Guest guest Posted November 24, 2004 Report Share Posted November 24, 2004 Group- I seek your collective wisdom. I have been an OT for several years in the OP arena, but just recently moved to work in a small (200 bed) community hospital in Upstate New York. I am doing mainly acute care evaluations. In an effort to better my own knowledge, I set a goal to develop some sort of parameters/guidelines/reference point/etc. to identify when OT is and is not appropriate for referral. I believe that I can assume the obvious reasons why OT is indicated, but no one in the hospital can efficiently state when/where/why OT need (or does not need) to be involved in the care of an acute care patient. As I began talking about things with my peers and coworkers, it became obvious that there has been a concern here regarding inappropriate referrals for both OT and PT. So my " project " has now bloomed into an initiative to educate groups (primarily our case managers/discharge planners and hospitalists) on the acute care rehab spectrum. I forsee a delicate walk that will need to be done to ensure that we do not seem like complainers and subsequently see a drop-off of all our referrals; we will need tact and preparation so as to make sure that we are called in when we are needed and not when we are not needed. A major problem that I am having is simply nailing down a basic statement of WHAT the purpose of acute care rehab is. Are we here to start the ball rolling for rehab? Are we here to triage? Are we here to ensure safety within the hospital and prevent unsafe discharge home? I think that we do all three, and that all three are beneficial. But I am not sure that those placing our referrals know what and why. At the admitted risk of extreme naivete, I seek any and all advice and assistance. Would folks be willing to share missions, policies, precautions/contraindications for eval and treatment, insight, references and anything else that is pertinent? I will be more than willing to call to talk, or give a fax or snail mail address if needed. Thanks all in advance, and thanks for your time and consideration in reading. Best wishes for great holidays, dc Cormican Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2004 Report Share Posted November 26, 2004 Ms. Wittwer- Thanks for the input. We have a similar form in place; the problem that I see is that the nurses don't seem to pay much attention to the accuracy of their input. Do you do training for the nurses at orientation? Do you have periodic updates and or competencies? Thanks again. dc Cormican >From: dwittwer@... >Reply-To: PTManager >To: PTManager >Subject: Re: Re: Acute Care OT/PT >Date: Fri, 26 Nov 2004 06:58:12 -0800 > > > > >I work at a 125 bed acute care facility. I have integrated into the >nursing admission form a rehab section that would trigger an eval/consult >for any of the three disciplines. The nurse is able to initiate a referral >with the physician. This has worked well at our facility. > >Dudi Wittwer, O.T.R. >Manager, Rehab Services >Bay Area Hospital >1775 Road >Coos Bay, Oregon 97420 >dwittwer@... > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2004 Report Share Posted November 26, 2004 We have participated in their orientation in the past but the nursing education department discusses our role in patient care during their orientation. I have had input into this orientation process and feel comfortable in what they are teaching. We attend the unit meetings when further education is identified. I am part of the Patient Care Quality Team. So when the nursing admission form is presented to this team for revision, they have always asked for my input. I feel the nurses do a good job in advocating for the patient when they need our services. Even the discharge planners have advocated for our services. Dudi Wittwer, O.T.R. Manager, Rehab Services Bay Area Hospital 1775 Road Coos Bay, Oregon 97420 dwittwer@... " Cormican " <bigdarkdan@hotma To: PTManager il.com> cc: Subject: Re: Re: Acute Care OT/PT 11/26/2004 11:01 AM Please respond to PTManager Ms. Wittwer- Thanks for the input. We have a similar form in place; the problem that I see is that the nurses don't seem to pay much attention to the accuracy of their input. Do you do training for the nurses at orientation? Do you have periodic updates and or competencies? Thanks again. dc Cormican >From: dwittwer@... >Reply-To: PTManager >To: PTManager >Subject: Re: Re: Acute Care OT/PT >Date: Fri, 26 Nov 2004 06:58:12 -0800 > > > > >I work at a 125 bed acute care facility. I have integrated into the >nursing admission form a rehab section that would trigger an eval/consult >for any of the three disciplines. The nurse is able to initiate a referral >with the physician. This has worked well at our facility. > >Dudi Wittwer, O.T.R. >Manager, Rehab Services >Bay Area Hospital >1775 Road >Coos Bay, Oregon 97420 >dwittwer@... > > > > > Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 29, 2004 Report Share Posted November 29, 2004 We have had a great deal of success with our inpatient referral criteria. I have pasted the criteria we use and this is part of an overall ancillary referral criteria reference sheet that is posted in all nursing areas and inserviced to nursing staff. We get approximately 35% of all hospital admissions referred to PT, 20% to OT and 10% to speech. We, on occasion get inappropriate referrals but these are addressed by me or the supervisor directly with the physician. Interpreter Services Pt. has limited skill in English Pt. normally communicates by sign language. Pastoral Care Patient/Family in need of emotional and/or spiritual support. Patient anxious re: illness/suffering/end-of-life issues. Patient Representative Patient has concern about rights or quality of care. Social Work Dependent person is at home unattended. Reason to suspect abuse, neglect or family violence. May need different care setting at discharge. May need community health or social service at discharge. Pt/family has decision-making difficulties which affect care Mental health, substance abuse or other significant social problem Physical Therapy (Requires MD Order) New musculoskeletal limitations or risk for worsening of chronic conditions Surgical patients with impaired mobility Ambulatory patients with a history of falls Uncertain discharge plan requiring functional evaluation for appropriate recommendation or unclear whether there is adequate function for safely returning patient's destination of choice. Bed rest for greater than 7 days New onset of neurological impairment benefiting from immediate therapy Occupational Therapy( Requires MD Order) Uncertain discharge plan requiring functional evaluation for appropriate recommendation or unclear whether there is adequate function for safely returning patient's destination of choice. Functional condition prevents them from participating in self-care activities necessary for discharge destination. New onset of neurological impairment benefiting from immediate therapy Bed rest for greater than 7 days. Diagnoses that would benefit from positioning devices or upper extremity orthotics. Speech Pathology (Requires MD Order) Limited ability to communicate due to medical condition, neurological function, or external device such as a ventilator. Following surgery on the neck, throat, or mouth At risk for aspiration or with a dysfunctional swallow. New onset of neurological impairment benefiting from immediate therapy Respiratory Therapy ( Requires MD Order) Change in breathing pattern, i.e., work of breathing Change in breath sounds, i.e., increased wheezing or ronchi Increase cough with sputum production Drop in SpO2 below 90% Dietary Any 1 below: On TF/TPN/PEG Pediatric failure to thrive DKA, newly diagnosed diabetes mellitus, new to insulin Any 3 below: Unintentional weight loss of greater than10% usual body weight Less than 90% of ideal body weight initial albumin equal to or less than 2.8 mg/dl or pre-albumin equal to or less than165 mg/dl abdominal surgery within the past month or impending abdominal surgery Chewing, swallowing problems or oral pain Nausea, vomiting, or diarrhea Poor appetite or minimal intake for 7 days or more Enterostomal Nursing Skin breakdown around leaky tube Ostomy appliances not staying on @ least 2-3 days Herniation near ostomy site needing hernia support belt. Marking of stoma site on ostomy pre-op patient Prolapsed stoma Teaching needs related to ostomy self-care Redge L MS OTR/L Director of Rehabilitation Services on Hospital Bremerton, WA 98310 Administrative Assistant: Wanda Kotte: wandakotte@... Quote Link to comment Share on other sites More sharing options...
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