Guest guest Posted November 18, 1998 Report Share Posted November 18, 1998 Our organization has also been dealing with similar questions. Historically, all ortho patients were seen bid Mon-Fri and once on Sat. All other acute patients were seen qd and not on Saturdays. We are currently rethinking this. While most of our therapists agree bid is excellent ofr ortho patients, we are now asking " Why not others " , in particular CVAs or amputees. Skilled vs nonskilled is a whole other problem. If anyone has an easy answer for that, PLEASE tell me. Michele Rehabilitation Services Coordinator >>> " NANCY E. RIGHI MFW241 " 11/16 1:31 pm >>> --- Received from MSJ.CRSNER NANCY E. RIGHI MFW241 11-16-98 131p -> ptmanageregroups How are people in other acute settings dealing with frequency of care? We have many disagreemnets between therapists and we have ortho suregons who demand bid for all ortho patients while some medical doctors don't even know we write notes never mind frequency. We also have problems with therapist agreeing on what is skilled versus nonskilled . ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 1998 Report Share Posted November 25, 1998 We see all our acute patients BID unless we receive a specific order for QD from the MD. Occasionally if we have a long termer with poor+ to fair- potential we request a QD order from the MD. With the length of stay so short, patients out for tests or just the fact that the patient isn't feeling well in the case of medical patients we usually only 'catch' them once a day anyway. ---------- To: ptmanageregroups Subject: hospital -acute Date: Monday, November 16, 1998 1:00 PM --- Received from MSJ.CRSNER NANCY E. RIGHI MFW241 11-16-98 131p -> ptmanageregroups How are people in other acute settings dealing with frequency of care? We have many disagreemnets between therapists and we have ortho suregons who demand bid for all ortho patients while some medical doctors don't even know we write notes never mind frequency. We also have problems with therapist agreeing on what is skilled versus nonskilled . ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 9, 1998 Report Share Posted December 9, 1998 I work in an acute care setting. If a physician orders PT BID and the therapist feels that Qd PT is more appropriate, how do your therapists go about changing that order/plan of care? I have been advised (by a clinical nurse specialist), that I must somehow get the MD's verbal OK or order clarification in order to change any order. What are other thoughts, and/or processes for this. Any help is appreciated. Re: hospital -acute >You wrote: > >How are people in other acute settings dealing with frequency of care? We >have many disagreement between therapists and we have ortho surgeons who >demand bid for all ortho patients while some medical doctors don't even >know we write notes never mind frequency. We also have problems with >therapist agreeing on what is skilled versus nonskilled . > > > >Here at the facility where I am the PT director (it is similar at the other facilities in the same system depending on load and staffing): >All inpatients are seen bid, especially the orthopedic and rehab type patients; wound care is done once a day. Other patients frequency depends on medical status and is left to the discretion and professional judgement of the therapist when establishing the plan of care. We have gotten no flack from the physician's when we determine that a patient no longer requires our services. The physician's aren't the ones we battle with over whether or not the patient is appropriate for therapy. The nurses are the ones always wanting us to get " patient up in chair bid " . We just document that is not a skilled physical therapy service and inform the nursing supervisor. Of course, there can be other instances when we have to make a professional judgement regarding services. It helps if your administrator backs you up with nursing and the docs. My administrator knows that I and my staff have the skills and knowledge necessary to make these calls as well as have a better understanding of medicare as it pertains to skilled therapy services. > >If there is a disagreement among PT staff as to what is skilled and non-skilled it is my job to mediate, educate and inservice the department staff on the difference. > > > Pat Jobes, PT >Director of Physical Therapy >North Hospital >Methodist Healthcare Memphis >jobesm@... > >------------------------------------------------------------------------ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 1998 Report Share Posted December 10, 1998 Hi and Tina - First of all, you may want to post this on the acuteptegroups list serve as well. You may get it to a different group of people. As for the difference of opinion regarding frequency, the PT should determine the appropriate intensity, frequency, and duration of care based on the patient's needs. If there is a discrepancy with what the physician ordered, we would contact the physician directly, explain the plan of care, identify any problem areas or questions, and resolve the conflict. Often we found that the physicians wrote for BID treatment because they wanted the patient to be ranged, walked, etc. In many cases, this can be delegated to an aide or nursing assistant once the PT has determined it is safe to do so. It is not billable as PT care (as you know). Bottom line - you have to determine what the patient needs, what the needs are of all the other patients, and the resources you have available to meet all of the needs. I found that after an intelligent and articulate discussion, most physicians agreed and changed the order. However, there are times when this just doesn't happen and you don't have the resources to meet all of the needs. Keep track of orders you cannot comply with and speak with the physicians and , nurses, and administrators to develop a strategy to rectify the situation. Thanks. Sinnott ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 1998 Report Share Posted December 10, 1998 in our facility (tertiary, trauma acute care, behavioral health,and LTC) we have realized that there are long standing differences in the orders that therapy receive ,the orders that nursing receives and the " functional " impact of those orders. Therefore, we rely less on what nursing uses as their standard practice. We have agreed with the Medical Board that Therapy will be ordered and that our care of plan will serve as the agreed upon orders, since we are the experts in the field. When there are remaining strong difference between clinicians, the supervisors get involved. It rarely comes to my level (admin) after that. Good luck! > Re: hospital -acute > > > >You wrote: > > > >How are people in other acute settings dealing with frequency of > care? We > >have many disagreement between therapists and we have ortho surgeons > who > >demand bid for all ortho patients while some medical doctors don't > even > >know we write notes never mind frequency. We also have problems with > >therapist agreeing on what is skilled versus nonskilled . > > > > > > > >Here at the facility where I am the PT director (it is similar at the > other > facilities in the same system depending on load and staffing): > >All inpatients are seen bid, especially the orthopedic and rehab type > patients; wound care is done once a day. Other patients frequency > depends > on medical status and is left to the discretion and professional > judgement > of the therapist when establishing the plan of care. We have gotten > no > flack from the physician's when we determine that a patient no longer > requires our services. The physician's aren't the ones we battle with > over > whether or not the patient is appropriate for therapy. The nurses are > the > ones always wanting us to get " patient up in chair bid " . We just > document > that is not a skilled physical therapy service and inform the nursing > supervisor. Of course, there can be other instances when we have to > make a > professional judgement regarding services. It helps if your > administrator > backs you up with nursing and the docs. My administrator knows that I > and > my staff have the skills and knowledge necessary to make these calls > as well > as have a better understanding of medicare as it pertains to skilled > therapy > services. > > > >If there is a disagreement among PT staff as to what is skilled and > non-skilled it is my job to mediate, educate and inservice the > department > staff on the difference. > > > > > > Pat Jobes, PT > >Director of Physical Therapy > >North Hospital > >Methodist Healthcare Memphis > >jobesm@... > > > >--------------------------------------------------------------------- > --- > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 1998 Report Share Posted December 10, 1998 > We have agreed with the Medical Board that Therapy will be ordered and > that our care of plan will serve as the agreed upon orders, since we are > the experts in the field. How is this set up and how is it documented? If I were to attempt this at my hospital... how would I go about it. " Getting the medical board to agree to that " is what I mean??? Thanks in advance. Tina INdpls, IN ----- See the original message at /list/ptmanager/?start=2446 ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 1998 Report Share Posted December 10, 1998 The docs don't usually write BID, mostly Eval and Treat. If a specific order is written and the therapist feels that it is not warrented, contraindicated and or unnecessary, we do call the doctor and then write the new order on the chart. If it is a case of the patient being too high level and independent. We just document the evaluation and findings and make a notation in the Dr. Progress Notes that the patient does not need PT at this time. More can be written depending on the situation. If the order is perscriptive, you must get new orders. On the issue of the physicain being aware of the plan of care, we acknowledge the order, and document that the evaluation is complete and in chart (which includes plan of care) Nothing is necessary on the Dr.'s part unless he DISAGREES with the Plan of Care. ((>%% of the time there is no disagreement. Pat Jobes, PT Director of Physical Therapy North Hospital Methodist Healthcare Memphis jobesm@... ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
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