Flashcards in Facilty & Community Based Tx Settings Deck (30)
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1
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)
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Acute Care Services
cardiac
pulmonary
gen med
oncology
pediatrics (NICU)
neurology (ICU)
trauma
orthopedics
burns
surgery (ICU)
AIDS
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Acute Care Services : Pro's
Variety of pts.
Fast paced, interesting
Expand clinical skills
Less repetition & boredom
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Acute Care Services : Con's
Lots of evals & Screenings
less intensity of tx development
Fast pace
Illness/co-morbidities or pt. may be limiting
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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
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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
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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
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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)
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Acute Care Documentation
Per session
d/c panning starts from visit 1
-home care
-rehab
-out pt.
-SNF
Document pt. report of caregiver A
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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
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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
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Rehab Features
Specialty units
Simulated home settings
-easy st (makeshift community in the hospital), apt.
Home assessments
Home visits
Pt/family ed
Vocational rehabilitation
13
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)
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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.
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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
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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)
17
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
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Homecare : Pro's
natural setting
tranistion
personalized
holistic
flexible
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Homecare: Con;s
less tools & equipment
isolated
pt. depression
lack of support
paperwork
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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
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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
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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
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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
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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"
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SNF Focus
ADL's , positioning
Splinting, endurance
Strengthening, coordination
sensory stim, cognitive
education of HHA/nursing
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Supervising OTA's
sit in on tx settings, read notes, schedule co-treats (2 per month), reg phone or face to face conversations
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Nursing home Documentation
Medicare guideline/forms
Document progress every 30 days
Interdisciplinary care plan meeting occurs quarterly
28
What are some of the medical scenarios that lead pts. to require ICU care
Pt. w the most severe & life threatening illnesses & injuries which require constant monitoring
Trauma pts (TBI, SCI, CVA)
Multiple organ failure, sepsis, respiratory failure
Burns, NICU, pts. w/ comorbidities
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The role of OT in the ICU
ROM, stretching, positioning, splinting
Muscle atrophy occurs immedietly so OT's should maximize strength & endurance exercises, sitting EOB
Protect skin for breakdown
Provide pt. education to A w/ ROM, exercises, trasfers, skin integrity
Check cognition
Sensory stim & relaxation
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