The Role of Therapy in the Critical Care UnitMadeline Mello, OTD/S

Faculty Advisor: Dr. Emmy Dagnan, OTD, OTR/L

MISSION ACKNOWLEDGMENTS

REFERENCES*

OUTCOMES

AGENCY NEEDS

EC GOALS

“TriStar Southern Hills’s mission is to deliver to our patients the highest quality patient care, compassion, and respect.”

Improved interprofessional communication and collaboration amongsttherapists and clinicians in the critical care unit (CCU). In order to best care for critically ill patients, therapists, nurses, and physicians need to have an accurate understanding of each others roles, effective communication, and active collaboration.

I would like to thank TriStar Southern Hills for allowing me to complete my Experiential Component at their facility. I would also like to thank Dr.Shelley Hix for being my Expert Mentor and providing me with resources and support throughout my entire EC. I would also like to thank the occupational therapists, physical therapists, speech therapists, CCU nurses, and CCUphysicians at TriStar Southern Hills for allowing me to learn from them during my experiential component. I have gained a great respect for all the individuals involved in this setting.

Adler, J., Malone, D. (2012). Early mobilization in the intensive care unit: a systematic review. Cardiopulmonary Physical Therapy Journal, 23(1), 5-13.

Dubb, R., Nydahl, P., Hermes, C., Schwabbauer, N., Toonstra, A., Parker, A., Kaltwasser, A., Needham, D. (2016). Barriers and strategies for early mobilization of patients in the intensive care units. AnnalsATS, 13(5), 724-730.

Loy, B., Micheff. H., Nguyen, K., O’Brien, V. (2015). Interprofessional Collaboration Be-tween Occupational Therapists and Nurses in an Acute Care Setting: An Exploratory Study. Masters’ Theses and Capstone Proects. Paper 133.

Needham, D., Korupola, R, Zanni, J., Pradhan, P., Colantuoni, E., Palmer, J., Brower, R., Fan, E. (2010). Early physical medicine and rehabilitation for patients with acute respi-ratory failure: a quality improvement project. Arch Phys Med Rehabil, 91, 536-542.Needham, D., as cited in Levitt, E. B. (2013) Physical rehabilitation in the intensive care Unit is better for patients and the hospital’s bottom line. Johns Hopkins Medicine, Retrieved from http://www.hopkinsmedicine.org/news/media/releases/physi-cal_rehabilitation_in_the_intensive_care_unit_is_better_for_patients_and_the_hospitals_bottom_line.

Rochester, C. L. (2009). Rehabilitation in the intensive care unit. Seminars in Respira-tory and Critical Care Medicine, 30, 656–669.

Schweickert, W., Pohlman, M., Pohlman, A., Nigos, C., Pawlik, A., Esbrook, C., Spears, L., Miller, M., Franczyk, M., Deprizio, S., Shmidt, G., Bowman, A., Barr, R., McCallister, K., Hall, J., Kress, J. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. The Lancet, 373, 1874-1882.

*For full list of references used in this project, please see separate document.

Compile pertinent evidence-based information to determine the role of occupational therapists (OTs), physical therapists (PTs), and speech language pathologists (SLPs) in the CCU.Collaborate with OT, PT, and SLPs who work in the CCU at TriStar Southern Hills and other local hospitals to gather information on their role in the CCU.Attend daily CCU rounds to better understand the dynamic of the healthcare professionals working in the CCU as well as gain a better understanding of the patient population in this particular hospital’s CCU.Evaluate information gained from the literature and personal interviews and synthesize information to implement program development including education to nursing on the roles of therapists (OT, PT, ST) at agency. Create an educational orientation manual for therapists working in the CCU. Create an educational health stream presentation for new nurses working in the CCU. Create easily accessible reference sheets outlining resources for support groups for patients who have received a recent life-changing diagnosis.

Literature review

To better understand the role of therapy in the CCU, I reviewed over 50 articles. The literature review outlines the current research on early mobility, the roles of both physical and occupational therapists in the CCU, and the importance of effective communication and interprofessional collaboration in this setting. Completion of this literature review was useful in gaining understanding of the overall role of therapy in the CCU and how it is most beneficial to the patient. Increasing my knowledge in this area assisted in creating an evidence based educational module and orientation manual to improve interprofessional collaboration and overall patient care in the CCU.

Educational Module

In order for a team-based approach to be effective in the CCU, all parties must have a mutual understanding of each other’s roles (Loy et al. 2015). The educational module (Figure 1) I created was designed to inform nursing and other health care professionals in the CCU on the role of OTs, PTs, and SLPs in the CCU. Early mobility has been shown to be safe, feasible, and effective (Adler et al., 2012; Dubb et al., 2016; Needham et al., 2010; Needham et al., 2013; Rochester, 2009; Schweickert et al., 2009). However, prior to any program development in this area, it is crucial that therapists, nurses, and physicians can work collaboratively and efficiently. This educational module will be available as a Health-Stream course that clinicians throughout the hospital will have access to.

Figure 1. Examples of Educational Module

Informational Hand Outs

Communication and collaboration should not stop with the clinicians. Patients have the right to be informed of theirresources. Most of the patients seen in the southern hills CCU have undergone a lifechanging event, received a new diagnosis or experienced an exasperation of a chronic disease. Frequently these patients have limited resources and are uninsured. I created informational handouts (Figure 2) for these patients outlining certain recourses available to them in regards to their diagnosis. These resources are free and open to the public.

Figure 2. Examples of Informational Handouts

Orientation Manual for Therapists in the CCU

I created an orientation manual for therapists who are unfamiliar with working with in the CCU. The manual outlines precautions, current protocols, and certain aspects of working in the CCU that might differ from their prior experience.