Congratulations April Westbrook, OT SPARC Winner!

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April Westbrook, OT
Keiser University, Ft. Lauderdale, FL — Grad Date: 12/31/20
Fidelity is a core value of Occupational Therapy. Through trust and loyalty, this value can “spark” others toward healing. In order for patients to open up and allow a therapist to truly impact their lives, they must gather a sense of loyalty and empathy first. This value is paramount in OT and is one that I had to refine within myself prior to jumping into the field. I had to truly trust my passion, dedication, and commitment to learning before making such an immense life change.

I fell in love with Occupational Therapy when a friend of mine introduced me to the field. As I read through the qualities and qualifications of an occupational therapist, I knew that OT would provide me with a unique opportunity to make a difference in the lives of others. It was a pivotal time in my life when I made this career change; I was a mother with three young children who had just undergone a divorce from a ten-year marriage, and I was working as a small business owner where I was unable to make an impact on the lives of others the way I knew that I could. Although it was certainly not an easy time to follow this “spark,” it is one of the most rewarding decisions that I have ever made. Through this decision, I have modeled for my children that you can follow your dreams and make the necessary changes in your life at any point. Through fidelity and dedication, anything is possible.

Upon beginning my career as a COTA, schooling became my full-time job. I would care for my three children in the mornings and evenings, study until midnight, and work my part-time job on the weekends. This dedication afforded me the opportunity to serve the most endearing of people and made me stronger than I ever thought possible. I have practiced the perseverance that I encourage in others and have gained a true insight for empathy.

After working as a COTA for six years, I began to consider making another life change to provide the best possible opportunities for myself, my children, and my future patients. I began to consider becoming an OTR through a bridge over program through Keiser University. I understood that gaining more knowledge in this field would provide opportunities to make a greater impact in my community, one individual at a time. Becoming an OTR meant that I would be able to create goals for my patients that would allow them to become their most successful and independent selves. I sought the opportunity to dedicate myself to my patients through the entire OT process, from evaluation, to creating goals, bonding through treatment sessions, all the way through discharge. This wasn’t within my scope as a
COTA, and I knew that it is what I needed to do to feel fully fulfilled in my career.

The most rewarding opportunity in the field of OT is to become the agent of change in one’s life. It is incredibly humbling to connect with those who are sick or disabled and provide a means to aid in their healing and create change. When an individual looks you in the eyes and says, “thank you for understanding, encouraging me to heal, and getting me to where I am today,” it makes every sacrifice worthwhile.

I have endured many obstacles, and at times, thought the tribulations were too great to persevere through. However, those obstacles became the pivotal points to leading me into this field. I look back at these obstacles and use them as a springboard to provide the most meaningful conversations with my patients. Conversations are driven by empathy, compassion, encouragement, and a “spark” for change in the lives of others. When we fight to endure challenges, dedicate every ounce of ourselves, and then overcome these adversities, it provides a platform to help others through truly understanding by way of empathy and perseverance. Occupational Therapy provides a perfect balance between technical knowledge and compassion through our code of ethics, core values, and standards of practice, all of which come together to empower others.

I am currently working towards completing my degree as a master’s student to become an OTR. It has been a long road, especially while completing my internships in the midst of a global pandemic, but fidelity and perseverance continue to lead the way. Becoming an agent of change for individuals whose voices are not always heard and to physically improve that person’s health, is what makes Occupational Therapy the most rewarding of fields. I plan to address those needs through compassionate service, a holistic approach, creative interventions, local advocacy, and evidence-based practice. I look forward to making a lasting impact in the lives of others by creating a “spark” for healing, hope, and endless opportunities.

I appreciate any support received and am committed to paying it forward through my dedication to serving others through Occupational Therapy

Making Vital Signs Vital

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By Tamala Sammons, M.A., CCC-SLP, Therapy Resource
We have been focused on why it is so important to measure vital signs as part of our clinical practice. Not only does the data help us with early detection of sepsis, identifying patient instability, having comparative baselines during exercise, and knowing when to stop an activity, but it also helps us make better clinical decisions around patient care. Now, therapy teams need to also focus on capturing measured vital signs into our daily documentation practices.

Measuring and documenting vital signs starts at the evaluation to ensure treatment plans are designed to address challenges with varying diagnoses and to ensure we provide interventions accordingly.

Next, vital signs are measured during treatment sessions to support decisions around interventions being provided. The key for us as therapists is to capture the data from vital signs as a guide to what interventions we will provide, or stop providing. In other words, we need to do more than simply take and record vitals. We need to use vital sign data as tools to make clinical decisions.

For example:

● Mr. Smith has O2 weaning as a goal. OT is documenting patient is SOB during activity; however, no vitals were recorded at evaluation or in TENs. Data was only entered into PCC. Here is why capturing vitals in our clinical documentation is also needed: Documentation is further enhanced when the OT documents how many liters the patient is on and levels of O2 before the activity, five minutes into the activity, and after the activity. This documentation is specific to the therapy session and needs to be recorded in the TENs as it supports what physical activity the patient can tolerate as part of decisions around O2 weaning and overall improvement with ADLs.

● Mr. Jones has precautions with BP risk identified on the PT evaluation. However, upon review of daily TENs, BP is not captured in the documentation pre-, five minutes into, and post-exercise. BP was entered into PCC, which is great for simply recording data. However, using the data in a meaningful way in our TENs supports the clinical judgment of a therapist (i.e., what decisions during treatment were made based on BP readings?) and further supports medical necessity for care.

● Mr. Romero had a CHF exacerbation and the hospital record noted he has 45% ejection fraction and he has SOB with walking greater than 75 feet. Documented vitals are paramount to ensure that his treatment with functional activities or prescribed exercise are keeping his HR between 25-35% of his target HR.

Other Examples:

● Pt. “V” has SOB and needs to rest frequently. What do the vital signs tell us and do we change direction in treatment due to those measures?

● Pt. “I” is on 2L O2. PT is working on ther ex and gait. Does O2 change with exercise? How long does it take to get them to recover?

● Pt. “T” is medically complex and post-septic. What do we know about pts who have been septic? How are we ensuring we are monitoring for s/s of sepsis while in therapy? What vitals are recorded in our documentation to support our clinical treatment decisions?

● Pt. “A” is doing breathing exercises with SLP due to COPD. What is the patient’s respiratory rate pre-, during, and post-breathing exercises? What are the O2 levels? How do we know the interventions are working?

● Pt. “L” is a cardiac patient. How are vitals documented during treatment sessions to support exercise prescription? How do we know our plan is working?

Please continue to work with your teams to not only measure vitals, but more importantly, integrate the data into evaluation and treatment documentation to support skilled intervention decisions, capture clinical judgement, and demonstrate medical necessity of our services.

 

Therapy to ED Leadership

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By Brian del Poso, OTR/L, CHC, RAC-CT, Therapy Resource
Next up in the series of interviews of our former DORs turned ED is the one and only Amy Gutierrez! She is not only a former DOR, but served as a Therapy Resource as well. Amy is currently the ED at Treasure Hills in Keystone. She was kind enough to share some of her thoughts with us:

As a DOR/Resource, you were in a good place in your career. What kinds of things were you thinking about when the thought of being an ED came up?
Jon (Anderson) was actually the one that brought it up in October of 2018 at the Leadership Summit meeting. Prior to that, I never really wanted the responsibility lol! I suppose that was when the seed was planted. Throughout that time period I considered taking my boards to becoming an Admin, I started asking questions to the other administrators. One of the most frequent questions I had was, “Is it fulfilling?” As a therapist and a resource, I know we make a difference and felt I had a purpose. I didn’t know if I would have the same sense of fulfilment as an ED. I was naïve to think that it wouldn’t be.

How did you come to the decision to push forward into the AIT/CIT program?
To be honest, I kind of jumped in. The position was offered to me at the beginning of October with the acquisition scheduled to happen in November. At that time, I was still in my Hybrid role as a DOR and Resource. I was fortunate enough to attend an AIT boot camp, which helped to solidify the decision I made in becoming an ED. As an Administrator, we are given an opportunity to change the lives of many. And where we do that as therapists and Resources, we have the opportunity to do it on a much broader stage. All of those little changes we want to make, or we wish the Admin would do, is now on us. I learned rather quickly nothing is ever as easy as it appears. We are entrusted with so much, at times it could feel overwhelming, but it’s in those moments you begin to see growth as a leader.

What do you think is the most important characteristic of a successful leader?
This is a hard question to answer. I admire so many of our own leaders but for different reasons. One of the most common traits they all have is their openness to give and receive feedback. They surround themselves with the right people. They share what they know and want every single person around them to be just as successful.

If you were to talk to a therapist about the ED role in general, what is the most important thing you would talk to them about?
Being open and honest about the things you don’t know. Ask questions, lots of them. I find myself calling my partners and resources multiple times a day. It’s OK not to have the answers. One of my mentors shared that with me early on. And it has saved me a million times over.

Any other thoughts for a therapist who might be thinking about becoming an ED?
You have to be ready for anything. I have been in my role for eight months now, and I can honestly say, I never expected to be an Administrator under the world’s current circumstances. But you do everything in your power for the people under your leadership and those entrusted to your care. Times and positions like these are what therapists are made for.

Washington Receives Eldergrow Grant

MP News

By Mira Waszak, Therapy Resource, Washington

Another gift of a grant in Washington. Pictured is Lynnwood Post Acute getting their setup and initial training.

The Eldergrow G.A.R.D.E.N Project would enable each of the nine participating Washington communities to help residents cope with this difficult time of isolation and loneliness, while also providing an interactive and meaningful activity to improve their quality of life now and long into the future.

Numerous health care studies show a positive link between gardening and healing. Contact with gardens and nature can augment a resident’s medical treatment, including mental, physical and emotional needs. Therapeutic horticulture has been proven to deliver tangible wellness benefits, including improved self-esteem, improved memory, reduced depression, improved motor skills, and increased socialization. The project goals include, but are not limited to: 1) Increasing the quality of life by improving the residents’ emotional states and 2) improving the quality of care by focusing on the six therapeutic horticulture wellness goals set forth from the American Horticultural Therapy Society. Eldergrow strives to reach an 80% resident attainment rate on both goals.

The plan to accomplish this for the nine communities will be to launch the Eldergrow G.A.R.D.E.N program as soon as possible, even if on a limited basis initially. The Eldergrow program is a well-managed, supported and respected therapeutic program offered through horticultural gardening which many residents enjoyed previously. It has been successfully used to engage residents in long-term care facilities with the best outcome of enhancing their quality of life. Eldergrow Educators use engagement and a hands-on approach, and they enable everyone in the care center — residents, staff and family, regardless of experience, physical or intellectual abilities — to participate in this program. Eldergrow enhances residents’ quality of life through therapeutic gardens physically, socially, cognitively and creatively.

Making PDPM Training Fun!

MP News

Submitted by Mira Waszak, Therapy Resource, Pennant – WA

Connecting and training with our teams has been challenging in our new normal. So how do we make training effective and fun on a Zoom call? Introducing PDPM Brain Benders by Jessika Booth, MDS Resource/Pennant WA. She created a simple but effective exercise bringing the 9 Washington IDTs together on a 30-minute Zoom call.

 

 

Jessika forwarded Reference tools the day before the Zoom meeting, which included:
PDPM quick reference guide
PDPM ST comorbidity CMI guide
NTA workbook
PDPM ICD10 Mapping
PDPM Nursing quick reference guide
And a sample diagnosis list

Zoom call format
Brain Bender Rules:
• Mute your lines unless called on or when conversation is opened to the group
• First facility to type facility name in chat answers the question
• If wrong, the second facility with name in chat will get opportunity for half of the points with correct answer
• Next question picked by facility with correct answer

Teams were only given the diagnosis sheet to answer some of the sample questions below:

Question: What PT/OT Clinical Category does the current primary diagnosis of OSTEOMYELITIS Unspecified – M86.9 map to?
Answer: Other Orthopedic

Question: Based on the diagnosis list provided, are there currently any SLP CO-MORBIDITIES available?
Answer: No, none of the diagnoses listed will map to an SLP Co-morbidity 410.

Question: Based on Diagnosis review, what would the IDT need to clarify in order to get the resident into a Special Care High Category?

Answers:
● The type of Quadriplegia — as you can only code I5100 Quadriplegia if it is a result of spinal cord injury.
● Sepsis — related to osteomyelitis and or UTI
● Respiratory Therapy — Hypoventilation Syndrome
● COPD and other restrictive lung disease — Hypoventilation Syndrome

Special thanks to Jessika Booth and our MDS partners! Congratulations to team Park Manor for winning this round of PDPM Brain Benders.

Think Thin! The Path to Thin Liquids

MP Learn

By Tamala Sammons, M.A., CCC-SLP, Therapy Resource

A new clinical campaign for our SLPs and IDT is the “Think Thin! A Path to Thin Liquids” approach. There is so much supporting evidence that promotes thin liquids over thickened liquids. When thick liquids are needed, then we need to consider utilizing the free water protocol.

 

 

 

Reasons to Think Thin:

Preventing Dehydration: Dehydration can lead to a variety of negative health consequences including:
• Changes in drug effects
• Infections
• Poor wound healing
• UTI’s
• Confusion
• Constipation
• Altered cardiac function
• Declining nutritional intake

Improving Quality of Life:
Traditional thought holds that aspiration of any material into the lungs can lead to aspiration pneumonia so many patients who have difficulty swallowing are placed on diet restrictions that avoid thin liquids.
However, a confounding evidence in the literature suggests that pulmonary aspiration of differing materials may not present an equal risk for the development of aspiration pneumonia. Aspiration will result in pneumonia only if the aspirated material is pathogenic to the lungs and the host resistance to the aspirated material is compromised. Research also discovered: “The risk of developing aspiration pneumonia was significantly greater if thick liquid or more solid consistencies were aspirated.” (Holas, DePippo, & Redding, 1994)

Being able to have Thin Water: Free Water Protocol
If a patient must be on a thickened liquid for any duration of time, research using a free water protocol found that fewer residents had UTI’s and dehydration and that when paired with proper positioning and oral care, there were no incidents of aspiration. Additionally, providing patients with thin water:
• Improves quality of life
• Improves Resident satisfaction with meals and less reports of thirst (Over 35% of patients are noncompliant with thickened liquids)
• Decreases risk of dehydration, UTI’s and pneumonia

Additional training information and materials will be coming over the next few weeks as we work to Think Thin!

CODE SEPSIS: Understanding the Sepsis Pathway and COVID

MP Learn

Submitted by Tamala Sammons, M.A., CCC-SLP, Therapy Resource

The Mission:
Improve Sepsis identification early to improve patient outcomes.

The Why:
Sepsis was 20% of our Medicare Readmissions as an Organization in Calendar Year 2019.
With every hour that treatment is delayed for sepsis, the mortality rate increases by 8%. Understanding and educating our facilities on SIRS and a focused vital-sign campaign with an SBAR-specific focus will improve our care delivery and reduce readmissions, improve our patient satisfaction, and help with our change in condition process.

COVID-19 and Sepsis: A Physician’s Lens
While there is still a lot to uncover about the pathology and presentation of COVID-19, we have learned a great deal about this virus and its potential impact in our post-acute care facilities. During our experience at one of the early COVID-19 outbreak facilities, it was discovered that an early presentation of many COVID-19 patients was the presence of a fever. Unfortunately, these fevers were managed with the typical order for acetaminophen and cooling measures, effectively masking the fever and avoiding any further escalation of care until the patient reached a point of medical instability.Sepsis POSTette

As with any patient in a post-acute care facility presenting with fever, even before COVID-19, timing is absolutely critical. Other changes of condition such as chest pain or possible stroke have led to long-standing, conditioned responses to immediately send patients out via 911. Fever is often the hallmark sign signaling the beginning of a patient experiencing sepsis — a diagnosis that carries a much higher chance of mortality, especially in the post-acute care population, but up until now has not received the attention it deserves. Oftentimes a febrile episode is masked or ignored, leading to a cascade of events leading to further demise, accelerated by a virus that now has the potential to spread like wildfire.

We are now at a point where identification of fevers (and other changes of condition) should signal a “code” event, essentially alerting the clinical team to provide immediate identification, isolation, and intervention. With every hour that a fever is ignored, the mortality rate for a potential sepsis patient increases by 8%. This simple, yet widely underappreciated clinical practice can prove to be a pivotal step in reducing the mortality in not just our COVID-19 patients, but in any patient who is on the path of developing sepsis. — Dr. Pouya Afshar

For more information, click here for our Sepsis POSTette

Therapy Update from VPAC

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By Dawn Thompson, DOR, Victoria Post Acute Care, El Cajon, CA
Hope everyone has been staying safe and healthy. Here is an update from the Hidden Gem of East County, Victoria Post Acute Care [Yes, that was really once a slogan of VPAC).

VPAC has continued to accept COVID + patients, and as of August 16, there had been approximately 140 COVID admissions and 95 discharges to the community (25 skilled currently). Our entire VPAC team has continued to embrace the adversity of COVID as a challenge to overcome and catalyst for learning and growth. We’ve been honored to discharge so many residents home with family members and to prior living situations. The joy on residents’ and staff’s faces when escorted out the front doors on a red carpet to waiting family members is priceless. We’re looking forward to crossing the triple digit threshold for community discharges.

Over the last few months, there have been many non-COVID-related changes within our department. Lead PT, Melissa, had a baby and has been out on maternity leave, and our wonderful SLP transitioned to a building in Texas. We’ve welcomed two new team members and are excited for their added contribution to the team. We continue to complete the LEAF form weekly for COVID-related time within the facility to have a true picture of department productivity.

Another major change within our department is the inclusion of the RNA team. The therapy team has absorbed the RNAs fully as rehab team members. The RNAs moved into the therapy gym, contribute in team meetings and participate in team building lunches/potlucks. This has allowed for greater relationship building and communication between therapists and RNAs. The increased conversation, coupled with our LTC screening process and new QM weekly meeting, have resulted in more referrals for LTC evaluations. We hope to continue developing LTC programming to better serve our VPAC residents [and increase PNSD].

We consistently find reasons to celebrate — this summer, we have had wedding celebrations, baby showers, birthday parties, goodbye and welcome parties. It’s become part of our weekly routine to have lunch together on Tuesdays. [See attached photos of celebrations].

Last month, I was invited to lead the culture portion of the resource call. We explored the Enneagram and team dynamics. I also had the opportunity to be a part of a COVID-19 Rehab Panel for the San Diego District CPTA (thank you, Sam). I was asked to share my experience and what I’ve learned from an outbreak with the facility and accepting positive patients from the community along with staying safe in the SNF setting, IDT treatment approach and mental health of COVID and SNF residents. It was a great experience exchanging information and experiences with peers.

As we persevere through the pandemic, I am often reminded how fortunate I am to have such wonderful teammates. I continue to be the proudest team leader.

Keep staying safe, wash your hands and wear a mask.

Natalie Blasczienski Award Winner

MP Celebrate

Congratulations, Dawn Thompson, DOR, Victoria Post Acute Care — Winner of the Natalie Blasczienski Award
Submitted by Jon Anderson, Therapy Resource, Keystone

During our Annual Therapy Leadership meeting, I had the honor and privilege to announce this year’s Natalie Blasczienski Award winner. This award, established in 2019, in essence, emulates the spirit and incredible human being of Natalie Blasczienski. Natalie was a PT and DOR at Legend Euless, Texas (now known as Westpark). She was often described as a superhero for her patients, a mentor/coach for her therapy/IDT team, and a proud momma of two young boys. Natalie’s spirit and enthusiasm was palpable, and she enriched the lives of countless seniors, through her selfless dedication to helping others.

In the summer of 2019, Natalie was diagnosed with breast cancer (she was in her early 30s). During her chemo intervention, she persevered and continued to work full time, never skipping a beat, and later that year she went into intermission. We were so excited, for we thought she had beat it, but unfortunately she had a rare reaction to the chemo treatment that resulted in severe cardiac damage, and we forever lost her physical presence in March 2019. However, her spirit is still very much alive, as Natalie made so many of us feel like family. Many of us will never forget how powerful of a presence she was; she never knew a stranger. With this award, we honor Natalie and the award winner who is nominated by their therapy team.

Through a survey nomination process, therapy teams across our affiliates shared so many countless stories about how their therapy leader was deserving. It was an incredible response, and the committee had a very difficult time determining who the winner would be. Those who nominated Dawn gave the following answers to our questions.

How has your therapy leader displayed unconditional love to your team, facility, and residents?
This therapy leader often leads with “I love you all” or “I’m so proud of our team!” One staff member describes her favorite: “You have a crazy day of documentation — I’m picking you up a coffee, what kind?” Isn’t that cool? Additionally, the team notices that this therapy leader is often the last department head to leave the building and is frequently caught volunteering after hours to do games and activities for the residents.

How has your therapy leader shown unwavering dedication to bettering your therapy team? Facility? And quality of life for the residents?
This therapy leader is described as the Michael Jordan of Rehab, making an immediate impact from the start. In fact, the rehab program has grown tremendously through the tireless efforts of this leader in supporting and facilitating education and training of the many new program offerings. This explosive growth has led the facility to add a second therapy gym. Furthermore, communication between therapy and nursing has been dramatically improved by the rollout of several communications so that both know the patients individualized needs. Therapy can communicate with nursing through “Emojis of Care” while nursing can fill out a “Hey Therapy” card to let therapy know if any resident has had a change in functional level, strength, balance, etc.

How has your therapy leader stepped up in the face of adversity and shown leadership in times of turmoil?
This facility was one of the first Ensign affiliates, as well as one of the first nursing homes in her region, to have a COVID-19 outbreak. Little was known about COVID at the time, and many residents/staff were sick. This therapy leader led by example, through exhibiting unconditional strength, love and courage.

Bringing the Fair to The Pines

MP Celebrate

Submitted by Joleen Linn, Therapy Resource, Wisconsin
From August 31 to September 4, The Pines Post-Acute & Memory Care in Clintonville, Wisconsin, decided to bring the fair to our facility. During COVID-19, the residents in our building have been having a hard time not seeing family or friends, or joining the community’s fun events that have been canceled due to the pandemic. With a few good ideas and some event planning, we decided to make The Pines into a fair. Who doesn’t love games, prizes and delicious food? Each day throughout the week, we planned a special day for each and every resident and staff member to make their day a little brighter.

Bringing the fair to The Pines Post-Acute & Memory Care has given us the biggest smiles throughout the week. We are very grateful for everyone who helped us in preparing for this week. We all know this year hasn’t been easy due to COVID, but there’s always some way to make their days a little brighter.

Day 1: Polka music, sun drop slushies, cheese curds
Roger Hartwig played music outside for everyone. He sang and played polka music with his accordion. Many of the residents sang along, danced and enjoyed the classic songs. Along with the music, the management team passed out sun drop slushies, cheese curds, onion rings, French fries and pickle pucks for everyone. We really wanted everyone to feel like they were at the fair.

Day 2: Bingo, bean bag toss and mini corn dogs
Today we had games spread out all over the building for residents to participate in and win prizes. One of the games the residents really enjoyed was playing bag toss. As the residents threw the bags through the holes, they got a chance to pick any prize they wanted out of the box. It consisted of calendars, candy and sweets, coloring books, stuffed animals and much more!

Day 3: Petting zoo with horses, dogs and goats
Day three was one of the most exciting days for our staff and our residents. We had horses, goats and a few dogs for everyone to see and pet. First came the horses: Prima the brown horse and Mister the white one. Then we had Luna the rodeo dog and the goats!

Day 4: Cream puffs and indoor games
Homemade cream puffs by The Pines activities director Kim! She made over 60 homemade cream puffs for all the residents and the staff. We had many games, including tip the pyramid, bag toss, plinko and pick a duck!

Day 5: Water Balloons, burger cookout and ice cream bars
Our last day, we had a cookout outside, including burgers and ice cream bars for all the staff and residents for lunch. We also had water balloons for a little bit of fun!