lecture week 5-7

Patient Centered Care

-Patient as decision maker

-Patient is an active participant

Intradisciplinary

-members work together within the same discipline

Interdisciplinary

-members work together within all disciplines

Multidisciplinary

-members work separately and independently

-in different disciplines,

-different medical specialties

Occupational Therapy ( OT)

-consists of activities to promote recovery

-rehabilitation to assist patients

-performing the activities of daily living

-IE: dressing

PT/OT Collaboration

-consulting

-coordinating

-talking with

-co-treating

Speech Language Pathologist (SLP)

-treat communication problems

-treat swallowing problems.

PT/SLP

consulting on

-speaking problems

-swallowing problems

-communication equipment

Orthotist

professional that designs, fabricates and fits braces

Prosthetist

Professional that specializes in:

-making and fitting artificial parts

-artificial limbs or prosthetics.

PT/Orthotist and Prosthetist Collaboration

-determine proper fit of the brace or prosthetic

-identify gait deviations associated with improper fit

Social Worker (MSW-Masters in Social Work)

-work with families to determine discharge plan

-arranging services and transfers to skilled nursing units

PT/Social Worker Collaboration

-Collaborate with discharge planning

-Equipment needs

-Caregiver support

Certified Nursing Assistant (CNA)

-Provide intimate, hands-on healthcare

-helping with bathing, dressing

-basic activities of life

LVN/LPN-Licensed Vocational Nursing/Licensed Practical Nursing

-An accredited nursing program must be completed

-National Council Licensure Examination must be passed to obtain a license

LVN

-Provide patients with basic nursing and medical care

-inserting catheters,

-changing bandages

-checking blood pressure

RN

-Associate of Applied Science in Registered Nursing (ASN) degree

-Bachelor of Science in Nursing (BSN) degree

-Diploma from an approved program in nursing

-National Council Licensure Examination must be passed to obtain a license

RN-Registered Nurse

-Dispense medication to a patient and give him or her treatments.

-Document the medical history and symptoms of a patient and coordinate plans for the care of a patient.

-Supervisory LVN, CNA

NP-Nurse Practitioner

-typically earn a bachelor's degree in nursing (BSN) and at least a master's degree in nursing (MSN)

-PAs are licensed by licensing boards in each state and must obtain a RN and NP licensure

NP-Nurse Practitioner

-Diagnosing and treating acute and chronic conditions

-Ordering, performing and interpreting lab work, x-rays, and other diagnostic tests

-Prescribing medication and other treatments

PT-Nursing Collaboration

-consulting

-asks for assistance

-reports

-instructs

ATC (Athletic Trainer Certified)

-A baccalaureate level degree with national cert. testing; typically state-regulated.

-rehabilitation of injured players after injury or post-surgery.

Restorative Aides

-rehab & restorative tasks

-nursing service

Respiratory Therapist (RT)

individual who provides treatment and/or management of acute and chronic breathing disorders through the use of respirators or the administration of medication in aerosol form

PT/Respiratory Therapist collaboration

-Consults regarding respiratory status

Radiologic Technician

-Trained in taking X-rays

-how to correctly position body

Nutritionist: Relevance to PT

-Wound care patients need adequate protein for healing

-Diabetic patients need dietary guidance

-Patient with dysphagia may be put on thickened liquids

Recreation Therapist

Plan, direct, or coordinate medically-approved recreation programs for patients in hospitals, nursing homes, or other institutions.

Health Care Professionals Involved in Counseling

-Social Worker

-Chaplain

-Psychologist

General Practitioner (GP)/Family Medicine

-Physicians who diagnose, treat, and help prevent diseases and injuries that commonly occur in the general population.

-May refer patients to specialists when needed for further diagnosis or treatment

Internist (internal medicine)

-Diagnose and provide non-surgical treatment of diseases and injuries of internal organ systems

Orthopedist, orthopedic surgeon

A specialist who treats musculoskeletal disorders

Physiatrist (fiz-ee-AT-rist)

a physician who specializes in physical medicine and rehabilitation with the focus on restoring function

Neurologist

A specialist who treats neurological disorders

Pediatrician

A specialist who treats infants and children

Cardiologist

A specialist who treats heart disorders

Pulmonologist (pul-mon-OL-o-jist)

A specialist who studies and treats diseases of the lung

Psychiatrist

A specialist who treat mental health disorders

Chiropractor

Specialize in the treatment and diagnosis of neuromuscular disorders

Physician's Assistant-PA

-PAs are educated at the master's degree level

-Are licensed

Physician's Assistant

-Diagnose illness

-Develop and manage treatment plans

-Prescribe medications

-Often serve as a patient's principal healthcare provider

PTA-Clarifying Your Role

-Introductions-always introduce yourself as a physical therapist assistant rather than a therapist.

-As a student you should introduce yourself as a student physical therapist assistant.

PTA-Clarifying Your Role

-Explain that the physical therapist and has performed the evaluation

-You will be working with them on the plan of care and reporting back to the physical therapist.

PTA-Clarifying Your Role

-Make sure to recognize those aspects of treatment that are beyond your role

-Report to the patient that you will consult with the PT regarding any related issues.

Patient Care Team Meetings

PT reports on patient progress in PT

PTA-Other Interdisciplinary Roles

•In-services

•Committees for quality assurance

•Committees for Safety

•HIPAA Compliance Activities

Role of a PTA-Defined by

-APTA Guidance

-State Practice Acts

-Regulators ( IE: Medicare)

-Individual Facility

APTA Guidance-PTA

•APTA Normative Model for PTA Education

•APTA's Minimum Required Skills for for the Physical Therapist Assistant Program Graduate

•APTA's Clinical Performance Instrument(CPI)

•APTA Guide to Physical Therapist Practice 3.0

APTA Normative Model for PTA Education

Defines Educational Expectations for the PTA

APTA's Minimum Required Skills for for the Physical Therapist Assistant Program Graduate

Defines the skills required for a PTA program graduate

CPI

Clinical Performance Instrument

CPI

Outline Clinical Role Expectations for the PTA

CPI-Clinical Role Expectations

•Safe practice

•Appropriate professional(clinical) behavior

•Accountability

•Cultural competence

•Effective verbal, non-verbal and written communication

CPI-Clinical Role Expectations ( cont'd)

•Self-assessment and self-directed learning behaviors

•Data collection and clinical problem solving

•Interventions: (therapeutic exercise, therapeutic techniques, physical agents, mechanical and electrotherapeutic modalities, functional training and application of devices and equipment)

•Resource management

CPI-Safe Practice

•Environmental safety

•Emergencies

•Infection control

•Body mechanics

•Monitoring patient

•First Aid and CPR

CPI-Data Collection

•Interview

•Observation

•Palpation

•Goniometry

•Manual Muscle Test (MMT)

CPI-Data Collection

•Measurement of length, girth and volume

•Functional testing and collection of standardized outcome measures

•Vital signs

•Determination of independence, safety

and status of patient in various activities

CPI-Clinical Problem Solving

-Collects and compares data from multiple sources

-Determine patient readiness for treatment

-Determine when the supervising PT needs to be notified

CPI-Clinical Problem Solving Examples-Patient Readiness

-Chart Review

-Patient Interview

-Patient Observation

CPI-Clinical Problem Solving Examples-Notify PT

•During patient interview patient states they have fallen since previous visit.

•During patient interview patient reports increased pain since previous visit.

-During provision of interventions patient reports new symptoms of pain, shortness of breath, dizziness etc

CPI-Interventions

-Therapeutic Exercise

-Physical Agents and Mechanical Modalities

-Therapeutic Techniques

-Electrotherapeutic Modalities ( E-Stim)

-Functional Training

-Application of Devices

Therapeutic Exercise-Examples

•Range of motion and muscle flexibility

•Strength

•Balance

•Coordination and agility

Physical Agents and Mechanical Modalities

•Cryotherapy

•Heat-HMP, US, SWD, paraffin, hydrotherapy

•Mechanical compression

•Bandaging

•Traction

Electrotherapeutic Modalities

•Biofeedback

•Iontophoresis

•TENS-transcutaneous electrical nerve stimulation

•Electrical stimulation (ES) for strengthening, tissue repair and pain

Therapeutic Techniques-Examples

•Passive range of motion (PROM)

•Massage

•Breathing techniques

•Wound care

Functional Training

•ADLs-activities of daily living

•Transfers

•Bed mobility

Application of Devices and Equipment

•Use of assistive devices-crutches, canes, walkers

•Use of adaptive, supportive devices, orthotics and prosthetics

CPI-Documentation

-SOAP

-EMR or EHR

-Narrative Notes

SOAP note format

subjective

objective

assessment

plan

EHR/EMR

-Electronic health record

-Electronic medical record.

SOAP Note-Subjective

•Subjective: Patient report of pain and symptoms

SOAP Note-Objective

•Objective: Data Collection and Interventions

SOAP Note-Assessment

•Assessment: Progress towards goals and patient response to treatment

SOAP Note-Plan

Plan: Next physical therapy visit and follow up if needed

PT Sole Responsibilities

•Interpretation of the physician referral

•Examination and evaluation

-POC

-Delegation to PTA

-Supervising the PTA

•Communication with PTA

-Overseeing of treatment

PT Sole Responsibilities (continued)

-Reexamination of patient

-Discharge of patient

-Interventions beyond the scope of practice for PTA

Supervision by PT

•General supervision:

•Direct personal supervision:

General supervision

-PT available by telecommunication-

-standard for most settings

Direct Personal Supervision

-PT available on-site at all times

-standard for private practice clinic (OP)

Requirements offsite supervision

-PT accessible to PTA: telecommunications-

•Scheduled and documented conferences PT/PTA

•Supervisory visits by the PT

PT/PTA collaboration

The PT/PTA team works together, within each partner's respective role, to achieve optimal patient/client care and to enhance the overall delivery of physical therapy services.

PT/PTA collaboration path

-PT Role

Initial Visit

Reevaluation

Discharge

-PTA Role

Interventions

Data Collection

Documents Progress

PT/PTA collaboration path

PT/PTA

-PTA Assists PT as requested

-PT Assists PTA as requested

-PTA consults PT as needed

-PTA can request PT re-evaluation

PTA Reporting of Unethical or Illegal Behavior

-As required by law, state practice act

-Report to supervisor

PT Aide

Duties & Regulations

-On the job trained

-Assist PT and PTA

-May not have own patient load or complete interventions according to Medicare guidelines.

-Typically carries out duties such as transporting patients, preparing equipment, etc

Laws

-Rules that are enacted by a governing body

-enforced by the judicial system

-(prosecuted in court)

Regulations

-the process of monitoring and enforcing the rules and standards

-adopted by administrative agencies that govern how laws will be enforced

Policies

-broad statements adopted to express the goals and viewpoint of a company or organization

APTA

American Physical Therapy Association

CPTA

California Physical Therapy Association

CMS

Centers for Medicare and Medicaid Services

OSHA

Occupational Safety and Health Administration

Social Security Amendment of 1965

Law created Medicare to provide health coverage for those 65 and older.

ADA (Americans with Disabilities Act)

Prevents discrimination against persons with disabilities in the areas of

-public accommodation

-telecommunications

-government services

Reasonable accommodations under ADA

-must be provided to the public or upon the request of the applicant.

Essential Job Functions under ADA

-duties the employee must be able to perform

ADA Violation

-Failure to provide reasonable accommodations is a violation of the ADA

-unless these accommodations would cause undue hardship.

Undue hardship under ADA

-significant difficulty or expense for employer to provide the accommodations

Accommodation Examples under ADA

-Remove physical barriers

-entrances provide ramps

-accessible bathrooms

-Public access public buildings

-Provide ancillary assistance IE: computer adaptations

-Braille text, adaptive telecommunication devices and accommodate service animals

IDEA

Individuals with Disabilities Education Act