Facilty & Community Based Tx Settings Flashcards Preview

618 Phys Dys 2 Quiz1 > Facilty & Community Based Tx Settings > Flashcards

Flashcards in Facilty & Community Based Tx Settings Deck (30)
Loading flashcards...
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)

2

Acute Care Services

cardiac
pulmonary
gen med
oncology
pediatrics (NICU)
neurology (ICU)
trauma
orthopedics
burns
surgery (ICU)
AIDS

3

Acute Care Services : Pro's

Variety of pts.
Fast paced, interesting
Expand clinical skills
Less repetition & boredom

4

Acute Care Services : Con's

Lots of evals & Screenings
less intensity of tx development
Fast pace
Illness/co-morbidities or pt. may be limiting

5

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

6

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

7

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

8

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)

9

Acute Care Documentation

Per session
d/c panning starts from visit 1
-home care
-rehab
-out pt.
-SNF
Document pt. report of caregiver A

10

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

11

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

12

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)

14

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.

15

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

16

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

18

Homecare : Pro's

natural setting
tranistion
personalized
holistic
flexible

19

Homecare: Con;s

less tools & equipment
isolated
pt. depression
lack of support
paperwork

20

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

21

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

22

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

23

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

24

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"

25

SNF Focus

ADL's , positioning
Splinting, endurance
Strengthening, coordination
sensory stim, cognitive
education of HHA/nursing

26

Supervising OTA's

sit in on tx settings, read notes, schedule co-treats (2 per month), reg phone or face to face conversations

27

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

29

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

30

What are barriers/challanges for OT's working in the ICU

Pt/ are sedated & unresponsive
Scheduling dificulties w/ pts. d/t labs & xrays
Line mangement
What to address 1st w/ complecated pts.
Inadequate staffing and lack of knowledge about OT