Week 1- Prognosis, POC, and Reexamination Flashcards
PART 1
PART 1
Clinical reasoning should be present in ________ _________ as well as __________.
- patient encounters
- documentation
Documentation helps to ensure ___________ as well as protect your license in the event of a legal inquiry.
reimbursement
What is the definition for prognosis?
The predicted optimal level of improvement in function and amount of time to reach that level.
The prognosis is established after the ________ is determined and is crucial in the development of the _______.
- diagnosis
- POC
In addition to predicting the optimal level of improvement and amount of time to reach that level, the prognosis must also include what?
Discussion of factors likely to influence prognosis to justify reasoning for determining the prognosis. (prognostic factors)
What things will we keep in mind when developing a prognosis?
- Health Condition
- Impairments
- Activity Limitations
- Participation Restrictions
- Contextual Factors
What are some things that can influence a prognosis?
- Age
- Motivation/Patient compliance
- Prior activity level
- Home support
- Cognitive/mental status
- Comorbidities
- Anatomical changes secondary to dysfunction
- Health status
- Psychosocial and socioeconomic factors
- Availability to resources
- Acute vs Chronic problem
- Concomitant conditions
- Severity of the current condition/level of impairment
- What model do we use to determine prognosis?
- It is determined by synthesizing the data collected through the __________ process.
- ICF Model
- examination
Examples:
- )What are we likely to conclude with a patient that demonstrates significant deficit in quad strength and activation?
- ) What are we likely to determine if a patient is highly motivated to return to sport coupled with the fact that the patient was healthy and active prior to injury?
- ) Likely to conclude that regaining full quad strength/neuromuscular control will exceed normal or expected timeframe.
- ) Likely to determine this patient will achieve predicted optimal level of function at an accelerated rate.
- Whenever documenting a prognosis, it is important to make an _________ (_____________) statement regarding the patient’s capacity to improve to the level you have designated as their predicted optimal level of function.
- This should include the details on why you are making this judgement and a discussion of the ________ factors influencing this.
- explicit (excellent, good, fair, poor)
- prognostic factors
Why is it important to make an explicit statement when writing a prognosis?
Supports or justifies the need for skilled PT
Where is the prognosis documented in the initial evaluation and/or reevaluation?
POC or Assessment
Documentation: Prognosis:
- Need to include ______ _______ as part of your prognosis.
- This is documented in the _________ or _________.
- Typically a ____-word statement (excellent, good, fair or poor).
- However, the statement needs to be substantiated by your clinical reasoning for coming to this conclusion.
- rehab potential
- POC or Assessment
- one
What is missing in this prognosis and rehab potential statement?
“The patient demonstrates excellent prognosis & rehab potential.”
- clinical reasoning
- level of function expected
- timeframe
For very complex patients, we may need to justify skilled care from the standpoint of ___________ needs and family education training.
equipment
PART 2: POC DEVELOPMENT
PART 2: POC DEVELOPMENT
What is the POC?
Specifies the general interventions to be used and the anticipated frequency and duration of episode of care.
What are the 4 components of the POC?
- Specific goals
- Predicted level of optimal improvement/anticipated discharge plans
- General interventions to be used
- Proposed duration and frequency
The POC will always be created with initial evaluations as well as ____________.
reevaluation
List some factors that are likely to influence POC development.
-Accessibility and availability of resources
-Adherence to the intervention program
-Age
-Anatomical and physiological changes related to growth and development
-Caregiver consistency or expertise
-Chronicity or severity of the current condition
-Cognitive status
-Comorbidities, complications, or secondary impairments
-Concurrent medical, surgical, and therapeutic interventions
-Decline in functional independence
-Level of impairment
-Level of physical function
-Living environment
-Multisite or multisystem involvement
-Nutritional status
-Overall health status
-Potential destinations at the conclusion of the episode of care
-Premorbid conditions
-Probability of prolonged impairment in body functions and structures, activity limitations, or
participation restrictions
-Psychomotor abilities
-Psychosocial and socioeconomic factors
-Social support
-Stability of the condition
Goals:
- Can be _____ or _____ term
- Apply the ICF model to goal writing (_________, ______, and ________ goals)
- What 5 things must goals be?
- short or long term
- Participation, Activity, and Impairment Goals
- patient centered, objective, measurable, functional, and include a time element for achieving the goal
It is important to relate goals back to _________.
function
Can you reveal new information in the goals that has not been discussed previously in your note?
No
Your ________, ______ measures, and ________ goals obtained in your history should guide goal writing.
tests and measures, outcome measures, and patient’s goals
Goals should be directly related to what 3 things?
- impairments
- activity limitations
- participation restrictions
Predicted Level of Optimal Improvement/Anticipated Discharge Plans:
- Can be documented in ____ or __________.
- Important to also list additional details regarding _________ plans including coordination with any other team care members.
- POC or Assessment
- discharge
General Interventions to be Used:
- Indicate _______ areas of intervention necessary to achieve goals.
- Remember, if you did not measure a specific characteristic, you ______ set a goal for it.
- It is also appropriate to indicate how the intervention is intended to be ________.
- broad
- cannot
- delivered (PT/PTA team, PT other than evaluating PT)
Interventions should be specifically chosen for the patient based on what 4 things?
- impairments
- activity limitations
- participation restrictions
- contextual factors
Implementing interventions based solely on an intervention protocol or by diagnosis goes against the ___________ and is not representative of _______-_________ care.
- ICF model
- patient-centered
Proposed Duration and Frequency:
- What is frequency?
- What is duration?
- Both may be estimated by taking what into consideration?
- Be sure to include the _______ (and family member/caregivers when appropriate) in this decision.
- Frequency=how often you will provide PT services
- Duration=anticipated length of the episode of care
- setting practicing in, capacity of patient to participate in POC, patient transportation needs, limitations from 3rd party payers
- patient
When do you document progress?
Essentially at every patient encounter.
Documenting progress can occur in what 3 areas?
- Daily note (brief summary of progress)
- Progress report (more detailed summary of progress than in daily note, compares current status to previous timeframe)
- Reexamination (most detailed form of summary of progress)
PART 3: POC MODIFICATION AND REEXAMINATION DOCUMENTATION
PART 3: POC MODIFICATION AND REEXAMINATION DOCUMENTATION
When does assessment of the patients response to treatment occur?
Every patient encounter
Alterations of the POC need to occur with what patient change in status?
- diminished
- not changed
- improved
Modifications to a POC require what to be performed?
Reevaluation
Describe each of the situations as diminished, not changed, or improved.
- ) Treating a patient for non-operative rotator cuff tear and the patient had surgery.
- ) Treating an athlete for a mild ankle sprain and they have currently achieved the goals set at initial evaluation
- ) Treating a patient for low back pain that has made no progress after 4 weeks of treatment
- )Treating a patient for poor balance and they had a fall at home that has limited their function compared to how they presented at initial evaluation
- ) diminished
- ) improved
- ) not changed
- ) diminished
Why is a reexamination performed?
To evaluate progress and to modify or redirect intervention.
What are some reasons to perform a reexamination?
- unanticipated change in patient status
- failure to respond to PT interventions as expected
- need for a new POC and/or time factors based on state practice act or other requirements
What are the (4) components of the reexamination?
- ) Clinical impressions or diagnosis
- ) Objective reassessment of tests and measures and outcome tools
- ) Goal status
- ) Evaluation
Clinical impressions or diagnosis is where we update the patients ___________ status, based on ___________ limitations and _________ restrictions.
- functional
- activity limitations and participation restrictions
During the reassessment of tests and measures and outcome tools, can we add new ones?
Yes, if the patient’s current presentation requires
During goal status we list progress towards goals, can we add new goals?
Yes, or revise current goals
During the evaluation (assessment):
- Interpretation of _____ and _______ and _________
- Interpretation of _____ achievement status
- _________ status
- Updated frequency and duration of the episode of care
- Statement of why skilled intervention is recommended
- Statement of plan to transition to next level of care
- tests and measures and outcome tools
- goal
- prognostic
