist
determines that the patient will no longer benefit from physiotherapy.
iv The physiotherapist should recognize that the patient has a right to discontinue
treatment/intervention at any time.
v The reason and refusal of physiotherapy intervention has to be documented
and signed by the treating physiotherapist and attached to the patients chart

10. DOCUMENTATION

1. The physiotherapist should clearly document all aspects of patient

care/management including the results of the initial examination/assessment

and evaluation, diagnosis, prognosis, plan or care/intervention/treatment,

response to intervention/treatment, changes in patient status relative to the

interventions/ treatment, re-examination, and discharge/discontinuation of

intervention and other patient management activities.

2. Physiotherapists should ensure that the content of documentation is accurate,

complete, and legible and finalized in a timely manner.

3. Physiotherapists should ensure that the content of documentation is dated and

appropriately authenticated by the physiotherapist

4. Physiotherapists should ensure that the content of documentation should have

records of equipment loaned and/or issued to the patient.

5. Physiotherapists should ensure that the content of documentation includes

when a patient is discharged prior to achievement of goals and outcomes, the

status of the patient and the rationale for discontinuation

6. . Physiotherapists should ensure that the content of documentation includes

reference to appropriate outcome measures, where possible.

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7. Physiotherapists should make sure that documentation is used properly by

ensuring it is stored securely at all times in accordance with legal

requirements for privacy and confidentiality of personal health information.

8. Physiotherapists should make sure that patients document should only

released, when appropriate, with patient’s permission.

9. Summary of the patient assessment and treatment has to be kept in the chart

while the patients are discharged.

10. The detailed assessment of the patient of the OPD has to be kept on the shelf in

OPD.

11. EDUCATION /ACADEMIC STAFFS

1. Academic staffs of physiotherapy department should Develop, monitor and

refine the clinical education component of the curriculum.
2. Academic staffs of physiotherapy department should facilitate quality learning
experiences for students during clinical education.
3. Academic staffs of physiotherapy department should evaluate students’
performance, in cooperation with other staff members
4. Academic staffs of physiotherapy department should educate students, clinical
and other academic staff members about clinical education.
5. Physiotherapists have to select clinical learning environments that demonstrate
the characteristics of sound patient/client management, ethical and
professional behavior, and current physical therapy practice.
6. Physiotherapists have to maximize available resources for the clinical
education program
7. Engaging core faculty members in clinical education planning, implementation,
and assessment.
8. A physical therapist should support high-quality education in academic and
clinical settings.
9. The physiotherapist should educate and provide consultation to other health
professionals regarding the purposes and benefits of physiotherapy.

17
10. The physiotherapist should contribute to the education of the public.
11. The physiotherapist should educate and provide consultation to consumers, the
general public, community organizations, clubs, and associations regarding the
purposes and benefits of physiotherapy, and the roles of the physiotherapist
and other support personnel.

12. RESEARCH

1. Physiotherapy staff should involve themselves in developing research proposal,

employ scientific and evidence based practise so as to integrate best research
evidence with clinical expertise.

2. All physiotherapy staff should involve in research activity or supporting research

activities or by assisting those engaged in research, publishing, assessing new
concepts and techniques.

3. Academic and clinical physiotherapists have to collaborate to conduct clinical

research to advance the science of physiotherapy appropriate to individual
education, experience, and expertise.

4. Physiotherapist should create a structure to sustain clinical research and provide

education and training opportunity to current and future researchers in
physiotherapy.

5. The researchers have to form a database of all research activity or present it to

other staff members.

6. All physiotherapists participating in research shall abide by ethical standards

governing protection of human subjects and dissemination of results. The
physiotherapist.

7. A physiotherapist Has to ensure that his/her knowledge of research literature

related to practice is current.

8. A physiotherapist has to ensure that the rights of research subjects are

protected, and the integrity of research is maintained.

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9. A physiotherapist should educate physiotherapists, students, other health
professionals and the general public about the outcomes of physiotherapy
research.

13. COMMUNICATION
i The physiotherapist should communicate and coordinate verbally and non
verbally with all aspects of patient management including the results of
the initial assessment and evaluation, diagnosis, prognosis, plan of treatment,
response to treatments, re-examination, and discharge/discontinuation of
treatment .
ii The physiotherapist should provide the patient or parents, guardians, or others
with relevant, clear, concise written and verbal information.
iii The physiotherapist, when communicating with appropriate family members,
should respect the wishes of both the patient and family members.
iv The physiotherapist should communicate with other physiotherapists to ensure
continuity of effective patient services and facilities.
v The physiotherapist, when communicating with members of a multi-professional
team should provide results for the patient, ensures that information is both
sought and communicated promptly and clearly within the team.

vi Physiotherapists have to follow ward rounds wherever they are posted and
allocated and create awareness about physiotherapy services and how we care
for the patients to Doctors and other healthcare professionals

vii Physiotherapist should develop standard terminology, documentation format or

reporting format important for communication with colleagues, other health care
professionals and patents.

viii Physiotherapist should have regular and ongoing communication with

colleagues regarding patient’s status.
ix Physiotherapist shall regularly involve in developing their communication skills
and judiciously use it among colleagues, patients and care givers.

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 14. COMMUNITY RESPONSIBILITY

The physiotherapist should take an active part and demonstrate community

responsibility by, for example, by participating in community activities, educating
public, assisting and advocating in formulating public policy including community
accessibility to people with disabilities, providing consultative services for the
public health infrastructure, or providing voluntary community services .
Academic staffs should treat their patients during clinical practice sessions and
whenever necessary should handover/transfer to clinical staffs after the end of the
practical sessions.
Physiotherapist should take an active part in community based rehabilitation
Physiotherapists should participate in community outreach activities.
Physiotherapists should endeavour to support activities that benefit the health status
of the community.
Physiotherapist should create an awareness of social responsibility, citizenship, and
advocacy, including participation in community and service organizations and
activities.

15. INFECTION CONTROL

a) The physiotherapy department should take all precautions to control infections

like practicing hand hygiene etc.

b) Availability of clean water for hand washing /liberal use of sanitizer should be

maintained throughout the working hours of the physiotherapy center.

c) Sanitation and hygiene of the toilet should be maintained.

d) Cleaning of all patient care areas with disinfectant should be done at least once a

day.

d) We have to use gloves only when appropriate and glove disposal box has to be

available in all corner of the department

e) All physiotherapists must have towel in their pocket

f) The department needs safety box to dispose sharp materials

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 16. EQUIPMENTS AND BOOKS

I. Equipments should be inspected and maintained routinely.

II. Where equipment and or books is/are borrowed, there should be a
documentation with signature
III. Appropriate personnel should be called for installation of equipment and
whenever there is a breakdown.
IV. Equipments and books must be handled with care by physiotherapy service
providers.

V. Borrowed materials including books must be returned within the time frame.

17. STAFF (PERSONAL/PROFESSIONAL DEVELOPMENT)

The physiotherapist should be responsible for individual professional development

and must maintain a high level of professional competence by continued

participation in varied learning experiences.

The physiotherapist should identify his/her learning needs with support from

appropriate peers/managers

The physiotherapist should continue to update and extend his/her knowledge and

skills through a variety of learning opportunities and keeps up to date with

developments in research and evidence based practice.

The physiotherapist should be an active participant of an in-service training program,

case presentations, journal club and ethio-physio news letter preparation systems of

the department

The physiotherapy department should have a written plan that provides for

appropriate and ongoing staff development according to the staff development of

university of Gondar.

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The staff development plan:

a).Include self-assessment, individual goal setting and organizational needs

b) Should include strategies for lifelong learning and professional and career
development.

c) Should be focused on specialization on musculoskeletal physiotherapy, pediatric

physiotherapy, sports physiotherapy, neurological physiotherapy, cardiopulmonary
rehabilitation Obstetrics and gynecology Physiotherapy, etc.

22
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