Week 11 Surgical+Standard+Precautions PDF

Week 11 Darren Bolger, CPO, MSPO   Quiz 7 (short) – Due Friday Announceme nts  Patient Interaction during next regular lab time  Thursday (11/7)  Tuesday (11/12)   Dress code  Business casual (no jeans)...

Week 11 Darren Bolger, CPO, MSPO   Quiz 7 (short) – Due Friday Announceme nts  Patient Interaction during next regular lab time  Thursday (11/7)  Tuesday (11/12)   Dress code  Business casual (no jeans)  Groups of 2 or 3 assigned by me  Assignment  Perform patient interview/exam to create clinical note  S and O of SOAP note Patient  20-25 minutes with patient  Ask appropriate/relevant questions related to Interaction scenario  Knee pain (chief complaint)  Medical history  Social history  Complete objective measures  Skin condition  Knee ROM  Circumference and M/L at knee center   Thursday  Stefanie and Madison  Avery, Lydia, Kate  Tuesday  Katelyn and Grace  Aryanna, Alicia, Tesia Groups  Maleah, Salina, Megan D  Megan F and Aiden  Everyone should participate  Discuss as a group your plan Multidisciplinary Care   Define patient-centered care  Demonstrate understanding of the collaborative Objectives role of the multidisciplinary rehabilitation team  Identify and describe the roles of other team members in patient-centered care   Rehabilitation for those with mobility issues is complex  Patients seldom have a single isolated problem  Health care is specialized Why Team  No single discipline has all necessary Care? expertise/knowledge required for high-quality care  Each member of the team assists in developing a comprehensive treatment plan O&P Settings   Patient as a person rather than diagnosis  Patient preferences, needs, values  Patient as the focus of everyone’s work  Goals and Outcomes Patient- Centered Care   Trust among team members  Cooperation and shared responsibility  Understand and respect the roles of others on Success the team  Know your scope of practice Factors of  Two-way communication Team Care  LISTEN to team and patient  Share information and knowledge  Embrace the value of patient-centered team care  Physician Nurse Physical Therapist (PT) Rehabilitati Occupational Therapist (OT) on Team Social Worker Dietitian Orthotist / Prosthetist   Generally the person directing the rehab team  Referral source – prescriptions  PCP – Primary Care Physician  PM&R - Physical Medicine and Rehabilitation (physiatrist) Physician  Surgeons  Orthopedic – amputation, bone injuries / disorders  Vascular – amputation, wound care  Neuro – spinal and cranial injuries / disorders  “Non-Physician Practitioners”  PA – Physician Assistant  NP – Nurse Practitioner   Critical partner in coordination of care, patient education  Implement wear schedule (donning/doffing)  Change dressings  Monitor changes Nursing  Mutual education  Levels of Nursing  RN – Registered Nurse (BS)  LPN – Licensed Practical Nurse  CNA – Certified Nurses Assistant   Movement experts – hands-on care, patient education  Work with the patient frequently  Patient goal-setting and progress  Problem solving Physical  Issue with the device or patient  Patient education Therapy  Donning/doffing, gait training  Patient documentation (outcome measures)  Levels:  PT – Physical Therapist (DPT)  PTA – Physical Therapy Assistant  PT Tech – Physical Therapy Technician (Aide)   Assist in developing skills for independence  Multiple environments: home, work/school, community  Focus on ADL’s – bathing/dressing, cooking/eating, etc.  Determine adaptations needed Occupation  Upper extremity focus: al Therapy  Stroke  Amputation  Documentation  Outcome Measures  Assessment   Connect patients with services/programs to address individual situation  Case manager Social Work  Help with family issues/barriers  Hospital discharge planning team  Work together for financial support of patient to pay for O&P services   Shape the public's food choices  Advocacy, community programs, health promotion  Provide medical nutrition education Dietitian  Nutrition to manage chronic conditions/illnesses  O&P  Energy levels, healing, weight management, inflammation Certified  Assess, design, fit, monitor, educate regarding use/care of prosthesis or orthosis to improve Prosthetist patient function. Orthotist  Experts in biomechanics, tissue mechanics, (CPO) materials and technology   For Patients  Convenience of single location  Difficulty to identify/organize different disciplines of care  Efficiency of care Benefits of  Solutions/decisions formulated with all disciplines present Multidisciplin  Improved outcomes ary Model  For Providers  Communication  Feedback and group discussion/input  Better understand implications of choices  Cohesive team  Satisfaction and valued member   Interprofessional education occurs when students from two or more professions learn about, from and with each other to enable Interprofessio effective collaboration and improve health nal Education outcomes (WHO, 2010) (IPE)  EMU “Excellence in IPE Event”  https://www.emich.edu/chhs/ipe/index.php   Read case provided  Discuss: Activity  Who are the members of the rehab team?  What is each member responsible for?  What are short-term or long-term goals for the rehab team?  Name: John Smith Age: 67 Diagnosis: Right-sided ischemic stroke resulting in left hemiparesis, foot drop, and upper extremity weakness affecting his arm and hand Prior Medical History: Hypertension, Type 2 Diabetes, previous myocardial infarction Activity Hospital Admission (Inpatient Rehabilitation): Post- stroke rehabilitation to improve mobility, functional independence, and activities of daily living (ADLs)  Primary Complaints: John reports difficulty lifting his left foot while walking and limited use of his left arm and hand, making daily tasks like dressing, eating, and grooming challenging. He’s concerned about losing independence in both mobility and ADLs. Standard Precautions   Define Standard Precautions  Demonstrate understanding of hand hygiene and Objectives various PPE commonly utilized  Identify the different types of transmission precautions and associated PPE required for each   2 million patients get hospital-related infections annually  90,000 die from those infection  Infection control practices to reduce transmission of microorganisms in healthcare settings  Assume that every person is potentially infected Standard with a pathogen that could be transmitted in the healthcare setting Precautions  Used for all patients, all the time  Protect BOTH healthcare workers and patients  What is included?  Hand hygiene  Personal protective equipment (PPE)  Gloves, mask/eye protection, gowns   Keeping hands clean is one of the best ways to prevent the spread of infection and illness  When to perform hand hygiene:  If visibly dirty or contaminated  Before contact with patients Hand  Before putting on gloves  After contact with patient’s skin Hygiene  After contact with bodily fluids or open wounds  After removing gloves  After contact with shared surfaces/patient equipment  Bacteria can survive DAYS on equipment/surfaces  Bed rails, computer keyboards, etc.  Alcohol-based hand Soap and Water rubs  Effectiveness depends  Rub hands together for on the volume applied at least 15-20 seconds to hands  Hum the "Happy  Rub hands together Hand Birthday" song from beginning to end until dry  Should still take Hygiene twice  Ensure all surfaces of around 15-20 seconds hands/fingers are  If dry before then, covered likely not enough applied  Alcohol-based hand Soap and Water rubs  Preferred method in all  When visibly soiled other situations  Kills germs more  Before eating effectively than When to  After using the restroom soap/water Use  After care of patients  Less damaging to skin (less dryness) with C. difficile  More accessible – placed at point of care   Wearable equipment intended to protect from exposure to or contact with infectious agents  Examples include: Personal   Gloves Gowns Protective  Masks Equipment  Eye protection  Face shields (PPE)  Goggles  The selection of PPE is based on the nature of the patient interaction and potential for exposure to blood, body fluids or infectious agents.   Prevent contamination from:  Contact with bodily fluids, open wounds, and other potentially infectious material  Direct contact with patients infected with pathogens transmitted by the contact route (VRE, MRSA)  Handling or touching contaminated patient care Gloves equipment and surfaces  Gloves are donned LAST when worn in combination with other PPE  And generally doffed FIRST  Hand hygiene is still necessary after glove removal  Undiscovered tears  Contamination from glove removal   Protect skin/clothing from spray/splash of bodily fluids  Provide full coverage of arms and body (and clothing) from neck to mid-thigh  Always worn in combination with gloves, and with other PPE when indicated Isolation  Gowns are usually the first piece of PPE to be Gowns donned  Isolation gowns should be removed in a manner that prevents contamination of clothing or skin  The exterior (contaminated) side of the gown is turned inward and rolled into a bundle  Should be removed before leaving the patient room to prevent contamination outside the area   Mucous membranes of the mouth, nose, and eyes are susceptible portals of entry for infectious agents  Masks provide coverage of nose/mouth  Eye protection from goggles or face masks Masks and Eye  Useful for: Protection  Protection from contact with infectious material from patients (respiratory secretions or bodily fluids)  Protection of patients from exposure to infectious agents carried by healthcare worker during sterile procedures  Cough etiquette for anyone with potentially infectious respiratory symptoms   Donning  https://www.youtube.com/watch?v=53_h0cfEHwI Videos  Doffing  https://www.youtube.com/watch?v=0-90-ucVHFs   Three primary categories:  Contact Precautions  Droplet Precautions  Airborne Precautions Transmissio n  Used when patient has confirmed or suspected infection and require additional precautions to Precautions prevent spread  Used in addition to Standard Precautions  A single-patient room is preferred whenever possible   Prevent transmission of infectious agents, that are spread by direct contact with the patient/environment  MRSA, VRE, C. difficile, norovirus Contact Precautions  Providers require:  Hand hygiene  Gloves and gown  Dedicated/disposable equipment when possible Contact Precautions   Prevent transmission of infectious agents, that are spread by respiratory droplets (sneezing, coughing, talking) Droplet  Influenza, strep, pneumonia Precautions  Providers require:  Hand hygiene  Mask and eye protection Droplet Precautions   Prevent transmission of infectious agents, that are spread by through the air  Tuberculosis, measles, chickenpox  Providers require: Airborne  Hand hygiene Precautions  Respirator (N95 mask)  Education on fit testing of mask  Room requirements:  Airborne infection isolation room (AIIR) – negative pressure Airborne Precautions Questions? Outpatient vs. Inpatient Environment   Explain O&P interventions for inpatient environments Objectives  Identify common surgical terms  Consider multidisciplinary team members in various environments O&P Settings  Outpatient Inpatient  “Ambulatory” care  Patient currently  Patient receives care admitted to the hospital  Surgery/OR and returns home the Workflow same day   Recovery  Inpatient floor O&P office Process  Patient’s home  Device is required for  PT clinic the patient’s stay  Specialty clinic  Generally orthotic (doctor’s office) devices  Device provided and  Device provided and billed to patient’s billed to the hospital insurance (Medicare)   “Vendors” need credentials/ID badge  Verify identification  Immunization history Inpatient  Hand hygiene  OR – need to scrub in Considerati  Appropriate PPE ons  Scrubs, isolation gown, hair net  Face mask, shoe covers, gloves  Documentation  May be using different EMR system   Finding the patient  Navigating the hospital  Nurses station  Verify that you have the correct patient  Discussing care with nurse, family members  Important to ask/identify people present Inpatient  Healthcare workers – what discipline/service Considerati  Family members – don’t assume the relationship ons  Labelling device, providing instructions  Patient may not stay in same room through discharge  Patient might not be going home after discharge  Discharge  How do they contact you for follow-up?   -plasty : to modify or reshape  Kyphoplasty  Arthroplasty Common Surgical Terms  -desis: surgical fixation or fusion  Arthrodesis   -ectomy: surgical removal (aka resection)  Discectomy  Laminectomy Common Surgical Terms  -otomy: surgical incision  Osteotomy Common Inpatient Devices   An orthopedic surgeon is performing a transtibial amputation surgery and she wants a RRD (Removable Rigid Dressing) immediately post op Inpatient  On-call order for a custom bivalve TLSO for a Scenarios Burst Fracture, following MVA. Required prior to out of bed mobilization