Week 7 = Finished

Yesterday marked the end of week 7, meaning I only have 5 weeks left here.

So far I have:
-started seeing a daily caseload on my own (mostly)
-learned 2 new computer programs for documenting
-lived on my own for 7 weeks in a city where I didn't really know anyone
-worked on the ortho, neuro, cardiac, and med-surg services
-had some great visitors, and had a really nice trip home
-received an amazing midterm review

Before I leave, I still need to/get to:
-complete my final project
-see Work Hardening, Low Vision, and Driving Rehab evaluations
-go into orthopedic surgery (the surgeon I'm going in with completes mostly knees and some hips)
-take a day off to go meet baby boy Smith when he's FINALLY born!
-talk with my boss' boss' boss (the head of our department) about how I want to come back and work if the hiring freeze gets lifted!
-go through the final review process
-pack up my apartment so I can move home prior to Christmas!

Overall, I'm still really loving it here. Last night we had "Ortho Girls Night Out" - the ortho guys showed a little twitch of jealousy - but we think we'll let them come next time.
We went to a Mongolian BBQ for dinner - I love that I can put my own meal together since I'm so picky! You get to pick everything you want - from the meat to the veggies to the sauce - it's great to have the amount of everything I want in my dish and then watch it get cooked right in front of my eyes. Thank goodness I don't have food allergies!
After the bbq we went to "la cave" which was a really nice underground (literally, it's under the ground, in the basement) wine/beer bar. They have a whole wall of wall coolers filled with all different kinds of beers, and the wine list is huge as well. It was nice to just be out hanging out with people I work with - 5 of us went, I learned so much about the people I work with!

Monday I'm headed to a different part of our system to spend the day learning about our Work Hardening & Low Vision Occupational Therapy departments. The building is called the Walker Center - it's a shared area with University Hospitals. It's going to be strange to be outside of the acute hospital area for a day - but a good experience.

It's also going to be strange to not wear scrubs on Monday!

Oh My... the 1/2 way point

Holy Crow - week #6 is turning out to be a little crazy!

On Monday, Joy & I were on the neurology service. We had patients with spinal issues, weakness, headaches, and one patient who had spinal fluid draining from his body into a bag... sounds totally gross -kind of is gross, but it's so cool that we can help him get back to his prior level of function by draining some of the fluid from around his brain so there is less pressure. Another patient had a few holes drilled in his head to help relieve pressure. He had surgery a few weeks ago and it appears that due to some medication side effects he had swelling of the brain. His wife was so wonderful and now that his medication is managed he should be getting back to his normal self soon.

On Tuesday, Joy was off for the day so I spent the day with another therapist on neurology service again. I learned so much about how documenting is different for the different services (ortho & neuro). Before we started working for the day we had an in-service about orthotics & prosthetics.  It was really interesting to see how patients are fit for prostetics after amputations.

Today, Joy & I were back on ortho (what a relief - it feels like going back home - just comfortable after being away!). Joy & I split up quite a bit and were able to get lots of patients seen today. The one downside was that my patients were decently difficult.

My first difficult patient had a knee replacement. The physical therapist saw him yesterday and recommended he was suitable to go home with assistance as needed. The patient's doctor told him he could go to skilled nursing/rehab prior to going home. When I asked the patient his plans for after discharge from the hospital he went into a tirade about how he was going to rehab and the doctor told him he could go, and how the only way he would go home was if our supervisor (the physical therapist & mine) would write a note on Cleveland Clinic letterhead stating if anything happened to him we (the therapy department) would be responsible for it all. After a difficult session of his bad attitude, I wrote my recommendation to send him to skilled nursing/rehab - and based my decision on what appeared to be a short term memory issue and some safety concerns. It was a close call if a recommendation to send him home or to rehab was the right choice. Insurance is now having some major issues as the PT says he can go home, and I say rehab is an ok option... My boss' boss got involved trying to help figure it all out and after quite an ordeal - he requested the PT & I go to see him again tomorrow to co-treat him and come up with a plan. I need to work on a plan tonight so I know exactly what I'm testing and how I am going to back up my recommendations tomorrow... the really good thing is that my boss & her boss back up my recommendations as long as I can back them up with facts.

My other difficult patient wasn't assigned to us today, but I was sitting next to the social worker/case manager when she was discussing the need for an OT evaluation prior to sending her application for placements to facilities before heading home. I offered to complete the eval so there would be whatever they needed. The patient was very nice, but very unrealistic about returning home. She was unable to understand that since she needed moderate assistance to get from laying in bed to sitting at the edge of the bed, and maximum assistance from 2 of us (the PT & myself) to help her stand. She was unable to stand for more than 30 seconds, and she needed 3 tries to stand. The PT & I spent our entire session talking to the patient about safety and going to get some additional rehab... sadly, I don't think she understood at all the need for her to be more independent before she goes home.

I really do love what I do - but I'm exhausted today! I'm hoping tomorrow doesn't go quite as wild as today!

Week 5, day 2

Today was a good day - although a little crazy! My supervisor and I have started splitting up to see patients. I head out with a physical therapist (PT) so I can have someone in the room with me in case a patient is unsafe (or if I need anything or feel uncomfortable).

I had some really heavy duty patients today. One patient needed maximum assistance from 4 of us (my supervisor, myself, a PT, and a tech from our department). She was a great lady and really tried, but between her hip surgery, her spinal surgery, and her weight has a lot of trouble with movement (lots of precautions of movements she shouldn't/can't do, plus she's been in bed for almost 3 weeks so she is very de-conditioned). She was sitting at the edge of the bed and got very dizzy so we had to quickly get her back laying in bed. It was quite a session...

I had another patient that required maximum assistance from 2 of us to move in her bed. She broke her femur and has had multiple surgeries trying to fix it (at another hospital - just one at the clinic). She's also been in bed for over 2 weeks. The PT and I spent 54 minutes in her room and didn't get her to sit up at the edge of the bed without both of us holding on to her. Hopefully, she will continue to get better as she heals and starts to get more therapy instead of spending as much time in bed without therapy.

I'm so excited to head home this weekend! I'm starting to spend my time planning everything while I'm home - as well as packing for my trip! I have quite a bit of Christmas shopping done already so I want to bring those gifts home - plus Halloween goodies for Colton (and a few for Baby Boy Smith). Overall, this week is going well - and now only 3 more days of work before I head back to NY!!

Week 4 done

I think I've been so wrapped up in working that I haven't been doing much updating.

Life has gotten into a much better flow at CC for me. I'm now seeing 4 patients a day - and responsible for all of their documentation. I'm even seeing some of the patients alone, while the rest I see with the physical therapist. My supervisor is really letting me get out there and see how things go for me on my own. She told me she thinks I have good clinical judgment and base knowledge so she is comfortable with me seeing patients on my own. I've also started to be responsible for making discharge recommendations for any patients when I complete the evaluation. This is probably the most difficult thing for me - at least it was this week.

I had quite a few patients who wanted to go a different place than I thought was the right place for them. It's interesting to see which patients will put their foot down and head to where they want to go even if we recommend something else. It's even more interesting to see what patients qualify for skilled nursing (read nursing home) care placements,and which patients qualify for acute (read at least 3 hours of therapy a day) rehab. Some patients are so set on going home they will fight tooth and nail to avoid both situations. If they are lucky enough to have good family support at home, typically we can make it work for them.

The only really difficult thing is when patients don't have any (or much) assistance at home and are unsafe. Hip replacements are very complicated when it comes to after surgery precautions. Patients that are unable to  remember or apply the precautions should not go home unless they have someone there to really help them remember and stay safe.

I also had a patient this week that selected not to follow the walker safety precautions at all - he joked about how far to move his walker (tossing it in front of him about 5 feet, standing up without it, etc) and he just didn't seem to care. It was really difficult for me to do - but I discharged him from OT since he didn't care to listen to anything I had to say. I felt that there were lots of things I could have helped him out with, but he just didn't care - so there's no real point in taking services from someone who wants to learn and be safe to give them to someone who does what he wants to do anyway.

I also learned about what some MDs think of therapists - the hard way. We had a patient in the ICU because her blood levels dropped exceptionally low (they should be around 13, she was at 4) and had to have blood transfusions. She had orders to be on bed rest, so we canceled her session for the day. Physical therapy & OT both canceled after the PT talked with the floor and we reviewed the chart (general surgery MD was concerned that there might be internal bleeding) and saw the bed rest order. The following day there was an order from the surgeon (the original surgeon) with a snide comment about how it would be nice if PT & OT wouldn't choose to ignore patients in the ICU. Instead of realizing that we did a thorough chart review and made a decision using our clinical reasoning skills he immediately just assumed that we were just ignoring a patient because it was easy to do. I learned that that MD, along with some of the others think that therapists should just do exactly what they say without thinking for ourselves. It was very eye opening about how important it is to make a clinical judgment - and have information to back it up. As the PT said "I obviously went to school for 7 years so I could follow blindly!"

Overall, the staff is really great with us. The nurses are generally great at following our recommendations and ask us for help when they aren't sure what is best for the patient. The PCNA (nurse's aides) are also great - we work together to help the patients all the time. When we know a patient may only be able to get up once, we go in and let the PCNA know so they can come in and change the bed while we're working. It's great for the patient to get the best service possible. Many of the MD's are great too - when they return our questions/pages and are willing to talk to us in person when we see them. Overall, I'm still very happy with the staff and placement in Cleveland!

"Max Assist Monday"

Today, each of my sessions was with a PT for either a co-treatment (eval for OT, treatment session for PT), or co-evaluation. Oh boy am I glad we were all in there together! Quite a few of the patients required all three of us to be active and involved in their transfers. We were able to get through our entire list of patients - except for one patient that declined to see us... she's had some pretty extensive surgery and is refusing pain medication. She's clearly in a lot of pain, but she's very strong about not wanting pain medication. The motto at Cleveland Clinic is "patient's first" so they are very respectful of her wishes, but I think the nurses, and therapy staff, are doing a good job of discussing pain management options with her. We let her know we would be back to check tomorrow to see if she was feeling up to therapy - and I hope either her pain decreases, or she accepts some assistance from medication.

I'm happy to say, today was tough, but it's over... and I did quite a bit of charting myself. I've even starting signing my reports (although, it's really just a button I click that says I signed it, no password or anything required), and using my pager number so if there are any questions people can contact me. Hopefully, there are no problems and no contacts to my pager...

Hopefully tomorrow isn't "Total Assist Tuesday!"

week 1 = DONE!

Today I finished my first week. There are still things I need to work on (like understanding which direction to head in the parking garage - sometimes up is the right answer even if I'm trying to get to the bottom..., how to get around the hospital, how to use the computer systems - yes, there are 2 we use for documentation, so it's confusing), but overall I feel really comfortable there. I got a great review for my first week, and talked about some things to continue to work on/learn about. 

I didn't go into my placement thinking I would like working in orthopedics, but I'm actually really enjoying my placement. The thing about Cleveland Clinic is that even something as "simple" as a hip replacement or a knee replacement isn't typically simple. We have lots of patients that have other medical conditions, are having a surgery done that other doctors declined to do (sometimes due to risks or the nature of the procedure), and some patients are having things fixed that were initially done incorrectly by other doctors. A lot of my patients are "revisions" which means they have already had a surgery and are having this redone. Quite a few of those take place when the original implant (new hip, shoulder, knee, elbow fixators) are infected. Doctors typically take out the infected implant and then put a spacer in to fill the area while they fight the infection. I thought this would be a specific or specialized piece, but most of the time it just looks like a disc. They are filled with antibiotic to help fight the infection right at the source to make sure all of it is gone before attempting a new joint.

I like that the end result is hopefully all the same - returning to prior level of function - for some of my patients that means they don't need OT after the initial evaluation. Other patients require visits from us while they are in the hospital as well as home OT or OT at a nursing/rehab facility. We get to make the recommendation as to where patients should go after release from the hospital based on the needs they have and the help they can get at home. I'm starting to feel more comfortable that I can make an educated decision about what would be best for the patient after discharge.

I spent a good portion of the week working on getting into the routine. I get into work each day and pull Joy's schedule (my supervisor) and then start on my chart reviews. Since we're working in acute OT our patients change very often and we typically don't know who we will have on our schedule the next day. I'm starting to learn how to read x-rays, doctor's orders, notes from other services (the MDs, nursing, other therapy), and understanding medical conditions, and tests (I actually know what it means when someone does blood work and what those numbers actually help tell us). I'm learning about how we bill insurance companies and private patients. I'm also spending a good deal of time working on my documentation skills. We use one program at the hospital for OT/PT charting, while the rest of the hospital uses a different program. The main program used is important for us to use to understand what else is going on with the patient besides just therapy. There are so many steps to charting, billing, assigning patients, etc - it's crazy! It takes up almost as much time as actually seeing patients. 

Our goal is to have about 5 billing credits per day - we haven't accomplished that yet (since each 15 minutes counts for .25 billing credits), but with all of the training my supervisor has to do with me I think we're doing pretty well. I'll keep you all posted on how things keep going.

I'm looking forward to sleeping & getting work done this weekend - and next weekend seeing my SNA!!

Day 2 out of 60

Yes, thanks to Nan, today I learned I am currently signed up to work 60 days... although I guess really it's 59 since I have Thanksgiving day off. Today was a good day at work again. The day started with a LONG commute due to the rain and an accident (not me, but traffic was quite backed up). We didn't start seeing patients until 9 am due to an article review. Each Tuesday there is a presentation, article review, discussion session, etc from 8-9. 
This morning we completed 4 evaluations with PTs. It's really nice that we work so closely with the ortho PTs (as we are ortho OTs currently). We go into the patient's room together so the patient only has to answer our common questions once. The co-evaluations/co-treatment sessions allow us to also increase the amount of patients who agree to participate since the only need to get out of bed once for both evals. 
There are two OTs in the orthopedic department and 1 COTA. They are all great and work really well together. I think there are 5 PTs (but I'm not exactly sure, and I'm not sure about the PT/PTA breakdown). I'm starting to learn about more documentation and how the department runs.
Lunch was nice today. Everyone eats in the common area (OT & PT department) and we enjoy taking a break (partially) from work. I'm starting to get to know some of the other staff members. We're figuring out the PT Olympics and what each person on the team will be responsible for in the relays.


Today I also got a few new things I need to carry around with me. 

Smelling salts (on the left) and a pager - who still carries pagers?? Everyone who works at CC, that's who!