MP

By Dustin Rex, PT, DPT, MS, CEEAA, DOR, Cedar Pointe Health and Wellness Center, Cedar Park, TX
Our wound care systems at Cedar Pointe, led by Tiffany Delafosse, RN, DON; Nikki Alvarez, LVN/LPN, ADON; and Elise Mixson, LVN/LPN, are consistently managing our wound care systems successfully and effectively. When he started, Ricardo Cacho, one of our physical therapists, expressed a specific passion for learning about wound care. The combination of clinically talented and motivated team members facilitated our discussion of Nursing and Therapy collaboration within this system.

During the third week of October, we identified a resident with a persistent, complicated wound and began supplementing our standard wound care approach with Closed-Pulse Irrigation (CPI) treatments performed by Ricardo. Through clinical leadership from our Nursing partners, our wound care team, and Dr. Pat Marasco, developer of the CPI system, our resident experienced abrupt differences in wound size and discomfort. By the middle of December, seven-and-a-half weeks, our team had healed their first wound: complete closure from an initial size of over 7 cubic centimeters (7 cm3). We expanded our use of CPI with other residents and have had similarly significant results. The course of healing is always an ongoing, multifactorial process; but, to date, our team has facilitated healing of a combined area of 7.5 cm length x 6.6 cm width x 5.3 cm depth in stage IV wounds in our resident population. All of the success starts with our Nursing partners, who have used their expertise to support and streamline the addition of therapy as a part of the wound care system.

Presently, in addition to CPI, we are participating in a pilot trial with an ultrasound mist wound care program. We have found benefits with both approaches, which allows us to expand our ability to help our residents; expanding our skills means more opportunities to make a difference. It has been a great experience collaborating to maximize the talents of our interdisciplinary team to directly influence our residents’ quality of life.

By Dustin Rex, PT, DPT, MS, CEEAA, DOR, Cedar Pointe Health and Wellness Center, Cedar Park, TX
We love hosting students across all disciplines for so many reasons — most significantly, students are able to shake up our routine, expose us to the cutting edge of our profession, and bring us back outside the box, where we are able to make the most difference for our residents.

We have recently hosted Chelsea Basilio, SPT, through the University of St. Augustine, Texas. Chelsea will be completing her internship in early April. As a part of the process, most students complete an in-service or project. Chelsea met with Brooke Brown, PT, DPT, and me about her project and what she specifically wanted to accomplish. She identified the need, created from scratch a tool that is comprehensive yet succinct, and composed it in a manner that is visually appealing for patients, families, and staff. It is a great training guide that reflects the essentials of transfer training (safety and function) and reveals the innate talents Chelsea possesses for problem solving and initiative.

Chelsea initially presented to our Rehab team and then also presented to our entire staff during our weekly IDT huddles. She helped create laminated copies for education and training along with hard copies for distribution to patients, families and caregivers.

Chelsea’s work was well-received by everyone and rightfully so. We are grateful for her time and contributions at Cedar Pointe and are similarly grateful for our university partners that continue to excel in training the next generation of clinicians.

By Camrin Nettey, MS, CCC-SLP, DOR, The Healthcare Resort of Leawood, KS
The Occupational Therapy team at The Healthcare Resort of Leawood is passionate about implementing the Abilities Care Approach to improve the quality of life for our residents with dementia. In doing so, they recognize the importance of collaborating with and providing education to other staffing departments within our facility to maximize the ongoing success of this program.

The team recently created a Powerpoint presentation, along with pocket-size strategy reminders to provide at an all-staff in-service. Through collaborating with other staff, we have seen countless success stories for the residents that we serve here at The Healthcare Resort of Leawood.

A recent celebration included a resident, Lee, who was having difficulty participating in bathing/showering tasks. Nursing staff voiced these concerns to the Therapy team, and our OTs identified strategies based on her Allen Cognitive Level that created opportunities to improve Lee’s active participation with showering/bathing. By integrating what they knew about the Allen Cognitive Levels, along with individualized information, the OTs successfully identified strategies to reduce Lee’s level of anxiety, provide dignity, and improve her quality of life.

“Using the Abilities Care Approach with Lee has not only helped her ability to participate more in her ADLs, but her overall demeanor has changed. Throughout the day after her therapy sessions, you can see a change in how she holds herself and interacts with others.” — Erin Mallory, COTA

By Gary McGiven, Milestone Therapy Resource, Utah
Milestone’s HR Resource Brandon Lane has rolled out a retention plan with most of our facilities to better live our culture and show our new-hires our Love One Another culture. As a visual for the whole department head team to see and be a part of, this plan includes a retention board. This board has weekly tasks for the department head team to complete, following the employee from new-hire through their first 12 weeks. Some of the weekly tasks include:
● Assign a mentor
● Phone check in
● Non-work connection (i.e., off-site activity with mentor and/or other facility employee)
● Thank-you treats
● Empower them to recognize and reward a peer
● Send a text

With the retention boards being a department head focus, the Therapy leaders and their teams decided they wanted to partner with the department heads to take part in the retention process. To coincide with the facility’s retention plan, the Therapy departments each came up with a plan. Some of those ideas include:
● Therapy involvement in orientation process (transfer, gait belt, and body mechanics training)
● “Therapy Moment” in each all-staff meeting
● Therapy leader identifies new facility hires and relays to the team; each team member is encouraged to introduce themselves and get acquainted with the new-hires
● Discuss facility hires in weekly Therapy meeting and find out what was learned about new-hires
● Therapy “Open Door Friday” new-hires are encouraged to stop by Therapy for a treat and some therapy education

These are just a few of the ideas for the retention boards and the Therapy team retention plans. Our Therapy teams take loss of employees very seriously and want to be part of the solution to making a work environment where we are the facility’s workplace of choice.

By Whitney Wilding, DOR Rosewood Rehabilitation, Reno, NV
We have started a Falls Team at Rosewood that includes two of my PTs and I meeting monthly to discuss issues and trends. We do our meeting following the monthly QA meeting and look at trend data as well as personal experience from those on the floor regarding issues, patterns, etc. I feel it has been very successful at this point! Here are a few of the things we have put together:

We started a screen form specific to falls as we felt the UDA in PCC did not gather the information we really needed to intervene properly after a fall. This screener is filled out by a therapist and includes time-of-day information, fall predictor information such as patient’s history of falls, and qualitative information such as fear of falling to complete our analysis. This also includes what Nursing interventions are currently in place and any referrals to Therapy following the incident. I have attached a copy of that for your perusal. After implementing this form, we began to take note of some patterns that were happening with falls that we could address. After implementing some additional safety measures to address the patterns we noted, our falls declined 18% month over month.

Next, Melinda — who is one of my all star PTs — put together a list of falls predictors that increase someone’s likelihood for falls. These include dementia/cognitive impairment, polypharmacy, DM/neuropathy, incontinence, prior falls, assist with ADLs, ambulation with an assistive device, and fear of falls per self-report. Next, we rolled this out to the entire Therapy team, who are including it and a rating score (i.e., 3/8) on their initial evaluations. This allowed us to prospectively look at those who are at risk for falls prior to the incident for our skilled patients. The idea is to see how we can support them by adding interventions aimed at decreasing fall risk within our treatments to prevent falls. We have just started rolling this part out, but l am very excited about the prospect of having this focus on our initial evaluations for all disciplines. Eventually, all disciplines will be included in a monthly falls meeting, and we are getting them thinking about this now.

We noted that quite a few falls were happening due to the patient’s need to toilet. The PTs again jumped on board and decided to start a day shift toileting program whereby we scheduled time daily for the skilled patients who had the above-mentioned risk factors. One therapist would have those patients scheduled for regular therapy and then follow-up during the second half of their day to work on functional mobility and transfers in a toileting program. They were successfully able to incorporate functional training with toileting to reduce fall risk. . The two weeks we were able to run the program so far evidenced no falls on shift (and high patient satisfaction 😊). Our next step is to include all PTs and OTs on a rotating basis to perform toileting rounds on day shift and see how this impacts our falls. Lastly, this ties in nicely with PIVOT for Nursing and strengthens our Therapy and Nursing partnership.