heart of florida regional medical center physical, occupational and speech therapy

22
HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

Upload: terence-lewis

Post on 15-Jan-2016

213 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

HEART OF FLORIDA REGIONAL MEDICAL

CENTER

Physical, Occupational and Speech Therapy

Page 2: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

ACUTE THERAPY SERVICES

• Acute phase of patient’s hospital stay.• Focused on the skilled aspect of patient care and

determining discharge disposition.• The key is to use our resources appropriately.• Other: Therapy services are also delivered in rehab

facilities, skilled nursing homes, home health, outpatient etc. Goals depend on the setting.

Page 3: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

SKILLED SERVICESServices that require skills of a therapist to perform

• Requires the judgment, knowledge and skills of a licensed therapist/therapist assistant to evaluate and treat patients to improve functional outcomes

• Must meet frequency, duration and treatment standards that are considered reasonable, necessary and effective for the patient’s condition

• Requires predictable improvement in a reasonable timeframe

• Requires ongoing assessments• Requires a physician referral

Page 4: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

Inpatient therapy gym

Page 5: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

UNSKILLED SERVICESServices that do not require skills of a therapist to perform

• Routine Services – General maintenance feeding, dressing, transferring or

mobilization– Sitting a patient up in a chair or Out of bed orders– Maintenance PROM (Passive Range of Motion)

• Conditions that are transient or easily reversible without professional skills.– UTI, elevated blood sugars

• Patients at baseline level of functioning• Patients unable to demonstrate new learning

Dementia, LOC, combative, disorientation, sedated, unable to follow commands

• Maintenance of skills or preventing decline

Page 6: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy
Page 7: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

SCREENS

• Nursing completes functional screens for each patient: There must be a RECENT CHANGE and REASONABLE EXPECTATION FOR IMPROVEMENT to trigger therapy.

• Speech therapy is indicated if there has been a recent change in communication and swallowing.

• Occupational therapy is indicated if there has been a recent change in strength and movement of the upper body or functional abilities.

• Physical therapy is indicated if there has been a recent change in mobility, functional abilities, strength and movement and a history of falls.

• We can only view record and speak to patient, family and staff during a screen we are not allowed to evaluate.

Page 8: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

CONSULTS ARE NOT INDICATED IF:

• Patient is on paralytics• Sedated and unable to follow commands• Unstable vital signs• Unstable medically• Agitated and combative• No diagnosis established• Patient has been immobile and no prognosis for

improvement• Pending test results to rule out acute cardiac or neuro

changes, fractures or DVT• Patient at prior level or baseline level• Simply wanting to get patient OOB.

Page 9: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

Skilled Acute OT, PT & ST Patient Care Decision Tree

Is Patient atbaselinelevel of

functioning?

Is Patient athighest level

of functionbased on

anticipateddischarge?

Is Patient’sprognosis forimprovement

fair or greater?

Is Patientable toretain

therapeuticeducation /

intervention?

Is a caregiverable to

follow throughwith therapeutic

intervention /training?

YES

NO

No therapyrecommended

YES YES YES

YES

No therapyrecommended

No therapyrecommended

Provideskilled

therapy

Provideskilled

therapy andContinueeducation

Is Patientmaking significant

functional improvementwith therapy?

YESContinueskilled

intervention

NO

Will Patientdeteriorate

withoutintervention?

NO

YES

Designate maintenance program: Floor ambulation, home program,

ambulation program

Provide education toPatient / caregiver

No therapyrecommended

NONO

Page 10: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

Activity Skilled for therapy Unskilled for therapy

Patient Positioning   X 

Patient positioning for tone reduction X   

Development of an exercise program X   

Passive range of motion other than post surgery   X 

Performance of established exercise program for deconditioning   X 

Bed mobility training X   

Getting patient out of bed   X 

Bed to chair transfer training  X  

Assisting a patient to the BSC    X

Bathing the patient   X 

Instructing patient/family in use of adaptive equipment (reacher, long shoe horn...) X   

Dressing the patient   X 

Gait training  X  

walking the pt in the room/hallway   X 

Instruction on use of assistive device (walker, cane…) X   

Feeding patient an established modified diet    X

Instructing patient/family on swallowing precautions X   

Determination of correct diet level for patient X   

Communication training X   

Follow through with memory strategies   X 

Page 11: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

General information

• We need new orders when a patient moves to a higher level of care eg. Medical to ICU.

• We do not need new orders when a patient moves to a lesser level of care eg. ICU to PCU.

• We need physician clearance to continue services after certain procedures.

• Patients are placed on hold pending test results to rule out fracture, stroke, DVT etc. or with unstable vital signs and medical condition.

Page 12: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

Outaptient Programs

• Sport injury rehab

• Post surgical rehab

• Orthopedic and total joint rehab

Page 13: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy
Page 14: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

Outpatient Programs

• Vestibular rehab

• Mobility and balance programs

• Wheelchair fitting

Page 15: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

Outpatient Programs

• Stroke and Neuro rehabilitation

• Back and neck rehabilitation

• Hydrotherapy

Page 16: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

Outpatient Programs

• Hand and upper extremity rehab

• Amputee and prosthetic limb training

• Custom orthotics

Page 17: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

Patient education is priority

Page 18: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

Hands on therapy

Page 19: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy
Page 20: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

Custom Orthotics

Page 21: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

Contact usHeart of Florida Therapy Center

40100 HIGHWAY 27, DAVENPORT,FLORIDA 33837

TEL. (863) 419 2500 or 422 4971 FAX (863) 419 2503

WWW.HEARTOFFLORIDA.COM

Page 22: HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

REFERENCE• Vanessa Sandarusi, MHSA, MBA, Joseph Tod, Lisa Holscher, PT, Anita Marie Greer, SP, Daniel McNulty, OT

(2010), Acute Therapy Practice changes presentation for Miami Valley Hospital Premier health Partners