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!
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!
What happened with the PT / OT co-eval? Rehab or go home to the grouchy one? sure hope he's doing ok!
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