Sometimes the answer is easily answered by referring to a law or regulation, but often the question has so many variables that an answer is not simple. The scope of practice of an individual licensed professional is not always the same scope as another individual with the same license.

Most often, an individual practitioner can determine his/her own answer to scope of practice questions. The Board provides this Decision-Making Guide to help licensed professionals ask themselves the right questions - and figure out the right answers to their own scope of practice questions.

The Board is always a resource if the answer is still unclear after a Licensee goes through the process outlined.

The Sample Application of Scope of Practice Decision-Making Guidelines about wound care is an actual question the Board recently reviewed.

Question: "Is wound care/management, specifically use of pulsatile wound lavage,
within the scope of OT practice in MA?"

  1. Is wound care/management using pulsatile lavage specifically permitted or prohibited in statute or Board regulations?
    [ Determine the precise question, then refer to the MA Practice Act(law) and Board regulations]
  2. Is wound care/management using pulsatile lavage taught in basic, entry level OT education programs?
    [ May need to look at core requirements for entry level ed.]
  3. Are there professional association or position statements that support wound care as a treatment modality that is appropriate for an OT who has additional education and training?
    [Professional association standards & Positions are on-line at professional association. web sites]
  4. Is there professional literature and/or research to support this activity as within the Scope of OT practice?
  5. Is this practice within an acceptable standard of care that would be provided by a reasonable & prudent OT with similar education and experience?
    [ Is there a "community standard"?]
  6. Is the OT prepared to accept responsibility and accountability for performing the specific wound care modality competently and safely?

For more information, please read the Allied Health Board Scope of Practice Decision-Making Guide Flowchart pdf format of    scope.pdf


1. Is wound care/management using pulsatile lavage specifically permitted or prohibited in statute or Board regulations?
[ Determine the precise question, then refer to the MA Practice Act(law) and Board regulations]

The statute that defines Occupational Therapy and the Board regulations governing OT practice do not specifically address wound care as an activity within an OT's scope of practice in MA. [ Neither the law or Board regulations either specifically permit or specifically prohibit wound care by an OT. Go to #2]

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2. Is wound care/management using pulsatile lavage taught in basic, entry level OT education programs?
[ May need to look at core requirements for entry level ed.]

Specific wound care modalities are not entry level competencies, but basic OT education related to wound care includes: anatomy and physiology of the integumentary, circulatory and musculoskeletal systems; principles of wound healing; asepsis; and basic nutrition are included in basic OT educational programs. [ Basic education lays the groundwork for the OT to learn specific procedural techniques. Go to #3]

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3. Are there professional association or position statements that support wound care as a treatment modality that is appropriate for an OT who has additional education and training?
[ Professional association standards & Positions are on-line at professional association. web sites]

The American Occupational Therapy Association (AOTA) Position Paper on Physical Agent Modalities defines physical agent modalities as adjunctive methods that produce a response in soft tissue through the use of light, water, temperature, sound or electricity. AOTA specifies that "…exclusive use of physical agent modalities as a treatment method during a treatment session without application to a functional outcome is not considered occupational therapy." An OT must be able to document that he/she has had additional education and training in use of this wound management modality. [ The AOTA supports the use of wound care modalities by OTs - see AOTA Position Statement. Go to #4.]

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4. Is there professional literature and/or research to support this activity as within the Scope of OT practice?

A bibliography for the role of OTs in Wound Management is available from AOTA [ Available from AOTA - licensee could also do own literature search, MED-LINE, CINAHL, etc.]

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5. Is this practice within an acceptable standard of care that would be provided by a reasonable & prudent OT with similar education and experience? [ Is there a "community standard"?]

The OT should be aware of and adhere to the acceptable professional standard of care for performing the modality as well as any agency/facility policies or procedures related to wound care management. [ A reasonable, prudent practitioner would make sure that he/she has the necessary knowledge & skills (or supervision?) and that agency/facility policy allows him/her to do the procedure]

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6. Is the OT prepared to accept responsibility and accountability for performing the specific wound care modality competently and safely?

It is an OT's individual professional responsibility to determine if he/she is ready to accept responsibility for performing the procedure competently and safely. [ Even if all of the above is in place, and the OT has the basic education, has had additional training, is allowed by agency policy - and for some reason (maybe the nature of the patient's condition?) is not prepared to accept accountability, the OT should not perform the procedure]

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