Acute Care Tricks

There are so many OTs in the Acute Care/Hospital setting, and yet sometimes it's as if we're the black sheep of the OT family. There's not a lot of OT research done in the field, we must work within the medical model, and turnover of patients and therapists is high. I remember when I was getting started, I borrowed books on PT in acute care to try to bridge some knowledge gaps and vowed that there should be more on the role of OT. (click through to continue)

After spending four years in the hospital system, I had made up a list of topics that were relevant to OT in acute care that weren't covered well in my textbooks and had decided to do a series of serious blog entries covering these topics. Of course, this was in my +50 hour work week and long commute days and just never got it started. That is about the time that I saw this book coming out, and while I was excited, I was also really depressed about not doing my series ahead of time, and I stopped writing on the topic for awhile. (I haven't been able to see the book yet, but based on the contents I think that it would be really good for people new to the acute care setting)

Anyway, that's a really long intro, but I wanted to share some of the off-book tips for acute care therapists (many of these would be relevant to physical therapists as well) that I've developed (or stolen from smarter people) over the past few years.

- learn to get good at manipulating equipment. If you don't know what it is, what it does, or what happens if it gets disconnected- ask and figure it out. A good nurse friend will come and disconnect IVs, foleys, and PEG tubes if they're able to per order. Ask people to show you how to pop the ICU monitors off the wall. Stack your O2 tank on the IV pole, hook a chest tube on a walker, pin loose drains to the patient's gown... possibilities are endless. Pay attention to what the good nurses and techs do and take a page from them.

- double up on everything. Think you need 2 washcloths for your ADL? Better bring 4. Because one will drop on the floor or get really dirty and you'll need another.

- Be creative with what you have. You can't carry a lot of items with you in acute care, so nothing can be a unitasker. A mitten (used to keep people from pulling wires) can be a ball, which is a good early purposeful activity in the ICU. Objects like a safety pin and comb can be good for fine motor and stereognosis testing.

- speaking of the ICU, if you are working with someone (particularly male) who isn't able to stay covered with a gown and is kicking the covers off, the sleeves of a gown can become leg holes to help keep some modesty.

- Try to make it easy for the next person who comes along. This is a list of things you should return to place before you leave the room. If your patient is anything less than 100% ambulatory, make sure the bed is right beside the chair. Don't leave all the cords tangled up in a corner. And if you can make the bed fresh (or even get the tech to help you during the tx) then it will very much be appreciated. When you're working with someone on their first day after an orthopedic surgery, or any time that you don't feel very confident that the person will actually make it to a chair, you need a different bed changing strategy. As a person is sitting EOB, (maybe as you're taking vitals or the PT is checking something) pull the four corners of the sheets off the bed. Then your helper can put the new fitted sheet and a folded draw sheet on as close to the patient. When your patient stands up, the helper pulls off the old and moves over the new stuff LICKETY SPLIT. Voila! new bed, ready for your person to collapse back onto if needed.

- In a pinch, the back of a sturdy chair can serve as a walker for standing. This usually ends up happening in the ICU when you weren't expecting a person to do any standing, but they surprise you in a good way. Not such a good way that they start cartwheeling across the room, but good enough to get a short stand in.

- lastly, there's one accessory you should never be without. Jumbo safety pins. Stick 10 of them on your lanyard or off your badge tag- they are so often useful.

What's the trick that makes your life in acute care easier?


Christopher Alterio said...

How about strategically using lotion to prevent heated splinting material from sticking to IVs, other tubing, bandages, etc. Of course it won't stick to itself either when it is greased so it is a tradeoff!

Cheryl said...

haha, all splinting tips need to come from someone other than me! The only semi-good thing I could figure out how to do was splint around an art line

Christopher Alterio said...

Yes, a friend who is a GREAT OT accidentally pulled a femoral arterial line while making a knee extension splint for a child in the ICU and that changed the rest of the staff forever. Isolating the work field carefully and using lotion became absolute standards. Something scary like that only has to happen once!

Unknown said...

Do you lotion the patient/lines/etc or the thermoplast? ('m kind of thinking the thermoplast

Physical OT said...

Thank you Cheryl, eve nthough this was posted 3 years ago I am finding these tips very useful and have battled with most of these problems myself, but felt too silly to ask for help. Thank you Christopher for the lotion tip, I will be making use of that as I am new to splinting.

Please send more advice and tips, we are starting a new practice in a newly built acute hospital and I need all the tips I can get!

Anonymous said...

A lot of my patients ask me if they can have something similar to a stress ball. We normally have these rectangle sponges of various strengths but we run out of the very fast in the acute setting. So one day, I filled a small glove with a few other gloves and tied it closed, then tied the fingers together; thus making a "makeshift stress ball". All my patients love working with it, and it’s ok if it gets lost because there are always gloves available :).

Anonymous said...

Think outside of the box...kerlix rolls make good hand rolls for contractures;
- have a box full of different containers to practice opening and closing
- adult coloring pages are free on-line and colored pencils are pretty cheap
- have word puzzles for pt's to work on as homework
- have your patients who are doing well with ADLs make their bed and straighten up their room to simulate IADLs at home
- for evals - get familiar with the PASS.
-don't forget to address those mental health issues - we are holistic you know
- have patients journal their journey is they have a chronic problem or an acute one that will take a long time to heal from - helps to address adjustment to disability
-even pts who are intubated can be seen by OT if they are alert. Work on applying lotion, washing face if they are safe, washing arms.
- think about using iPads or other tablets for communication with non-verbal (intubated/trached) pts.
I have so many ideas after 29 years in OT and 15 in acute care!
Tracy, Harrisburg, PA