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Occupational Therapy ICU part 2 Roundtable 2014

Occupational Therapy ICU part 2 Roundtable 2014






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    Occupational Therapy ICU part 2 Roundtable 2014 Occupational Therapy ICU part 2 Roundtable 2014 Presentation Transcript

    • Occupational Therapy in the ICU 3 Problems to target: prolonged bedrest and ventilation, sensory deprivation and stress, and cognitive impairment
    • OT TreatmentsOT Treatments Upper Extremity Exercise, positioning, splinting Early participation in functional activities and ADLs Cognitive stimulation Use of technology for alternative treatment interventions Participation in ICU diaries
    • ICU DiariesICU Diaries Purpose: to fill memory gaps and provide an understanding of what happened in a chronological narrative account. Connects facts with autobiographical memory (or lack of) to make sense of a time that may have been dominated by delirium or confusion. A way to communicate the experience with others.
    • Communication technologyCommunication technology Encouraged use of and iPad and/or Eye Gaze System for communication while on vent or trach Use of iPads for fine motor coordination tasks and UB strengthening Use of iPad and/or Eye Gaze System for cognition activity
    • Program GoalsProgram Goals Designated OT’s in the ICU Prioritizing ICU patients Advocate Team Approach to patient care Participate in Research Log Book by documenting highest level of ADL performance (sitting or higher)
    • Additional ResourcesAdditional Resources Family involvement menu, Mobility guidelines, Engagement tool
    • Family Involvement MenuFamily Involvement Menu Welcome: Welcome to Mayo Clinic hospital ICU Purpose: We believe that you know the person we are serving better than we do. We would like to invite you to participate in your loved ones care. Contract: We would like to participate in the care of this person with the following tasks. We are receptive to instruction. tasks: incentive spyrometry, bath care, eating care, exercise, etc
    • Mobility toolsMobility tools Mobility Board / Quality BoardBoard / Quality Board Guidelines/fact sheets levels of consciousness (assessment, activity, therapy) Is my patient ready to start mobility activity today? (neuro, respiratory, cardiovascular screens) Progressive Mobility tolerence screen Progressive Mobility decision tree for PT /OT consults
    • Function toolsFunction tools standardize as much as possible grip test 6 minute walk test Quality of Life measure
    • EngagementEngagement Operant Conditioning: learning that occurs through rewards and punishments of behavior (ie: positive and negative reinforcement) Motivational Interviewing: using patient goals or values to shape care Resist righting, understand patient motivation, reflective listening, empowerment as apposed to using goals centered on external factors
    • Engagement toolsEngagement tools Done in collaboration with whole team Starter: Hand-off communication tools for therapist to therapist and for therapist to / from nurse Advanced model: Bundle system-wide an interdisciplinary approach to communicating function so there is seamless progress when patients move unit to unit
    • SafetySafety Study concluded out of 5300 PT sessions with 50% sitting or higher activity level, there were only 34 potential safety occurrences (89% of them were changes in vital signs). There were no major events such as catheters or trachs removed or MI’s. There were 2 assisted falls and 1 unassisted fall. Only 8 events that needed minimal intervention. Potential area of study as we proceed with our culture of mobility.
    • Thank You Carmen Cononie, Kristien Daron, Rebekah Davis, Hali Cole