Case Study: Treatment Resulting in Burns

The Scenario

The College receives a variety of complaints, including complaints about alleged burns from electrophysical equipment during treatment. These complaints often include photographs of burn marks in the shape of the applications/pads used. This case study provides registrants with information regarding the importance of taking steps to prevent burns and to provide guidance on how to handle the situation should it occur.

Complaint Case Study

On May 30, 2019, I received physical therapy from Jane Doe to address back pain I was experiencing from of a cycling accident the previous week. This was my first visit to Jane. I was shocked by her incompetence and lack of professionalism. During the appointment, Jane applied TENS pads to my upper back, turned the machine on and left the room for about 20 minutes.

When Jane returned, she removed the pads, mumbled something that I was unable to hear and left. I paid for the treatment and returned to work.

Over the next few hours, the area where the pads had been applied started to itch and hurt.

When I returned home, I looked at my back in the bathroom mirror and was horrified to see burn marks and water blisters in the shape of the TENS pads (see photographs). I went to a walk-in clinic and was diagnosed with first and second degree burns. The doctor applied a topical medicine and bandaged the areas.

When I called Jane’s clinic to tell her what happened, she became defensive and argumentative. Since it was clear to me that she was more interested in covering herself than in making sure I was okay, I just hung up. I don’t want this to happen to anyone else and hope that the College can do something about it.

Relevant Practice Standards

If you decide to use an electrophysical device to treat the patient and obtained their informed consent, review the following practice standards and take the steps necessary to mitigate the risk of burns:

This includes ensuring that the electrophysical device is properly serviced and maintained, as recommended by the manufacturer. If a complaint is filed, the Inquiry Committee of the College will require production of these records.

Good Practice

Along with the Practice Standards requirements, we recommend you follow these guidelines before using an electrophysical device:

  • ask whether any lotions or topical medications have been applied to the treatment area and decide if they may impact the appropriateness of treatment
  • conduct sensation testing
  • follow the manufacturer’s instructions
  • check and record the device settings
  • set a timer (if applicable)
  • monitor the treatment

If you plan to leave the treatment room during an electrophysical treatment, you should inform the patient:

  • how to reach you and how long you will be gone
  • how to reach another qualified therapist if you are not immediately accessible
  • to alert you during the treatment if there is anything that may indicate a problem (e.g. burning sensation, smell of burnt hair, etc.)
  • how to turn down/off or disconnect the device if there is a problem

Adverse Outcome

If you suspect that a patient has been burned by electrophysical equipment during treatment, Practice Standard 16: Risk Management requires you to:

  • recognize the adverse event and respond immediately to minimize the impact on the client
  • disclose the details of the adverse event to the patient promptly and transparently, according to best practice guidelines and employer policies and procedures
  • document the adverse event and complete any reports appropriate to the practice setting

You must also apply your professional judgement in the circumstances using the following principles and professional values from the Code of Ethical Conduct to guide your actions: Respect for Autonomy; Beneficence; Least Harm; and Justice.

Remember that the focus must be on the safety and well-being of the patient.

While not expressly set out in the College’s Practice Standards, we recommend that you:

  1. Inform the patient that you suspect they have suffered a burn and identify the suspected cause.
    Example: “It looks like you may have been burned by the TENS machine.”
  2. Show the patient the suspected burn area, apologize for the incident, and check in with the patient.
    Example: “Let me show you what I mean. I’m sorry this happened, are you experiencing any pain?”
  3. Mitigate any harm by providing first aid to the area (if you are qualified and the patient consents) like applying a cool compress or ointment.
  4. Recommend that the patient seek (immediate, if necessary) medical attention.
  5. Ask the patient’s permission to take a photograph of the area to place in his/her clinical record.
  6. Check the settings on the electrophysical machine and record/photograph for the clinical record (preferably in the presence of the patient) and explain to the patient why you are doing this.
    Example: “I am just going to document the machine settings, so I can follow-up on this.” (See #9 below)
  7. Request the patient’s permission to contact them later by telephone or email to follow-up. If they agree, check in with the patient to see how they are doing until the situation has resolved.
  8. Make a written record of your initial and any follow-up conversations with the patient regarding the incident.
  9. Have the device checked/tested and do not use it again until you have results confirming that it’s operating within proper parameters.

You are not required to inform the College of the incident. However, if the patient files a complaint with the College, you will be notified that the Inquiry Committee has commenced an investigation into the matter. You will be invited to respond to the complaint and required to provide all relevant records.

Additional Resources

The Canadian Physiotherapy Association has the following resources related to this case study:
https://physiotherapy.ca/sites/default/files/cpa_epas_jan-2019.pdf
https://physiotherapy.ca/epa-practical-resource
https://physiotherapy.ca/apology

If you have further questions, please contact the College at (604) 742-6556 or 1-833-742-6556 or info@cptbc.org.

 

Published: June 18, 2019