Pediatric Settings Flashcards
Inpaitent,Outpatient, clinic, etc.
Hospital-based settings
Stress/fear, financial burden and distance from home is apart of what type of care?
Family and child-centered care
Hospital based settings
What are some accrediting and regulatory agencies within hospital settings?
1. Centers for Medicare and Medicaid Services (CMS)
2. ____
3. Commission on Accreditation of Rehabilitation Facilities (CARF)
4. ____
Joint Commission (JCAHO)
&
Occupational Safety and Health Administration (OSHA)
Hospital based Settings
These are ____ for services
* Private insurance
* Medicaid
* CHIP (Childrens Health Insurance Program)
(state specific Programs)
CPT Codes (Current Procedural Terminology)
Reimbursments
Inpatient and Outpatient
Acquisition of skill and function or maintaining and imporoving skills is called?
Habilitation
Inpatient and Outpatient
Regaining skills and function that have been lost due to illness or injury is called?
Rehabilitation
Inpatient and outpatient
In which pediatric settings are we focusing on habilitation vs rehabilitation or both?
Habilitational setting: Typically; Early Intervention, School based OT, outpatient peds
Rehabilitation- ICU, SCU, Acute care
Both: Outpaitent
The Team
True/False: Family (including the child), Pediatric Medicine and Rehabilitation Specialist (PM&R), Other MDs, Inpatient Care manager (nurse), and therapy team are all apart of The Team
True
Setting Specifics
True/False: Documentation timeframes vary, but reguire documentation within 24-48 hours.
True
The OT Process: Specific settings
Acute Care:
* OT Profile- Gathering information (evaluation)
* Analysis of occupation ( Screening vs. assessment)- ____, ____, ____, & ____
* Goal setting- ____, ____ ONLY, often less Occupational based, but have Occupational goals; Family input is a challenge
* Intervention- managing vital signs, lines, team schedules, precautions
* Discharge planning/Targeted Outcomes: Home or Inpatient rehab; sometimes hard to predict.
Analysis of occupation- Time factor, space issues, medical and Functional status
Goal Setting- COAST, Short term only
The OT Process:
These other considerations are seen in what setting?
- Screening/Consultation for equipment needs
- Team communication
- Cause of Admission
- Children with Complex, chronic medical conditions Frequent ICU visits are common
- Determination of inpatient rehab referral
Acute Care
The OT Process:
These other considerations are seen in what setting?
- Productivity (no-shows, late policies)
- Communication with other disciplines
- Family involvement DURING assessment and ongoing sessions
- Constant assessment & adapting intervention plan between during sessions
- Discharge issues
Outpatient Rehab
The OT Process: Specific settings
These other considerations are seen in what setting?
- Culture of rehab department can affect the role of OT, goals and timeframe, etc.
- Usually require supervsision from family or “sitter” ____ hours/day
- Diagnosis specific considerations (TBI, SCI, multi-trauma; ____ & ____)
- Context (in room vs. therapy gym)
- Meetings- daily, weekly, family present or not; formal vs. informal meetings; discharge meetings.
Inpatient Rehab
Supervision required 24 hours/day
Diagnosis specific considerations (TBI, SCI, multi-trauma; Precautions and Safety)
The OT Process: Specific Settings
Inpatient Rehab:
- OT Profile- Gathering information
- Analysis of Occupation- Usually need to complete and submit ____ within ____ hours.
____ (WeeFIM or similar) and ____ (MMT, ROM, pain and focused observation of relevant areas of OT domain) - Goal setting- COAST, usually Short-term and long-term goals.
- Intervention- Scheduling tips/barriers, ____ Carryover between sessions (nurse/family communication)
- Disharge planning/Targeted Outcomes
Analysis of Occupation- Usually need to complete and submit Evaluation within 24 hours
Standardized (WeeFIM or Similar) and non-standarized (MMT, ROM, pain focused observation of relevant areas of OT domain)
Intervention- Scheduling tips/barriers,Medication Management Carryover between session (nurse/family communication)
The OT Process: Specific Settings
Outpatient Rehab:
* Ot Profile- Gathering Information
* Analysis of Occupation- Usually need to complete and submit ____ within ____ to ____ hours (can vary)
* Goal Setting- ____, ____ & ____ goals (Based on expected number of visits). Family should be Intimately involved in GOAL SETTING
* Intervention- Frequency decisions, home programs/Carry-over, Can have intensive outpatient programs (daily,half or full-day)
* Dishcharge planning/targeted outcomes
Analysis of Occupation- usually need to complete and submit Evaluation within 24-48 hours
Goal Setting- COAST, Short-term & Long-term goals
The OT process
What are the three Cons to Goal Setting in Inpatient Rehab:
Goal setting- COAST, usually Short-term and long-term goals.
1. Difficulty ____ ____
2. ____ but not replicating other disciplines
3. ____ ____ can be a challenge
- Difficulty predicting progress
- Complementing but not replicating other disciplines goals.
- Family input can be a challenge
Specialty Clinics
True/False: Many specialty clinics are not “follow-up clinics” within a hospital organization.
False: Many follow-up clinics ARE within a hospital organization
This type of care is available and who is on the team varies. The role of OT is not consistent.
Specialty clinics or free-standing
Specialty Clinics
OT Competencies for success in specialty clinics:
1. Extensive knowledge of the conditions in the clinic.
2. ____
3. Creativity, flexibility, ability to “think quick)
4. ____
5. Therapeutic use of self
- Awareness of resource access across communities
- Advocacy skills
What are some examples of specialty clinics?
- Seating clinics
- Feeding Clinics
- Ortho Clinics
ALL Hospital-based Settings
- Vital Signs
- Pain
- Self report: Children ____ of age and older can rank their pain using several validated scales:
What are the scales and what does the child?
- children 3 years and older
- Wong-Baker Faces Scale: 6 cartoon faces (0-10 scale) 0= “no hurt” and 5= “the worst hurt”
- Visual Analogue scale: 10 cm. line with one end marked as the worst pain. The child is asked to make a mark on the line being measured in cm from the no pain end.
ALL Hospital-Based Settings
True/False: Documentation cannot edit once the medical record. (initial eval, re-eval, daily notes, discharge summary, equipment justification, home programs)
Document progress towards goals each session (may not address all goals every session)
Can modify goals in daily notes at any time if they appear unrealistic
True
ALL Hospital-Based Settings
Goals should be ____ and ____ even when the system is not set up that way.
- EMR: often have pre-populated goal templates
- Bad habits
- Client-centered & Occupation-based
ALL Hospital-Based Settings
Why do therapists have frequent review of goals? (2 points)
- Intervention planning
- Re-assessment
Goal Examples: Identify what setting this goal is most suitable in
LTG: John will self-feed at least 80% of a meal with min verbal cues to maintain attention 5/7 days/week within 3 months
STG: John will self-feed for the first 5 minutes of a meal with moderate verbal cues to maintain attention 3x/week within 2 weeks.
Outpatient Rehab
Goal Examples: Identify what setting this goal is most suitable in
The patient will reach and grasp a washcloth in supported sitting at edge of bed following verbal and physical cues, 2/3 times within 1 week.
LTG- are not often written in ____ due to the expected short length of stay
Acute care: ICU
Goal Examples: Identify what setting this goal is most suitable in
LTG: In 3 weeks, the client will don and doff an overhead shirt in an unsupported seated position, with supervision for safety 90% of the time.
STG: The client will don an overhead shirt with minimal assistance, while seated in her wheelchair, 2/5x this week.
Inpatient Rehab
Goal Examples: Identify what setting this goal is most suitable in
Often write recommendations vs. goals
Specialty Clinics
ALL Hospital-Based Settings: Communication with TEAM
Which setting most fits the points given below:
- Splint schedule
- ROM
- positioning schedule
- transfer precautions
- visual concerns
- ADL schedule
- feeding precautions
Acute/Inpatient
ALL Hospital-Based Settings: Communication with TEAM
Which setting most fits the points given below:
- Initiating and maintaining contact with team
- home program carry-over
- dealing with no-shows
Outpatient
ALL Hospital-Based Settings: Communication with TEAM
Which setting most fits the points given below:
- Who is following up with what?
- Does the team communicate before presenting recommendations to family?
- Who is in the room at the same time?
- Communicating “next steps”
Specialty Clinic
ALL Hospital-Based Settings: Communication with TEAM
Which of the following is NOT a focus of communication in an acute/inpatient hospital setting?
A) Splint schedule
B) ROM (Range of Motion)
C) Feeding precautions
D) No-shows
D) No-shows
ALL Hospital-Based Settings: Communication with TEAM
In an outpatient setting, which of the following is important for team communication?
A) ADL schedule
B) Initiating and maintaining contact with the team
C) Transfer precautions
D) Positioning schedule
B) Initiating and maintaining contact with the team
ALL Hospital-Based Settings: Communication with TEAM
What is a key consideration in specialty clinic communication?
A) Dealing with no-shows
B) Communicating next steps
C) Feeding precautions
D) Splint schedule
B) Communicating next steps
ALL Hospital-Based Settings: Communication with TEAM
Which setting involves communication regarding who is following up with what and who is present in the room?
A) Acute/Inpatient
B) Outpatient
C) Specialty Clinic
D) All of the above
C) Specialty Clinic
ALL Hospital-Based Settings: Communication with TEAM
What is a shared aspect of communication across all hospital-based settings?
A) Visual concerns
B) Communicating next steps
C) Home program carry-over
D) ADL (Activities of Daily Living) schedule
B) Communicating next steps
