PCM 2 Unit 2 Entry Lvl Practitioner in Acute Care

Question 1

What is needed for Clincial Decision Making?

Answer 1

• Self awareness of abilities and limitations
• Observant of patient, environment
• Ability to integrate and synthesize information from multiple resources
• Predict and anticipate patient presentation and needs
• Screen medical record for appropriateness of PT services
• Clearly communicate in verbal and written documentation clinical decision making
• Select appropriate examination and intervention

Question 2

What are the Expected Clinical Decisions made by Acute Care PTs?

Answer 2

• Patient saftey
  –Intervention selection
  –Readiness for mobility
  –Method of executing of mobility
• Need for continued therapy and additional consultations withing acute and post discharge
• Need to withhold or discontinue physical therapy services
• Problem solving to reduce or elimate barriers to the patient acccessing care within the acute setting and in post acute care after discharge
• Approtprateness of delegating POC to PTA
• Anticipate patients needs and resources for further care

Question 3

Clinical Decision Making

What takes place in the Examination?

Answer 3

• Review of the medical record
• Communication of relevant information and interpretation with support staff re: patient condition
• Select appropriate examination screens and measure
• Communicate with the patient
• Observe of situation, enviornment and patient current condition

Question 4

Clincal Decision Making

What takes place in the Plan of Care?

Answer 4

• ICF model: current condition medically, tolerance of activity, level of assistance
• Anticipation of needs/prognosis upon discharge
• Access to resource/insurance limitation
• Need for continued therapy post discharge
• GOALS
• Intervention selection

Question 5

Clinical Decision Making

What takes place in the Discharge Planning?

Answer 5

This begins with the end in mind
This begins on day of initial evaluation
- Cognition and safety awareness
- Level of support
- Home environment
- Need for durable medical equipement
- Recognize regulations imposed by healthcare systems and insurance companies
- Assess and consider expectations and desires of stakeholders
- Coordinate and communicate with the interprofessional team to ensure patient recives resouce and placement upon discharge

Question 6

What are some communication considerations?

Answer 6

• Style and delivery
  –Verbal and non-verbal components
  –Medical literacy
  –Cultural needs
  –Language barriers
• Clarity of clinical decisions with supportive data
  –Verbal
  –Written
• Use of strategies to improve patient safety, reduce errors
  –Situation, background, assessment and recommendations
  –Huddles
• Maintain professional and respectful dialogue during crucial conversations

Question 7

How can we, the PTs, ensure the safety of the patient?

Answer 7

• Thorough review of medical record (PMH, lab values, meds, fall risk, systems review), with this determining the appropriateness of initiating PT
• Consideration and anticipation of mobility affecting medical stability, and medication affect on physiological response to activity
• Application of PPE (Personal Protective Equipment)
• Ensure safe environment
• Identify lines, tubing, and equipement along with specific precautions
• Knowledge of ventilator equipment and the impact of patient mobility and POC, prognosis and discharge plane
• Recognize need for additional assistance and collaboration from interprofessional team within the treatment session

Question 8

With Patient Management, what should PT document?

Answer 8

• Defensible documentation that expresses clinical decison making with sound rationale
• Communicate to the interprofessional team through written documentation needs for patient care management
• Report accurately all aspects of the patient encounter including medical status, safety, parameters of the intervention, and patient response