Treatment Settings Flashcards
Acute care
Diagnostic related groups (DRG) determine LOS - insurance allows stay (5days on acute care)
if pt. isnt d/c on day 5 they lose money
**avariance- more studies b/c something else is going on - wont lose money here b/c something else medically is going on
1st day of admission=d/c is being planned- rehab?
Acute care services
CCU pulmonary gerneral med oncology NICU ICU trauma ortho burns ICU AIDS -specialized for diff services can have a team for each service or rotate 4 wks if a unit is slow you will be pulled to do evals on another unit
Skills of an acute care OT `
Broad knowledge of eval/tx- less formalized assess (quick and dirty- UQS, MMT, A&Ox3, more questioning with pt and fam, may only see pt 1-2x
knowledge of medical procedures, tests, medical complication -increase w/ experience / know how dif ppl w dif dx act/present
d/c planning skills- right from start, services?
comm resources- equip/ services
think on feet quickly- ask nurse
adaptable- plan B pick up dif pt
good organization & problem-solving skills - gage tx. for better or worse- no specific equip
categories of acute care pop
single episode/injury- fall @ home, MVA, one time thing (explain what OT is)
acute phase of long term injury- beg phase of SCI - going to rehab- introduce OT- get stabilized and started- splinting and positioning, prevent contractures
chronically ill pt with acute exacerbation- parkinsons for # of years-having exacerbation-make safer at home family ed
admit for invasive, diagnositc test, regulation of meds
UTI, increase WBC’s
Acute TX focus
mobility- bed, basic transfer/skills, rolling
endurance building- dowel or ex program to build them up- during mobility 15 min sessions
feeding
grooming- cog skills , basic
ADL’s- basic, s/u, bring utesils to mouth
toileting- urinal, positioning
splinting/positioning- basic resting, hand splints, pillow for edema
edema reduction
ROM-active/passive
sensory stim
cog/perceptual stim & training- a&Ox3-why their getting services
strengthening
motor control- balance to sit EOB, sit- stand, don/doff shoes, socks
see about 2x before d/c- off to rehab or home
acute care assessment
care maps/critical pathways- for DRG- don’t keep someone longer than needed, referrals & whats happening when no services are missed (whole team has access initiate off an eval)
brief, checklists- electronic of assessment and goals - DONE BEFORE LEAVING ROOM!!! dont force pt. “quote what pt says”
observations are critical *gut feeling . *pt appears
completed within 1st session
document each session
Documentation
per session
d/c planning starts from visit #1- document caregiver, @ home support
-home care- not designed to be 24/7
-rehab
-outpt
-skilled nursing home
- what environment does this pt. need to go to
Rehabilitation
interdisciplinary approach- each do own thing, together to help pt.
long or short-term - weeks to months - depending dx & needs can get more of 1 service than another
DRG exempt- need case mix (medicare) - stroke, sci, cardio
75% of clients falling into certain DX categories - or lose funding
*get to know pt intensely involved in getting to help pt. -see improvements -dx. needs to "fit" in to dx/ rehab will lose funding from medicare
TEST Patient criteria for rehab
needs 24 hr. nursing/medical care- medication, dependant on ADL’s, catheter, decreased vitals (monitor)
wound, pressure ulcer, non Indep. w ambulation & transfers, no support
3 hour rule- has to be able to tolerate 3 hrs a day of OT/PT- 1 1/2 in AM of both and 1 1/2 in the afternoonm of both
multidisiplinary team care- meet atleast 1x a wk- look at progression -d/c planning/appropriate
potential to make gains in reasonable amount of time- can be very slow (subacute rehab)
potential to releam- dementia, not good candidate for rehab ( cant remember precautions)
motivation to participate
home for safe d/c - look at stair/ accessability
(SCI, stroke, cardio-pulm, good prognosis, motivated, active before dx)
Subacute
more of one service than another when needed
nursing facility, no 3 hr rule, less intensive rehab
rehab features
specialty units
simulated hoem settings- training
apartments- stay prior to d/c, any problems?
easy street- grocery store, bank
-all simulated within protected environment
home assess- take pt w you or go w pt. / able to assess pt at same time
home visits- make sure pt. can get to appts.
pt/family ed- big on rehab, ROM, transfers, w/e is most impiortant , spliting, positioning, stretching, communicate w fam and when you feel appropriate for them to be there
vocational rehab- returning to work/school/ vehicle
rehab tx focus
ADLs mobility strengthen coordination endurance balance UE fx trunk fx visual perception- general screens for cardio pulm cog- more in deph adaptive equip comm. reentry acceptance of disability max quality of life
Rehab doc
I.E - may extend beyond 1st visit, depending on dx and facility (72hrs), highly variable, depending on pt.
weekly progress notes/ goal mod.- more frequent if something happens, can be more than once a wk
monthly re eval notes/ goal mod- look at goals every 30 days, and mod., targeting problem areas, re eval only those areas
d/c summary- in deph, summarize problem, well planned in rehab, include adaptive strategies/equip, can change goal if dated (pt will be min assist w transfers instead of indepen.) progress pt has made in rehab (date/timeline of therapy) (pt was instructed in….) what goals were met/not met, follow up services, refusal of euip, maintenance programs, resources- anything recommended
Pt. Criteria for subacute rehab
receive a minimum of 150 min of tx per wk
(low rehab - ultra high rehab) - categorize to certain level of care
must show pt will improve every 30 days - target pt w potential to improve
good option for pt who need less intensive tx then rehab or who can not tolerate rehab
focus is similar to rehab
-dont meet rehab criteria according to less than 3 hrs a day, medicare but need rehab services (elderly, cardio pulm pts.), dont need daily OT/PT, can get one more than another depending on what they need
home care
pt who are d/c from various settings
home bound - pt cant easily get out of their home like many typically would- can go out to MD/ get hair done but cant go to the mall, going out is so hard/tiring they need services to get out of home
case can be open be open by PT or nurse
medicare allows 60 day period for referral
2 mo. to work w pt - can re-certify if they have the need
goals set within this or re certification is done - never over 8 weeks ( typically don see for entire time period)
