Occupational Therapy Inpatient Service Treatment Frequency Guidelines BID

Impairment Rationale: Skin integrity: Splint checks with a new or modified splint where poor skin integrity or circulatory compromise requires diligent skilled assessment to monitor tolerance Skin integrity: Splint checks until : -skin integrity is stable -appropriate wearing schedule is tolerated -pt/caregiver education is completed Edema management checks until: -pt/caregiver independently don/doff edema control garments appropriately and independently -skin integrity and perfusion are intact -pt/caregiver correctly position affected area correctly ROM/Positioning: A/AA/PROM exercises of face, neck, UE when loss of soft tissue length/joint integrity will occur at a QD interval because of impaired ability to complete exercises alone and/or family/caregiver education needs ADLs: Pt making daily gains in bathing, dressing, func mobility, toileting performance through use of adaptive equipment strategies, pt/family education, and/or graded/modified activity demands Pt making daily gains in self feeding performance through use of pt education, adaptive equipment, graded/modified activity demands Skin integrity: Splint checks once schedule is established, but regular follow-up is required to reassess as needed with fragile or compromised integument Edema management: Once established program in place, to monitor and modify intervention as healing or medical issues dictate Skin integrity: Stable splinting status; weekly reassessment for modifications or changes of current program Edema management: Stable program in place; weekly reassessment for modifications of current program

QD

TIW

QW

ROM/ Positioning: A/AA/PROM exercises of UE when pain or activity tolerance limits session length or when patient compliance with therapeutic exercise is limited and loss of soft tissue length or joint ROM occurs at QD frequency ADLs: No identified impairment rationale for BID intervention

ROM/positioning: A/AA/PROM program of face, neck, and UE have been taught to patient, family, caregivers, however patient presents with risk of soft tissue shortening or loss of joint ROM without skilled OT intervention to supplement, modify, or progress plan of care ADLs: Pt is not able to make daily gains in ADL performance, but requires continued OT intervention due to one or more of the following reasons: -Acute medical issues preclude daily participation -Functional endurance requires graded participation in ADLs -Motor and/or process skills required for ADL activity limit participation -On-going patient/family/caregiver education

ROM/Positioning: Stable positioning program, however patient at risk for loss of tissue length/ROM secondary to prolonged immobility; weekly reassessment for change in status ADLs: Patient presents with self care at baseline, but due to on-going medical issues, patient may have functional decline over time without periodic patient/caregiver education Patient making very gradual gains in ADLs, secondary to medical issues, but is able to tolerate and process small gradations of ADL progression with weekly education Cognitive/processing skills: Patient making very slow functional gains secondary to medical issues. Re-assessment at least weekly for readiness to engage in retraining.

Cognitive/processing skills: No identified impairment rationale for BID intervention

Cognitive/Processing skills: Patient making daily gains in arousal, ability to engage in activities, and subsequent improvement in occupational performance with significant cueing and adaptive strategies Family/caregiver education is on-going and resulting in enhanced patient occupational performance and safety

Cognitive/Processing skills: Patient not able to tolerate daily intervention or skilled cognitive retraining secondary to medical issues Family/caregiver education limited secondary to availability or patients ability to engage in task

Visual/Perceptual skills: No identified impairment rationale for BID intervention

Visual/Perceptual skills: Patient making daily gains in acquiring compensatory and adaptive strategies to engage in routine occupations Family/caregiver education is on-going and resulting in enhanced patient occupational performance and safety

Visual/Perceptual skills: Pt is not able to make daily gains in visual compensatory strategies secondary to cognitive deficits or medical issues, however, requires on-going OT intervention for reinforcement, progression of plan of care, or patient/caregiver education

Visual Perceptual skills: Patient making slow functional gains secondary to medical issues. Re-assessment at least weekly for readiness to engage in training.

Disposition Rationale: Pt with imminent discharge to setting with limited or no follow-up services, requiring multiple teaching sessions to ensure safe and effective occupational performance at discharge.

Pt with upcoming discharge to home requiring daily education and intervention to maximize occupational performance in ADLs, UE func use, toileting, safety, and adaptive equipment.

Pt with disposition plan which includes on-going OT upon discharge to home, ambulatory, or rehabilitation setting, secondary to complex medical issues or the severity of functional impairment.

No identified disposition rationale for weekly intervention

N. Kelly, OTR/L---May 2006 2006, Department of Rehabilitation Services, Brigham & Womens Hospital, Boston, MA