Competency and Practice Management Flashcards
Beneficence
- safety and well-being of clients
EX.
- Treat each client fairly and equitably
- Advocate for recipients to obtain needed services
- Promote public health and safety and well-being
- Charge fees that are reasonable and commensurate with the services provided
Nonmaleficence
- avoid inflicting harm
EX.
- Obligated to identify and address problems that may impact professional duties and bring concerns regarding professional skills of colleagues to the appropriate authority
- Avoid any relationships, activities, or undue influences that may interfere with services
Autonomy
- privacy and confidentiality
EX.
- Collaborates with clients and caregivers to determine goals
-Informs clients of the nature, possible risks, and outcomes of services
-Receives informed consent for services
-Respects a client’s decision to refuse treatment
-Maintains confidentiality concerning information
Justice
fairness and objectivity in OT services
ex.
- OT practitioners must advocate for their clients and provide opportunities for their clients to
participate equally in occupations.
- Advocate for clients, promote activities for all patients, provide services to all regardless of race,
socioeconomic status, religion, or culture, educating about the value of occupational therapy services.
Veracity
- provide comprehensive, accurate, and objective information
- telling the truth
Fidelity
- faithfulness
- treat people with respect and fairness
ex.
- Maintaining confidentiality in matters related to colleagues and staff
-Accurately representing qualifications, views, and findings of colleagues
- Reporting any misconduct to the appropriate entity
OT role in abuse
- have to report any possible abuse
- report to site supervisor at minimum
OT intervention for abuse
-treatment for physical and emotional injuries
- development of a trusting relationship
-provision of support to family and loved ones
-referral to appropriate disciplines and agencies
- contributor to staff training programs to prevent abuse
AOTA
- contains Code of Ethics
- informing and educating members about current ethical issues
- upholding the practice and education standards of the profession
- monitoring the behavior of members
-reviewing allegations of unethical conduct
NBCOT
- certifies therapists
State Regulatory Boards (SRBs)
- protect the public from potential harm that might be caused by incompetent or unqualified practitioners
- have the authority by law to discipline members of a profession if the public is
determined to be at risk due to malpractice - intervene in situations where the individual has been convicted of an illegal act that is directly connected with professional practice (fraud or misappropriation of funds through false billing practices)
direct supervision
- face to face
- -includes co-treatment, observation, instruction, modeling and discussion
Indirect supervision
- no face to face contact between supervisor and supervisee
- includes electronic, written and telephone communication
types of supervision
- supervision of OT by more experienced OTs is RECOMMENDED NOT REQUIRED
- Close- daily, direct contact
- Routine- direct contact every 2 weeks
- General- at least monthly contact
- minimal- provided only as a needed basis
Intradisciplinary team
- one or more members of one discipline evaluate, plan, and implement treatment of the individual
- Other disciplines are not involved; communication is limited, thereby limiting perspectives on the case
multidisciplinary team
- A number of professionals from different disciplines conduct assessments and interventions independent from one another
- limited communication
- COMMONLY SEEN IN ACUTE CARE SETTINGS
interdisciplinary team
- interactive and cooperative
- program planning carried out by group
- COMMONLY SEEN IN INPATIENT REHAB
transdisciplinary team
- Ongoing training, support, supervision, cooperation, and consultation among disciplines are important to this model, ensuring that professional integrity and quality of care is maintained
- Evaluations and interventions are planned cooperatively, yet one member may take on multiple responsibilities
- COMMONLY SEEN IN COMMUNITY BASED SETTINGS
Medicare guidelines
- for people 65 or older and individuals w/ chronic kidney and end stage renal disease
- Medicare Part A- inpatient hospital, home health
- Medicare Part B- outpatient settings or SNFs
homebound status
- takes considerable effort to leave home
- can leave for medical appointments or infrequent appointments (haircuts, weddings)
- they can attend certified day care program
Payment systems
Hospitals- DRGs
- eval- medical diagnosis/secondary conditions
SNFs- RUGS
- eval- MDS
Home health- HHRG( home health resource group)
- eval- OASIS
Inpatient Rehab- CMG (case mix groups)
- eval- IRF-PAI
criteria for DME
- for medical purpose (ex. wheelchair/walker)
- not useful for person without injury/illness
- grab bars and raised toilet seats can’t be reimbursed
because they are not considered medically neccessary
Correcting errors in documentation
- errors are crossed out with one line, initialed and dated
- only can use blue/black ink
OTA documentation guidelines
- can write notes in medical charts and documentation formats
- their notes are not required to be co-signed
- notes included in medical charts, IEPs, and other legal documents are co-signed by OT
Documentation for eval and reval
- assessments used and results
- summary and analysis of assessment in functional, measurable terms
- references to other reports and information
- OT problem list
- recommendations for OT services
- client’s understanding and interest
Intervention plan documentation
- prioritized problem list
- goals for problem list
- goal statement
- short/long term goals
- activities and treatment procedures
- type, amount, duration, frequency of treatment
- explanation of treatment plan
intervention implementation documentation
- activities, procedures, modalities used
- response to treatment
- goal modifications
- attendance and participation
- adaptive equipment
- home programs
- compliance w/ home program
discharge plan documentation
- summary of eval and intervention
- compare initial and discharge status
- specific number of sessions, goals achieved, interventions, functional outcome
- reason for discharge
- home programs
- client education
- equipment provided
- reccomendations
- refferals
SMART GOALS
- Specific- “increase self-care skills”
- Measurable- number of times
- Attainable- realistic
- Relevant-
- Time
SOAP
- Subjective
- Objective
- Assessment
- Plan
Rehab Act of 1973
- prohibits discrimination due to disability in any program that receives federal assistance
American Disabilities Act of 1990
- prohibits discrimination against qualified people w/ disabilities
- have to provide reasonable accommodations
IDEA
- addresses functional and academic performance
- multi-year IEP for long-term planning and student’s natural transition
- increased flexibility in IEP meetings
- recommendations for early intervention, special education, and other services based on evidence based practice
IDEA part B, C and Section 504
Part B- include special education and related services(occupational therapy) form all students age 3-21 years old
Part C- develop and make available comprehensive services for all infants
and toddlers who have developmental delays
Section 504- Ensures that educational
programs are accessible to individuals with disabilities and may include accommodations
- Ex. A student
with ADHD may need a quiet setting to take a quiz
Response to Intervention
Tier 1: Universal/Core Instruction
Universal screenings, peer-to-peer comparisons when assessing, regular progress monitoring. When
a student is struggling despite Tier 1 supports, Tier 2 is initiated
Tier 2: Targeted Intervention
More intensive academic instruction, small group, Tier 1 components as well
Tier 3: Intensive Intervention
One-to-one and small group instruction provided within general education or special education.
acute care settings
- require immediate care
-clients are medically unstable - LOS is 1-7 days
- extension of LOS requires significant documentation to justify
- OT evaluation process
- quick and accurate screening of major difficulties impeding function (eg. cognitive status, home safety skills)
- OT intervention focus:
1) stabilization of client’s status
2) engagement of the client in the therapeutic relationship and purposeful activities/meaningful occupations so that he/she can see that change is possible, thereby increasing motivation to pursue follow-up
3) discharge planning and after-care referrals
4) family, caregiver, and consumer education
sub-acute hospitals
- length of stay is 5-30 days
- extension of LOS requires significant documentation to justify
- OT Eval
- in-depth assessments and more thorough observation of clients functional performance
- OT intervention
- functional improvements in performance skills and areas of occupation
- active engagement of the client in the treatment planning implementation and reevaluation process
- discharge planning
Subacute/SNF
- therapy is less than 3 hours a day
- interdisciplinary approach
- goal oriented and allows for slower progress
Long term acute care
- for chronic or catastrophic illnesses or disabilities that require extensive medical care and/or dependency on life support or ventilators (patients often have multiple diagnoses with major complications) (Typically ventilator dependent, complex wounds, or on more than 2 antibiotics)
- OT evaluation and intervention is often limited by the population’s severe and complex medical need
- evaluation and intervention is concerned with palliative care and the prevention and treatment of complications (eg. positioning to prevent decubiti and contractures)
- for individuals who are cognitively intact, the focus of evaluation and intervention is mastery of the environment and the attainment of client-centered goals
- evaluation and intervention is concerned with palliative care and the prevention and treatment of complications (eg. positioning to prevent decubiti and contractures)
inpatient rehab
- for clients who are medically stable
- can tolerate 3 or more hours of therapy
- requires 24 hour nursing care
- GOAL- functional improvement in a reasonable time frame
outpatient rehab
- for client for are medically stable
- for clients who live at home
- requires 1-3 therapies
- GOAL
- educate patient/family for final discharge home
Hospice
- for terminally ill
- GOAL- comfort measures, MINIMAL TO NO REHABILITATION, family education
Nursing Home
- clients will generally D/C to a SNF if they came from a SNF and then transition to a nursing home
- little to no goals for rehabilitation
- family is unable to care for the client due to intensity of
care required - GOAL- patient safety and assistance with ADL’s
- may discharge home (with or without home health services) or to hospice.
pre- vocational programs
- people who may have never developed work skills due to developmental delays, environmental insufficiencies, illness, or disability
- people who may have lost these skills due to illness or disability
- OT evaluation is focused on the individuals tasks skills, social interaction skills, work habits, interests and aptitudes
- OT intervention
- improving task/social skills
- developing work habits/routines
- explore work interests
vocational programs
- person has the prerequisite abilities to work (good task skills and work habits) but requires training for a specific job and/or ongoing structure, support and/or supervision to maintain employment
- Person has to develop their work capacities to a level acceptable for competitive employment (strength and endurance)
OT Eval- person’s functional skills and deficits related to work in their current and expected vocational environment
OT intervention-
1. Remediation of underlying performance skill deficits and compensation for client factors that affect the work performance area
2. Development of general work abilities and specific job skills
3. Consultation to and/or supervision of vocational direct care staff
4. Identification and implementation of reasonable accommodations in accordance with ADA
5. Referral to state offices of vocational and educational services (One-stop centers) for persons with disabilities for further evaluation, education and training
partial hospitalization
- Admission is for a medical or psychiatric condition that has been sufficiently stabilized to enable an individual to be discharged home or to a community residence (halfway house or supported apartment) however, the individual still has symptoms remaining which require active treatment
clubhouse programs
- Membership is open to adults and elders with a current mental illness or a history of mental illness
- All members have equal access to all clubhouse functions and opportunities regardless of functional level or diagnosis
- Individuals who pose a significant and direct threat to the safety of the clubhouse community are the only persons excluded
adult day care
admission is for adults and elders with chronic physical and/or psychosocial impairments and for individuals who are frail but semi-independent
-Services are provided in a congregate or group setting
-Individual schedules will vary
1. Flexibility in scheduling is provided to address daily caregiver needs and allow for planned respite
2. Schedules can range from one afternoon per week to 5 full days
needs assessment methods
Survey, interview or self-report of target population. A representative sample is required
-Key informant, which involves the surveying of specific individuals who are knowledgeable about the target population needs
-Community forums to obtain information through public meetings or panels
-Service utilization review of records and reports
-Analysis of social indicators to identify social, cultural, environmental, and/or economic factors that can predict problems
methods of program evaluation : methods to collect data
- direct observation and/or review of client charts
- safety checklists, incident reports, and/or client/family complaints
- surveys of clients, families and/or staff
-review of treatment sessions and missed treatments
- initial, discharge, and follow-up assessments
- review of statistics on costs and service volume
steps of evidence based practice
ASK- Turn a practice issue or problem into an answerable question
ACQUIRE- Systematically search for and retrieve evidence
APPRAISE- Judge the trustworthiness and relevance of the evidence
AGGREGATE: Pull all the evidence together
APPLY: Incorporate the evidence into the decision making process
ASSESS: Evaluate the outcome
Levels of Evidence
Level 1- systemic review (meta- analysis)
Level 2- Randomized Control Trials
Level 3- Non-randomized controlled cohort
Level 4- Case series, case-control
Level 5- expert opinion
Correlation coefficient
.7 or higher- high correlation
.3 to .7 - moderate correlation
less than .3- weak correlation
inter-rater reliability
- greater than .75- excellent agreement
.40 to .75 - fair or good agreement
less than .40 poor agreement
p-value
0.05 or lower- significant
0.05 or higher- non-significant, meta-analysis should occur because it allows researchers to examine aggregated studies that may explain contradictory outcomes.
null and alternative hypothesis
- If the p-value is lower, the null hypothesis is rejected, and we claim that the result is statistically
significant and that the alternative hypothesis is true EX. (TMPOT made an impact on student’s
performance). - IF p-value is higher than .05, we
do not reject the null hypothesis and need to question the significance of TMPOT.
standard deviation
- Standard Score of 2 standard deviations (-2) below
the mean warrants OT services for that specific skill.
A score needs to be combined with observational
findings in order to reflect functional deficits. - Any score that is above (to the right of -2) does
not warrant OT services. That is considered a
minimal delay. You can provide family education
or give them a checklist to monitor milestones - When the score is above the mean (0), the
performance is considered above average, they
certainly do not need OT services in that
performance area.
percentile score
- A percentile score of 20 indicates that 20% of people scored at or below the client. And that 80% of people scored higher than them.
OTA service competency
- OTA/COTA can expand role by establishing service competency
- they do not become independent, will continue to work with the OT supervision
COTA/OTA role
- primary role is to implement treatment
- can contribute to eval process
- can’t independently eval or initiate treatment
- develop/implement intervention plan under OT supervision
- monitor/document response to intervention under OT supervision
Supervision continuum
- supervision of OTs is RECOMMENDED AND NOT REQUIRED
- entry-level OTs, intermediate and advance OTAs can supervise level 1 fieldwork students
- intermediate/advanced OTs can supervise level 1 and 2 fieldwork students
difference between Medicare part A and part B
Inpatient Part A requires services for minimum of 5 days per week
Part B typically covers 3 days per week outpatient services
