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!!