Background: Occupational therapy is the scientifically-based use of purposeful activity that maximizes independence, prevents disability, and maintains the health of individuals who are limited by physical injury or illness, psychosocial dysfunction, developmental or learning disabilities, or the aging process. Some examples of the practice of occupational therapy include: using specifically-designed activities and exercises to enhance neuro-developmental, cognitive, perceptual motor, sensory integrative, and psychomotor functioning; administering and interpreting tests such as manual muscle and sensory integration; teaching daily living skills; and adapting environments for persons with disabilities.

An occupational therapist is a person licensed by the Board of Occupational Therapy Practice (Board) to practice occupational therapy. An occupational therapy assistant is a person licensed by the Board to assist in the practice of occupational therapy under the supervision of, or with the regular consultation of, a licensed occupational therapist.

Statutory provisions do not list wound care as within the scope of practice of occupational therapists or occupational therapy assistants. The Board has issued an informal opinion stating occupational therapy includes wound care management, and has considered adopting an official interpretive statement that occupational therapy includes wound care management and sharp debridement (the removal of dead or contaminated tissue from a wound). In response to a draft interpretive statement issued by the Board, the Attorney General issued an opinion concluding that sharp debridement is not included in the scope of practice for occupational therapists. The Attorney General's opinion did not address the issue of whether wound care in general is within the scope of practice.

Summary of Bill: Wound care is made part of the scope of practice of an occupational therapist. An occupational therapist may provide wound care management under the referral and direction of a physician or other authorized health care provider. The referring provider must examine the patient prior to the referral.

Wound care management is defined as the part of occupational therapy treatment that facilitates healing, prevents edema, infection, and excessive scar formation, and minimizes wound complications. Wound care includes: assessment; application of dressings and topical medications; cleansing; and sharp debridement, which is defined as the removal of devitalized tissue from a wound with scissors, a scalpel, and tweezers without anesthesia.

Wound care may also be provided by an occupational therapy assistant under the direct supervision of an occupational therapist. The supervising occupational therapist must be on the premises and quickly and easily available, and must have examined the patient. Wound care services by an occupational therapy assistant are more limited than those provided by an occupational therapist.

In order to perform debridement, an occupational therapist must have specialized training. Training in debridement may be provided through entry-level or continuing education, mentoring, co-treatment, and observation.

In order to be authorized to perform wound care, including sharp debridement, an occupational therapist must submit an affidavit to the Department of Health (DOH) attesting to his or her education and training (an occupational therapist whose practice meets the educational and training requirements as of the effective date of the act must submit his or her affidavit to the DOH by July 1, 2011). The requisite amount of training varies depending on the type of wound care involved.

The education and training requirements may also be satisfied if the occupational therapist is certified as a hand therapist by the Hand Therapy Certification Commission or as a wound care specialist by the American Academy of Wound Management, the National Alliance of Wound Care, or equivalent organization approved by the Board.