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Occupational Therapy in Acute Care

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Kari Whitaker

on 13 October 2015

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Transcript of Occupational Therapy in Acute Care

Occupational Therapy in Acute Care
Presented by:
Pamela Anderson and Kari Whitaker

What is the role of occupational therapy in acute care?
Registered occupational therapist (OTR) receives an order from MD or APRN to evaluate a pt
OTR evaluates & determines if OT services warranted
OTR creates care plan/goals
Certified occupational therapy assistant (COTA) follows through with care plan/goals
COTA communicates with OTR throughout treatment plan
What is the focus of OT in acute care?
Physical disabilities primary frame of reference
ADL training
Functional transfer training
Caregiver training
DME recommendations
Exercise programs
Other frames of reference
Respiratory Lines
Back Braces
Know what you do and why you are doing it
Objectives: by the end of this lecture, you will be able to answer the following questions:
What does acute care mean?
What is the role of occupational therapy in acute care?
What kinds of medical equipment do you need to know about?
What are some common diagnoses and complications?
What does interdisciplinary mean and who makes up the interdisciplinary team?
What are the dos and don'ts of documentation?
Case study – following a patient from ICU to discharge from the hospital

Common Complications
Barriers to Mobilization
Activity orders
Appropriate OT orders
ICP monitors
Open wounds
Medical complications
Endurance for activity
State of alertness
What kinds of medical equipment do you need to know about?
Peripheral/central lines:
IV, PICC, TLC, arterial line
Respiratory lines:
Oxygen tanks, nasal cannula, trach collar, vent lines, trach cuffs, chest tubes
DVT prophylaxis
ICDs, compression stockings
Keeping track of vitals
BP cuff, pulse oximeter, telemetry
Back braces
Aspen collar, soft cervical collar, TLSO brace, LS brace, Jewett brace
What does acute care mean?
A reasonable working definition of acute care would include the most time-sensitive, individually-oriented diagnostic and curative actions whose primary purpose is to improve health.
A proposed definition of acute care includes the health system components, or care delivery platforms, used to treat sudden, often unexpected, urgent or emergent episodes of injury and illness that can lead to death or disability without rapid intervention.
The term acute care encompasses a range of clinical health-care functions, including emergency medicine, trauma care, pre-hospital emergency care, acute care surgery, critical care, urgent care and short-term inpatient stabilization
Common Diagnoses
Elective surgeries: Total joint replacements and spine surgeries
Orthopedic injuries: intertrochanteric hip fx, femur fx, tib/fib fx, humerus fx, ulnar/radial fx, multiple fx
Central and peripheral nervous system injuries: CVA, ICH, SDH, SAH, TBI, GBS, MS, SCI, surfer's myelopathy
Respiratory system: PNA, COPD, acute respiratory failure
Others: cellulitis, sepsis, kidney failure, organ transplants
Interdisciplinary Team
Rehabilitation Services
Occupational Therapy
Physical Therapy
Speech Language Pathology
Discharge Planners
Social Workers
Case Managers
Charge RN
Respiratory Therapy
Integrative Wellness
Pain and Palliative Care
QHS Behavioral Health Liasion
Intensive Care Unit
Highest acuity of care
Minimal Lines
Foster Family
Am J Occup Ther. 2013 May-Jun; 67(3): 355–362.
Occupational Therapy for Patients With Acute Lung Injury: Factors Associated With Time to First Intervention in the Intensive Care Unit
OBJECTIVE. Very early occupational therapy intervention in the intensive care unit (ICU) improves patients’ physical recovery. We evaluated the association of patient, ICU, and hospital factors with time to first occupational therapy intervention in ICU patients with acute lung injury (ALI).
METHOD. We conducted a prospective cohort study of 514 consecutive patients with ALI from 11 ICUs in three hospitals in Baltimore, MD.
RESULTS. Only 30% of patients ever received occupational therapy during their ICU stay. Worse organ failure, continuous hemodialysis, and uninterrupted continuous infusion of sedation were independently associated with delayed occupational therapy initiation, and hospital study site and admission to a trauma ICU were independently associated with earlier occupational therapy.
CONCLUSION. Severity of illness and ICU practices for sedation administration were associated with delayed occupational therapy. Both hospital study site and type of ICU were independently associated with timing of occupational therapy, indicating modifiable environmental factors for promoting early occupational therapy in the ICU.

Lancet. 2009 May 30;373(9678):1874-82. doi: 10.1016/S0140-6736(09)60658-9. Epub 2009 May 14.
Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial.
Schweickert WD1, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP.
BACKGROUND: Long-term complications of critical illness include intensive care unit (ICU)-acquired weakness and neuropsychiatric disease. Immobilisation secondary to sedation might potentiate these problems. We assessed the efficacy of combining daily interruption of sedation with physical and occupational therapy on functional outcomes in patients receiving mechanical ventilation in intensive care.

Sedated adults (>/=18 years of age) in the ICU who had been on mechanical ventilation for less than 72 h, were expected to continue for at least 24 h, and who met criteria for baseline functional independence were eligible for enrolment in this randomised controlled trial at two university hospitals. We randomly assigned 104 patients by computer-generated, permuted block randomisation to early exercise and mobilisation (physical and occupational therapy) during periods of daily interruption of sedation (intervention; n=49) or to daily interruption of sedation with therapy as ordered by the primary care team (control; n=55). The primary endpoint-the number of patients returning to independent functional status at hospital discharge-was defined as the ability to perform six activities of daily living and the ability to walk independently. Therapists who undertook patient assessments were blinded to treatment assignment. Secondary endpoints included duration of delirium and ventilator-free days during the first 28 days of hospital stay. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00322010.

All 104 patients were included in the analysis. Return to independent functional status at hospital discharge occurred in 29 (59%) patients in the intervention group compared with 19 (35%) patients in the control group (p=0.02; odds ratio 2.7 [95% CI 1.2-6.1]). Patients in the intervention group had shorter duration of delirium (median 2.0 days, IQR 0.0-6.0 vs 4.0 days, 2.0-8.0; p=0.02), and more ventilator-free days (23.5 days, 7.4-25.6 vs 21.1 days, 0.0-23.8; p=0.05) during the 28-day follow-up period than did controls. There was one serious adverse event in 498 therapy sessions (desaturation less than 80%). Discontinuation of therapy as a result of patient instability occurred in 19 (4%) of all sessions, most commonly for perceived patient-ventilator asynchrony.

A strategy for whole-body rehabilitation-consisting of interruption of sedation and physical and occupational therapy in the earliest days of critical illness-was safe and well tolerated, and resulted in better functional outcomes at hospital discharge, a shorter duration of delirium, and more ventilator-free days compared with standard care.
Crit Care Med. 2013 Jul;41(7):1790-801. doi: 10.1097/CCM.0b013e31828a2abf.
Physical rehabilitation of the critically ill trauma patient in the ICU.
Engels PT1, Beckett AN, Rubenfeld GD, Kreder H, Finkelstein JA, da Costa L, Papia G, Rizoli SB, Tien HC.
Author information

To 1) review the existing evidence for early mobilization of the critically ill patients in the ICU with polytrauma; 2) provide intensivists with an introduction to the biomechanics, physiology, and nomenclature of injuries; 3) summarize the evidence for early mobilization in each anatomic area; and 4) provide recommendations for the mobilization of these patients.

A literature search of the MEDLINE and EMBASE databases for articles published in English between 1980 and 2011.

Studies pertaining to physical therapy and rehabilitation in trauma patients were selected. Articles were excluded if they dealt with pediatrics, geriatrics, burn injuries, isolated hand injuries, chronic (i.e., not acute) injuries, nontraumatic conditions, and pressure/decubitus ulcers, were in a language other than English, were published only in abstract form, were letters to the editor, were case reports, or were published prior to 1980.

Reviewers extracted data and summarized results according to anatomical areas.

Of 1,411 titles and abstracts, 103 met inclusion criteria. We found no articles specifically addressing the rehabilitation of polytrauma patients in the ICU setting or patients with polytrauma in general. We summarized the articles addressing the role of mobilization for specific injuries and treatments. We used this evidence, in combination with biologic rationale and physician and surgeon experience and expertise, to summarize the important considerations when providing physical therapy to these patients in the ICU setting.

There is a paucity of evidence addressing the role of early mobilization of ICU patients with polytrauma and patients with polytrauma in general. Evidence for the beneficial role of early mobilization of specific injuries exists. Important considerations when applying a strategy of early physical therapy and mobilization to this distinctive patient group are summarized.
Research Articles
Ambulation Devices
Heart rate
Blood pressure
SAFE Guidelines
AC Video Sample 2
AC Video Sample 3
Documentation Dos and Don'ts
Full transcript