Facilty & Community Based Tx Settings

Question 1

Acute Care

Answer 1

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)

Question 2

Acute Care Services

Answer 2

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

Question 3

Acute Care Services : Pro’s

Answer 3

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

Question 4

Acute Care Services : Con’s

Answer 4

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

Question 5

Skills of an Acute Care OT

Answer 5

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

Question 6

Categories of Acute Care population

Answer 6

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

Question 7

Acute Tx Focus

Answer 7

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

Question 8

Acute care assessments

Answer 8

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)

Question 9

Acute Care Documentation

Answer 9

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

Question 10

Rehabilitation: Overview

Answer 10

Interdisciplinary approach
Long or short-term
DRG expempt
75% of clients must fall into certain Dx categories or they will lose their funding

Question 11

Pt. criteria for reab

Answer 11

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

Question 12

Rehab Features

Answer 12

Specialty units 
Simulated home settings 
-easy st (makeshift community in the hospital), apt. 
Home assessments 
Home visits 
Pt/family ed 
Vocational rehabilitation

Question 13

Rehab tx focus

Answer 13

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)

Question 14

Rehab Documentation

Answer 14

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.

Question 15

Pt. criteria for subacute rehab

Answer 15

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

Question 16

Homecare : Overview

Answer 16

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)

Question 17

Homecare Tx Focus

Answer 17

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

Question 18

Homecare : Pro’s

Answer 18

natural setting 
tranistion
personalized 
holistic 
flexible

Question 19

Homecare: Con;s

Answer 19

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

Question 20

Homecare documentation

Answer 20

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

Question 21

Out pt. OT : Overview

Answer 21

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

Question 22

Out pt. Tx focus

Answer 22

HEP, strengthening
ADL: more specific (i.e. hand function/feeding)
coordination
Cognition/Perception
ROM, motor control
Cognitive/perceptual remediation (sequencing, organizational skills)
Endurance

Question 23

Out pt. documentation

Answer 23

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

Question 24

Nursing Home (SNF) : overview

Answer 24

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”

Question 25

SNF Focus

Answer 25

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

Question 26

Supervising OTA’s

Answer 26

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

Question 27

Nursing home Documentation

Answer 27

Medicare guideline/forms
Document progress every 30 days
Interdisciplinary care plan meeting occurs quarterly

Question 28

What are some of the medical scenarios that lead pts. to require ICU care

Answer 28

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

Question 29

The role of OT in the ICU

Answer 29

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

Question 30

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

Answer 30

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