Facilty & Community Based Tx Settings Flashcards
(30 cards)
Acute Care
Emergency department (ED) or direct admit Diagnostic related group's DRG's determine LOS (about a 5 day stay- insurance losses $ if d/c isnt met by day 5 unless its a variance)
Acute Care Services
cardiac pulmonary gen med oncology pediatrics (NICU) neurology (ICU) trauma orthopedics burns surgery (ICU) AIDS
Acute Care Services : Pro’s
Variety of pts.
Fast paced, interesting
Expand clinical skills
Less repetition & boredom
Acute Care Services : Con’s
Lots of evals & Screenings
less intensity of tx development
Fast pace
Illness/co-morbidities or pt. may be limiting
Skills of an Acute Care OT
Broad knowledge of eva;/tx (less formal)
Knowledge of medical procedures, tests, medical complications
d/c planing skills
community resources
think of feet quickly
adaptable
flexible
good organization & problem solving skills
Categories of Acute Care population
Single episode/injury
Acute phase of long term injury (SCI, TBI)
Chronically ill person w/ acute exacerbation
Admit for invasive, diagnostic tests, regulation of meds
Acute Tx Focus
mobility endurance building (dowel/towel HEP) ADL's (feeding, grooming, tolieting) Splinting Positioning Edema reduction ROM Sensory stim Cognitive/perceptual stim & training (A&Ox3) Strengthening Motor control
Acute care assessments
Care maps/critical pathways (time logs for referales, prevents DRG’s)
Brieif checklist
Observations are critical
Completed w/in 1st tx session (must be completed that day even if you need to go off pts. report)
Acute Care Documentation
Per session d/c panning starts from visit 1 -home care -rehab -out pt. -SNF Document pt. report of caregiver A
Rehabilitation: Overview
Interdisciplinary approach
Long or short-term
DRG expempt
75% of clients must fall into certain Dx categories or they will lose their funding
Pt. criteria for reab
Needs 24 hour nursing/medical care (D w/ medication, transfers, ambulation, cathiterization)
3 hr rule (5-6 days a week, speech does not qualify)
Potential to make gains in reasonable part of time (subacute is more slow paces than rehab: consider pts. cognitive, perceptual, tolerance and anxiety levels)
MOTIVATED TO PARTICIPATE
home for d/c
Rehab Features
Specialty units Simulated home settings -easy st (makeshift community in the hospital), apt. Home assessments Home visits Pt/family ed Vocational rehabilitation
Rehab tx focus
ADL's, endurance Mobility, balance Strength, UE function Coordination, Trunk Function Visual-perception, cognition Adaptive equipment, community re entry Acceptence of disability Maximize quality of life (self-concept, roles)
Rehab Documentation
Initial eval: may extend past 1st visit (facility dependent)
Weekly/daily progress notes/goal modification
Monthly re-evaluation notes/goal modification
D/C summary: in depth progress summary: includes- pt. needs, where they are going, adaptive stratagies/equipment, goals the were met & unmet, follow up services needed.
Pt. criteria for subacute rehab
Receive a min of 150 minutes of tx per week (low rehab to ultra high rehab): they do not need daily OT/PT
Must show pt. will improve every 30 days (avoid sending pt. who are at their baseline)
Good option for pts. who need less intensive tx than rehab or who can not tolerate rehab
Focus is similar to rehab
Homecare : Overview
Pt who are d/c from various settings
Home bound: pt can not easily get out of their home (i.e. getting outside is taxing, complicated, or unsafe)
Case must be opened by either PT or nursing
Medicare allows a 60 day period per referral (can recertify past 60 day mark)
Goals set within this or recertiication is done (goals need to be recertified every 8 weeks)
Homecare Tx Focus
Transition fro hospital stay (help pts. avoid going back to their poor behaviors) ADL performance (*toileting) Functional mobility Strengthening Endurance building Safety/Judgement Motor control HEP (to maximize A/IADL's) Pt/family/HHA education Resumption of roles Problem-solving
Homecare : Pro’s
natural setting tranistion personalized holistic flexible
Homecare: Con;s
less tools & equipment isolated pt. depression lack of support paperwork
Homecare documentation
Per visit
Functional re-assessments; every 30 days
montly re evaluation
d/c summary- short & less detailed
Notes are computerized & vital signs are monitored every visit
Out pt. OT : Overview
90% are hand pts. 10% tend to be neuro pts. Tx frequency 2-4x weekly Pt. need to have transportation Need for increased exercises Pt. should be able to carry over HEP
Out pt. Tx focus
HEP, strengthening
ADL: more specific (i.e. hand function/feeding)
coordination
Cognition/Perception
ROM, motor control
Cognitive/perceptual remediation (sequencing, organizational skills)
Endurance
Out pt. documentation
Per visit (increased time is spent on documentation, usually completed on the spot)
Monthly re-evaluations (may be done more frequently than monthly - ROM, Edema)
d/c summary: track of progress, services
Most tx need pre-approval by insurance company
Physican must approve d/c
Nursing Home (SNF) : overview
Either temporary or permanent placement (d/c to appropriate age population if possible)
Good for pts. with decreased tolerance and slow progression
Restorative skill directed
Group/individual tx (group only 25% of the time)
Maintenance
Prevention/wellness focus (falls, secondary issues due to diabetic issues)
OT as “outside contractor”
