Patient safety is an important concept in physiotherapy practice. Physiotherapists work to improve the lives of their patients – they should not cause further harm.

Applying patient safety principles helps patients feel safe and may prevent something bad or unpleasant from happening. After reviewing some patient concerns, our Practice Advisors created the following list of tips to help you maintain patient safety, reduce risks and improve patient outcomes.

1. Use professional communication

Communication is often referred to as the “go-to clinical skill.” In fact, the majority of complaints that the College considers are related to communication in some way.

Your choice of words, tone of voice, and different communication methods (in person conversations, email, text, printed handouts, exercise graphics, etc.) can be effective (or ineffective) ways of sharing information with patients. When communication is done well and kept professional, patients can be empowered to actively engage in their care. Their feedback and engagement will drive the direction of the care plan.  

 •  Communication is a learned skill that takes practice.

 •  Consider role playing with a peer to help improve your communication.

 •  Practice using clear and concise language and avoiding jargon.

 •  Confirm with your peer their understanding of what you intended to communicate.

 •  Ask them for feedback on the clarity of your message, spoken pace, and your non-verbal style.

With practice, effective communication can be learned and improved. Review the Communication Skills resource for more information.

2. Understand the concept of power imbalance in a therapeutic relationship

Do you routinely check in with the patient throughout the treatment session to ensure they’re feeling safe and comfortable?

There is an inherent power imbalance in the therapeutic relationship.

 •  To support patient safety, you must ensure patients understand the proposed treatment, the reasons why that treatment is being proposed, the risks and benefits of treatment, as well as alternatives that can be considered. This is known as consent.

 •  The patient must consent to any clinical touch before you start an assessment or treatment. Never assume patients already know what is going to happen in a physiotherapy session.

 •  Be sure to check in with the patient during treatment and pay attention to their body language. Ask if they’re ok, if they need a break or if they want to try a different approach.

Review the Boundaries and Sexual Abuse Standard and Consent resource for more information.

3. Slow down and consider the risks to the patient

Remember to pause and consider the risks to the patient from the proposed treatment or modality. Before applying anything (electrotherapy modality, hot pack, etc.), you should identify any risks to the patient, such as:

 •  What medication is the patient on?

 •  Are there potential contraindications to treatment?

 •  Is there any medical history that might impact the proposed care?

 •  Did you complete a skin sensation test on the area of the body that will be treated?

 •  Did you provide ways for them to call for help if needed? For example, a call bell given to the patient.

Also create a patient safety management plan which helps to identify the anticipated risks in your setting and how to manage any safety incidents.

4. Be certain equipment is maintained and tested frequently

Do you know how the equipment you use in treatment is maintained and kept safe?

Equipment, which includes things like hydrocollators and electrode pads, should be inspected, maintained, and serviced according to the manufacturers’ guidelines, health facility’s policies, and College standards.

Equipment that is not maintained and tested properly could pose a risk to patient safety. Review the Infection Control and Equipment Maintenance Standard for more information.

5. Make sure you understand privacy requirements  

All physiotherapists should understand the role of the Health Information Custodian (HIC) or the agent of the HIC, as detailed in The Personal Health Information Protection Act (PHIPA).

 •  You should know if you are the HIC or an agent of the HIC

 •  You should be able to describe what is included in patient health information and how your workplace protects a patient’s privacy.

 •  You should read the HIC's policies, including the processes at your workplace for collecting, accessing, maintaining, or releasing patient information and the steps to take if there is a privacy breach.

Review the Privacy resource for more information.

6. Follow current and generally acceptable Infection Prevention and Control Policies

You should keep up to date on acceptable Infection Prevention and Control (IPAC) practices. Be sure to visit Public Health Ontario – they have resources to help you learn more about best practices in IPAC.

Physiotherapists must understand their role in infection prevention and control. You must have written policies on IPAC and apply them to your practice setting even if your employer doesn’t have them in place. Review the Infection Control and Equipment Maintenance Standard for more information.

7. Prioritize self-care

It may seem counter-intuitive, but your mental, physical and emotional wellbeing are important for patient safety. Remember to look after your health and seek support as needed.

Burnout can lower a person’s brain function and affect their clinical decision-making, memory, and attention. Higher levels of burnout are associated with patient dissatisfaction and an increase in complaints.

Consider short periods of exercise, connecting with friends and family, taking lunch away from the computer, and meditation. More suggestions and resources are available in our blog: Patient Care Begins with Self-Care: Mental Health Supports for PTs.